PAPERS AND ADDRESSES 
By 
WILL'AY W. KEEN, M.D. SELECTED PAPERS AND 
ADDRESSES 
BY 
WILLIAM WILLIAMS KEEN, M.D., LL.D. 
Emeritus Professor of Surgery, 
Jefferson Medical College of Philadelphia 
PHILADELPHIA 
GEORGE W. JACOBS & COMPANY 
PUBLISHERS Copyright, 1923, by 
George W. Jacobs Company 
All rights reserved 
Printed in U. S. A. 
VAIL-BALLOU COMPANY 
BiWQHAMTOH AMO NSW YORK To 
JOHN CHALMERS DA COSTA, M.D., 
S. D. Gross Professor of Surgery Jefferson Medical College, 
Philadelphia. 
Pupil, Assistant, Colleague, Successor. 
A token of admiration and affection. PREFACE 
The papers and addresses included in this vol- 
ume appeared originally in various periodicals 
during a number of years. They are reprinted 
here for ready reference and for permanence, in- 
stead of being lost in the immense mass of period- 
ical literature. 
They appeal to several different classes of read- 
ers, medical, missionary, military, historical, educa- 
tional and to the general lay public. 
There are some reiterations in different papers 
and addresses. They were addressed to wholly dif- 
ferent audiences, at different dates. Only by con- 
stant insistence on facts can one drive them home 
into the minds and hearts of his hearers or readers. 
Moreover, in a book they can easily be skipped— 
an advantage the reader enjoys over an auditor. 
They should be read, keeping carefully in mind 
the dates when they were written. Constant prog- 
ress in knowledge and in technic in many directions 
materially change our views. 
William W. Keen. 
Philadelphia. 
November, 1922 CONTENTS 
PAGE 
The Graduation Ceremony 1 
Festival Held at Upsala 22 
Community of Interest 29 
Service of Missions 52 
Charles Darwin 91 
An Impossible War 103 
Early Years of Brown University 107 
Auld Lang Syne 152 
Before and After Lister 157 
Dangers of Ether 203 
A Story of Three Tablets 241 
A World of Billions 249 
Red Cross and Antivivisectionists 273 
Immortal Youth 290 
Things Surgeons Stand For 292 
Vivisection 309 
A Message of Hope 333 THE GRADUATION CEREMONY 
WITH AN ACCOUNT OF SOME MODERN 
SURGICAL CELEBRATIONS 1 
Having been present within the last five years at 
several rather unusual surgical functions, it has oc- 
curred to me that it might be of interest to the 
members of the Keen Surgical Society to learn 
something about the graduation ceremonies and 
other similar special functions at other institutions 
than our own, and not only in our own time, but in 
the more formal and ceremonial middle ages. 
My principal source of information as to the 
latter is an admirable address delivered to the 
graduates in medicine of the University of Edin- 
burgh in July, 1904, by Prof. D. J. Cunningham, 
the distinguished Professor of Anatomy in that 
University. It is called “The Evolution of the 
Graduation Ceremony” and is a mine of informa- 
tion in reference to this subject. It deals not only 
with the ancient medical customs, but with the 
graduation ceremonies as observed at present in the 
chief European Universities. 
In the middle ages there were many thousands of 
students in some of the most distinguished Univer- 
sities. For example, Bologna, (which in 1888 
1 Address delivered before the W. W. Keen Surgical So- 
ciety of the Jefferson Medical College. Dec. 11, 1905. From 
the Medical Library and Historical Journal, March, 1906. 2 
SELECTED PAPERS AND ADDRESSES 
celebrated the 800th anniversary of its founding,) 
in the 14th century, had as many as 13,000 
students, and Paris at one time had as many as 
30,000.2 
Very few of the students, however, took the de- 
gree of doctor, either in law (which was divided 
into civil law and canon law), medicine or theology. 
None of our other modern degrees existed. 
Every graduate was a “Doctor,” i. e., an educated 
or learned man, in one of these three faculties. 
The few who did take the degree, expected to enter 
faculties as teachers. Hence, there being so few, of 
course the ceremony was one of much greater indi- 
vidual importance and was carried out with all the 
formality and symbolism which commended them- 
selves peculiarly to the scholastic medieval mind. 
The candidate or graduand3 was presented for 
the degree by one of the faculty, usually the Dean, 
who was and is still called the “Promoter.” He 
stands technically in the position of a Godfather or 
sponsor for the person upon whom the degree is to 
be conferred. Even to-day, at the graduation 
ceremony of the University of Dublin, the Pro- 
moter says, “I present to you these my sons, etc.” 
I cannot, perhaps, better indicate the importance 
of such an occasion than by quoting a paragraph 
from Prof. Cunningham’s address: “A love of 
pomp and pageantry was a leading characteristic 
2 How times have changed since 1905 when these figures 
astonished us! They are equalled and in a few cases even 
exceeded by the number of students in American Universities 
in 1922. 
3 Changed to “graduate” after receiving his degree. THE GRADUATION CEREMONY 
3 
of the medieval mind, and the graduation cere- 
mony afforded the most abundant opportunity and 
the most ample scope for the indulgence of this 
propensity. For several days before the celebra- 
tion elaborate preparations were made. Attended 
by the University Bedells [beadles], with their in- 
signia and maces, and often also accompanied by 
trumpeters and pipers, the candidates, mounted on 
horseback, paraded the streets and gave formal in- 
vitations to their friends and to all notables of the 
district to attend the ceremony. At last the event- 
ful day arrived and the whole town was in a state 
of expectancy. It was a holiday: the shops and 
booths were shut, the artisans had stopped work 
and the streets were thronged with people eager to 
witness the procession. This, as a rule, started 
from the house of the candidate, but in certain 
cases it was formed at the school buildings. Pre- 
ceded by mace-bearers, the Bedells, the trump- 
eters, and the players on the fife, the graduand, 
mounted on a richly caparisoned horse, was con- 
ducted to the Cathedral. The entire University, 
teachers and scholars, in their appropriate robes, 
followed in the wake of the candidate, and as the 
procession moved through the town, the air was 
filled with the din of music and trumpets, mixed 
with the harsher sounds of clanging bells.” 
Even in my own day, when I was graduated 
from Brown University in 1859, Commencement 
Day, though then already fading in importance in 
our busy hustling age, still convulsed the State of 
Rhode Island—not a very big one it is true— 
almost to its very borders. Business was largely 4 
SELECTED PAPERS AND ADDRESSES 
suspended and the day was a holiday in Provi- 
dence: the sheriff of the county then, as now, pre- 
ceded the president and other dignitaries of the 
University in entering the church, wearing a broad 
blue sash crossing his breast diagonally and carry- 
ing his official sword, which I suppose represents 
the mace, which one sees in such ceremonies abroad. 
His function was to preserve order and in the early 
days it was evidently an active function. (See the 
“Early days of Brown University,” p. 107.) 
We have also a description of such a pageant 
from the pen of John Locke, the celebrated philos- 
opher, who also studied medicine. In Dr. John 
Brown’s essay on “Locke and Sydenham,” he 
quotes an account of the ceremony at Montpellier, 
France,4 as described by Locke: In 1675 Locke 
went abroad for his health, and remained some 
time at Montpellier. He kept a diary, and large 
extracts are given by Lord King. The following 
is his account of the annual “capping” at Mont- 
pellier: “The manner of making a Doctor of 
Physic is this: First a procession in scarlet robes 
and black caps—the Professor took his seat—and 
after a company of fiddlers had played a certain 
time, he made them a sign to hold, that he might 
have an opportunity to entertain the company, 
which he did in a speech against innovations—the 
musicians then had their turn. The inceptor or 
candidate then began his speech, wherein I found 
* “Montpellier/’ says Gosse, in his life of Sir Thomas 
Browne, who was also a student there in 1630, “was almost 
indispensable in those days to foreign students who could get 
no training like it anywhere else in Europe.” THE GRADUATION CEREMONY 
5 
little edification, being chiefly complimentary to 
the chancellor and the professors who were present. 
The doctor then put on his head the cap that had 
marched on the Bedells staff, the sign of his doctor- 
ship, put a ring on his finger, girt him about the 
loins with a gold chain—made him sit down beside 
him—that having taken pains he might now take 
his ease, and kissed and embraced him in token of 
the friendship which ought to be amongst them.” 
The ceremony was usually held in the Cathedral, 
which, as you know, is so named from the 
“cathedra” or chair of the Bishop. Westminster 
Abbey has no Bishop’s throne or chair because it 
is not a Cathedral in the legal sense, but is an Abbey 
church. The Dean of Westminster, who is, of 
course, the head of the ecclesiastical corporation, is 
not responsible to the Bishop of London or any 
other Bishop, but he is directly under the juris- 
diction of the Archbishop of Canterbury. Where 
no Cathedral was available, the degrees were con- 
ferred as a rule in the principal church of the city. 
Now, however, even in Europe they are very fre- 
quently conferred in an academic rather than an 
ecclesiastical building. 
The various symbols connected with the gradua- 
tion in medieval times were as follows. You will 
see in our modern “commencements,” there is left 
but little of the former gorgeous pageantry. 
First, the graduand sat on a seat below the 
Faculty just as you do in the Academy of Music, 
but on receiving the degree which conferred upon 
him the rights of a teacher, he assumed a chair on 
the platform. 6 
SELECTED PAPERS AND ADDRESSES 
Second, an open book was handed to the gradu- 
and to remind him that his studies must be con- 
tinued. 
Third, a closed book was also given him in order 
that he might understand that wisdom was not to 
be gained from books alone, and that he must not 
be bound absolutely by the authority of his prede- 
cessors, wise as they may have been. 
Fourth, a cap was put on his head, and in the 
Scotch Universities, this cap is still used, as I shall 
describe later. Hence where the cap is used the 
graduation is not called the conferring of diplomas, 
or as we call it “Commencement,” but is called 
“Capping.” The students of theology were given 
a black cap, those of law a red cap, those of 
medicine, caps of different colors, violet and blue 
being the commonest. 
Fifth, a ring was placed upon his left ring finger 
to indicate he was wedded to science. It also had 
another significance; namely,—that there was a 
sort of academic knighthood conferred by the de- 
gree. 
Sixth, a kiss, the “osculum pacis,” usually upon 
both cheeks, was given by the authority conferring 
the degree. If in these days of women graduates we 
had co-education at the Jefferson and the kiss of 
peace still held its place in the graduating cere- 
mony, I tremble to think of the emotions of our 
honored President, or the Dean. 
In some Universities there were additional 
symbols connected with the graduating ceremony, 
which were not, however, by any means universal. 
In Spain the graduate was invested with a sword, THE GRADUATION CEREMONY 
7 
a girdle and spurs of gold. In certain Universities 
there are traditions that he had to keep a vigil the 
night before the ceremony, and in Vienna it is 
stated that, as is the case with a candidate for 
knighthood, he had to undergo on the previous 
evening the “ordeal of a bath.” It is a little odd 
to hear this grateful daily boon called an “ordeal.” 
But I fear that many medieval knights had but a 
slender acquaintance with the virtues of water 
either internally or externally. 
In addition to this the torch-light procession 
which not uncommonly terminated the festivities 
was originally symbolical, the lighted torch stand- 
ing for the torch of learning. 
Of course such an elaborate graduation cere- 
mony entailed a large expense which had to be 
borne by the candidate for the degree of Doctor. 
In addition to this he was expected to give hats, 
caps, robes, clothing, and even confectionery to 
not a few of the persons who took part in the cere- 
mony. Some rather curious details in relation to 
these gifts are to be found in Prof. Cunning- 
ham’s address. This expense reminds one of the 
fact that Lord Roberts, when recently offered the 
Garter by King Edward, declined the honor be- 
cause the fees amounted to over $5000, a sum 
his modest means did not permit him to expend. 
The whole ceremony, of course, terminated with 
a banquet, at which there was not only a lot of 
eating, but much more drinking than was desirable, 
much singing and jesting. In fact hilarity went so 
far in some Universities that statutes wTere drawn 
up forbidding the presence of trumpeters, actors, 8 
SELECTED PAPERS AND ADDRESSES 
and jesters. Sometimes the students who were 
not invited as guests gathered around the door of 
the building and amused themselves by snatching 
the food and wine from the servants as they were 
carrying them into the hall. In Spain and 
Portugal the unfortunate graduate had to provide 
a bull-fight for the amusement of the University. 
At Paris, Oxford, and Cambridge, the papal 
authority was invoked to prevent an expense ex- 
ceeding what would be equivalent to about $2,500 
at the present day. 
Little by little all this pomp and display has 
lessened until to-day only a remnant of it is left. 
In fact in some Universities, as, for example, at 
Strasburg and Munich, as soon as the student has 
passed his examination, he goes home and his di- 
ploma is sent to him, so that there is no ceremony 
whatever. So, too, with the examination of the 
Royal College of Surgeons of England, there is no 
graduation ceremony, but the diploma is sent to 
the successful candidate. 
In a few of the European Universities, some- 
what of the ancient ritual has been retained. In 
the University of Rome, the ring, the hood, the 
chain, and the kiss are all employed at the present 
time, but Prof. Durante, who received a degree in 
Edinburgh, came without any academic gown, be- 
cause, as he informed me, the University of Rome 
had no official robe. 
In Prague a chain is thrown around the neck, a 
ring placed on the finger, and a book presented. 
Each of these acts is announced by a blast of 
trumpets. At the Swedish University of Upsala THE GRADUATION CEREMONY 
9 
the ceremony begins with a salvo of artillery, and 
the whole is attended throughout with fanfares of 
trumpets and the din of cannon. Not only are 
there the cannon and the trumpeters, but the 
Doctor of Philosophy is crowned with a laurel 
wreath, usually made by his friends, fiancee or his 
nearest young lady relation. The doctors of theol- 
ogy, law and medicine are capped with a black silk 
hat having a golden buckle. In Louvain, Belgium, 
besides the procession, the candidate is capped, 
ringed, and placed in a magisterial chair. 
Dr. M. B. Tinker, of Ithaca, New York, a grad- 
uate of the Jefferson who also took his degree at 
the University of Berlin, has kindly given me the 
details of the ceremony in that University as 
follows: “Only one man passes through the cere- 
mony at a time although sometimes there are three 
or more men who come before the Dean on one day. 
The candidate with several of his friends, in full 
evening dress including white tie and white kid 
gloves, is seated at one side of the great University 
aula. The Dean of the Faculty with his flowing 
crimson academic gowm of silk and velvet comes in 
at the great doors and seats himself on the opposite 
side of the room, just below the platform and 
stand which is used by the orators and the Uni- 
versity authorities on state occasions. The fact 
that the candidate is in waiting is announced to the 
Dean and he rises, bows, and states that he is 
ready to receive any communication from him. 
The candidate then states in a regular form that is 
used on such occasions that he has successfully 
passed the tentamen and rigorosum examinations 10 
SELECTED PAPERS AND ADDRESSES 
and that he is now prepared to present his disserta- 
tion for discussion and to defend it, if necessary, 
before all comers. [You see how valiant a knight 
he is!] He further asks the privilege of presenting 
his theses and defending them in the German 
language. All conversation between the Dean 
and the candidate up to this stage is carried on in 
Latin. I need hardly say, I am sure, that most 
candidates write out their little speech and have it 
corrected by some of the University instructors in 
Latin and then commit it to memory. The Dean 
then rises, bows and grants permission for the 
candidate to defend certain theses with regard to 
his dissertation or other medical subjects in 
German. The candidate states his main conten- 
tions and inquires if any one present wishes to take 
exception to his position. Usually there are at 
least three opponents, who rise one after the other, 
and beg leave to dispute with the candidate. The 
candidate answers their arguments as best he can. 
The opponents usually express their approval of 
the arguments offered by the candidate in reply to 
what they have said and the Dean adds a word or 
two of criticism or commendation. Pie then uses 
the following Promotion Formula: ‘Candidate, 
most distinguished! most worthy! After success- 
fully passing a rigorous examination, you have 
petitioned the Faculty of Medicine that the highest 
honors in medicine be conferred upon you. Your 
Dissertation and Theses having been by you 
learnedly defended against the arguments of op- 
ponents, there remains no impediment to your ob- 
taining the degree of Doctor of Medicine. Before, THE GRADUATION CEREMONY 
11 
however, this can be conferred upon you, you must 
bind yourself by an oath in the words of which you 
will now most straitly swear.’ 
(The Doctor at this stage pronounces the fol- 
lowing oath) :— 
“ ‘I promise and swear that I will not practice 
the art of healing for my own good, but in order to 
show forth the glory of God, to protect the health 
of men, and, as far as lies in my power, to increase 
knowledge; that I will carry out the work of a 
physician with the greatest faith and duty, and, as 
long as I have the power, with care and prudence; 
that I will come to the assistance of anyone in labor 
without distinction or preference, with no ambition, 
but with equal attention to rich and poor; that I 
will endanger the life of no man by rash experi- 
ment; that I will never turn the practice of Medi- 
cine away to vain or ignoble ends, but will persevere 
with unremitting study to fathom and learn the 
Art; that I will treat my brethren of the Art 
kindly, amicably, and as the dignity of the Art de- 
mands ; that I will associate myself with most ready 
spirit and with no regard for my own ends, with 
what ability I can with their labors for the health 
of the sick, and in everything will take pains to 
raise the Art, which I profess, to the sanctity of a 
religion. Ita me Deus adjuvet et sacro-sanctum 
ejus Evangelium.’ 
(Then the Dean proceeds) : 
“ ‘Which matter be blessed and fortunate, and 
may Almighty God ordain it to be for the good of 
your country. By the authority and under the 
auspices of Wilhelm II., Emperor of Germany, 12 
SELECTED PAPERS AND ADDRESSES 
King of the Prussians, most powerful, most just, 
most gracious, and by the Decree of the Medical 
Faculty, I, * * *, Doctor of Medicine, Public 
ordinary Professor, presently Dean of the Medical 
Faculty and Promoter lawfully appointed, create 
you, * * * , Doctor of Medicine, declare you so 
created, and proclaim you as so declared. 
Having fulfilled the requirements which were to be 
fulfilled, ascend to the higher seat of the Doctors.’ 
(The young Doctor proceeds from the lower 
seats to the higher and the Dean gives him the di- 
ploma with the following words:) 
“ ‘Hail! most learned sir! most worthy Doctor! 
I congratulate you on the honours conferred upon 
you! I hand you your diploma, sealed with the 
seal of the Medical Faculty. May you carry on 
worthily and successfully continue the profession 
you have now begun. Farewell!’5 
“There is then a great deal of hand-shaking and 
congratulations from fellow students and friends 
and the ceremony is completed except that the suc- 
cessful man usually takes his friends out to a 
restaurant for a banquet. 
“I think the University of Berlin adheres more 
strictly to the old-time manner of conferring its 
degrees than any of the other Universities. In 
hardly any other University is it required that the 
candidate shall use the Latin language. Formerly 
it was required that he should write his dissertation 
and defend it in Latin. The defense of the disser- 
5 These formulae used by the Dean and the oath taken by 
the candidate I have interpolated from the address of Profes- 
sor Cunningham, into Dr. Tinker’s account. THE GRADUATION CEREMONY 
13 
tation is now a matter of form in most cases, even 
in Berlin. Notices are posted several days be- 
fore the exercises are to take place so that if any 
one cares to enter the debate he has an opportunity 
to do so. As a rule the candidate meets his so- 
called opponents the night before at some concert 
garden and enjoys a very pleasant social evening 
with them. They tell him what criticism they will 
offer and it is arranged just what reply he shall 
make to each and all of these criticisms. Alto- 
gether it is a rather pleasant affair.” 
Only at the Universities of Spain and at Coimbra, 
in Portugal, does the medieval ceremony survive 
to its fullest extent. 
I have had the pleasure of witnessing three 
ceremonies which were somewhat analogous to 
those of graduation. These took place at the 
Royal College of Surgeons of England, the Royal 
College of Surgeons of Edinburgh, and the Univer- 
sity of Edinburgh. A short account of each may 
be of interest to you. 
The Royal College of Surgeons of England was 
founded in 1540 by Henry VIII. By a legal 
technicality they lost their charter in 1799 and a 
new charter was conferred upon them by George 
III. in the year 1800. In the year 1900 they cele- 
brated the first centenary of the new charter by a 
very elaborate ceremony in Burlington House, Pic- 
cadilly, London. You will find in our library two 
photographs, one representing the ceremony when 
the degrees were conferred, the other the dinner in 
the evening. The Prince of Wales, now King 14 
SELECTED PAPERS AND ADDRESSES 
Edward VII., was made the first Honorary Fellow 
in private at Marlborough House. Two days 
later, on July 26th, Lord Salisbury, the leader of 
the Conservative Party, and Lord Rosebery, the 
leader of the Liberal Party, and thirty-two sur- 
geons from various countries in the world were 
made Honorary Fellows. Not more than four 
were selected from any one country. 
This function was one of the most brilliant that 
I have ever seen on any academic occasion. The 
only ones that would compare with it were the 
recent ones in Edinburgh, which I shall describe in 
a moment. A procession was formed, the mace 
bearer leading the way and followed by the officers 
of the College, the candidates for the Honorary Fel- 
lowship, and the Fellows. The President of the 
College, Sir William MacCormac, in his red robe 
of office, occupied the center of the stage. On his 
right and left were the first and second Vice-Pres- 
idents of the College, next, on the right, was the 
Marquis of Salisbury in his robes as Chancellor 
of the University of Oxford, a robe of heavy black 
silk elaborately embroidered in gold, and on the left 
the Earl of Rosebery in his scarlet gown as Doctor 
of Laws of the University of Edinburgh. All of 
the thirty-two professional candidates for the honor 
were grouped in two rows of chairs in a semicircle 
in front of the President. Nearly all were in 
academic or military costumes; the Spaniards wore 
capes of bright yellow, the French wore coats em- 
broidered with green vines and leaves. Of the 
candidates from other countries some were in uni- 
form and others in the various University gowns of THE GRADUATION CEREMONY 
15 
their several countries. A very small number were 
in full evening dress. The audience was equally 
brilliant, nearly all present wore academic robes of 
all colors and especially all varieties of hoods, repre- 
senting different Faculties and different degrees, 
while the uniforms of the Army and Navy and the 
bright summer dresses of a large number of ladies 
completed a spectacle which wTas worth travelling a 
long distance to see. 
As his name was called each candidate stepped 
up in front of the President, and was presented 
with a diploma. He then bowed and resumed his 
seat. No robe was put on him at the ceremony. 
He provided himself with one later if he desired it. 
The robe is of black alpaca faced with crimson, but 
has no hood. A few addresses were made by one 
representative of each of the principal countries 
from which the Honorary Fellows came. The cere- 
mony was concluded by an historical address by the 
President. In the evening an elaborate dinner was 
held at Lincoln’s Inn, one of the stateliest halls of 
the Lawyers of London. At the dinner, after- 
dinner speeches were made by the Prince of Wales, 
Lord Salisbury, Lord Rosebery, the Lord Fligh 
Chancellor, and other distinguished guests.6 
The Royal College of Surgeons of Edinburgh is 
the oldest surgical body in the world not connected 
with a University. It was founded in 1505, ante- 
dating both the Royal College of Surgeons and the 
Royal College of Physicians of England. On July 
20th, 1905, they celebrate their 400th anniversary 
6 For a full account of the addresses, etc., see the Lancet, 
1900, Vol. II, pp. 281 and 339. 16 
SELECTED PAPERS AND ADDRESSES 
by conferring a number of Honorary Fellowships 
upon surgeons from different parts of the world. 
The description of the procession with the mace- 
bearer, the President of the Royal College of Sur- 
geons, Sir Patrick Heron Watson, the gorgeous 
robes, the uniforms, and the ladies present would 
be practically a duplicate of the preceding descrip- 
tion of the similar function in London five years 
before. 
The ceremony was held in McEwen Hall. The 
Honorary Fellows were seated in a row in front of 
the platform, each wearing the dark blue robe of 
the College with light blue facing and white silk 
“frogs,” but without any hood. The Promoter, 
Sir Halliday Croom, made a brief address in pre- 
senting each candidate for the degree. The can- 
didate then advanced to the platform, was taken by 
the hand by the President, was presented with the 
diploma of the College, and the hood was thrown 
over his shoulders, after which he signed in the 
Sederunt Book the following oath: 
“I hereby promise faithfully to maintain and 
defend all the rights, liberties, and privileges of the 
Royal College of Surgeons of Edinburgh, and to 
promote the interests thereof to the utmost of my 
power. I also promise faithfully to obey all the 
laws of the said Royal College, made and to be 
made.” 
As soon as all the degrees had been conferred, a 
large number of congratulatory addresses from 
various Universities and learned Societies were pre- 
sented, beautifully engrossed on parchment and 
enclosed in handsome cases. After this each of THE GRADUATION CEREMONY 
17 
the Honorary Graduates spoke for two or three 
minutes only in returning thanks. In the evening 
a festival dinner was held, at which addresses were 
made by M. Paul Cambon, the French Ambassador 
to Great Britain, Prof. Halsted of John Hopkins, 
Sir William Turner, the Principal of the Univer- 
sity, and a few other distinguished guests.7 
Two days later occurred a special ceremonial of 
the University of Edinburgh for conferring 
Honorary Degrees. 
Scotland has four Universities; the oldest is the 
University of St. Andrews, founded in 1411. 
Geographically it lies a little to the north and east 
of Edinburgh. The next in order of time is the 
University of Glasgow, founded in 1451; the third 
the University of Aberdeen, founded in 1494, and 
the fourth the University of Edinburgh, founded 
in 1582. The Medical Department of the Univer- 
sity of Edinburgh was established in 1685. 
It has been one of the most distinguished seats of 
learning in Great Britain. Among the names 
which have made it illustrious I can only mention 
the following: Sir Walter Scott, Dugald Stuart, 
Carlyle, Sir William Hamilton, Darwin, Cullen. 
Sir James Y. Simpson, Syme, and Lord Lister. 
What an illustrious galaxy! How it excites our 
admiration and our envy! In one respect the Uni- 
versity and one family occupy a unique relation. 
“In 1720, more than half a century before our 
Revolution, Alexander Monro, primus, was elected 
professor of Anatomy at the enormous salary of 
7 For a full account of the proceedings, see the Lancet, 
1905, Vol. II, p. 307. 18 
SELECTED PAPERS AND ADDRESSES 
=£15 per annum. From this time until 1859, the 
year that I graduated from Brown University, 
when Monro, tertius, died, the history of Anatomy 
in the University of Edinburgh and that of this 
astonishing family are almost identical. All of 
them lived to an old age, Alexander, primus, dy- 
ing at seventy, Alexander, secundus, at eighty- 
four, and Alexander, tertius, at eighty-six. All 
were professors early in life; at twenty-three, 
twenty-one, and twenty-five, respectively. All of 
them taught for long periods: thirty-eight, fifty- 
four, and forty-eight years; and father, son and 
grandson, they held the anatomical chair in Edin- 
burgh from 1720 till 1846, a period of one hundred 
and twenty-six years!” 8 
The University of Edinburgh has a peculiar 
relation to a still older and a much younger Univer- 
sity. The older is the Dutch University at Ley- 
den, where Boerhaave, one of the most influential 
teachers of medicine during the 18th Century on 
the whole continent of Europe, was the reigning in- 
fluence and whither Edinburgh men flocked for 
their medical education. The younger one is the 
University of Pennsylvania, and through the Uni- 
versity of Pennsylvania, the oldest of all our Ameri- 
can medical schools, the University of Edinburgh 
and especially Cullen, its foremost teacher in the 
latter half of the 18th Century, have influenced the 
development of early medical teaching, medical 
manners and medical habits in America to a very 
notable degree. The head of the University of 
8 See Addresses and Other Papers, by W. W. Keen, 
p. 13, “Early History of Practical Anatomy.” THE GRADUATION CEREMONY 
19 
Pennsylvania, and the head of the City of Edin- 
burgh, are called not President or Mayor, but Pro- 
vost. The title of our chair of Physiology at the 
Jefferson, the “Institute of Medicine,” is identical 
with the title of the same chair in the University 
of Edinburgh. 
Almost all of our colonial physicians and sur- 
geons went to Edinburgh to finish their medical 
education. Physick, our earliest and most distin- 
guished surgeon; Redman, the founder of the Col- 
lege of Physicians of Philadelphia; Benjamin 
Rush, the great signer of the Declaration and the 
most influential physician in America during 
the Revolutionary period, and a host of others 
were graduated at Edinburgh. 
It was, therefore, with very unusual pleasure 
that I was present at this special ceremonial for the 
conferring of Honorary Degrees. The procession 
was headed by the mace-bearer, followed by Sir 
William Turner, the distinguished anatomist, who 
is the Principal of the University, in his heavy 
black silk robe lavishly embroidered with silver. 
Mr. Chiene, the well-known Professor of Sur- 
gery, told me that in conferring the degrees at the 
regular graduation a few days later, the Principal 
wTas compelled to lift the two pounds of silver on 
the right arm of his robe over 700 times, i. e., he 
lifted in all over three-quarters of a ton! No 
mean feat for a man past three score and ten. 
Then followed the other University officers, the 
candidates for the Honorary Degree of Doctor of 
Laws, the graduates of Edinburgh and other Uni- 
versities, Army and Navy officers, etc. The robe of 20 
SELECTED PAPERS AND ADDRESSES 
the University of Edinburgh is of bright scarlet 
broad-cloth 9 faced with light blue silk, the hood of 
black silk lined with blue, and the cap is the four 
square velvet cap called after John Knox and not 
the usual “mortar board” hat. The large number 
of these robes with the brilliant gowns of other Uni- 
versities, the Lord Provost of the City in his 
ermine robe and gold chain of office and other 
official and academic costumes again produced the 
same kaleidoscopic effect of color described in the 
former functions. The candidates for the Hono- 
rary Degrees again sat in the front seats on the 
floor of McEwen Hall. The Promoter, Sir Lu- 
dovic J. Grant, was most happy in his presenta- 
tion of the ten candidates, beginning with the 
French Ambassador, M. Paul Cambon. As the 
name of each candidate for the degree was an- 
nounced, he ascended upon the platform, was 
addressed in a few words by the Principal, Sir 
William Turner, and then bowing his head, was 
touched by Sir William with the velvet cap, which 
has done service for many years, and which with 
91 discovered in Bower’s History of the University of 
Edinburgh, Vol. I, p. 54, the reason why this bright color 
was adopted. In 1692, by an ordinance of the University, 
the red robe was prescribed so that thereby “vaging and vice 
might be discouraged.” Evidently in those more turbulent 
days than our own, when town and gown were often arrayed 
against each other, a “vagabond” or “vicious” gentleman 
radiant in the scarlet robe of the University would be much 
more readily nabbed by the police than if he wore the ordi- 
nary dress of a citizen. Curiously enough I found that this 
origin of the red robe was practically unknown among the 
faculty and friends of the University. THE GRADUATION CEREMONY 
21 
characteristic Scotch thrift, is made from an old 
pair of velvet breeches of George Buchanan, the 
celebrated Scotch Historian and Poet, who was 
tutor to King James I. Each candidate already 
had on the scarlet robe of the University and over 
his neck was thrown the hood pertaining to his 
degree. No diploma was presented with the 
degree. As soon as they had been conferred, Sir 
William Turner then called upon M. Cambon to 
respond for the Continental guests and upon my- 
self to respond for the English speaking guests.10 
In 1911 I was invited to attend the celebration 
of the 500th anniversary of the founding of the 
University of St. Andrews in 1411. It was as 
picturesque and as interesting as any of the pre- 
ceding celebrations. Lord Rosebery was the 
Lord Rector and gave in the Rectorial Address a 
formal historical review of the life and work of this, 
the oldest of the four Scottish Universities. 
It was a most scholarly production. Later at the 
dinner and again at a luncheon he made two other 
addresses both full of wit and humor without re- 
peating himself or ever for a moment becoming 
dull, a remarkable performance. 
10 For a full account of the ceremony, see the Brit. Med. 
Jour., 1905, Vol. IIV p. 240. AN ACCOUNT OF THE FESTIVAL 
HELD AT UP SAL A 
BY THE UNIVERSITY OF UPSALA, SWEDEN, 
IN MAY, 1907, IN COMMEMORATION OF 
THE 200TH ANNIVERSARY OF THE 
BIRTH OF CAROLUS LINNAEUS1 
As your delegate to the Linnaeus Festival of 
the University of Upsala and of the Royal Aca- 
demy of Sciences in Stockholm, held from May 23 
to 26, 1907, in commemoration of the 200th anni- 
versary of his birth, I have the honor to make the 
following report: 
As the ceremonials—particularly that of the con- 
ferring of honorary degrees—differ in many 
respects from those usually seen in America, I have 
ventured to describe them in some detail. As I 
have pointed out in an address on the “Graduation 
Ceremony,” 2 Upsala has preserved more of the 
medieval customs than any of the European univer- 
sities except the University of Coimbra in Portu- 
gal, from which there was a delegate present wear- 
ing the picturesque robe and cap seen only there. 
1 The American Philosophical Society and Harvard Univer- 
sity were the only American Institutions invited to send dele- 
gates, Harvard having given Linnaeus an honorary degree 
and Linnaeus having been a member of the American Philo- 
sophical Society. 
2 See the preceding address. LINNAEUS FESTIVAL AT UPSALA 
23 
Moreover the present is the first occasion on 
which honorary degrees have been conferred by Up- 
sala on any foreign scholars. Even in 1877 when 
they celebrated the 400th anniversary of the foun- 
dation of the University in 1477 no degrees were 
given to foreigners. 
Never have I seen so well organized a fete. Be- 
fore his arrival everyone had the number of his 
room, a numbered check for his baggage, for his 
seat at every function, for his hat, etc. All bag- 
gage was taken in charge at the station; carriages 
were there for everybody. The delegates and 
their families were the guests of the University for 
the two days in Upsala, and all charges for rooms 
and meals were defrayed by the University. More- 
over, the Stockholm Academy of pre- 
sented each delegate with four volumes in octavo, 
one in folio of the works of Linnaeus and a 
medal as delightful mementos of a remarkable fes- 
tival. 
In front of the railroad station and in front of 
the “University House” were planted a circle of 
standards with the flags of all the nations repre- 
sented, while the town was profusely decorated with 
flags and evergreens. As the students number 
1,800 in a population of only about 25,000 they 
practically are the town. 
When the special train arrived the students were 
there in procession to greet their guests. As all 
of them wear white caps (the one hundred women 
students wearing the same), as the marshals wore 
long effective, broad sashes of bright yellow and 
blue (the Swedish colors), and there were over a 24 
SELECTED PAPERS AND ADDRESSES 
dozen banners and corps flags grouped in the 
center, the scene was very picturesque. The sing- 
ing by the students was the best I have ever heard. 
A brief Latin salutatory speech ended the proceed- 
ings at the station. 
As soon as we reached our rooms there appeared 
a young woman to measure our heads for the hat or 
wreath and our ring fingers for the ring at the fol- 
lowing day’s promotion. 
At noon on the 23rd, the proceedings were held 
in the splendid aula of the University House. 
This hall resembles in general that at Yale. It is 
very nearly as large and even handsomer. The 
king’s health prevented him from taking part in 
any of the functions, but he was well represented by 
the Crown Prince,3 who is also Prince Regent, a 
very affable man of about fifty. He and the other 
members of the royal family mingled with their 
guests most informally and agreeably. After a 
cantata by a band and a chorus and an address by 
Rektor Schuck the various countries were called 
alphabetically and the addresses from various 
universities and scientific bodies were presented. 
Only one delegate from each country spoke—an 
excellent arrangement, as it shortened the time 
very acceptably. 
In the afternoon the students gave a delightful 
concert and garden party in the Botanical Garden. 
At 6:30 the Archbishop and the Rektor entertained 
one hundred and seventy guests at dinner. The 
three toasts were proposed by Dr. Schuck in 
3 The present King. LINNAEUS FESTIVAL AT UPSALA 
25 
French, Swedish, and faultless English, and I was 
told that he was equally at home in German, 
Italian, Spanish and Latin. A reception ended a 
delightful day. 
On May 24th the conferring of degrees took place 
in the cathedral. This is 360 feet long and a fine 
example of pure Gothic. It was founded in 1250 
and contains tombs of Gustave Vasa and other 
famous Swedes. In the north aisle lie the bones of 
Linnaeus and in a chapel near by a dignified simple 
monument records his birth and death. I was told 
that there were about 6,000 people present and I 
hardly think it an exaggeration. In the west 
gallery besides the large organ was a military band 
and in the choir an orchestra and an excellent 
chorus. The procession was led by about a dozen 
marshals in their white caps and Swedish sashes, 
and when the delegates in academic robes, uniform 
or evening dress were seated, the marshals and the 
bearers of the banners and flags lined each side of 
the middle aisle while the Prince Regent and the 
rest of the royal family entered. 
After singing a cantata composed in 1877 for the 
quattro-centenary, honorary degrees were conferred 
in Theology, Jurisprudence, Medicine and Philos- 
ophy. The Promoter in each Faculty first made a 
short Latin address. Each graduand then ad- 
vanced into the choir by three steps of the “Parnas- 
sus,” as the ascent was called in the program. In 
Theology, Law and Medicine the Promoter placed 
a top hat on the candidate’s head, a ring on his left 
ring finger, and handed him three diplomas, one, the 
official one, sealed and stamped with a 100 Kroner 26 
SELECTED PAPERS AND ADDRESSES 
Stamp ($28; this tax was paid by the government), 
the two others being duplicates, but unsealed and 
unstamped. The hat was peculiar. In color it 
was black, but the vertical portion was plaited 
vertically in plaits about one inch wide; in the front 
of the band was a small gold shield. 
Each graduand in Philosophy, their highest Aca- 
demic honor, instead of receiving a hat, had pinned 
on his breast beforehand a laurel wreath. This 
was unpinned by a marshal on the first step of the 
Parnassus and was handed to the Promoter, who 
thereupon crowned the recipient, placed the ring on 
his finger, gave him his diplomas, and shook hands 
with him most cordially. The new laureates in 
descending the Parnassus bowed to the Archbishop, 
the Rektor and the Crown Prince. 
When the first candidate in each Faculty was 
capped or crowned a battery of artillery on the 
place in front of the cathedral began firing a salute 
and continued until the last degree in this Faculty 
had been conferred, only to break out anew for each 
succeeding Faculty. 
After all the degrees in each Faculty had been 
conferred the orchestra rendered a musical selection. 
They were all finely given, but the music chosen 
amused us. For the Theologs (I presumed they 
were Lutherans), they gave the “March of the 
Priests of Baal”; for the lawyers, “See the Con- 
quering Hero Comes”; the doctors were welcomed 
by Schubert’s “Death and the Maiden”; (I con- 
cluded, charitably, that she had appendicitis and 
was rescued from Death by the doctor) ; while the 
new Doctors of Philosophy were honored by LINNAEUS FESTIVAL AT UPSALA 
27 
Mendelssohn’s “Wedding March,” which I inter- 
preted as either a reminiscence, an exhortation or a 
prophecy. 
The rings differ for each Faculty, that for Philos- 
ophy being engraved outside with the laurel wreath 
and on the inside with the name of the owner, that 
of the University, the degree conferred, and the 
date. In Theology and Law, degrees were only 
conferred upon Scandinavians. In Medicine, 
Haeckel of Jena was the most notable among the 
thirteen foreigners. In Philosophy, Professor 
Hjelt of Helsingfors, who had received his docto- 
rate in 1847, and eighteen Swedes who graduated 
in 1857, were made “Jubilee” Ph.D’s. Fourteen 
foreigners received this honorary degree, among 
them two Americans, Professor Far low of Har- 
vard and your delegate. 
The American Philosophical Society and 
Harvard University were the only American insti- 
tutions invited to send delegates, Harvard having 
given Linnaeus an honorary degree and Linnaeus 
having been a member of the American Philo- 
sophical Society. 
After the conferring of the degrees followed one 
of the prettiest and pleasantest features of the day. 
The newly made doctors all marched in their robes, 
hats and wreaths to the nearby University Llouse 
and stood on the ample steps, while the whitecapped 
students, with songs, banners and flags, marched 
up and stood in front of the steps. After some fine 
singing the leader greeted the new doctors, now 
their brethren, in an admirable Latin speech, to 
which a reply was made in Swedish by one of the 28 
SELECTED PAPERS AND ADDRESSES 
honorary doctors, and the students, after the usual 
four Swedish “hurrahs,” marched off singing, lift- 
ing their hats as they passed the guests massed on 
the steps. 
Another official dinner and a ball, ending in that 
latitude in broad daylight at 3 a. m., concluded 
the exercises in Upsala. 
On the 25th the Academy of Sciences met in 
Stockholm in the Academy of Music. A cantata 
was sung, after which Count Morner, the President, 
delivered an oration and the institutions which had 
been invited presented addresses, in groups from 
each country, only the first delegate making a brief 
presentation speech. Another dinner followed in 
the evening. 
On the 26th an excursion was made in the morn- 
ing to Hammarby, the home of Linnaeus, and from 
4 to 5.30 p. m., the Prince Regent entertained the 
foreign delegates and a few official Swedes at a tea 
and garden party at the palace quite informally, 
and most delightfully. THE COMMUNITY OF INTEREST 
OF THE MEDICAL SCHOOL AND 
THE PUBLIC 1 
My sincere thanks are due for the distinguished 
honor of an invitation to deliver this important 
annual address. I also wish to congratulate you, 
gentlemen of the graduating class, on the admirable 
instruction that you have had. I have scanned 
anew the list of your Faculty and your equipment 
as shown by the annual announcement and I see 
among the former, friends whom I esteem for their 
professional and personal eminence, and among the 
latter facilities for education which far surpass any- 
thing which I had as a student. 
Among the list of names that stand on your last 
announcement, however, is one which awakens sad 
memories of a sudden and tragic death. You have 
had a great bereavement in the untimely cutting 
off in the midst of a most promising and brilliant 
career of John Slade Ely. I am told that his place 
is to be filled by Dr. Blumer, who has already dis- 
tinguished himself both in Albany and in Califor- 
nia, and so the work of the school will still progress 
most satisfactorily. The world’s work cannot stop. 
The old order ever gives place to the new. 
It is to me an especial pleasure to come from the 
Jefferson Medical College in Philadelphia to greet 
1 Address at the Commencement of the Medical Depart-1 
ment of Yale University, June 25, 1906. 30 
SELECTED PAPERS AND ADDRESSES 
you, because I remember that its great founder, 
George McClellan, was a graduate of Yale. My 
scholarly Professor of the Practice of Medicine, 
Samuel H. Dickson, was another graduate of Yale, 
and my very highly esteemed personal friend, 
William H. Welch, the father of modern American 
pathology, and many other medical friends are 
also graduates of this venerable and distinguished 
University. 
To you graduates personally, as your names are 
added to the long roll of faithful and honored 
graduates of the Medical Department of Yale, I 
commend the last words ever publicly spoken in 
Scotland by that devoted missionary, able geogra- 
pher, and sanctified physician, David Livingstone, 
as he was leaving for the wilds of Africa, never to 
return. He was visiting one of his sons at school, 
and gave the students this sententious advice, “Fear 
God, and Work Hard.” 
This counsel you instantly recognize also is in 
line with that of our well-beloved Osier, when he 
speaks of Work as “the Master Word in Medicine.” 
Be certain of one thing: do honest work every day, 
meeting the tasks of each day, no matter how 
humble or how obscure, with a determination that 
you will put your best work into them, and you 
will assuredly meet with your reward in due time. 
I have yet to see the man who put this spirit into 
his work fail of attaining his goal. Even if it be 
not in this world, though in fact usually it is so 
attained, it will be reached in a better one, where I 
trust that all of you may be received with a “Well 
done, good and faithful servant.” MEDICAL SCHOOL AND THE PUBLIC 
31 
The subject that I have chosen is, “The Com- 
munity of Interest of the Medical School and the 
Public.” Let me put it in a nutshell. 
What should the medical school do for the 
public? Two things: (1) Give the public the 
best educated practioners in every department of 
medicine, and (2) increase our knowledge of the 
science and art of medicine in order to make our 
profession still more efficient. 
On the other hand, what should the public do for 
the medical school? As I shall show you, the in- 
come of a medical school from its students is never 
adequate to defray the ordinary running expenses 
of a good medical school, to say nothing of an in- 
crease of the plant either in buildings or in teachers. 
It is the duty of the public, therefore, to provide all 
the needed facilities for the making of the best 
doctors and for original research, in order that 
the medical school may render its best service to 
the public. 
First, The Medical School. In carefully look- 
ing over your announcement, I am glad to see that 
you have provided all of the four means of medical 
instruction, namely, (1) Didactic Lectures; (2) 
Recitations; (3) Laboratory Facilities, and (4) 
Clinical Instruction. I pass very lightly over the 
first two of these methods (didactic lectures and 
recitations), not because they are unimportant 
(though some of our modern schools are disposed 
to decry them), but because you already have them, 
and have them, as I look at it, in a proper propor- 
tion to the rest of your work. Never, in my 
opinion, will the didactic lecture pass entirely from 32 
SELECTED PAPERS AND ADDRESSES 
the sphere of medical teaching any more than will 
that of the public speaker in other departments of 
instruction. 
But every member of a Faculty should remember 
that if he is to give didactic lectures, they should be 
of the very best and highest quality that he can 
possibly produce. A very significant remark was 
made to me in Boston two weeks ago by a gentle- 
man in speaking of his old teacher in medicine, who, 
he said, was “a first-rate man to sleep under.” As 
soon as any teacher becomes a gentle opiate, the 
Trustees should seek for his successor as quickly as 
possible. Give me a man with clear-cut ideas, in- 
terested with his very soul in the subject he is teach- 
ing, aflame with enthusiasm to plant the knowledge 
he has to give in the mind of every single student 
before him, and with a good command of his mother 
tongue—such a man emphasizing the most im- 
portant points will impress the facts of medicine 
indelibly upon the mind of his students vastly 
better than will any text-book, over which the 
student often nods assent to every statement. 
Recitations, like writing, tend to promote exact- 
ness of knowledge and hence I thoroughly believe 
in them, but like the lecturer, the teacher to whom 
the student recites is quite as important as the book 
from which he recites. 
The expense of these two methods of teaching can 
readily be met by the ordinary fees of students: 
but now, we come to two very different conditions. 
The third and fourth methods of teaching are by 
the laboratory and the clinic. Here we require 
very expensive plants and a very expensive teaching MEDICAL SCHOOL AND THE PUBLIC 
33 
corps. Moreover, both must grow steadily with 
the growth of medicine, and so the expense con- 
stantly increases. In the Jefferson Medical Col- 
lege we have 14 different laboratories, namely, the 
dissecting room (the anatomical laboratory), the 
laboratories of histology, of embryology, of 
physiology, of chemistry, of physiological chemis- 
try, of pharmacy, of pharmacology, of practical 
obstetrics and obstetrical operations, of surgical 
operations, of bandaging and fracture dressings, of 
morbid anatomy, of bacteriology and hygiene, to 
which is to be added also a laboratory of clinical 
medicine. When I was a student, over 40 years 
ago, no medical school had more than one—the 
dissecting room. 
These many laboratories mean large buildings, 
as they require large floor space, for each individual 
student must be accommodated. They must have 
plenty of ground in order to secure good light. 
They require an expensive equipment. The equip- 
ment of our laboratory of physiology in the Jeffer- 
son alone cost over $12,000, and that is but one of 
the 14. Moreover, a quarter of a century ago we 
had a Faculty who constituted and who thought 
themselves the perfect number seven. Each gave 
his lectures to the entire student body in all the 
classes en masse. I use the words “all the classes” 
cynically, for there were but two classes until a 
comparatively few years ago—and they were both 
taught together, for 18 weeks per annum. Two 
years—thirty-six weeks—of this meager training 
and, presto! we were doctors and authorized by 
law, like Saul, to slay our thousands or even 34 
SELECTED PAPERS AND ADDRESSES 
to vie with the more nimble and athletic David. 
Now we have graded courses with instruction 
covering 35 weeks in each year for four years— 
140 weeks in place of 36—and what is still more 
costly, personal instruction either to single indi- 
viduals or to a small group of individuals by in- 
structors who must be paid. 
When I began the study of medicine at the 
Jefferson in 1860, including the janitor himself, 
there were less than a score of men engaged in 
teaching us. To-day, we have over 11 score of in- 
structors, an increase, you will observe, of over 
1100 per cent., and the 36 weeks of the entire course 
have been multiplied practically fourfold, yet the 
fees have increased less than 100 per cent. These 
changes at the Jefferson have been duplicated in 
every school which was in existence 40 years ago and 
which has met the demands of the times. The fees 
are practically as high as they can be made, other- 
wise it will be impossible for many1 an earnest 
student of the finest fiber and best qualities to pur- 
sue the study of medicine, and the profession will 
be restricted practically to the well-to-do or even to 
the rich. 
The medical school occupies precisely the same 
position as the college or the technical school. A ll of 
us give instruction at far below cost. If the com- 
munity wants the best doctors with the best pos- 
sible education, the facilities for obtaining such an 
education must be provided for them by the com- 
munity. It can never be done through the fees of 
the students. The deficit, as I shall directly point 
out to you, must be provided by broadminded, MEDICAL SCHOOL AND THE PUBLIC 
35 
liberal citizens who see the value of such instruc- 
tion to their own families and to the community. 
Moreover, to the laboratories must be added the 
hospital, and it must not be a hospital where the 
doctor will simply make his rounds and order this 
or that medicine or do this or that operation. If 
it is worthy of its function, it must be a hospital 
with an up-to date staff, in which all the newest 
methods of investigation are used, in which hours of 
time and hours of labor are spent over single 
patients in studying the secretions, the excretions, 
the blood and the history as well as the symptoms, 
and the physical signs. It is a fair statement to 
say that to-day in our best conducted hospitals tne 
poorest of the poor get better and more thorough 
investigation and treatment than many of the well- 
to-do and even of the wealthy. The facilities for 
studying a case thoroughly exist only in a well- 
equipped hospital. No home, however luxurious, 
can ever provide them all. 
You may object that New Haven is too small a 
place to provide enough clinical patients for such 
instruction. How, then, about Wurzburg, with a 
population in 1900 of only 75,000; Bonn with 
50,000; Heidelberg with 40,000; Gottingen with 
30,000; Jena with 20,000; or Tubingen with only 
15,000? Every one of these small towns has a 
University Medical School with clinical professors 
known all over the world. Little Tubingen with 
only 15,000 inhabitants, has a medical Faculty of 
21 professors, including a Von Bruns, a Doderlein, 
a Vierordt, and a Heidenhein—and New Haven in 
1900 had 108,000 inhabitants. 36 
SELECTED PAPERS AND ADDRESSES 
As I have pointed out elsewhere,2 the joint work 
of a college and a teaching hospital is of enormously 
greater value to the community than simply the 
care of the sick in an ordinary hospital. “As I 
look over my work in the Jefferson, I see in the 
hospital scores of patients, even hundreds of them, 
every year who go out happy and in comfort, con- 
tented and restored to their families and to wage- 
earning power, and it is no end of pleasure to me 
to remember such cases. But when I look over the 
faces of the hundreds of young men that I have the 
pleasure of teaching, when I remember that I can 
instil into them high ideals, when I can bring to 
the birth in their lives, the ‘research habit’ and the 
desire to learn, and remember that they will go all 
over the world and cure hundreds, nay, thousands 
more than I can, which work is the greater?— 
the curing of my scores of patients or the teaching 
of hundreds of young men to go out to cure scores 
of thousands and to bring the blessing of many an 
exultant wife and many a poor widow upon their 
heads for the work that they have learned to do 
through me?” 
The teaching of students is the most important 
function of a hospital connected with a medical 
school, and for this reason there should be such an 
intimate affiliation between college and hospital 
that the Professor of Surgery in the one, by virtue 
of his very appointment, shall become the teacher of 
Clinical Surgery in the other; that the man who is 
Professor of Medicine in the one shall always be 
2 “The Need for Increased Endowments for Medical In- 
struction/’ Keen (Addresses and Other Papers, p. 399). MEDICAL SCHOOL AND THE PUBLIC 
37 
able to illustrate bis lectures and enforce his teach- 
ing by the clinical examples he can show in the 
other. 
Again, “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 de- 
tect every false step, the omission of an important 
clinical laboratory investigation, the neglect of the 
careful examination of the back as well as the front 
of the chest, the failure to detect any important 
physical sign or symptom? Who will be most 
certain to keep up with the progress of medical 
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 Annals of Surgery and can 
trip him up if he is not abreast of the times? I 
always feel at the Jefferson Hospital as if I were on 
the run with a pack of lively dogs at my heels. I 
cannot 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, catalog, and re- 
member, or give place to others who will. 
Students are the best whip and spur I know.” 3 
But the function of a medical school and its 
hospital is not completed by the mere cure of the 
sick in the latter and the mere education of its 
students in the former. “Mehr licht,” said the 
3 “Duties and Responsibilities of Trustees/’ Keen (Ad- 
dresses and Other Papers, p. 384). 38 
SELECTED PAPERS AND ADDRESSES 
dying Goethe, and that is the tocsin cry which calls 
forth the very best talents of the medical profes- 
sion. The little oasis of knowledge in which we 
exist is hemmed in by a great desert of dense igno- 
rance. It is the glory of the human mind that 
starting from knowing nothing it has achieved the 
magnificent results which the past centuries have 
given to this, the best of all. A new idea thrills 
far more than any libation of champagne; a new 
discovery is at once a reward for past work and a 
stimulus to future labor. He who has never felt 
the thrill of satisfaction from the one or the other 
knows not one of the highest joys of life. It is, 
therefore, the duty of the medical school and the 
hospital to increase our knowledge by invading this 
surrounding desert of ignorance and make each de- 
cade greater, wiser, and better than the one before 
it. Hence there must be facilities for investigation, 
experimental as well as clinical. That means again 
a large increase in the expense of such institutions, 
an increase which can neither be paid for out of the 
fees of ordinary students nor the fees of research 
students themselves, for usually their heads are as 
full of ideas as their pockets are empty of dollars. 
Secondly, The Public. In order to obtain these 
thoroughly competent physicians and to increase 
knowledge the public must provide buildings, 
equipment and endowments in the form of endowed 
professorships, fellowships, scholarships, and in- 
vested funds for the general expenses of the Col- 
lege. 
Let me call especial attention to one fact: that 
we of the profession of medicine do not say to the MEDICAL SCHOOL AND THE PUBLIC 
39 
public “go,” but we say “come.” I challenge any- 
one to contradict the statement that the most un- 
selfish profession which has to do with earthly 
things is the medical profession. We give of our 
time, our skill, our labor, not only to those in whom 
our friends are interested and ask it for them as a 
matter of favor, but there are few doctors who do 
not every day of their lives give hours of their time 
and their very best skill to the poorest without ever 
thinking of any pecuniary reward; hours of time 
and degrees of skill for which the wealthy willingly 
pay large fees. 
In “The Gold Headed Cane,” Mead says: “I 
crept over the backs of the poor into the pockets 
of the rich,” but I can assure you that it is no short 
and easy climb. Moreover, I do not know of any 
personal friends in the profession, men earning 
their tens of thousands, wTho ever turn a deaf ear to 
the deserving, nay often, to the undeserving poor. 
Moreover, it is often forgotten that not only does 
the doctor give his personal services and even his 
personal self (for I have known more than one life 
ruined or sacrificed by infection or exposure while 
attending the poor), but he gives all the products 
of his skill in the way of new instruments, new dis- 
coveries, new inventions, freely to the public. In 
other departments of science, men may freely pa- 
tent these discoveries and make thousands out of 
them, but it is a thoroughly well-established prin- 
ciple in medical ethics that no such pecuniary ad- 
vantage shall inure to the physician or surgeon by 
any similar discovery or invention. 
You tell me that this is unjust. I grant it to 40 
SELECTED PAPERS AND ADDRESSES 
some extent. But it is precisely this uncommercial 
spirit which distinguishes a profession from a trade. 
If I devise an instrument by which lives can be 
saved, suffering lessened or health restored, it 
should be just as available for a patient in Tokyo 
as for a patient in New Haven; for a patient in 
Egypt as for a patient in Paris. A splendid 
evidence of the altruism of the profession was their 
loud protest when Behring patented a remedy, 
which ought to have been free to every poor con- 
sumptive at the lowest possible cost. Had Behring 
been a Fellow of the College of Physicians of Phil- 
adelphia he would have been expelled from our 
Fellowship for daring to restrict the use and the 
usefulness of such a remedy—or, rather, he woidd 
not have dared to do it. The more valuable the 
remedy and, therefore, the greater the demand for 
it, and the larger the gain from its being patented, 
the more positively does the profession utter its pro- 
test against any such selfish gain at the expense of 
humanity. 
If the public, therefore, provides such medical 
schools and such medical men as I have been de- 
scribing, the benefit of one is the benefit of all. 
The discovery of one may be the cure of millions. 
The medical situation in America is wholly dif- 
ferent from that in Europe. Here wre are depen- 
dent not upon the Government, but upon private 
generosity. Let me tell you in a few words wrhat 
is done in Germany and France for medical educa- 
tion. In 1896 the Universities of France were 
reorganized and now the State pays the salaries of 
all the professors and also makes appropriations MEDICAL SCHOOL AND THE PUBLIC 
41 
for other expenses. Through the kindness of Dr. 
W. T. Harris, the late Commissioner of Education, 
who has done so much for the cause of education 
in this country, I am enabled to give you the French 
statistics for the year 1898, the latest year for which 
they are available. The appended table shows that 
in the seven Universities of Paris, Bordeaux, Lille, 
Lyons, Montpellier, Nancy and Algiers, while the 
Universities derived from their own resources an in- 
come of 528,469 francs, that is, a little over 
$100,000, the State appropriated in that same year 
2,628,290 francs, or nearly $526,000, i. e., more 
than five times as much as the income from fees 
and other funds. 
UNIVERSITIES OF FRANCE 
From Funds be- 
State longing to the 
Appropriation. Universities. 
Paris Frs. 1,099,170 Frs. 260,593 
Bordeaux 330,900 52,216 
Lille 262,450 35,900 
Lyon 384,850 60,765 
Montpellier 251,200 62,797 
Nancy 232,550 31,562 
Algiers 167,175 24,636 
Frs. 2,628,295 Frs. 528,469 
$525,659 $101,694 
Faculties of Medicine, 1898 * 
So, too, I have taken from Prof. Lexis’s (of Got- 
tingen) Report on Public Education in the Ger- 
man Empire, prepared for the Louisiana Purchase 
Exposition in St. Louis in 1904, the statistics as to 
the income of the 21 Universities in Germany. 
* Compiled from Statistiques de l’Enseignement Superieur, 
1900. 42 
SELECTED PAPERS AND ADDRESSES 
These are with one exception (Freiburg, 1902) for 
the year 1903. The sum total of the receipts of 
the Universities from fees and other ordinary 
sources was 9,774,607 marks (or in round numbers a 
little less than $2,500,000), whereas the state gave 
to them 19,032,869 marks (or in round numbers 
$4,750,000, almost twice their private revenues. 
In the University of Berlin alone, the receipts were 
503,000 marks ($124,750), while the state allow- 
ance was 2,904,700 marks ($725,950). In only 
four of the Universities (Gottingen, Greifswald, 
Munster and Jena) were the receipts from the State 
less than the receipts from the University from its 
own resources, and it is noteworthy that the only 
one of these four in which the resources of the Uni- 
versity materially exceeded the allowance from the 
State was the University of Munster, which was 
only founded in 1902. 
GERMAN UNIVERSITIES 
Name. 
