Part 17

"Lives of great men all remind us We can make our lives sublime."

One of those was Jean Fernel, who was born in France about 1497 and died in 1558. I do not know that his life history offers anything so very startling, although he came to be regarded as the most memorable physiologist of his generation, but he adopted a motto which I think we all might well select for our own, and it was because of this motto that I have mentioned his name at this point. It was this: "Destiny reserves for us repose enough." If each of you will take this individually to himself he will find in it stimulus enough for all kinds of hard work.

The first of the eminently great men now to be mentioned in this connection was Herman Boerhaave, born in 1668 and died in 1738. He enjoyed the reputation of being perhaps the most eminent physician who ever lived. The eldest son of a poor clergyman with a large family, he was originally intended for theology, and with this in view studied philosophy, history, logic, metaphysics, philology and mathematics, as well as theology. A mere accident, resulting from intense party spirit and doctrinal differences, prevented his devoting his life to theology, and he turned next to mathematics and then to chemistry and botany, subsequently studying anatomy and medicine. He graduated in 1693 and began at once to practice in Leyden, with such success that he was early offered the position of ordinary surgeon to the king, which, however, he had the moral courage to decline. Subsequently he taught medicine and botany, to which chairs was also added later that of chemistry. This fact of itself will show to you something of the condition of medical science of that day, when one man could teach chemistry, botany and medicine. His rarest talents, however, were developed in the direction of clinical instruction, and in this particular field he won such repute that hearers were attracted to Leyden from all quarters of the world and in such numbers that no university lecture-room was large enough to contain them. His practice grew in extent and remunerativeness in pace with his reputation, and when he died he left an estate of two millions. So famous was he that it is said of him that a Chinese official once sent to him a letter addressed simply "To the Most Famous Physician in Europe." That he had fixed convictions and practices may be better understood from the fact that so little difference did he make between his patients that he kept Peter the Great waiting over one night to see him, declining to regulate his visiting list by the means or position of his patients.

Boerhaave was universally regarded as a great student and a great physician, but it was probably his qualities as a man which led to the astonishing extent of his reputation. Essentially modest, not disputatious nor belligerent, he had a remarkable influence over the young men who came near him, while he had a habit of speaking oracularly or in aphorisms, which are not always so profound as they sound and yet often make a man's dicta celebrated. Save that he introduced the use of the thermometer and the ordinary lens in the examinations of his patients, his teachings do not form any really new system. In the classification of men he would be regarded as a great eclectic, in the purer sense of the term. Probably his greatest service to medicine was in the permanent establishment of the clinical method of instruction, and perhaps his next greatest real claim to glory is the character of the instruction and the inspiration which he gave to two of his greatest scholars, viz.: Haller and Van Swieten. He was not the founder of a school. He left no great nor memorable doctrines for which others should contend, but he left a name for studiousness, honest and logical thinking, which was a priceless heritage for the university with which he was connected.

The next great scholar to whose life and works I would invite your attention for a moment, is Morgagni, born in Italy in 1682, died in 1772. He was a pupil of Valsalva, whose assistant he became at the age of nineteen. Brought up in this way, as it were in the domain of anatomy, it is not strange that he devoted his attention throughout his life especially to the anatomical products of disease. It matters little to us now that he was wont to regard these products as the causes of disease and thus neglected their remote causes. He it was who taught us to apply to pathological anatomy the same scrupulous attention to tissue alterations and changes which the ordinary anatomist would note in dissecting a new animal form. He was scarcely the founder of the science of pathological anatomy, for this credit belongs to Benivieni, but he did very much to popularize the study and to show its importance. More than this, he wrote a work which for his day and generation was colossal. It bore the title "De Sedibus et Causis Morborum per Anatomen Indagatis." It consisted of five books. The first appeared in Venice in 1761. This proved a perfect mine of information to which one may often turn even to-day, and read with wonder the observations published one hundred and fifty years ago. They stamp Morgagni as a great scientist as well as anatomist. His industry will be indicated by the fact that even after he became blind he did not cease to work.