Founded 
State Allowance 
Other Receipts 
Berlin, 
1809 
M.2,904,700 
M.503,000 
Bonn, 
1818 
1,157,000 
286,000 
Breslau, 
1702-1811 
1,300,000 
407,000 
Gottingen, 
1787 
635,000 
774,200 
Greifswald, 
1456 
494,000 
547,000 
Halle, 
1694 
1,141,000 
720,300 
Kiel, 
1665 
944,000 
277,000 
Konigsburg, 
1544 
1,043,000 
197,000 
Marburg, 
1527 
787,000 
231,000 
Munster, 
1786-1902 
370,500 
1,166,000 
Munich, 
1472-1826 
1,002,216 
371,516 
Wurzburg, 
1402-1582 
598,600 
422,000 
Erlangen, 
1743 
912,700 
313,200 
Leipzig, 
1409 
2,008,200 
1,361,500 
Tubingen, 
1477 
1,395,000 
257,000 
Heidelberg, 
1386 
911,500 
653,500 
Freiburg, 
1457 
713,000 
101,666 
Giessen, 
1607 
832,100 
334,300 
Jena, 
1558 
414,603 
561,025 MEDICAL SCHOOL AND THE PUBLIC 
43 
Name. 
Founded 
State Allowance 
Other Receipts 
Rostock, 
1419 
458,000 
284,000 
Strasburg, 
1567-1872 
1,010,750 
106,400 
M.19,032,869 
M.9,774,607 
$4,758,217 
$2,443,652 
Professor Bardeen in his address entitled “Anat- 
omy in America” 4 gives a table based upon the 
reports of the Commissioner of Education, in which 
he contrasts the condition of the Universities, col- 
leges, professional and technical schools in the 
United States in the sessions 1875-6 and 1901-2. 
I have extracted only the figures relating to medi- 
cine. This table shows certain facts which empha- 
size what I have before stated as to individual in- 
struction. The number of students in 1875-6 had 
increased by 1901-2 practically three-fold, but the 
number of instructors had increased five-fold. 
The number of students per instructor in 1875-76 
was 8.75; the number of students per instructor in 
1901-2 was 5.33, and I have no doubt that if in this 
were included the large number of hospital instruct- 
ors as well as those in the medical schools, it would 
mean that there was an instructor for at least every 
four, and possibly every three students. Mean- 
time, however, the total income from all sources had 
increased less than four-fold. 
TABLE OF THE COMPARATIVE STATUS OF MEDICAL 
INSTITUTIONS IN 1875-6 AND 1901-2 (BARDEEN) 
No. Institutions Year. 
80 1875-6 
154 1901-2 
Amount of Productive Year 
Funds 
$ 220,266 1875-6 
2,132,568 1901-2 
4 Bulletin of the University of Wisconsin, No. 5, Science 
Series III, No. 4, September, 1905. 44 
SELECTED PAPERS AND ADDRESSES 
TABLE OF THE COMPARATIVE STATUS OF MEDICAL 
INSTITUTIONS IN 1875-6 AND 1901-2 (BARDEEN) 
No. Instructors Year 
981 1875-6 
5,029 1901-2 
No. Students 
8,580 1875-6 
26,821 1901-2 
No. Books in Library 
62,970 1875-6 
156,929 1901-2 
Est. Value, grounds, build- 
ings, apparatus 
$ 3,154,350 1875-6 
Year 
12,986,642 1901-2 
Income from Productive 
Funds 
$15,771 1875-6 
1901-2 
Income from Tuition and 
Fees 
$364,552 1875-6 
1901-2 
Total Income 
$ 380,323 1875-6 
1,356,600 1901-2 
In an address in 1900 before the American Med- 
ical Association I contrasted the position of the- 
ology, which is almost wholly a literary study, 
requiring no laboratories and no large corps of 
assistants, and, therefore, conducted at a minimum 
cost, with that of medicine with its manifold require- 
ments. In 1898 (United States Education Re- 
port), “each theological student had the income 
of an endowment of $2,250 provided for his aid: 
each medical student the income from $83.” 5 I 
contrasted these two, not with a view of disparaging 
in the least what has been done for the theological 
schools, but simply to show that a study which needs 
a relatively inexpensive plant has been enormously 
better endowed than a study which requires a plant 
of very large and ever-growing cost. 
That the American public are at last awakening 
to this need of endowment of medical schools is 
shown by recent gifts. In answer to letters of in- 
quiry, I find that since January 1, 1900, there have 
5 “The Endowment of Medical Colleges/’ Keen (Addresses 
and Other Papers, p. 304). MEDICAL SCHOOL AND THE PUBLIC 
45 
been given to 10 medical schools in Philadelphia, 
New York, Chicago, Boston, New Orleans and 
Baltimore over $7,000,000. Part of this has been 
given for the hospitals directly connected with the 
medical schools, but the bulk of it has been for an 
increase in the medical plant and as endowments to 
meet deficits in their receipts. Included in these 
$7,000,000 are the $4,000,000 and over given for 
the noble buildings of the new Harvard Medi- 
cal School and for endowment. 
Besides this even more encouraging instances of 
a broad-minded appreciation of the research and the 
increase of knowledge for the benefit of humanity 
are the establishment in New York of the Rocke- 
feller Institute for Medical Research with an 
Endowment of $25,000,000 and in Chicago the 
Memorial Institute for Infectious Diseases with 
an endowment of more than $2,000,000. If such 
gifts for education and research continue to pour 
in, as they ought to do, then America will make 
noble contributions to knowledge for the mitigation 
of the ravages of disease. 
But you will say, Why should public-spirited, 
patriotic citizens give money to endow medical 
schools? There are several very good reasons: 
(1) Let me appeal to the self-love of the commu- 
nity. When you are sick is the best doctor any too 
good for you and for those dear to you? If, then, 
you want the very best educated, most skilful doc- 
tors, by whose services you and your families may 
be either kept in health or restored to health, you 
must give liberally for such a school as this very 
one at Yale. 46 
SELECTED PAPERS AND ADDRESSES 
(2) May I appeal to a better and higher motive, 
to that altruism which is peculiarly characteristic of 
a Christian nation? The wrongs and sufferings of 
the slaves did not directly affect your fathers—the 
men of my generation—yet a million of lives were 
willingly laid down by this nation that the bond- 
men might go free. And shall not the bondmen 
of disease also be liberated, not by your laying 
down your lives, but by your laying down your 
dollars ? 
(3) And, again selfishly, the money should be 
given for the increase and diffusion of knowledge 
not only for our own generation, but for genera- 
tions to come. It should be given not only for 
present needs, but for those higher investigations 
which will make the doctors of your children and 
your children’s children far better than the doctors 
of today,—present sacrifice for the good of the un- 
born, upon which Benjamin Kidd has laid such 
noble stress. 
(4) The last reason appeals to selfishness as did 
the first, and yet, one may say in a most unselfish 
way. I plead for a Yale endowment for the satis- 
faction it will give to the donor. The man who 
has not given away just a little more than he felt 
he could afford to give has lost one of the sweets 
of life. I am sure that no gift will be looked back 
upon at the end of one’s life with more gratification 
than that to a good medical school, even more than 
to a hospital. “The medical school which trained a 
Lister, a Pasteur, or a Koch has done more for 
humanity than all the hospitals of this community 
combined.” MEDICAL SCHOOL AND THE PUBLIC 
47 
You may challenge this assertion. You may say 
that the wonderful century, as Wallace has well 
termed the 19th, has done practically everything 
and there are no worlds left to conquer. Viewed 
from the commercial standpoint, will such gifts 
pay by what they will accomplish? Let me assure 
you, never before have there been such well-founded 
reasons for unbounded confidence in the future of 
medicine. Never have such resources been at our 
disposal; resources from physics, as in the X-rays, 
and very possibly future, similar, yet even more 
remarkable discoveries; resources in chemistry, as 
shown by the remarkable work of your own Chit- 
tenden, whose name is known from the rising to 
the setting sun. Never before have there been so 
many means at our disposal for clinical examina- 
tion as well as for laboratory investigation. 
Perhaps it will be of some interest to you to look 
at a few of the victories of modern medicine. 
First of all was the extraordinarily useful victory 
over small-pox by Jenner in 1796. This was en- 
tirely the result of clinical observation. Even after 
110 years the very germ which probably causes it 
is not yet ascertained. This is left for the labora- 
tory, and it may be for some of you, young gentle- 
men. 
Look at the magnificent victory over yellow 
fever; a victory, mark you, achieved almost wholly 
by laboratory research and without any patients till 
the clinical test of laboratory results had to be 
made. Here again the doctor said “come” and not 
“go.” But it cost us the brave life of a Lazear who 
died that so many other thousands upon thousands 48 
SELECTED PAPERS AND ADDRESSES 
might live. For 170 years Cuba had been enthralled 
summer and winter by this dreadful plague until 
Leonard Wood, Colonel Gorgas and the three im- 
mortal names of the Commission, Reed, Lazear and 
Carroll, struck off the fetters and ever since we have 
had a free and healthy Cuba. See what Gorgas is 
doing on the Isthmus of Panama in vanquishing 
yellow fever and malaria, both of them mosquito- 
born diseases—not a single case of yellow fever since 
last December,0 and malarial mortality no greater 
than that of pneumonia. His splendidly success- 
ful work is going to make possible the building of 
the canal, the greatest engineering triumph of the 
20th century—an impossibility without his work. 
Look at the victory over diphtheria. As your 
own Welch has eloquently set forth, this again is a 
victory of the laboratory,—with test tubes and 
animals, instead of your children and mine. See 
how it has been confirmed by later clinical observa- 
tion. In the Trousseau Hospital in Paris before 
the use of the serum, the mortality of diphtheria 
was 60 per cent. After the introduction of the 
serum, it fell to less than 15 per cent. In Geneva 
the death rate fell from 35.7 per cent, to 9 per cent., 
and in the table of Bayeux of over 200,000 cases 
from all parts of the world, the average mortality 
was 16 per cent, as contrasted with a former mor- 
tality of 35 per cent.; in other words, a reduction of 
more than 50 per cent. In Chicago the decrease 
in the mortality was 63 per cent. Would not the 
endowment of a laboratory which would give such 
6 Not a single case of yellow fever lias originated on the 
Isthmus for 16 years! (1922) MEDICAL SCHOOL AND THE PUBLIC 
49 
results as these pay a dividend on the investment 
greater than any Western Anaconda or any Eas- 
tern Golconda? 
Look at the work in tuberculosis, another in- 
stance in which the laboratory has furnished the 
means by which we have learned how to cope with 
the disease. In 1882, less than a quarter of a cen- 
tury ago, Koch discovered the bacillus of tubercu- 
losis and studied its life history. From that great 
discovery and the knowledge that tuberculosis is 
a distinctly contagious disease and that the bacillus 
does not thrive in the fresh air and the sunlight, 
has arisen the magnificently successful crusade 
against the great white plague, which has saved so 
many lives and which in the future bids fair almost 
to exterminate this hectic pestilence. 
The laboratory studies of Pasteur on fermenta- 
tion led Lister in the late 60’s and early 70’s to ex- 
periment in the laboratory with test tubes and hay 
infusion, and convinced him that putrefaction was 
caused by germs. He had not seen them with 
mortal eye, but with the clearer and surer vision of 
the imagination, and then he taught us how to van- 
quish even an unseen foe. I need not recount to 
you the triumphs of Antisepsis: with those of 
Anesthesia they are known of all men. The aboli- 
tion of pain, the shortening of illness, impossible 
operations made possible, the saving of untold mil- 
lions of lives as a containing result. 
This brief sketch of what has been done, chiefly 
within the last thirty years, in only five diseases, is 
the promise of great improvement in time to come. 
Already we see the glimmer of a new dawn. He 50 
SELECTED PAPERS AND ADDRESSES 
who will discover, as it surely will be discovered, the 
cause of cancer, will deserve a monument nobler 
than that of any hero of the battle-field. In time 
we shall discover the cause and be able to compass 
the cure, or still better, the prevention of measles, 
whooping-cough, scarlet fever, chicken-pox, 
mumps, which are so grimly and absurdly called 
the “usual diseases of childhood,” as if any diseases 
ever should be “usual” and more especially ever be 
allowed to ravage our homes and destroy our 
innocent children. 
Do not such achievements as I have described, 
and such others as I have prophesied, and still 
others as yet undreamed of, justify a splendid 
endowment for the medical department of this Uni- 
versity, so that upon its shining career shall be shed 
new luster, and the Sons of Eli be prouder of it 
than ever because of its achievements in the service 
of humanity.7 
7 Those desiring to read further upon this subject are 
referred to the following papers: 
(1) Welch: “Some of the Advantages of the Union of 
Medical School and University/’ New Englander and Yale 
Review, September, 1888. 
(2) Welch: “The Relation of Yale to Medicine,” Yale 
Medical Journal, November, 1901. 
(3) Welch: “Higher Medical Education and the Need for 
Its Endowment,” Medical News, July 21, 1894. 
(4) Barker: “Medicine and the Universities,” American 
Medicine, July 26, 1902, and the University Record 
(Chicago medical number), July, 1902. 
(5) Lexis: “A General View of the History and Organiza- 
tion of Public Education in the German Empire,” 1904. 
(6) Bardeen: “Anatomy in America,” Bulletin of the Uni- 
versity of Wisconsin, No. 115, Science Series, Vol. Ill, No. 4. MEDICAL SCHOOL AND THE PUBLIC 
51 
(7) Keen: “Addresses and Other Papers,” especially “The 
Debt of the Public to the Medical Profession,” “The Endow- 
ment of Medical Colleges,” “The Mission of a Medical Col- 
lege,” and “The Need for Increased Endowments for Medical 
Instruction.” THE SERVICE OF MISSIONS TO 
SCIENCE AND SOCIETY 1 
Fathers and Brethren: Mr. William A. Mun- 
roe, whom you elected your President a year ago 
passed to his reward August 26, 1905. Death, 
which treads with equal step in cottage and palace, 
has robbed us of a noble leader. Those who knew 
him best loved him most. The Union will give fit- 
ting expression to our sorrow, but I cannot refrain 
in these few words from lamenting the great loss 
which the Church and the cause of Missions have 
suffered in his death. 
Upon me, therefore, devolves the duty of ad- 
dressing you at the opening of this, the ninety- 
second session of the American Baptist Missionary 
Union. I have chosen as my theme “The Service 
of Missions to Science and Society.” I can only 
give a very brief outline of a few of the most im- 
portant services, for the more they are investigated 
the larger do they loom upon our vision. 
Even before the era of modern missions the con- 
nection between missions and science was well rec- 
ognized, for Robert Boyle, the philosopher and 
founder of the Royal Society in 1660, laid it down 
as the special object of that institution to propa- 
1 The Presidential Address delivered before the American 
Baptist Missionary Union, at Dayton, Ohio, May 21, 1906. 
Reprinted by the kind permission of the Society. THE SERVICE OF MISSIONS 
53 
gate Christianity along with and through literature 
and science. He was also the founder of the first 
Protestant society for the propagation of the gos- 
pel. Leibnitz, in planning the Berlin Academy, 
included the same idea in its scope, and thence it 
extended to other similar societies in Halle, Wit- 
tenberg, Vienna and St. Petersburg. 
AN EVOLUTION IN MISSIONS 
The idea in the minds of our first modern mis- 
sionaries was, naturally, that their duty was solely 
to preach the gospel.2 This was, still is, and ever 
must be their chief aim. 
But they were soon compelled by circumstances to 
broaden their ideas of duty. Who could see dense 
ignorance all around him without yearning to teach 
the people so that they might at least read the word 
of God and be able to communicate with each other 
in writing? Naturally it would quickly be per- 
ceived that the more plastic mind of childhood 
would profit most by such teaching. Hence the 
origin of schools, of the printing-press, and of trans- 
lations of the Bible and of other books. Many of 
these people had only a spoken language, and to 
teach reading and writing, the language must be 
reduced to writing, thus requiring skilled philolo- 
gists. 
The ravages of disease, as a result of ignorance, 
filth and superstition, inevitably caused attempts 
to teach the first principles of sanitation often com- 
bined with elementary medical treatment, and 
2 Strange that this narrow view should again be advocated 
in 1922. Well may the heathen protest against it. 54 
SELECTED PAPERS AND ADDRESSES 
hence the medical missionary, the hospital, the 
trained nurse and other agencies to ameliorate the 
physical sufferings and suppress the physical vices 
of the heathen world. In other words, there has 
been an evolution in missions as inevitable as it is 
desirable. 
Moreover, even the most devoted missionary 
must have some recreation, for that “all work and 
no play makes Jack a dull boy” is doubly true 
of one banished from family, home and country. 
What was more natural than to write full descrip- 
tions of the geography of the country, of the 
manners and customs of strange peoples and of the 
curious animal and vegetable forms seen on all 
sides? Thus literary, scientific and sociological 
studies are seen to be a normal and indeed unavoid- 
able outgrowth from missions, especially in their 
later and fuller development—what in commerce 
woidd be called important “by-products.” 
Moreover, the missionaries of today are not 
simply the pious, devoted enthusiasts of the past. 
All missionary societies, our own among them, 
recognize the fact that they must provide men who 
are trained experts as well as earnest Christians, if 
they would reap the largest harvest. Hence our 
training schools to fit them for their work. Hence, 
too, the splendid student volunteer movement 
which will add in the next four years annually a 
thousand trained young men and women from our 
colleges and universities—four full regiments— 
to the ranks of this devoted army of the Church 
militant, destined to be also the Church trium- 
phant. THE SERVICE OF MISSIONS 
55 
You will observe thus that the entire conception 
of foreign missions has changed from the early 
days of Carey and Judson. Then, as has been 
eloquently set forth by Rev. Dr. Sidney L. Gulick, 
the missionary devoted himself to the individual 
pagan, now to the community and its entire wel- 
fare, as well as to that of the individual; then to 
preaching the gospel of righteousness alone, now 
he adds to this the gospel of cleanliness; then he 
was an expert only in the Scriptures, now he makes 
all science, philanthropy, literature and learning, 
in a word, all service to society as well as to religion, 
his efficient aids in winning souls to our Lord Jesus 
Christ. 
“The missionary,” says Dr. Gulick, “is now seen 
to be not merely saving a few individuals from the 
general wreck of the pagan world, but planting a 
new life which will transform that world and bring 
it into the kingdom of God. . . . Christ must be 
made King in our organized life as communities, 
and thus society be saved, even as he has been 
made Saviour of individuals. . . . The newer well- 
balanced sociological conception of foreign mis- 
sions is one which, while it does not forget man’s 
individual nature and value, does emphasize 
strongly the thought that only as society is trans- 
formed with the individual is the individual fully 
saved. 
“Foreign missions in all their activities aim at 
the double purpose of saving both individuals 
and society—the establishment of the kingdom 
THE MANIFOLD SERVICE OF THE MISSIONARY 56 
SELECTED PAPERS AND ADDRESSES 
of God through the production of children of 
God.” 3 
THE DEVELOPMENT OF MEDICAL MISSIONS 
When Benjamin W. Crowninshield objected to 
granting the charter of the American Board of 
Commissioners for Foreign Missions on the ground 
that it “would export religion, whereas there was 
none to spare among ourselves,” he forgot that 
“religion is a commodity of which the more we ex- 
port the more we have remaining.” 4 But he also, 
unconsciously, recognized and recorded the fact 
that in one very proper sense religion is a valuable 
national product and its export an untold blessing 
to entire nations who receive it. 
Naturally, I am especially interested in the won- 
derful development of medical missions, not only 
because it is my chosen profession, but because so 
many of my own students are doing the Master 
such good service in Japan, Korea, China, India, 
Siam, Persia, Syria, Palestine and Egypt. 
Our Lord himself was the first medical mission- 
ary, for he “went about doing good” during all his 
ministry, and most of his miracles were for the heal- 
ing of bodily ailments. 
The medical missionary often finds that his pro- 
fessional services open the door to his Christian 
teaching. Notable instances are the favors ex- 
tended to missionaries and their hospitals by Li 
Hung Chang, and the career of Dr. H. N. Allen, 
3Gulick: “The Modern Conception of Foreign Missions/’ 
The Outlook, No. 4, 1905, p. 563. Vide infra, note 1, p. 86. 
4 Pierson: The Crisis of Missions, p. 191. THE SERVICE OF MISSIONS 
57 
whose services to a wounded Korean prince led to 
the introduction of modern missions into Korea, 
and to Dr. Allen’s being appointed American min- 
ister by two Presidents. 
Dr. Peter Parker, the first medical missionary 
of the American Board,a “had great difficulty in 
securing a building, and when it was ready no 
patients came the first day. On the second, a 
woman courageously trusted herself in the hands 
of the foreigner. Next day half a dozen came, 
encouraged by her success, and soon the street was 
full. So anxious were they to secure his services 
that even women of the better class stayed in the 
street all night, so as to secure an early admission. 
Long lines of sedan-chairs almost choked up the 
narrow lane. Great men with their attendants 
waited their turn to see the foreign doctor. As 
many as a thousand were waiting at once, and 
there was danger that people would be injured by 
the pressure. Sometimes blind people from a far- 
off village clubbed together to charter a boat to 
Canton, and then waited four or five days after 
their arrival till there was a vacancy for new 
patients.” One Chinese transported his blind old 
mother a thousand miles, nearly twice as far as 
from here (Dayton, Ohio), to Philadelphia, in a 
wheelbarrow to consult one of my own students.6 
The medical development of missions, it is inter- 
esting for us to note, is especially British and 
5 Ely Volume: Missions and Science, p. 411 
6 Dennis: Christian Missions and Social Progress, ii, 193. 
(In later references to “Dennis,” this work is meant unless 
bis other work is specified). 58 
SELECTED PAPERS AND ADDRESSES 
American. In 1899 Dr. Dennis7 states that ex- 
clusive of the physicians of the Countess of Duf- 
ferin’s fund, a philanthropic but not strictly a 
missionary agency, there were “338 American, 
288 British and 27 Canadian medical missionaries 
in the various fields, as compared with 20, the total 
number for all the societies of Continental Europe, 
and 7 for Australasia. . . . The admirable ser- 
vices, moreover, rendered by skilled nurses sent out 
from some of the European societies, especially by 
the Kaiserswerth Deaconesses, should be carefully 
noted here as contributing much to the efficiency 
of medical and surgical practise in the hospi- 
tals.” 
These medical missionaries have introduced anes- 
thetics which abolish pain, vaccination which ban- 
ishes smallpox, and the intelligent treatment of 
other epidemics (for example, the plague and chol- 
era which make such awful havoc in the teeming 
centers of oriental life), and antiseptic surgery 
which saves thousands of lives and untold suffer- 
ing. 
But the West as well as the East owes not a little 
to the medical missionary. Perhaps the one most 
useful drug in medicine is quinine, and the world 
owes it to the Jesuit missionaries of South America. 
Before the chemists extracted its active principle it 
was originally administered as the pulverized bark 
of the cinchona tree, and was popularly known as 
“Jesuits’ bark”; while Calabar bean, the Kola nut, 
and Strophanthus, valuable modern remedies, we 
7 Ibid. ii. 402. THE SERVICE OF MISSIONS 
59 
owe to Dr. Nassau, an American missionary in 
Africa. Much of our knowledge of cataract, 
lithotomy, elephantiasis, leprosy, and many other 
tropical diseases, come from medical missionaries, 
since these disorders are either peculiar to the 
tropics or are very prevalent there. 
THE GOSPEL OF CLEANLINESS 
That godliness is profitable for the life that now 
is as well as that which is to come was most evident 
to me in Nellore. Dr. Downie did not need to 
point out to us that this house was that of a 
Christian convert, and that of an unconverted 
native, for one look was enough to distinguish 
them. The former was clean and neat, free from 
accumulation of filth, and showed every evidence of 
thrift and orderly comfort, while the latter was its 
unsanitary counterpart. That today the greatest 
physical need of India and Burma is decent sani- 
tation was most evident when we smelled the de- 
cayed fish diet of the native Burmese, and in India 
saw hundreds of pilgrims drinking the green scum- 
covered water of many a temple tank. We also 
saw hundreds of others standing in the river, waist- 
deep, drinking the foul water of the Ganges at 
Benares, while other hundreds at their elbows were 
washing themselves and their clothing in the river, 
with decaying bodies of animals floating on the 
tide, and a large sewer delivering its filth into the 
same stream less than three hundred feet away. 
Is not the preaching of cleanliness in such a com- 
munity as truly missionary work as preaching the 
gospel? 60 
SELECTED PAPERS AND ADDRESSES 
Dr. Dennis 8 again sums up the results in 1902, 
\vhen there were 379 hospitals and 783 dispen- 
saries ministering to 6,500,000 patients annually in 
Asia, Africa and Oceanica, and 67 medical and 
nurses’ training schools, with 631 pupils. What 
do not these figures represent in lives, in comfort, 
in happiness and hope for this world and often for 
the next! 
Under the influence of missionary societies and 
the Lady Dufferin Association, the attitude of the 
people of India toward the education of women, and 
especially their medical education, is rapidly chang- 
ing. The Lady Dufferin Association in 1898 had 
240 native women students, and the North India 
School of Medicine for Christian Women, in which 
my friend and former student, Dr. Anna M. 
Fullerton, is so active, is doing a similar work. 
CHRISTIANITY A PRACTICAL FORCE 
Christian altruism is a new idea to the heathen 
world. An eye for an eye and a tooth for a tooth, 
neglect and often abandonment of the suffering 
and the unfortunate, is the rule of conduct. Service 
to others for Christ’s sake and because every man, 
being a child of the same Heavenly Father, is a 
brother, is to them a startling anomaly. What a 
deep and lasting impression then must be made 
upon their minds by the 533 orphanages, foundling 
asylums, homes for infants, leper hospitals, schools 
for the blind, the deaf and dumb, opium refuges, 
homes for widows and orphans, and asylums for the 
insane carried on by self-sacrificing and devoted 
8 Centennial Survey of Foreign Missions. THE SERVICE OF MISSIONS 
61 
men and women who give up their time, their labor, 
their talents, and often their health, and even their 
lives in the service of suffering fellow human 
beings! Whatever the people may think of 
Christianity as a system of religion, these beautiful, 
bountiful and unselfish ministries for the sick, the 
suffering and the unfortunate must appeal strongly 
and constantly to their common humanity. Where 
has heathenism a similar altruistic roll of honor? 
Says Giddings.9 “The successive world-empires 
of Persia, Macedonia and Rome prepared the way 
for the Christian conception of universal brother- 
hood. So long as this conception was nothing more 
than an esoteric affirmation that all men are 
brothers, because they are children of one Father, 
it made but little impression upon the social mind; 
but when by the genius of St. Paul it was con- 
verted into an ideal, into the doctrine that all men 
through a spiritual renewing may become brothers, 
the new faith underwent a transformation like that 
which converted the ethnic into the civic conception 
of the state, and Christianity became the most tre- 
mendous power in history. Gradually it has been 
realizing its ideal, until, today, a Christian phil- 
anthropy and a Christian missionary enterprise, 
rapidly outgrowing the esoteric sentimentalism of 
their youth, and devoting themselves to the diffu- 
sion of knowledge, to the improvement of condi- 
tions, and to the upbuilding of character, are unit- 
ing the classes and races of men in a spiritual 
humanity10 
9 Principles of Sociology, p. 360. 
10 Italics my own.—W. W. K. 62 
SELECTED PAPERS AND ADDRESSES 
Well may Sir Charles Aitchison, a former lieu- 
tenant-governor of the Punjab, say: 11 “Apart 
from the strictly Christian aspect of the question, I 
should, from a purely administrative point of view, 
deplore the drying up of Christian liberality to mis- 
sions as a most lamentable check to social and moral 
progress and a serious injury to the best interests 
of the people”; or Sir Charles Warren, governor 
of Natal: “For the preservation of peace between 
the colonists and the natives one missionary is 
worth a battalion of soldiers.” 12 
Besides his strictly evangelistic efforts, the mis- 
sionary will and, indeed, must inculcate the plain 
social virtues, honesty, sobriety, frugality, and in- 
dustry so lauded by Franklin. They are as 
foreign to the heathen world as is the Christian 
altruism, of which I have above spoken. But with- 
out them there can be little social progress. One of 
the greatest services missionaries have rendered has 
been in demonstrating these virtues in their own 
lives and enforcing them upon their converts. It 
is a service to society of simply untold value. 
Listen, for instance, to the testimony of Alfred 
Bussell Wallace, Darwin’s great compeer: 
“The missionaries have much to be proud of in 
this countiy [the Celebes]. They have assisted 
the government in changing a savage into a civi- 
lized community in a wonderfully short space of 
time. Forty years ago the country was a wilder- 
ness, the people naked savages, garnishing their 
rude houses with human heads. Now it is a garden, 
11 Dennis, ii. 407. 
12 Vide infra, note 2, p. 86. THE SERVICE OF MISSIONS 
63 
worthy of its sweet native name of ‘Minahasa.’ 
Good roads and paths traverse it in every direction; 
some of the finest coffee plantations in the world 
surround the villages, interspersed with extensive 
rice-fields, more than sufficient for the support of 
the population. The people are now the most in- 
dustrious, peaceable, and civilized in the whole 
archipelago. They are the best clothed, the best 
housed, the best fed, and the best educated; and 
they have made some progress toward a higher 
social state.” 13 
Or to the testimony of a cold, official Brit- 
ish Blue Book: “Insensibly a higher standard 
of moral conduct is becoming familiar to the 
people.” 14 
Is not this an enviable record of service to his 
fellow men—a record repeated in scores of savage 
communities ? 
Moreover, the Christian missionary is engaged 
in a ceaseless endeavor to uplift the nations from 
the vices which flourish so vigorously on heathen 
soil. Review only a few of these evils and see what 
a gigantic task confronts him. 
Intemperance exists practically in every part of 
the world, but its worst phases are seen by the 
missionary. It neutralizes much of his best ef- 
forts. 
The opium habit exists in a large part of Asia. 
Not only the missionary, but the strong hand of 
VICES COMMON ON HEATHEN SOIL 
13 Wallace: The Malay Archipelago, i. 397. 
14 New York Tribune, July 25, 1886. 64 
SELECTED PAPERS AND ADDRESSES 
the government is enlisted in the warfare against it, 
yet how deadly is its influence and how fearful its 
ravages in spite of both these forces leagued to- 
gether, largely, alas, due to the attitude of 
Christian Great Britain! 
Gambling in its many forms is so universal and 
so difficult to destroy that in our own and other 
civilized lands, its mischiefs, I fear, are today 
upon the increase. The missionaries doing their 
best to eradicate it in heathen lands are not to be 
blamed if they are discouraged, when American 
women clothe themselves from their winnings, and 
pawn their jewels to pay their losses at bridge. 
Are the Chinese who ruin themselves at fan-tan, 
or the Filipino who bets on his game-cock, any 
worse? 
Immorality, polygamy, concubinage, infanticide, 
and divorce are allied gigantic evils which the mis- 
sionary has to contend with on every hand. That 
the same evils exist here is true; but here they 
exist more or less surreptitiously and under pro- 
test, whereas in heathen lands they are open and 
legal. 
family life 
In most heathen lands, while the love of father 
or mother for the children, it may be, is as strong 
as elsewere, yet family life, as we know it, scarcely 
exists in most of heathendom. Quoting in part 
from Marshall’s Principles of Economics,15 Kidd 16 
says: “The religious movement of the sixteenth 
15 Vol. i. 34, 35. 
16 Social Evolution, p. 297. THE SERVICE OF MISSIONS 
65 
century deepened the character of the people, ‘re- 
acted on their habits of life, and gave a tone to 
their industry.’ Family life was intensified, so 
much so, that ‘the family relations of those races 
which have adopted the reformed religion are the 
richest and fullest of earthly feeling; there never 
has been before any material of texture at once so 
strong and so fine with which to build up a noble 
fabric of social life.’ ” 
The object lesson of the daily home life of a 
Christian family in its tender care, especially for 
the feeble and the suffering, its pervading courtesy 
and love, its purity and moral example, can never 
be lost upon a heathen people often practically 
destitute of such ideals. 
No better testimony could be given than that of 
the Japan Gazette?1 which said, as Dr. and Mrs. 
Hepburn were leaving Japan, and with an imperial 
decoration, after thirty-three years of residence 
there: 
“We may rest quite assured that it was the 
daily life of Dr. Hepburn and his fellow workers 
in the early days which moved Japan first to 
tolerate and then to welcome missionaries to these 
shores, and it is to the missionaries that Japan owes 
the greater part of her present advancement. The 
missionary has been Japan’s instructor, an in- 
fluence wholly for enlightenment and good.” 
And the Japan Mail18 said: 
“No single person has done so much to bring 
foreigners and Japanese into close intercourse. 
17 October 19, 1902. 
18 October 18, 1902. 66 
SELECTED PAPERS AND ADDRESSES 
His dictionary was the first book that gave access 
to the language of the country and remains to this 
day the best available interpreter of that language; 
but even more than his dictionary has helped to 
facilitate mutual acquaintance has his life assisted 
to break down the old barriers of racial prejudice 
and distrust.” 
THE DEGRADATION OF WOMEN 
The position of woman in the East and in Africa 
has always excited the sympathy and philanthropic 
labors of the missionary. Practically she is largely 
an article of barter and sale, often a slave, and 
never the one companion of her husband, the one 
mother of his children, his comforter and coun- 
sellor, his good angel. That she is entitled to equal 
property rights, to loyal affection, to an education, 
and, if necessary, that this education should give 
her an honorable support, has never been dreamed 
of. Yet exactly this position in the social fabric 
is what Christian missions claim for her and in 
many ways are securing for her. “If the mission- 
aries had done nothing else for China,” says 
Colonel Denby, for thirteen years American 
minister there, “the amelioration of the condition 
of the women would be glory enough.” 19 
The needle of a missionary’s wife opened the 
zenanas of India to Christian missions.20 
We all know something of the dreadful cruelties 
of child marriage. The medical women of India 
know these far better than any others, and even for 
19Denby: China and Her People, p. 228. 
20 Pierson’s Crisis in Missions, pp. 170-1 and 183. THE SERVICE OF MISSIONS 
67 
very shame’s sake, they cannot depict them in 
plain speech. We know, too, something of the 
former cruelties of Indian suttee and the existing 
dismal state of Hindu widows, many of them mere 
children; but we do not appreciate how dreadful 
are these daily tortures, nor that, according to 
Dubois,21 there are not less than 25,000,000 of these 
poor unfortunates—a number nearly equal to one- 
third of the entire population of the United States! 
(1906) Here are gigantic evils in society which 
the missionary is doing his best to abolish; and, 
thank God, he is making increasing headway. 
SLAVERY AND THE SLAVE TRADE 
In Africa, slavery and the slave trade are partly 
things of the past, due largely to the exertions and 
influence of Livingstone and other missionaries. 
What crimes that cried to heaven for vengeance 
were committed while they lasted, it is impossible to 
describe. Society owes a large debt of gratitude 
to the strong men and women who by their protests 
and appeals finally achieved these results. John 
Howard, William Wilberforce and Elizabeth Fry 
are names hallowed in the annals of English phil- 
anthropy, and justly so. Their counterparts, 
found in many an African mission station, have 
received their reward in blessings from liberated 
slaves and from their Heavenly Father. 
But this work is not yet finished. The “open 
sore of the world” still exists on the Congo. Op- 
pression, cruelty, murder, and nameless outrages 
are still perpetrated there upon the poor blacks 
21 Hindu Manners, Customs, and Ceremonies, ii, 356. 68 
SELECTED PAPERS AND ADDRESSES 
who have no powerful friends at court, no Hebrew 
rabbis, no American ambassadors like Straus, and 
no English premiers like Gladstone, as Russian 
Jews, Armenians and Bulgarians have had. Who 
has stirred the blood of Christendom to protest 
against these outrages? Brave missionaries, who, 
having witnessed them, cry aloud without ceasing. 
Were they to hold their peace, the very stones 
would utter a protest. Misrepresentation, abuse, 
and callous indifference in many high quarters have 
stood in their way, but so sure as there is a just 
God in heaven, so surely will their cry at last be 
heard, and Leopold of Belgium will cease to hoard 
up gold, every piece of which is besmeared with 
the life-blood of some poor African.22 
Cruel and barbarous punishments, human sac- 
rifices and cannibalism have been largely, and in 
many places completely, abandoned as a result of 
missionary efforts, and Christian peace and civili- 
zation have replaced them. Witness Fiji, Sa- 
moa, Hawaii, Africa, and many another mission 
field. 
Charles Darwin,23 certainly an impartial ob- 
server, says: “The success of the Tierra del Fuego 
22 Even as this address was read came the news of a law 
recently enacted on the Congo, by which any person (and 
whom could this mean but the missionaries?) convicted of 
slandering an official (how easy such a conviction by in- 
terested judges!) could be condemned to five years in an 
African jail under the Equator—a sentence equivalent to 
death to a European. Under its provisions one missionary 
had already been arrested, a thousand miles from those who 
could serve as witnesses in his behalf! 
23 Life and Letters, ii. 307. THE SERVICE OF MISSIONS 
69 
Mission is most wonderful, and shames me, as I 
always prophesied utter failure. It is a grand suc- 
cess.” Again in his Voyage of the Beagle, he 
says:24 “The lesson of the missionary is the en- 
chanter’s wand”;25 a sentiment which finds an echo 
from Max Muller, “I know of no nobler life than 
that of a true missionary,” 26 and from the king of 
Siam, who declared, “American missionaries have 
done more to advance the welfare of my country 
and people than any other foreign influence.” 
education: the result of evangelization 
I have already pointed out how inevitable it was 
that education, especially of the young, would soon 
be engrafted upon the early evangelistic efforts of 
the missionaries. 
Ignorance is the handmaid of superstition and 
vice. What Tuskegee and Hampton and Shaw 
University are doing for the black race in our coun- 
try must be done still more in heathen lands if the 
people are to be elevated and civilized. Not only 
must the masses be taught to read and write in 
order that the truths of the Bible and their litera- 
ture may be available, but educated native teachers 
and preachers also must be provided for them. It 
is impossible to send American and other mission- 
aries in sufficient numbers to do all the great work 
needed among the many millions of Asia, Africa 
24 P. 452. 
25 See also Voyage of the Beagle, American Edition, pp. 
437, 439, 441, 448, 452, 454-8, for further testimo- 
nies. 
26 Chips from a German Workshop, iv. 316. 70 
SELECTED PAPERS AND ADDRESSES 
and Oceanica. Native teachers in large numbers 
must be educated. They, more than foreigners, 
can get close to the people and thoroughly under- 
stand them. 
Twenty years ago Pierson 27 stated that in sixty 
years, from a totally illiterate nation 300,000 of 
the inhabitants of Madagascar had learned to 
read. 
Especially is this educational progress necessary 
at present, when the whole East is entering upon 
a new life. China is a giant awakening from a 
long sleep. Within a year her escape from the 
educational thraldom of thirteen centuries has been 
announced by the abolition of the old examina- 
tions of her literati and the institution of examina- 
tions in Western learning in its place. Shall 
Christendom allow such an opportunity to escape? 
The soil has been upturned; shall we neglect to 
sow the seed? Never again will such a door be 
opened to us, and God will surely hold us account- 
able if we neglect this golden opportunity. 
Japan is advancing by leaps and bounds, and if, 
as is within an easy probability, she abandons her 
native tongue and adopts English as her national 
language, Great Britain and America will incur a 
new and almost staggering responsibility. 
The present movement in our own Church for 
a great advance along higher educational lines is 
eminently justified by the needs of the millions of 
the East and of Africa, by the intellectual awaken- 
ing just noted, by the signal success of past efforts, 
27 Crisis in Missions, p. 263. THE SERVICE OF MISSIONS 
71 
and by the fine example of other churches in dis- 
charging this urgent duty. 
At Rangoon I saw the splendid work of the late 
Dr. Cushing, and his colleagues, where now 
there are 800 students eager to learn and later to 
teach. At Beirut I have seen the Syrian Protes- 
tant College doing a superb work in education. In 
medicine alone they will supply educated phy- 
sicians for all the Arabic- and Turkish-speaking 
countries to replace the present barbarous 
medicine from which the people suffer so sadly. 
I have seen Robert College at Constantinople, 
from whose halls have issued the makers of modern 
Bulgaria. We need not three such colleges, but 
three hundred, if we would do the work of the 
Lord as it ought to be done. Oh, that our con- 
secrated wealth could be poured into the coffers of 
God till they should be filled to overflowing! 
It is significant that the emperor of Korea has 
suggested as a name for a Methodist institution of 
higher learning in that benighted land, Pai Chai 
IIak Fong,—“Hall for Rearing Useful Men,” 
—a name after “Poor Richard’s” own heart. 
Moreover, as in our own land, industrial train- 
ing is often as useful as the more intellectual. 
This is given in many places.28 Alexander M. 
Mackay is known on the Victoria Nyanza as the 
“industrial missionary,” who has won his way by 
his carpentering quite as much as by his teaching. 
Every time you see a soldier clad in khaki, it should 
remind you that this fast-brown dye was dis- 
28 See Noble’s Redemption of Africa, ii, 562, and Dennis, 
ii. 152. 72 
SELECTED PAPERS AND ADDRESSES 
covered by Haller of the Basel African Mission, 
who, by his industrial education, as Dennis finely 
expresses it, has changed a “pagan liability” into 
a “Christian asset.” 
In Dennis’ Centennial Survey of Foreign Mis- 
sions there are catalogued 94 missionary univer- 
sities and colleges with 36,000 students, 179 in- 
dustrial training schools with over 9,000 students, 
879 high schools and seminaries with 85,000 pupils 
and nearly 19,000 day schools with almost a mil- 
lion students! Surety James Bryce is right when 
he says, “The gospel and the mission schools are at 
present the most truly civilizing influences which 
work upon the natives, and upon these influ- 
ences, more than on any other agency, does the 
progress of the colored race depend.” 29 
PHILOLOGY LINKED WITH EDUCATION 
Inextricably interwoven with education is the 
science of language. Existing languages in highly 
developed form like Chinese, Japanese, Hindu- 
stani and Arabic had to be learned by the mission- 
aries. That this is no light task we all can well 
believe. Indeed we can almost agree with Milne 
when he epigrammatically describes learning Chi- 
nese as “work for men with bodies of brass, lungs 
of steel, heads of oak, hands of spring steel, e}res 
of eagles, hearts of apostles, memories of angels, 
and lives of Methuselah.” 30 
But bad as is this situation, many missionaries 
29 Impressions of South Africa, p. 393. And yet there are 
some who wish to stop this splendid work. (1922) 
30 Dennis, iii. p. 413. THE SERVICE OF MISSIONS 
73 
are confronted with a far worse one; that is, with 
languages which are only spoken and have no 
written alphabet whatever. Imagine yourself set 
down in France, Germany, or Italy without any 
written language and obliged to devise a written 
alphabet to represent these spoken languages; or 
still wrorse, that you lived among African tribes 
with sounds and gurgles utterly foreign to your ear 
and tongue—how think you would you succeed in 
giving them not only a written language, but a 
literature? Is it any wonder that it took Judson 
twenty-seven years to translate the Bible into 
Burmese? 
Listen to the predicament of Mr. Bichards of 
Mozambique, who writes:31 “These people had 
never heard of ink till we brought it to them. 
There was no history, no book, no dictionary, no 
alphabet, not a single idea as to how thought and 
words could be transferred to paper and from 
paper into the comprehension of one who had never 
heard the words before they were transferred to 
paper. They could not tell what paper was, but 
called it a ‘leaf.’ ” 32 
Yet in the face of these difficulties, apparently 
almost insurmountable, of the 600 spoken lan- 
guages and dialects of Africa, 200 have been re- 
duced to writing. Many of them were on the point 
31 Dennis, iii. 419. 
32 Any one wishing to realize the prodigious difficulty of 
reducing spoken to written speech should read the amusing 
as well as instructive account given by Rev. Henry Richards 
in Pentecost on the Congo, page 6, published by the 
American Baptist Missionary Union, Boston, Mass. 74 
SELECTED PAPERS AND ADDRESSES 
of extinction and have since become extinct. 
They would have been utterly lost to philology had 
it not been for the missionaries. Perhaps half as 
many more languages in other parts of the world, 
that is, 300 languages in all, have been reduced to 
writing and preserved. “No other motive is con- 
ceivable,” says Dr. Cust, the celebrated phi- 
lologist,33 “to induce men of scholarship and indus- 
try to run the risk of disease and death, for the 
purpose of reducing to writing the form of speech 
of downright savages, except for the one purpose 
of religious instruction"34 Is it any wonder, 
then, that he says, “The missionary appears to me 
to be the highest type of human exellence in the 
nineteenth century, and his profession to be the 
noblest?” 35 
The debt of philologists to missionary labors has 
been repeatedly acknowledged by many of the lead- 
ing linguists of all lands. The late Professor 
Whitney of Yale, the distinguished Orientalist, 
says: “I have a strong realization of the value of 
missionary labors to science. The American Ori- 
ental Society has been much dependent on them for 
its usefulness. There would hardly he occasion for 
the society, at all, hut for them” 30 
Few missionary languages, even those most de- 
veloped, had even a dictionary. We owe to mis- 
sionary philologists nearly 150 dictionaries, includ- 
33 Dennis, iii. 422. 
34 Italics my own.—W. W. K. 
35 Pierson: Crisis in Missions, p. 254. 
36Liggins: The Great Value and Success of Foreign Mis- 
sions, pp. 223-4. Italics my own.—W. W. K. THE SERVICE OF MISSIONS 
75 
ing the earliest ones of Ulfilas for the Goths, Cyril 
for the Slavs, our own Eliot for the American 
Indians, Hepburn for the Japanese, Morrison 
and S. Wells Williams for the Chinese, Jaschke 
and Heyde for the Tibetans, Judson and 
Stevens for the Burmese, Brown for the 
Telugus, etc. The oldest inscription in Phoenician 
characters and one of the most important phi- 
lological discoveries of modern times (second only 
perhaps to that of the Rosetta stone and the cele- 
brated Nestorian tablet37 discovered by Bridgman, 
in China), was the finding of the Moabite stone by 
Rev. F. A. Klein, the missionary, in 1868. The 
letters of Rev. W. K. Eddy to the London Times 
first called attention to the superb sarcophagi at 
Sidon, now among the priceless treasures of the 
museum in Constantinople.38 
Up to 1901, the Bible itself has been translated 
into 475 languages, of which 432 translations were 
made in the nineteenth century, an unparalleled 
series of philological achievements. Well may we 
call it, after St. Chrysostom, “The” Book. No 
other can compare with it in number of copies, in 
universality of circulation or in the worth of its 
contents. 
GEOGRAPHY AND NATURAL HISTORY 
That geography owes a large debt to mission- 
aries no American can doubt when he remembers 
the early Jesuit missionaries whose names are so 
37 Ely Volume, p. 172. 
38 Dennis, iii. 4-29. 76 
SELECTED PAPERS AND ADDRESSES 
familiar to us: Pere Marquette, Hennepin, La 
Salle, Le Jeune and others. The great Northwest 
and its lakes and the Mississippi are redolent with 
their memories. The thrilling story of how Ore- 
gon and the whole northwest Pacific coast was 
saved to the United States by the heroic midwinter 
ride of Rev. Marcus Whitman, and his interviews 
with Daniel Webster, then secretary of state, and 
with President Tyler, is well told in the Mission- 
ary Herald39 and the Ely Volume.40 
When starting on one of his journeys, Living- 
stone wrote: “Cannot the love of Christ carry the 
missionary where the slave-trade carries the 
trader? ... I shall open up a path to the interior 
or perish. I have never had the shadow of a shade 
of doubt as to the propriety of my course.” And, 
at a later period, when almost dying for want of 
food, “Took my belt up three holes to relieve hun- 
ger” is the pathetic note in his journal. 
Africa in the nineteenth century is the counter- 
part of America in the sixteenth, and Livingstone 
has been well called the “Columbus of Africa.” 
Numberless have been both the travelers and the 
missionaries who have explored its interior, which, 
when I studied geography, was labeled (eterra in- 
cognita," and the then current maps showed the 
“Mountains of the Moon.” Now these mountains 
are known to be myths, but the sources of the Nile 
have been at last discovered, and the whole conti- 
nent mapped largely by missionaries. Livingstone 
39 1869, pp. 76-80. 
40 Pp. 13-15. THE SERVICE OF MISSIONS 
77 
alone traveled 29,000 miles in its interior and 
added one million square miles, or one-twelfth of 
its area, to the known regions of the globe. Even 
Speke, who discovered the great lakes, Tanganyika 
and Victoria, said: “The missionaries were the 
prime and first promoters of that expedition.” 
The Victoria Falls on the Zambesi, the greatest 
in the world, far exceeding our own Niagara, were 
first seen by Livingstone of all civilized men, and 
Mounts Kilimanjaro and Kenia, worthy rivals of 
Mont Blanc, were first discovered by Krapf and 
Rebman. 
Moreover, wherever missionary geographers 
went, they naturally described the people and the 
flora and fauna of the land, thus making important 
contributions to natural history, to comparative 
anatomy, to the industrial resources of the world, 
and, in one way or another, to nearly every science. 
Thus, to name only a few notable examples, we 
owe to missionaries the introduction in the West of 
sorghum, of African rubber, and of the silkworm,41 
at present of such enormous commercial value. 
The jinrikisha was devised by Jonathan Goble, and 
the strange discovery of that before practically un- 
known animal, the gorilla, was due to a mission- 
ary. 
In 1847 the great comparative anatomist, Rich- 
ard Owen, for the first time gave a scientific de- 
scription of the gorilla. It was based upon a skull 
sent from Africa by Dr. Savage, a mission- 
ary, and Professor Owen named it after him 
41 Ely Volume, p. 14-3. 78 
SELECTED PAPERS AND ADDRESSES 
(Troglodytes, or Gorilla Savagei). A year 
earlier Dr. Leighton Wilson, another missionary,42 
had sent a skull to the Boston Society of Natural 
History, and still later the complete skeleton of a 
gorilla, now in the Academy of Natural Sciences 
of Philadelphia, was obtained from Dr. Nassau. 
Robinson and Smith’s Researches in Palestine, 
Mt. Sinai, and Arabia Petrasa, and Thomson’s 
The Land and the Book are well known to 
every one. They completely revolutionized the 
former ideas of the geography of Palestine; and 
the more modern Palestine explorations both by 
the British and the American societies owe a large 
debt to missionary labors. 
The Princeton Review 43 says: “Our mission- 
aries have rendered more real service to geogra- 
phy than all the geographical societies of the 
world.” 
Mr. G. M. Powell, of the Oriental Topographi- 
cal Corps, in a paper read before the American In- 
stitute, says:44 “Probably no source of knowledge 
in this department has been so vast, varied, and 
prolific as the investigations and contributions of 
missionaries. They have patiently collected and 
truthfully transmitted much exact and valuable 
geographical knowledge, and all without money 
and without price, though it would have cost mil- 
lions to secure it in any other way.” 45 
42 Whitney: Oriental and Linguistic Studies, Second Series, 
p. 101. 
43 Vol. xxxviii. p. 622. 
44 Missionary Herald, 1875, p. 120. 
45 Ely Volume, pp. 3-5. THE SERVICE OF MISSIONS 
79 
The intimate acquaintance of the missionaries 
with the habits, modes of thought of the people, and 
their languages has made them very frequently 
of great value, especially to British and American 
diplomatists, as is frequently noted by Hon. John 
W. Foster, lately American secretary of state, in 
his American Diplomacy in the Orient: 
“The well-known English missionary and Chi- 
nese interpreter, Dr. Robert Morrison, was the 
chief interpreter of the Amherst Embassy in 1816, 
and he acted as the official interpreter and trusted 
adviser of the British Government and the East 
India Company at Canton for twenty-five years. 
During the Opium War, and in the peace negotia- 
tions, Dr. Gutzlaff, the German missionary and 
historian, was in the employ of the British Gov- 
ernment, as interpreter and adviser, and was most 
useful in the negotiations. He was also of service 
to the government of the United States in a similar 
capacity. . . . When Mr. Roberts was sent by the 
American Government to negotiate treaties with 
Siam and other oriental countries, he first went to 
Canton and there engaged the services as interpre- 
ter of Mr. J. R. Morrison, the son of Dr. Mor- 
rison. ... 
“These instances are cited to show what an im- 
portant part the missionaries have borne in the in- 
ternational relations of the Pacific. The instances 
might be multiplied, and a detailed examination of 
these relations will disclose that up to the middle of 
the last century the Christian missionaries were an 
DIPLOMACY 80 
SELECTED PAPERS AND ADDRESSES 
absolute necessity to diplomatic intercourse.” 46. . . 
“Minister Denby, who, from his long official 
residence in China, was the most competent judge, 
in a despatch to the Department of State, said of 
the missionaries, ‘that their influence is beneficial 
to the natives; that the arts and sciences and civil- 
ization are greatly spread by their efforts; that 
many useful Western books are translated by them 
into Chinese; and that they are the leaders in all 
charitable work. ... In the interest, therefore, of 
civilization, missionaries ought not only to be tol- 
erated, but ought to receive protection’;” 47 and 
again, “Believe nobody when he sneers at mission- 
aries. The man is simply not posted on the 
work.” 48 
Dr. Peter Parker and Bev. E. C. Bridgman, 
missionaries in China, were made the Chinese sec- 
retaries of Caleb Cushing’s Embassy in 1844. Dr. 
Parker twice served as charge d'affaires in China. 
He was made full commissioner to negotiate with 
the Chinese Government in 18.56. 
Bev. Dr. S. Wells Williams accompanied Com- 
modore Perry in 1853 on his first visit to Japan as 
his chief interpreter. Hon. William B. Beed, 
our minister to China, later made him secretary of 
legation upon the promotion of Dr. Peter Parker. 
Dr. W. A. P. Martin, a Presbyterian missionary, 
also was one of Mr. Beed’s most zealous assistants. 
Dr. Williams’ Middle Kingdom and his Chinese 
46 American Diplomacy in the Orient, by John W. Foster, 
pp. 110, 111. 
47 Foster, loc. cit. p. 412. 
48 Liggins, p. 27. THE SERVICE OF MISSIONS 
81 
Dictionary are enduring monuments of his linguis- 
tic attainments. For over twenty years he acted 
as secretary and often as charge d’affaires of the 
American legation in China. 
Hon. William B. Heed, our minister to China, 
with whom Dr. Williams had served, says of 
him: “He is the most learned man in his varied 
information I have ever met. . . . He is the most 
habitually religious man I have ever seen.” 49 
To this Minister Reed elsewhere adds: “I went 
to the East with no enthusiasm as to missionary 
enterprise. I came back with the fixed conviction 
that missionaries are the great agents of civiliza- 
tion. I could not have advanced one step in the 
discharge of my duties, could not have read or 
written or understood one word of correspond- 
ence on treaty stipulations, but for the mission- 
aries.” 50 
The diplomatic services of Dr. Judson are 
too well known to be described, and the present 
British ambassador to the United States, Sir Mor- 
timer Durand, has lately given him full credit. 
But time fails me even to sketch in barest out- 
line the manifold services of missionaries to geol- 
ogy, meteorology, anthropology, ethnography, 
folk-lore, numismatics, music, history, and many 
philanthropic agencies for the betterment of man- 
kind. For these I must refer you to the copious 
literature of missions, and especially to the Ely 
Volume on Missions and Science, edited by Rev. 
Thomas Laurie, D.D.; The Great Value and Sue- 
49 Foster, pp. 273-4. 
50 The Envelope Series, April, 1905, p. 21. 82 
SELECTED PAPERS AND ADDRESSES 
cess of Foreign Missions, by Rev. John Liggins; 
Are Foreign Missions Doing any Good? (London, 
1894) ; and to Christian Missions and Social Pro- 
gress, by Rev. Dr. James S. Dennis, and the same 
author’s Centennial Survey of Foreign Missions. 
To give a general idea, however, of the wide 
scope of the missionary contribution to science, I 
asked my friend, Rev. Frank S. Dobbins,51 to go 
over the Royal Society’s catalogue of scientific 
papers, Silliman’s Journal, and other scientific peri- 
odicals, the Journal and Proceedings of the Royal 
Geographical Society and the various Asiatic soci- 
eties, in order to discover with some approach to 
completeness to what an extent the missionaries 
had distinctly contributed to scientific literature as 
such. 
To these statistics are to be added a considerable 
number of papers unavoidably overlooked in such a 
rapid search, and the numerous papers of a scientific 
character in the Missionary Herald, which Carl 
Ritter, “the prince of geographers,” says, “is the 
repository to which the reader must look to find the 
most valuable documents that have ever been sent 
over by any society, and where a rich store of scien- 
tific, historical, and antiquarian details may be 
seen.” 52 
51 Throughout the preparation of this paper I have had the 
hearty and most intelligent assistance of Mr. Dobbins. I 
also wish to acknowledge the valuable cooperation of Miss 
M. E. Emerson, the reference librarian of the Providence 
Public Library, and of Mr. Herbert Putnam, the accom- 
plished librarian of the Library of Congress. 
62 Ely Volume, p. 3. THE SERVICE OF MISSIONS 
83 
Mr. Dobbins has found 520 scientific papers, of 
which 
108 concern geography, 
89 geology, 
56 botany, 
48 philology, 
44 sociology, 
18 numismatology, 
18 comparative religion, 
19 archaeology, 
10 meteorology, 
and the remaining 110 have to deal with almost 
every other branch of science. 
Of 130 separate articles in the first volume of 
the Asiatic Society Journal (North China branch), 
52 are by Protestant missionaries, and out of the 
2,936 pages in the first six volumes of the Journal 
of the American Oriental Society, 1,215, almost 
one half, are by missionaries. 
Morever, when the Council of the Asiatic Soci- 
ety (North China branch) seeks for scientific in- 
formation by circular letters of inquiry on such 
subjects as “Inland Communications in China,” 
“Coins, Measures, and Weights,” “Tenure of 
Land,” “Infanticide,” etc., they always send let- 
ters to the missionaries, and the replies from mis- 
sionaries frequently outweigh both in number and 
importance those received from others. 
The extent to which the labors of the mission- 
aries, both evangelistic, scientific, and sociological, 
have been recognized by officials, scientists and 
travelers, as I have investigated the subject, has 
been a matter of gratification and surprise. I can- 84 
SELECTED PAPERS AND ADDRESSES 
not possibly take the time to quote more than 
a very few of the most important. Even of their 
names, I can mention but a few, but these few are 
of weight since they represent a non-missionary 
constituency who as a rule at least would not be 
prejudiced in favor of missions, including as it 
does (see Bibliography, p. 87) : 
Scientists, like Charles Darwin (1), Alfred 
Russell Wallace (2), Benjamin Silliman(3), 
Louis Agassiz (4), Lewis H. Morgan (5), Prof. 
J. D. Dana (6) ; 
Officers of the Army and Navy, such as General 
Sir Herbert B. Edwards (7), Admiral Wilkes (8), 
Admiral Belknap (9), Captain Younghusband 
(10), Major MacDonald (11), Captain Manning 
(12); 
Travelers, such as Mrs. Isabella Bird Bishop 
(13), Miss Gordon Cumming (14), William E. 
Curtis (15), and Hon. Richard H. Dana (16) ; 
Viceroys of India, such as Lord Northbrook 
(17), Lord Lawrence (18), and Lord Dufferin 
(i9); 
Lieutenant-Governors of various Indian Prov- 
inces, such as Lord Napier and Ettick (20), Sir 
Augustus Thompson (21), Sir William Muir 
(22), Sir Bartle Frere (23), Sir Charles Elliott 
(24), Sir Charles Aitchison (25), Sir Richard 
Temple (26), and Sir William W. Hunter (27), 
two of the greatest of many great Anglo-Indian 
administrators; 
Ambassadors and Ministers in the Diplomatic 
Service, such as George P. Marsh (28), General 
Lew Wallace (29), E. F. Noyes (30), S. G. W. THE SERVICE OF MISSIONS 
85 
Benjamin (31), D. B. Sickles (32), Lord Strat- 
ford de Redcliffe (33), Col. Alfred E. Buck (34), 
Hon. William B. Reed (35), Sir Philip Currie 
(36), Col. Charles Denby (37), John W. Foster 
(38), Sir Ernest Satow (39), Edward H. Con- 
ger (40), Sir Mortimer Durand (41), and James 
B. Angell (42) ; 
Statesmen, such as Lord Palmerston (43), Hon. 
James Bryce (44), the Marquis of Salisbury (45), 
Count Okuma (46), and President McKinley (47) ; 
Philologists, such as Max Muller (48), Robert 
N. Cust (49), and W. D. Whitney (50); 
Explorers, such as Elisha Kent Kane (51), and 
Sir Henry M. Stanley (52) ; 
Writers, such as Robert Louis Stevenson (53), 
Julian Hawthorne (54), Sir Edwin Arnold (55), 
and William T. Stead (56) ; 
And, finally, Representatives of the Nations to 
Whom Missionaries are Sent, such as the Chinese 
Commissioners only lately in New York, who said: 
“We take pleasure this evening in bearing testi- 
mony to the part taken by American Missionaries 
in promoting the progress of the Chinese people. 
They have borne the light of Western civilization 
into every nook and corner of the empire. They 
have rendered inestimable service to China by the 
laborious task of translating into the Chinese lan- 
guage religious and scientific works of the West. 
They help us to bring happiness and comfort to the 
poor and the suffering by the establishment of 
hospitals and schools. The awakening of China, 
which now seems to be at hand, may be traced in 
no small measure to the hand of the missionary. 86 
SELECTED PAPERS AND ADDRESSES 
For this service you will find China not ungrateful” 
(57). 
Such is the stoiy of nearly a century of mission- 
ary effort. Is it not a cheering report of wonderful 
progress? Karen and Telegu, Shan and Indian, 
Chinese and Burman, African and Terra del Fue- 
gian, all are bowing the knee in loving adoration 
of the Lord Christ, and all advancing in civiliza- 
tion, in social progress, in the arts and comforts of 
life, in freedom from disease, in happiness and in 
purity of living. 
May the time soon come when all the nations 
of the earth may join with us in the stately chorus, 
“Hallelujah! Hallelujah! For the Lord God 
Omnipotent Reigneth!” 
NOTES 
Note 1. In his preface to the History of the English 
People, which is undoubtedly the best English history of the 
century, John Richard Green says: “If some of the conven- 
tional figures of military and political history occupy in my 
pages less than the space usually given to them, it is because I 
have had to find a place for figures little heeded in common 
historjr, the figures of the missionary, the poet, the printer, the 
merchant and the philosopher.” 
Note 2. “In 1822 the Chief Justice, Honorable E. 
Fitzgerald, stated that while in ten years the population had 
increased from 4,000 to 16,000 the number of criminal 
cases . . . had fallen from forty to six, and that of the six 
not one was from any of the villages under a missionary or a 
schoolmaster.” (Are Foreign Missions Doing any Good? 
p. 45.) THE SERVICE OF MISSIONS 
87 
1. Darwin: Life and Letters, ii, 307. Voyage of the 
Beagle, 437 to 458. Liggins, the Great Value and 
Success of Foreign Missions, 202. 
2. Wallace, A. R.: Malay Archipelago, 210. 
3. Silliman: Lie;s;ins, 224. Ely Volume, Missions and 
Science, 122. 
4. Agassiz: Liggins, 224. Ely Volume, 122. 
5. Morgan : “Systems of Consanguinity and Affinity of 
the Human Race, Smithsonian Contributions to 
Knowledge,” xvii, pp. 8 and 9. 
6. Dana: Ely Volume, 137. (From Dana’s “Geol- 
ogy-”) 
7. Edwardes: Liggins, 84-87 and 95. 
8. Wilkes: Liggins, 198. 
9. Belknap : The Envelope Series, Vol. viii, No. 1, 
April, 1905, 21. (American Board of Commis- 
sioners for Foreign Missions, Boston.) 
10. Younghusband : The Missionary Question in China, 
in the Heart of the Continent. (From the Chris- 
tian Missionary Intelligencer, August, 1896, 635.) 
11. Macdonald: Soldiering and Surveying in British 
East Africa, 143. 
12. Manning: Church of Scotland Home and Foreign 
Missionary Record, September, 1896, 281. 
13. Bishop : Heathen Claims and Christian Duty. 
(American Board of Commissioners for Foreign 
Missions, Boston, 1900.) 
14. Cumming: Wanderings in China, i, 204. At Home 
in Fiji. 
15. Curtis: The Yankees of the East, ii, 424-5, 429-30, 
435-7. 
16. Dana: Ely Volume, 212, 444. Liggins, 2, 187. 
17. Northbrook: Liggins, 95. 
BIBLIOGRAPHY 88 
SELECTED PAPERS AND ADDRESSES 
18. Sir Richard Temple: Life of Lord Lawrence, 199. 
19. Dufferin: Independent Testimonies Concerning 
Christian Work. (London Church Missionary So- 
ciety.) 
20. Napier and Ettrick : Liggins, 97. From the Home- 
ward Mail, November 27, 1871. 
21. Thompson: Liggins, 96. 
22. Muir: Liggins, 98. From the Mildmay Missionary 
Conference, 1876. 
23. Frere : Liggins, 98. 
24. Elliott: Chamberlain, The Cobra’s Den, 238. 
25. Aitchison: Liggins, 101. 
26. Temples: Oriental Experiences, 155, 159, 161. 
India in 1880, 176. Ely Volume, 463. Liggins, 79, 
99, 100. 
27. Hunter: India of the Queen, xvi, 214, 216-7, 219. 
Liggins, 103-05. 
28. Marsh: Liggins, 209-10. 
29. Wallace, Gen. Lew : The Envelope Series, viii, 
No. 1, April, 1905, 8. Liggins, 210-11. 
30. Noyes: Ely Volume, 379, 424. Liggins, 228. 
31. Benjamin: Liggins, 171. From Persia and the 
Persians. 
32. Sickles: Liggins, 192. From the Foreign Mission- 
ary, May 1886. 
33. DeRedcliffe: Liggins, 207-8. From the Mission- 
ary Herald, January, 1859. 
34. Buck: Edward Abbott, New York Evening Post, 
December 19, 1903. The Envelope Series, Vol. viii, 
No. 1, April, 1905. (American Board of Com- 
missioners for Foreign Missions. Boston, 1900.) 
35. Reed: The Envelope Series, viii, No. 1, April, 1905, 
26. 
36. Currie: The Congregationalist, November 19, 1896, 
in Dennis, ii, 54-5. THE SERVICE OF MISSIONS 
89 
37. Denby: China and Her People, i, 212-235. Lig- 
gins, 27. From the Missionary Review. Foster’s 
American Diplomacy in the Orient, 412. 
38. Foster: American Diplomacy in the Orient, 107-8, 
109-11, 114-15, 386-7, 411-12. Student Volunteer 
Convention, Nashville, March, 1906. 
39. Satow: Dennis, iii, 446. 
40. Conger: A recent address sent to me in a personal 
communication. 
41. Durand: Address before the Student Volunteer 
Convention, Nashville, March 3, 1906. 
42. Angell: Liggins, 61. Address at the Annual Meet- 
ing of the American Board of Commissioners, Oc- 
tober, 1883. 
43. Palmerston : Are Foreign Missions Doing any 
Good? pp. 17-18. 
44. Bryce: Trans-Caucasia and Ararat, new edition, 
467-8. Impressions of South Africa, 1897, pp. 384, 
et seq. 
45. Salisbury: Church Missionary Intelligencer, April, 
1904, 291. 
46. Okuma: Sherer’s Young Japan, 311. 
47. President McKinley: Dennis’s Centennial Survey 
of Christian Missions, 68. 
48. Muller: Chips from a German Workshop, iv, Lec- 
ture on Missions, 238. Vitality of Brahmanism, 
296. 
49. Cust: Liggins, 23, 33-4, 209. From the Languages 
of Africa. 
50. Whitney: Journal of the American Oriental So- 
ciety, vii, p. 9; lvii, p. 16. Ely Volume, 4, 193. 
51. Kane: Arctic Explorations, ii, 121. 
52. Stanley: Atlantic Monthly, October, 1897, 475; 
Darkest Africa, Vol. ii; Independent Testimonies 
Concerning Missionary Work, pp. 3 and 4. (Lon- 90 
SELECTED PAPERS AND ADDRESSES 
don Church Missionary Society.) Pierson, The 
Crisis in Missions, pp. 125-6. 
53. Stevenson: In the South Seas, 89. 
54. Hawthorne: Cosmopolitan, September, 1897, 517. 
55. Arnold: Youth's Companion, September 13, 1900, 
443. 
56. Stead: Africa, Its Partition and Its Future, by 
Stanley and others, New York, 1898, 54-5. 
57. The Outlook, February 10, 1906, 291. 
58. Testimony by other Orientals to the value of Chris- 
tian Missions may be found in Max Muller’s Chips 
from a German Workshop, iv, 285; Liggins, 105 
to 110; Dennis, ii, 60-62, 410-11. 
59. Are Foreign Missions Doing any Good? By the 
author of Foreign Missions and Home Calls, and 
dedicated to the Speaker of the House of Commons, 
London. Elliot Stock, 1894, has many other quota- 
tions from Orientals, Indian administrators and 
others. CHARLES DARWIN AS A MODEL 
STUDENT OF NATURE 1 
Fifty years ago next September—for Com- 
mencement was still held in September in those 
medieval days—my class graduated from Brown 
University. I well remember my own attitude at 
the commencement in 1855, (the first I ever atten- 
ded,) towards the semi-centenarians who had 
graduated in 1805—men whose birth almost reached 
back to the Revolution itself. I considered that 
they were taking up room and using up oxygen 
that belonged to us young fellows, and that they 
ought to hurry up, or rather hurry down, into the 
hospitable graves that were yawning for them. 
Yet Theron Metcalf of this very class of 1805, who 
was born only three years after Yorktown, actu- 
ally had the audacity to live till 1875—two years 
after I had been deemed mature enough to become 
a member of the Corporation and his colleague! 
I have no doubt that the freshmen of to-day look 
upon us of ’59 as almost the contemporaries of the 
ichthyosaurus, but I can assure them that that 
is absolutely a fish story. 
But in truth we must recognize the fact that our 
lives are fast ebbing away and that though the 
1 An after-dinner address on Commencement Day at Brown 
University, June 16, 1909, when the class of 1859 celebrated 
our semi-centenary. Reprinted for the Brown Alumni 
Monthly for July 1909 by the kind permission of the Editor. 92 
SELECTED PAPERS AND ADDRESSES 
average human life is far longer that it was fifty 
years ago, we cannot expect an indefinite prolonga- 
tion of existence. You remember the story told 
by Baron Rothschild—the founder of the house— 
whose physician was called to see him when he fell 
ill at 90 years of age. He assured the doctor that 
he could not survive. “Not a bit of it, Herr 
Baron,” was the cheerful reply, “You’ll live to be 
100.” “No, no,” replied the veteran banker, I 
suspect with a twinkle in his eye, “do 3mu suppose 
that when the Lord can get me at 90 he’s going to 
wait till I go to par?” 
But old as we unquestionably are, we still re- 
member our college days with enthusiasm and have 
eagerly watched the growth of the University in 
numbers and in power. In 1859 the faculty num- 
bered only 10 and the students 225; now they num- 
ber 112 and 993 respectively.2 The courses of 
instruction were few in number compared with the 
wealth of choice now provided. But the very 
meagerness of the number made our instruction 
more individual and, perhaps, more lasting, and 
our memories are still stocked with the facts learned 
in the classrooms of Lincoln and Harkness, 
Gammell and Chace, and their peers. We would 
even be willing, if it be not made too minute, to be 
quizzed offhand on the topography of Athens. I 
hope we would not find ourselves in the position of 
the lady who, after hearing a lecture on the Parthe- 
non, enthusiastically thanked the speaker, adding 
“I am so much obliged to you for settling one ques- 
2 In 1922 they number respectively 90 and 3,149 besides 
the Administrative officers. DARWIN AS A STUDENT OF NATURE 
93 
tion that has long perplexed me—whether the Par- 
thenon was on the Acropolis or the Acropolis on the 
Parthenon.” 
That the Providence girls of 50 years ago were 
the sweetest, best and prettiest mortal man ever 
saw is indisputable—the class of 1909 to the con- 
trary notwithstanding. How well I recall the 
skating parties, the sailing parties, when the pro- 
pitious breezes often becalmed our boat and Cupid 
bestirred our hearts, the combined search for the 
stealthy fragrant arbutus and the brighter-hued 
laurel, and the occasional mildly extravagant drives 
into the surrounding country. On one of these 
I saw a wayside sign—but memory after over a 
half century is often a sad traitor and it may be 
that I only heard of it—with the legend “Coffins 
made and repaired” Whether this was grim 
humor to attract custom or an exaggerated instance 
of New England thrift intended to establish the 
custom of bequeathing so inevitable a final luxury 
along with the family plate and jewels I know 
not. But the bizarre idea long lingered in my 
mind until finally I beheld its realization in the 
museum at Constantinople. A sacrilegious wretch 
named Tabnit had opened an old sarcophagus, had 
incontinently tossed out the remains of his pred- 
ecessor and provided that his own should be re- 
placed in this second-hand coffin. He had not 
even directed the inscription recording the virtues 
of his predecessor to be erased, but his own name 
was inscribed below the first with the added caution, 
“Do not open this sarcophagus as you will find 
nothing valuable in it.” Suspecting, however, 94 
SELECTED PAPERS AND ADDRESSES 
that one who thus besmirched his own bones would 
also lie, later explorers lifted the lid and found 
many jewels and much other pelf. 
That Annus Mirabilis—1859—was remarkable 
for two things. (1) We graduated and (2) the 
“Origin of Species” was published. You may 
smile but I assure you that there is a subtle connec- 
tion between the two events which does not appear 
on the surface. The struggle for existence and 
the survival of the fittest were two doctrines which 
occupy many pages in that memorable book. See 
now the final irrefutable proof of the truth of these 
doctrines after half a century! We have struggled 
to exist and lo! here we are! The fittest have 
survived! Naturally then we are all enthusiastic 
Darwinians. 
But badinage aside, the past half-century has 
seen a wonderful thing. One book, scarcely 
larger than an ordinary novel, has changed the 
mental attitude of the whole race, not only in 
science, but practically in almost every realm of 
human thought. On its appearance it was greeted 
with scorn, vehement invective, fierce criticism and 
even with the thunder of ecclesiastical anathemas. 
Only those who lived, say from 1860 to 1875, can 
ever realize the extent and the violence of the con- 
troversy on the platform, in the pulpit, at the 
dinner-table—everywhere. Yet behold a miracle! 
After fifty years, though there are still a few feeble 
vioces raised from time to time in protest and dis- 
sent, its doctrines are now the common truths of 
practically all thoughtful and intelligent men and 
the semi-centenary of its publication has been made DARWIN AS A STUDENT OF NATURE 
95 
the occasion of scores of celebrations in Europe 
and America—a tribute to the work and genius 
of one man which has no parallel in scientific annals. 
The addresses so far as I have read them have traced 
the influence of Darwin upon various phases of 
human knowledge and human thought, but few, 
if any of them, have pointed to him as a model 
student of nature.3 
I propose, therefore, to ask you to look very 
briefly at this aspect of Darwin’s life and to appre- 
ciate the lessons we may learn from it. 
1. The first feature of his character was his 
infinite pains in collecting and verifying an im- 
mense mass of facts. No one can read the “Ori- 
gin” without being deeply impressed with this. 
Portfolio after portfolio, 30 to 40 he says, of data 
on the many subjects he was investigating were 
his capital in trade—a “huge pile of notes,” as he 
well calls those relating only to the “Transmuta- 
tion of Species.” “I worked,” he says “on true 
Baconian principles and without any theory”—< 
observe these words “without any theory”—“col- 
lected facts on a wholesale scale ... by printed 
enquiries, by conversation . . . and by extensive 
reading. ... I have bought many books and at 
their ends I made an index of the facts that concern 
my work, or, if the book is not my own, Avrote out 
a separate abstract, and of such abstracts I have a 
larger drawer full.” 
He was fortunate in inheriting means suffi- 
3 A strange phenomenon has occurred in the last 2 or 3 
years—a recurrence of this bitter controversy. But like the 
earlier one it will assuredly fail. 96 
SELECTED PAPERS AND ADDRESSES 
cient for his personal and scientific needs, but per 
contra he lost years of his laborious life from ill 
health. His persistent industry in spite of almost 
constant daily suffering for 40 years may well 
amaze us all. 
2. He was never content only to read, to inquire 
or even only to observe, but when possible always 
put everything to the test of experiment. Hence 
the constantly recurring experiments in plants, the 
evidence from breeders of animals, of pigeons, and 
other birds in which the experimental method could 
be used. No scientist should ever accept any new 
statement without thus verifying it by experiment if 
that is possible. In the last half-century the experi- 
mental method has done more to forward science 
and to make it exact than all the speculations since 
the days of Aristotle. 
3. Darwin’s was an “open mind.” While 
always challenging alleged new facts and requir- 
ing the most conclusive evidence of observation 
and experiment before accepting them, yet, even 
though they controverted his previous opinions and 
apparently well-established theories, he was not 
hostile to them because they were new. They must 
win a sure victory over former notions, but he would 
see that they had fair play. 
I do not know any better illustration of this in- 
fluence of scientific study on the minds of savants 
in general than our former and our present no- 
tions as to the constitution of matter. 
The twentieth century has opened most auspi- 
ciously with a great and fundamental discovery— 
that of radio-activity. For the first time also in the DARWIN AS A STUDENT OF NATURE 
97 
history of science a woman—Madame Curie—has 
been foremost in the work. This discovery has 
thrown into confusion our fundamental concepts 
as to matter and the more we know, the more are 
we puzzled. The idea that there may be only one 
primordial substance has recently received a no- 
table impulse in the apparent conversion of ra-' 
dium into helium and by the still later observations 
which seem to show that other substances have been 
transmuted into carbon so that the chemists and 
physicists seem to have discovered at least a frag- 
ment of the Philosopher’s Stone. 
This openness of mind, this willingness to give 
up a cherished theory should be one of the chief 
virtues of scientific men. Of course there are 
always conservatives “dyed in the wool” who reject 
every new idea simply because it is new. But the 
great bulk of savants may be said always to append 
to their statements of facts other than self-evident 
propositions a large interrogation mark, enclosed 
though it be in a bracket. That is to say there is no 
postulate so firmly established but that it may be 
modified or overturned by later discoveries. “By 
doubt they are established,” says Huxley, “and 
open inquiry is their bosom friend.” Honest 
doubts once solved are the foundation-stones of 
robust faith. Experiment then. Take nothing on 
faith, except, of course, in the higher realms of 
thought. Love knows no “instruments of preci- 
sion.” Test everything else by the balance and the 
yard stick! 
4. This openness of mind was especially shown 
by Darwin by his mental attitude towards his own 98 
SELECTED PAPERS AND ADDRESSES 
theories. Most of us are quite content for other fel- 
lows’ ideas to be upset, but few like Darwin wel- 
come criticism of our own ideas or are willing that 
our own intellectual children shall be declared 
other than the smartest and best-looking. “Dar- 
win,” says Huxley, “may be trusted always to 
state the case against himself as strongly as pos- 
sible.” Listen to what he himself says: “Dur- 
ing many years I had followed a golden rule, 
namely, that whenever a published fact, a new 
observation or thought came across me, which was 
opposed to my general results, to make a memo- 
randum of it without fail and at once; for I had 
found by experience that such facts and thoughts 
were far more apt to escape from the memory than 
favorable ones. Owing to this habit very few 
objections were raised against my views which I 
had not at least noticed and attempted to answer.” 
Well may he call this “a golden rule,” too often, 
I fear, more honored in the breach than the observ- 
ance. Well would it be if it were observed not 
only in science but in every other department of 
thought. 
Moreover he not only noted these unfavorable 
observations for his own private consideration and 
reflection, but fearlessly published them. The 
“Origin” is full of such instances. Never have I 
known a man so fair in discussions, a man of so 
limpid and transparent a mind. 
5. Having collected, arranged, and digested his 
facts, then came the brilliant generalizations, the 
statement of great principles. While minutely 
observant, he never limited his vision to the dative DARWIN AS A STUDENT OF NATURE 
99 
case or the enclitic de. He saw not only the trees 
but the great forests. Reflecting upon his mar- 
shaled facts, seeking for the explanation of the 
often bewildering diversity of his observations, he 
was many times baffled, but never dismayed or dis- 
couraged. Who does not share his delight when 
he writes of one problem, “I can remember the very 
spot in the road whilst in my carriage when to my 
joy the solution occurred to me.” Who of us who 
have been teachers—a title beyond all other titles 
—cannot remember how our nerves have been set 
a-tingle to the very finger-tips, when by some happy 
phrase or apt illustration suddenly flashing into our 
minds, we have been able to explain to our pupils, 
or even to ourselves, a difficult problem, or have dis- 
covered a new truth. The joy of the miser at dis- 
covering a hidden treasure of gold shrinks into utter 
insignificance beside such a delight. 
But these generalizations were never formulated 
in haste. Though flashes of deep insight some- 
times came to him early, he waited and waited, 
patiently accumulating more evidence, and con- 
stantly reflecting, till he felt sure of his ground and 
then he published. Even after he believed he had 
really discovered the method by which new species 
were formed, he says, “I was so anxious to avoid 
prejudice that I determined for some time not to 
write even the briefest sketch of it.” The first 
brief sketch of 35 pages was not written till after 
four more busy thoughtful years had passed! The 
“Origin” was not printed till 22 years after his 
first note-book was opened and till he had written 
two condensed sketches and a third bulky work, 100 
SELECTED PAPERS AND ADDRESSES 
of which the “Origin” as published was a condensa- 
tion—and all this laboriously written out by hand. 
The “Descent of Man” was the result of 24 years 
of labor; the “Expression of the Emotions” of 33 
years, and the work on “Earthworms” of more than 
40 years of thought. Were everyone as patient 
and self-restrained, I warrant that yonder John 
Hay Memorial Library would suffice for scores of 
years longer than we now anticipate. 
6. One more trait in Darwin, unhappily not 
common among scientists, was his deliberate de- 
cision not to engage in controversy. Like Gama- 
liel, he believed that “if this work be of men it will 
come to naught, but if it be of God [that is to say of 
the truth,] ye cannot overthrow it.” Time has 
vindicated his wisdom and his work, and his beauti- 
ful character is not besmirched by controversy, and 
the heated and unwise words which controversy 
begets. 
7. One serious warning he gives us. “Up to the 
age of 30 or beyond it, poetry of many kinds, such 
as the works of Milton, Gray, Byron, Wordsworth, 
Coleridge and Shelley, gave me great pleasure and 
even as a schoolboy, I took intense delight in Shake- 
speare.” The same was true of pictures and of 
music. “But now,” he goes on, “for many years, 
I cannot endure to read a line of poetry; I have 
tried lately Shakespeare and found it so intolerably 
dull that to read it nauseated me” and he had almost 
lost his taste for pictures and music. Well may he 
call this a “curious and lamentable loss of the higher 
aesthetic tastes,” and say, “If I had to live my life 
again I would have made it a rule to read some DARWIN AS A STUDENT OF NATURE 
101 
poetry and listen to some music at least once every 
week.” 
Looking back on the brief sketch I have drawn, 
how impressive is the noble character of this scien- 
tific giant. Humbly may we walk in his footsteps 
and copy his splendid example! 
Mr. Bryan and many others, especially the so- 
called “Fundamentalists” confuse Evolution with 
Darwinism. They believe them to be identical. 
On the contrary, Evolution long antedated Dar- 
winism. I cannot state the distinction between 
them better than in the words of Prof. James H. 
Robinson (Science, July 28, 1922, p. 95) as 
follows: 
“Recently a serious misunderstanding has re- 
sulted from the report that men of science are giv- 
ing up ‘Darwinism,’ that ‘Darwinism is dead.’ 
This has puzzled those who supposed that Evo- 
lution was a well substantiated assumption, and has 
filled with a somewhat malicious joy those who 
have always denounced the notion as wicked and 
opposed to Scripture. 
“But to the biologist, Darwinism does not mean 
the theory of man’s animal descent, which was for- 
mulated long before the publication of the ‘Origin 
of Species,’ but is confined to the ingenious theories 
which Darwin so patiently worked out to account 
for the facts of Evolution. The statement that 
Darwinism is dead does not mean that the evidence 
for the evolutionary hypothesis has in any way been 
weakened so that any really competent man of 
science doubts our animal derivation. It only 
means Darwin’s explanations of how one species 102 
SELECTED PAPERS AND ADDRESSES 
may have been derived from another, has proved, as 
a result of increasing knowledge, to be mistaken or 
wholly inadequate.” 
Or again in the words of Prof. H. E. Walter, of 
Brown, “as the analysis of the living world grad- 
ually came to shift from species to individuals it 
was shown that individuals may be regarded as 
simply aggregates of unit characters which may 
combine so variously that it becomes more and 
more difficult to maintain constant barriers of any 
kind between the groups of individuals arbitrarily 
called ‘species.’ ” [1922] “AN IMPOSSIBLE WAR”1 
The Chairman and other Speakers have all very 
naturally and veiy rightly referred to the captivat- 
ing idea that we should celebrate the completion of 
100 years of Peace between Great Britain and 
America. But there is an earlier instance of the 
splendid magnanimity of Great Britain to which no 
one has alluded to-night and to which scant justice 
has been done by any one in the past. In 1876, we 
celebrated 100 years of our national independence 
by an extensive and most successful Universal 
Exposition in which all nations joined. Each 
nation erected a building to house its Commission- 
ers. Among the foremost in the extent and value 
of its exhibits and the importance of its official 
building was Great Britain. Without British aid 
the Exhibition would have been shorn of most of 
its luster. At the close of the Exhibition this 
“British Building” was presented to the City of 
Philadelphia. It still stands in full view from the 
Belmont Drive in Fairmount Park, a mute but 
eloquent witness to the magnanimity of a great 
nation. 
To assist not grudgingly but heartily in making 
1 Address at the Banquet to the Foreign Delegates (British 
and Belgian) to Arrange for the Celebration of the 100th An- 
niversary of Peace between Great Britain and America in 
1914-1915, at Philadelphia, May 13th, 1913. 104 
SELECTED PAPERS AND ADDRESSES 
such a celebration by another nation a great suc- 
cess is an incident unique in history. 
Recall the startling facts: We were celebrating 
a war which began at Bunker Hill and was ended 
by the surrender of Cornwallis at Yorktown; we 
were the victors and the British were the van- 
quished; at the end of a century they joined with 
us in celebrating our victory and their defeat. I 
challenge you to find a parallel event in the world’s 
international relations. 
A war with a nation so magnanimous as to 
celebrate in 1876 their own defeat and to treat us 
not as foreigners, but as trans-Atlantic brethren 
ought to be and is “An Impossible War.” 
Think, gentlemen of the British Delegation, of 
the great gifts you have bestowed upon us!— 
Chaucer and Bacon, Shakespeare and Milton, 
Hampden and Burke, Jenner and Lister! How 
many memories cluster around each name! Re- 
call too what we in turn have given to you—Wash- 
ington and Lincoln; Longfellow and Emerson, 
Hemy C. Lea and Horace Howard Furness; and 
the blessed sleep of Ether! 
It is not unbecoming in me on this occasion to 
vaunt my own profession. The three boons, vacci- 
nation, anesthesia, and antisepsis—an ever blessed 
Trinity of Benedictions, and all three, thank God! 
sprung from Anglo-Saxon loins—have already 
done more to mitigate suffering, prolong life and 
promote human happiness than all the warriors, 
from Genghis Khan to Napoleon, have done to 
produce suffering, destroy human life and make 
the earth a desert. “AN IMPOSSIBLE WAR” 
105 
Your Civil Liberty and orderly processes of 
Law, gentlemen, have found a congenial soil in 
America, and we have even bettered your Religious 
Liberty by totally severing all relations between 
Church and State. 
I repeat then my assertion that a war between 
two such kindred nations is impossible—unthink- 
able. It would be a crime against Humanity! 
I have spoken of the actions of Great Britain in 
1876 as an unparallelled instance of magnanimity. 
But it is to remain without a fellow for only a few 
weeks. 
Six weeks from now on the field of Gettysburg, 
hallowed by the blood of heroes and by Lincoln’s 
immortal address, the soldiers of the Blue and the 
Gray—all who after 50 years are still living and 
still active—will meet again. There, on the very 
spot where they did their utmost to slay each other 
a half century ago, with clasped hands will they 
bow their heads over the graves of their brave com- 
rades and breathe a prayer of thanksgiving for 
Peace! Show me if you can another such meeting 
on any other battlefield ! 
But, while there never has been such an one be- 
fore, permit me to express the fervent hope that 
there may be yet another. 
A few days ago, as President of the American 
Philosophical Society, I signed a remarkable ad- 
dress. Its signers consist of the Presidents of 
fifty-five Scientific, Educational, and Philanthropic 
Institutions in the United States. The address 
is beautifully engrossed on vellum and is to be 
presented to the German Emperor on June 15th, 106 
SELECTED PAPERS AND ADDRESSES 
1913. It extends to His Imperial Majesty our 
collective congratulations upon the fact that on that 
day he completes a reign of 25 years and especially 
that it has been a reign of unbroken Peace. 
I cast a forward glance and in the near future 
—only eight years away—I see the year 1921 
exactly half a century after 1871! What a 
glorious augury it would be for the Peace of the 
world—for the Golden Age that is sometime sure 
to come!—if France and Germany could then again 
meet on the field of Sedan, not in armed conflict, 
but to celebrate a Liberte, Egalite, et Fraternite 
which should never again disappear from the 
earth.2 
Then would we be able to sing not “Peace hath 
her Victories no less renowned than those of War,” 
but “Peace hath her Victories far more renowned 
than those of War!” 
Since the above was written the Great War has 
ratified and emphasized the sentiments I here ex- 
pressed. The great hope of the world lies in the 
amity, cooperation and solidarity of all the English 
speaking peoples. 
Those who would make trouble between us I re- 
gard as enemies of the Human Race. Especially 
those, who, in responsible public office, in Congress 
and elsewhere endeavor to divide us into hostile 
camps.—[October, 1922.] 
2 What a comment on this hope is the fact recently disclosed 
by the chief of staff of the Austrian army, that he and Von 
Moltke chief of staff of the German army planned in 1909 
that the next war should be launched by Austria in 1914! THE EARLY YEARS OF BROWN 
UNIVERSITY 
1764-1770 1 
Infancy always appeals to us. The confiding 
helplessness of a young life arouses our chivalry. 
The many and constant perils besetting especially 
its early years excite our sympathy. The splendid 
possibilities enwrapped in it kindle our imagination. 
If we live long enough to see its weakness change 
to strength; its abilities develop; its character un- 
fold, and its influence grow so that it becomes a 
power in the land, well may we rejoice over the 
strong man that he is, and review with absorbing 
interest the early days of the child that he was. 
1Address delivered in the Baptist Church at Warren, Oc- 
tober 13, 1914, as a part of the celebration of the Sesqui- 
Centenary of Brown University. Reprinted by the kind per- 
mission of the University. 
Rhode Island College was incorporated in 1764, and 
located at Warren. The Baptist Church in Warren, of which 
James Manning, the first President of the college, was also 
minister, was founded at the same time. The College was 
removed to Providence in 1770. In 1804 the name was 
changed to Brown University. 
In my references I have often quoted Mr. Guild’s volumes 
because they are widely accessible, instead of the University 
archives, which can only be consulted in Providence. Mr. 
Guild’s Brown University and Manning must not be con-* 
founded with his Manning and Brown University. 108 
SELECTED PAPERS AND ADDRESSES 
This is my pleasant task to-day—to recount the 
history of the first six years in the life of Brown 
University.2a 
It is peculiarly congenial to me, for in 1762 the 
“first mover” in the enterprise, as he rightly calls 
himself, was Morgan Edwards, the pastor of my 
own church, the First Baptist Church of Philadel- 
phia. The first student of the University, William 
Rogers, became pastor of my own church, and 
married my grandparents in 1788. In 1790 
Thomas Ustick, of the third class (1771), while our 
pastor, baptized my grandfather. Henry Hol- 
combe, of the class of 1800 (hon.), while pastor of 
our church, married my parents in 1823. Wil- 
liam T. Brantly, of the class of 1831 (hon.), 
another pastor of our church, baptized my parents 
in that same year. George Dana Boardman, of 
the class of 1852, and George Hooper Ferris, of 
the class of 1891, have been my pastors and warm 
personal friends. 
In Brown University I obtained my own educa- 
tion and inspiration, for which I owe a debt of 
gratitude that I can never repay. Up College 
Hill fifty-five years ago proudly marched my class- 
mates and I singing our “Song of Degrees.” 
Forty-one years ago I was honored by an election 
2a When I was preparing this address Professor Bronson’s 
History of Brown University had not been published, but by 
his kindness I saw and profited greatly by the manuscript of 
the early part relating to the history of the University while 
in Warren. Since the celebration I have, had the great 
pleasure of reading the entire book since published, and have 
added a few footnotes referring to his text. EARLY YEARS OF BROWN UNIVERSITY 
109 
to the Corporation of the University. Since then 
I have taken part in the election of one hundred 
members of the Corporation, including all (forty- 
six) of the present members of the Corporation, 
excepting myself and one other, and fifty-four 
others who have all passed away save one4 who re- 
signed. I have known all its presidents save the 
first three. Is it any wonder that I feel so deeply 
an hereditary and personal interest in this an- 
cient University? 
In view of the fact that Professor Bronson’s 
new History of the University deals at length with 
the Charter, the removal to Providence, and other 
questions which aroused much controversy in their 
day, and as our distinguished alumnus, Mr. Justice 
Hughes, is to give the principal Historical Address, 
I shall only make allusions to these other well- 
known historical events. My chief endeavor will 
be to set forth the local conditions, manners, and 
customs existing in Warren and Providence from 
the beginning of the University, including 1770 
the date of the second commencement. I include 
this second commencement, although it was held in 
Providence, because practically all the work of that 
class was done in Warren. 
I must disarm criticism, and especially from a 
Warren audience, by disclaiming in advance any 
desire to expose and emphasize the faults and 
foibles of our predecessors. But conditions one 
hundred and fifty years ago were very different 
from those of to-day, and they are a necessary 
frame for the picture. I have drawn a similar 
picture in the Bicentenary History of my own 110 
SELECTED PAPERS AND ADDRESSES 
Philadelphia church 2b without offense, and I feel 
sure that here, too, I shall find the same friendly 
forbearance. The failings which I mention were 
the faults of the times. The individuals were only 
a few examples out of many. I have ventured to 
introduce an occasional touch of humor to lighten 
what would otherwise be a dull recital of mere 
historical facts. 
The nascent years of the University were filled with 
the increasing mutterings of political discontent 
which soon found expression in the Revolutionary 
War, and each recurring semi-centenaiy, strange 
to say, has been similarly marked by war. Our 
first, in 1814, occurred before the end of the War 
of 1812; in 1864, our full century arrived during 
the bloody crisis of the Civil War. In both these 
emergencies Brown loyally bore its part. In 1914, 
at our third half-century, peace in Mexico is still 
trembling in the balance, and war has “raised 
its horrid front” in Europe in more terrible form 
than ever before in history. Thank God that the 
healing wounds of my own guild are for the saving 
of human lives and not for their destruction. 
Chronologically Brown ranks the seventh of the 
nine colleges established prior to the Revolution, 
viz.: 
1. Harvard University 1636 Congregational 
2. College of William and Mary 1692 Episcopalian 
2b Vide, e. g., Letters of John Gano and Others, pp. 34, 58, 
62, 66; Manners and Customs, pp. 149, 180, in the Bicente- 
nary History of the First Baptist Church of Philadelphia, 
1898, edited by W. W. Keen. EARLY YEARS OF BROWN UNIVERSITY 
111 
3. Yale University 1701 Congregational 
4. University of Pennsylvania 1740 Episcopalian 
5. Princeton University 1746 Presbyterian 
G. Columbia University 1754 Episcopalian 
7. Brown University 1764 Chiefly Baptist 
8. Rutgers College 1766 Dutch Reformed 
9. Dartmouth College 1769 3 Episcopalian 
Morgan Edwards, pastor of the First Baptist 
Church of Philadelphia, the “first mover” in the 
matter, was born in Wales in 1722. He was “bred 
a Churchman,” but became a Baptist in 1738. He 
reached Philadelphia May 23, 1761.4 He was one 
of those men whose arrival anywhere meant that 
the “wheels began to go round,” and things began 
to be done. In our own church he started the 
“Minute Book” in his copperplate handwriting; 
and also our “Marriage Book,” which contains 
a complete record of all the marriages by our minis- 
ters for one hundred and fifty-three years.5 He 
was very influential in the Philadelphia Baptist 
Association and other church activities. When 
moderator of the Association he was not only the 
first to propose, in 1762, the founding of a college, 
but later was active in obtaining the charter; pro- 
cured more funds for the college when it sorely 
needed them than any one else; served on the orig- 
inal Board of Fellows for twenty-five years; and 
preached at the first commencement (1769). He 
3 The Seal of Dartmouth is dated 1770. 
4 Vide his Autobiography, in his Materials for a History 
of the Baptists in Pennsylvania, 1770, vol. i, pp. 47-49. 
* For these and other details, see my Bicentenary History 
of the First Baptist Church. 112 
SELECTED PAPERS AND ADDRESSES 
published “Materials towards a History of the 
American Baptists,” 0 four volumes of a series of 
twelve, which he projected but never completed. 
Most fitting is it, therefore, that our Philadelphia 
alumni will honor his name by establishing the 
“Morgan Edwards Fellowship” by a gift of over 
$10,000 on this the one hundred and fiftieth anni- 
versary of the University which owes its birth to 
him. 
Like all the early American colleges, Brown 
arose especially from the need and the desire for 
an educated ministry. In England, out of two 
hundred Baptist ministers only thirty or forty 
could read the Greek Testament, and only seven 
or eight in all America were liberally educated.7 
Among those were Morgan Edwards and James 
Manning. The mass of the Baptists were indiffer- 
ent or hostile to ministerial education. “The Bap- 
tists of the Philadelphia Association had long since 
taken the lead in all that pertained to the elevation 
of the character and dignity of the denomination, 
and their influence had been profoundly felt in New 
England and the South.” 8 As early as 1722 Rev. 
Abel Morgan, in that Association, was the leader 
in a movement for an academy—a proposal that 
6 Vol. i, Philadelphia, 1770; vol. ii, Philadelphia, 1792; 
vol. iii, “Delaware,” in the Pennsylvania Magazine of History 
and Biography; vol. ix, pp. 45 and 197, reprinted also by 
Lippincott & Co., Philadelphia, 1885; vol. iv, “Rhode Island,” 
in the Collections of the Rhode Island Historical Society; vol. 
vi. 
7 Sears, Centennial Discourse, 1864, p. 8. 
8 Newman, History of Baptist Churches in the United 
States, p. 380. EARLY YEARS OF BROWN UNIVERSITY 
113 
failed owing to Morgan’s death. In 1756 the 
Association founded the academy at Hopewell, 
New Jersey. James Manning, Hezekiah Smith, 
Samuel Stillman, Samuel Jones, and John Gano, 
all so actively indentified with the founding of 
Brown; David Howell, the second professor at 
Brown; and Charles Thompson and William 
Williams, of the first graduating class were all 
educated at Hopewell Academy. 
In 1762 there were but sixty Baptist churches 
and only five thousand members in all the colonies. 
In 1770, in Rhode Island, the books used in the 
schools were the Bible, the spelling book, and the 
primer. “When one had learned to read, write, 
and do a sum in the rule of three he was fit for 
business.” 9 So vague and naive was the knowl- 
edge of geography that Rhode Island was once 
described as located “in the West Indies in Amer- 
ica.” 10 The minister especially needed to be edu- 
cated, for he was by far the foremost man in the 
community, the doctor and the lawyer, his near 
neighbors, yielding him the pas.11 
The meticulous exactness of theological belief 
which was then deemed a test of orthodoxy is shown, 
for example, in a circular letter preserved among 
9 Reminiscences of Samuel Thurber, in Staples’s Annals 
of Providence, pp. 600-607. 
10 Tolman, “History of Higher Education in Rhode Is- 
land,” in United States Bureau of Education, Circular No. 1 
1893, p. 24. 
11 For a graphic account of the minister, see McMaster, 
History of the People of the United States, vol, i, pp. 31 
seqq. 114 
SELECTED PAPERS AND ADDRESSES 
the archives of the First Baptist Church in Phil- 
adelphia, which begins thus: 
“The Church of Christ meeting in Upperfree- 
hold, in the County of Monmouth, New Jersey. 
Holding Eternal Election, particular Redemp- 
tion Irresistable grace in Effectual Calling, and 
final perseverance in grace, (also the Baptism of 
professing Believers only, by immersion only,)” 
etc. It is curious that “the baptism of professing 
believers only” and the method “by immersion 
only” seem, by their parenthetical position, to be 
quite subordinate to the other theological dogmas 
announced in this paragraph.12 
On the other hand, orthodox conduct was less 
common. Tustin 13 notes the painful fact that in 
the first eighty years of the life of the Warren 
church ten per cent of the whole membership had 
been permanently excluded! In the History of my 
own church (1698-1898) I also noted the large 
number of exclusions of both men and women for 
drunkenness, profanity, and immorality. In War- 
ren, in 1769, to curb profanity and other evil 
practices, the town ordered two pillories, one of 
which at least was set up on the sidewalk, so that no 
one could miss seeing it and its occupant. 14 
Conditions were very primitive. In 1775 there 
were only thirty-seven newspapers in the whole 
12 Keen, Bicentenary History, p. 34. 
13 Discourse at the Dedication of. the New Church Edifice of 
the Baptist Church and Society, Warren, by Josiah P. Tustin, 
Pastor, Providence, 1845, pp. 140, 141. 
14 Fessenden, History of Warren, Rhode Island, p. 89, in 
the Supplement to Tustin’s Discourse. EARLY YEARS OF BROWN UNIVERSITY 
115 
country: fourteen in New England, four in New 
York, nine in Pennsylvania, leaving only ten for 
all the other colonies.15 Women still rode on pil- 
lions. Letters were often sent by hand even after 
the post-office passed into Franklin’s charge; they 
were “to be left at Mr. Westcott’s,” or “care of 
John Holmes at the Sign of George Washington,” 
a tavern, for the recipient. It was so well known 
that the post-riders read the letters that, for a long 
time after the Revolution, letters were often writ- 
ten in cipher.16 
When Morgan Edwards first proposed a college 
he was laughed at as a visionary, but after the 
college was actually started, the Philadelphia As- 
sociation, in 1764, 1774, and 1782 17 warmly rec- 
ommended it to the support of the Baptist 
churches. They appealed not only to Baptists, 
but “to all the friends of literature in every denom- 
ination.” 
Morever, the Association aided early Philadel- 
phia students. In 1767 a Mrs. Hobbs left a legacy 
of <£350 to the Association, and immediately the 
Association directed that £14 should be paid toward 
the education of Charles Thompson, of the class 
of 1769, the second pastor of the War- 
ren church. Usually (1767, 1769, 1771, 1773) the 
grant was made on condition that the beneficiary 
give what seems now a frank, but unusual, bond 
“to return the money in case the Association should 
15 McMaster, op. cit., vol. i, p. 27. 
16 McMaster, op. cit., vol. i, p. 40. 
17 Gillette, Minutes of the Philadelphia Baptist Association, 
pp. 91, 135, and 181. 116 
SELECTED PAPERS AND ADDRESSES 
be disappointed in him!” In 1769 the sum of <£14 
was voted for Thomas Ustick, of the class of 1771, 
later pastor of my own church. The next year ap- 
plication was made by both Ustick and Vanhorn, 
but Vanhorn was preferred. 
After carefully weighing the desirability of va- 
rious colonies, especially South Carolina and Rhode 
Island, as a location for the proposed college, the 
latter was selected on account of the absolute 
liberty of conscience which obtained there, and of 
the large proportion of Baptists in the colony and 
in its government. 
The charter was not obtained “In February, 
1764,” as is often stated. The General Assembly, 
it is true, met by adjournment in East Greenwich 
upon “the last Monday of February, 1764,” but the 
charter passed the lower house on March 2, the 
upper house on March 3, 1764, and was ordered to 
be signed, sealed, and registered. The governor 
did not actually sign it until October 24, 1765.1S 
Meantime, however, the Corporation met in New- 
port on September 5,1764, and again on September 
4,1765. On this date (before the governor had act- 
ually signed the charter. What a robust faith our 
fathers had!) the President was elected, and a Fac- 
ulty, consisting solely of the President, was chosen 
to guide the student body which had already existed 
for twenty-four hours in the person of William 
Rogers, a boy of fourteen years of age. The Presi- 
dent was James Manning, who had graduated at 
Princeton three years before (1762), and was not 
yet twenty-seven years of age. 
18 Charter of Brown University, with Index, p. 12. EARLY YEARS OF BROWN UNIVERSITY 
117 
The fundamental liberality of the charter, which, 
though written in the middle of the eighteenth cen- 
tury, breathes the spirit of the twentieth, is shown 
by a number of its provisions: (1) By the inclusion 
of four denominations, instead of making the Cor- 
poration consist only of Baptists. The prescribing 
of the exact number allotted to each denomination 
was evidently intended not only to prevent the 
non-Baptists from ousting the Baptists, but also to 
prevent any effort of the Baptists to oust the non- 
Baptists, either of which might easily have been 
feared in that age of bitter sectarianism. The 
number of each denomination was approximately 
in proportion to their respective size; hence no 
Presbyterians and no Methodists were named for 
there were almost none of them in Rhode Island in 
1764. (2) By what is quite as striking, the open- 
ing of the positions of all grades of teachers, with 
the sole exception of the President, to all denomina- 
tions, and the absolute and total exclusion of any 
religious test. (3) By what, as professor Bron- 
son has pointed out, is an especially marked pe- 
culiarity of Brown, the exclusion from the courses 
of public instruction of all teaching of “sectarian 
differences of opinion,” and that “youth of all re- 
ligious denominations” shall be on an equal footing 
in every respect. 19 
19 This fundamental difference in the studies at Brown and 
at Yale (an excellent type of the early colleges) is well shown 
by the following extracts from Dexter’s Yale Biographies and 
Annals, the reference to which was kindly furnished me by 
Dr. Anson Phelps Stokes. (See also his just published 
Memorials of Eminent Yale Men.) The study of Divinity, 118 
SELECTED PAPERS AND ADDRESSES 
Specific instances showing how Brown lived up 
to these fine promises in the Charter are most in- 
structive. September 6, 1770, the Corporation 
voted “that the children of Jews may be admitted 
into this institution and entirely enjoy the freedom 
of their religion without any constraint or imposi- 
of Hebrew, the “repeating of sermons” [let us hope that “re- 
peating” indicates that the sermons were not their own] the 
reciting of Wolebius’s and Ames’s Theology and the shorter 
catechism, etc., show that the teaching of “sectarian differ- 
ences of opinion,” which was absolutely banished from the 
class-rooms at Brown, was then required at Yale—a condition 
long since abolished. The stress laid upon Hebrew, as well 
as Latin and Greek, may explain the fact that President Stiles 
at Yale once delivered an oration in Hebrew, Chaldaic, and 
Arabic (Sears, loc. cit., p. 27). Undoubtedly it was a rather 
startling exhibition of learning. Whether it profited the 
audience Dr. Sears does not venture to state. 
The following is the course of study at Yale in 1714, as 
given by Benjamin Lord: 
“Books of the Languages and Sciences recited in my Day 
were Tully and Virgil, but without any notes: Burgersdicius 
and Ramus’s Logick, also Heerebord’s set Logic, &c.; Pierson’s 
manuscript of Physicks, &c., I have no copy of. We recited 
the Greek Testament; knew not Homer, &c.; recited the 
Psalms in Hebrew: . . . We recited Ames’ Medulla on Satur- 
days, and also his cases of Conscience sometimes; the two 
upper classes used to dispute syllogistically twice or thrice a 
week. ... As for the Mathematicks, we recited and studied 
but little more than the rudiments of it, some of ye plainest 
things in it.” [This included surveying.] Dexter, Yale 
Biographies and, Annals, vol. i, pp. 115, 116. 
The course of study as copied from the [Yale] College 
Rules by a Freshman in November, 1726, is as follows: 
“All undergraduates except freshmen, who shall Read eng- 
lish into Greek, shall Read some part of ye old testament out 
of Hebrew into Greek In ye morning, and shall turn some part EARLY YEARS OF BROWN UNIVERSITY 
119 
tion whatever.” In 1774 the Seventh Day Bap- 
tists were exempted from the law requiring atten- 
dance at Church on Sunday. The Quakers were 
also exempted from the law which prohibited the 
of ye new testament out of ye english or lattin into ye Greek 
att evening att ye time of Recitation before they begin to 
Recite ye original tongues. 
“All undergraduates shall publickly Repeat sermons in ye 
hall in their Course, and also batchellors, and be Constantly 
examined on sabbaths at evening prayer. 
“All students shall after they have Done resciting Rhet- 
orick and ethicks on fridays recite Wolebius’ theology and on 
Saturday morning they shall Rescite Ames theologie thesis in 
his Medulla, and on Saturday evening ye Assemblies shorter 
Chatecbism in Lattin and on Sabbath Day attend ye explica- 
tion of Ames’s Cases of Conscience. 
“In ye first year after admission on ye four first days of ye 
week all students shall be exercised in ye Greek and Hebrew 
tongues, onely beginning logick in ye morning att ye latter end 
of ye year unless their tutors see cause by Reason of their 
Ripeness in ye tongues to Read logick to them sooner; they 
shall spend ye second year in logick with ye exercise of them- 
selves in ye tongues. ye third year principally in pliysicks: 
and y9 fourth year in metaphisicks and mathematicks still 
Carrying on ye former studies: but in all Classes ye last Days 
of ye week are allowed perpetually for Rhetorick, oratory and 
Divinity and in teaching of both tongues, and Arts, and such 
authors are to be used as shall be approved of by ye Rector 
and tutors. . . . 
“No scholar shall use ye english tongue in ye Colledge with 
his fellow scholars unless he be called to publick exercise 
proper to be attended in ye English tongue but scholars in 
their Chambers and when they are together shall talk Lattin.” 
Dexter, loc. cit., vol. i. p. 348. 
[The 36th law of Rhode Island College in 1774 reads: “In 
the hours of study [i.e. nearly all day] no one shall speak to 
another in the College or the College yard except in Latin.” 
Guild, Brown University and Manning, p. 270.] 
Entrance Examinations and Course of Study at Yale in 120 
SELECTED PAPERS AND ADDRESSES 
students from wearing their hats within the college 
walls.20 
In 1769 the Faculty was enlarged by the addi- 
tion of David Howell (already for three years a 
tutor) as “Professor of Natural Philosophy.” 
He taught until the war closed the college.21 The 
third member of the Faculty was Joseph Brown, 
1745: “In the first Year They Shall principally Study the 
Tongues & Logic, and Shall in Some measure pursue the Study 
of the Tongues the Two next Years. In the Second Year 
They Shall Recite Rhetoric, Geometry and Geography. In 
the Third Year Natural Philosophy, Astronomy and Other 
Parts of the Mathematicks. In the Fourh Year Metaphysics 
and Ethics, but every Saturday shall Especially be allotted 
to the Study of Divinity, and the Classes Shall dureing the 
whole Term recite the Westminster Confession of Faith . . . 
and on Friday Each Undergraduate in his Order about Six at 
a Time Shall Declaim in the Hall in Latin, Greek, or He- 
brew.” Dexter, loc. cit., vol. ii, p. 5. [Surely we should 
pause and drop a tear of sympathy for our suffering prede- 
cessors.] 
At the College of William and Mary the ecclesiastical in- 
fluence was still more marked. The President was a salaried 
“Commissary of the bishop of London,” and most of the early 
professors were “incumbents of neighboring churches.” One 
decree even so late as 1769 was almost monastic. “The privi- 
leges of a wife and family were accorded to the President 
alone. . . . Entering into marriage . . . ipso facto vacated 
the office of any Professor.” Address of President Lyon G. 
Tyler, December 5, 1904, before the Phi Beta Kappa Society 
at William and Mary College. 
20 Guild. Brown University and Manning, pp. 265-267. 
21 Professor Goddard in his Memoir of President Manning 
(p. 6) says of Howell: 
“Except however as a tutor we have never heard that he 
participated in the ordinary duties of academical instruction.” 
That Howell never delivered any lectures on laXv during the EARLY YEARS OF BROWN UNIVERSITY 
121 
Howell’s successor, who resumed the teaching of 
Natural Philosophy in 1784, shortly after the war 
ended. The fourth was the celebrated Benjamin 
Waterhouse, M. D., who taught Natural History 
from 1781 to 1791. 
Waterhouse was a Newport boy, a nephew of 
Dr. John Fothergill, of London, who, as will soon 
be seen, was an early benefactor of the college 
through Morgan Edwards. Waterhouse was per- 
haps the most highly educated physician of his 
day in this country. With John Warren and 
Aaron Dexter he founded the Harvard Medical 
School in 1782-83, 22 and was noted as the first to 
introduce vaccination into America. He served 
on the Board of Fellows of Brown for thirteen 
years (1782-95).23 
This insistence on Science was in accordance 
with the charter, which decreed that “the public 
thirty-four years he held the professorship (1790-1824) is 
generally admitted, but in his letter of resignation, dated 
March 11, 1779 (Guild, Brown University and Manning, p. 
311), he says: “Although experimental philosophy was the 
direct object of my profession, yet “other branches of learn- 
ing were devolved upon me.” Guild (p. 68) says that these 
“other Branches” were French, German, and Hebrew. More- 
over, in his letter of resignation, he declares that he is unwill- 
ing to receive “the emoluments of office without discharging its 
duties,” and the records of the Corporation show (pp. 57, 60, 
62, 66) that he received a salary when tutor of from <£25 to 
£72, which was increased to £90, and later (1774) to £100 
(all lawful money), during his professorship. 
22 See Oliver Wendell Holmes’s delightful Address at the 
Centenary of the Harvard Medical School. 
23 In the John Carter Brown Library is an undated broad- 
side of a syllabus of his lectures at Brown and Harvard. 122 
SELECTED PAPERS AND ADDRESSES 
teaching shall in general respect the sciences.” 
The scientific subjects actually taught are not ex- 
actly known, but probably they differed somewhat, 
by subtraction, from those taught in 1783 (when 
“science” included geography, arithmetic, algebra, 
Euclid, trigonometry, surveying, navigation, and 
astronomy), and by addition also, under Water- 
house at least. At that time the college spent 
about <£700 “lawful money” on the philosophical 
apparatus and the library, one-half of which was 
given by John Brown.24 Even with this addition, 
however, the philosophical and astronomical appa- 
ratus could hardly have been compared with the 
fine collections at Harvard (destroyed by fire 
in 1764), Yale, and especially at William and 
Mary.25 
The meeting of the Corporation was held on 
Wednesday, September 5, 1764, in Newport. Of 
the forty-seven members of the Corporation named 
in the charter (one place was purposely left vacant 
24 Guild, Brown University and Manning, p. 347. 
25 I bad collected considerable material towards a compari- 
son of the teaching of science in the nine American colleges 
founded before the Revolution, but greatly to my regret I am 
obliged to omit it on account of the great length of time and 
space required for even a partially adequate treatment of the 
subject. Those interested will find in the histories of the 
individual colleges a great deal of information. To these I 
would add the valuable series of Circulars of Information on 
Higher Education, issued by the United States Bureau of 
Education under the editorship of Herbert B. Adams. Each 
State is considered by itself, and each college individually. 
Also, much information is included in Caliori’s Teaching and 
History of Mathematics in the United States, and other simi- 
lar publications of the Bureau of Education. EARLY YEARS OF BROWN UNIVERSITY 
123 
for the future President), only twenty-eight had 
qualified.26 Of the twenty-eight, twenty-four 
were present; certainly a very good attendance, 
especially in view of the then difficulties of travel. 
They were a distinguished company,27 headed by 
the Chancellor, Hon. Stephen Hopkins, chief jus- 
tice, governor, member of the Continental Con- 
gress, and signer of the Declaration of Indepen- 
dence. One-fourth were university men: from 
Harvard four, from Yale two, from Princeton 
one. 
The most urgent need was money to meet im- 
mediate expenses. Accordingly sixty-nine gentle- 
men were appointed to receive subscriptions, not 
only in the New England colonies, but “in the 
Western part of this Continent.” It is curious at 
this day to find that the “wild and woolly West” of 
1764 included Baltimore, Philadelphia, and New 
York! Twenty-three other places were specified 
by name. With prophetic vision, Oyster Bay was 
one. 
Rev. Hezekiah Smith, of Haverhill, collected in 
1769 about $2500 in the southern colonies, but the 
largest amount was obtained by Morgan Edwards. 
On February 2, 1767, I find the following note 
in the records of our Philadelphia church: “Mr. 
Edwards applied to the Church for leave to go to 
Europe to execute a commission he hath received 
26 Three qualified the next year, and to three of those who 
never qualified, honorary degrees were generously given in 
later years. Was this as a reward or as a means of heaping 
coals of fire on their heads? 
27 Cf. Newman, loc. cit., p. 263. 124 
SELECTED PAPERS AND ADDRESSES 
from the College in Rhode Island; he afso in- 
formed the Church that he had wrote to twelve min- 
isters to supply his place in his absence, ten of 
whom had agreed to his proposal; each to officiate 
a month in his turn, and to be allowed each five 
pounds a month out of Mr. Edwards’s salary. 
The Church granted Mr. Edwards leave to go to 
Europe and wished him all success.” He carried 
with him a letter, undated, but evidently written 
early in 1767, signed by the President and the 
Chancellor. The signature of Stephen Hopkins 
at this date was quite firm. Two years later the 
lines began to waver, and in 1776, nine years be- 
fore his death, his well-known signature of the 
Declaration was extremely tremulous. 
Edwards, as was his wont, lost no time. 
“Detto, fatto33 was his motto. Two weeks after this 
vote he sailed, and in less than two years had 
collected <£888 10s. 2d. sterling. As he says, he 
“succeeded pretty well considering how angry the 
Mother country then was with the Colonies for 
opposing the Stamp Act.” 
The manuscript list of the subscribers is in our 
archives. The largest subscribers were the First 
and Second Presbyterian Churches in Belfast 
(£13 9s. 0d. and £14 15s. id.). It is interesting 
to note among the subscribers Thomas Penn, £20, 
Benjamin Franklin, £10, Thomas Hollis, £10 
Dr. John Fothergill, esteemed by all doctors, £5 
5s. The lowest amounts named are one and two 
shillings. 
Encouraged by these collections, the permanent 
location of the college and the erection of suitable EARLY YEARS OF BROWN UNIVERSITY 
125 
buildings were now actively discussed. After 
much rivalry and not a little hard feeling, the 
matter was finally settled. The college and Man- 
ning both moved to Providence in May, 1770. 
Why had little Warren ever been selected as the 
first home of the college? 
The town was named after Admiral Sir Peter 
Warren, who had cleared the coast of French ships 
of war and thus rendered a great service to War- 
ren, which depended chiefly on its maritime com- 
merce. In 1746 it had been definitely assigned 
by the King in Council to Rhode Island instead of 
to Massachusetts. Its population even in 1770 
was only 979, while Providence had 2958, and 
Newport could boast of 11,000. Newport was the 
leading town in Rhode Island in commerce and 
culture as well as in inhabitants, was next in size 
to Boston, and had two Baptist churches. 
Swansea was a small inland town about three 
miles from Warren. Here was a Baptist Church, 
founded for over a century (1663). The Swan- 
sea, the two Newport, and the Providence Bap- 
tist churches were all supplied with pastors. In 
Warren there were about sixty Baptists. They 
were not organized into a church, but evidently 
the desire for such a church was in their hearts, 
and they had already taken active steps towards 
founding it before the plan for a college was first 
mooted in Philadelphia. This intention to found 
a separate church in Warren was doubtless known 
to the Philadelphia Baptists. It was therefore 
very natural, as the projected college had ab- 126 
SELECTED PAPERS AND ADDRESSES 
solutely no funds, that, whatever might be its per- 
manent site, it should begin in Warren, where the 
president could be supported by his salary as min- 
ister of the church and also by opening a Latin 
school. 