Perhaps the most wonderful figure in the whole history of modern medicine is that of Albrecht von Haller, of Berne, born 1708, died 1777, and often known as the Great. No more versatile genius than his has ever adorned our profession. A most precocious child, he developed remarkable abilities in the direction of poetry and music, as well as medicine, and the only wonder is that he lived to such a ripe old age, enjoying the fruits of his labors, having displayed throughout his entire life an industry and productiveness which were most remarkable. Before he reached the age of ten he had written a Chaldee grammar, a Greek and Hebrew vocabulary, and a large collection of Latin verses and biographies. During the next few years he translated many of the Latin authors, and wrote an original epic poem of some four thousand verses on the Swiss Confederacy. All of this work he had completed by the age of twenty-one. It is not strange that among those who knew of his precocity he was generally known and regarded as a "wonder child." It will thus be seen, too, that medicine was but one of the many subjects of his study. He studied a year in Tübingen, where the riotous living of his fellow students repelled him; then he went to Leyden, falling there under the influence of the illustrious Boerhaave. How much he drew from this source no man may accurately say at present, but a more brilliant example he certainly could not have had. He finished his studies in Leyden before he was twenty and then traveled through England and France, but was compelled to flee from Paris to escape arrest for hiding cadavers in his room for purposes of dissection. This will prove an evidence of taste for study if not of taste in other directions.

Suddenly developing a passion for mathematics, he went to Basle and worked so hard as to almost ruin his health. This necessitated a trip to the mountains and here his interest in botany was aroused and indirectly that in medicine continued. Soon after he returned to Berne to take up the practice of medicine. Here he studied and worked so hard as to arouse a suspicion of his sanity, but he kept up his health by frequent trips to the Alps in search of flowers. His fondness for botany and his taste for poetry seemed to grow with equal pace and he seems to have been among the first of modern students to appreciate the beauty and grandeur of Swiss mountain scenery. When he was twenty-five years of age appeared the first edition of his poems, many editions appearing later. Here in Berne also he published so many essays on botany, anatomy and physiology that widespread attention was attracted to his eminent learning, and he was called to fill the chair of anatomy and botany in the new university of Göttingen, where he spent seventeen years of extraordinary mental activity, publishing countless papers and at the same time continuing his poetic and his nomadic habits. He established in Göttingen a great botanic garden, founded scientific societies, published five books on anatomy, all elaborately illustrated, printed a series of commentaries on Boerhaave's lectures, and is said to have contributed altogether thirteen thousand articles relating to almost every branch of human knowledge. It is not strange that the fame of the University of Göttingen depended largely upon Haller's reputation.

But Haller developed a clear case of nostalgia, and after being fêted by the nobility, honored by almost every monarch in Europe, and receiving every honor that universities and philosophic societies confer, he resigned from his chair in Göttingen and returned to Berne, to his fatherland. Here, amid his old home surroundings, he worked for twenty years more at the same tremendous rate, discharging diverse duties of state and private citizenship, founding and promoting industries and asylums, and serving constantly upon commissions of all kinds. While thus engaged appeared that phenomenal work, his great Treatise on Physiology, so full of original observations that it has been stated that should discoveries which have been re-discovered since Haller be collected they would fill several quarto volumes. The physiological institute of Berne is to-day known as the Hallerianum, as it should be, for it is distinctly the product of his genius. He died at a ripe age, after having performed an incredible amount of work, the greatest scholar of his own or perhaps of any century, revered and honored, faithful to the last and exhibiting in his last moments that "philosophic calmness of the cultivated intellect" of which Cicero loved to write. It is related of him that on his deathbed he kept his fingers on his own wrist, watching the ebbing away of his own existence and waiting for the last pulsation from his radial artery. Finally he exclaimed, "I no longer feel it," and then joined the great majority.

Perhaps Haller's greatest contribution to physiological lore was his doctrine of irritability of tissues. It took the place of much that had caused previous discussion and is accepted to-day as explaining, as nearly as we can explain, numerous phenomena.

In this same great wonder-century lived also John Hunter, the greatest of England's medical students, the most famous surgeon of his day and the most indefatigable collector in natural history and natural science that ever lived. He was born in 1728 and died in 1783. He was led to study medicine by the fame of his illustrious brother William, and began his studies by acting as prosector for him. He soon became a pupil of Cheselden, perhaps the most famous English surgeon of his generation. Hunter developed very early those extraordinary powers of observation and that originality in investigation which later made him so famous. Early in his medical career he came for a time under the influence of Percival Pott. This was at a time when surgery had emerged from barbarism and when the French Academy of Surgery had erected it into the dignity of a science. He entered St. George's Hospital in 1754 as a surgeon's pupil. Later he became a partner with his brother in the latter's private school of anatomy, but John, being a poor lecturer, was distinguished by his services in the dissecting-room rather than in the amphitheater. The customs of his time and the jealousies of the various medical factions then existing in London led to numerous acrimonious disputes, in the literary part of which William Hunter, who was much the more cultured student, took the lead, while John, who lacked in scholastic ability and had much less education, was relied on to supply the anatomical data. John was painfully aware of his deficiencies in literary culture and is said once to have replied to the disparaging remarks of an opponent: "He accuses me of not understanding the dead languages, but I could tell him that on the dead body which he never knew in any language living or dead."