The two enterprises—the church and the college 
—went hand in hand. The first step had to do 
with the erection of the meeting-house; the second 
and third with the college; the next two with the 
church; the sixth with the college; the seventh with 
both church and college; the eighth with the col- 
lege; the ninth to the twelfth with the church, and 
finally the thirteenth with the college. 
The chronological order of events in detail is as 
follows: 
1st. February, 1762. The collection of building 
materials for a “Meeten house” was begun, as 
shown by bills in the archives of the Warren 
church. This was eight months before Morgan 
Edwards proposed that a college should be founded, 
a year and eight months before the first payment 
on the lot was made, a year and nine months before 
the Warren church was constituted, and almost 
three years before the date of the deed for the lot. 
Surely they were “forehanded.” 
2nd. October, 1762. In the Philadelphia Bap- 
tist Association, the only Association then in exist- 
ence, Morgan Edwards first mooted the question 
of a college. 
3rd. July, 1763. James Manning, representing 
a committee of the Philadelphia Association,28 
28 Sears, Centennial Discourse, pp. 11, 12, and Appendix 
B, p. 62. EARLY YEARS OF BROWN UNIVERSITY 
127 
visited Newport on his way to Halifax, and took 
the first definite steps toward a charter for the pro- 
posed college. 
4111. October 21, 1763. The first payment to 
the “widow Rachel Luen for a Lot of Land for 
to set meten house on.” The deed for this lot is 
dated January 29, 1765. The lot was not fully 
paid for until 1783, twenty years after the first 
payment and eighteen years after date of the 
deed.29 
5th. February 17, 1764. “The Congregation” 
(observe it is not “the Church”) “at Warren gave 
Rev. James Manning a call to come over from 
New Jersey and settle amongst them.” 30 
6th. March 2 and 3, 1764. The charter of the 
college was granted. 
7th. April 13 or 14, 1764. James and Mrs. 
Manning (they had been married March 23, 1763) 
arrived at Warren. He began at once to preach 
to the as yet unorganized Baptists and also opened 
a Latin school.31 
8th. September 5, 1764. First meeting of the 
Corporation of the college. 
9th. September, 1764. It was agreed to draw 
up a covenant and organize a church. 
10th. October 4, 1764. The Swansea Church 
dismissed twenty-five members to the proposed 
Warren church. 
11th. November 15, 1764. The Warren church 
29 Archives of the Warren church. 
30 Warren archives. 
31 Sears, op. cit., p. 17, and Appendix E, p. 71. 128 
SELECTED PAPERS AND ADDRESSES 
was solemnly constituted 32 with fifty-eight mem- 
bers, 33 all of whom assented to the covenant by a 
rising vote. 
Three of the members then presented a formal 
call34 from the now organized “Church” to Mr. 
Manning. He accepted, and was at once installed. 
The provision for his salary is naively in- 
definite: “As we are of opinion that they who 
preach the Gospel should live by the Gospel we do 
here declare our intention to render your life as 
happily by our brotherly conduct towards you and 
communicating our temporal things to your neces- 
sities so long as God . . . shall continue us to- 
gether.” Tustin (pp. 121, 122) says that the 
church “appears to have given him a liberal sup- 
port.” 
12th. November 25, 1764. Manning was dis- 
missed from the Scotch Plains church, New Jer- 
sey, to the Warren church “of the same faith and 
order.” 35 It should be observed, however, that 
the Scotch Plains church still clung to the “Lay- 
ing on of Hands,” whereas the Warren church in 
its original covenant boldly and expressly declared 
32 Bound volume of Warren Church Minutes, p. 1; Spald- 
ing, Centennial Discourse at Warren, November 15, 1864, pp. 
13, 14. The original minutes were destroyed when the church 
was burned by the British, May 25, 1778. Fortunately a 
complete copy down to November 30, 1869, had been made 
by Mr. John Throop and was copied into the Minute Book. 
33 The Church Minutes say twenty-five from Swansea. 
Tustin, p. 118, says thirty-five, but both agree on fifty-eight 
as a total number. 
34 Tustin, pp. 171-173, gives the full text. 
35 Tustin, p. 168, gives the letter in full. EARLY YEARS OF BROWN UNIVERSITY 
129 
“That the Imposition or Non-Imposition of 
Hands upon believers after Baptism is not essen- 
tial to Church Communion.” 36 This petty con- 
troversy was a serious bone of contention between 
the “Five Principle” and the “Six Principle” 
Baptists, and later involved Manning and the 
Providence church in trouble. In the Warren rec- 
ords, June 28, 1765, is a charmingly frank and very 
charitable note that Sister B. B. had been “bap- 
tized and come under the Imposition of Hands 
and has since walked circumspectly human frail- 
ties excepted 
13th. September 4, 1765. At the second meet- 
ing of the Corporation, again held in Newport, 
James Manning was formally elected President. 
Both enterprises were now completely organ- 
ized, with James Manning at the head of each. 
This harmonious cooperation continued until the 
question of the permanent location of the college 
arose. For the details of this rather violent strug- 
gle I must refer you to Professor Bronson’s His- 
tory. Suffice it to say that Providence finally won 
the day, and on May 3, 1770, Manning went with 
the college to Providence. 
Let us now look at a few details of condi- 
tions at Warren during the period from 1764 to 
1770. 
The size of the first meeting-house is variously 
given. In a subscription list of 1765 it is described 
as “sixty one feat, width forty fore feat.” This 
would seem to be more reliable than the spelling. 
36 Tustin, p. 171. 130 
SELECTED PAPERS AND ADDRESSES 
Tustin says it was about forty-four feet square, and 
Guild, following Morgan Edwards, says it was 
forty-four by fifty-two feet.37 It had pews, gal- 
leries, a turret containing a little bell, called the “to- 
bacco bell,” as it was paid for by this means, and a 
porch. 3S The pulpit was not built until May, 
1765. The “gallories” were not finished nor all 
the “pues” placed possibly until 1774, for on Feb- 
ruary 3, 1772,39 a contract was awarded for fin- 
ishing the “gallories” and for putting in thirty-six 
“pues.” For doing this work the contractors were 
allowed two years—a liberal allowance. 
In this contract, and therefore presumably in 
the earlier ones, the contractors were given the 
right to sell the pews. On April 24, 1765, the 
proprietors of the pews, who had believed that the 
total sum thus realized would be sufficient to com- 
plete the building, fearing that it would not be 
enough, agreed that if this sum was insufficient 
they should pay proportionately such sums as 
would complete it or forfeit their pews. This 
“syndicate” for “underwriting” the entire cost, as 
we might now call it, was signed by twenty-three 
persons.40 
There does not seem to have been any stove. In 
37 Collections of the Rhode Island Historical Society, vol. 
vi. p. 342. 
38 Tustin, p. 173, and Guild, following him, say there was 
no porch, but this is presumably wrong, as I found a bill dated 
May, 1765, in the Warren church archives, with an item, “To 
horse hire and time for going to look for stuff to build a 
porch for the Metenhouse ,£6.10.0.” 
39 Warren archives. 
40 Warren archives. EARLY YEARS OF BROWN UNIVERSITY 
131 
Morgan Edwards’ various volumes the presence or 
absence of a stove in almost every case is carefully 
noted; e. g., Pennepek had one, but the Philadel- 
phia church had not. McMaster 41 thus vividly de- 
scribes the situation in the winter: “Not a meet- 
ing house was warmed, not a chimney, not a fire- 
place, not a stove was to be seen.” 
The Third Church, Newport, is described by Ed- 
wards as having pews, galleries, and a “clock,” the 
only mention I have seen of this useful monitor. 
Usually an hour-glass was on the pulpit, and its 
third turning marked the minister’s final lap. 
Possibly in Newport they thought that the more 
aggressive suggestiveness of the clock, added to 
the frigidity of the air, might shorten the sermon 
by at least one turn of the hour-glass in very 
cold weather. One minister, says McMaster,42 
“preached in a great coat and mittens and com- 
plained that his voice was drowned by persons 
stamping . . . their feet to keep warm.” 
For Dr. Manning and the prospective stu- 
dents 43 a parsonage had to be built. This was a 
large building, costing £2534 17s.—an apparently 
formidable sum, but Professor Bronson informs 
me that it was “old tenor,” and so was equivalent 
to only $600. Even that was a large sum in those 
days. 
While examining the old bills and other docu- 
41 McMaster, ii, 568. 
42 Ibid. 
43 This is conclusively shown in one bill, April 18, 1768, 
which mentions “the College chamber.” It is also shown by 
the lottery of 1767, referred to later. 132 
SELECTED PAPERS AND ADDRESSES 
ments in the archives of the Warren church I 
chanced upon some orthographical gems which I 
must share with you. Our forbears, who luckily 
escaped the many birchings visited upon their de- 
scendents by Noah Webster and Lindley Murray, 
were not satisfied with the dull uniformity of a 
single spelling, but exhibited the vivacity which 
accompanied an unexpected and often star- 
tlingly variegated orthography. Contempora- 
neous documents of the other early colleges showed 
an equally liberal charity. If political independ- 
ence was desirable, why not also orthographical 
independence? If “Liberty of Unlicensed Print- 
ing” was good for John Milton, why was not 
“Liberty of Unlicensed Spelling” good for John 
Gano?44 Accordingly they cut their teeth, as it 
were, upon such simple beginnings as “winder 
fraims,” “dores,” and “meten hous.” These latter 
provided only a few possible variants. When it 
came to “Parsonage,” however, they found a rich 
field for their cooperative fertility of invention, and 
then went “ganz los.” I discovered thirteen new, 
but all different, ways of spelling this one word, 
from “passeenage” to “posneg.” The following 
will suffice: “Parseenage, parsnige, pasanage, pas- 
seage, paisonnag, parsinig, pasneg hous, parsing 
hous, personage, personog, pasonage, posneg, par- 
44 See my History of the First Baptist Church, Philadel- 
phia, p. 64. Even the punctuation, capitalization, and spell- 
ing of John Quincy Adams were corrected by his colleague, 
Jonathan Russell, a graduate of Brown in 1791, when the 
Treaty of Ghent was being negotiated. (Frederick Trevor 
Hill, Atlantic Monthly, August, 1914, p. 236.) EARLY YEARS OF BROWN UNIVERSITY 
133 
snig.” Had I made a thorough search, I might 
possibly have enlarged the list to a score, unless 
indeed their positive genius in cacography had ex- 
hausted itself. 
Possibly an English annex to the “Latin School” 
might have been useful. 
The prevalence of the unwarranted soft “g” in 
the above list is even more marked in a long itemized 
memorandum of the losses of Rev. Charles Thomp- 
son, of the class of 1769 (who had followed Man- 
ning in the pastorate at Warren), for his effects 
which had been destroyed when the parsonage and 
the church were burned by the British. Among 
many “go as you please” spellings I find one mys- 
terious “black gug” and two “ginn gugs.” He does 
not add the comment “wore some” or “half wore,” 
as he does to his shirts and “stockens.” 45 
One Martin Luther, however, who emulated his 
namesake of the sixteenth century in overturning 
established usages, not content with a revolution in 
spelling, made additional assaults upon grammar 
and sobriety. In a bill dated July 3, 1764, he pro- 
vided a new past participle for the verb “disburse.” 
It reads: 
Disbusted by Martin Luther to Wordes bulding the meeting house 
960 feete of pine hordes £96. 
106 gallons of rum £254. 
Eroors excepted. 
Paid, 
Martin Luther. 
As they paid for rum two and a half times as much 
as for “hordes” it is perhaps too much to hope that 
45 History of Warren, Rhode Island, in the War of the 
Revolution, by Virginia Baker, Warren, 1901. 134 
SELECTED PAPERS AND ADDRESSES 
there were no “Eroors” in conduct as well as in the 
account which were “excepted.” 
The members had not only to wrestle with the 
problem of how to spell as well as to build the par- 
sonage, but also how to finance it, for it differed 
from the church in not having any pews which could 
be sold. In 1767 they therefore inaugurated a 
lottery for raising <£150 “Lrwful money” toward fin- 
ishing the parsonage house, as the students “cannot 
be accommodated in said house in its present con- 
dition.” Those who bought the tickets were very 
properly called “adventurers.” To us such a 
scheme, especially in connection with a church, 
seems very extraordinary. But at this time in 
England as well as in the colonies, and in Rhode Is- 
land during exactly a century (from 1714 to 
1844), 46 there was a rage for lotteries for almost 
every purpose—to build meeting-houses, wharves, 
bridges (e. g., the old Weybosset bridge in Provi- 
dence), for opening of streets, for colleges, etc. 
Thus the First Baptist Church in Providence in 
1774 asked for a lottery to raise £2000; in 1830 
and 1837 there were two lotteries for the Rhode 
Island Historical Society; in 1793 the Corporation 
of Rhode Island College petitioned the General 
Assembly for the grant of a lottery of $4000 for 
purchasing Dr. Forbes’s orrery and other articles 
of philosophical apparatus and for the college li- 
brary, etc.;47 in 1796 another was asked by Brown 
46 See a most interesting paper by the late Judge Stiness, 
“A Century of Lotteries in Rhode Island,” Rhode 
Island Historical Tracts, 2d Series, No. 3, 1896. 
47 Newman, loc. cit., pp. 264, 265. EARLY YEARS OF BROWN UNIVERSITY 
135 
University for $25,000, and in 1811 another for 
$20,000. Harvard and Princeton also were aided 
by lotteries. 
In the archives of the Warren church is the full 
printed proposal for such a lottery, dated No- 
vember 28, 1794, and signed by our old friend 
Martin Luther (who had “disbusted” certain 
monies for the meeting-house thirty years before) 
and two others. I have no doubt that Martin 
Luther and his fellow members would have stoutly 
maintained as a theological dogma that “ye cannot 
serve God and Mammon ” but when it came to the 
practical work of building a new meeting-house to 
replace the one burned by the British, they clearly 
combined the two, for the proposal reads as fol- 
lows: 
“As this lottery was granted for promoting 
public worship and the advancement of religion we 
flatter ourselves that every well wisher to Society 
and good order will become cheerful adventurers.” 
So far for piety, but Mammon now has its inning: 
“For those who adventure from motives of gain the 
scheme is advantageously calculated, there being 
less than two Blanks to a Prize” The italics are 
in the original. 
As already stated, Manning was elected Presi- 
dent at the second meeting of the Corporation, 
September 4,1765. His official title exceeded even 
Holmes’s famous “settee of professorships,” for 
he was not only President but “Professor of Lan- 
guages and other Branches of Learning.” It is 
significant of the feeling that the location of the 
college at Warren was only temporary, that this  SELECTED PAPERS AND ADDRESSES 
136 
vote continued, “with full power to act immediately 
in these capacities at Warren, or elsewhere” In 
1769, when Howell wras elected “Professor of 
Natural Philosophy,” the President’s title was 
abridged to Professor of Moral Philosophy. 
One day before there was any President or 
Faculty, the first student was inscribed on the 
roll of the college—the first in the long and honored 
roll which now numbers 7748 names. This first 
student, whose career we shall subsequently follow, 
was William Rogers, a boy of fourteen. For nine 
months and seventeen days he was the only student. 
On June 20, 1766, Richard Stites increased the 
“students”—a plural is now proper—to two, while 
four others entered during November, 1766. In 
1768 a seventh student completed the first class, 
who were graduated in 1769. The charge for 
tuition was twelve dollars per annum. On August 
11, 1766, there is a receipt in Manning’s hand- 
writing for “three Spanish milled dollars,” being 
one quarter’s tuition.48 Boarding cost a dollar and 
a quarter a week, single meals six cents. 
Manning’s salary as president was much less in 
evidence than that as pastor. The income from 
the funds collected by Morgan Edwards in 1767- 
68 was pledged for this salary. Notwithstanding 
this, a committee of the Corporation, on September 
17, 1769, reported that the President had served 
the college for three years and had received no com- 
pensation, so the sum of <£50 “lawful money” 49 
48 Guild, Brown University and Manning, p. 52. 
49 Professor McMaster has kindly epitomized for me the 
monetary conditions as follows: “The Spanish milled dollar EARLY YEARS OF BROWN UNIVERSITY 
137 
was ordered to be paid to him. This would be 
equivalent to $166.66 in Spanish milled dollars. 
The committee very properly stated that in their 
opinion this sum was quite inadequate, and that he 
should not be debarred “from being recompensed 
in a more ample manner whenever it should be in 
the power of the Corporation to do the same.” 
Fortunately the church and the Latin school eked 
out his living expenses. In 1772, in a letter to 
Rev. John Ryland, Manning states that his salary 
was £67 13s. 4d. sterling, or about $338. So 
scrupulous was he that he had always included as a 
part of this meager salary the five guineas sent to 
him annually by Ryland from England.50 
The first mention of any library was at the meet- 
ing of the Corporation in 1768, when the President 
was requested to write to Morgan Edwards, then 
in London, to bring “such books as he shall think 
necessary at this time, not exceeding £20 value.” 51 
Several of the subscribers secured by Edwards gave 
some books. The University still has the pine 
prior to 1640 was rated at four shillings and six pence ster- 
ling. Later different colonies rated it variously from six 
shillings to eight shillings., so that while in New England the 
‘pound’ was worth $3.33, in some of the other colonies it was 
worth as little as $2.50. In 1704 Queen Anne issued a proc- 
lamation fixing the value of the Spanish milled dollar at 
six shillings. This was ‘Proclamation Money’ or ‘Lawful 
Money.’ Between 1710 and 1740 Rhode Island issued paper 
money to be received and paid as of the same value as current 
coin. This was ‘Old tenor’ money. In 1740 ‘New tenor’ 
bills were issued at six shillings and six pence, and were made 
equivalent to twenty-seven shillings in ‘Old tenor.’ ” 
50 Guild, Brown University and Manning, p. 192. 
51 Sears, loc. cit., p. 94. 138 
SELECTED PAPERS AND ADDRESSES 
table of William Williams, the drawers of which 
held the entire library while the college was in 
W arren. 
In 1709 the first commencement was held in 
Warren. On August 10, 1769, doubtless in prep- 
aration for this notable event, a subscription list, 
headed by Manning with twelve shillings, was 
circulated for repainting the meeting-house “both 
outside and inside,” “providing the business be im- 
mediately prosecuted.” On the day before this 
commencement the Corporation voted “That the 
Meeting House in Warren be fitted up at the 
charge of the Corporation in the best manner the 
shortness of time will permit.” 
It was a great day. “Tradition says that a 
Company of Baptist preachers from Georgia rode 
over a month on horseback to be there!” 52 Ap- 
parently the governor did not attend this, the only 
commencement held in Warren. 
John Howland 53 gives a very vivid account of 
the stateliness of the first five commencements in 
Providence: The Commencements in Providence 
for the first five years were held in Mr. Snow’s 
meeting house, that being then the largest in town. 
Governor Wanton always attended from New- 
port. . . . Escorted by the company of Cadets in 
showy uniforms, he headed the procession with the 
President. The Governor’s wig, which had been 
52 Bronson, History of Brown University, p. 40. 
63 Life and Recollections of John Howland, class of 1835 
(hon.), who died in 1854, aet. 97, by E. M. Stone, Provi- 
dence, 1857, p. 159, quoted by Guild, Brown University and 
Manning, p. 143. EARLY YEARS OF BROWN UNIVERSITY 
139 
made in England, was the size and pattern of that 
of the speaker of the House of Commons, and so 
large that the shallow crowned hat could not be 
placed on his head without disturbing the curls. 
He therefore placed it under his left arm, and held 
his umbrella in his right hand. This was the first 
umbrella ever seen carried by a gentleman in Provi- 
dence, though they had been some time in use by 
Ladies on a sunny day. Governor Wanton was 
the most dignified and respectable looking man we 
had ever seen. The white wig of President Man- 
ning was of the largest dimensions usually worn in 
this country.” 
For sixty years to my own knowledge the sheriff 
of the county of Pirovidence, with his cockade, his 
broad blue sash, and his sword of state, without any 
deputies, has been amply sufficient to preserve 
“civil peace, good order and decorum at Commence- 
ment.” 54 
The first commencement foreshadowed 1775, 
only six years away, for “not only the Candidates 
but even the President was dressed in American 
manufactures.” There were both a morning and 
54 I inquired of Mr. Stephen 0. Edwards as to whether the 
attendance of the sheriff was directed by statute or only 
resulted from custom. His reply is as follows: 
“I find in the laws of 1798 the following provision: ‘And 
he it further enacted that it shall be the duty of the Sheriff 
of the County of Providence to attend the celebration of the 
Commencement of the University or College in this state 
annually, and to preserve the civil peace, good order and 
decorum, during the same.’ 
“In the laws of 1882 this provision reads as follows: ‘It 
shall be the duty of the Sheriff of the County of Providence, 140 
SELECTED PAPERS AND ADDRESSES 
an afternoon session, and all the seven in the grad- 
uating class pronounced orations. Such was the 
avidity for oratory that Morgan Edwards also 
preached them a sermon in the evening. Two of 
the class debated the question whether the Ameri- 
cans could “affect to become an independent 
State.” In this “Disputatio forensica” Varnum 
was a warm advocate of American freedom. 
“Doubtless,” he says, “we should long since have 
obtained redress had we not been tormented by 
Worms in our own Bowels” (i. e., “Torys”).55 
Though warmly in favor of our independence, his 
conclusion was that Great Britain could overwhelm 
us, and that the attempt to form an independent 
state would end in disaster. William Williams, 
with so many of his deputies as may he necessary (at least 
four), to attend the celebration of the annual commencement 
of Brown University in this State and to preserve peace and 
good order and decorum during the same.’ 
“The provision stands as follows in our present laws: ‘The 
sheriff of the county of Providence, with as many of his depu- 
ties as he may deem necessary, shall attend the celebration of 
the annual commencement of Brown University and shall pre- 
serve peace and good order and decorum during the same.’ ” 
Since my text and Mr. Edwards’s letter were written I 
have had the pleasure of reading Professor Bronson’s History 
of Brown University. On pages 87 and 139-142 will be 
found interesting details of the disorders at commencement 
between 1788 and 1798. owing chiefly to the booths, etc., set 
up on the grounds of the Baptist Meeting-House for the sale 
of intoxicants, etc. The votes of the Corporation found ex- 
pression in the laws above cited. 
55 Guild, Collections of the Rhode Island Historical Society, 
vol. vii, pp. 267-298. We hardly appreciate how many 
“Tories” there were. On page 280 Guild states that over EARLY YEARS OF BROWN UNIVERSITY 
141 
however, believed that we could successfully resist 
Great Britain, and ended his speech with the words, 
in capital letters, “America shall be free.” 56 
The Salutatory and the “Syllogistic Disputation” 
were in Latin. (In 1776 one oration was in 
Hebrew.) Charles Thompson, the valedictorian, 
“took a most affectionate leave of his classmates,” 
and the reporter adds, “the scene was tender, the 
Subject felt and the Audience affected.” 
Of these first seven graduates, one died in 1775. 
Four entered the patriot army. Bichard Stites 
was a captain and died of wounds in 1776. James 
M. Varnum became distinguished as a major-gen- 
eral in the army, and later at the bar and as a 
member of Congress. He was able to converse in 
Latin with Blanchard, the quartermaster-general 
of the French forces in Providence. Charles 
Thompson was Manning’s successor in the Warren 
church. In 1778, while on leave from the army, 
he was captured by the British in their raid upon 
Warren and held a prisoner for some weeks. 
William Bogers had a noteworthy career. He 
was pastor of my own church 1772-75, chaplain 
1100 Loyalists, or, as they were commonly called, “Torys,” 
left Boston with the British army; and in 1783, when the 
British army left New York, over 30,000 accompanied them. 
On the other hand, of the 3200 biographies of Baptists in 
Cathcart’s Baptist Encyclopaedia, all save one were patriots, 
and this one recanted at a later date (Guild, Brown University 
and Manning, p. 16). 
56 Quoted by Guild, Brown University and Manning, pp. 
83-85. See also a most interesting account, with a reproduc- 
tion of the broadside of 1769, by Winsbip, Brown Alumni 
Monthly, May, 1913. 142 
SELECTED PAPERS AND ADDRESSES 
and later brigade chaplain in the army 1776-81, 
professor of oratory and belles-lettres in the Uni- 
versity of Pennsylvania for twenty-two years, and 
a laureate of the University of Pennsylvania, of 
Yale, and of Princeton. In this same History 
(page 58) I note that among his publications is 
“The prayer delivered on Saturday the 22nd of 
February, 1800, in the German Reformed Church, 
Philadelphia, before the Pennsylvania Society of 
the Cincinnate, published by particular request, 
8vo. pp. 12.” I must confess that the patience of 
the “Cincinnate” may well have been exhausted by 
twelve pages of prayer. 
One probably unique incident in his life is thus 
recorded.57 It is an extract from the records of 
King’s Church (now St. John’s), Providence, and 
relates to Sunday, June 19, 1782: “At the request 
of the wardens, the Rev. Mr. William Rogers, a 
Baptist clergyman, preached in the Church this and 
the following Sunday, and on the 30th of the same 
month he again preached, and the wardens were 
requested to wait upon and thank him for this day’s 
service, and present him with the contribution, and 
ask him to officiate in Church next Sunday in his 
way, provided he cannot conform to our liturgy, 
but if he will conform, the congregation invite him 
further to serve them.” The italics are in the 
original. 
Of the other two members of this first class, one 
was a Fellow of the University for twenty-nine 
57 Updike, History of the Episcopal Church in Narragan- 
sett, Rhode Island, etc., 1st ed., 1847, 2d ed., 1907, vol. ii, 
pp. 188, 189. EARLY YEARS OF BROWN UNIVERSITY 
143 
years, a teacher, and a pastor. The seventh died 
about 1785. 
But if the graduating class was small, the number 
of honorary degrees—twenty-two—was large, over 
three times the number of degrees in course. Of 
these, seven are curiously stated to have received 
their degree “at their own request.” They were 
all college men, three from Harvard, two from 
Princeton, and one each from Yale and the Uni- 
versity of Pennsylvania. Fourteen were “well 
recommended by the Faculty for literary merit”; 
four of these were college men. One of the twenty- 
two, Henry Ward was accidentally omitted from 
both lists by the reporter. Six of the twenty-two 
were clergymen in Great Britain. Among the 
Americans were David Plowell, the second member 
of the Faculty, Joseph Wanton, the deputy gover- 
nor, and four clergymen, staunch early friends of 
the college, Morgan Edwards, Samuel Jones, 
IPezekiah Smith, and Samuel Stillman. 
Master of Arts was the only honorary degree 
conferred until 1784, when Stephen Hopkins was 
given an LL.D. In 1786 Granville Sharp, the 
philanthropist and founder of the Society for the 
Abolition of Slavery, was similarly honored. The 
next year the same degree was given to Jefferson; 
in 1790, to Washington; in 1792, to Hamilton; and 
in 1797, to John Adams. In 1840 Benjamin 
Franklin—not the original philosopher but an 
Episcopal clergyman—was graduated with an A.B. 
In the broadside or programme of the first com- 
mencement one very significant sentence appears, 
but in small type: “Nomina alphabetice disposita 144 
SELECTED PAPERS AND ADDRESSES 
sunt.” In older colleges a different practice 
had prevailed. “In all the Harvard College cata- 
logs previous to 1773,” says Sibley, “the graduates 
. . . are arranged not in alphabetical order, but 
according to their social position or family rank.58 
Judge Wingate, writing to Librarian Peirce re- 
specting the excitement which was generally called 
up when a class in college was ‘placed,’ says ‘the 
scholars were often enraged beyond bounds for 
their disappointment, and it was some time before 
a class could be settled down to an acquiescence in 
the allotment.’ The higher part of the class, those 
whose names came first in the earlier catalogs, 
generally had the most influential friends; and they 
commonly had the best chambers in college assigned 
them. They also had a right to help themselves 
first at the table of commons. ‘I think,’ Judge 
Wingate concludes, ‘that the government of the 
college, in my day, was a complete aristocracy.” 59 
5S See W. C. Lane, The Rebellion of 1766, in Harvard Col- 
lege, p. 41, footnote; Publications of the Colonial Society of 
Massachusetts, 1906, vol. x. Kingsley, in his History of 
Yale College, vol. i, pp. 95, 96, says, “In 1768 the names were 
for the first time arranged in alphabetical order. Before 
this the names had been arranged according to the rank in 
society which it was supposed their fathers held; and accord- 
ing to Dr. Woolsey, one of the most severe punishments con- 
sisted in placing a student on the list, in consequence of some 
offence, below the rank to which his father’s condition would 
assign him, thus declaring that he had disgraced his family. 
Dr. Woolsey tells the story of a shoemaker’s son who, when 
questioned as to the quality of his father, replied that he was 
‘upon the bench,’ which gave him of course a high place.” 
50 Guild, Proven University and Manning pp. 89, 90, EARLY YEARS OF BROWN UNIVERSITY 
145 
A practice similar to this prevailed when families 
were seated in church. In the list of scholars at 
Harrow in the eighteenth century, “Mister” always 
signified the son of a peer.60 Democratic, liberty- 
loving Rhode Island in this simple and inconspic- 
uous word, “alphabetice” reechoed the new note 
for democracy and liberty sounded by Yale a year 
earlier. But we took this stand at our very first 
possible opportunity, that is, at the very first com- 
mencement. 
The date of the annual meeting of the Corpora- 
tion was fixed by the charter on the first Wednes- 
day in September, “at which or at any other time 
the Public Commencement may be held and 
celebrated.” Commencement from the beginning 
until 1870, eleven years after I graduated, was 
always held on the first Wednesday in September. 
This was most inconvenient for the students, and 
a severe tax on the resources of not a few. The 
college work ended in June, and to compel men to 
come back three months later simply to receive 
their “sheepskins” was a hardship. Morever, 
it was equally inconvenient for the people of Provi- 
dence, especially as the summer vacations grew 
longer and longer and people returned to the city 
later and later. Finally, in 1870, the date of com- 
mencement was changed to the third Wednesday in 
June.61 
At the second meeting of the Corporation 
(1765) it was directed that a seal be prepared, but 
60 Bruce, William and Mary College Quarterly Historical 
Magazine, April. 1914, p. 249. 
61 In 1851 commencement was held in July, but after two 146 
SELECTED PAPERS AND ADDRESSES 
a copperplate for diplomas was not ordered until 
September, 1773. Possibly this was partly due 
to the odious Stamp Act, for, said Senator La 
Fayette S. Foster, speaking at the centennial 
dinner: “Lord Grenville, the Chancellor of the Ex- 
chequer, in March, 1764, . . . gave notice in Par- 
liament that he would apply the stamp act to the 
colonies, and that stamp act imposed a tax even 
upon college diplomas.”62 Meantime the di- 
plomas were evidently written, for Manning, in a 
letter to Rev. John Ryland on November 12, 1772, 
says that the college had conferred an A.M. on Ry- 
land’s son, “but through my hurry and absence 
from home since Commencement I have not got 
his diploma written.” 63 
When the college was moved to Providence, 
years’ trial was again held in September until 1870, when it 
was permanently changed to June. (Guild, Brown Univer- 
sity and Manning, p. 347.) 
At Harvard the first commencement was held on October 
22, 1642, the second in September, 1643. During the rest of 
the seventeenth and most of the eighteenth centuries it was 
held on the second Saturday in August. For the first half 
of the nineteenth century the date was the last Wednesday in 
August. In 1849 it was changed to July, and in 1869 to the 
fourth Wednesday in June. 
At Yale the date was the second or third Wednesday in 
September down to 1831; from 1832 to 1850 in August, 
usually the third Wednesday or Thursday; from 1851 to 1872 
in July; from 1873 to 1880 on the Thursday after the last 
Wednesday in June; from 1880 to 1908 on the last Wednes- 
day in June. In 1909 the date was fixed on the next to the 
last Wednesday in June. 
62 Centennial Celebration, p. 168. 
63 Guild, Brown University and Manning, p. 191. EARLY YEARS OF BROWN UNIVERSITY 
147 
Manning reopened his Latin school, which later 
became the University Grammar School. He 
was immediately invited to preach for the First 
Baptist Church and soon after became its pas- 
tor. 
The second commencement (1770) was held in 
Mr. Snow’s meeting-house, and notwithstanding 
the reported “decorum” that prevailed, the Cor- 
poration were obliged to pay for breakages of win- 
dows, etc., owing to the throng. “The members of 
the Grammar School joined in the procession. 
Before the Assembly broke up a piece from Homer 
was pronounced by Master Billy Edwards [son of 
Morgan Edwards], one of the Grammar School 
boys not nine years old.” 64 
Poor Billy Edwards!65 
Four students only were graduated, one of 
whom, Theodore Foster, attained prominence as 
a United States Senator, judge, and antiquary. 
But the Fellows kept up the pace set for the year 
before in the matter of honorary degrees. This 
ratio in 1769 was three for one, and in 1770, with 
four graduates, they gave the honorary A.M. to 
twelve men, of whom seven were Englishmen. 
Only one of the twelve (Benjamin West) achieved 
any distinction. 
64 Guild. Brown University and Manning, pp. 164; 165. 
65 Ryland (Guild, Brown University and Manning, p. 173) 
states that his son “rendered his Greek Testament into Eng- 
lish all through before he was nine years old and at nineteen 
is very ready at Hebrew, Latin and French.” What cruel 
drudgery for children! It may well have disgusted them with 
the Bible. 148 
SELECTED PAPERS AND ADDRESSES 
In the bill of Nicholas Brown & Co.GG for the 
expenses incurred in building University Hall and 
the President’s house in 1770, several items are of 
interest. 
At the meeting of the Corporation (held, be it 
observed, at 7 a. m.) , at the time of the very success- 
ful first commencement in September, 1769, a com- 
mittee was appointed to buy a site in Bristol county 
(in which Warren was situated) and erect a build- 
ing. This aroused a lively opposition in other 
counties against Warren as the permanent loca- 
tion. 
A special meeting of the Corporation was held at 
Newport, November 14 to 16. Professor Bron- 
son’s History gives the details. Suffice it to say that 
the Corporation rescinded the vote in favor of 'War- 
ren, and directed that the building committee “do 
not proceed to procure any other materials . . . ex- 
cepting such as may easily be transported to any 
other place,” if such place be selected before Janu- 
ary 1, 1770. It was then explicitly voted “that 
the College edifice be at Providence,” upon the 
condition that the subscription of Providence be 
larger than that of Newport or of any other 
county. 
Another special meeting for final action was 
called in Warren for February 7, 1770. The de- 
bate on the location was evidently conducted in 
public, for it was before “a crowded audience.” 
It was also very long and very heated. The dis- 
cussion lasted from ten o’clock Wednesday morn- 
66 Guild, Brown University and Manning, pp. 153-155, 
quotes a number of items from this bill. EARLY YEARS OF BROWN UNIVERSITY 
149 
ing until ten o’clock Thursday night, when finally 
Providence won over Newport by twenty-one to 
fourteen votes. The decision turned upon the 
amount of the respective subscriptions. Moses 
Brown 67 confesses that, as at first computed, New- 
port exceeded the subscriptions of Providence 
“land and all.” 
The word “land” throws light on certain 
items in the bill of Nicholas Brown & Co., for 
on January 1, 1770 (over a month before the 
final vote in favor of Providence was taken), are 
the following items: (1) Three persons (only one 
of whom, Joseph Brown, was a member of the Cor- 
poration) were sent to Cambridge “to view the 
Colleges.” Their total expenses were <£7 3s. 8/4d. 
(2) Five shillings and three pence were voted for 
the hire of horses to go seven miles “to purchase the 
lot for the College”; and (3) three shillings and 
seven pence were paid for a horse and ferriage in 
going to Rehoboth “to contract for brick.” While 
the entries are all dated January 1, 1779, they were 
clearly for services rendered at various times be- 
fore that date. Evidently, therefore, the Provi- 
dence people had faith that the ultimate decision 
would be in their favor. 
As an illustration of the habits of the time, some 
other items also in this bill are of interest. On 
June 19, 1770, an entry reads one shilling and six 
pence “for one pail to carry water to drink in.” 
This pail, however, I fear did not suffer from over- 
use, for from that same date, June 19, to July 18, 
just twenty-six days excluding Sundays, thirty- 
67 Guild, Brown University and Manning, p. 123. 150 
SELECTED PAPERS AND ADDRESSES 
six 68 items appear for “West India rum,” “good 
rum,” “very good rum,” or “old rum.” When the 
president’s house was “raised” the rum was 
sweetened with sugar. The laying of each floor of 
University Hall and the raising of the roof were 
rewarded by sweetened rum. The well-diggers 
were especially favored, for twenty-four of the 
thirty-six items were for them, and when they 
actually “found the spring” the Chancellor, 
Stephen Hopkins, himself ordered an extra half 
gallon. 
But I have lingered too long over the details of 
this interesting though brief period of our history. 
Looking back over all these six years of almost 
disheartening struggle, what lesson should we 
learn ? 
The honored, yea, revered founders of this Uni- 
versity were men of heroic mold. Undaunted by 
the many obstacles blocking their pathway, they 
fearlessly grappled with them all and overcame 
them all. They budded into meeting-house and 
parsonage, and Latin school and College, their 
own rugged character and determination to suc- 
ceed, and what is more they did succeed. They 
have been splendidly seconded by their successors. 
Witness the fair “College sur la Colline,” and 
witness its worthy fruitage in private culture and 
character, in public service to church and state, to 
industry and invention, to literature, education, 
theology, medicine, and law, and to honorable com- 
mercial life. 
68 See original bill in the University archives. EARLY YEARS OF BROWN UNIVERSITY 
151 
The little seed planted by Morgan Edwards, 
watered and watched over by James Manning, has 
grown to be a stately tree, whose branches have 
sheltered every creed, whose fruit has nourished six 
generations of brave men and women who have 
helped to build, to preserve, to instruct, and to 
develop this nation; who have carried the Gospel to 
the ends of the earth; who have taught us to live 
not by bread alone, but by the things of the spirit. 
These are the things that elevate and ennoble char- 
acter, and Brown University has ever set on high 
these real and eternal verities of God. “AULD LANG SYNE”1 
I heard recently the story of a man who owned a 
circus with which of course went a menagerie. 
Sometimes he indulged a little too freely in the 
flowing bowl and had suffered for it. On this oc- 
casion he wras rather more frazzled than usual, but 
was sober enough to know what to expect if he 
showed himself to his not over-indulgent spouse. 
Instead, therefore, of seeking his own bed he finally 
unlocked the lions’ cage and lay down there. In 
the morning his wife, after much searching, at 
last found him in the cage. Her only greeting was 
two words and a double gesture. Shaking both 
fists at him, she exclaimed, “You coward!” 
Now, on the contrary, I have boldly ventured in 
here facing even a whole battalion of women with- 
out any fear, for I know by nearly thirty-five years 
of experience in the Woman’s Medical College of 
Pennsylvania how good and friendly jrou have 
been and, I am sure, still are towards myself. In 
1880 I accepted the post of lecturer in the College 
and in 1884 I became full Professor of Surgery. 
After five years I was obliged to resign, as other 
duties became too urgent and absorbing, but I have 
never lost my interest in the College and am glad 
1 After Dinner Speech in reply to the Toast of “Auld 
Lang Syne,” at the anniversary dinner of the Woman’s Medi- 
cal College of Pennsylvania, May 4, 1915. “AULD LANG SYNE” 
153 
to attest it by my presence on this festal occasion. 
Your genial Dean gave me my marching orders 
in advance. I was to tell you, first, how I liked 
you when I was with you; second, how I like you 
now, and third, what I hope for you in the future. 
When I was with you I found you—or rather 
the predecessors of most of those before me—a 
body of enthusiastic, hard working, intelligent 
students who were daunted by no task, were equal 
to any emergency and were ever faithful to your 
duties. 
Two, or rather three, of my students stand out in 
an individualized way from among the large 
number I had the pleasure of teaching at the WOm- 
an’s Medical College of Pennsylvania. 
First, Mrs. Joshee and her friend Ramabai who 
was occasionally a hearer though not an enrolled 
student. They were the first two in a long line of 
Oriental students,—a line still persisting, for one 
from Ramabai’s school in India and her husband 
are our fellow guests to-night. No women in the 
whole Far East have done finer and more valuable 
work than that inaugurated and still carried on by 
Ramabai for her fellow countrywomen, and the 
work of our many graduates in the Orient. 
A third student who lives vividly in my recollec- 
tion furnished me in May, 1887, wholly unique sur- 
gical experience—unique, I fancy, even in the an- 
nals of Surgery. The student referred to sought 
my advice for a number of tuberculous glands in the 
neck. As they were on the point of becoming ab- 
cesses I advised their removal. To this she im- 
mediately consented but added “upon one condi- 154 
SELECTED PAPERS AND ADDRESSES 
tion.” “And what is that?” “That I shall not 
take ether or chloroform.” “But, my dear child,” 
I said, “surely you do not understand. This opera- 
tion will last probably an hour and a half. I must 
make an incision from your ear to the breast bone 
and then along the clavicle nearly to the shoulder, 
raise both flaps over a large area and dissect the 
glands most carefully from the jugular vein, carotid 
artery, probably the great subclavian vessels and 
certainly from all the numerous large nerves in 
the neck. If you jump from sudden pain I 
do not know where the point of my knife may 
go.” 
“Yes,” she replied, “I quite understand. I will 
stand any amount of pain without budging, but I 
will not take either ether or chloroform.” “Why 
not?” “Because I have already had two operations 
for similar glands elsewhere, both done by Prof. 
Henry B. Sands of New York, one with ether and 
the other chloroform, and I suffered so intensely 
from the after effects that I prefer to endure the 
pain of the operation. If I can not have the glands 
removed without the anesthetic, I will not have the 
operation performed.” “Well,” said I seeing her 
absolutely fixed determination, “only within a few 
days I have seen an account of a new local 
anesthetic called cocain, and if you are willing I 
will try that, but I can’t promise how much it will 
dull the pain as I have never used it.” “Anything 
except ether or chloroform,” was the quiet but de- 
cided answer. A few days later I operated. I 
am well aware that the cocain was but partially 
effective but she never so much as winced. 
Now, however, comes the additional and unique “AULD LANG SYNE” 
155 
surprise. I had made my incisions and had begun 
to dissect the flaps when she said to me,“Would you 
mind if one of the residents (the operation was 
done in the Woman’s Hospital and the residents, 
of course, were women) were to get me her hand 
glass and let me watch the operation?” For a 
moment I confess I was—if I may venture to use 
the word—“flabbergasted.” But I instantly made 
up my mind that any one who could face fearlessly 
an hour and a half of pain without any anesthetic 
would be able to watch the operation without flinch- 
ing. And so it proved. For over an hour she held 
the glass and watched every stroke of my knife, and 
even when I was separating the glands from the 
great jugular vein she did not make a single move- 
ment of head, hand or foot. 
Her later history is interesting, instructive, and 
worthy of her. She was sent to Seoul, Korea, as 
a medical missionary. There (for Cupid flings his 
darts in Korea as elsewhere) she married a doctor. 
After the battle of Pyang Yong in the Japanese 
War of 1895, they went up to attend the wounded. 
There her husband fell a victim of typhus. She at 
once came home on furlough and her second child 
was born in the United States; her first had died in 
Korea. Later she returned to Korea, and for 
some time she has worked in a fine large hospital 
built for the Mission by the late Mr. L. H. Sever- 
ance of Cleveland. Some years ago she established 
the first school for the blind and later the first school 
for the deaf and dumb ever founded in Korea. 
About three years ago she called to see me and I 
was proud of her work, as well I might be. The 156 
SELECTED PAPERS AND ADDRESSES 
Woman’s Medical College of Pennsylvania, also, 
may well count such a woman as one of many who 
have conferred honor upon the College and benefits 
untold upon humanity. 
The second command of Dr. Marshall was to tell 
you how I like you now. The answer shall be 
short, sharp and decisive. If I didn’t like you now, 
I wouldn’t be here! 
And, third, what do I hope for your future? I 
believe in you “up to the hilt.” There is a place 
for an exclusively woman’s medical college in this 
country. Your splendid record for sixty-five years 
is one to be proud of. That you will not only be 
sure to equal it in the future but will surpass it I 
have not the slightest doubt. May your most 
ardent hopes be more than fulfilled! BEFORE AND AFTER LISTER1 
LECTURE I. “BEFORE LISTER” 
On July 1, 1861, I entered the service of the 
State of Massachusetts as assistant surgeon, and 
on July 4 was sworn into the service of the United 
States in the shadow of yonder capitol. On Au- 
gust 1, I was honorably discharged and resumed 
my medical studies at the Jefferson Medical 
College. Strange as it now seems, when assistant 
surgeon I was not yet a graduate in medicine. As 
an evidence of the loose way in which medical and 
military matters were then conducted, I was actu- 
ally appointed without any examination whatever. 
After graduating in March, 1862, I again 
entered the service in May, after an examination, 
and was ordered to the Eckington Hospital then 
in the outskirts of Washington. Shortly after- 
wards I was ordered to fit up two churches as 
hospitals and to have them ready in five days. It 
was 5 p. m., on a Saturday afternoon. 
People sometimes imagine that a practising physician 
can be transformed into an army surgeon merely by put- 
ting a uniform on him. I was not lacking in ordinary 
1 Two lectures before the U. S. Army Medical School, 
Washington, D. C., April 27 and 28, 1915. They were 
written before Godlee’s Life of Lister was published. 158 
SELECTED PAPERS AND ADDRESSES 
intelligence and was willing to work, but I was utterly 
without training. To get those two churches ready as 
hospitals I had to have beds, mattresses, sheets, pillow- 
cases, chairs, tables, kitchen utensils, knives, forks, 
spoons, peppers and salts, all sorts of crockery and other 
necessities for a dining-room, all the drugs, appliances 
and instruments needed for two hundred sick and wounded 
men; I needed orderlies, cooks and the endless odds and 
ends of things which go to make up a well-organized 
hospital. I did not know how to get a single one of these 
requisites. As to drugs, I did not know whether to order 
six ounces or a gallon of laudanum, an ounce or two or a 
pound or two of opium, and I was in utter darkness as to 
the mode of getting any of the other things from a tea- 
spoon to a cook. However, I inquired and as soon as I 
learned how, I set myself to work. For two nights I 
slept only about three hours each, and I had the satis- 
faction of reporting to Dr. Letterman, the remarkable 
Medical Director of the Army of the Potomac at the end 
of three days, instead of five, that I was ready. On the 
fourth day I had one hundred wounded men in each hos- 
pital.2 
I congratulate you in this more enlightened age 
and as students in this fine school where you are 
trained and drilled in matters which we had to cope 
with in our stumbling way, by dint of desperately 
hard work, without guidance, often learning only 
by our bitter mistakes. 
We, the few surgeons still surviving those mo- 
mentous four years, may well say to you Morituri 
salutamus. 
1 have been so very fortunate as to live during 
the whole period of the greatest revolution surgery 
2 Keen, “Addresses and Other Papers,” 1905, p. 424. BEFORE AND AFTER LISTER 
159 
has ever passed through. How strange seem these 
words of Erichsen, then the foremost London 
surgeon and Lister’s early chief at University 
College Hospital, uttered in 1874, just as surgery 
was on the eve of its very greatest triumph. 
Surgery in its mechanical and manipulative processes, 
in its art in fact, is approaching, if it has not already 
attained to, something like finality of perfection.3 
Anesthesia in 1846 and 1847 had robbed opera- 
tions of the terror of agonizing pain. Quick 
“slap-dash surgery”—a necessity before the days 
of anesthesia—then gave way to delicate, pains- 
taking, artistic surgery. Antiseptics thirty years 
later relieved the patients from the terrors of death 
and gave to the surgeon restful nights and joyous 
days. 
Hence when I received the kind invitation to ad- 
dress you it seemed to me that I could possibly 
render you some service by describing the state of 
surgery “Before and After Lister,” since my testi- 
mony would be that of an eye witness. 
When the Apostle Paul was about to be bound 
and scourged you remember that he claimed im- 
munity as a Roman. “With a great sum obtained 
I this freedom,” explained the chief captain. “But 
I,” said the Apostle, with justifiable pride, “was 
free born.” “With a great sum” of the most stren- 
uous labor the men of my generation acquired the 
knowledge and the skill and the immense satisfac- 
tion of the antiseptic and aseptic era—but you, you 
3 Wrench, “Lister’s Life and Work/’ p. 281. 160 
SELECTED PAPERS AND ADDRESSES 
are “free born” and have entered into a rightful 
heritage from your fathers. “Before Lister” and 
“After Lister” in the surgical calendar are the 
equivalents of “b. c.” and “a. d.” of our common 
chronology. 
Modern military surgery may be said to begin 
with Ambroise Pare in the middle of the sixteenth 
century. Gunpowder, though long known, had 
been used in warfare to any large extent for only a 
few decades. The belief, shared fully by Pare 
himself, that such wounds were “poisoned,” was 
universal. Treatment was directed to the destruc- 
tion of the supposed poison by pouring boiling oil 
and hot pitch into such wounds. In the heat of his 
anger at the inhumanity of the new weapons he 
says in his preface to Book XI, “Of wounds made 
by gunshot and other fiery Engines and all sorts 
of Weapons”:4 
I think the deviser of this deadly Engin hath this for 
his recompense that his name should be hidden by the 
darkness of perpetual ignorance as not meriting for this 
his most pernitious Invention Any Mention from Pos- 
terity. 
Yet with a curious inconsistency he immediately 
gives the name of a German monk as the “deviser.” 
Listen to his quaint story of how he discovered 
that gunshot wounds were not poisoned. In 
1536 
it chanced on a time that by reason of the multitude that 
were hurt I wanted this Oil [“03d of Elders Scalding hot 
4 “The Works of that Famous Chirurgeon Ambrose Parey,” 
translated by Th. Johnson, London, 1678, p. 270. BEFORE AND AFTER LISTER 
161 
with a little Treacle mixed therewith”]. Now because 
there were some few left to be dressed I was forced . . . 
that I might not leave them undrest to apply a digestive 
made of the yolk of an egg, Oil of Roses and Turpentine. 
I could not sleep all that night for I was troubled in mind, 
and the dressing of the precedent day (which I judged 
unfit), troubled my thoughts; and I feared that the next 
day I should find them dead, or at the point of death by 
the poison of the wounds. . . . Therefore I rose early in 
the morning. I visited my Patients and beyond expecta- 
tion I found such as I had dressed with a digestive only, 
free from vehemency of pain, to have had a good rest and 
that their wounds were not inflamed . . . but . . . the 
others that were burnt with the Scalding Oyl were feverish 
tormented with much pain . . . and swoln. When I had 
many times tried this in divers others, I thought this 
much, that neither I nor any other should ever cauterize 
any wounded with Gunshot.5 
But he still advocated the actual cautery for 
arresting hemorrhage even down to early in 1522. 
But later in that same year he changed his practise 
and thus describes his introduction of the ligature 
—a famous advance. 
I confess here freely and with great regret that here- 
tofore my practise has been entirely different from that 
which I describe at present after amputations. ... I 
advise the young surgeon to abandon such cruelty and 
inhumanity and follow this better method. . . . Having 
several times seen the suture of veins and arteries for 
recent wounds which were attended by hemorrhage I have 
thought that it might be well to do the same after the 
amputation of a limb. Having consulted in reference to 
5 Johnson’s “Pare,” p. 272, 162 
SELECTED PAPERS AND ADDRESSES 
this matter with Etienne de la Riviere, Ordinary Surgeon 
to the King, and other surgeons sworn of Paris, and hav- 
ing declared my opinion to them, they advised that we 
should make the experiment [espreuve] on the first 
patient that we had, but [note his cautious uncertainty] 
we would have the cautery all ready in case of any 
failure of the ligature. I have done this on the person 
of a postilion named Pirou Garbier, whose right leg I cut 
off . . . following a fracture.6 
At the Siege of Danvilliers7 also in 1552 he 
records the amputation of the leg of a gentleman 
in the suite of M. de Rohan “without applying the 
actual cautery.” In another places Pare says 
that he was taught this new method “by the special 
favor of the Sacred Deity.” He also refers to 
Galen’s advocacy of the ligature. After many 
trials, Pare definitely adopted the ligature and 
“bid eternal adieu to all hot Irons and Cauteries.” 
He does not seem to have lost sleep over the liga- 
ture as he did sixteen years before when he aban- 
doned the boiling oil and the hot pitch. Both were 
experiments on human beings. “Human vivisec- 
tion” would have been the outcry of a sixteenth- 
century antivivisection society. But had he or 
some successor not made these experiments we 
should still be filling gunshot wounds with boiling 
oil and hot pitch and searing amputation flaps with 
the actual cautery. How much greater a boon to 
humanity it would have been if years earlier instead 
6 Malgaigne’s “Pare,” Chap. XXVI., pp. 227, 230. 
7 Malgaigne’s “Pare,” III., 698. 
8 Johnson’s “Pare,” London, 1678, Book XII., Chap. 
XXIV., p. 305. BEFORE AND AFTER LISTER 
163 
of experimenting in both cases on human beings 
first, Pare had experimented on a few animals to 
determine whether gunshot wounds were poisoned 
and whether the ligature or the cautery was the best 
means of arresting hemorrhage! 
We can also incidently learn how the doctrine of 
euthanasia was applied in Pare’s time in the case 
of the desperately wounded by the following inci- 
dent. 
In his first campaign, entering a stable where 
he expected to put up his own and his man’s horses, 
Pare 
“found four dead soldiers and three propped against the 
wall, their features all changed, and they neither saw, 
heard nor spake, and their clothes were still smouldering 
where the gun-powder had burnt them. As I was looking 
at them with pity there came an old soldier who asked me 
if there was any way to cure them. I said no, and then 
he went up to them and cut their throats gently and with- 
out ill will toward them.” 9 
Leaping over three and a half centuries of only 
moderate progress, let us next consider the state of 
surgery one hundred years ago. No better repre- 
sentative perhaps could be chosen than John Bell, 
the professor of surgery in Edinburgh, whose “Dis- 
courses on the Nature and Cure of Wounds” had 
reached a third edition in 1812, and his “Principles 
of Surgery” a new edition in 1826, to which his 
brother, Sir Charles Bell, also contributed. 
In the former he states that tents or setons were 
much in use and the surgeons “were quite delighted 
9 Paget’s “Ambroise Pare/’ p. 31. 164 
SELECTED PAPERS AND ADDRESSES 
with seeing prodigious quantities of matter spout- 
ing out when they drew their spigot away” (p. 
299). 
As to the abdominal wounds he says. 
“Having put it down as a prognostic, which is but too 
well confirmed, by much melancholy experience, that 
wounds of the belly are mortal, there is no reason why we 
should, in recording our cases, take any note of a man 
having died after such a wound. Death from such a 
wound is a daily and expected occurrence and, therefore, 
is not marked; but if we find that a man has escaped, are 
we not to record every such escape?” (p. 313). 
Per contra, to-day recovery has been achieved 
after 19 wounds of the abdominal viscera! 
He considers wounds of the joints also as mortal. 
Amputations even in the most favorable circum- 
stances did not heal under four, five or six months! 
In his “Principles of Surgery” 10 he pictures 
the wards of a hospital as follows: You look 
“upon limbs variously wounded, but all of them lying out, 
swollen, suppurating, fistulous, rotting in their own filth, 
having carious bones, bleeding arteries and a profusion of 
matter; the patients exhausted in the meanwhile, with 
diarrhea, fever and pain.” 
Again he refers to a wounded limb as “soaking 
in suppuration” and again, of its “lying in a slush 
of matter and foul poultices.” 
He relates the case of an officer under the care 
of Guerin, a French surgeon. He was wounded 
10 John Bell’s “Principles of Surgery,” new edition, with 
comments by Charles Bell, London, 1826, p. 86. BEFORE AND AFTER LISTER 
165 
by a ball which had broken the fifth rib twice and 
traversed the entire chest. After dilating the 
wounds, Gu£;rin introduced a seton [“a great strap 
of coarse linen”], 
“which, of course, went across the breast as a bow-string 
crosses a bow, and this seton he continued to draw [to 
and fro] with a perseverance which is truly wonderful 
from the first day to the thirty-eighth day of the wound; 
during all of which time the patient’s sufferings were 
dreadful” (p. 458). 
In fifteen days the patient was bled twenty-six 
times. After the removal on the thirty-third day 
of a splinter of bone, which had been imbedded in 
the lung, the patient, strange to say, recovered 
both from the wound and from the surgeon. It 
is not to be wondered at that Bell condemns such 
treatment. But at that time it existed in the prac- 
tise of the most reputable surgeons. 
Erysipelas, tetanus, pyemia, septicemia were 
rife. Hospital gangrene was endemic in many if 
not most hospitals, due to inevitable infection in 
practically every wound. Veritable epidemics were 
frequent. Is it any wonder that it had always 
been present for nearly two hundred years in the 
Hotel Dieu in Paris when there were often from 
two to six patients (and such patients!) in one bed? 
Passing along the streets of Paris even during the 
Crimean War 11 “one could recognize at a distance 
a surgical hospital owing to the stench of the human 
putridity it contained.” In the surgical wards, 
“no matter how well ventilated, there was a fetid 
11 Wrench’s “Life of Lord Lister/’ p. 239. 166 
SELECTED PAPERS AND ADDRESSES 
sickening odor” up to the days of Lister himself, 
wrote Sir Hector Cameron, Lister’s house surgeon 
in Glasgow. Death always stalked grimly behind 
the surgeon. 
“Secondary hemorrhage, tetanus, erysipelas, septicema, 
pyemia and hospital gangrene were never all absent . . . 
and at times pyemia and hospital gangrene became 
alarmingly epidemic.” 12 
After vividly describing the ravages of hospital 
gangrene Bell then vehemently asks: 
“What, then, is the surgeon to do? Is he to try experi- 
ments with ointments and plasters while the men are dy- 
ing around him? Is he to seek for washes and dressings 
to cure such a disease as this? Is he to expend butts of 
wine contending, as it were, against the elements? No! 
Let him bear this always in mind, that no dressings have 
ever been found to stop this ulcer, that no quantities of 
wine or bark which a man can bear have ever retarded 
this gangrene; let him bear in mind that this is a hospital 
disease, that without the circle of the infected walls the 
men are safe; let him, therefore, hurry them out of this 
house of death; let him change the wards, let him take 
possession of some empty house and so carry his patients 
into good air; let him lay them in a schoolroom, a church, 
on a dunghill, or in a stable; let him carry them anywhere 
but to their graves.” 13 
To-day we do not even know the bacteriology 
of this foul disease. I saw many cases of it during 
the Civil War, but since 1865 I have never seen a 
single case. There has been no opportunity to dis- 
12 Cameron, British Medical Jour., Dec. 13, 1902, p. 1844. 
13 Bell, “Principles of Surgery,” 1826, I., p. 149. BEFORE AND AFTER LISTER 
167 
cover its germ if, as is probable, it is a germ disease. 
Lister made its return impossible. 
But let us come down to the next period im- 
mediately before Lister’s work. 
You can do no better than read that remarkable 
and revolutionary paper entitled “Hospitalism” 
by Sir James Y. Simpson, of Edinburgh, published 
in 1867. 14 It was a bombshell whose explosion 
aroused the profession as hardly any other paper in 
my lifetime. The controversy was bitter and wide- 
spread. Fortunately, antisepsis came close upon 
its heels and has forever done away with such a dis- 
grace. 
Simpson collected the statistics of the obstetrical 
mortality in hospitals and in homes with the follow- 
ing startling result. 
Of 888,302 women delivered in hospitals, 30,391 died or 
1 in 29—3.4 per cent. 
Of 934,781 delivered at home, 4,045 died, or 1 in 212—- 
0.47 per cent. 
The reason for the greatly increased mortality 
in maternity hospitals—over seven times greater 
than in individual homes—was chiefly puerperal 
fever. After Oliver Wendell Holmes (1843) and 
Semmelweiss (1861) had attacked the evil, Pas- 
teur finally in 1879 showed its bacteriological cause 
and gave it the coup de grace. 
The 0.47 per cent, of Simpson’s home cases has 
been reduced to 0.15 per cent, and even 0.08 per 
cent, in the maternity hospitals of to-day. 
But his chief assault was upon the surgeons. He 
14 Simpson’s Works, Vol. II., p. 345. 168 
SELECTED PAPERS AND ADDRESSES 
analyzed the four main amputations—arms, fore- 
arm, thigh and leg—and excluded amputations at 
joints and all the minor amputations (fingers, toes, 
etc.). 
Of 2,089 such amputations in hospitals, 855 died, or 41 
per cent. 
Of 2,098 in country practise, 222 died, or 10.8 per cent. 
The latter were collected from 374 country prac- 
titioners, thus eliminating the personal equation. 
The difference was clearly due to the crowding 
and lack of sanitation in the hospitals of that day. 
ITe gives two very interesting tables. The first 
is most instructive in showing the results in the 
then unsanitary state of all hospitals. 
Mortality After the Four Selected Amputations in 
Proportion to the Number of Beds in the Hospitals. 
In the large Parisian hospitals 62 in 100 die 
In British hospitals with 300 to 600 beds . 41 in 100 die 
In British hospitals with 300 to 201 beds . 30 in 100 die 
In British hospitals with 200 to 101 beds . 23 in 100 die 
In British hospitals with 100 to 26 beds . 18 in 100 die 
In British hospitals Avith 25 beds or less . 14 in 100 die 
In isolated rooms in country practise . . . 11 in 100 die 
In the second he tabulates the mortality accord- 
ing to the experience of the operator. 
Death Rate After the same Four Amputations in 
Accordance with the Experience of the 37Jf, Operators 
Those who had done less than 6 amputations lost 1 in 7 
Those who had done from 6 to 12 amputations lost 1 in 9 
Those who had done 12 or more amputations lost 1 in 12 BEFORE AND AFTER LISTER 
169 
What an argument for the necessity for a year 
in a hospital for the recent graduate before allowing 
him full liberty of action! 
In France matters were as bad if not even 
worse. T. Holmes and Bristowe in 1861 had found 
that in Paris, of 102 of the four amputations in 
question, 67 died, a mortality of 65.7 per cent., or 
two out of every three. Out of 1,656 amputations 
in the Paris hospitals collected by Malgaigne and 
Trelat 803 died, 48.5 per cent., almost one in every 
two (Simpson, p. 291). 
To-day, how entirely changed is all this. Lis- 
terism has transformed what Bell well called 
“Houses of death” into “Havens of safety.” No 
home, however wealthy its inmate, can be as sani- 
tary, as surgically clean or give as good results as 
a modern hospital. 
The best evidence of the truth of this statement 
I can give you is the statistics of Dr. W. L. Estes,15 
of South Bethlehem, Pennsylvania Surgeon to the 
Bethlehem Steel works. They are of especial 
value in that they are the statistics of the same 
surgeon in the same hospital and on the same class 
of patients. He reports the result in 724 major 
amputations. In 616 single amputations there were 
28 deaths, a mortality rate of 4.54 per cent. Of 
469 of the four selected amputations, 25 died, a 
mortality of 5.3 per cent. Of synchronous double, 
triple and one quadruple amputation, many of them 
complicated with other wounds and operations, 
there were 108, with 19 deaths, a mortality of only 
15 Annals of Surgery, July, 1913. 170 
SELECTED PAPERS AND ADDRESSES 
18 per cent. It is very noticeable that in an ear- 
lier paper in 1894 in which he had reported the first 
46 cases of synchronous double, triple and quad- 
ruple and complicated amputations, there were 13 
deaths, 28.3 per cent., whereas from 1894 to 1913 
in the last 62 such cases there were only six deaths, 
a mortality of 9.6 per cent., showing again the value 
of still larger experience even to an already experi- 
enced surgeon. In the second series there was no 
quadruple amputation. 
But as officers of the Medical Corps of the 
Army you will be especially interested in the facts 
as to military surgery before and after Lister. 
Capt. Louis C. Duncan of our corps published a 
very interesting and comprehensive article 1<; just 
before the present European war broke out. 
He states that in Motley’s “Rise of the Dutch 
Republic” in three volumes covering “30 years of 
almost constant sanguinary warfare” in the six- 
teenth century he “never once alludes to an army 
surgeon or an army hospital”! The surgeons 
were undoubtedly not officially attached to the 
army, but were in the suites of kings, princes 
or great nobles, as was Pare, in the same century. 
To Sir James McGrigor in the Peninsular 
Campaign (1808-11) only fifty years before our 
Civil War, is given the credit by Duncan of first 
collecting accurate military medical statistics. 
One hundred and fifty years ago 25 per cent, 
or more of the wounded died. In the Civil War 
and in the Franco-Prussian War of 1870-1 the rate 
16 Journal of the Military Service Institutions of the United 
States, March-April, 1914. BEFORE AND AFTER LISTER 
171 
had fallen to about 15 per cent., while to-day up to 
the present war not over 5 or 6 per cent, die of 
wounds. 
The Crimean War will always be an example of 
utter inefficiency in the English and of even worse 
in the French army. Its one bright spot is the 
splendid epoch-making work of a woman, Florence 
Nightingale, whose labors were unceasing and 
effective. Every later war has seen less sick- 
ness and fewer deaths because of what she then 
accomplished. 
Chenu, the French medical historian of that war, 
has made one curious and interesting calculation, 
partly official, partly estimated. The number of 
projectiles of all kinds actually fired he gives as 
89,595,363. The total number of killed and 
wounded was 175,057. This would show that it 
took 512 projectiles to kill or wound one man. 
Such a disproportion would more than justify a 
cartoon during our Civil War. Two soldiers were 
surprised by a hundred of the enemy. One pro- 
posed to the other to run for it. “No,” was the 
cool reply, “there’s no danger, for they say only 
one ball in 200 ever hits and there are only one 
hundred of those fellows.” 
Duncan’s figures give 82,901 British soldiers 
sent to the Crimea, but the average strength was 
only 34,559, or only about 40 per cent., of effec- 
tives. The killed (2,755) and the deaths from 
wounds (2,019) gave a battle death rate of 69 per 
1,000 per annum, while the disease death rate rose 
to 230 per 1,000 per annum. In all, 300 men out 
of each 1,000 perished each year! 172 
SELECTED PAPERS AND ADDRESSES 
But the French statistics are still worse. While 
315,000 were sent out, the average strength was 
less than 104,000 effectives, or only 33 per cent. 
The killed numbered 7,607 and the deaths from 
wounds 8,813. The battle death rate was 70, the 
disease death rate 341, per 1,000 per annum. Over 
6,000 died from typhus alone. 
Could there be a nobler example of the altruism 
of our profession—an altruism often tested and 
never in vain—than that shown by Drs. Richard 
P. Strong, Thomas W. Jackson, and many other 
doctors and trained nurses, and now finally by the 
chief of our corps—that friend of humanity— 
Major General William C. Gorgas in hastening, 
regardless of danger, to the relief of Serbia, sorely 
smitten by the deadly typhus fever? 
Chenu’s report gives a summary of the English 
as well as the French losses. Comparing it with 
Simpson’s civil statistics eleven years later the mor- 
tality of the four selected amputations (arm, fore- 
arm, thigh and leg) was as follows: Of 2,089 of 
these four amputations in civil hospitals the mor- 
tality in Simpson’s table was 41 per cent. In the 
Crimean War among the British there were 460 
such amputations and 183 deaths, or 40 per cent. 
In the French army there were 5,972 such amputa- 
tions with 4,023 deaths, a mortality of 67.4 per 
cent. In both armies disarticulation at the hip- 
joint had a mortality of 100 per cent., i. e., every 
case died. It is instructive also to compare the 
fate of those who had an amputation of the thigh 
(1,666 French cases) with a mortality of 92 per 
cent., and 48 cases treated conservatively, i. e., BEFORE AND AFTER LISTER 
173 
without amputation, with a mortality of only 70 
per cent.! 
In our Civil War Duncan quotes the figures of 
Fox, which are “the latest revised statistics and 
are all larger than those of the Medical and Sur- 
gical History of the War.” The average strength 
of the Union Armies was 806,755, and the deaths 
359,528, of whom 67,058 were killed in battle and 
43,012 died of wounds. This gives a battle death 
rate of 33 per 1,000 per annum. The disease death 
rate was 65 per 1,000 per annum. The case death 
rate from disease was only 3.4 per cent., a very low 
figure. 
I can testify to the excellent condition of the 
Civil War hospitals, of which I saw many, but 
only in the East. When I say “excellent con- 
dition” it must be with the reserve that we knew 
nothing as to bacteriology, which did not exist, nor 
of infection, which was utterly unkown as to its 
causes and prevention. The general sanitary con- 
ditions, and by this I mean shelter, ventilation, 
cleanliness, good food, as good nursing as intelli- 
gent orderlies could give, etc., were all excellent. 
But the surgical conditions as we now know were 
simply dreadful. Practically every wound sup- 
purated, and in summer I have seen many wounds 
swarming with squirming maggots as large as chest- 
nut worms—disgusting, but fortunately, not espe- 
cially dangerous. 
In my Surgical Reminiscences of the Civil 
War” 17 I have given many statistics taken from 
the official Medical and Surgical History of the 
17 Keen, “Addresses and Other Papers/’ 1905, p. 420. 174 
SELECTED PAPERS AND ADDRESSES 
War, a few of which I will reproduce that you may 
see what blessed conditions you “free born” men 
have inherited. Pymeia (blood-poisoning) was 
one of our worst scourges. There were 2,818 cases, 
and of these only 71 recovered, a death rate of 97-4 
per cent. Few of you probably have seen even one 
such case. I have given a matter-of-fact descrip- 
tion of it in my “Surgical Reminiscences,” but if 
you wish to see it sketched by a master’s hand read 
that most touching and beautiful of all medical 
stories I know—“Rab and his friends,” by dear old 
Dr. John Brown, of Edinburgh. He vividly 
paints the sudden change in the wound, the pulse, 
the eye, the mind, on and on, worse and w7orse, until 
“that animula, blandula, vagula, hospes comesque 
wras about to flee.” 
Tetanus had a mortality of 89.3 per cent. Of 
amputations at the hip-joint 83.3 per cent. died. 
Trephining had a mortality of 61 per cent. Even 
of ligations of the femoral artery, 374 in number, 
281 died, or over 75 per cent. Of 2,235 cases of 
secondary hemorrhage, 61.7 per cent. died. Hos- 
pital gangrene, of which there were several hundred 
cases, had only a mortality of about 25 per cent., 
because we early learned the correct though em- 
pirical treatment, viz., the application of the 
actual cautery, pure bromine, strong nitric 
acid or similar destructive agents which killed 
the germ, whatever it was, and arrested the dis- 
ease. 
The Franco-Prussian War of 1870-71 was 
marked by notable progress in military sanitation 
in the German army, yet in spite of this there were BEFORE AND AFTER LISTER 
175 
74,205 cases of typhoid fever, almost 10 per cent, 
of the entire average strength (788,213) and 8,904 
deaths, a mortality of 11.3 per cent. 
Surgically the results were nothing to boast of. 
Eisterism had as yet made but little progress in the 
profession. Carbolic acid was used to some extent, 
but there was no thorough antiseptic system, for 
the germ theory was as yet neither understood nor 
accepted. 
Of tetanus there were 294 cases, and 268 died, 
a mortality of 91.1 per cent. 
The total of the four selected amputations was 
2,194 with 1,196 deaths, a mortality of 54.5 per 
cent.—over one half. 
Disarticulation at joints showed an average 
mortality of 56 per cent. Fifteen amputations at 
the hip-joint gave a mortality of 100 per cent., and 
resections claimed 40.2 per cent, of deaths. Even 
at the knee-joint Stromeyer amputated 36 times 
with 36 deaths and Nussbaum 34 times with 34 
deaths.18 
The French results were naturally worse, for 
their armies were constantly being defeated and 
retreating, and, especially in the latter part of the 
war, they consisted largely of volunteers, while the 
Germans were mostly veterans of the Schleswig- 
Holstein and Austro-Prussian wars. 
Of the Boer War (1899-1901) only two features 
need be noticed. First, that typhoid attacked 
57,684 men and killed 8,022, while the Boers only 
killed 7,781. Bacteria were more deadly than 
bullets, as Osier has said. 
18 Wrench’s “Lister/’ p. 236. 176 
SELECTED PAPERS AND ADDRESSES 
Secondly, the modern missile was for the first 
time in general use, with the result that instead of 
about 15 per cent, of the wounded losing their lives, 
only about 8.8 per cent. died. The wounds from 
the new missile were much less severe and healed 
more quickly than ever before. The first aid packet 
also had come to the help of the soldier. 
The Spanish American War, surgically speaking, 
was of little moment, as the numbers killed and 
wounded were too small to make the statistics of 
any great value, but it is gratifying to find that 
only 4.6 per cent, of the wounded died. 
Typhoid, however, held high carnival. It caused 
86.24 per cent, of all the deaths! Happily we can 
say that hereafter—thanks chiefly to the anti- 
typhoid inoculations—there will never be another 
such holocaust. (Vide Lecture II.) 
The statistics of the Russo-Japanese War also 
need detain us only a moment. I shall only quote 
the Japanese official statistics, as given by Major 
Lynch, of our army.19 There were 47,387 killed. 
Of 173,425 wounded 11,500 died, a mortality of 
6.7 per cent. The killed and those who died of 
wounds numbered in all 58,887, while the deaths 
from disease numbered only 27,158, a remarkable 
showing. 
The present war naturally has yielded so far 
very few statistics. These can only be collected 
and tabulated after some years of peace. So far 
as I can judge, I fear that, while the mortality 
19 “Reports of Military Observers attached to the Armies 
in Manchuria during the Russo-Japanese War/’ Part IV., p. 
399. BEFORE AND AFTER LISTER 
177 
from disease (except perhaps from typhus, espe- 
cially in Serbia) will be less than in former wars, 
the military conditions are such that the larger 
number of artillery wounds, the unavoidable delay 
in gathering the wounded into hospitals, the appar- 
ent absence of any truce for collecting the wounded 
and burying the dead, and the virulent infection 
from the soil may result in a large mortality rate 
and possibly a larger percentage than in previous 
wars in spite of the benefits of Listerism. But 
were the first aid-packet and the Listerism treat- 
ment not available the mortality ratio in this pre- 
sent horrible war unquestionably would be far 
greater than that which will be recorded. 
This short resume gives us some idea of surgical 
conditions preceding the great revolution inaugu- 
rated by Lister to which we will next proceed. 
LECTURE II. AFTER LISTER 
Yesterday the dominant note was one of despair 
and defeat. To-day the dominant note shall be one 
of joy and victory. 
Instead of hospitals reeking with pus and emp- 
tied by death, of operation after operation, when 
the roll was called, reporting a mortality of 40 
per cent., 50, 75, 90, and even 100 per cent.—we 
have hospitals of immaculate whiteness and emptied 
by quick recovery, while the roll-call of operations 
reveals very few mortalities exceeding 10 per cent.; 
most of them having fallen to 5 per cent., 2 per 
cent., 1 per cent., and even small fractions of 1 per 
cent. 
The story of Lister’s work as recorded in his 178 
SELECTED PAPERS AND ADDRESSES 
successive papers 1 is one of the most fascinating in 
all surgery. His earliest studies, from 1853 to 
1863, were in physiology and pathology. Next he 
took up his researches on putrefaction (or as we 
should now say infection and suppuration) which 
led to his devising the antiseptic system. He wyas 
influenced to make these observations and experi- 
ments, which he applied with such signal success to 
surgical problems, by Pasteur’s earlier researches. 
He always cheerfully acknowledged his debt to the 
eminent Frenchman. When a student in Paris in 
1865 I knew Pouchet fils and was an interested 
spectator in the fight between Pasteur and Pou- 
chet’s father as to spontaneous generation. Le- 
maire’s book on “Acide Phenique” (carbolic acid) 
was published that same year. 
Bacteriology did not exist as a science, but 
Pasteur, Lister and a few of the elect in the upper 
realms of imagination saw the “germs” or “mi- 
crobes and firmly believed them to be the cause of 
infection. In 1900, at the age of seventy-three, 
Lister restated his earlier work 2 and illuminated 
it by many observations, experiments and draw- 
ings made in these early years, but first published 
fifty years after they were made. 
If you wish to know the man, his fertility in de- 
vising new and convincing experiments, and his 
mental acumen in interpreting them “read, mark, 
learn and inwardly digest” that paper and use it 
as a model. 
1 Lister’s Collected Papers, 2 vols., Oxford, 1909, 
* Brit. Med, Jour., 1900, II., 969. BEFORE AND AFTER LISTER 
179 
Pare in his naive way tells us that he sought 
various applications which might “mitigate the 
pains [of his patients] and happily”—mark the 
word “happily”— “bring them to suppuration.” 
That is the “laudable pus” of the pre-Listerian 
days. Lister, on the contrary, believing that in- 
fection and suppuration were evils, and avoidable 
evils, sought by various means to prevent them. 
But he says “all my efforts [during his work in 
Glasgow, 1860-69] proved abortive,” and then 
adds significantly “as I could hardly wonder when 
I believed with chemists generally that putrefac- 
tion was caused by the oxygen of the air.” 
They and he were deeply impressed with the 
absence of putrefaction in simple fractures when 
the air and its oxygen had no access to the fracture. 
In my own lectures, as I often used to express it, 
“The very best antiseptic dressing is an unbroken 
skin.” In compound fractures on the other hand 
when the air and its oxygen had access to the 
lesion, putrefaction always took place and caused 
a frightful mortality. 
To test this supposed noxious influence of 
oxygen he devised many experiments, and among 
them one which may be well called an “experi- 
mentum crucis.” He filled four flasks one third 
full of urine (a quickly putrescible liquid) and 
drew out the necks to tubes one twelfth of an inch 
in diameter. All these tubes were left open. 
Three of these long necks he bent at various angles 
downwards (B) ; the fourth (A) was left verti- 
cal and also open. He then boiled all four flasks 
and awaited the result. The air and its oxygen 180 
SELECTED PAPERS AND ADDRESSES 
had free access to the urine, being slowly drawn 
in during the colder night hours and driven out in 
the warmer daytime in all four flasks. Any 
supposed “germs” floating in the air, he reasoned, 
being heavier than air, could not climb up the 
slanting necks and fall into the liquid. In a short 
time the urine in the flask with the vertical open 
neck was decomposed, but the other three flasks, 
also with open necks but bent downward, 
remained undecomposed for ten years!, 
when an accidental fire destroyed them. 
Could there be a more con- 
vincing proof that the oxygen 
had no influence whatever in 
producing putrefaction, but 
that it was due to living mat- 
ter, “germs,” in the air? It 
was a fine instance of the 
“scientific use of the imagi- 
nation.” “Germs” had been observed from time to 
time, but had not been generally accepted as the 
Vera causa of putrefaction. The experiment just 
related was tried about 1867. The commonest, all- 
pervading germs, the staphylococcus and strepto- 
coccus, were not identified and proved to be the 
chief pyogenic (pus-producing) organisms until 
1881, fourteen years after Lister had seen them 
so clearly with his mind’s eye! Even in 1898 when 
I published my “Surgical Complications and Se- 
quels of Typhoid Fever” I had to prove by 
elaborate citations of experimental and clinical evi- 
dence that the typhoid bacillus itself could cause 
suppuration, and that it had actually been observed BEFORE AND AFTER LISTER 
181 
in the circulating blood—for the past ten years or 
more a work of supererogation. 
From Glasgow Lister went to Edinburgh 
(1869) as the successor of his father-in-law, Syme, 
and continued to experiment, to practise and to 
publish, but only a few were convinced, among 
them being Syme himself. 
On the continent in the early 70’s Saxtorph in 
Copenhagen, Thiersch in Leipzig, Volkmann in 
Halle, Nussbaum in Munich, and Championniere 
in Paris were among Lister’s earliest and most en- 
thusiastic disciples. In America not much atten- 
tion was paid to his work until he visited Philadel- 
phia in September, 1876, to attend the Interna- 
tional Medical Congress held in connection with the 
Centennial Exhibition. He was made president 
of the Section on Surgery and read a paper on 
the antiseptic method. 
At that time I heard him and became fully con- 
vinced of the truth of the “germ theory” and of 
the value of his antiseptic method. When I went 
on duty at St. Mary’s Hospital, October 1, 1876, 
I adopted the system (and was the first surgeon in 
Philadelphia to do so) and have never abandoned 
it. For me it changed surgery from Purgatory 
to Paradise. 
But the reception given to his paper at our con- 
gress was anything but enthusiastic. The only sur- 
geon who practically accepted Lister’s method was 
that excellent St. Louis surgeon, John A. Hodgen. 
But so hazy were the general ideas of bacteria that 
in his own paper Hodgen speaks only of “germs” 
and “germinal matter” and had no idea of bacte- 182 
SELECTED PAPERS AND ADDRESSES 
riology as we now know it, for the science, and even 
its name, did not yet exist. 
In the discussion of Hodgen’s paper Hewson 
advocated his then well-known views on the value 
of dry earth as an “antiseptic.” Frank Hamil- 
ton, of New York, while claiming extraordinarily 
good results from the open-air treatment and the 
warm-water treatment and other rival methods, 
“damned with faint praise” the antiseptic method. 
Kinloch, of Charleston, took the same attitude; 
Carpenter, of Pottsville, a Civil War surgeon, 
advocated chlorine in septic cases. Others sang 
pseans in praise of “perfect cleanliness” and said 
they “used both carbolic and salicylic acids, but not 
for the purpose of excluding germs.” In the dis- 
cussion on Lister’s paper, Van Buren, of New 
York, doubted the safety of the spray of hernia 
and abdominal sections and Satterthwaite, of New 
York, rejected the germ theory of putrefaction. 
In 1877 Girard, of the U. S. Army, 3 became 
the enthusiastic supporter of Listerism. 
In 1880 Markoe, of New York, while admitting 
the fine results of Listerism, spoke of “its some- 
what arrogant pretension to be the true and only 
gospel of the surgery of wounds.” 4 
In 1882 Listerism was again discussed in the 
American Surgical Association. Briggs, of Nash- 
ville, endorsed Lister’s method as “an epoch in sur- 
gery.” Yet so limited was our knowledge of 
“germs” even then that warfare was waged only 
3 Circular No. 3, Surgeon General’s Office, August 20, 1877. 
4 Amer. Jour. Med. Sci., LXXIX., 1880, p. 305. BEFORE AND AFTER LISTER 
183 
upon those “in the air.” When these could be ex- 
cluded he said “putrefaction . . . fails to occur.” 
Yet Briggs qualifies his endorsement by saying 
that the 
“supremacy [of the antiseptic method as contrasted with 
other methods of treatment] . . . can not be demon- 
strated by statistics . . . and the present unsettled 
opinion concerning the proper status of his [Lister’s] 
method is due in great measure to that fact.” 
He emphatically dissented from the germ theory, 
and added 
“Carbolic acid is the keystone of the Listerian wound 
treatment. . . . The germ theory is at fault and fur- 
nishes a very unstable foundation for a system of wound 
treatment.” 
Moore, of Rochester, N. Y., proposed to ex- 
clude the air 
“by passing carbonic acid gas directly into the place where 
the operation is to be performed. In consequence of its 
being heavier than the atmosphere it preoccupies the 
spaqe”( !). 
Campbell, of Georgia, “did not believe that bac- 
teria . . . are the cause of that condition [sup- 
puration].” The various men named were among 
our foremost American surgeons. 
Lister’s opponents entirely missed the great 
fundamental facts underlying the germ theory and 
Lister’s antiseptic method, viz., that infection in all 
its various forms was always of bacterial origin— 
a wholly novel and momentous idea. Each form 
of infection, e. g. tetanus, tuberculosis, typhoid, 184 
SELECTED PAPERS AND ADDRESSES 
etc., it was soon proved, arose invariably and solely 
from its own specific kind of germ. Whether 
carbolic acid or any other germicide was the best 
was a mere matter of detail and not of principle. 
In commenting on this discussion in which one 
prominent speaker is said to have asserted that 
Listerism “is now dead”—a remark I do not find 
in the Transactions—The Lancet, a belated, but 
then, and ever since, a real convert, truly said 
“Surely it is too late in the day to contest the truth of 
the germ theory.” 5 
Yet even a year later (1883) at the American 
Surgical Association while B. A. Watson, of Jer- 
sey City, fully accepted Listerism, other prominent 
surgeons of Philadelphia, New York, New Or- 
leans, Mobile, and other cities even declared in the 
discussion that no surgeon in their cities or states 
used the method. McGraw, of Detroit; Dawson, 
of Cincinnati; Campbell, of Georgia; Prince, of 
Illinois, were “doubting Thomases,” while Kin- 
loch, of Charleston, and Nancrede, then of Phila- 
delphia, advocated it. 
But if its progress was obstructed in the LTnited 
States, its foes in Great Britain were even more 
strenuous and for a season more successful. 
In spite of the striking results in Glasgow and 
in Edinburgh Lister was looked at askance as “un- 
orthodox.” 
1875 The Lancet0 had said 
5 July 1, 1882, p. 1088. 
6 October 16, 1875, p. 565. BEFORE AND AFTER LISTER 
185 
“there is less antiseptic surgery practised in the met- 
ropolitan hospitals than ever there was.” 
At the Clinical Society 7 in a debate on antisep- 
tic surgery in 1875, Mr. Maunder said with a fine, 
but, as the event showed, a too precipitate sarcasm: 
“Mr. Lister expects to prevent traumatic fever and 
. . . suppuration.” 
Timothy Holmes, while professing to have used 
antiseptics “for some years,” declared his disbelief 
in Mr. Lister’s theory with regard to “germs.” 
The Lancet's editorial on the debate said it was 
“evident that few of the speakers either place faith 
in Lister’s theory or carry out his practise in full.” 
After eight years in Edinburgh Lister was 
chosen professor of surgery in King’s College, 
London, in 1877. This was the last stand of his 
opponents. The British Medical Journal, how- 
ever, heartily urged the appointment of “the great 
surgeon of Edinburgh.” 
October 1, Lister gave his first lecture. He 
took as his subject “Bacteriology,” though not us- 
ing that title for, as Stewart said, “as yet the science 
had not a name.” 8 
Stewart9 gives a vivid account of the dreary 
days during which he and the other assistants 
whom Lister had brought with him from Edin- 
burgh wandered in wards of other hospitals 
7 Lancet, October 30, 1875. p. 628. 
8 The earliest instance of the use of the word “bacteriology” 
I have found is a quotation dated 1884 in the Oxford Dic- 
tionary. 
9 Wrench, p. 274 et seqq. 186 
SELECTED PAPERS AND ADDRESSES 
“heavy with the odor of suppuration” while 
Lister’s own small wards were filled with empty 
beds. Instead of the Edinburgh crowds of “500 
eager listeners” their “hearts were chilled by the 
listless air of the 12 or 20 students who lounged 
into lecture at King’s”—only 12 or 20 students! 
But a month later the tide turned.10 A case 
of fractured patella was admitted and in violation 
of all surgical precedent, for in that septic era to 
open a knee-joint meant too often the loss of limb 
or even life, Lister boldly opened the joint, but 
with every antiseptic precaution, and wired the two 
fragments together. This elicited the remark 
from a distinguished London surgeon: 
“When this poor fellow dies, someone ought to proceed 
against that man for mal-practise.” 
But the man got well. Soon after this a case 
with an enormous malignant tumor of the thigh, 
which had been declined by other surgeons, came 
to Lister. He amputated the limb and, 
“the members of the staff and students visiting this inter- 
esting patient were astonished to find him in a day or two 
sitting up in bed and reading a paper, being free from 
pain and free from fever.” 
A little later Paget and Hewitt both refused to 
operate on a lady of social importance with a large 
tumor of the shoulder-blade. luster operated in 
the presence of Paget and Hewitt and she recov- 
ered without suppuration, fever or pain. 
Yet two years later still (1879) Savory, Thomas 
10 Wrench, p. 278 et seqq. BEFORE AND AFTER LISTER 
187 
Bryant, Tait and Spence, while claiming to prac- 
tise antiseptic surgery so far as strict cleanliness 
was concerned, declined to subscribe to Lister’s 
doctrines or to practise his method. 
But the enthusiastic acclaim of the International 
Medical Congress in Amsterdam in that same year 
set the seal of approval of the profession at large. 
This may be said to be the date of the general ac- 
ceptance of Lister’s theory and Lister’s method. 
London then capitulated. 
In 1902, twenty-three years later, London made 
ample amends for its persistent early skeptism by 
a most generous outburst. The Boyal Society, of 
which Lister had been president and from which he 
had received two medals, gave a banquet in honor 
of the jubilee of his doctorate. It was a most dis- 
tinguished occasion, and was made preeminent by a 
happy sentiment by Mr. Bayard the American 
Ambassador. Said he, addressing Lister: 
“My Lord, it is not a Profession, it is not a Nation, it 
is Humanity itself which, with uncovered head, salutes 
you.” 
Better, far better, such a eulogium than the peer- 
age which had been already bestowed upon him. 
Having now traced so imperfectly the fortunes 
of the germ theory, let us see the results of Lister’s 
labours. The first results are his own, especially 
in Glasgow. There the horrible conditions he has 
so startlingly portrayed11 should have made his 
wards a charnal house. 
11 Lancet, 1870, I., pp. 4, 40, and quoted in my “Animal 
Experimentation and Medical Progress,” pp. 216-18. 188 
SELECTED PAPERS AND ADDRESSES 
The mortality in the other accident ward was so 
excessive that it had to be closed. But in Lister’s 
ward, separated from the other only by a corridor 
twelve feet wide, for the nine months “in which his 
antiseptic system had been fairly in operation 
. . . not a single case of pyemia, erysipelas or 
hospital gangrene had occurred.” 
The reason for the first attempt to apply the 
antiseptic system to man is well stated in his very 
first paper on the antiseptic method in 1867.12 He 
wrote 
“The frequency of disastrous consequences in compound 
fracture, contrasted with the complete immunity from 
danger to life or limb in simple fracture, is one of the 
most striking as well as melancholy facts in surgical prac- 
tise.” 
Well might he say this, for while simple frac- 
tures had practically no mortality, the mortality of 
compound fractures at that time was from 28 to 
68 per cent! In this, his first paper, he reported in 
detail eleven cases, with one death, an unheard of 
mortality of only 9 per cent.! 
Thus encouraged, he attacked with an equally 
happy outcome abscesses, especially that bane of 
surgery in those septic days, abscesses of the spine. 
Be it observed too that fifteen long years were to 
elapse before the tubercle bacillus, the cause of 
such abscesses, was discovered by Koch (1882). 
From accidental wounds it was but a step to de- 
12 Lancet, 1867, I., p. 326 et seqq. and II., p. 95, and 
Lister’s “Collected Papers,” II., p. 1. BEFORE AND AFTER LISTER 
189 
liberately infect wounds, i e., surgical operations. 
Here too preventive antisepsis gave equally valu- 
able results. 
Lister, however, was much more given to estab- 
lishing principles and methods than to statistics, 
but some of his early disciples published striking 
proofs of the value of his method by contrasting 
their former results with those which followed the 
acceptance of the germ theory and the adoption of 
Lister’s antiseptic treatment. 
Thus Dennis 13 (1890) says that 
“The time is within my own recollection when, in Bellevue 
Hospital, amputation was immediately performed as a 
routine treatment to prevent blood poisoning, upon the 
admittance of a compound fracture; and this operation 
was considered by surgeons as offering to the patient the 
only chance of recovery.” 
This corroborates what Syme had already said 
in Edinburgh, that on the whole he was inclined 
to think 
“it would be better if in every case of compound fracture 
of the leg amputation were done without any attempt to 
save the limb.” 14 
Dennis in his paper reported 681 cases of com- 
pound fracture, with only 19 deaths, a mortality 
of only 2.8 per cent., and only one of these 19 
deaths was from sepsis, or 1/7 of 1 per cent.! 
In Nussbaum’s insanitary hospital in Munich, 
13 Medical News, April 19, 1890, p. 423. 
14 Cameron, Brit. Med. Jour., December 13, 1902, pp. 1844- 
45. 190 
SELECTED PAPERS AND ADDRESSES 
which Lister visited in the summer or autumn of 
1875, he states 15 that pyemia had been 
“very frequent and hospital gangrene which made its 
appearance in 1872, had become annually a more and 
more frightful scourge until in 1871 it had reached the 
astounding proportion of 80 per cent, of all wounds that 
occurred in the hospital, whether accidental or inflicted 
by the surgeon 1” 
After trying every possible different method of 
treatment and still being unable to combat hospital 
gangrene and pyemia, Nussbaum finally adopted 
Lister’s full antiseptic treatment and from the be- 
ginning of 1875 they had “not had one single case 
of hospital gangrene . . . and were doubtful 
whether they had had one case of pyemia”; and 
“the convalescent wards—which previously had been filled 
and overflowing constantly—Lister saw standing one 
after another empty, because patients, no longer affected 
with hospital gangrene, recovered much more rapidly.” 
In Halle, Volkmann 16 was operating in an ex- 
tremely unhealthy hospital in small, overcrowded 
wards, with the toilet rooms opening directly into 
them and a large drain running directly under- 
neath. It was so bad that it had been condemned 
to demolition. In the two years after his introduc- 
tion of the antiseptic method in 1872, no single 
patient suffering from compound fracture had died 
15 Brit. Med. Jour., 1875, II., p. 769, and “Lister’s Works,” 
Vol. II., p. 248. 
10 “Lister’s Works,” II., pp. 249-51, Brit. Med. Jour., 1875 
II., p. 769, and Lindpainter (Volkmann’s assistant), Deutsch., 
Zeit. f. Chir., October, 1876, p. 187. BEFORE AND AFTER LISTER 
191 
either from the fracture or from a necessary 
amputation, nor was there a single death from 
secondary hemorrhage or gangrene. No case of 
blood poisoning had occurred for a year and a half, 
though sixty amputations had been done. Just 
before Lister’s method had been introduced, of 17 
amputations 11 had died from pyemia alone, a 
mortality of 65 per cent. Just after adopting 
Listerism the death rate of his amputations fell to 
4 or 5 per cent.17 
Hospital gangrene had been as it were “blown 
away” by a puff (“weggeblasen”) ; not a single 
case occurred. In Lindpainter’s extensive tables 
of Nussbaum’s cases one is struck, on glancing 
over them, to see how before the antiseptic method 
was adopted case after case is marked “died,” 
“died,” “died,” and in the later tables, after its 
adoption, almost a uniform “recovered,” “recov- 
ered,” “recovered.” 
But the most striking testimony to the value 
of Lister’s services to suffering humanity is not 
the statistics of the mortality in amputations, com- 
pound fractures, puerperal fever 18 or in any single 
disease or operation, but in the enormous and 
successful enlargement of the beneficent field of 
surgery. In my own early days “before Lister” 
the common operations were 
1. Amputations. 
2. Ligation of arteries. 
3. Removal of external tumors. 
17 Lancet, 1881, II., p. 281. 
18 See the extraordinarily interesting paper by J. Whitridge 
Williams, Jour. Am. Med. Ass., April 22, 1911. 192 
SELECTED PAPERS AND ADDRESSES 
4. Lithotomy. 
5. Tracheotomy, chiefly for Diphtheria and for- 
eign bodies. A few resections, colostomies, tre- 
phining (when unavoidable) and herniotomies (for 
strangulation) were done. Ovariotomy was never 
done until the tumor had become so large as to 
threaten life, and then operation was denounced by 
many as wholly unjustifiable, for it had a mortality 
as high as two out of ever}7 three cases. The head, 
the chest, the abdomen were ticketed “Noli me tan- 
gere” except in the rare cases when operation was 
absolutely unavoidable. 
I used to wonder why the students in “Rab and 
His Friends” rushed to the amphitheater to get 
the best seats to see Syme amputate a breast—a 
so very common operation nowadays. But then I 
recalled the fact that even in my student days, when 
anesthesia was the rule, capital operations were 
rare. But in the preanesthetic days operations 
were far rarer. In the five years preceding the 
introduction of ether at the Massachusetts General 
Hospital (Boston) the entire staff only per- 
formed in all 184 operations or three operations a 
month! When operations had become not only 
painless, but safe, then the number performed in- 
creased almost at a geometrical ratio, so that at 
present the numbers even of single operations by 
single surgeons—e. g., of ovariotomies, appendec- 
tomies, goiters—mount into the thousands. What 
is still more gratifying, the usual death rates 
of most capital operations in the pre-Listerian 
days of one patient in four, in three, or in two, 
or even two out of the three (!) have been BEFORE AND AFTER LISTER 
193 
changed to one in twenty, thirty, fifty, or to 
even less than one life lost in one hundred or even 
one in two hundred operations! 
It is impressive—most impressive—to call the 
list of only the most frequent and the most impor- 
tant of our present operations. Were Mott, Bige- 
low or Pancoast—all of whom I remember well—- 
to come to life again they would wonder whether 
we were not stark crazy. 
The following list I have made—currente calamo 
—on the instant. 
Amputations are far less frequent. After a 
single battle in the Russian campaign, Larrey, 
Napoleon’s great surgeon, performed not less than 
200 amputations. To-day of 200 similar cases, 
sometimes even with wounds involving joints, the 
great majority would recover without amputation. 
Formal ligations are far fewer. 
External tumors of any size are now removed 
from all parts of the body without fear of erysip- 
elas, which so worried Sir Astley Cooper before 
he operated on the king for a simple wen. The 
mere fact that any tumor is internal—inside the 
head, the chest, the abdomen, or the pelvis—has 
practically no influence on the decision whether it 
should or should not be removed. 
Martin of Berlin, has done over 1,000 ovarioto- 
mies, with a mortality of less than 2 per cent., and 
the Mayos from 1905 to 1914, inclusive (the only 
period for which I had the annual reports at hand), 
reported 609 cases with 5 deaths, or eight tenths 
of 1 per cent. Colostomy and enterostomy are 
frequent. Many thousands of simple hernias have 194 
SELECTED PAPERS AND ADDRESSES 
been cured by operation, with practically no mor- 
tality; and if done in strangulation, with slight 
mortality. 
The new surgery of the head attacks tumors 
even of the hypophysis, punctures the lateral and 
the fourth ventricles with impunity, successfully 
extracts foreign bodies and in some cases relieves 
epilepsy and mental derangements. 
Trephining—even for exploration—is frequent 
and per se involves slight danger, as in decom- 
pression. 
In the neck simple goiters even of large size 
are removed, with a mortality of 1 and 2 per cent.; 
and laryngectomy is common. 
In the chest, that very citadel of life, the heart 
itself is sutured for gunshot and stab wounds, sav- 
ing one life out of two; the esophagus is attacked 
for cancer and the removal of foreign bodies; large 
portions of the chest wall are removed for old 
empyemas, and the lungs can now be operated on 
at leisure, thanks to insufflation anesthesia. 
In the abdomen, the various operations on the 
stomach, even to its total extirpation, are too many 
to name in detail; and with a success that is truly 
marvellous. We play with the intestines at will, 
opening them for foreign bodies and for drainage 
of the contents, removing what we wish, anastomos- 
ing them and short circuiting their contents. 
Tumors of the liver unless malignant are extirpated 
with a very low mortality and wounds of its sub- 
stance are treated with success; gall stones and 
gall bladders are removed every day; the spleen is 
anchored, sutured or removed as we find best; the BEFORE AND AFTER LISTER 
195 
pancreas is no longer inaccessible; the kidney and 
the ureter, like the stomach, have their own list of 
operations far too long to rehearse. 
In the pelvis the bladder is opened and partly 
or even wholly extirpated; the prostate removed; 
the uterus, the ovary, the tubes, the parovaria have 
a long list of life-saving, comfort-giving operations 
to their credit. 
We suture and anastomose nerves; we suture and 
anastomose blood vessels even in the new-born, we 
criss-cross the circulating blood to prevent gan- 
grene, and endoaneurismorrhaphy has practically 
banished the Hunterian operation for aneurism and 
saved many a limb and life. We transplant skin 
and bones and joints, and even half joints, with 
success. To all these we have added the X-rays, 
the serum and vaccine treatment of many surgical 
disorders and are gradually throttling disease, 
sometimes at its very birth. 
It almost takes one’s breath away! Yet it is an 
incomplete and ever-lengthening list! As Mum- 
ford 19 well says: 
“Daring has become conservatism; rashness has become 
common sense.” 
Practically our ability to do all these life-saving 
operations is the result of the researches, the experi- 
ments, and the achievements of Lister and his 
followers. Had antisepsis not made all operations, 
including the opening of the head, the chest, the 
abdomen, and the pelvis, safe, we should still be 
practising the Very limited surgery of the 60’,9. 
19 Keen’s “Surgery/’ I., p. 76. 196 
SELECTED PAPERS AND ADDRESSES 
Every year thousands whom now we restore to 
life and health would still be dying. 
What now are the prospects of Listerism in the 
present horrible war? I have so far used the term 
“antisepsis.” Asepsis is a later and a natural 
development of antisepsis and in civil life is of 
course preferable. The underlying and enduring 
principle of Listerism—the germ theory—is the 
same in both. There is no fundamental antago- 
nism, but really a fundamental agreement between 
the two methods. 
In the present war the surgeons whose papers 
I have so far read are almost a unit in favor of 
the antiseptic rather than the aseptic treatment 
of the wounded. They are right in my opinion, 
and the reason is plain. Comparatively few of 
the wounded reach hospitals with uninfected 
Wounds. Mild wounds, and even in some cases 
severe ones, if they can be dressed soon after being 
inflicted, heal readily. 
Sir Anthony Bowlby’s20 striking description 
of the conditions in the trenches shows the difficul- 
ties very clearly: 
“In this trench warfare, if a man is hit, he often falls 
into filthy mud and water, which may be three feet deep 
or more. The trench is only two and a half feet wide. 
It is night, you can only grope about in the dark and can 
do no dressing of any kind, for you can’t even get any 
clothes off in the dark, and in so cramped a space, and 
you must try to get the man away to a “dressing station” 
half a mile distant, and thence to a field ambulance. If 
it is daylight, jmu can’t get the man out of the trench at 
20 Jour. Am. Med. Ass., April 10, 1915, p. 1257. BEFORE AND AFTER LISTER 
197 
all, and he may have to be kept there for many hours, 
because he would certainly be killed if he were got out of 
the trench. And the water in the trenches is hopelessly 
polluted and soaks his clothes and his wound. Large 
lacerated wounds, and especially bad bone smashes, are 
so contaminated that it can never be possible to render 
them aseptic.” 
There is a noteworthy difference between the 
results of the wounds in the case of the trench- 
inhabiting soldiers and the wounds of sailors. 
The latter escapes the dangers of the soil-in- 
fected trenches. 
“Sailors with the most severe type of wound, ragged, 
irregular, with uneven surface produced by herniated 
muscle and retracted severed fibers, usually have recov- 
ered promptly. Soldiers suffering from slight wounds 
have often had them contaminated with bacilli from the 
soil; particularly the anaerobes.” 
Hypertonic salt solutions like sea water are 
actually remedial by promoting the flow of lymph 
in the wounded tissues. 
But in a very large number of wounded soldiers, 
possibly the majority, hours and sometimes even 
days of delay ensure infection and then the sur- 
geon is face to face with the one overwhelming 
surgical problem which has so far baffled all our 
efforts, viz., how to transform a septic wound into 
an aseptic wound and keep it so, and at the same 
time how to combat the toccins already diffused1 
throughout the body, but without doing harm to 
the patient himself. Cheyne,21 Ehrlich, Wright 
21 Lancet, February 27, 1915, p. 419. 198 
SELECTED PAPERS AND ADDRESSES 
and Carrel are all at work and it may be that the 
happy day when this, the most pressing and urgent 
problem in surgery, shall be solved, may come 
through this devastating war.22 
Meantime Souttar 23 extols plenty of fresh air 
or better still of oxygen (our old supposed ene- 
mies in the 60’s) and says 
“Men with wounds so foul that their presence in the 
wards could not be permitted, were placed, suitably pro- 
tected, in the open air, the wounds being left exposed to 
the winds of heaven, covered only with a thin piece of 
gauze. The results were almost magical, for in two or 
three days the wounds lost their odor and began to look 
clean, while the patient lost all signs of the poisoning 
which had been so marked before.” 
Of tetanus in our Civil War there were in the 
Union army in all 505 cases and 451 deaths, 89.3 
per cent. In the War of 1870-1 in the German 
army there were 294 cases and 268 deaths, or 91.1 
per cent. In the present war there have been 
many cases in the allied armies in the west, but I 
have seen no numbers or percentages. In the 
German army, however, Czerny24 says that 
22 In the British Medical Journal of April 10, 1915, a most 
important article by Sir Almoth E. Wright on “Wound In- 
fections” is begun. This should be very carefully read. On 
pp. 735-38 of the same Journal for April 24, 1915, is another 
very important paper giving full directions for treatment. 
See also an interesting editorial in the Journal American 
Medical Association, May 23, 1915, p. 1765. [See Keen’s 
Surgery, Vols. VII & VIII passive for the final lessons of the 
War.—W. W. K., 1922.] 
23 Brit. Med. Jour., March 20, 1915, p. 504. 
2iBrit. Med, Jour., March 20, 1915, p. 521. BEFORE AND AFTER LISTER 
199 
“the greatest danger to the wounded had been tetanus. Of 
60,000 wounded Bavarians, 420 developed tetanus, which 
proved fatal in 240 cases (57.1 per cent.). The pro- 
phylactic value of the tetanus serum had been established, 
but its extensive employment was not always feasible.” 
This is a far larger percentage of cases than in 
our Civil War, or the Franco-Prussian War, but 
the mortality is far less—probably due to the even 
partial employment of the serum. [Later tetanus 
was almost wiped out by the immediate use of 
large doses of the antitoxin.—W. W. K., 1922.] 
During the Civil War I never saw a case of 
“gas-gangrene” which has been so prevalent and 
dangerous in the present war. The soil of Bel- 
gium and France, which has been cultivated and 
roamed over by animals for more than twenty cen- 
turies, is highly infected. Over ten different gas- 
producing bacteria have been found. 
Sidney Rowland’s experiment25 well shows the 
virulent infection of the soil. Shaking up some 
of the soil from the trenches with some water, he 
injected a few drops into a guinea pig and the 
animal was dead in eighteen hours with widely 
diffused gas gangrene. Soldiers have died from 
the disease in thirty-six hours. 
Delorme has advised, as the germ is anaerobic, 
the injection of peroxide of hydrogen. Hart- 
mann believes it needful to open the wounds freely 
and employ thorough irrigation with the perox- 
ide 26—a most important procedure. Early treat- 
25 Brit. Med. Jour., November 28, 1914, p. 913. 
26 Jour. Am. Med. Ass., Jan. 16,1915, p. 259. See also Law- 
son and Whitehouse, Brit. Jour. Surg., Jan. 9, 1915. p. 444. 200 
SELECTED PAPERS AND ADDRESSES 
ment of infected wounds even in cases of gas gan- 
grene results favorably in the hands of Cazin. 
Of 158 cases received even up to forty-eight hours 
after battle all recovered in spite of their serious 
nature. Among those received after four or five 
days’ transportation the mortality reached 10 and 
even 20 per cent.27 
[Finally practically every wound was treated 
by debridement and epluchage—free incision to 
open the entire wound, removal of all dead and 
dying tissue, and the Carrel-Dakin treatment 
followed by early closing of the wound after all 
infection has been overcome. The results were 
marvellously good. See Keen’s Surgery, Vols. 
VII and VIII.] 
I have related the terrible mortality from ty- 
phoid in the Boer and the Spanish-American wars. 
One bright spot in the present war is the conquest 
of typhoid. In spite of greatly increased numbers 
and of most unfavorably sanitary conditions in 
the trenches as I have shown, conditions wThich 
in former wars would have given rise to dreadful 
epidemics of typhoid, the following statistics in 
the British army officially given to Parliament on 
March 4, 1915,28 show emphatically how well this 
scourge of every past campaign has been con- 
quered. There had been only 606 cases in all: 
247 among the partially (136) and fully (111) 
inoculated, with two deaths (0.81 per cent.) and 
359 among the unprotected, with 48 deaths (7.47 
per cent.), over nine times as many deaths propor- 
27 Jour. Am. Med. Ass., January 16, 1915, p. 259. 
28 Brit. Med. Jour., March 13, 1915. p. 485. BEFORE AND AFTER LISTER 
201 
tionately! The one reason for this splendid show- 
ing is the use of the antityphoid inoculation. If 
instead of its being only voluntary in the British 
army it had been compulsory as in our own army, 
the results would have been even better. And yet 
a blatant band of men and women both in England 
and our own country are doing all they can to 
oppose the use of this life-preserving remedy! 
Let us now in conclusion take a general review 
of the surgical progress I have so inadequately 
sketched. 
During the horrible days of Pare, Bell, Simp- 
son, arid our own Civil War there was still grad- 
ual improvement, but no fundamental change 
occurred for three centuries after Pare, introduced 
the ligature and banished the boiling oil. 
But about the middle of the nineteenth century, 
and especially in its last quarter, experimental re- 
search took the field. Everything that could be 
put to the test of accurate experiment in medicine 
and surgery was thoroughly investigated phys- 
ically, physiologically, chemically, microscop- 
ically, biologically, bacteriologically. Laborato- 
ries were found and research workers vied with 
each other in countless investigations. A flood of 
light was thrown upon every problem. And see 
the result I have just read to you! Medicine pro- 
per, obstetrics, all the specialties, sanitation and 
hygiene, furnish equally impressive calendars of 
progress—principally the result of experimental 
research. 
Chief among these experimental researches 
were those of Pasteur (of whom I have said far 202 
SELECTED PAPERS AND ADDRESSES 
too little for want of time) and of Lister. They 
inaugurated a wholly new era in surgery. 
Then followed the battle for the germ theory 
and antiseptic surgery, ending in final victory. 
Meantime a new science, bacteriology, was born. 
Next came the wide extension and application 
of the new surgery to almost all the surgical ills 
that flesh is heir to. The wonderful results to 
both life and limb that I have recounted have 
naturally followed. 
Even amid the disabilities and obstacles of war 
itself Lister’s work has been a boon beyond price. 
While the soldier and the scientist have been 
busy devising ever more frightful engines of de- 
struction to maim and to kill, we surgeons have 
been equally busy devising means for saving 
thousands of lives and limbs in civil life, and even 
amid the carnage and savagery of war. 
Surely our hearts should be lifted in gratitude 
to God for giving us such splendid powers of 
reasoning, experiment and research—all for the 
service of our fellow men. THE DANGERS OF ETHER AS AN 
ANESTHETIC 1 
It is a great pleasure to tender my thanks to 
the Trusties and the Committee for their kind in- 
vitation to deliver an Ether Day Address. 
In this historic place, 69 years ago this very 
day, occurred the first public use of ether as an 
anesthetic. We, who are accustomed to anes- 
thesia, can hardly appreciate the courage of 
Warren and Morton on that memorable sixteenth 
of October, 1846. Surely also the bravery of the 
patient himself should not be over-looked, The 
name of Gilbert Abbott should always be held in 
remembrance. 
I have often called the attention of my classes 
to a patient lying limp and apparently almost 
lifeless on the operating table. Lift the arm and 
it falls as if it were that of a corpse, touch the 
sensitive eye and the lids do not move. Cut the 
tender skin and it elicts no response. “Will he 
ever wake up?” “May not the flickering flame of 
life gradually fade away forever?” “Have I not 
unwittingly killed this man?” Such must have 
1 Address delivered at the Massachusetts General Hospital, 
on the sixty-ninth anniversary of Ether Day, October 16, 1915. 
Reprinted by the kind permission of the Editor from the 
Boston Medical and Surgical Journal of December 9, 
1915. 204 
SELECTED PAPERS AND ADDRESSES 
been the insistent questions in the minds of those 
intrepid adventurers on that momentous occasion. 
How eagerly must they have welcomed the first 
faint evidences of returning consciousness! Had 
that young man died then and there, for how 
many years would the blessings of anesthesia have 
been withholden from the human race? Only 
eleven years earlier (1835) Pere Velpeau, the 
great French surgeon, had said, “E viter la douleur 
dans les operations est un chimere qu’il n’est pas 
permis de poursuivre aujourd’hui.” Who would 
have dared to repeat the dangerous experiment? 
For an experiment and a most hazardous experi- 
ment on a human being, it certainly was. Hap- 
pily the result justified their temerity and millions 
have been blessed by the bravery of the surgeon, 
the anesthetist, and the patient. 
In Berlin where I was a student in 1865-6 the 
story ran—and I believe it was authentic—that 
a short time earlier Henry B. Sands, then the lead- 
ing surgeon of New York, urging the greater 
safety of ether upon Langenbeck, at his request, 
gave ether for him in his clinic. The patient died 
on the table from the anesthetic before the opera- 
tion was ever begun. Naturally this deferred the 
use of ether in Germany for years and cost many 
lives. 
In this city and this hospital my topic—The Dan- 
gers of Ether as an Anesthetic—may at the first 
blush seem ungracious. But our profession ever 
seeks the unvarnished and untarnished truth. 
To recognize that there are dangers is the first 
step in eliminating them. When life is at stake THE DANGERS OF ETHER 
205 
ignorance is not bliss. Forewarned is forearmed. 
When I accepted the invitation and selected my 
topic, which had not been considered in any of the 
former Ether Day Addresses, I thought I had 
chosen an easy task. But I had hardly begun my 
work when I found that great progress had been 
made, as to much of which I was inadequately in- 
formed. 
While I have had a large experience during a 
long and active surgical life, yet, in consequence 
of my retirement from active practice in 1907, I 
have had little or no personal experience with a 
number of the newest anesthetics and the latest 
modes of their administration. Accordingly, to 
make up for this lack, I devoted the past summer 
to the diligent study of the recent work on anes- 
thetics and anesthesia by reading the extensive lit- 
erature (especially the valuable physiological liter- 
ature) of the last ten years, to a considerable cor- 
respondence (as the friends whom I persecuted will 
testify,) and in the early autumn through some 
careful observations of the administration of anes- 
thetics in Boston, New York, and Philadelphia. It 
has had all the fascination of novelty and the exhil- 
aration of success. 
When I began my medical studies in 1860 there 
were but two anesthetics in use, ether and chloro- 
form. Now the many anesthetic drugs, the dif- 
ferent methods of using them, by inhalation, by 
insufflation, by arterial or venous infusion, by dif- 
ferent routes,—the mouth, the nose, the rectum, 
the colon—by local anesthesia, by spinal anesthe- 
sia, by one drug alone or by two or more, together, 206 
SELECTED PAPERS AND ADDRESSES 
or in varying sequences, by simple or complicated 
apparatuses, or costly and elaborate chambers for 
differential pressure, have almost reached the 
classical “57 varieties.” 
During the last 10 years especially, the admin- 
istration of anesthetics has been rapidly chang- 
ing. It is becoming more and more an exact 
science instead of a mass of only empirical knowl- 
edge gained by practise and at the cost of danger 
or sometimes even of life. The multiplicity of 
valuable papers, the many set discussions in our 
medical societies, the exhaustive studies in our lab- 
oratories of research on the physics, the physiology 
and the chemistry of respiration and of anesthet- 
ics, the pathological changes observed in animals 
after intentional or accidental deaths from various 
anesthetics, and after similar accidental deaths in 
human beings, the accumulated large statistics all 
demonstrate the deep interest, the scientific activ- 
ity and the happy results of this new outburst of 
work in anesthesia. 
One of the happiest results of this restless search 
for improvement is the rise of the professional an- 
esthetist, an expert who by mastery of the subject 
and knowledge and prescience of danger, is able 
to avert or to remedy the danger—an expert who 
is more and more definitely coming to be recog- 
nized as comparable to the expert specialist in 
other departments of medicine and surgery. Says 
Bloodgood,1 “Accumulated experience and read- 
ing . . . impress me more and more that anesthesia 
is an art in every sense of the word. Specially 
1 Prog. Med., December, 1905, p. 173. THE DANGERS OF ETHER 
207 
trained anesthetists are necessary for safety 
The recent organization of the American Associ- 
ation of Anesthetists is another welcome evidence 
of progress. That professional specialists in anes- 
thesia are greatly needed is strikingly shown by the 
frank reply to my questionnaire by the chief anes- 
thetist of one of our best American hospitals. “To 
what do you attribute the deaths from ether?” was 
my question, and his reply began “Lack of skill in 
its administration.” 
That such experts are especially needed in 
America is shown by the fact that Gwathmey’s 
American statistics 2 compared with those of Hew- 
itt in England show that in this country our per- 
centage of mortality from ether is over three times 
as great as in Great Britain. 
Lest the general public who may read this may 
take alarm and exaggerate the dangers of ether, 
let me say at once that the deaths are estimated in 
various statistics as being only one death in 4533 
administrations in America (Gwathmey), one in 
5112 in Germany,3 one in 16,302 in Great Brit- 
ain,4 and even only one in 50,000 (Rovsing).5 
But even if it be only one in 50,000 yet if that 
one is your boy, it is a sorry consolation to know 
that 49,999 others escaped. 
As soon as I fixed upon my topic I sent out to 
the members of the American Surgical Association 
2 Anesthetics, p. 855. 
3 Gurlt, Arch. klin. Chdr., 1897, lv, 473. 
4 Hewitt and Robinson, Anesthetics, London, 1912, p. 139. 
5 Abdominal Surgery, Edited by Pilcher, p. 76. See second 
footnote, page 236 of this address. 208 
SELECTED PAPERS AND ADDRESSES 
a questionnaire as to immediate and delayed ether 
deaths, requesting exact figures if they were avail- 
able, and estimated figures if they were not. I re- 
ceived 67 replies, for which I tender my sincere 
thanks to my correspondents, a number of whom 
took also much pains in compiling their statistics. 
In 20 replies the figures were exact, though those 
of several active surgeons covered only a very few 
years. These returns showed 
Exact number of etherizations 262,002 
Number of deaths 34 
Or 1 death in 7,706 cases. 
This is an improvement over Gwathmey’s statis- 
tics, but the 34 deaths do not include some de- 
layed deaths from pneumonia, nephritis, etc., 
which would probably bring the proportion down 
to about Gwathmey’s figures or possibly worse. 
The 47 others—including, I regret to say, myself 
—could only estimate the number of their cases and 
deaths. The approximation to former statistics is 
gratifying as showing that the estimates were rea- 
sonably accurate and not too seriously optimistic. 
Estimated number of etherizations 356,500 
Estimated number of deaths ...... .| i. . . . 73 
Or 1 death in 4,884 cases. 
Both the estimated and the exact numbers show 
that we have still over three times the proportional 
number of deaths as in Great Britain—a serious 
blot on our methods and results. This calls loudly 
for reform. The systematic use of duplicate 
charts, if collected from all available sources at in- THE DANGERS OF ETHER 
209 
tervals of five years, would show whether our re- 
sults were improving or growing worse. 
Compared with chloroform the dangers of ether 
are almost negligible. In Great Britain from 
1910 to 1913 there were 700 inquests on deaths 
from anesthetics.G Of these, chloroform and its 
mixtures were responsible for 478 and ether for 
only 28. What is the relative percentage of fatal- 
ities of each, however, we do not know. 
Personally I was brought up by the elder Gross 
in the Chloroform School, and I generally used it in 
my earlier cases. But I was soon convinced of my 
error, and for the last forty years I have used 
chloroform very, very rarely. I regard it either 
alone or in mixtures as a most dangerous anesthe- 
tic. With Bevan7 and the Committee on Anes- 
thesia of the American Medical Association,s I 
would urge that it should be discarded, excepting 
in a few special cases, also in the tropics and in the 
military surgery on or near the battlefield, and on 
naval vessels during action.0 In base hospitals 
and on hospital ships ether should be used.* 
What we want is such an anesthetic and such 
anesthetists that there shall be no deaths at all. 
The search for this ideal anesthetic must be vig- 
6 Editorial, Jour. Araer. Med. Assn., April 4, 1914, p. 1098. 
7 Trans. Amer. Surg. Assn., 1915, and Journal American 
Medical Association, October 23, 1915, p. 1418. 