It was in this way that he was led into unseemly encounters with the Munros, of Edinburgh, and with his late teacher, Pott. The same sort of dispute finally separated the two brothers, and they parted company after a very unseemly exhibition of jealousy and fraternal discord.

After studying human anatomy for several years, John Hunter became profoundly impressed with the need for much larger knowledge of comparative anatomy, but about this time ill health compelled a temporary change and so he went into the army as a staff surgeon. This was at the time when Europe was engaged in the sanguinary Seven Years' War, and so it happened that Hunter had ample opportunity for studies and observations in military surgery--at the siege of Belleisle and later in the war in the Peninsula. Here he made many of those observations on gunshot wounds which he published at various periods later and which helped to make him famous.

He resumed his work in London in 1763, and here again he had to undergo a long trial of those qualities of passive fortitude and active perseverance under difficulties which were his prominent characteristics. His personal needs were small but his scientific requirements were large, and to these latter he devoted every guinea which he could earn in his small but slowly growing practice. His own manners were so brusque, and he was so lacking in the refinement of many of his colleagues and competitors, that it took rare mental qualities to force him to the front, to which he nevertheless rapidly advanced. Bacon has said, "He that is only real had need of exceeding great parts of virtue, as the stone had need be rich that is set without foil," and this was never more true than in John Hunter's case. His leisure hours were never unemployed. He obtained the bodies of all animals dying in the public collections in London and so began to form that enormous collection which became known later as the Hunterian Museum. As his means afforded it he built and added to his accommodations and carried on those vast researches into animal anatomy and physiology to which the balance of his life was devoted. Although his practice gradually increased and he became in time the most famous surgeon and consultant in London, he used, nevertheless, to spend three or four hours every morning before breakfast in dissection of animals, and as much of the rest of the day as he could spare. Pupils and students who wished to consult him had to come early in the morning, often as early as four o'clock, in order to find him disengaged. He had that rare ability to do a maximum of work with a minimum of sleep which has been so conspicuous in the case of Virchow. Before he died, Hunter attained to a large competence, and his anatomical collection, consisting of some ten thousand preparations, made largely with his own hands, was purchased after his death by the Government, for seventy-five thousand dollars, and presented to the College of Surgeons where it forms the chief part of the so-called Hunterian Museum.

Hunter's principal claims to greatness obtain in this, that he not only brought the light of physiology to bear upon the practice of our art, but by his writings and teachings and especially by his example led men to follow along the paths he cleared for them. It is no small claim to glory to be known by such pupils as Hunter had. By these, by his colossal industry in building up his museum, and by his writings, he will ever be known as the most prominent figure in the medical history of Great Britain.

The fifth man in this quintette of geniuses which I am presenting to you to-day was Francis Xavier Bichat, who was born in France in 1771, and died in 1802. Although he was thirty-one years old at his death, his career was so phenomenal, almost meteoric, that it deserves to be held up as showing what one can do in the early period of his life, if he will but work. As one reads of his originality and talent one is led almost insensibly to compare them with those of some of the world's famous musicians who, also, have died in early manhood after giving to the world their immortal works, e. g., Schubert, Mozart and Mendelssohn. Bichat was the son of a physician and applied himself early to medical studies in Nantes, Lyons, Montpellier and finally in Paris, where he became the pupil and trusted friend of Desault, then the greatest Parisian surgeon. When Desault died, in 1795, this young man began lecturing for him, at the age of twenty-four. He displayed a wonderful, almost feverish scientific activity, more particularly in the direction of general and pathological anatomy. He was the originator of the phrase which he made famous: "Take away some fevers and nervous troubles, and all else belongs in the domain of pathological anatomy." Coming upon the stage shortly after Morgagni left it, he was able by his genius, his logical acumen and his graces of speech and manner, to give an attractiveness and importance to this subject which it had hitherto lacked.

It was his great service to more clearly differentiate closely related diseased conditions and to insist upon a study of post-mortem appearances in connection with previously observed clinical phenomena. He also established the tendency of similar tissues to similar anatomical lesions. In fact our view of what we call general tissue systems we in reality owe to him, since without use of the microscope he distinguished twenty-one kinds of tissue, which he studied under the head of general anatomy, while he held that descriptive anatomy had to do with their various combinations.