8 Jour. Amer. Med. Assn., June 11, 1910, p. 1987. 
9 McCullough, Jour. Amer. Med. Assn., Sept. 25, 1915, p. 
1090. 
* The papers and discussions on Anesthesia in the Ameri- 
can Surgical Association in 1911 and 1915 will well repay 
perusal by every surgeon and every anesthetist. 210 
SELECTED PAPERS AND ADDRESSES 
orously continued by experimenting first upon ani- 
mals. It has not yet been found, for every anes- 
thetic known has its own dangers. I fear that 
even the best future anesthetic may not be wholly 
free from this possibility. As I have more than 
once pointed out, the ideal anesthetic should not 
preserve the consciousness of the patient, who 
would easily be terribly frightened at the least 
suspicion of danger, dangers which the surgeon has 
often encountered and easily vanquished. His 
fears would not only alarm the patient, but would 
often provoke uncontrollable physical movements 
which would cause serious dangers or entirely pre- 
vent the operation. This ideal anesthetic must 
also, if possible, be pleasant to administer, effica- 
cious in abolishing all pain, free from noxious af- 
ter-effects, and, if possible, without danger to life. 
Our commonest anesthetic—ether—is to me, per- 
sonally, both as surgeon and as patient, so little 
repulsive, and has such very slight danger in com- 
petent hands, that after having used it thousands 
of times with patients, and taken it myself on six 
different occasions, so far as any feeling of appre- 
hension or repugnance is concerned, I would as lief 
lie down on the table and take ether as I wrould sit 
down at my table and eat my breakfast. No one, 
however, except by force majeure shall ever again 
give it to me as on the first occasion, in 1863, from 
a closed cone saturated with ether, in advance, 
which almost suffocated me. By the open drop 
method on a mask or the Allis inhaler,* which are 
* The ether should be dropped on the Allis inhaler just as 
on a mask, slowly at first, faster and faster in a few minutes, THE DANGERS OF ETHER 
211 
practically equivalent, I have five other times been 
most pleasantly and efficaciously anesthetized. 
Not once have I had the least nausea. The long- 
continued ether taste and once some gas pains were 
the only unpleasant aftermaths. Hand ineoc- 
pertus loquor. 
“If patients could be educated to be as pleased 
when they are told that a surgical operation is 
necessary as they are when given a tonic, Utopia 
would be reached,” says Bloodgood. 
I had such an Utopian case some years ago when 
a young girl burst into tears upon my telling her 
that an operation for appendicitis was necessary. 
I tried to comfort her, but to my surprise she re- 
plied between her sobs that she was weeping for 
joy, for she had feared I would decide not to oper- 
ate. Such Utopias, however, are not yet common, 
but I have found them gradually growing more 
frequent as the public are more and more con- 
vinced of the safety of modern operations and the 
danger of delay. 
The students in our medical schools see a great 
many anesthetized patients, but their attention is 
given chiefly to the operation. Too often they 
receive little and in some schools no careful in- 
struction in anesthesia. Far too frequently the 
function of the etherizer is delegated to the ever- 
changing junior residents, as if, forsooth, it were 
of minor importance. Next to the surgeon and 
even before his first operative assistant, in my opin- 
ion, stands the anesthetist, holding the scales of 
but never poured in. Moderate rebreathing can be obtained 
by covering the upper surface by the hand. 212 
SELECTED PAPERS AND ADDRESSES 
Life and Death. Happily, at least in the use of 
ether, the margin of safety is so wide that even 
inexperience and inattention are rarely harmful. 
It should be the duty of our medical schools and 
their hospitals to instruct all students in anesthesia 
and to give them experience by having them admin- 
ister anesthetics under the supervision of their ex- 
perts. In view of the constant and necessary 
change of internes there should be on the staff of 
each division one permanent expert. In small hos- 
pitals at least one of the staff should make it his 
business to become an expert by constant study 
and practice. 
The anesthetist if possible should always see the 
patient beforehand. He can thus establish an 
“entente cor diale” which will do much to prevent 
fear and other psychic elements of danger. 
Gerster says that long ago he learned in Bill- 
roth’s clinic to be careful with patients who ex- 
hibited fear but that he never understood the 
reasons until Crile and Yandell Henderson ex- 
plained them. 
The most striking instance of the physical re- 
sults of fear I have ever known personally was a 
little girl of nine in my ward at the Jefferson Hos- 
pital. A year earlier and before she entered the 
hospital, her clothing had caught fire and she had 
been so dreadfully burned that I was compelled 
to amputate the left arm at the shoulder joint. 
She made an excellent recovery per primam, 
but had not been discharged because an old 
ulcer on the deltoid flap had not yet quite healed. 
Four weeks after the amputation she was suddenly THE DANGERS OF ETHER 
213 
awakened in the middle of the night by a nearby 
fire. The ward was high studded, the windows 
many. It was no wonder, therefore, that remem- 
bering her own dreadful experience and seeing the 
flames and the brightly illuminated ward, she should 
think the ward itself afire and become terrified. 
A thoughtful nurse took her temperature, which 
had long been normal, and found it 105.4°. The 
next morning it was 99°. 
A similar but less striking instance is recorded 
by Crile and Lower 10 in which simple fear raised 
the temperature to 101.2° and the pulse to 150. 
Bloodgood 11 reports a case in which fear alone 
caused the blood pressure to fall in ten minutes 
from 140 to 80mm. In some cases even death has 
resulted from fear before an anesthetic has been 
given. 
Crile is none too insistent upon the psychic as 
well as the physical conditions, which are so con- 
ductive to smooth recovery. 
The condition of the blood should be ascer- 
tained beforehand in all serious operations, espe- 
cially in anemic patients. Da Costa 12 and Da 
Costa and Kalteyer13 and others have demon- 
strated the diminution of hemoglobin due to ether. 
While Mikulicz advised against any general an- 
esthetic in case the hemoglobin was below 30% 
Da Costa and Kalteyer represent a better present 
opinion by drawing the line at 50%. 
10 Anoci-Association, p. 97. 
11 Prog. Med., December, 1912, p. 218. 
12 Med. News, March 2, 1895, p. 125. 
13 Annals of Surgery, 1901, Vol. xxxiv, p. 329. 214 
SELECTED PAPERS AND ADDRESSES 
Observation and charting of the blood pressure 
not only beforehand, but at frequent and regular 
intervals during every important or prolonged 
operation, especially as a guide to the degree of 
shock, is admitted to be important by all anesthe- 
tists. 
The anesthetist should give quick warning of 
any serious fall in the blood pressure, which will 
enable the surgeon to decide for or against trans- 
fusion, for or against attempted extirpation of a 
brain tumor, for continuing or quickly terminating 
an operation. This decision can thus be made 
with scientific accuracy far more surely than by 
observation of the general physical appearance of 
the patient. Accurately known blood pressure is 
of greater value than the rate or quality of the 
pulse, and as pointed out by Harmer, gives warn- 
ing from 5 to 20 minutes earlier than the pulse. 
Moreover, in the doubtful cases it is the most use- 
ful. 
Prior to operations the anesthetist as well as 
surgeon should make himself familiar with the 
condition of the heart, kidneys, blood pressure, 
hemoglobin, and any unusual condition; should 
see that the mouth, tongue, teeth and tonsils are 
in proper condition and that provision be made to 
prevent chilling of the patient,—an important point 
never to be overlooked. Chilling and hemorrhage 
are the most potent factors in producing shock. 
Chilling by cold solutions and by alcohol used in 
pre-operative preparations are injurious as de- 
monstrated by ITarmer. 
The anesthetist should provide against certain THE DANGERS OF ETHER 
215 
dangers common to all anesthesias, such as false 
teeth and other foreign bodies in the mouth, the 
prevention of paralysis of the musculo-spiral and 
other nerves from pressure or from abnormal po- 
sitions of the arm or leg. I have had one non-fatal 
case of hemiplegia occurring a few hours after 
etherization. It is possible but not certain that 
this was a direct result of the increased blood pres- 
sure. Several other similar and sometimes fatal 
cases have been reported. It is to be remembered 
that in a few cases a hemiplegia has occurred shortly 
before the time set for operation. Had the hemi- 
plegia occurred only a few hours or days later it 
might have occurred during the operation and have 
been (erroneously) attributed to the ether. 
During operation the anesthetist should attend 
strictly to his own business and especially remem- 
ber that the first half hour is the period of greatest 
danger. He should glance at the operation only 
from time to time, not to study the operation, but 
in order to anticipate the need for lighter or deeper 
anesthesia and when the anesthetic may be 
stopped. Of course he should keep himself con- 
stantly informed of the general condition of the 
patient by observation of the respiration, the most 
important function of all, of the blood pressure, 
pulse, pupil, color, and condition of the skin as to 
sweating. 
I believe that an anesthesia chart should be kept 
in every case—even for a brief etherization. How 
elaborate this should be is a debatable question. 
The American Surgical Association could do good 
service, as Lilienthal has suggested in a letter to 216 
SELECTED PAPERS AND ADDRESSES 
me, if through a committee it should prepare a 
standard chart adapted to most hospitals and most 
anesthetists. I am persuaded that a chart tends 
to concentrate the attention of the anesthetist upon 
his “job” and make him more careful. In a few 
years such charts would also furnish us with very 
valuable and extensive exact statistics. The form 
should be full enough to make it valuable and to 
compel the average anesthetist to make close and 
continuous observation, yet not so elaborate and de- 
tailed as to defeat its own object. Some especially 
expert anesthetists would prefer a more elaborate 
chart for more detailed observations. The Amer- 
ican Surgical Association might also prepare this 
fuller form and each anesthetist could make his 
choice. 
On first seeing the charts used by Boothby,14 I 
was staggered by their apparent complexity. 
When analyzed, however, I found there was less 
than one observation per minute. In practice, as 
I have observed, Boothby easily records them all 
himself in a quiet leisurely fashion. Instead of 
distracting attention from the patient, these rec- 
ords fix the anesthetist’s attention much more 
closely upon the patient’s condition than if no chart 
is used. The occasional anesthetist will hardly be 
able to utilize any but the simplest chart. 
If it be objected that a chart, and especially a 
full one, is a great deal of trouble, I answer: 
“Giving ether is a serious business, always at- 
tended by possibility of danger. Life may depend 
14 Jour. Pharmacol, and Exp. Thcrap., March. 191p. 329. THE DANGERS OF ETHER 
217 
on the carefulness of the anesthetist, and this is 
surely worth any amount of trouble.” 
One feature of the chart of the Massachusetts 
General Hospital is exceedingly valuable, viz.:— 
that there is a first or pre-operative part to be filled 
in by the house officer (surgical or medical), who 
has had charge of the patient, giving most of the 
data which the anesthetist should know beforehand; 
a second part relating to the data and conditions 
during operation to be filled in by the anesthetist; 
and a third post-operative part to be filled in by 
the nurse in charge of the case immediately after 
operation. A duplicate carbon copy should be 
made, the original to be filed with the notes of the 
case; the copy filed with the consolidated “Anes- 
thesia Records.” 
Here the question arises whether a doctor or a 
woman nurse is in general the more desirable an- 
esthetist. No hard and fast rule can be laid down, 
surely no legislative action is called for, though it 
has been actually proposed. If one has an Alice 
Magaw (Kessel) or a Florence Henderson of the 
Mayo Clinic* or a Sister Ethelrida of Murphy’s 
Clinic the decision is easily in favor of the trained 
nurse. If, however, one has such skilled doctors 
for anesthetist as we find especially here in Boston 
and other of our large cities the decision may he 
reversed. 
* For two admirable and practical papers see Alice Magaw, 
Surg., Gynecol, and Obst., 1906, Vol. Ill, p. 795, and Collected 
Papers, Mayo Clinic, 1905-09, p. 567; and Florence Hender- 
son, St. Paul Med. Jour., February, 1914, p. 74, and Collected 
Papers, Mayo Clinic, 1913, p. 701. 218 
SELECTED PAPERS AND ADDRESSES 
The nurse lives in the hospital and can see the 
patient at all times. She can soothe the timid pa- 
tient, who is more often of her own sex, better than 
most men. She is more vigilant in observing small 
details. She will be less likely to be lured away 
from the role of the professional anesthetist than a 
man, who too often uses anesthesia merely as a 
stepping-stone to private surgical practice. A 
doctor, however, because he has studied medicine, 
is more thoroughly equipped than a nurse (until 
her experience runs into hundreds of cases) to ap- 
preciate possible or even impending dangers. 
Moreover, the doctor is less apt to be upset and 
“flustered” by a sudden perilous emergency. The 
best solution of all perhaps is an intelligent and 
alert woman doctor, such as Dr. Isabella C. Herb 
in Bevan’s Clinic. Such Herbs, however, do not 
grow in every surgical garden. Personality, in- 
telligence, zeal and quick wit may easily be worth 
more than greater knowledge. 
In order that medical men and women shall de- 
vote themselves to anesthesia as a specialty, the 
public must be taught that safety lies in having an 
expert anesthetist, and that like any other expert, 
if he is to obtain a living as such, he must be well 
paid, otherwise he cannot devote his whole time to 
this specialty. 
I might add also that the profession itself does 
not yet sufficiently appreciate this same point. 
Roberts 15 cordially endorses this view. The peril 
he so valiantly attacked is gradually passing away. 
One of the real but infrequent dangers of ether 
15 The Anesthesia Peril, Therap. Gaz., Feb. 15, 1908. THE DANGERS OF ETHER 
219 
is its inflammability. I should probably omit this 
because of its infrequency had I not had personally 
what might have been a very serious accident. 
Nearly everybody thinks that the vapor from 
a volatile substance of course rises upwards. The 
etherizer must never forget that the vapor of ether 
is heavier than air and falls downwards. Saturate 
a bit of gauze with ether. Hold the back of the 
hand first above the gauze and then below it and 
you will never forget that ether vapor falls. In 
1863, after Gettysburg, in a large military hospital 
of 3000 beds in pavilions built wholly of wood, I 
was trying to secure a large bleeding vessel just 
above the inner end of the clavicle. The only 
available light was five candles stuck in five augur 
holes in a square block of wood and held necessarily 
very near the ether cone. Suddenly the ether 
flashed afire, the etherizer flung the glass bottle 
of ether (it was before the days of our present tin 
cans) in one direction and the blazing cone fortu- 
nately in another. We narrowly escaped a serious 
conflagration. Why did I not use chloroform, 
which is non-inflammable, in conditions well known 
before I began to operate? I fear I must admit 
gross thoughtlessness. My only consolation is that 
the patient suffered no harm. Neither he nor I 
was burned and he recovered without further 
incident. 
So happy an outcome does not always occur, for 
there are on record number of cases of more or 
less serious burns of both patient and surgeon. In 
one case, when the switch of an electric hand light 
was turned on to observe the color of the face (the 220 
SELECTED PAPERS AND ADDRESSES 
patient being prone) the spark ignited the ether. 
“Inflammability of the patient” might also be 
mentioned as a possible danger to the surgeon. 
Here again I speak from two personal experiences. 
In one, the patient in his early frenzy, disengaged 
himself suddenly from the etherizer, scattered the 
assistants and was about to assault me, when for- 
tunately, a strong Irish orderly who, again for- 
tunately, was standing behind him, so that the 
dazed patient was not aware of his presence, seized 
him around the waist and held him till the stage 
of excitement quickly passed away. Though bound 
like Samson with many withes, four strong men 
and the etherizer a few minutes later scarcely pre- 
vented his reducing the table to firewood in a second 
attempt to “get” me. 
The other case I relate especially as a warning 
that no one should ever give ether without the 
presence of another person, except in emergencies 
when such help cannot possibly be obtained. 
Many years ago I had to open an abscess in a 
young man. The etherizer did not appear, and 
as the patient was suffering I unwisely gave him 
the ether alone. He had taken only a few inhala- 
tions when he was seized with the delusion that I 
was about to do him harm. With one sweep he 
threw the ether cone away, leaped up, seized a 
chair and swinging high above his head was ready, 
nay determined, to brain me. As he was an ath- 
letic six-footer, and as he stood between myself 
and the door, fight and flight were equally impos- 
sible. I lost no time, you may be sure, in entering 
what I believe the lawyers call a plea of “confession THE DANGERS OF ETHER 
221 
and avoidance”; a confession of my folly, and a 
lively avoidance of my enemy. I have always 
accepted the axiom that two bodies cannot occupy 
the same space at the same time, hut ever since 
that “episode,” as Artemus Ward would have called 
it, I have been equally convinced that one body 
can be in two places at the same time. The only 
refuge I did not seek, was under the bed, and the 
evident reason for my not achieving that igno- 
minious retreat was that my legs would have 
broken before I could have attained its friendly 
protection. Don’t hint at a “mauvais quatre 
d’heureA Less than two such “bad minutes” more 
than satisfied me and I am sure would have fully 
satisfied you. 
The incident, which I can now blithely portray 
as a comedy thus perhaps making its lesson less 
quickly forgotten, came perilously near to ending 
as a tragedy. Had the uplifted chair not been an 
impediment as well as a weapon, and had I not been 
forty years younger and forty pounds lighter, you 
would probably be listening to some other orator 
today. 
In the case of women patients the rule never to 
give ether alone should be absolute, for delusional 
dreams do occasionally occur during anesthesia 
and are honestly believed after recovery. A charge 
of assault may easily follow either as a result of this 
sincere belief, or as a means of blackmail. If no 
witness was present the only evidence can be the 
positive assertion by A and the equally positive 
denial by B. How can the most intelligent jury 
be sure to decide aright? Morever, if sudden 222 
SELECTED PAPERS AND ADDRESSES 
death should occur, a third person as a witness 
would evidently be most desirable. 
Unfortunately I have to confess my own delin- 
quency in not keeping any record of my etheriza- 
tions. I must, therefore, rely upon my own and 
my assistants’ memories as to any fatalities. Two 
deaths from chloroform stand out very clearly in 
my memory, and had I had any from ether I feel 
quite certain that I should not have forgotten so 
deplorable an event. I have had several very 
narrow escapes, but after a most careful review of 
my cases and conferring with Drs. DaCosta, Taylor 
and Spencer, who have etherized at least 75% of 
all my cases, we are all four so fortunate as not to be 
able to recall a single case of death, either immed- 
iate or remote, from ether. 
Three of my patients have almost been drowned 
by an “inundation of mucus/' One was a boy 
three or four years old whose mouth, shortly after 
the operation was begun, looked as if he were blow- 
ing soap bubbles. The loud bubbling respiration 
and his cyanosis could not be misinterpreted. He 
was saved by the simple expedient of holding him 
upside down by his heels. Frothy watery mucus 
poured in a stream from his mouth and nose. In 
a few moments the operation could he resumed and 
was completed without any further trouble. The 
second was a man who was similarly rescued by 
Dr. Taylor’s mounting the table, placing the man’s 
legs over his shoulders and thus almost completely 
inverting him. The third case—a woman—was 
fortunately in a hospital and on a suitable table. 
She was at once placed in the extreme Trendelen- THE DANGERS OF ETHER 
223 
burg position and quickly relieved. I mention 
these because I have seen reports of several deaths 
during operation, which, so far as I could judge 
might have been prevented by a similar simple 
method, which is always available. 
This “drowning” by mucus, as Connell has 
pointed out, is most likely to occur in the narrow 
zone between a light subconscious anesthesia and a 
profound and asphyxial anesthesia. In that same 
zone also vomiting and consequent aspiration pneu- 
monia are serious dangers. 
The dangers on the cardiac side I need not de- 
describe in detail as Dr. Finney 16 considered them 
fully in 1901 and I have little to add. I may be 
allowed a moment only to say that I would far 
rather operate on a case with a bad heart than 
with bad kidneys. Finney also called attention to 
the infrequency of deaths from heart disease under 
ether as compared with their great frequency in the 
general community. Patients with any cardiac 
disease of course run greater risks than those with 
healthy hearts, but as Ochsner has well said, such 
cases “are safe because they are considered especi- 
ally unsafe” and therefore extra care is given 
them. 
The chief danger is from myocardial rather than 
from valvular disease. I may cite a single case as 
evidence that valvular disease may not be so great 
a danger as is sometimes believed. 
The worst case of valvular disease I have ever 
seen I operated on in January, 1888,—a woman 
16 Trans. Coll. Phys. Phila., 1901, 13. 224 
SELECTED PAPERS AND ADDRESSES 
then 62 years of age with marked tricuspid and 
mitral regurgitation. I resected the inferior dental 
nerve for unbearable tic. Ether was very carefully 
given and no trouble arose. In 1895 at nearly 70 
years of age, she required a second operation for 
a recurrence. Had I not done the first operation 
myself I might almost have doubted whether the 
jaw had ever been touched, so perfectly normal did 
the bone appear and so apparently normal were 
the nerve and its canal. Her valvular disease had 
become far worse. Prof. H. A. Hare kindly took 
charge of the ether. In both operations the Allis 
inhaler was used. During the second operation the 
external jugulars were enormously distended and 
the blood from the wound was very dark, especi- 
ally toward the end of the operation. Hare writes 
me: “It was the most serious case of valvular dis- 
ease that I have seen take an anesthetic. Neither 
have I ever seen such marked tricuspid regurgita- 
tion nor such extraordinary pulsation of the liver 
in any case, much less in a patient who has been 
anesthetized. It is interesting to note that the ad- 
ministration of just enough ether to keep her under, 
acted as a stimulant to her heart so that her pulse 
improved. It was only toward the latter part of 
the operation that the regurgitation became so great 
that intense cyanosis developed.” Yet she was out 
of bed on the third day and went home on the sixth. 
She died two and a half years later. She was a 
patient of Drs. S. Weir and John K. Mitchell. 
The latter made the post mortem and reported that 
the right auricle itself was as large as a good sized 
heart and held the entire fist. The mitral orifice THE DANGERS OF ETHER 
225 
admitted the tips of four fingers, the tricuspid the 
thumb and three fingers. The pericardial sac was 
entirely obliterated. 
The respiratory dangers are even more to be 
feared than the cardiac. During anesthesia the 
chief danger is paralysis of the respiratory center; 
after anesthesia a post-operative pneumonia. 
The studies of Haldane, Priestly, Poulton and 
others in England and of several observers, not- 
ably Yandell Henderson of Yale, in this country 
have brought prominently before the profession the 
danger of Acapnia, i. e. the lack of carbon dioxid.* 
This gas, formerly regarded only as a noxious 
waste product, is now believed to be the irritant 
which calls into activity the extremely sensitive 
respiratory center.f 
Poulton 17 by forced breathing for two and a 
half minutes before the British Physiological 
Society, produced such a dangerous acapnia in 
himself that several of the physiologists expressed 
* Henderson has a series of valuable papers in the Amer. 
Jour. 1908-1911, Vols. xxi-xxvii. That on Acapnia 
and Anesthetics, is in Vol. xxvi, p. 260. 
f As noted by Campbell, Douglas, Plaldane and Hobson 
(Jour. Physiology, 1913, Vol. xlvi, p. 301) the facts recently 
brought forward by Hesselbalch point clearly to the conclu- 
sion that what the respiratory center really responds to, when 
it responds to CO, is the balance of H-ion concentration in 
the blood; and as an increase of 2mm. of C02 pressure cor- 
responds to a scarcely measureable increase in the H-ion con- 
centration of blood, it follows that the respiratory center is 
extremely sensitive to changes in the H-ion concentration. 
(See also Douglas and Haldane, Jour. Physiol., 1909, Vol. 
xxxviii, p. 420.) 
17 Johns Plopkins Hosp. Rpts., August, 1910, p. 235. 226 
SELECTED PAPERS AND ADDRESSES 
alarm for his life and one had to leave the room. 
When a patient struggles or screams while be- 
ing etherized, thus over-ventilating the lungs and 
dangerously diminishing the carbon dioxid, if the 
etherizer becomes nervous and gives the ether inter- 
mittently, and especially if in these conditions any 
considerable amount of ether be suddenly poured 
on the inhaler, it may easily be enough to cause 
death by reason of its concentration. It must be 
clearly understood that not the amount of ether in- 
haled, but its concentration in the respired air, is 
the chief danger. Even two or three deep inspira- 
tions in such conditions are fraught with danger not 
only to the respiration but to the heart.18 Herein 
lies one of the chief merits of the Connell anesthet- 
ometer, as such a sudden concentration is impos- 
sible.* 
In the acapnic cases Henderson suggests a very 
simple means of temporary re-breathing in order 
to supply the needed carbon dioxid by holding a 
(grocer’s) paper bag over the mouth and nose for 
a time. In an emergency the two hands could be 
placed over the patient’s mouth. 
It is also possible that not only may there be 
an insufficiency of the stimulating carbon dioxid but 
in certain conditions there may be a reduction in 
the irritability of the respiratory center itself which 
18 Henderson, Trans. Amer. Surg. Assn., 1911, p. 234. 
* The foregoing and some other later statements seem 
simpler and more easily understood by others than physi- 
ologists than if they were in every detail more technically 
exact. THE DANGERS OF ETHER 
227 
may add to the danger.* Future experimental 
research may reveal more clearly these causative 
conditions and also the means of avoiding them. 
“The great hyperpnea produced by a rapid fall 
in the oxygen pressure of the inspired or alveolar 
air is not due to the direct effect of want of oxygen 
on the respiratory center, but to that of the carbon 
dioxid present ... in the blood. The action of 
this carbon dioxid is reinforced by the acid or other 
products produced by the want of oxygen, so that 
the threshold pressure at which the carbon dioxid 
excites the center is lowered.19 
But besides its effect on the respiratory center, 
an excessive loss of carbon dioxid, it is claimed,20 
produces paresis of all unstriped muscular fibers, 
including those of the vascular system. The blood 
then accumulates in the internal vessels, and so is 
followed by facial pallor instead of normal pink- 
ness. To guard against the paresis and consequent 
pallor Bryant and Henderson,21 who regard acap- 
nia and anoxemia as “the anesthetist’s Scylla and 
Charybdis,” propose that his “sailing orders” should 
be “keep the patient pink.” Whether this theory 
* See the admirable paper by Peabody, “Studies on Acid- 
osis and Dyspnea in Renal and Cardiac Disease,” with refer- 
ences to other papers. Arch. Int. Med., August, 1914, Vol. 
xiv, p. 236. 
19 Haldane and Poulton, “Effects of Want of Oxygen on 
Respiration,” Jour. Physiol., 1908, Vol. xxvii, p. 390. 
20 Henderson, Amer. Jour. Phys., 1909, Vol. xxiv. p. 66; 
and Hooker, Amer. Jour. Phys., 1911, Vol. xxiii, p. 361, and 
Vol. xxxi, p. 47. 
21 Jour. Amer. Med. Assn., July 3, 1915, p. 1. 228 
SELECTED PAPERS AND ADDRESSES 
is correct or not, the order is well worth obeying. 
Under the Equator, however, and in our equato- 
rial fellow citizens I fear that it would hardly be 
an attainable tint. 
In the intestines, it is claimed that this paresis 
of the unstriped muscle halts peristalsis, thus caus- 
ing the gas pains which sometimes are a post-oper- 
ative complaint and may be a serious danger.* 
But if acapnia is prevented by a preliminary dose 
of morphin and atropin and by moderate rebreath- 
ing during etherization, normal peristalsis, it is 
claimed, will persist at the end of a laparotomy. 
The greatest respiratory danger of ether is post 
operative pneumonia. While ether itself is, I 
believe, a moderate irritant to the air passages (in 
spite of Rovsing’s assertion), undoubtedly the prin- 
cipal cause of such post-operative pneumonia is 
aspiration of the contents of the mouth. Kelly 22 
of Liverpool and Holcher 23 by putting coloring 
matters in the mouth have placed the fact of such 
aspirations beyond doubt. Kelly has shown 
equally clearly that one of the great advantages of 
endotracheal insufflation is that this aspiration 
practically does not occur. 
The aspirated matter will consist of the oral 
mucus (not seldom, be it remembered, laden with 
the pneumococcus), the discharges from any lin- 
gual, oral, dental or tonsillar ulcer or abscess, and 
the contents of the stomach, which have been vom- 
* Such “gas pains” have not been very common in my own 
experience and observation. 
22 Brit. Med. Jour., 1912, Vol. ii, p. 17. 
23 Arch. klin. Chir., 1898, Vol. lvii, p. 175. THE DANGERS OF ETHER 
229 
ited but not wholly ejected. Hence the necessity 
too little appreciated both by surgeons and an- 
esthetists of getting the mouth, tongue, teeth and 
tonsils in proper condition before operation.* 
Besides this, the utmost care should he used by 
the anesthetist to prevent vomiting if possible. “If 
on minimal [not, observe, maximal] dosage, the 
breathing becomes shallow with an occasional deep 
breath,” vomiting is impending. (Connell.) 
Should it occur, the anesthetist should promote the 
speedy and complete escape of the vomitus by 
turning the head sidewise in extension and thus 
prevent or diminish aspiration. The prevention 
of aspiration pneumonia lies largely in the hands 
of the anesthetist. One of my correspondents con- 
fesses to have had two deaths on the table from in- 
halation of the vomitus during recovery from the 
ether. 
But we must not attribute all the pneumonias 
which follow ether to the irritation of the ether 
itself, to its mode of administration or even to as- 
piration. Armstrong 24 has shown that pneumo- 
nias are especially frequent in cases of septic foci 
existing at the time of operation and attributes 
these pneumonias largely to septic emboli, an opin- 
ion re-enforced by Beckman 25 of the Mayo Clinic. 
In operations in the upper abdomen such emboli 
are especially to be feared. This is due partly to 
* I have seen foul roots of old teeth which should have been 
removed some days before the operation extracted by the sur- 
geon at the end of an operation. 
24 Brit. Med. Jour., May 19, 1906, p. 1141. 
25 Annals of Surgery, 1913, Vol. lvii, p. 718. 230 
SELECTED PAPERS AND ADDRESSES 
the natural inhibition of diaphragmatic breathing 
and therefore of full expansion of the lower part 
of the lungs by reason of the pain. 
Pneumonias may also follow local anesthesia, in 
which there can be no question of aspiration. 
Gottstein 20 and Mikulicz 27 both report larger per- 
centages of pneumonias after local anesthesia than 
after general anesthesia. The experience in 
the Mayo Clinic confirms this observation. The 
probable reason is that the weaker and more seri- 
ous cases have had local anesthesia. “Most of the 
lung complications have developed in patients who 
have been operated on for carcinoma, especially of 
the stomach, and the autopsy has shown fine me- 
tastic growths in serial sections of the lungs.* 
Anuria fortunately is not a very frequent sequel 
of ether, but is a very serious one. Ether as a rule 
decreases the urine for a day or sometimes longer. 
I always watch the bedside chart with anxiety for 
the first two or three days to ascertain the urinary 
output. As a rule after 24 or 48 hours there is a 
moderate increase. I have lost two patients from 
anuria. The first was a case of nephro-lithiasis, 
occurring unfortunately just a year before the dis- 
covery of the X-rays. I knew of course of the 
moderate frequency of bilateral renal calculus, and 
that temporary suppression sometimes followed 
unilateral nephrotomy. In this case during the 
first 28 hours after the nephro-lithotomy only 
26 Arch. klin. Chir., 1898, Vol. lvii, p. 409. 
27 Verhandl. Deutsch. Gesellsch. Chir., 1901, Part ii, p. 
560. ,, A", 
* Letter from Miss Henderson. THE DANGERS OF ETHER 
231 
eleven ounces of urine in all were secreted; in the 
next four days only twenty-five to twenty-eight 
ounces daily. In spite of vigorous treatment, the 
amount fell to fourteen, and then to three and a 
half ounces with absolute suppression for the last 
36 hours. She died on the eighth day. I had anx- 
iously considered the question of an exploratory 
operation on the other kidney, but there was 
absolutely no clinical evidence of any stone 
there. If no stone were found at a second oper- 
ation and she had died, I should forever have had 
a burden on my conscience. The X-rays would 
have decided the question and might have saved 
her life, for a calculus in the other kidney was 
found at the post mortem. 
The other case had a large sarcoma of the 
shoulder. Removal of the entire half shoulder 
girdle was the only possible operation. He died in 
31 hours, never having secreted a drop of urine. 
Chace 28 reports the examination of the urine 
in 125 consecutive cases. Two cases—with no 
albuminuria before operation—died from sup- 
pression on the seventh day. In the great ma- 
jority both of normal and abnormal kidneys there 
is happily only a temporary diminution, but the 
amount of the urine should always be most care- 
fully recorded and vigilantly watched. 
At present it is impossible to predict such sup- 
pression. The remedies, such as they are, are well 
known but may easily be of no avail. 
Glycosuria also may follow etherization, as was 
28 Postgraduate, N. Y., 1904, Vol. xix, p. 302.  SELECTED PAPERS AND ADDRESSES 
232 
first shown in dogs by Hawk 29 in 1904. As a rule 
it is only temporary. Hawk and his associates 
have shown that this glycosuria, at least in dogs, is 
especially dependent on diet. A carbohydrate-free 
diet always was followed by glycosuria while after 
a mixed diet there was none. That this glycosuria 
is not wholly the result of etherization (at least in 
cats) but may be in part an “emotional glyco- 
suria,” caused by the excitement attending opera- 
tion, was first pointed out by Cannon,* and has 
since been confirmed by others both in this country 
and in Germany. Henderson and Underhill30 
attribute the glycosuria to acapnia. Higgins and 
Ogden 31 have shown that injuries of the head were 
followed by glycosuria in nearly 10% of the 
cases. 
In diabetics it would therefore be advisable to 
use nitrous oxid and oxygen or, if possible, local 
anesthesia, since ether might precipitate a fatal 
diabetic coma. 
Acidosis. Recently the dramatic fatal cases re- 
ported by Brewer, Beesly and Bevan and the re- 
searches of Crile, Hawk, Bevan and Favill; of your 
Boston men, Ladd and Osgood, Peabody, Kelly, 
Brackett, Stone and Low, and numerous others, 
have focussed attention upon acidosis and its va- 
rious results, especially acetonuria. 
Could anything be more distressing than such 
29 Arch. Int. Med., July, 1911, Vol. viii, p. 39. 
* Proc. Amer. Philosophy Soc., 1911, p. 227, and Amer. 
Jour. Physiol., 1911-12, Vol. xxix, p. 261. 
80 Amer. Jour. Physiol., 1911, Vol. xxviii, p. 275. 
81 Boston Med. and Surg. Jour., Feb. 21, 1895, p. 197. THE DANGERS OF ETHER 
233 
a case of Brewer’s?32 A boy of 12—a successful 
operation for appendicitis—everything practically 
normal till the third night after the operation. 
Then pulse, temperature, and wound all being 
normal, sudden attacks of terror awaking him from 
sleep, his screams heard all over the building, in- 
creasing somnolence in the intervals, next a sweet- 
ish breath, repeated vomiting, acetone and diacetic 
acid found in the urine and death in 32 hours after 
the first piercing scream! Such a case breaks a 
surgeon’s heart. 
The pathological changes in acidosis are espe- 
cially pronounced in the liver, so much so that Be- 
van and Favill call it an “hepatic toxemia.’* 
Crile * and others have shown that this is a local 
pathological instance of a more widely distributed 
normal process. All the activities of the body, 
every “transformation of energy” produces acid 
by-products, which in turn must be neutralized if 
life is to be sustained. The kidney, as pointed out 
by L. J. Henderson,33 separates the non-volatile 
acid from the base of these acid by-products of 
metabolism, excretes the acids in solution and re- 
turns the bases to the blood to be used over again in 
neutralizing additional acid. The volatile acid— 
carbon dioxid—escapes by the lungs. The II-ion 
concentration of the blood (Ph) is an index of the 
32 Annals of Surgery, 1902, Vol. xxxvi, p. 481. 
* Influence of Inhalation Anesthesia on Acidity of Blood, 
etc., Annals of Surgery, January, 1915. p. 6; Phenomena 
of Acidosis, etc., Trans. Amer. Surg. Assn., 1915, both by 
Crile. 
33 Jour. Biol. Chem., 1911, Vol. ix, p. 403. 234 
SELECTED PAPERS AND ADDRESSES 
acidity of the blood and of its carbon dioxid 34 
content. This carbon dioxid stimulates the res- 
piratory center and also causes an increased out- 
put of adrenalin. Crile claims that his histologic 
and chemical studies have shown that the changes 
in acidosis are limited to the brain, the adrenals and 
the liver. Certainly these organs and especially 
the liver do show marked changes. “While in aci- 
dosis the H-ion concentration of the blood is not 
altered, its reserve alkalinity (i. e. the ability to 
retain normal reaction despite the addition of acid) 
is decreased to a measurable amount.35 Carbo- 
hydrate starvation especially favors acetonuria. 
Kelly 36 examined the urine in 400 cases in the 
Boston City Hospital and found 46 wdiich showed 
acid intoxication in 17 different disease conditions. 
Ladd and Osgood37 in their important paper 
showed that in 120 patients etherized with the 
Blake cone, acetonuria was found in varying de- 
grees and in proportion to the length of the ether- 
ization in 106 (88%), whereas in 162 by the open 
method this percentage fell to 26%, or less than one 
third as many as when the cone was employed—a 
34 Peabody: “Studies on Acidosis and Dyspnea in Renal 
and Cardiac Disease/’ Arch. Int. Med., August, 1914, Vol. 
xiv, p. 236. 
35 Van Slyke, Stillman and Cullen, Proc. Soc. Exp. Med. 
and Biol., 1914-1915, Vol. xii, p. 165. 
36 Annals of Surg., 1905, Vol. xli, p. 161. 
37 Annals of Surgery, 1907, Vol. xlvi, p. 460. 
Since the delivery of this address an interesting statistical 
paper on the “Examination of the Urine in 214 Consecutive 
Cases in Deaver’s Clinic” by Bradner and Reismann has been 
published in the Amer. Jour. Med. Sci. Nov., 1915, p. 727. THE DANGERS OF ETHER 
235 
very serious indictment of the cone method. 
Gatch38 has emphasized this danger and I think 
explained the reason for it. 
In some cases the symptoms,—persistent vom- 
iting, sweetish (acetone) odor of the breath, pe- 
culiarly pink lips, dry tongue and mouth, give us 
warning. Examination of the blood and urine 
will convert suspicion into certainty. 
The administration of water, glucose and sodium 
bicarbonate, the lessening of all physical and psy- 
chical conditions which increase the transformation 
of energy are the best preventive remedies. If 
there is no manifest and speedy improvement no 
general anesthetic should be given. Local an- 
esthesia should be employed. 
But in not a few cases no symptoms whatever 
betray its approach until the storm bursts in all 
its fury. Future studies and experiments on ani- 
mals it is to be hoped may furnish us with warn- 
ing signals that may enable us to prevent or van- 
quish this not very common but terrible danger. 
What now is the conclusion of the whole matter? 
In my opinion “straight ether” by the open drop 
method on an Allis inhaler or a simple mask is by 
far the best and safest routine anesthetic. I am 
glad that such staunch upholders of more elaborate 
and accurately scientific methods of administra- 
tion, as Boothby and Connell, both uphold this dic- 
tum. Because the margin of safety with ether is 
so wide, this is especially the method of choice for 
doctors who only occasionally give an anesthetic. 
In some clinics from which I have replies in ex^ 
38 Trans. Amer. Surg. Assn., 1911, p. 198, 236 
SELECTED PAPERS AND ADDRESSES 
act figures, many thousands of patients have been 
etherized esj)ecially by this method without a death. 
Alice Magaw (Kessel) and Florence Henderson 
have to their credit respectively 22,000 and 20,000 
administrations without a death. But other clin- 
ics have a mortality of one in 5,000, one in 3,000 
to one in 451,* thus bringing the average 
mortality down to 1 in 7706. Inclusion of the 
late deaths would make the proportion still less 
favorable, f 
Evidently we ought to and must attain better 
results, especially when the British surgeons and 
anesthetists have shown us that they can be realized. 
To attain these better results we need in my opin- 
ion: 
1. Many professional anesthetists. 
2. The use of an anesthesia chart in all cases. 
3. The collection of statistics, best by the Amer- 
ican Surgical Association at intervals of five years. 
4. Instruction of all medical students in the 
theory and practice of anesthesia. 
* As to this report from one of the ablest of American sur- 
geons, it is but just to state that he only recently began to 
keep systematic anesthesia records. It is evident from the 
details he gives that very exceptional cases happened to he 
operated on during the short period since he began his re- 
cords. We must all admire his honesty in giving the exact 
figures. 
f All the British and American figures as well as Gurlt’s 
and Rovsing’s (See reference No. 5, p. 207) are to some ex- 
tent a matter of definition of what is a “death from ether.” 
One surgeon (or anesthetist) would admit and another reject 
the late pneumonias and alleged “status lymphaticus” (Hen- 
derson, Trans. Amer. Surg. Assn., 1911, p. 230), those from 
intercranial pressure, suppression of urine, etc. THE DANGERS OF ETHER 
237 
5. Straight ether by the open drop method as 
a routine method instead of mixtures and sequen- 
ces. I believe all of the latter to be more danger- 
ous than ether. 
6. More accurate dosage of the ether by the 
anesthetometer as a gas on the basis of its anes- 
thetic tension, i. e. the partial pressure of the ether 
vapor in the respired air. 
Meyer and Gottlieb39 frankly attribute the 
great majority of accidents to “faulty manage- 
ment and incautious dosage of the anesthetic” and 
again (pp. 74-5) to “the administration of too high 
concentrations of the anesthetic.” A knowledge of 
this concentration or “anesthetic tension” cannot 
be obtained by observation. It must be by exact 
measurement in millimeters of mercury. 
In spite, therefore, of the splendid results in 
certain most competent hands, I believe that others 
less skilled would achieve better results by some 
such “instrument of precision,” and the most 
skilled and successful would find great comfort in 
this more exact knowledge. 
Science began with the substitution of the bal- 
ance, the yardstick and the clock, for even the most 
accurate guesses as to weight, dimension and time. 
In anesthesia the same I feel must hold good. 
Of all the apparatuses I am acquainted with, the 
Connell anesthetometer appeals to me as the best. 
It deals with ether in the form in which it actually 
reaches the patient’s lungs, that is as a gas and not 
as a liquid. The tension is easily and quickly reg- 
39 Pharmacol. Clinical and Exp., Translated by Hasley, 
Lippincott, 1914, p. 68. 238 
SELECTED PAPERS AND ADDRESSES 
ulated according to the needs of the patient. The 
alcoholic, the child, and the adult all require to be 
saturated to the same ether tension in order to 
saturate their tissues up to the point of anesthesia. 
Inquiry as to whether any deaths had occurred in 
cases in which the anesthetometer had been used 
disclosed only one, a patient at the Brigham 
Hospital operated on by Dr. Harvey Cushing. 
Dr. Walter M. Boothby, than whom no one could be 
more careful or more skilful, gave the anesthetic. 
The patient was a man with a very large cerebellar 
tumor pressing upon the medulla. He died from 
respiratory failure eight minutes after the begin- 
ning of the anesthesia. It is very clear I think, that 
neither anesthetist, the anesthetic, nor the appa- 
ratus was responsible for the fatal result. It was 
due to the situation and size of the tumor. 
I have never seen so smooth an etherization as 
one by Boothby with the anesthetometer for nearly 
two hours in one of Cushing’s brain cases. The 
patient’s breathing was inaudible throughout, in 
sharp contrast to the moderately stertorous breath- 
ing and coughing of another patient anesthetized 
elsewhere a few days later by the Roth-Drager 
apparatus. The anesthetometer looks complicated, 
but its management is easily mastered and it then 
fulfils exactly the requirements just quoted. In 
fact, I think it is the only apparatus that does. It 
will be useful only to those who can afford the ex- 
pense and who are constantly engaged in giving 
ether, especially in hospitals. It will not supplant 
the open drop method as a routine method to be 
used by the great majority. The very accuracy of THE DANGERS OF ETHER 
239 
the apparatus is a temptation to place too implicit 
reliance upon it, forgetful of the fact that the re- 
action of the patient and the disease cannot be ac- 
curately predicted. 
EVERY CASE OF ANESTHESIA IRRESPECTIVE OF THE 
METHOD EMPLOYED REQUIRES UNREMITTING WATCH- 
FULNESS FROM FIRST TO LAST. 
Endotracheal and endopharyngeal40 insufflation 
are most valuable additions to our methods. * 
Thoracic surgery, which for years had lagged be- 
hind all other departments of regional surgery, has 
suddenly broadened and improved by leaps and 
bounds, as a result first of the differential pressure 
chambers and later of insufflation methods, so that 
now all the organs in the chest are freely accessible. 
One important note of caution sounded by Cotton 
and Boothby I must repeat and loudly,—there 
must always be provided a safety valve to prevent 
excessive pressure and serious damage to the lung 
and the right heart. 
What of the future? New anesthetics and im- 
provements in our present methods, possibly even 
the discovery of the ideal anesthetic, will give us, I 
hope, a new, a safe and an agreeable anesthetic ere 
the centenary of anesthesia occurs on October 16, 
1946. 
40 Boston Med. and Surg. Jour., March 28, 1912, p. 486. 
* The hybrid Latin and Greek terms “intra-tracheal,” 
“intra-pharyngeal,” etc., should be discarded for “endotra- 
cheal,” “endopharyngeal.” etc., derived wholly from Greek. 
Trachea, pharynx, etc., are not Latin words, but simply Greek 
terms transferred into Latin as we have transferred menu, 
chauffeur, etc., into English. Imagine our writing “intra- 
carditis” or “intra-metrium”! 240 
SELECTED PAPERS AND ADDRESSES 
Finally: In glorious, yea inspiring, contrast to 
the work of destruction promoted by other depart- 
ments of Science, as shown in the present horrible 
war, is the blessed work of our Guild. In war as 
in peace, winning victory after victory over disease 
and death, we devote all our knowledge, skill, and 
ingenuity, century after century, to the solace and 
service of Humanity. THE STORY OF THE THREE 
TABLETS 1 
Listen to the enthralling story of three memorial 
tablets. 
1. On the wall of the library of the Naval Med- 
ical School is a bronze tablet. The inscription 
closes with the eloquent and thrilling motto, “Duty 
Stronger than Love of Life.” What is the story 
of which this is the flower and epitome?2 
On June 12, 1881, the Arctic exploring steamer 
Jeannette, after drifting hopelessly for twenty- 
two months in the grip of the relentless ice-pack, 
was crushed by the ice off the bleak shore of Siberia. 
The leader of the expedition was Lieutenant 
Commander George W. DeLong. The medical 
1 Reprinted by the kind permission of the Editor of The 
Military Surgeon, for January, 1918. 
2 This incident particularly interests me as I knew Admiral 
Melville for a number of years, especially in the American 
Philosophical Society. I seem to have been favored in know- 
ing Polar explorers, for Dr. Elisha Kent Kane, another of the 
Medical Corps of our Navy, one of the early Arctic explorers, 
was a fellow-townsman in whose exploits, as a young lad, I 
felt a pride though I never knew him personally. I well 
remember with what avidity I devoured his book. 
During the Civil War for some months under Dr. Isaac I. 
Hayes, Dr. Kane’s surgeon and successor in the Arctic ad- 
venture, I served as the Assistant Executive Officer, while 
Hayes was the Surgeon-in-Chief of the Satterlee Hospital 
and the late John S. Billings was the Executive Officer. 242 
SELECTED PAPERS AND ADDRESSES 
officer was Passed Assistant Surgeon James Mark- 
ham Ambler. Both were officers of the United 
States Navy. 
On June 17, the officers and crew, thirty-three in 
all, began their perilous retreat over ice and water 
and land, dragging three boats and five sleds weigh- 
ing respectively from 2,300 to 6,000 pounds. 
Often they had to traverse 13 miles to drag the 
whole outfit only one mile. In a gale the cutter in 
which were DeLong and Ambler with twelve others 
became seperated from the other two boats and on 
September 17 reached land, with provisions for 
just six days! Had they known it, only 25 miles 
away was a village and safety, but alas, it was not 
shown on any map! Oh, the pity of it! 
Occasionally a little game was obtained, but fi- 
nally matters grew so desperate that on October 
9, when the only food left was 2 ounces of alcohol 
per man, two of the party, at Ambler’s suggestion, 
were sent ahead in the forlorn hope of finding 
succor. On October 22, when these two in turn 
had become too weak to travel farther, a wandering 
native found and rescued them. 
The other twelve crawled on steadily, losing one 
after another from death by starvation until on 
October 30 DeLong, Ambler and the Chinese cook 
alone were left alive. These three “struggled 
along a few hundred farther and laid 
Admiral Peary, again of our own Navy, has long been a 
friend and was once a surgical patient. Sir Ernest Shackle- 
ton I have met repeatedly in Edinburgh and in this country. 
I have also met Amundsen. Happily I escaped meeting Dr. 
Cook. THE STORY OF THE THREE TABLETS 
243 
themselves down on the snow for the last time.” 
On March 23, 1882, Chief Engineer (later Ad- 
miral) George W. Melville, also of our Navy, who 
with the whaleboat party had found help, after long 
search discovered their bodies frozen by the cruel 
ice which then, having sated its vengeance, seemed 
to relent and preserved them for reverent burial at 
home. 
The commander, DeLong, had offered Ambler 
the chance of life by being one of the two sent 
ahead, but in his pathetic and noble journal he says, 
“I thought my duty required me with him and the 
main body for the present!” “Duty” was indeed 
“stronger than love of life.” 
“Certainly,” says Medical Director Gatewood, 
“that party never lost its trust in God. While 
perishing there was divine service. Day by day 
trembling lips uttered the Creed and the Lord’s 
Prayer.” Discipline was maintained. Personal 
as well as official rights were recognized. The 
strong helped the weak. “There was never even a 
disregard for the proprieties!” They were Ameri- 
can gentlemen, members of that corps of the United 
States Navy which knows not only how to live but 
how to die. Even the Chinese cook was worthy of 
equal praise and honor. 
2. In the Johns Hopkins Hospital is another 
bronze tablet to the memory of Jesse W. Lazear, 
Acting Assistant Surgeon in our Corps in the 
United States Army, one of the Yellow Fever 
Commission, who died of yellow fever contracted 
in the line of duty. The fine inscription written by 
President Eliot reads as follows: 244 
SELECTED PAPERS AND ADDRESSES 
WITH MOKE THAN THE COURAGE AND DEVOTION 
OF THE SOLDIER HE RISKED AND LOST HIS LIFE TO 
SHOW HOW A FEARFUL PESTILENCE IS COMMUNI- 
CATED AND HOW' ITS RAVAGES MAY BE PREVENTED. 
He knew well the risk he ran, for the way in 
which yellow fever was transmitted, though then 
unproved, was more than suspected. He, a non- 
immune, undertook the especially dangerous work 
with the mosquitos themselves. Like Ricketts he 
accepted the challenge of death and lost. No! No! 
Not so! They both wow Immortal Life! Happily 
there was no suffering of months in Lazear’s case. 
The disease—yellow fever—laid its heavy hand 
upon him, and his noble, gentle spirit soon took its 
flight to the bosom of God and rests there forever. 
3. In far-away Ecuador in the outskirts of 
Guayaquil, you will find the third tablet no less 
inspiring than the other two. It records the heroic 
conduct of Passed Assistant Surgeon William M. 
Wightman of the Public Health Service, who died 
of yellow fever on May 16,1909. It is of enduring 
bronze—“aere perennius"■—and was erected by his 
appreciative fellow officers of the Public Health 
Service to commemorate his sacrifice to duty. 
In the absence of Surgeon General Blue, Acting 
Surgeon General A. H. Glennon writes for me 
the brief but pathetic story of his illness. “Al- 
though suffering from an attack of dysentery, he 
persisted in staying at his post. On the evening of 
May 11, he had the chill which marks the onset of 
yellow fever, but knowing that his immediate su- 
perior was out of town, he got up to conduct the THE STORY OF THE THREE TABLETS 
245 
preventive measures for which he was detailed to 
Ecuador. When he was finally forced to give up, 
the disease ran a short period and terminated fa- 
tally.” 
Far from country and friends, faithful to the 
duty entrusted to him, faithful even unto death 
this simple record, brief but eloquent, reads as 
follows: 
“william m. wightman, passed assistant 
SURGEON, U. S. PUBLIC HEALTH AND MARINE 
HOSPITAL SERVICE 
MAY 18, 1857—MAY 16, 1909. 
“greater love hath no man than this 
THAT HE LAY DOWN HIS LIFE FOR 
HIS FRIEND.” 
God grant that we, of these three noble associ- 
ated medical services, especially in these terrible 
yet noble days of a war for world freedom, for 
Civilization over Barbarism, for right over brutal 
might, may be enabled to equal these three men 
in the splendor of their devotion to their corps, to 
their country and to humanity. 
When the editor of The Military Surgeon asked 
me to write a few words addressed especially to the 
young medical men now flocking by thousands to 
the help of our dear country, men who are neces- 
sarily ignorant of the traditions and examples of 
the three Goverment Medical Services, I first in- 
tended to give a brief resume of the scientific 
services of the three corps. 
In the army I would have recalled the name of 246 
SELECTED PAPERS AND ADDRESSES 
William Shippen, who during the Revolutionary 
War anticipated the celebrated “Flying Ambu- 
lance” of Larrey; the work of the first physiolo- 
gist in America, Beaumont, and his patience and 
generosity, as well as his professional skill with his 
unruly patient, Alexis St. Martin; of the splendid 
scientific work done by Weir Mitchell and many 
others during the Civil War; of Letterman, my 
old chief in the Army of the Potomac; the bacterio- 
logical work of Sternberg; the splendid record of 
Hoff in stamping out smallpox in Porto Rico; the 
yellow fever services of Reed and his colleagues in 
Cuba and of Gorgas in Panama, the typhoid work 
of F. F. Russell, and many other achievements in 
the Army. 
In the Navy I had in mind to relate the heroic 
death of William Longshaw, whose gallantry was 
twice recounted on the deck of sixty ships of war. 
He was killed in the assault on Fort Fisher, Jan- 
uary 15, 1865, while binding up the wounds of a 
dying comrade. Their dead bodies were found ly- 
ing side by side the next morning. 
I had in mind also to relate the fine scientific 
work of Rixey, Gibson, Bell, Gatewood, Stitt, 
Beyer, Braisted, and others. 
In the public Health Service, I would have 
shown how the health of the whole nation and espe- 
cially our protection from the ravages aforetime 
of yellow fever, of cholera, plague, and typhus and 
still (for shame) of smallpox, resulted from the 
confident audacity of Waterhouse, Professor at 
Harvard and at Brown, and Surgeon in charge of 
our very first U. S. Marine Hospital at Boston THE STORY OF THE THREE TABLETS 
247 
Mass, (only two months after Jenner’s announce- 
ment of the efficiency of vaccination he obtained the 
virus from England, vaccinated his own children 
and then exposed them to infection without harm). 
I should here recount their life-saving researches in 
typhoid, hook-worm disease, measles, pellagra and 
rocky mountain spotted fever; fearlessly facing 
death, deliberately selecting the places where dis- 
ease was most ruthless. Some of them are known 
by reason of valuable researches, many of them are 
the silent faithful modest heroes known only to the 
Recording Angel who has writ their names high 
in the roll of fame. 
But Col. C. C. McCulloch has done this far more 
completely and authoritatively than I could do it 
for the Army. The scientific achievements of the 
Navy and of the Public Health Service await a 
similar historian. I hope before long to see such 
histories published in The Military Surgeon. 
They would foster an esprit de corps which would 
thrill all men new to the service and make 
them proud to wear the uniform of their several 
corps. 
This task is too large for a simple paper like 
this. I am obliged, therefore, to be content with 
the touching “Story of the Three Tablets.” 
Meantime the Great War is telling anew the old 
unselfish devotion to duty of our predecessors in 
the sacrifices of our present heroes. 
Never before have there been so many casualties 
in the medical service. In this war, surgeons, 
while presumably classed as “non-combatants,” 
share danger equally with the line officers. And 248 
SELECTED PAPERS AND ADDRESSES 
they are not a whit behind the latter in bravery and 
devotion. 
My own first commission is dated July 1, 1861, 
as first lieutenant in the Massachusetts Fifth In- 
fantry. I was sworn into the service of the United 
States in July 4, 1861, on the east front of the 
Capitol at Washington. After a long intermis- 
sion in civil life, my present commission is dated 
April 11, 1917. As one of the oldest men in 
service it is a great joy to assure these thousands 
of younger men—God bless them!—that they are 
joining services with a goodly heritage of glorious 
traditions. I am sure that they will never allow 
them to be tarnished. A WORLD OF BILLIONS 1 
Occasionally it is a great relief to turn away for 
a season from a review of the Great War with all 
its horrors, atrocities, and sorrows, and think about 
some wholly detached subject. Our passions are 
stilled, our emotions subdued, and our minds are 
freshened for a time. 
“Does my title suggest the Liberty Loans?” you 
ask. No, not that. “Then the number of bushels 
of various grains in our harvests?” No, not that. 
“Then it must be the number of dollars spent 
every year or month or day by the various belli- 
gerents,” No, not even that. You will hardly 
guess it. It came to my mind in this wise. 
Not long since, one morning as I was shaving, it 
suddenly occurred to me that there were only two 
means by which we could actually measure the 
growth of any part of the human body from day 
to day—the finger nails and the hair. During 
the Civil War, S. Weir Mitchell, George R. More- 
house, and I often compared the rate of growth, 
especially of the finger nails, for example, in cases 
of gunshot wounds of the great nerves of an arm, 
or of paralysis of one half of the body. We stained 
one or more corresponding nails and both hands (or 
1 Reprinted by kind permission of the Editor from The 
American Museum Journal, now entitled “Natural His- 
tory,” Vol. XVIII, No. 8, 1918. 250 
SELECTED PAPERS AND ADDRESSES 
feet) with nitric acid or nitrate of silver. The new 
growth of the nails would be free from stain and 
would show the relative rate of growth on the 
two hands at a glance. But the growth of the 
nails is too slow to be a satisfactory index of daily 
growth. On the contrary, the hair, and especially 
the beard, grow so rapidly that in twenty-four 
hours the stubby outgrowth of each hair is long 
enough to be easily seen. It gives one an untidy 
appearance. “Unshaven” is equivalent to neglect 
of the proprieties, one might almost say, of the 
decencies of life. As I thought of it while my 
razor wras rasping away the hair, I reflected that 
it introduced me into “a world of billions.” 
But this immediately brought to my mind an- 
other instance of multiplied billions, not the bil- 
lions of cells in solid substances like the hairs, but 
the billions of cells in that life-giving fluid—the 
blood. 
As is well known, the blood consists of a liquid 
in which float the red blood cells or blood “corpus- 
cles.” These are round, disklike cells about !4ooo 
of an inch in diameter. Besides these red cells 
there are other cells called the “white cells” or 
“leucocytes.” These number several thousand in 
a cubic millimeter, but though of great importance, 
physiologically and pathologically, we may disre- 
gard them in our census of the blood cells. 
My friend, Prof. John C. Da Costa, Jr. of the 
Jefferson Medical College, at my request has fur- 
nished me with the following estimates: 
The total amount of blood in a man weighing 
144 lbs. and in good health is about 12 pints. The A WORLD OF BILLIONS 
251 
number of red blood cells in each cube of blood 
measuring only one millimeter (14s of an inch) 
on each side is about 5,000,000. Sometimes this 
rises to 6,000,000, 7,000,000, or even 8,000,000 in a 
cubic millimeter. The number of red blood cells 
in one pint is, therefore, on the lowest basis, ap- 
proximately 10,240,000,000,000, that is, ten thou- 
sand, two hundred and forty billions. 
I 
Remarkable Activity in the World of 
Billions 
The number of these red blood cells destroyed and 
renewed every day in the ordinary activities of life 
cannot be accurately estimated. But we can get an 
approximate idea. 
No physical or mental process can be accom- 
plished without the destruction and regeneration of 
these blood cells in bringing oxygen from the lungs 
to burn up waste tissue and to aid in building up 
new cells and new tissues. 
You lift an arm, you eat a meal, you reason 
about everything—every one of these actions 
means the using up of the cells in the muscles of 
the arm, or of the muscular cells of the walls of the 
stomach, and the cells of the glands producing 
gastric juice, or of the cells of the brain. The 
blood is one of the agents in effecting these various 
processes, and billions upon billions of its cells are 
used up every day. 
The loss of blood in accidents, wounds, and op- 
erations must be made up quickly in order to keep 252 
SELECTED PAPERS AND ADDRESSES 
us in good health. In an accident or in any se- 
rious operation the loss of blood may easily amount 
to a half tumblerful, a tumblerful, or even more. 
A tumbler holds six ounces. A loss of half a pint, 
eight ounces, is not very uncommon. In a serious 
accident, such as a shell wound in Franee, attended 
with great hemorrhage, the loss might amount to 
as much as three pints—about one fourth of the 
estimated total amount in the body. Bierfreund 
estimates that such a loss may be made good in four 
weeks. In three pints of blood there be 
about 30,720,000,000,000, that is, thirty thousand, 
seven hundred and twenty billions of blood cells. 
In every hour of the four weeks then there would be 
a regeneration of more than 45,000,000,000 of cells, 
or more than 750,000,000 cells every minute, day 
and night, for four weeks! 
Not only are the blood cells destroyed and re- 
generated at this enormous rate, but all the tissue 
cells which make up the muscles, the bones, the 
brain and the nerves, the liver, pancreas, spleen, 
kidneys, all the bodily organs are being destroyed 
and regenerated day by day. 
Confessedly these figures are only approximate, 
but even if they are, the impression of the enor- 
mous cellular activity of the entire body is justified. 
Is it not a wonder that the body does not get tired 
of doing such hard and never-ceasing work? 
But to return to the beard and the growth of 
each hair, which introduced us to the of bil- 
lions. The amount of daily growth of the beard 
may vary possibly from man to man, with health 
and illness, with the seasons, with the quantity and A WORLD OF BILLIONS 
253 
quality of the food, possibly from race to race, or 
with different latitudes from the poles to the 
equator. Even different parts of the beard grow 
at different rates—toward the margin of the beard 
near the eyes the growth is less rapid than on the 
cheeks and the upper lip. 
The number of hairs in the beard it is impossible 
to count, but let us assume that it would probably 
be say 5000 on an average face. Then we must 
remember that the beard is only a small portion of 
the hair on the human body. Besides the hair on the 
face there are hairs on the head, in the eye-brows 
and eye-lashes, and finally the fine lanugo or soft 
hairs which overspread the entire body, growing to 
groups of long hairs in the armpits and other parts 
of the body, but disappearing entirely on the palms 
of the hands and the soles of the feet. With age, 
we men at least, usually lose the hair on the top of 
the head which becomes bald over a smaller or 
larger area. On the ears the hair often increases 
markedly in length after the middle life. Even in 
women a mustache not uncommonly develops 
sometimes to an almost disfiguring degree. I have 
seen in some male patients the ordinarily fine hairs 
over the body, arms, and legs develop into a hairy 
coat over nearly the whole body, quite comparable 
with that of the lower animals. 
My problem was: How much does each hair of 
the beard grow every twenty-four hours; how 
many new cells are thus produced in each hair; and 
finally, what is approximately the total number of 
new cells produced in the beard each day? 
Recently I collected the fragments of hair which 254 
SELECTED PAPERS AND ADDRESSES 
I shaved from my face and asked professor Aller 
G. Ellis, of the Jefferson Medical College, to 
measure them and if possible give me an estimate 
of the number of cells per hair which must have 
grown on my face in twenty-four hours. He 
found that each hair had grown about one milli- 
meter (/45 of an inch) in the twenty-four hours, 
and that the number of cells in that length of one 
hair would be about 10,835. This would indicate a 
growth of more than 450 cells every hour, day in 
and day out. This, remember, is for the new 
growth of only one of the hairs shaved off. If 
now we accept 5000 as the number of hairs on my 
face alone, that would mean 54,175,000 new cells 
had grown every twenty-four hours, or 2,257,292 
cells every hour, or 37,621 cells every minute in the 
beard alone. Cut the figures in half if you wish, 
the fact is just as marvelous. 
If we broaden the calculation to the hair all over 
the body, growing on the head at probably a some- 
what slower rate and still more slowly all over the 
rest of the body, we should have a world of billions 
upon billions of hair cells, as of blood cells, produced 
every day. 
The same enormous activity is seen in the de- 
struction and restoration of the cells in many 
glands such as those that secrete the saliva which 
flows so abundantly when we chew our food; in 
the glands of the stomach, for its share in the 
digestive processes; in the glands lining the entire 
twenty-five feet of the intestine, producing the in- 
testinal juice (succus entericas) so important in 
digestion. To these are to be added the enormous A WORLD OF BILLIONS 
255 
activity of the accessory organs of digestion, such 
as the liver, which secretes about twenty-five ounces 
(about VA pints) of bile every day, and the pan- 
creas, which pours out a large quantity of pancrea- 
tic juice to aid in digestion. To these must again 
be added the activity of the kidneys and of the 
millions of sweat glands. These two—the kidneys 
and the sweat glands—curiously enough are much 
alike. The skin might be called a kidney unrolled 
and spread out over the surface of the body, and 
conversely, the kidneys two portions of rolled-up 
skin placed within the abdomen. 
In emergencies the skin may actually perform 
the function of the kidney. When I was a medical 
student—in the long, long ago, now verging upon 
sixty years!—I had in my own person a striking 
example of this “vicarious” action of the skin 
when my kidneys “struck work.” I was very ill 
with a violent tonsillitis and a high fever—how 
high I do not know, for it was before the days of 
the clinical thermometer (!), but I should judge 
that it must have been 104° to 105° F. Lying in 
bed, I perceived a most disagreeable urinary odor. 
I first thought it was due to the neglect of the maid. 
But this proved not to be the case. I soon ob- 
served whenever I brought my hands near to my 
face as in taking a drink of water or using my 
pocket handkerchief that a whiff of this disagree- 
able odor was instantly perceived. Then I de- 
liberately investigated the condition of my skin 
and found that it *was doing nearly all the work of 
the kidneys—a most dangerous condition, which 
might easily be followed by uremic coma and 256 
SELECTED PAPERS AND ADDRESSES 
speedy death. Prof. J. M. Da Costa, who was 
attending me, at once took the most vigorous 
means to stimulate the kidneys. These remedies, 
with hot drinks, a sharp purgative, and abundant 
drinking of water soon averted the danger. In 
the case of some patients the urea excreted by the 
skin has actually formed crystals on its surface 
How many billions, trillions, and quadrillions of 
cells in the blood, the hair, the innumerable glands 
of the intestines, in the liver, the pancreas, the kid- 
neys, the brain, and the skin perish and are re- 
placed every day no one can possibly" estimate. 
That such huge armies of cells serve us every day, 
every hour, every minute of our lives day and night 
in sickness and in health, and as a rule in orderly 
sequence so that the balance of health is main- 
tained, or in case of illness is restored, gives one 
an idea of the wonderful mechanism of the human 
body—nay, of the whole animal and even of the 
vegetable kingdom, for only by the same nice 
adjustment of number and function of cells to the 
needs of the body of the man or the animal or the 
plant can health be maintained. 
Moreover, the great strength of these minute 
cells is wonderful. We are all familiar with the 
bricks or even the heavy flagstones around the 
trunks of trees on our sidewalks which are lifted 
and tilted by these same little cells growing slowly 
but inexorably. I well remember seeing in the old. 
churchyard at Jamestown, Virginia, a full-grown 
sycamore tree which had split a great bowlder in 
two. The little tree had found a chink into which 
it had insinuated the tip of its slender stem. Then A WORLD OF BILLIONS 
257 
these myriad Lilliputian cells, slowly but steadily 
increasing in number, had gradually thickened the 
tree trunk as a wedge and finally had rent the stone 
asunder. 
II 
The Organization of the World of 
Billions 
Every plant and every animal, including man 
himself, starts from one microscopic cell which 
multiplies indefinitely until the number mounts 
to millions and billions. The rapidity of this 
growth in some instances is almost inconceivable. 
The cholera bacillus multiplies from one to two; 
these two divide into four; these four into eight, 
sixteen, and so on every twenty minutes. In 
seven hours, provided it has room enough and food 
aplenty, one single cholera bacillus would have 
more than 2,000,000 descendants, and three hours 
later more than 1,000,000,000, and so on. These 
1,000,000,000 in twenty minutes would become 
2,000,000,000; in twenty minutes more 4,000,000,- 
000. In twelve hours after the first single cell 
with which we started had begun to multiply, its 
descendants would number about 64,000,000,000,- 
000, sixty-four thousand billions of cells. What 
would the number be in a week or a month! 
Or again, consider the silkworm. In thirty days 
after being hatched from the egg it increases in 
weight 15,000 times; that is 500 times its original 
weight every day. We can get a more impressive 
idea of what this means by comparing it with a 
human baby. Were the same rule to hold, a baby 258 
SELECTED PAPERS AND ADDRESSES 
weighing seven pounds at birth would weigh 3500 
pounds the very next day, and when a month old 
would weigh 105,000, or more than fifty short 
tons, which, however, could hardly be called “short 
weight.” If you will pardon the abominable but 
expressive argot of the street, that would be “some 
baby.” But we may be somewhat consoled by re- 
membering that both mother and nurse would be 
of corresponding elephantine bulk—made to “fit 
the job” as the exponents of efficiency would 
say. 
But this is a gross, unimaginative way of look- 
ing at such a phenomenon. When we analyze it 
seriously, what a wonder world we enter upon! 
How these little silkworms must feed, feed, feed! 
Think of the abounding life of each microscopic 
cell. Every one has to multiply itself five hundred 
times in every twenty-four hours. Yet all goes 
on in an orderly manner, according to the law of 
its being, but with incredible swiftness, day after 
day. 
In the development of a human or an animal 
body the increase is far more, however, than a mere 
numerical increase, although that in itself is a won- 
derful phenomenon. Among these multitudinous 
cells a wholly new factor soon comes into view. 
They do not all continue merely as multiplied du- 
plicates of their predecessors but they begin to 
differentiate among themselves. Some will be- 
come first cartilage, that is, gristle cells, and later, 
when the blood carries to these cartilage cells lime 
and phosphorus and other mineral ingredients, 
these cells bathed in the liquid portion of the blood A WORLD OF BILLIONS 
259 
will pick out each its own required mineral com- 
pounds and will turn from soft, flexible cartilage 
to stiff, yet elastic bones—the skeleton of the ani- 
mal. 
Other cells will remain soft but will select those 
ingredients which are necessary to form the mus- 
cles—that is, the red flesh of animals or the white 
and dark meat of birds. These muscles acting on 
the bones as levers will move them so that we can 
lift the ribs and by the diaphram depress the floor 
of the chest and thus aid further in expanding the 
lungs for inspiration; then we reverse the action, de- 
press the ribs, compress the abdominal viscera, and 
so push up the diaphragm, thus compressing the 
lungs for expiration. Thus the alternate processes 
of breathing—a continuous function essential to 
life—are carried on. We are also enabled to reg- 
ulate our breathing and our vocal chords in such a 
manner that we can speak or laugh, swallow or sing. 
Still other muscles attached to our jaws permit 
us to eat, others attached to our leg-bones allow us 
to move about, others to our arms and fingers fit 
them for labor or other useful functions. 
But these muscles do not move of themselves. 
They require a stimulus connected with the center 
for our mental organization. Thus then the need 
for a nervous system—in fact, as I shall show, for 
two interdependent and correlated nervous sys- 
tems. The first of these two systems is composed 
of the brain, the spinal cord, the nerves emerging 
from the latter, and the special end-organs in which 
the nerves terminate. From the skin by means 
of these special organs at the ends of the nerve 260 
SELECTED PAPERS AND ADDRESSES 
fibers, impulses start and are carried to the brain. 
In the brain they are appreciated, for instance that 
the finger is in contact with a source of too great 
heat. The brain quickly decides that the finger 
must be withdrawn, and sends down to the proper 
muscles the order to retract at once. In such a 
case, long before the whole of this brief description 
has been read, the muscles have executed the order. 
This is but one example of a voluntary movement 
resulting from a sensation. 
The second nervous system consists of the sym- 
pathetic system. At certain important points 
collections of nerve cells are gathered into small 
bodies called ganglia. These ganglia are con- 
nected with one another by a large number of 
nerves. The familiar “solar plexus” just in front 
of the spine at the level of the “pit of the stomach” 
is the largest and most notable collection of such 
ganglia. 
The nerves of the sympathetic system are dis- 
tributed to the muscular cells in the walls of every 
artery in the body. This muscular coat consists 
chiefly of circular fibers, which, by their contraction 
and relaxation change the caliber of the arteries and 
thus regulate the supply of blood to all parts of 
the body according to its needs. 
For example, the eye is a very familiar instance. 
When a cinder gets into the eye, in a short time 
the white of the eye becomes very red or “blood- 
shot,” but returns to its normal whiteness as soon 
as the foreign body is removed. The sudden red- 
ness of a young girl’s “blushing” cheek is caused 
in the same way. A WORLD OF BILLIONS 
261 
Again, when we have eaten a meal, the stomach 
needs a very large and sudden increase in its supply 
of blood to elaborate the large quantity of gastric 
juice required for digestion. Instead of a rather 
dirty looking brownish yellow appearance, as when 
it is empty, the stomach (like the eye) at once be- 
comes of a bright red color from the dilated blood 
vessels. As soon as the meal has been digested, 
the nerves stimulate the circular muscles of the 
arteries. By their contraction these immediately 
lessen the caliber of the blood vessels, and less and 
less blood reaches the stomach until at length the 
supply is only enough for the ordinary demands of 
the stomach in its period of inactivity, and it has 
reverted to its original brownish yellow color. 
These sympathetic nerves are distributed not 
only to the muscular coat of the blood vessels but 
to many other muscular fibers which are involun- 
tary, that is, not controlled by the will. We have 
an excellent illustration of this in the iris, the circu- 
lar colored disk in the eye with a hole in the center 
which we call the pupil. This is constructed like 
a wheel with a circular hub and radiating spokes. 
The “hub” consists of circular muscles which, by 
contracting, narrow the pupil to a pin point. The 
spokes are radiating muscular fibers which 
pull the pupil wide open. We go out into 
blinding blazing sunlight. For a moment we 
wink and blink, or have to shade the eyes by the 
hand or by closing the eyelids. But in a few sec- 
onds the muscular fibers of the hub contract 
strongly, the pupil narrows down to a pin point, 
and the eye is automatically protected from the 262 
SELECTED PAPERS AND ADDRESSES 
injury which it would otherwise suffer. On the 
contrary, we go into a darkened room. At first 
we may stumble over the furniture which we can- 
not see on account of the small amount of light 
entering the eye through the minute pupil. In 
a few minutes the pupil has been dilated by 
the “spokes,” or radiating fibers, to a maximum, 
and we can see everything with perfect clear- 
ness. 
All these changes, be it observed, are perfectly 
involuntary. They are accomplished for us, and 
in fact, in spite of ourselves. We do not order 
the blood vessels to dilate when a meal is eaten, 
or order them to contract when it is digested. We 
do not order the pupil to contract or dilate accord- 
ing to the brightness or the dimness of the light. 
In fact we cannot by any possibility control the 
caliber of the blood vessels of the stomach, or the 
size of the pupil. It is all done for us whether 
we wish it or not. And it is most fortunate that 
this is so. Suppose it had to depend on our con- 
scious volition. Suppose, tired out and hungry, 
we ate a hearty meal and fell asleep! The stomach 
would get no increase of blood, there would be little 
or no gastric juice secreted, no digestion would 
take place. What endless confusion there would 
he! Before long we should surely perish! In the 
case of the pupil, the bright light might easily 
seriously damage the eye, or we could never see in 
a dimly lighted room. 
In this rather long discussion we have almost 
forgotten that we were considering the differentia- 
tion of the rapidly multiplying cells into bone A WORLD OF BILLIONS 
263 
cells, muscle cells, and cells forming1 the brain, 
spinal cord, nerves to control the voluntary muscles, 
and the sympathetic nerves to control the involun- 
tary muscles. 
If we examine a chicken embryo, we shall find 
even as early as the third day the well-recognized 
and differentiated parts of the organs of sight, of 
hearing, etc. When we remember the ultimate 
excessive complexity of these organs, especially of 
the eye and the ear in man, this faculty of differen- 
tiation causes our wonder and astonishment to be- 
come intense. By it cells that at first could not be 
distinguished from one another eventually develop 
into cornea, iris and pupil, lens, and retina—the 
retina alone having ten different layers!—and the 
strong and tough outer protecting fibrous envelope 
of the eye; the three bony semicircular canals of 
the internal ear lined with their soft membrane, 
the wonderful spiral cochlea in which are distributed 
the nerve filaments forming the ultimate organ of 
hearing; the three little bones of the ear attached to 
one another and by flexible membranes to the inter- 
nal ear, and externally also to the drum of the 
ear. 
And as if all this were not enough, there are 
certain other cells which become segregated—shall 
we say segregate themselves ?—from the others and 
develop on an entirely different plan from any of 
the others. Some of them form a long hollow tube, 
the esophagus, followed by a dilated part, the 
stomach, and then the intestines. The stomach 
has a wholly different function from all the rest of 
this long tube, which is about twenty-five feet 264 
SELECTED PAPERS AND ADDRESSES 
long in man and far longer in some of the lower 
animals. The stomach portion of the tube sud- 
denly narrows again at the pylorus, the outlet from 
the stomach into the small intestines, and finally 
widens anew into the large intestine. Through- 
out its length this digestive tube is lined with differ- 
ent sorts of glands to aid the different stages of 
digestion. Connected with this long digestive 
tube are two large accessory solid organs— 
the liver to secrete bile, the pancreas (the “sweet- 
bread” in animals) to furnish a juice to aid diges- 
tion. 
At the same time other cells are segregated at 
one point to form the spleen. Its function is still, 
in part, as yet obscure. Its presence is not essen- 
tial to life for many times it has been removed, and 
the patients get along without it, as they do also 
without any gall bladder or appendix. 
Still other cells are segregated into two masses 
of cells which form the two kidneys. The character 
and function of these become wholly changed. 
Their secretion is wholly different from that of 
the glands in connection with the mouth (for sa- 
liva), in the stomach (for gastric juice), in the 
liver (for bile), in the pancreas (for pancreatic 
juice), in the intestine (for the intestinal juice) 
all aiding in digestion, that is, in the nourishment 
of the body. The cells of the kidney select from 
the blood such of the waste products as other- 
wise would accumulate in the blood and quickly 
threaten life. Hence their enormous importance. 
As a surgeon I would far rather operate on a 
patient with very grave heart disease, than on A WORLD OF BILLIONS 
265 
one whose kidneys were seriously out of order. 
The sweat glands of the skin as I have already 
pointed out are analogous to the kidneys, and 
supplement, or may even replace them. 
All the stages of development of all these differ- 
ent tissues have been diligently worked out, chiefly 
in the fertilized egg of the hen. One can abstract 
an egg from an incubator at any definite time, one 
hour, two, three, four hours, or on the second, third, 
fourth, fifth day and so on, carefully open the egg 
shell, harden the embryo chick in certain fluids and 
then cut it into very thin slices which are kept in 
their serial order. These “serial sections” are so 
thin that the light easily passes through them. This 
enables us to study each one in detail. They can 
be cut also lengthwise, crosswise, or obliquely. By 
these means the embryologist can examine each sec- 
tion, each system, each organ, or even a part of 
any organ. By suitable stains one can differen- 
tiate and study the individual cells of the various 
tissues. 
Occasionally accident will furnish a human em- 
bryo in which similar examinations by similar 
methods may be made. These absolutely establish 
the fact that the development, as studied in the 
chick and the lower animals and in the human 
ovum and embryo, follows exactly similiar lines. 
Similar organs develop in similar ways. The whole 
animal kingdom from the lowest animal consisting 
of only one cell to man, follows the same general 
plan although varying in details from animal to 
animal, and growing more and more complex as 
we ascend in the scale. 266 
SELECTED PAPERS AND ADDRESSES 
Ill 
The Wonderful Powers Implicit, i. e. 
Infolded, in the Fertilized Ovum. 
Haying reviewed the enormous number of cells 
in the blood and the body—whether of man or 
other animals—and their orderly development by 
differentiation in structure and function, it will be 
of interest to consider the wonderful powers impli- 
cit—that is to say, which are infolded—in an ovum. 
These powers remain latent until fertilization takes 
place. Then they immediately start up into amaz- 
ing activity. We can best study it in the develop- 
ment of the chick in the fertilized hen’s egg as just 
indicated. From the moment when the hen begins 
to sit, hour by hour, there begins and goes on during 
the whole period of incubation (twenty to twenty- 
one days) the most marvelous growth and develop- 
ment. Within even the first three days there is 
developed, in the growth from the one single cell, a 
mass in which can already be distinguished the front, 
middle, and hind parts of the brain, the starting 
points of the eyes and the ears, even the pulsating 
heart can be seen, divided at first into only two 
separate halves. There is a beginning of the circu- 
lation of the blood. What will become the lungs, 
the liver, and the pancreas are recognizable. Later 
the fore and hind limbs of quadrupeds, the wings 
and legs of birds, or the arms and legs of the human 
body begin as little buds. The cartilages of the 
digits (fingers and toes in man) soon follow. Fos- 
ter and Bayfour 2 say that on the fifth day “the 
2 Elements of Embryology, p. 275. A WORLD OF BILLIONS 
267 
embryo of a bird does not materially differ in its 
early phases from that of a reptile or a mammal, 
even in the points of structure which are most dis- 
tinctively avian” (that is, characteristic of birds). 
By the sixth day the distinction becomes clear. 
In all this apparent “hurly-burly,” as when a 
cell in the silkworm multiplies itself 500 times 
each day, or less swiftly in the cases of vertebrates, 
there is an orderly, almost uniform development of 
each animal after its kind. 
For a moment let us limit ourselves to the con- 
sideration of the human body and ovum. Look at 
the symmetrical and asymmetrical organs of the 
body. We have two ears, and two eyes both placed 
in front and not at the side of the head as in the fly, 
the horse, and many other animals, always at a 
certain distance apart, within a very slight maxi- 
mum and minimum range; two arms, two legs, 
two lungs, two kidneys. Even the nose is 
symmetrical; but the two nostrils are fused into one 
central organ. The tongue also is composed of two 
symmetrical halves fused together. The bones of 
the head are as a rule in pairs, right and left, or if in 
the middle line, they have originated in two sym- 
metrical halves as in the upper jaws (maxillae) 
which are not fused together, while in the lower jaw 
(the mandible) the two halves are permanently 
united for its special function of biting and crush- 
ing the food. The ribs, right and left, correspond 
to one another. The complete or ideal vertebra 
consists of a body and a pair of ribs which are also 
joined together in front, not directly but indirectly, 
by means of the sternum or breast-bone. In the 268 
SELECTED PAPERS AND ADDRESSES 
neck the ribs are suppressed, but have their repre- 
sentatives in little processes or knobs of bone. In 
the loins (the lumbar region) there are also no 
ribs, but their representative vestiges are even more 
marked than in the neck. 
Asymmetry rules chiefly in the internal organs. 
Most of the heart lies to the left of the mid-line of 
the body. As already stated it begins as two sepa- 
rate halves, which soon fuse into one heart with four 
cavities, two auricles and two ventricles. Each of 
these four chambers has a different function but all 
four are coordinated into one beautifully regulated 
organ. The heart is one of the most wonderful 
pieces of mechanism in the world, more powerful 
in proportion to its weight than any Baldwin loco- 
motive, more delicately constructed than the finest 
watch; an organ which must do, and—mirabile 
dictu!—does do its own repairs while busy at its 
work. It knows no Fourth of July or Christ- 
mas or Easter holiday, never even can know the joy 
and relief of sleep, “tired nature’s sweet restorer.” 
It begins its orderly, reiterated contractions and 
relaxations long before birth, and they cease only at 
death. It must continue them in health and in sick- 
ness, when its function is often sadly disturbed. In 
mid-career let it stop for but a few moments and 
death comes swiftly, almost instantly. 
Sometimes, oddly enough, by a very early irreg- 
ular development, asymmetrical organs are trans- 
posed, and then, as in Malade imaginaire’,’ 
“nous avoirs change tout cela,J is literally true. 
This is very rare, so much so that in a long and 
active professional life, I personally have never seen A WORLD OF BILLIONS 
269 
a case. When it occurs, the heart, stomach, and 
spleen lie on the right side, the liver and appendix 
on the left, and the large bowel reverses its course, 
running upward on the left side. 
In this enormously complex machine, far more 
complex than any of man’s making, a machine, all 
parts of which, like the heart, must be repaired with- 
out the omission of an hour’s or even a moment’s 
work, it is not surprising that things sometimes go 
awry. The wonder is rather that they almost 
always develop aright. Nature is persistently 
conservative. To this conservatism we owe it that 
most people are practically normal. Especially 
fortunate is this conservatism during the early 
development of the embryo. Then, every cell is 
working feverishly and at top speed, and a minute 
divergence of, it may be, even a single cell, fol- 
lowed by a progressively greater and greater 
divergence from the normal in its descendants, 
would produce an arrest of development here, or 
an error of development there; but only occasion- 
ally is there such a failure of orderly or of complete 
development. The result is a local failure, or even, 
it may be, multiple failures in normal growth. If 
there is one deformity, therefore, there are very 
apt to be others. 
The saddest of all these errors of development 
are those cases in which there has been a defective 
development of the brain and hence a mentally de- 
fective child. How many scores, or I might even 
say hundreds, of such children have been brought 
to me with the fond delusion that, “He is naturally 
an unusually bright child, you know, but with a 270 
SELECTED PAPERS AND ADDRESSES 
pressure on the brain.” How often have I had to 
dash unfounded hopes to the ground! The chil- 
dren have been brought to me in the confident ex- 
pectation that I could cure them by a surgical opera- 
tion that “would remove the pressure on the brain.” 
An explanation that the defective development 
was by no possibility to be laid at the door of either 
the father or the mother, but that the defect was pre- 
natal, and had long preceded birth has often 
afforded the distressed parents some little comfort, 
although it can never wholly remove the heartache. 
The only hope for such children is in educating the 
more or less blighted faculties; a long continued, 
expensive business, and often with but a slight im- 
provement as a reward for years of parental devo- 
tion. In other cases, such as cleft palate, harelip, 
and clubfoot, surgery holds out relief by operation. 
Let us now go back again to the single cell of the 
fertilized ovum in which the human or animal body 
always begins. We have seen its development into 
many billions of cells which have become differen- 
tiated from one another and have formed many 
different tissues (bone, muscle, or nerve), and many 
different organs (brain, eye, ear, liver, or kidney), 
in which the ultimate cells differ enormously from 
one another, although all have had this common 
origin in the single cell of the fertilized ovum. 
Think for a moment of the enormous powers la- 
tent in that single little microscopic, primordial 
cell! Nothing that I know of can for a moment 
compare with it. If we know its origin we can 
foretell its development into a horse, a bird, a fish, 
or a human being. We can foretell that it will show A WORLD OF BILLIONS 
271 
the racial traits of its parents to a greater or less 
degree, the white skin, the black skin, the yellow 
skin; the straight hair or the curly hair; the oblique 
or the horizontal eye; the racial nose of the Roman, 
the Greek, the Hebrew, or the Negro; the high- 
cheek-bone of the American Indian. There are 
marked physical resemblances in many, if not in 
most cases, even to the features of the parents and 
the brothers and sisters which in turn may be trans- 
mitted to the next generation. Nay, more, in that 
tiny cell are contained the forces that make not only 
for the physical structure and the intellectual char- 
acters of his race, but also for those of his nation, 
and it may be, particular family. In it are con- 
tained in posse, and if fertilized and developed, in 
esse, the powers of a Newton, a Shakespeare, a 
Franklin, or an Abraham Lincoln. 
Why should the little bud which is to become a 
human arm develop at exactly the right place and 
not grow out on the front of the chest or on the back 
nearer the spine? Why should the human arm 
grow to its proper length and then stop, instead of 
growing far longer as it does in our simian ances- 
tors? Why should the two arms (and the twro 
legs) always grow to virtually the same length? 
Why should the human body grow for about twenty 
years and then stop growing? 
The answer is evident. In that single, primor- 
dial cell there existed a force, a law of orderly de- 
velopment which compelled all these phenomena to 
take place, and to take place at the proper situation 
and in the proper sequence; and, when the proper 
time came, the laws enshrined in that primordial 272 
SELECTED PAPERS AND ADDRESSES 
cell said to the lengthening arm and the heighten- 
ing frame, “Stop,” and they stopped! 
As a rule each tiny egg develops in an orderly 
normal way the characteristics of its particular 
breed of ancestors. The sheep’s ovum will develop 
into a timid adult, while that of the lion will be 
courageous and cruel; in the different breeds of 
horses one ovum will develop into a powerful draft 
horse, another into a fleet race horse; if it be a dog’s 
ovum it will develop, it may be, into the swift grey- 
hound, the fierce bulldog, or the fawning spaniel. 
If this be true of horses, dogs, and cattle, should it 
not be true of men ? I firmly believe in the virtues, 
and alas, as the Great War has revealed them, in 
the vices, inherent in different breeds of men and 
nations. Good blood is a great asset whether in a 
horse, a cow or a man. 
I confess I stand in awe before such manifesta- 
tions of power packed, one might say, into such a 
microscopic space. To me there is no other expla- 
nation of such a mighty gift save from an Almighty 
Giver—the Fountain of Life, the ever blessed God. 
I bow before Him in reverence and also in gratitude 
that we live in a world of such wonderful order, in- 
stead of a world of blind Chance. THE RED CROSS AND THE ANTI- 
VIVISECTIONISTS 
AN APPEAL TO THE FAMILIES AND FRIENDS OF 
OUR HEROIC TROOPS AND TO THE COMMON 
SENSE OF THE AMERICAN PEOPLE 1 
First of all let me make two facts clear. 
1. This paper has been written entirely on my 
own responsibility and not at the suggestion directly 
or indirectly of the Red Cross, I have been moved 
to write it solely in the interest of our brave soldiers, 
and especially because their sufferings and lives are 
involved in the suit against the Red Cross by the 
antivivisectionists to prevent the use of $100,000 
of the Red Cross funds in such beneficent life-saving 
researches. 
2. The Red Cross as an organization is neither an 
opponent, nor an advocate, nor a defender of vivi- 
section. It states officially that the supreme aim of 
the Red Cross is to relieve human suffering [and it 
might well be added “and to save thousands of hu- 
man lives”]. 
“The War Council was advised from the ablest sources 
available that an immediate appropriation for medical 
research would contribute to that end. The War Council 
could not disregard such advice.” 
1 Reprinted; with slight additions, by the kind permission 
of the Editor, from Science for Feb. 22, 1918. 274 
SELECTED PAPERS AND ADDRESSES 
They then refer to the many unsolved medical 
and surgical problems that have arisen from wholly 
new conditions and methods of warfare. Letters 
from a number of my surgical friends in France 
emphasize and the medical journals teem with 
papers on these new problems. They relate to the 
treatment of the horribly infected wounds—and 
practically all wounds are of this kind—never met 
with in civil surgery; to the treatment of “trench 
fever”—a peculiar form of fever never before seen; 
of “trench heart”; of “trench foot,” often followed 
by lockjaw; of “trench nephritis” (inflammation of 
the kidneys) ; gas gangrene; tetanus; shell shock; 
poisonous gases; fearful compound fractures, 
especially of the thigh, etc. Every man enabled 
to return to active duty as a result of solving these 
problems helps to win the war. Every man who 
dies, or is permanently disabled because of our 
ignorance, hinders our winning the war. 
It must be remembered that our surgeons, phy- 
sicians, and physiologists over there are the very 
flower of the American medical profession. These 
fine men, under the supervision of the Medical Staff 
of the United States Army, superintend all the 
work. Nothing is done that has not the direct 
approval of Brigadier General A. E. Bradley, 
Medical Corps, U. S. Army. 
Experiments on animals form a necessary but a 
minor feature of the researches. 
“The animals used are principally guinea pigs, rabbits 
and white rats. If operations causing pain to animals 
are performed, anesthesia is used.” RED CROSS AND ANTIVIVISECTIONISTS 
275 
This certainly does not suggest “cruelty” or 
“torture.” 
I appeal to the common sense of the American 
people and especially to the families and friends of 
our brave soldier boys: Which do you prefer, 
(1) That our soldiers shall be protected from at- 
tacks of these new (as well as of the familiar) dis- 
eases, their sufferings lessened or even prevented, 
and their lives saved, or (2) will you insist that 
not a single guinea pig, rabbit, or rat shall suffer 
the slightest pain or lose its life, in researches to 
lessen the suffering and save the lives of our sol- 
diers ? 
Remember, if you choose the second you deliber- 
ately condemn your son, brother, or husband to 
sufferings far beyond any suffering of these ani- 
mals. In many cases, as I shall show, you will 
condemn your dear one to death, and in some cases 
a horribly painful death. 
In the “Bill of Complaint” of the antivivisec- 
tionists, seven grounds of opposition to vivisection 
are mentioned. The sixth reads as follows: 
“That although it [vivisection] has been practised for 
many years, nothing has been discovered by means of it 
that is at all beneficial to the human raced* 
This is the crux of the whole matter. If this 
were true I would vigorously oppose vivisection 
myself. It is a monstrous falsehood. 
I entered upon my medical studies in 1860. I 
took part in the horrible surgery of the Civil War 
—as we now know it was. I have taught anatomy 276 
SELECTED PAPERS AND ADDRESSES 
and surgery to not far from 10,000 students. I 
taught and practised the old dirty surgery—the 
only kind we then had—up to October 1, 1876. 
Since that date I have practised and taught the new 
antiseptic surgery, which has been created by re- 
searches similar to those now proposed. Since the 
Great War began I have diligently studied the 
newest surgery. I submit, therefore, that I may 
be presumed to be fairly familiar with these stages 
of surgery. Let me give now a few examples of 
some of the things that have “been discovered by 
it [vivisection]” and that are “beneficial to the hu- 
man race.” 
I may remark in passing that annuals themselves 
have benefited by the same means, almost, and pos- 
sibly quite as much as the human race. 
1. Typhoid Fever.—This has been one of the 
historic scourges of armies. In 1880 the bacillus 
—the cause of the fever—was discovered. It was 
soon proved that the disease was spread through 
infected milk, infected water, and very largely by 
the house fly. The last, after walking over the 
excrement of a typhoid patient, and then walking 
over our food, conveys the disease. Prevention of 
contamination by these three means—sanitary 
measures based on the discoveries of bacteriology— 
prevents the disease to a large extent. But our 
real triumph over the disease was not achieved until 
lately. 
I may here call attention to the fact that the 
antivivisectionists entirely reject bacteriology, a 
science which has disclosed to us the causes of 
many diseases, and has enabled us to prepare anti- RED CROSS AND ANTIVIVISECTIONISTS 
277 
toxins to neutralize the poisons developed by these 
bacteria. Without bacteriology the physician and 
the surgeon today would be as helpless as a mariner 
without a compass. 
Cases Deaths 
During the Civil War typhoid fever 
resulted in 79,462 and 29,336 
In the Boer War there were . . . 58,000 “ 8,000 
(In that war the total number of 
deaths was 22,000. Typhoid 
alone, therefore, was responsible 
for more than one third of all the 
deaths!) 
In our war with Spain there were 20,738 “ 1,580 
(Our Army numbered 107,973 
men. Therefore every fifth sol- 
dier fell ill with typhoid in 1898! 
Over 86 per cent, of all deaths in 
this war were due to typhoid! ! 
During the Boer War imperfect attempts were 
made to control typhoid by an antitoxin similar to 
that against diphtheria, which has saved such mul- 
titudes of children. Gradually the method has 
been improved so that in our army it was at first 
recommended as a voluntary protection (1909). 
The results were so favorable that in 1911 it was 
made compulsory. It has been said that it should 
still be voluntary. But as eveiy case of typhoid 
imperils the health and life of multitudes we surely 
have a right to make it compulsory so as to protect 
all the rest. All that is necessary to prove its effec- 
tiveness is to look at these tables of cases and deaths 
in our Army and Navy. 278 
SELECTED PAPERS AND ADDRESSES 
TYPHOID FEVER IN THE UNITED 
STATES ARMY 
Year Cases Deaths 
1906 .... 210 12 
1907 .... 124 7 
1908 .... 136 11 
1909 .... 173 16 
1910 .... 142 10 
[vaccination made compulsory] 
1911 .... 70 8 
1912 .... 27 4 
1913 4 0 
1914 7 3 
1915 8 2 0 
TYPHOID FEVER IN THE UNITED 
STATES NAVY 
1909 .... 189 17 
1910 .... 193 10 
1911 .... 222 15 
[vaccination made compulsory] j„ 
1912 .... 57 2 
1913 .... 22 4 
1914 .... 13 0 
1915 .... 15 1 
On the Mexican border, though the fever was 
rife near the camps, only one man out of 20,000 
troops, a civilian, who unfortunately escaped vac- 
cination, fell ill with it but recovered. 
Now let us see the results in the armies in the 
present war. 
In the British armies, on March 1, 1917, Mr. 
2 Four in tbe United States; 4 in Hawaii. RED CROSS AND ANTIVIVISECTIONISTS 
279 
Forster, Under Secretary for War, stated in the 
House of Commons that 
The last weekly returns showed only twenty-four cases 
in the four British armies in France, Salonica, Egypt and 
Mesopotamia. He added that the total number of cases 
of typhoid fever in the British troops in France down to 
November 1, 1916, was 1,684, of paratyphoid3 2,534, 
and of indefinite cases, 353, making a total of 4,571 of 
the typhoid group. 
Now the English armies numbered at least 
5,000,000. If they had suffered as our Army did 
in 1898 there would have been 1,000,000 cases! In 
fact there have been less than 4,600! Besides that, 
the percentage of fatal cases in the inoculated men 
was 4.7 per cent., in the uninoculated 235 per cent.; 
and perforation of the bowel the most dangerous 
complication, occurred six times more frequently 
among the unvaccinated than among those who had 
been protected. In the British armies the anti- 
typhoid vaccination is still voluntary but more than 
90 per cent, have sought its protection. If it had 
been compulsory, hundreds of the 4,571 who died 
would have been saved! 
In our own Army in more than four months 
(September 21, 1917, to January 25, 1918), a 
period one month longer than our war with 
Spain (the Surgeon General’s Office gives me the 
official figures), we have had an average (i. e., 
every day of these four months) of 742,626 men in 
our cantonments and camps. These men have 
come from all over the country, in many cases from 
3 A form of fever caused by a bacillus somewhat similar to 
the typhoid bacillus but causing a much milder infection. 280 
SELECTED PAPERS AND ADDRESSES 
places where autumnal typhoid was reaping its an- 
nual harvest, in practically all cases unprotected by 
vaccination. Between these two dates there have 
been 114 cases of typhoid and 5 of paratyphoid. 
Had the conditions of 1898 prevailed there would 
have been 14-4-,50 6 cases instead of 199 in all! The 
reason is clear. The men were all immediately vac- 
cinated against typhoid, paratyphoid and small- 
pox.4 
Besides this as soon as the antityphoid inocula- 
tion was completed the number of cases rapidly fell 
and from December 14 to February 15—9 weeks 
—there have been only 6 cases of typhoid and one 
of paratyphoid among probably now nearly 
1,000,000 men! Truly marvelous! 
Now all this is the direct result of bacteriological 
laboratory work. Was it not worth while? Has 
it not “benefited the human race”? Are you not 
glad that your son is thus protected? 
I may add that the German armies show a sim- 
ilar absence of typhoid. I have seen no figures but 
only general statements. 
Tetanus or “Lock-jaw”—Few people realize 
what terrible suffering this disease causes. The 
mind of the patient is perfectly clear, usually to 
the very end, so that his sufferings are felt in their 
full intensity. All of my readers have had severe 
cramps in the sole of the foot or calf of the leg. 
The pain is sometimes almost unbearable.” In 
tetanus not the muscles of the jaw alone are thus 
gripped, but the muscles all over the body are in 
4 Of the last disease, there have been only 4 cases, all un- 
vaccinated. RED CROSS AND ANTIVIVISECTIONISTS 
281 
cramps ten or twenty-fold more severe, cramps so 
horrible that in the worst cases the muscles of the 
trunk arch the body like a bridge and only the 
heels and the head touch the bed! 
'Never shall I foget a fine young soldier during the 
Civil War who soon after Gettysburg manifested the 
disease in all its dreadful horror. His body was arched 
as I have described it. When at intervals he lay relaxed, 
a heavy footstep in the ward, or the bang of a door, would 
instantly cause the most frightful spasms all over his now 
bowed body and he hissed his pitiful groans between 
tightly clenched teeth. The ward was emptied, a half- 
moon pad was hung between the two door-knobs to pre- 
vent any banging; even the sentry, pacing his monotonous 
steps just outside the ward, had to be removed beyond 
earshot. . . . The spasms became more and more severe, 
the intervals shorter and shorter; it did not need even a 
footfall now to produce the spontaneous cramps, until 
finally a cruelly merciful attack seized upon the muscles 
of his throat and then his body was relaxed once more 
and forever. He had been choked to death. 
Do you wonder at the joy unspeakable which we 
surgeons have felt of late years as we have con- 
quered this fearful dragon? In 1884 the peculiar 
germ, shaped like a miniature drumstick, was dis- 
covered. Its home is in the intestines of animals, 
especially of horses. The soil of France and Bel- 
gium Jias been roamed over by animals and man- 
ured for over 2,000 years, even before Julius Ccesar 
conquered and praised the Belgians. The men in 
the trenches and their clothing are besmeared and 
bemired with this soil, rich in all kinds of bacteria, 
including those of tetanus, gas gangrene, etc. 282 
SELECTED PAPERS AND ADDRESSES 
When the flesh is torn open by a shell, ragged bits 
of the muddy clothing or other similarly infected 
foreign bodies are usually driven into the depths 
of the wound. Now the tetanus bacilli and the 
bacilli of “gas gangrene” are the most virulent of 
all germs. It takes 225,000,000 of the ordinary 
pus-producing germs to cause an abscess and 1,- 
000,000,000 to kill, while 1,000 tetanus bacilli are 
enough to kill. This readily explains the fright- 
ful mortality from tetanus during the Civil War. 
It killed 90 patients out of every hundred attacked. 
In the early months of the Great War the armies 
suddenly placed in the field were so huge that there 
was not a sufficient supply of the antitoxin of tet- 
anus. Hence a very considerable number of cases 
of tetanus appeared. Now it is very different. 
At present every wounded soldier, the moment he 
reaches a surgeon is given a dose of antitetanic 
serum. As a result, tetanus has been almost wiped 
off the slate. I say “almost,” because to be effec- 
tive the serum must be given within a few hours. 
The poor fellows who lie for hours and even days 
in No Man’s Land cannot be reached until too late. 
All the surgeons on both sides concur in saying that 
tetanus, while it occurred here and there, has been 
practically conquered. 
Every step of this work has been accomplished 
by the bacteriologists and the surgeons working to- 
gether in the laboratory and the hospital. Would 
you seriously advise that no such experimental re- 
searches should have been carried on and that your 
boy should suffer the horrible fate of my own poor 
Gettysburg boy? Confess honestly, are not these RED CROSS AND ANTIVIVISECTIONISTS 
283 
and other similar researches to be described as hu- 
mane?—as desirable?—nay, as imperative? 
Nay, more, “We feel,” say forty-one of our medi- 
cal officers on duty in France, “that any one en- 
deavoring to stop the Red Cross from assisting in 
its humanitarian and humane desire to prevent 
American soldiers from being diseased, and pro- 
tecting them by solving the peculiar new problems 
of disease with which the Army is confronted is in 
reality giving aid and comfort to the enemy.” 
But the antivivisectionists declare that bacteri- 
ology is false—that such vaccination is “filling the 
veins with ‘scientific filth’ called serum or vaccine”! 
They are doing their best to persuade our soldiers 
not to submit to any such “vaccination”! 
Smallpox.—The word vaccination leads me to 
say a word about smallpox. I confess that I was 
amused by a recent paper in an antivivisection jour- 
nal entitled “Vaccination as a Cause of Smallpox”! 
During the last year hundreds of thousands of sol- 
diers have been vaccinated against smallpox. 
Surely there should have been some cases of that 
disgusting disease if it were caused by vaccination. 
But what are the facts? I have just received 
the Report of Surgeon General Gorgas for 1917. 
The section on Smallpox reminds one of the cele- 
brated chapter on “Snakes in Ireland.” On p. 81 
on Smallpox in the Army in the United States, I 
read “2Vo cases of smallpox occurred within the 
United States proper during the year.” On p. 
175, I read “No cases [of smallpox or varioloid] 
occurred in the islands” [among the American 
troops in the Philippines]. On p. 188, I read 284 
SELECTED PAPERS AND ADDRESSES 
under Smallpox that “nine cases occurred during 
the year” [among the Philippine Scouts]. 
My friend and former student, Dr. Victor G. 
Heiser, as director of health in the Philippine Is- 
lands for years, vaccinated over 8,000,000 persons 
without a death—and with what result? In and 
around Manila the usual toll of smallpox had been 
about 25,000 cases and 6000 deaths annually. In 
the twelve months after his vaccination campaign 
was finished there was not one death from small- 
pox. 
Per contra, in 1885 in Montreal, as stated by 
Osier, one Pullman porter introduced smallpox 
into a largely unvaccinated city. There followed 
3164 deaths and enormous losses to the Montreal 
merchants. 
But why say more? We all know that a single 
case in any community causes every intelligent 
person to be protected by vaccination. 
Gas Gangrene.—One of the terrible and new 
surgical diseases developed by this war is called 
“gas gangrene.” It has no relation to the poison- 
ous gases introduced by the barbarous Germans 
at Ypres. About twenty-five years ago Professor 
W. H. Welch, of the Johns Hopkins Hospital, 
discovered a bacterium which produced gas in the 
interstices between and in the muscles. This ba- 
cillus does not occur in Great Britain. I never 
saw a case of gas gangrene in the Civil War, and 
but one case since then in civil practice. On the 
contrary in Belgium and France in the soil and, 
therefore, on the clothing and on the skin of the 
soldiers these bacilli abound. From what Bash- RED CROSS AND ANTIVIVISECTIONISTS 
285 
ford calls the “cesspool of the wound” the germs 
travel up and down in the axis of the limb. If the 
gas escapes from the puncture it will take fire from 
a match. Gas has been observed within five hours. 
An entire limb may become gangrenous within six- 
teen hours. If the limb is amputated the gas 
may be so abundant that the limb will float in 
water! Death is not long delayed. 
Now your son in France runs a very serious 
risk of becoming infected with this deadly germ. 
Would you be willing positively to forbid any ex- 
periments on animals which could teach us how to 
recognize this infection as early as possible? 
Would you forbid any experiments which might 
teach us how to conquer or better still to prevent 
this virulent infection and save his life? Which 
would you prefer should suffer and very possibly 
die, a few minor animals or your own son? If a 
horse or a dog or even a tiny mouse can help in this 
sacred crusade for liberty and civilization, if it 
even suffers and dies, is it not a worthy sacrifice? 
Should they be spared and our own kith and kin 
give up their lives ? 
I need not wait for a reply! I am sure you 
would say “My boy is worth 10,000 rabbits or 
guinea pigs or rats! Go on! Hurry, hurry! and 
find the remedy.” That is true humanity which 
will save human lives even at the expense of some 
animals’ lives. 
Now see the result. By careful observation and 
experiments with different remedies the surgeons 
have discovered valuable methods of treatment. 
But very many still die. Prevention is always far 286 
SELECTED PAPERS AND ADDRESSES 
better than cure. At the Rockefeller Institute 
Drs. Bull and Ida W. Pritchett have discovered 
a serum which in animals prevents this gas gan- 
grene and yet does no harm to the animal. It is 
now being tried on the soldiers in France. 
Again I ask: Is it not our duty even to insist 
on such experiments so that our troops may he 
spared the dreadful suffering and even death 
following this virulent infection? If the Bull- 
Pritchett serum proves ineffective should not our 
efforts be redoubled? The common sense of the 
American people will reply: “Yes, by all means. 
You will be recreant to humanity and to your duty 
if you do not.” 
Modern Surgery.—In Howard Marsh’s fine 
phrase, “Lister opened the gates of mercy to man- 
kind.” Pasteur and Lister are the two greatest 
benefactors of the human race in the domain of 
medicine. I’m not sure but that I might even omit 
the last five words. 
The revolution which Lister produced in surgery 
is so well known to every intelligent person that I 
need say only a few words. Forty years ago a 
wholly new surgical era was inaugurated by Pas- 
teur and Lister. In the Civil War there were re- 
corded 64 wounds of the stomach and only one re- 
covered. Otis estimated the mortality at 99 per 
cent. In more than 650 cases of wounds of the in- 
testines there were only 5 cases of recovery after 
wounds of the small bowel and 59 from wounds 
of the large bowel—together out of 650 only 64 re- 
covered, i. e., more than 90 out of every 100 died! 
The complete statistics of the present war can- RED CROSS AND ANTIVIVISECTIONISTS 
287 
not be tabulated and published for some years. I 
give, however, the result of one series of abdominal 
gunshot wounds as a contrast, on a far larger scale 
and in far worse wounds. Out of 500 such opera- 
tions, 245 recovered! and only 255 died. Contrast 
51 per cent, of deaths in these wounds with mutila- 
tion and infection unutterably worse than the Civil 
War, with 99 per cent, of deaths, according to Otis. 
Is not this a triumph of bacteriological and surgi- 
cal research? Would you prohibit similar re- 
searches now when your boy’s life may be saved by 
them? 
Is not this one of the things that have “been dis- 
covered” by vivisection and has not such change in 
surgical treatment been of “benefit to the human 
race”? In all honesty would you be willing to 
have your son treated as I myself (may God for- 
give me!) ignorantly treated hundreds during the 
Civil War? 
This advance I not only think and believe, but 
also I know, is due to Pasteur and Lister and 
their followers. I know it by personal experience 
just as you know the high cost of living, the short- 
age of sugar, and the scarcity of coal. 
The bacteriology which the antivivisectionists 
scorn and reject I know is the corner-stone of 
modern surgery. Before Lister’s day out of 100 
cases of compound fracture 66 died from infec- 
tion. Now the percentage of deaths is less than 
one out of 100. Before Lister my old master in 
surgery, Dr. Washington L. Atlee, one of the 
pioneers in practising ovariotomy, lost 2 out of 
every 3 patients—now only 2 or 3 in 100 die. Be- 288 
SELECTED PAPERS AND ADDRESSES 
fore Lister we never dared to open the head, the 
chest or the abdomen unless they were already 
opened by the knife, the bullet or other wounding 
body. Now we open all these great cavities freely 
and do operations of which the great surgeons of 
the past never dreamed in the wildest flights of 
their imagination. Could they return to earth 
they would think us stark crazy until they found 
that the mortality was almost negligible and the 
lives saved numbered hundreds and thousands. 
I have given but a few instances of the many 
wonderful benefits which have resulted from medi- 
cal research in every department of medicine. 
But I believe they are sufficiently convincing. I 
should have been glad to tell the story of tuber- 
culosis, syphilis, the bubonic plague, yellow fever, 
malaria, the hookworm disease, diphtheria, typhus 
fever, cerebrospinal meningitis, Malta fever, lep- 
rosy, and may other diseases, every one of which 
has had its progress stayed, its victims rescued, its 
toll of human lives cut down enormously, some- 
times to one half or less, by researches similar to 
those which will be conducted in France. Most 
important and life-saving researches on surgical 
shock already have been made by Porter, Cannon, 
and others. Ought these to be abandoned and our 
soldiers left to perish when we can save their lives? 
I can sympathize with the deep feelings of those 
who wish to spare pain to animals, but is it not a 
higher and more imperative, a holier sympathy that 
has spared and will spare pain eventually to human 
beings and also to other animals in uncounted 
numbers ? RED CROSS AND ANTIVIVISECTIONISTS 
289 
Do you wonder that after more than forty years 
of steady practice, teaching and writing, I assert, 
conscious of the great responsibility of my words, 
that “I regard experimental research in medicine 
as a medical, a moral and a Christian duty toward 
animals, toward my fellow men, and toward God.” 
There is so much yet to be learned, chiefly by 
experimental research! So many devoted lives to 
be saved to our country and to mankind if we only 
knew how! Do you wonder that I am in dead 
earnest? 
Finally. What have the antivisectionists them- 
selves done to diminish sickness and save life? 
A. In animals? Absolutely nothing. 
In spite of the enormous ravages of animal dis- 
eases causing enormous suffering to animals and 
costing this country $215,000,000 every year, not a 
single disease has had its ravages diminished or 
abolished as a result of anything they have done. 
They have not even tried* But medical research is 
saving every year thousands of animals from an- 
thrax, hog cholera, chicken cholera, Texas fever, 
and other diseases. 
B. In human beings? Absolutely nothing. I 
do not know a single disease of human beings which 
has had its ravages checked, abated or abolished by 
any work ever done by the antivivisectionists. 
Again, they have not even tried. 
The only thing they have done has been to throw 
as many obstacles as possible in the path of those 
who are striving to benefit both animals and men. 
This present suit is characteristic. IMMORTAL YOUTH 
A MESSAGE TO THOSE WHO LOST THEIR 
SONS IN THE GREAT WAR 
To many of the patriots and loving yet bereaved 
fathers and mothers whose sons have fallen in the 
Great War, I have found that one of the most 
comforting thoughts has been that their “boys” 
have been thereby endowed with “Immortal 
Youth.” 
No matter how long the parents live, their boy 
will never grow old to them. Had he and they 
lived together for ten, twenty or forty the 
boy of twenty-odd wrould have become the man of 
even sixty-odd with gray hairs and the pes anseri- 
nus furrowing his temples. Once he has given life 
itself for Liberty and Civilization, he has passed 
from the Realm of Time, with its changes and its 
vicissitudes, its aging and its decrepitude, into 
the Realm of Immortality. There he will never 
lose the bloom of youth with his well-remembered 
inspiring buoyancy, his affection, his ardent, hope- 
ful, cheerful life. Immortality for him and them 
knows neither Decay nor Decline. Its voice is 
ever that of vigorous, hopeful, radiant Eternal 
Youth. 
I believe as firmly in Immortality and the Fu- 
1 Reprinted from the North American Review, March, 1919, 
by the kind permission of the Editor. IMMORTAL YOUTH 
291 
ture Life as I do in my present existence. Hence 
I believe that Immortal Youth is the future of our 
young heroes who have made what is well called 
the “Supreme Sacrifice.” SOME OF THE THINGS WE SUR- 
GEONS AS A PROFESSION 
STAND FOR 1 
It is trite, but profoundly true, for me to say 
that the distinguished honor you conferred upon 
me six long and fateful years ago, in April, 1914, 
in New York City, is deeply appreciated. How 
ignorant we were as to what was then “in the lap 
of the gods”! How little we dreamed that in 
three months’ time the dogs of war would be loosed 
on faithful Belgium and heroic France; that when 
Britain’s honor was touched, she, too, would spring 
to arms in defense of the Rights of Humanity, of 
the sacredness of what the whole civilized world 
recognized as solemn binding treaties, but which 
Germany deemed only “scraps of paper”! 
The heart of the people of America was with you 
then and is with you to-day. Many of us tugged 
at the leash when the Louvain Library was given 
to the flames, when Rheims was ruined by the rep- 
resentatives of Kultur, and still more when the 
Lusitania was torpedoed without warning and 
went to the bottom in twenty-one minutes. Eleven 
hundred and fifty-four men, women, and children, 
including one whom we all loved—a gracious 
1 The Presidential address at the Fifth International Con- 
gress of Surgery, Paris, July 19, 1920. Reprinted from the 
Annals of Surgery for September, 1920, by the kind per- 
mission of the Editor. SOME THINGS WE STAND FOR 
293 
woman ion an errand of mercy—were thus murdered 
by the pitiless Huns. I have seen the coarse, mis- 
dated medal struck by the Germans to commemo- 
rate forever this hideous crime. 
Many of us are also tugging at the leash to-day, 
longing to help you in your hour of peril. We 
resent the sinister influences at work, even in some 
high places, to create dissension between us and our 
“Allies,” as I love to call you. We would gladly 
throw in our lot with you all—Belgium, Britain, 
France, Italy, Portugal, and Japan. 
What amazing courage and steadfastness you 
have shown. What impossible things you have 
done on plain and on mountain peak, in trench and 
in hospital, on land, on the sea, under the sea, where 
you were comrades of the fish, high in the air, 
where you outstripped and were the envy of the 
eagle. 
We were lost in admiration of your prowess, and 
suffered with you in your sacrifice of those that 
were dearest to you. Even in your hours of de- 
feat instead of yielding to despair you showed 
what the “inspiration of adversity” could do, and 
plucked victory from the Hun. 
Finally, when we Americans were allowed to 
come to your aid, how exultantly our young men 
and old men, young women and old women sprang 
to your help and were at least of some aid, though 
at the eleventh hour. It will always be a joy to 
us that Chateau-Thierry was the nearest approach 
of the Huns to Paris—a perilous nearness of but 
half a hundred kilometers. There, with uplifted 
and forbidding hand our message ran: “Thus far 294 
SELECTED PAPERS AND ADDRESSES 
and no further,”—“and it was so,” as saith the 
Scripture of the Creative Week. 
How prophetic, though all unconscious, was the 
presidential address of that noble Belgian, Pro- 
fessor Depage, in April, 1914! How he turned 
words into deeds of great pith and moment at La 
Panne! What lessons in the surgery of wounds 
he taught us! 
How splendidly all of you wrought not only for 
humanity, but for science! In the four years of 
the war, how you have transformed surgery! A 
new era dates from 1914 to 1918! 
For me to attempt to discuss any surgical sub- 
ject before you would be presumptous. It is for 
me to sit at your feet and learn how you have ac- 
quired your present affluence of surgical know- 
ledge. 
In this address, therefore, I venture to recall to 
your minds some of the things which we as a pro- 
fession should stand for. 
I regret that I can only give a brief paragraph 
or two to each topic. As to some, you will not all 
be in accord with me. I can only state my own 
belief as to what is, or ought to be, the attitude of 
our guild. 
1. Education.—I need only to point you to one 
so lately rapt from us, Osier the scholar, who 
taught us all what we should study; not only prac- 
tical medicine in its various branches, among which 
we may have a chosen one, but the history of med- 
icine, the biographies of our past heroes; nor yet 
only medicine, but the humanities representing the 
“Literature of Power” as contrasted with the “Lit- SOME THINGS WE STAND FOR 
295 
erature of Knowledge”; not only solid prose, but ca- 
denced poetry, with its wings to lift us towards the 
stars; not only modern literature, but we should 
also drink of the old, old fountains of inspiration 
from Judea, Greece, and Rome. Medical educa- 
tion, strictly so called, has made great strides in 
the last thirty years due to the persistence of the 
leaders in medical thought and influence. It must 
still make progress semper et ubique. 
2. Research.—I need only pronounce the word 
to awaken in your minds the contrast of the last 
years of the great war with the first year when you 
were groping your way to the light. The abso- 
lutely proved conquest of typhoid, typhus, tetanus, 
smallpox, and perhaps above all the victory over 
unparalleled infection, are eloquent witnesses to 
the value—the medical, military, economic and hu- 
manitarian value—of research. This is the great- 
est of the great achievements of the war. 
The savant in the laboratory and the clinician in 
the hospital have been wedded at the bedside in the 
bonds of a scientific fellowship, never before so 
welcome and never before so fruitful for the good 
of mankind. 
Fortunately, in our medical schools, our insti- 
tutes of research, and the new Red Cross labora- 
tories at Geneva, this wonderful work will be still 
further developed. 