To Bichat was largely due the overthrow of purely speculative medicine because he placed facts far in advance of theories and ideas. Books he said are or should be merely "memoranda of facts." That he made many such memoranda will appear from the fact that before his untimely death he had published nine volumes of essays and treatises, nearly all bearing on the general subject of anatomy, normal and morbid. He also had not only his limitations but his faults. He strangely denied the applicability of so-called physical laws to body processes, he minimized the importance of therapeutics, and he sought to place the vitalistic system upon a realistic basis. Nevertheless he set an example not only for the young men of France, but of all times and climes, which should be often held up before them.

And so I have thus placed before you five bright and shining illustrations of what brains and application can accomplish, selected from different lands in order to show that medicine has no country, and from a previous century in order that you may the better realize how meagre was their environment in those days as compared with that which you enjoy. Perhaps you will say, "there were giants in those days." True, but the race has not entirely died out. While Spencer and Virchow live one may not call the race extinct, nor can the times which have produced such men as Helmholtz, DuBois-Reymond, Darwin, Huxley, Leidy or Marsh, fail to still produce an occasional worthy successor.

But it is time now to draw this rather rambling discourse to an end. The effort has been partly to attract your attention to some of the side lights by which the vista of your futures may be the more pleasantly illumined, and partly, by placing before you brief accounts of the careers of some of your illustrious predecessors, to show that eminence in medical science inheres in no particular nationality nor race, neither comes it of heredity nor by request. Like salvation it is available to all who fulfill the prerequisites. It is a composite product of application, direction, fervor in study, logical powers of mind, honesty of purpose, capability of observation, alertness to improve opportunities, all combined with that somewhat rare gift of tact, which last constitutes the so-called personal equation by which many humanitarian problems are solved. Study nature for facts; study lives of great men for inspiration how to use them.

"Were a star quenched on high For ages would its light, Still traveling downward from the sky, Shine on our mortal sight. So when a great man dies For years beyond our ken, The light he leaves behind him lies Upon the paths of men."

If then you regulate your mental habits by such a code other habits will of necessity fall into the proper line. The only other admonition I would give you in parting is summed up in these beautiful lines of our own Bryant:

"So live that when thy summons comes to join The innumerable caravan which moves To that mysterious realm where each shall take His chamber in the silent halls of death, Thou go not like the quarry slave at night, Scourged to his dungeon, but sustained and soothed By an unfaltering trust, approach thy grave Like one who wraps the drapery of his couch About him and lies down to pleasant dreams."

That the sentiment is not new, however, will appear in this other and ancient version which Sir William Jones has thus rendered from the Persian:

"On parent knees, a naked newborn child, Weeping thou satst while all around thee smiled, So live that, sinking to thy last long sleep, Calm mayst thou smile while all around thee weep."

THE CAREER OF THE ARMY SURGEON

Commencement Address at the Army Medical School, Washington, D. C., May 29, 1909.--From "The Military Surgeon," July, 1909.

The experience of listening to a so-called Commencement Address under these peculiar circumstances is doubtless as novel to you as is to me its preparation. So different is this occasion from that usually spoken of as Commencement Day, that it taxed my judgment as much as it did my ability to--as it were--"meet the indication," and to try to say the appropriate thing. It behooves me to remember that this is in effect not an address to a class of students just entering a learned profession, but an effort on the part of one on the borderland of experiences gathered from a civil surgeon's work, yet enjoying a quasi military title, with strong ties and leanings--to some extent inherited--toward the course of the army surgeon and the fascinations of the soldier's life. Self-evident it is that you need no admonition which I could give, for the very fact of your presence here indicates that your selection by your superior officers stamps their approval of your ability as well as your character.

Time has wrought vast changes in the personnel of the army medical corps, as in every other branch of the service. From the days of Xenophon, with his selection of the best material afforded, to the dark middle ages with practically no provision, then to the later centuries with their menial barbers and barber surgeons, and then the very gradually improved conditions which bettered the service, down to the present time, when the best is none too good, there has been that same evolution which has characterized all the rest of mankind's surroundings and man's realization of his public and private duties. From the days when the first duty of the so-called army surgeon was to minister to his commanding general, and when the private soldier received but the scantiest if any attention, we have arrived at that time when the good health of the entire army is the aim and pride of the medical corps, and when public opinion demands for every enlisted man a degree of watchful care greater than many parents bestow upon their own families. The line officer of to-day can no longer afford to disregard the advice of his medical officers, and camp sanitation is now of even greater importance than operative technique, because preventable sickness and the incapacity caused by disease are recognized as far more to be dreaded than the bullets of the enemy.