3. Professional Uprightness.—In one respect, I 
have an exultant pride in the honor and upright- 
ness of our ancient guild. With our women pa- 
tients, our honor is always at stake. We see them 
alone and we trust them with that which we hold 296 
SELECTED PAPERS AND ADDRESSES 
dearer than life itself. On the other hand, they give 
their honor into our hands with many and unusual 
temptations. Yet, how rare it is that a medical 
man is even accused of wrongdoing! Among the 
hundreds of thousands in many lands (and there 
are black sheep in every flock), the lapses from 
honorable and upright conduct are so few that even 
its possibility scarcely ever occurs to any woman as 
the door of the consulting room is closed. 
The wonder is that among woman patients there 
are not more adventuresses who would endeavor to 
blackmail us. The community trusts us as no other 
class of men is trusted, and we, God he thanked, 
have proved ourselves worthy of their trust. 
We are a profession, as distinguished from a 
trade. In the latter there is always a ready means 
of fixing values by the pound or the yard or by 
number. The services of our guild can never be 
weighed in the balance or be measured by length 
or breadth or number. We should never lower 
our standards. 
A new remedy, a new splint or brace, or a new 
method of treatment, therefore, should be as free 
as the air we breathe, a new splint devised in Phil- 
adelphia should be as available in Paris, in Tokio, 
in Cape Town, or in Buenos Aires as in Philadel- 
phia. A new remedy should be available for all 
doctors and all patients in all parts of the world. 
They should not be compelled to wait till they 
could get either the one or the other from Philadel- 
phia or Paris or London, especially when, as often 
may be the case, to wait even a day may mean death 
or disability. SOME THINGS WE STAND FOR 
297 
4. Venereal Diseases.—Never before has this 
menace to the health and general welfare of the 
community been so generally appreciated by the 
public as well as by our profession as during and be- 
cause of the war. What injures the individual in- 
jures the state. Hence the most extraordinary and 
extraordinarily successful campaign against vene- 
real diseases inaugurated by the war should be 
zealously continued, now that the war is over. 
Ever since the fifteenth century, increased and 
disseminated by the war, syphilis has always been 
a scourge both to armies and to the populations 
among whom they were encamped. But in the 
great war the incidence both of syphilis and of 
gonorrhea immediately dropped to a startling 
degree the moment that the men came under army 
discipline and with the safeguards which surrounded 
each camp. By these same means the health of 
the community was protected. The incidence of 
venereal diseases in the Army was far below that 
in the civil community. 
Now that the armies have been demobilized, the 
lessons taught the men by lectures and especially 
by the cinema films, it is hoped, will not be forgot- 
ten but will still act as deterrents. 
But after all, the only sure and permanent de- 
terrent will be a change in our moral attitude, our 
moral standards. There must be a “change of 
heart” to make permanent a change of conduct. 
Our young men must be convinced that at the 
marriage altar where a new family is founded, 
the bridegroom should be as clean and as pure as 
the bride. He should realize his responsibility in 298 
SELECTED PAPERS AND ADDRESSES 
the conservation of his wife’s health and in the crea- 
tion of strong and healthy children. 
A single standard of sexual morality is the only 
righteous and just standard. It should be just 
as disgraceful in the judgment of the men and 
women in the community for a man to have a mis- 
tress, as for a woman to have a privileged lover. 
Social ostracism, now visited only upon the woman, 
should be meted out equally to the man. 
We—we doctors, I mean—who especially well 
know all the evils not only to the husband, but to 
the wife and to their children—would not willingly 
give our daughters to men who are victims of 
gonorrhea or of syphilis. Surely, those of us who 
have sons would be unwilling for them to marry 
young women already besmirched. Shall our 
daughters be less jealously guarded than our sons? 
You know what it would be for your son or your 
daughter to have wretched, syphilitic children, 
doomed to a life of misery, to whom death would 
be a blessing and the tomb a welcome relief. 
In the United States, impressed especially by 
the gravity of the venereal peril, eleven states of the 
forty-eight have passed laws to safeguard the com- 
munity from the perils of transmissible and espe- 
cially of venereal diseases in the marriage relation, 
in order to safeguard the health of the wives and 
children. The requirements vary all the way 
from a medical certificate, after a physical exami- 
nation, made shortly before marriage, to a mere 
affidavit of one or both parties that they are free 
from any venereal or other communicable disease 
which would impair the health of the children born SOME THINGS WE STAND FOR 
299 
of such a union. The penalty is fine or imprison- 
ment or both. 
I have made a number of personal inquires from 
lawyers of the best standing as to how these laws 
really are working. Some have been enacted too 
recently to enable any reliable judgment to be 
formed as to their value; some are ineffective, or in- 
effectively enforced; some are evaded by marriage 
in an adjacent state having no such law. Those 
that are really enforceable and also enforced are of 
value, in the judgment of health officials and law- 
yers, partly because their penalties act as deterrents 
but chiefly because of their moral and educational 
value. 
This movement is sure to grow. I venture the 
opinion that as the facts as to these diseases and 
the requirements of the laws become more widely 
known, especially among young women about to 
marry, they will be more and more insisted upon 
by the young women themselves or by their 
parents.2 
Proper education in sexual matters should he 
given to young boys and girls by their parents or 
by physicians. They should be taught the facts 
of reproduction in a clean and pure way before 
they acquire such knowledge by the often filthy 
2 The best two publications to be consulted are, “American 
Marriage Laws in Their Social Aspects,” by Fred. S. Hall 
and Elizabeth W. Brooke, Russell Sage Foundation, New 
York, 1919, and a careful study in “Social Hygiene” for 
April, 1920, 105 West 40th Street, New York City, by Mr. 
Bernard C. Roloff, Executive Secretary of the Illinois Social 
Hygiene League. 300 
SELECTED PAPERS AND ADDRESSES 
teaching from boys and girls a little older than 
themselves. 
5. Our Altruism.—We are the only self-de- 
structive profession. In unselfish devotion to the 
welfare of the community, in the battle royal 
against disease, in the fight for pure water and 
pure milk and wholesome housing—in a word, in 
preventive medicine, I glory in the fact that we 
doctors are always the leaders. 
Every disease that is abated, such as smallpox, 
typhoid, typhus, diphtheria, dysentery, and such 
like, has had its chief adversary in our profession. 
A single epidemic of smallpox in a single city will 
bring more actual revenue to the doctors than a 
quarter of a century of vaccination, but we are the 
vanguard in insisting upon vaccination in order to 
stop this procession of death. We lead the fight 
for pure water and pure milk to prevent epidemics 
of typhoid—again wholly to our own financial 
detriment. 
This twentieth century will be only a few years 
older when yellow fever, one of the former great 
scourges of the Western Hemisphere, will be 
actually blotted out of existence. This will be the 
first instance ever known of such a wonderful 
miracle in the history of the human race. The 
glory of it belongs to our profession—to Carlos 
Finlay, to Walter Reed and his associates, and to 
that prince of sanitarians, Major General William 
C. Gorgas, of the United States Army, whose 
world lamented death has occurred since these lines 
were written. 
AH honor, then, to the men of our guild SOME THINGS WE STAND FOR 
301 
for unselfish devotion to the health of the state. 
6. Abstention from Alcohol.—I have no doubt 
there will be a greater diversity of opinion on this 
point than on any other. I can only state my own 
opinion and give the reasons why I hold it. What 
I shall say has no relation to the use of alcohol as 
a medicine but wholly to its use as a beverage. 
Without doubt, the least prejudiced conclusion, 
based upon the results obtained by the most scien- 
tific and most rigid experimental investigation, is 
that of Dr. Raymond Dodge and Dr. Francis G. 
Benedict, head of the Carnegie Nutrition Labora- 
tory in Boston. His conclusion is tersely stated 
in these words: “Any use of alcohol, even though it 
be occasional, must be regarded as contrary to 
scientific teachings.” 3 Miles,4 experimenting on 
doses of 30 c. c. of absolute alcohol, suitably diluted, 
says that 27 cases out of 30, i. e., 90 per cent., 
showed inferior functioning after this dose. Krae- 
pelin5 and Mitander6 demonstrated greater or 
less losses of efficiency in the target practice of 
experienced marksmen after small doses, such as 
30 to 40 c. c., of alcohol. 
While these results are attained by .scientific 
experiments of great accuracy in a small number of 
men, the result of prohibition in the LTnited States 
3 Scientific Aspects of Moderate Drinking, Boston Med. and 
Surg. Journal, Feb. 18, 1904. 
4 Effect of Alcohol on Psycho-Physiological Functions, 
Carnegie Institution Publication No. 216, 1918. 
5 Munch, med. Woclinr., 1899, No. 42. 
6 Bericht des 10. Internat. Kongr. gegen den Alkohol, 
Budapest, 1905, pp. 193-204. 302 
SELECTED PAPERS AND ADDRESSES 
and later of the adoption of the Prohibition Amend- 
ment to the Constitution, demonstrate the extraor- 
dinarily beneficial results even within the few 
months since its adoption, The fact that private 
stocks of liquor are not yet exhausted, and that 
machinery for the effective enforcement of the law 
is at yet incomplete, and therefore that liquor can 
be obtained if one can pay the higher prices now 
charged only add to the strength of the argument 
from these results. 
For actual conditions in New York City I have 
to thank Mr. Bird S. Coler, Commissioner of the 
Department of Public Welfare, and Dr. John 
Fitzgerald, temporarily in charge of Mr. Coler’s 
offices. They have most courteously given me 
complete information covering nine large mu- 
nicipal hospitals, and one even more valuable 
source of information, a large municipal lodging 
house. 
Of course, I can only epitomize the facts and 
opinions of the medical officers in charge. 
In the lodging house the admissions for Jan- 
uary, February, and March, 1919, under license 
numbered 22,350. In the corresponding months 
for 1920 under prohibition, they were 4607.7 Not 
only were the results so remarkable in numbers, 
but “the applicants were better, cleaner, and 
healthier than formerly.” Intoxicated applicants 
were rare, while “formerly we were obliged to call 
a policeman nightly to have the drunks removed.” 
The employees were giving better care to their 
7 The report for March being rendered on the 26th, I added 
the average for the remaining five days. SOME THINGS WE STAND FOR 
303 
personal appearance and were saving money. “I 
have met men on the street,” writes the superin- 
tendent, “who were formerly regular lodgers and 
was surprised at their neat and clean appearance. 
They are working steadily and buying clothes in- 
stead of drink.” 
Among the hospitals the general result was a 
largely decreased number of admissions, especially 
for intoxication and delirium tremens. Also, 
again, among the employees there was great im- 
provement. One report says of them that some 
of the former worst offenders were opening bank 
accounts. 
The Psychopathic Ward at Bellevue Hospital, 
in New York City, handles more alcoholics of the 
vagrant and poor class than any other hospital. 
Dr. M. S. Gregory, the Director of that ward, 
writes than in January and February, 1920, instead 
of 400 to 500 cases a month, there were only one 
or two a day so that the ward was abolished! As 
soon as the lax administration of the law set in, 
the number increased to five or six or even ten a 
day. This, however, was a much smaller number 
than before prohibition. 
In Philadelphia, the House of Correction, in 
which the most of the cases of vegrancy and alco- 
holism are treated, instead of a population of over 
2000 before prohibition, has a population of only 
about 400 to 500 since prohibition became effec- 
tive. In the first four months of 1920, the savings 
by reason of fewer employes, less wages, less food, 
and other expenditures, were sufficient to pay all 
the expenses of the entire Department of Public 304 
SELECTED PAPERS AND ADDRESSES 
Welfare for the remaining eight months of the 
year.8 
A similar diminution of the number of inmates 
in the County Prison in Philadelphia has raised 
the question whether the House of Correction and 
the County Prison could not be combined with 
consequent large economies. Four adjoining 
counties in Massachusetts are about to abolish 
three jails as the one remaining jail can accom- 
modate all the prisoners of the four counties. 
In Philadephia in the first six months of 1919, 
under license, there were 17,114 arrests for intoxi- 
cation. In the last six months under war prohibi- 
tion, the number was 6509, a decrease of 62 per 
cent. 
In the alcoholic department of the Almhouse 
(Philadelphia City Hospital) the admissions in the 
last six months of 1917 and 1918, i. e., before war 
prohibition, were 1470 and 1184, respectively. In 
the same period in 1919 under war prohibition, 
there were only 276, a decrease of 77/4 per cent. 
In Massachusetts, Mr. H. C. Parsons, Deputy 
Commissioner for Probation for the whole state, 
as a result of the first year of prohibition, reports 
that during the first five months of 1919, under 
license, there were 34,176 arrests for drunkenness. 
In the corresponding months of 1920, under pro- 
hibition, there were only 10,324—a diminution of 
practically 70 per cent. 
Judge Cabot, of the Juvenile Court, states that 
the family relations are greatly improved. The 
8 Personal statement to me by Hon. E. L. Tustin, Director 
of Public Welfare, in Philadelphia. SOME THINGS WE STAND FOR 
305 
parents, instead of neglecting their homes, are try- 
ing to make them attractive to live in, and instead 
of spending their time and money in the saloons, 
are taking their children to the cinema (“movies”) 
and to church. 
Many rural courts have no culprits before them 
for days and even weeks. 
During the war the great improvement in social 
conditions following the prohibition of vodka in 
Russia told the same story. 
I need not urge on this audience the argument 
that alcohol is the most powerful and most fre- 
quent cause of sexual immorality and its attendant 
venereal diseases, to say nothing of the evil effects 
of the alcohol itself. 
Whatever may be the conclusions of scientific 
experiment on the effects of alcohol, the huge ex- 
periments on the millions of human beings in the 
United States as shown above and in Russia seem 
to me to be conclusive that total abstention from 
alcohol results in less drunkenness, less poverty, 
less crime, less disease, fewer accidents, and smaller 
expense to the city and the state. If so, is it not 
our duty as a profession to urge total abstinence 
from the standpoint of the health and the general 
welfare of the entire community?9 
As the Supreme Court of the United States has 
9 Since the date of this address, the most important testi- 
mony that has been published is contained in a pamphlet 
issued by the “Manufacturers Record” of Baltimore, Mary- 
land. It contains extracts from about 400 business men who 
view the subject from the economic and the moral standpoint. 
Much of this testimony takes into account the very imperfect 
enforcement of the law. I have room only for what the Pres- 306 
SELECTED PAPERS AND ADDRESSES 
decided that the Eighteenth, the Prohibition 
Amendment, is constitutional, and is, therefore, the 
supreme law of the land, it is proper to call atten- 
tion to the serious effect that prohibition will have 
upon industry and trade. 
ident of the United States himself says and one other quota- 
tion from the same journal for June 8, 1922. 
“In every community men and women have had an oppor- 
tunity now to know what Prohibition means. They know 
that debts are more promptly paid, that men take home the 
wages that once were wasted in saloons; the families are better 
clothed and fed, and more money finds its way into the sav- 
ings banks. The liquor traffic was destructive of much that 
was most precious in American life. ... In another genera- 
tion I believe that liquor will have disappeared not merely 
from our politics, but from our memories.” 
Warren G. Harding 
May 29, 1922. 
... In my own experience which is principally agricul- 
ture in which I have several hundred people engaged . . . 
the change is as different as from night unto day. Before 
national Prohibition came into effect I seriously considered 
that it was impossible to continue my development and agri- 
cultural operations on a large scale; it certainly was very 
unprofitable with so much waste of time and money caused by 
a large per cent, of drunkenness among those with whom I 
had to deal. I think this trouble has been reduced fully 95 
per cent, and where formerly my men were mostly uncertain 
and unreliable, I now have less than 1 per cent, of such 
trouble. . . . My labor and tenants are far more industrious, 
better satisfied and more prosperous generally as well as better 
fed, better clothed and better housed since the advent of na- 
tional Prohibition. Many of them have paid for first class 
farming outfits and have anywhere from two to twenty mules 
fully paid for, and some have their own money in the bank to 
raise their this year’s cotton and other crops; several have 
even bought valuable farms. ...” 
S. E. Simonson, Luxora, Ark. SOME THINGS WE STAND FOR 
307 
Under prohibition undoubtedly fewer hours are 
lost by workingmen and fewer industrial acci- 
dents occur, since both are largely due to alco- 
holic excesses. In the modern keen competition 
for the markets of the world, a drinkless nation 
will thus have a most important economic advan- 
tage over a drinking nation, both in the better 
character of its workmen and in the more uninter- 
rupted hours of labor. Hence the output of its 
products will be greatly increased and the cost les- 
sened. 
7. Bravery.—In combating great plagues, when 
and where have the doctors been cowards? Where 
have they run away to gain safety for themselves, 
leaving the victims of disease to suffer and die un- 
attended? 
Let Serbia and Poland respond. Let the south- 
ern cities in the United States—Norfolk, Mem- 
phis, New Orleans—so often devastated by yellow 
fever, reply. In Europe and America, let the 
cities which have been decimated by cholera give 
answer. 
The case needs no argument. It is confidently 
committed to the jury of the world without in- 
structions from any judge. The verdict is and 
has always been, “Guilty of the highest bravery 
known among men.” Without the gorgeous trap- 
pings of war, without the beating of drums and the 
blare of trumpets, with only “Duty” as a watch- 
word, and Godlike Compassion as a motive, they 
have ministered to the sick and dying and only too 
often have been among the slain. 
8. Finally, we stand for pure and undefiled re- 308 
SELECTED PAPERS AND ADDRESSES 
ligion as the surest guide for the present and the 
surest hope for the future. Observe, I say, not 
theology, which is a separating, a sundering force, 
but religion, which is even etymologically that 
which binds together, and morally is the supreme 
hope of the world. 
BE STRONG 
Be strong! 
We are not here to play, to dream, to drift; 
We have hard work to do, and loads to lift. 
Shun not the struggle; face it. ’Tis God’s gift. 
Be strong! 
Say not the days are evil—who’s to blame? 
And fold the hands and acquiesce—O shame! 
Stand up, speak out, and bravely, in God’s name. 
Be strong! 
It matters not how deep intrenched the wrong, 
How hard the battle goes, the day, how long; 
Faint not, fight on! To-morrow comes the song. 
—Maltbie D. Babcock. VIVISECTION 1 
Vivisection means literally “cutting a living be- 
ing.’’ Every surgical operation is literally a vivi- 
section. In common speech, however, the word 
has obtained a much wider meaning—namely, any 
mode of experimenting on an animal, by admin- 
istering a drug by the mouth, by a hypodermic 
syringe or by the other means; by varying the qual- 
ity or the quantity of food; and also any cutting 
operation for the purpose of research. The proper 
term is “experimental research.” 
The three principal objections to “Experimen- 
tal Research” are: That it is cruel; that only 
25 per cent, of the profession approve of it; and 
that it has been of no benefit either to man or to 
animals. I will consider them in the order given. 
1. That cruel suffering was inflicted in the past 
is an undoubted fact, but we must never forget that 
prior to October 16, 1846, anesthesia was impos- 
sible, for no effective anesthetic was known. 
Even the words anesthesia and its derivatives did 
not exist. I condemn the utter indifference to 
pain such as was admitted by Klein before the first 
English commission in 1875; whether he is now 
alive or not I do not know. Dr. B. A. Watson, 
of Jersey City, was cruel in his experiments on 
1 Reprinted by the kind permission of the Editor from The 
Country Gentleman for February 12, 1921. 310 
SELECTED PAPERS AND ADDRESSES 
shock and was soundly rebuked at the time. 
Mantegazza, in his book on the Physiology of Pain, 
is the only experimenter of whom I have any 
knowledge who did perform cruel experiments for 
the very purpose of studying the effects of pain 
per se. 
But, while the experiments mentioned above are 
constantly described by the A-V’s, one important 
fact is nearly always omitted—the dates of these 
events. The reader, uninformed in the history of 
medicine, is apt to believe that these men are now 
living and still performing such experiments. 
Doctor Watson died in 1892. His experi- 
ments were done thirty years ago, in 1890. Man- 
tegazza’s book was published in 1880, forty years 
ago. The “ferociously cruel Magendie” was born 
in 1783, six years before the Constitution of the 
United States was adopted, and his last paper 
was published in 1842, four years before the in- 
troduction of anesthesia in 1846. Dupuytren was 
born in 1777 and died in 1835, eleven years be- 
fore anesthesia was known. 
To compare the work of men who never knew 
there was such a thing as an anesthetic with those 
of to-day is like comparing the antiquated meth- 
ods of the engineers of seventy-five and one hun- 
dred years ago with the methods of General Goeth- 
als and his associates in Panama. 
The A-V’s—I adopt A-V as a clearly under- 
stood contraction of antivivisection and its deriva- 
tives—insist that vivisection is cutting up and tor- 
turing live animals with the alleged idea of gaining 
from their toi'ments certain biological and patho- VIVISECTION 
311 
logical facts designed to be used in the treatment of 
human maladies. All this is precisely what modern 
research by experiment on animal is not. Tortur- 
ing animals and studying their torments are not 
the occupation of research workers. Such suffer- 
ing, especially severe suffering, would defeat the 
very objects of such researches. “To rend them to 
shreds,” could by no possibility give the least in- 
formation on any problem of health or disease. 
Had the A-V’s followed Owen Wister’s sug- 
gestion and said, “The Declaration of Indepen- 
dence wras signed by Christopher Columbus on 
Washington’s birthday during the seige of Vicks- 
burg in the presence of Queen Elizabeth and 
Judas Iscariot,” their statement would have 
been equally veracious and more striking. 
Moreover, the A-V’s studiously avoid any 
mention of anesthesia in connection with the many 
cases which they quote. For instance, take an ex- 
periment by Crile, of Cleveland. Crile is said to 
have poured boiling water into the intestines of a 
dog while he was alive. If this description were 
literally true Crile should have been prosecuted 
and would have been convicted by his testimony. 
Yet no prosecution was ever instituted by those 
who express such horror. 
But what are the real facts? For certain rea- 
sons, later proved to be valid for both animal and 
man, Crile suspected that operative roughness, or 
any procedure which involved serious injury and 
which were the animal conscious would be ex- 
tremely painful but which when the animal was 
rendered unconscious to pain could not cause the 312 
SELECTED PAPERS AND ADDRESSES 
least pain, was nevertheless injurious to the animal 
and would endanger its recovery after any opera- 
tion. He suspected that the tearing out of a can- 
cerous breast—as I was taught to do by Joseph 
Pancoast, the best surgeon of his age, sixty years 
ago—so as to lessen hemorrhage, seriously injured 
the patient and might easily turn the scale against 
recovery, although, being anesthetized, the patient 
was not conscious of the least pain. 
Accordingly, Crile tested his idea upon dogs. 
He did pour boiling water into the belly—not into 
the intestines—he did crush the paws with stout 
pincers and did burn the paws in a gas flame, and 
so forth, and in his book—Surgical Shock, p. 14 
—he especially states that “in all cases the animals 
were anesthetized,” a statement the A-V’s care- 
fully suppress. 
What has been the result of his researches? 
Crile has become the Apostle of Gentleness to all 
the surgical world. By heeding his warnings 
many a life was saved in the Great War, through 
watching the blood pressure, especially in shock, 
when even a slight additional injury, by operating 
roughly, might turn the scale. 
Now is it fair to suppress all mention of an an- 
esthetic in such apparently cruel experiments, es- 
pecially when the author expressly stated that an 
anesthetic had been given in every case? 
It may be that the operator is a physiologist 
seeking to unravel the complex processes of the 
nervous system or a surgeon testing a new opera- 
tion. On a struggling animal no exact observation 
can be made and no delicate surgical operation VIVISECTION 
313 
can be performed. An anesthetic, therefore, is 
an absolute necessity, apart from any humane mo- 
tive. 
It has been asserted that the lips of animals are 
sewed or clamped together to prevent their screams 
from disturbing the operator’s nerves. Never, till 
now, in all my long life have I heard such an allega- 
tion. I do not believe it is true. Besides that 
try the experiment on yourself. Hold your lips 
together and find out whether you can still scream. 
I can. 
“Under incomplete anesthesia,” is a phrase often 
quoted against Crile. Let me give an instance 
from my own experience. A young lady was 
threatened with a permanently stiff elbow. To 
prevent this serious disability I had a dentist give 
her nitrous oxid several times. As soon as she was 
unconscious I forcibly flexed and extended the 
joint. Any one ignorant of surgery and looking 
on would have exclaimed. “What a brute that sur- 
geon is!” For she writhed and struggled so that 
three of us had difficulty in preventing her from 
landing on the floor. Yet when she recovered she 
knew nothing of her struggles and had not felt the 
slightest pain. That was “incomplete anesthe- 
sia.” 
Again, the surgeon has every possible selfish 
motive to facilitate in every way the speedy recov- 
ery of the animal by the greatest kindness and care. 
If the mortality of his new operation is large his 
hopes are blasted and his reputation suffers. 
The head nurse of one of America’s best surgi- 
cal clinics was called to the Bockfeller Institute 314 
SELECTED PAPERS AND ADDRESSES 
to care for the animals. Yet an A-V describes it 
as “Hell at close Range.” 
Claude Bernard’s experiments on the effects of 
heat on dogs are made much of in A-V literature. 
“Some” are said to have been baked to death and 
“some” merely boiled at temperatures of between 
200 and 300 degrees Fahrenheit. Again, what 
are the real facts? First, these experiments were 
done forty-four years ago, in 1876, to determine 
the effects of heat alone on healthy animals—that 
is, with none of the profound disturbances caused 
by disease. Second, there were just three dogs. 
The naming of 300 degrees is unwarrantable, for 
the highest temperature in Bernard’s three experi- 
ments was just 100 degrees Centigrade, or 212 de- 
grees of our absurd Fahrenheit scale. The dogs 
died when their own body temperature reached 
about 112 degrees Fahrenheit, only a few degrees 
higher than a not uncommon temperature in high 
fever in our patients. 
In industry we have men exposed to very high 
temperatures. In 1892 (Medical News, lxi, p. 
262) Coplin published the results of exposure of 
500 and 800 men, the day and night shifts, in a 
sugar refinery at temperatures from 95 degrees 
Fahrenheit to 165 degrees Fahrenheit in a hot 
July. Of this large number, 213 had to stop work 
on account of heat exhaustion. In consequence of 
his wise and vigorous treatment, aimed especially 
at reducing their body temperatures, 185 were able 
to return to work and onhr one died. 
I do not hesitate to condemn Bernard’s omission 
of opium or other narcotic in his experiments; but VIVISECTION 
315 
at least his experiments should be truthfully 
quoted. 
I can also contribute a bit of personal experience 
just here. I have had quite a lot of accidents— 
“annual accidents,” my friends insist on calling 
them. I have broken my nose and both collar 
bones, have dislocated one shoulder and broken the 
other. Also, in addition to other minor opera- 
tions, I have had a portion of my large bowel cut 
out. I might almost pose as a “museum speci- 
men.” 
When my dislocated shoulder threatened to be- 
come stiff I was “baked alive”—that is, my 
shoulder and a considerable adjacent area on my 
arm, chest and back were so baked—up to 250 de- 
grees Fahrenheit without discomfort, and with the 
result that my arm is as useful as ever. 
When the piece of my large bowel was cut out 
and the two open ends sewed together—I was 
nearly seventy-five years old at that time—I was 
reclining in bed with a letter pad on my knee three 
days after the operation, was out of bed in ten 
days, and here I am, nine years later, in good 
health. 
Before the perfection of the antiseptic method 
by Lister and others, and before the very many 
experiments needed to determine just the best and 
safest way to do such an operation, no prudent 
surgeon would have dared to attempt such an 
operation on a human being. I should have been 
allowed to die. The very many meticulous details 
required to sew the two open ends of the bowel 
together so exactly as to prevent any possible leak- 316 
SELECTED PAPERS AND ADDRESSES 
age—for the least leakage meant a fatal peritoni- 
tis—had been worked out by experiments on ani- 
mals, and my friends and I thank God that they 
had been so determined. 
If we are to improve our treatment in any de- 
partment of medicine, only two courses are open 
to us: First, to try a new drug or a new method 
first on animals and, if the results justify it, then 
use the better treatment on man; Second, try it first 
on man. Personally I advocate the first. 
Mrs. Caroline Earle White, long the leader and 
still the idol of the A-V’s, in 1886 published an an- 
swer to one of my addresses. On page 4 she said: 
“I take issue with Doctor Keen . . . where he 
says ‘These experiments cannot be, nay, they must 
not be, tested first upon man.’ I assert, on the 
contrary, that in the majority of cases they must be 
tested first upon man or not tested at all ” * 
On page 10 she said: “Doctor Keen next men- 
tions that “in India alone 20,000 human beings die 
annually from snake bites and that as yet no anti- 
dote has been discovered. . . . How can we seek 
intelligently for an antidote,’ he asks, ‘until we 
know accurately the effects of the poison?’ The 
answer that suggests itself to me is very different 
from the one which he makes. . . . Here is an 
opportunity which is not often afforded of experi- 
menting upon human beings * Since they would 
infallibly die from the snake bites, there can be no 
objection to trying upon them every antidote that 
can be discovered.” The proposal is as absurd as 
it is cruel. 
* Italics my own. VIVISECTION 
317 
Thirty-five years have passed since Mrs. White 
thus urged “human vivisection.” I have yet to see 
the first repudiation of it by any A-V! 
In 1909 a set of rules regarding experiments on 
animals was drawn up. They are given in full in 
my book on Animal Experimentation and Medical 
Progress, p. 246. I know of no laboratory in the 
United States in which these rules are not posted 
up; and, what is more, they are lived up to. 
These rules provide for the scrupulous care of 
the animals. No operations whatever are permit- 
ted except with the sanction of the director, usually 
a responsible member of the faculty. In case the 
operation would cause greater discomfort than that 
attending anesthesia, the animal must first be “ren- 
dered incapable of perceiving pain.” Exceptions 
are allowed only by express sanction of the director. 
Such exceptions are excessively rare. “At the 
conclusion of the experiment the animal shall be 
painlessly killed.” 
2. With regard to the attitude of the medical 
profession, in an extraordinary pamphlet called 
“Medical Opinions Against Vivisection,” issued 
without any date by the New York A-V Society, 
on page 2 it is stated that only 25 per cent, of the 
medical fraternity are in favor of experimental re- 
search. We are not informed how this astonish- 
ing conclusion has been reached by the authors of 
the pamphlet. 
The only real way to obtain any correct idea of 
the general sentiments of the profession is by 
knowing what the profession itself has said 
in the great International Congresses of Medi- 318 
SELECTED PAPERS AND ADDRESSES 
cine and Surgery in Europe and America, 
with their thousands of members; in the national 
associations—for example, the American Medical 
Association, comprising over 84,000 members; in 
the American Association for the Advancement of 
Science, having also thousands of members; and in 
special societies with hundreds of members. 
These organizations have passed resolutions in- 
dorsing experimental research again and again. On 
pages xv-xviii of my book on Animal Experi- 
mentation, etc., I give several of these resolutions 
in full. How were these expressions of opinion 
possibly passed and, as is frequently recorded, 
unanimouslyif three-quarters of the profession 
are neutral or hostile? Why did not these three- 
quarters protest? 
On the other hand, I do not know of a single 
organization, medical or scientific, which has passed 
any resolution against such research. 
The last British Commission on Vivisection, 
1906-07, of which, observe, opponents as well as 
advocates of research were members, unanimously 
passed the following resolution—Final Report, p. 
20: 
“We desire further to state that the harrowing 
descriptions and illustrations of operations in- 
flected on animals, which are freely circulated by 
post, advertisement or otherwise, are in many cases 
calculated to mislead the public, so far as they sug- 
gest that the animals in question were not under an 
anesthetic. To represent that animals subjected 
to experiments in this country are wantonly tor- 
tured would, in our opinion, be absolutely false.” VIVISECTION 
319 
The same is true of the United States to-day. 
So much for quantity. Now let us look at the 
quality of the men on the two sides. 
The pamphlet just alluded to contains several 
hundred names. It has influenced many persons. 
In a letter to one of my friends, Mrs. Belais, 
president of the New York A-V Society, says: 
“Errors occur very infrequently”—her italics— 
“but we are always most punctilious about correc- 
tion.” How “accurate” the pamphlet is the fol- 
lowing will show. 
Dr. William H. Welch, of Johns Hopkins, our 
champion advocate of experimental research, 
appears in the list of its opponents! Doctor 
Woglum, of the Crocker Cancer Commission, is 
classed as another opponent! Sir David Ferrier, 
my old Scotch friend and a world-famous experi- 
menter on the brain, who has lived in London for 
over forty years, as I know personally, is listed in 
Paris, France, and among the opponents! 
How “punctilious’ they are about such correc- 
tions is evident by this instance: 
In the London Times of April 18, 1902, Sir 
Frederick Treves protested against the misuse of 
his name as an opponent of research. In 
1920, eighteen years after this and later repeated 
protests, his name is still so misquoted in this story 
pamphlet. 
Of living, really eminent medical men, I cannot 
count a score who are opposed to experimental re- 
search. 
3. Let us now consider a few of the benefits of 
experimental research. 320 
SELECTED PAPERS AND ADDRESSES 
The A-V’s declare that bacteriology, one of the 
greatest discoveries ever made in medicine, is not 
a science at all. They claim that germs are not 
the cause of typhoid, tetanus, diphtheria, tuber- 
culosis, and on forth; that all the wonderfully ef- 
fective vaccines and serums against these various 
diseases are, “pouring filth into the blood,” and are 
of no use anyhow. In their suit against the Red 
Cross they alleged that “nothing has been dis- 
covered by means of it [vivisection] that is at all 
beneficial to the human race,” and in a letter, dated 
July 29, 1920, sent to every member of the 1921 
Pennsylvania legislature, they state, “The results 
of this cruelty are of no value to the human 
race.” 
They deny that any benefits have followed from 
the researches of Pasteur and Lister! 
I can give only a few examples of many perfectly 
attested benefits. I shall consider each very 
briefly: Typhoid fever, puerperal (childbed) 
fever, diphtheria, tetanus, syphilis, yellow fever, 
The Surgery of War, The Surgery of Peace and 
The Cry of the Animals. 
Typhoid Fever. In the Civil War 10 per cent, 
of all deaths were from typhoid. 
In the Spanish-American War every fifth 
soldier in our Army fell ill of typhoid, and 86 per 
cent, of all deaths were from typhoid. 
In the Great War almost none! Why? Be- 
cause in the interval between 1898 and 1914 
vaccination against typhoid had been discovered 
and developed. 
Let me illustrate by two great experiments on VIVISECTION 
321 
8000 and on about 750,000 human beings respec- 
tively : 
Plymouth, Pennsylvania, a town of 8000 people, 
was supplied with water from a reservoir fed by a 
mountain stream. In the first three months of 
1885 one man living on the banks of this stream, 
w'as ill with typhoid fever. His copious dejecta 
were thrown out upon the snow without disinfec- 
tion. When a warm thaw with rain occurred to- 
wards the end of March, the germs of typhoid 
from the dejecta were washed into the stream. 
On April tenth an epidemic of typhoid broke out 
in the town and caused, in all, 1104 cases and 114 
deaths. 
From September 21, 1917, to January 25, 1918 
—the figures are official—a period about two weeks 
longer than the war with Spain, there were, on the 
average, 742,626 soldiers every day in the camps in 
the United States. They came from unprotected 
communities, where autumnal typhoid was rife. 
Yet during these four months there were but 114 
cases of typhoid and five of paratyphoid fever, a 
milder fever closely resembling typhoid. Had the 
conditions of 1898 prevailed, there would have been 
144,506 cases and about 15,000 deaths. 
Why was typhoid almost banished? Because 
every soldier on enlisting was immediately vacci- 
nated against the fever. As soon as this vaccina- 
tion was completed in these new recruits in the less 
than five weeks from December 14, 1917, to Jan- 
uary 15,1918, there were only six cases in the three- 
quarters of a million men. These magnificent re- 
sults were a direct outcome of laboratory work. 322 
SELECTED PAPERS AND ADDRESSES 
During the Great War the British A-V’s did 
their best to dissuade the soldiers from being vac- 
cinated. Had the soldiers heeded them, thousands 
of lives would have been needlessly sacrificed.2 
Childbed, or Puerperal Fever. In my stu- 
dent days—1860-1862—childbearing caused the 
death of three to five mothers in every hundred. 
Was not this a horrible result of a normal and nec- 
essary human function? 
But sometimes this mortality rose to 20 per cent, 
and, in local epidemics, even fifty-five mothers out 
of every one hundred died! 
What are the present figures? You will find 
them in detail in A. W. W. Lea’s “Puerperal Infec- 
tion” (London, 1910, p. 24). Cases already in- 
fected entering the maternity ward, of course, are 
excluded. Lea quotes various wonderful statis- 
tics, culminating in one series of 8373 successive 
births without the death of even one mother from 
infection. 
Why this enormous saving of human lives. Be- 
cause in 1843 Oliver Wendell Holmes showed 
that, in some then unknown way, the doctor and 
the nurse carried the fever from patient to patient. 
Thirty-six years later, 1879, Pasteur, in a debate 
in the Academy of Medicine of Paris, when a doubt 
was expressed as to whether the germ, asserted to 
be the cause of this dreadful mortality, would ever 
be seen, leaped to the blackboard, drew what we 
2 For later and better statistics see the correspondence be- 
tween Surgeon-General Ireland of our army and Surgeon- 
general Goodwin of the British Armies in the Journal of the 
American Medical Association, January 2, 1922, page 233. VIVISECTION 
323 
now know as the Streptococcus, one of the deadliest 
germs, and cried out, “Look! This is the germ of 
puerperal fever!” And this germ, which formerly 
left death and woe in its path, is now under our 
heel. 
When your own wives and daughters face the 
pangs and perils of maternity to whom will you 
turn for help—to those who have practically abol- 
ished childbed fever or to those who would have 
prevented this blessed victory? 
It is claimed by the A-V’s that all this is due to 
sanitation and to cleanliness. But what are san- 
itation and cleanliness? They are based wholly on 
laboratory researches into what the streptococcus 
is, what it does, how the infection is spread 
and how it may be abolished. In other words, 
this saving of lives is due to bacteriology, a science 
which the A-V’s totally reject. 
Diphtheria. Up to 1895 every active surgeon, 
myself among the number, was often called upon 
to do a tracheotomy—that is, to open the windpipe, 
or trachea, in the neck to prevent the death of a 
child by suffocation from diphtheria. 
I have not the time to paint the picture in detail 
of the agonized mother begging for the life of her 
child, yet dreading the operation. And no won- 
der! The surgeon dreaded it almost as much, 
for death, alas, too often followed in spite of his 
efforts. 
In 1895 the antitoxin against diphtheria was 
introduced and soon became a common treatment. 
Exactly as the use of the antitoxin increased in 
frequency the calls on the surgeon for tracheot- 324 
SELECTED PAPERS AND ADDRESSES 
omy decreased. After a few years I was never 
called on to do this operation, and my experience 
is duplicated, I may safely say, by practically every 
surgeon. 
The mortality of diphtheria increases with every 
day that the use of the antitoxin is delayed. When 
given on the veiy first day, in 218 cases of a series 
of nearly 4000, the mortality was zero—not one 
death. If delayed till the second day, the mortal- 
ity was 5 per cent. If delayed till the third day, 
it rose to 12 per cent. If delayed till the fourth 
day, it rose to 16 per cent. 
Tetanus, or Lockjaw. I wish I had space to 
describe this horrible disease as I saw it in the Civil 
War, when it killed nine out of every ten men 
attacked by it. Imagine the muscles all over the 
body to be gripped by cramps, so severe that the 
whole body is sometimes bent backward, only the 
heels and the head touching the bed. Unfortu- 
nately, the patient’s mind is as clear as my reader’s 
at this moment. Finally a mercifully cruel spasm 
of the muscles of the throat chokes the patient to 
death. 
The germ of tetanus was discovered in 1884. 
Its home is in the intestines of animals, especially 
of the horse. 
The soil of Belgium and Northern France has 
been cultivated and roamed over by horses and 
other animals for 2000 years, as every schoolboy 
knows from Csesar’s Gallic War. It is the most 
dangerous spot of ground, I suppose, on earth, for 
it is full of the most virulent germs of tetanus and 
other infections. VIVISECTION 
325 
In the Great War practically every wound be- 
came infected and with a virulence never before 
met with. Hence, very soon it became the rule to 
give every wounded soldier a full dose of the anti- 
tetanic serum at the very first opportunity. Tet- 
anus at once became less and less frequent, so that 
later one case in Paris was shown to Dr. Harvey 
Cushing, of Harvard, as a curiosity. 
Syphilis. This scourge has ravaged the world 
since the sixteenth century. In this long time we 
have been able to ameliorate the disease but prac- 
tically never to cure it. 
Why? Because we did not know the cause. 
Until this was found we were fighting in the dark. 
Now mark what the advent of the experimental 
method meant. 
Metchnikoff, in 1903, first succeed in inocula- 
ting the disease in apes and later in other animals. 
Experiments on animals, impossible before that 
time, were immediately begun. In 1905 Schau- 
dinn and Hoffmann thus discovered the germ. In 
1910, after a most extraordinary series of experi- 
ments with six hundred and five other remedies, 
which had to be discarded as ineffective or too dan- 
gerous, Ehrlich discovered his Salvarsan, or 606. 
Since that date we have had the whip hand over 
this desolating plague. Many of the victims of 
this dreadful disease are innocent women; many 
others are innocent children, some already dead 
when born and others destined happily to an early 
grave; still others, less fortunate, doomed to drag 
out a miserable existence. Not a few of the 
victims were innocent doctors, accidentally in- 326 
SELECTED PAPERS AND ADDRESSES 
fected, of whom I have known five; one committed 
suicide. 
In seven years experiments on animals did more 
for alleviating human misery from this one disease 
than clinical observation on man alone had done in 
over four centuries. 
Yellow Fever. We were more fortunate in 
the fight against yellow fever, for by the research 
work of Reed, Lazear and others was discovered 
the means by which the disease was carried, and, by 
attacking the mosquito, a wonderful victory was 
won. 
But lately Noguchi, that genius of the Rocke- 
feller Institute, has finally discovered the actual 
germ of the disease. This discovery enabled him 
to prepare a preventive serum. To-day, December 
tenth, as I am writing these words, the newspapers 
announce that the serum of Noguchi has been 
tried where the fever exists and has been found to 
confer immunity upon those who have never had 
the fever. 
Very soon the dream of Surgeon-General Gorgas 
will be realized, that yellow fever will have been 
banished from the world. 
Surgery of War. I have mentioned the in- 
tensity of the infection seen in the Great War. 
At first our ordinary disinfectants failed utterly. 
Two classes of wounds were recognized—the 
contaminated and the infected. 
A contaminated wound is one in which the 
tissues involved had had a moderate number of 
bacteria strewn on the surfaces of the wound. 
The missiles of the war far exceeded those of any VIVISECTION 
327 
other war in their enormous velocity. When a 
fragment of shell struck the body, it contaminated 
all the surfaces of the wound, but also, by the im- 
pact of the blow, killed or devitalized a certain 
thickness of tissue next the surface of the wound. 
This dead and dying tissue is the very best food 
for the various bacteria. In from six to, say, 
twelve hours, or sometimes more, these germs pene- 
trate deeply into the tissues. Then the wound 
is an infected wound. 
In a contaminated wound it was found that the 
germs could be removed in a mass by cutting away 
all the contaminated tissue. Then the wound could 
be closed at once; and eighty-five to ninety wounds 
in every hundred would heal at once. 
In an infected wound this procedure alone was 
not sufficient. The bacteria were too deep and too 
numerous. Then Carrel and Dakin came to the 
rescue. They showed, by experiments, that a weak 
solution of bleaching powder was the most efficient 
antiseptic, provided it could be kept continually in 
contact with the entire surface of the wound. Car- 
rel’s little rubber tubes, connected with a reser- 
voir, were laid in the wound in every direction, and 
every two hours fresh solution irrigated the entire 
surface of the wound. 
The enormous number of lives of our gallant 
soldiers saved will be shown when the medical 
and surgical history of the war is published. 
Never before has such a large percentage of the 
wounded been saved, nor with such relatively small 
disability. 
The Surgery of Peace. I need not enter into 328 
SELECTED PAPERS AND ADDRESSES 
details here. Every intelligent reader knows that 
surgical operations have been robbed, not only of 
pain by anethesia but also of their chief danger— 
infection. An amputation of a breast or an oper- 
ation for the removal of gallstones or of the appen- 
dix early in the attack has now practically no 
mortality, whereas prior to Lister’s day amputation 
of the breast was a very dangerous and therefore 
rare operation, and removal of gallstones and oper- 
ations for appendicitis were never even attempted. 
Most of such sufferers died because the danger of 
infection practically prohibited any operative in- 
terference. Ovariotomy was done. But two out 
of every three patients died; now scarcely one in 
a hundred dies. 
The Cry of the Animals. I wish I could 
voice the pleas of the animals, demanding that 
their happiness, health and lives should also be 
conserved. 
In 1915, when prices were normal, the following 
were the direct losses in the United States every 
year, as conservatively estimated in dollars: 
Hog Cholera $75,000,000 
Texas Cattle Fever 40,000,000 
Tuberculosis 25,000,000 
Contagious Abortion 20,000,000 
$160,000,000 
Other Diseases of Animals 52,850,000 
Total in 1915 $212,850,000 
Not only was there loss of dollars of value and 
of urgently needed food but this loss meant sick- 
ness, suffering and death to millions of cattle, hogs, 
horses, sheep, poultry. Are not their suffering and VIVISECTION 
329 
death to be weighed in the balance as well as the 
suffering and death of human beings? 
Take only one disease—anthrax, or woolsorters’ 
disease—as an example of what has been done. 
Pasteur conquered anthrax. When he began 
his researches thousands of cattle and sheep were 
dying from anthrax every year. It was a veri- 
table plague. Morever, in Europe hundreds and 
hundreds of human beings were also fellow vic- 
tims. As Huxley pointed out, the money value 
of this one victory was enough to pay the whole 
indemnity paid by France to Germany after the 
war of 1870! 
Read in his Life, by Valery Radot, the dramatic 
account of his final experiment in 1882 on twenty- 
five already vaccinated and twenty-five unvaccina- 
ted sheep. All of the fifty were inoculated on May 
thirty-first with the virulent germs of anthrax. He 
predicted that by June fifth the twenty-five un- 
vaccinated animals would be dead and the twenty- 
five vaccinated would be living. On June second 
twenty-three of the unvaccinated sheep were dead, 
and the other two were dying. Every one of the 
twenty-five vaccinated sheep had escaped. The 
animals of all France, nay, of all the world, are his 
debtors for this victory. 
Now, in the name of common sense, was not 
this a righteous and commendable experiment, 
and were not the prior experiments which gave 
such conclusive evidences of the means of escape of 
millions of hogs, cattle and sheep and thousands 
of human beings a scientific, a humane and there- 
fore a Christian duty? 330 
SELECTED PAPERS AND ADDRESSES 
What is true of anthrax is true of many other 
diseases of animals. In addition, there are diseases 
of animals in which we have not yet found the germ 
and therefore have no reliable means of vaccina- 
tion against them. These, too, must be and will 
be conquered in time by continued research. 
If the A-V’s had been in control in France in 
the seventies and eighties, anthrax and other dis- 
eases of animals, now partly or wholly conquered, 
would still be as rampant as ever. 
If only the animals themselves could speak! 
Would they not, with one accord, cry out: “Save 
us from our professed friends, who are in reality 
our deadly enemies!” 
But a new era seems to be coming. An edi- 
torial in the November, 1920, issue of the Open 
Door, the journal of the New York A-V Society, 
relates that the San Francisco S. P. C. A. makes 
the following statement in the San Francisco 
Bulletin of October 19, 1920: 
“Our investigations have shown that the animals 
receive the same care and consideration accorded to 
human beings who are subjected to operations of 
various kinds.” 
This statement was made as a result of “un- 
announced visits to vivisection laboratories.” If 
only the other societies would do the same, their 
views would be greatly changed and they would 
support such experiments because of the enormous 
benefits to animals as well as to the human race. 
The Blue Cross has shown that the doors are all 
open in every one of the eighty-six laboratories of 
research in the United States.—October 1922. VIVISECTION 
331 
I am not a vivisector, but I know that every day 
and in every operation upon my fellow creatures 
since 1876 I have been guided by the results of ex- 
perimental research. Research has given to sur- 
geons, physicians and obstetricians new operations 
and new means of treatment wholly impossible of 
attainment by any other method, and these have 
been blest of God to millions of our suffering fel- 
low men as well as to animals. These researches 
have changed the surgery of desperation before 
1876 into to-day’s surgery of assurance. 
And there is still so much to be learned! So 
much ignorance to be dispelled! Were there room 
I could tell of cases in which my own ignorance—an 
involuntary ignorance shared by all my fellow 
surgeons—has cost human lives, as afterward I 
learned to my unending sorrow. 
Do you wonder then that my cry—that our cry, 
as a profession—is for more light? 
By 1921 the serum discovered by the Bureau of 
Animal Industry by experiments on 17 hogs had 
reduced the loss from Hog Cholera from $75,000,- 
000 to about $28,000,000, a saving to the farmers 
of over $47,000,000 and adding over 2,000,000 hogs 
to the food of a starving world. 
On October 12 in Reading, Pennsylvania, over 
600 women representing over 60,000 women of the 
State Federation of Women adopted the following 
resolution by a vote of over 600 to about 10 neg- 
ative votes. 
whereas, it has been conclusively demon- 
strated that the health and happiness of hundreds 
of thousands of animals, and of many millions of 332 
SELECTED PAPERS AND ADDRESSES 
human beings, have been promoted and their lives 
prolonged by the application of knowledge ob- 
tained through scientific experiments on animals, 
and 
whereas, These researches are conferring a 
wonderful boon upon the starving nations by con- 
stantly adding greatly to the food supply of the 
world. 
THEREFORE, BE IT RESOLVED, THAT THE STATE 
FEDERATION OF PENNSYLVANIA WOMEN, assembled 
in annual general Convention in the City of Read- 
ing, Pennsylvania, on the twelfth day of October, 
1922, hereby put on record their gratitude to Med- 
ical Science for past discoveries so profoundly 
beneficial to human beings and to animals, and we 
believe that such beneficent researches should be 
continued and encouraged. A MESSAGE OF HOPE1 
During an active surgical life of almost half a 
century, I have seen many hundreds of cases of 
cancer, and I am happy to assure my readers that 
it is curable, provided the advice of those who have 
been in constant contact with this terrible disease 
is sought and followed. 
In a very large number of cases, especially of 
cancer of the breast, the following represents the 
conversation which followed a careful examination: 
“How long ago did you first notice this lump 
in your breast?” 
“About a year ago.” (Or it may be even longer.) 
This is an astonishingly frequent reply. 
“Why in the world didn’t you come to me at 
onceV’ 
“Why, Doctor, it didn’t hurt me at all.” (As if 
“pain” meant that it was a dangerous lump, and 
“no pain” that it was a harmless lump! Cancer 
at the beginning is almost never painful.) 
“I am sorry to tell you that I fear you have come 
too late to expect a cure. Had you come the 
moment you discovered this lump I could have re- 
moved it by a very easy and safe operation, from 
which you would have been well within a week. 
1 Reprinted by the kind permission of the Editor from the 
Woman's Home Companion for December, 1921, 334 
SELECTED PAPERS AND ADDRESSES 
But now I can promise nothing, except to do my 
very best for you.” 
How often my heart has been wrung by such a 
conversation (worded of course more tactfully and 
not in this brusque, almost brutal, form) with a 
wife and mother, who, by her neglect to seek aid at 
once, has condemned her husband and her children 
to lose so dear a wife, so cherished a mother, just 
when she is most needed! How often have I said to 
myself, “If only women knew; if only women 
knew!” 
Sometimes they would declare, “I was afraid to 
come, for fear you would tell me it was cancer.” 
To which I have so often replied, “If you smelt 
smoke in your house would you sit still and wait 
because you were afraid that you would find your 
house was afire? Why not do for your own self 
what you would do for your own house? Find 
out the truth at once.” 
Sometimes she would say—I am almost ashamed 
to admit it, but it is true: “I did see my doctor, 
and he told me to wait and see whether it would 
grow any bigger.” I am glad to say this is not 
true of the younger men, but only of some of the 
doctors who graduated years ago and have not 
kept up with our modern discoveries. “If you 
saw a little fire in your house,” I would reply, 
“would you wait to see if it would grow bigger 
before you tried to put it out?” 
If every woman who had found a lump in her 
breast would consult a competent surgeon at once 
—that is to say, within forty-eight hours, if possible, 
but in any case within a Week—I am sure that A MESSAGE OF HOPE 
335 
eighty-five out of every hundred, and it might 
well be ninety out of every hundred, would be 
cured and stay cured. So cancer is curable—pro- 
vided you consult a good surgeon at once. Re- 
member that, when you find a lump already formed, 
the disease has been at work for weeks, and it may 
be for three or four months, before a discover- 
able lump has been formed. 
I have patients on whom I operated fifteen, 
twenty, and more years ago, and they are still 
well; but they came early, except one unexpectedly 
happy case over twenty years ago. One breast 
had been removed before I saw her. The disease 
had returned on that side, and had begun in the 
opposite breast. I operated for the recurrent 
disease and also amputated the second breast, and 
she is well to-day—twenty years later. 
The complete operation is not a very long one. 
It has to-day, remember, practically no mortality, 
and the recovery is complete in a week or ten days 
without much suffering. Before the days of anti- 
septic and aseptic surgery, the suffering was severe 
and prolonged, practically every case became in- 
fected, and the mortality was large. Usually the 
patient was in the hospital for from four to six 
weeks, or longer, and if erysipelas or severe in- 
fection occurred, it might be three or four months 
before she was well—if, indeed, she escaped with 
her life. 
The same rule applies to women who notice any 
abnormal discharge of blood. Consult a compe- 
tent surgeon at once. Certain internal cancers 
that were formerly beyond our power to cure are 336 
SELECTED PAPERS AND ADDRESSES 
now well within our power, but solely on the con- 
dition noted—instant competent advice. 
Every man or woman who passes blood from 
the bowels should at once seek an examina- 
tion. That is the anti-cancer slogan: “instant, 
THOROUGH EXAMINATION BY A COMPETENT 
surgeon.” It may come from a slight and easily 
curable affliction; but it may, on the other hand, be 
the very first observed sign of something serious. 
Here, again, pain or its absence is no criterion of 
danger. 
In men, cancer of the stomach or of the bowels 
is the most frequent. If a man steadily loses 
weight—twenty, thirty, forty pounds—and has in- 
digestion, internal cancer of the stomach or bowel 
should be suspected. If he does not soon get 
better, say within two or three months, the 
abdomen should be opened and any necessary oper- 
ation be done. The diseased section of the stomach 
or bowel is removed; but too often the exploratory 
operation is done too late and the disease returns 
after a while. If no cancer is found, the abdomen 
is closed and he is practically sure to get well within 
ten to fourteen days. 
Warts and moles—not such as come and go on 
the hands of young people, but those which remain 
apparently harmless for years without any change 
—are serious sources of danger, more particularly 
those which are discolored, brown, or black. After 
many years of a quiet existence, for some unknown 
reason suddenly they begin to grow. Very soon 
the glands in the neck, armpit or groin begin to en- 
large, at first always quite painlessly. When A MESSAGE OF HOPE 
337 
these glands become enlarged the whole system is 
often involved and the possibility of saving life is 
very doubtful. 
All such permanent, pigmented moles and warts 
should be removed before they begin to grow, to- 
gether with the whole thickness of the skin. To 
tie a woman’s long hair around them is the very 
worst thing to do. It only stimulates them to 
grow more rapidly. 
The deaths from cancer are continually increas- 
ing, and have reached a most alarming total. In 
the World War, from April, 1917, to July, 1919, 
76,433 of our gallant soldiers lost their lives by 
wounds and disease. In the same length of time, 
about 180,000 of our population died from cancer 
—over 100,000 more than the total military deaths! 
Of our total annual deaths of persons over forty 
years of age, one person in every ten dies of cancer. 
Of all deaths among women over forty, one out of 
every eight is caused by cancer. Do not these 
figures startle you, my reader? Is it not all-im- 
portant that you should recognize the red flag of 
“danger,” when you discover the first recognizable 
sign of possible cancer—a “lump” anywhere, or 
an abnormal discharge of blood? 
“What is the cause of cancer?” you ask; “and 
why aren’t you busy finding it?” I answer that 
no one problem of disease is being attacked as is the 
cause of cancer. If we find the cause, we will be at 
the half-way house on the road to prevention or 
cure. 
There are special laboratories of research on 
cancer alone in Boston, New York City, London, 338 
SELECTED PAPERS AND ADDRESSES 
Paris, Heidelberg, and other cities, and also not 
a few* personal investigators in other places, all 
laboring to discover the cause, and how to prevent 
cancer and thus to avoid the dreadful alternative 
of a surgical operation. 
The problem has been attacked from the sur- 
gical, the pathological, the microscopic, the chem- 
ical, the biological, and the experimental side. 
We have learned a great deal; for instance, that 
cancer is always a strictly local disease at the be- 
ginning, so that, if you remove this small lump 
early enough, cure is almost certain. If you wait, 
the disease spreads by the absorbent vessels and the 
blood vessels to the neighboring glands (under the 
jaw, in the armpit or the groin, or in the internal 
glands) or to distant parts, and then the case is 
hopeless for cure. All we can do is palliate. 
Early operation before the disease has thus spread 
is the sine qua non for success. 
The X-rays and radium are being very exten- 
sively experimented with, and most hopefully in 
certain forms of cancer. It is with this in view 
that the fine women of America presented Madame 
Curie with one gram (15 grains) of radium, cost- 
ing one hundred thousand dollars. I have per- 
sonally known of some remarkable cures by the 
X-rays and radium. But they should be used only 
by experts, or they may do irreparable damage. 
Even if they do no damage, in case they do not 
cure, their use not seldom delays operation until it 
is too late. 
We have also learned by these laboratories of re- 
search that this, that, and the other line of research A MESSAGE OF HOPE 
339 
is not the true road to the discovery of the cause. 
Thus, by exclusion, we are gradually limiting our 
researches to the methods which give promise of 
possible success. 
I feel as certain of our ultimate success as I do of 
my own existence. I am expectant, hopeful, im- 
patient for that glorious day to come. It will 
most likely come like a thief in the night to some 
lonely, patient, persistent worker. Then, indeed, 
after it has been tested and found true, may we 
chant a Te Deum—and turn our energies to the 
solution of the many other problems in medicine. 
Above everything else not to do, I urge that 
none of the so-called “cancer cures” be used. I 
have seen the damage done by many of them, and 
the happy time when early operation might almost 
certainly have cured has gone by, and again “Too 
late” is the sad verdict. 
The American Society for the Control of Cancer 
was formed in 1913. Dr. Charles A. Powers, a 
retired surgeon of Denver, wlhom I am proud to 
call an old friend, is the president. They are 
carrying on a vigorous campaign of enlightment, to 
wake up the nation to the growing peril of cancer. 
They are a very live body. A large number of 
doctors and members and, what is most encourag- 
ing, an increasing number of public-spirited men 
and women are also members. The nominal dues 
are five dollars a year, but many give up to fifty 
dollars a year as patrons, and others, to aid the 
cause, give their hundreds and thousands. The 
society sends out circulars, pamphlets, etc., by the 
thousand, organizes lecture courses in many places, 340 
SELECTED PAPERS AND ADDRESSES 
and spreads abroad the good news of the curability 
of cancer, provided that their advice is strictly fol- 
lowed. This year [1921] they propose to make a 
special effort during the week of October 30th to 
November 5th to arouse a nation-wide interest and 
a nation-wide activity to control cancer, by persuad- 
ing all who have or suspect they have the disease 
to secure immediate competent advice and treat- 
ment. 
I earnestly urge that every reader of this paper 
will join this admirable and wholly altruistic so- 
ciety. It takes much effort and much money to 
wake up a whole nation; but that is exactly our 
intention. We doctors are heartily in accord with 
the objects of this society. 
Readers of this paper may obtain any desired 
information on this subject by the writing to the 
American Society for the Control of Cancer, 25 
West 45th Street, New York City.