Part 19

"Peace hath her victories no less than war." This epigram is as true of the conflicts in which the medical profession engage as of any other. This same sentiment has been put in other words. It is said, "That peace hath higher tests of manhood than battle ever knew." For instance, in New York there is a simple tablet commemorating, in loving remembrance, the death of eighteen young physicians who, one after another, attended a ship load of emigrants sick of typhus fever on Quarantine Island. They fought their good fight and were buried without martial music, adding eighteen names to the innumerable list of victims who have fought the silent battle of dealing with disease, public gainers only in this, that someone has been thoughtful enough to record their names in this semi-public fashion.

Taken again the case of Dr. Franz Muller, of Vienna, who contracted the bubonic plague while working in the laboratory with its germs. Just so soon as he realized that he himself was infected he locked himself in an isolated room, and pasted upon the window pane a sheet of paper containing this message, "I am suffering from plague. Do not send a doctor to me, as in any event my end will come in four or five days." He refused to admit those who were anxious to do for him, wrote a letter to his parents which he placed against the window, so that it could be copied from the outside, then burned the original, fearing that if sent through the mail it might carry the elusive germ. Was not this equal to any instance of valor under the excitement or the stress of battle and cannonade? Could anyone more worthily win a Victorian Cross, or any other emblem of courage and heroism?

Many of you have been in, or will go to Havana. It will be worth your while to make a pilgrimage to the cemetery there, where were buried sixteen young medical students who lost their lives under peculiar circumstances, which afford as well an illustration of Spanish tyranny and injustice. In 1871 one of the professors in the medical school died, and was followed to his grave by the students whom he had taught, and who loved him. Unfortunately they committed an indiscretion by scribbling with a pencil in a public place some criticism on the government; in consequence they were reported, arrested and court-martialed. The written paragraphs were evidence sufficient, and the Governor General ordered the ranks of students to be decimated. There were 160 students all told, and in accordance with this sentence sixteen of them were next day shot without any further ceremony. Of these the youngest was not quite sixteen years old, and his father offered his entire fortune for his life, but without avail. Later the citizens of Havana erected a monument of white marble, at no small cost, to commemorate this sacrifice.

There comes over me, as I prepare these words to read to you, a feeling of their inadequacy, and of lack of personal justice to many of my auditors. Brought up in civil life, with but a smattering of military training, I am rehearsing incidents of which you may read as easily as I, while at the same time I do not forget that from the lives of many of my auditors there might be drawn just as many illustrations of courage, fortitude, endurance and personal valor as any that the Surgeon General's library records. Unfortunately I am not familiar with them. They are, happily in one respect, too numerous to mention, and again are not yet public property, because modesty is ever the accompaniment of these other traits which we all admire so much. Hence, gentlemen, if I seem to you to disregard or forget many an incident in your lives or the careers of your friends, ascribe it to my ignorance rather than to my intent, and to the fact that I have never seen a battle, and that my fights with disease have not been fought in camps, but within the walls of the quiet sick room or hospital ward. Nevertheless I am never happier than when I can try to compel a wider public recognition of what you are constantly doing and of your valorous deeds.

Next to those general improvements in the service which have come about through natural causes, and as results of a better appreciation of its needs, and of a generally improved state of the profession, nothing has come from outside during the past fifty years which has been so helpful and advantageous as the support afforded by the Red Cross, and the introduction of skilled nurses; in fact the greatest help which the medical service of the army and navy can enjoy is that which comes from this volunteer and outside source. By the way, I wonder how many of you recall, or are familiar with, the beginnings of the Red Cross movement? So important has it become that its history should be well known to all. In June, 1859, was fought the bloody battle of Solferino, at the conclusion of which some 36,000 French, Sardinian and Austrian soldiers lay dead or dying on the field. The medical corps was, of course, absolutely inadequate to the work thrown upon them, and as usual thousands of wounded men had to care for themselves as best they could. A Swiss traveler, Henri Dunant, viewing the scenes, and being profoundly impressed by them, not only assisted in the work of relief, but wrote a book entitled, "A Souvenir of Solferino," in which he urged more humane, widespread and speedy aid to the wounded. M. Moynier, president of the Society of Public Utility, of Geneva, a man of independent means; Dr. Appia, a wise physician, and M. Ador, an eminent lawyer of Geneva, also became interested in the movement. The attention of the General of the Swiss Army was called to it and his co-operation enlisted. In this way came about, in 1863, the formation of a permanent society for the relief of wounded soldiers. At a meeting held in October in the same year men from many countries joined in discussing the subject, and an international conference was held, which resulted in calling an international convention, to be held at Geneva in the autumn of 1864.

Such was the beginning of the Red Cross movement, which has now extended all over the world, and has afforded an opportunity for all races, creeds and nationalities to care for those who are made victims of war or pestilence, or who suffer from any other great disaster with which private charity is unable to cope. It marks a step in the evolution of mankind, and has now achieved such universal recognition that national governments and individual potentates are glad to join hands in the great work.

A more concrete application of the same idea has been the comparatively recent formation of ambulance corps and later of nursing bureaus, within our own service, and the employment of trained nurses. This has not been in all respects an easy matter to bring about, nevertheless it has redounded to the credit and to the welfare of all concerned. Never at any time were the sick and injured, either in private or in military practice, so well cared for as now, and America should lead the world to-day, as ever, in the adequacy of its provisions and the perfection of its methods. In private this is notably the case in ordinary hospital work, as seen by all travelers, upon the continent and in Great Britain, who take pains to make comparisons with the way in which things are done there and in our own country. Although Florence Nightingale immortalized herself by showing what woman could do on the battle field and in military camps, it has remained for Americans to improve upon the lessons which she taught, while at the same time revering her for her wonderful devotion to her self-imposed duty and her enthusiasm. In its performance the lessons of the Crimean and the Civil War, for instance, have left their impressions upon history in such a way as may never be erased, and certainly no one was ever more entitled to the designation of "angel of the sick room" than was Miss Nightingale.

Wars of conquest bring about curious results and in unexpected ways. While greed, lust and fanaticism have been the three great impelling and underlying motives for most of the wars which man thrusts upon his fellow-men, one far nobler motive has been the occasional and the only just cause of strife, namely, the desire for liberty; still this is always secondary and the product of some other man's or people's greed. As only by the cataclysms of the natural world has it been prepared for man's habitation, so by some wars have come benefits unforeseen, with an amelioration of the condition of mankind in general, which could not have been secured by any less drastic measures. It is, however, a sad commentary on man's intelligence that most honor is paid to those who have taken the most lives rather than to those who have saved them. No school boy in the remotest districts but is brought up with some trifling knowledge of the world's heroes, so-called, though they were in reality the world's wholesale murderers. Yet you may find many persons, credited with higher education, who are still densely ignorant of the benefits conferred by those two greatest discoveries in the world's history (both of Anglo-Saxon origin), anaesthesia and antisepsis, who will talk entertainingly and at length of Darius, Caesar, Hannibal and the more modern military lights, yet who never heard of Morton nor of Lister. Yet if to-day you inquire what is doing in the various parliaments of the world you learn that the talk is ever of more numerous and more powerful engines of destruction, and that those in power have no time to devote to improvements in the army or navy medical service, and that it is even now impossible to secure anything like adequate attention to our needs in this direction.

Means of taking human life must be constantly at hand; means of saving it are of small importance until the emergency has arisen; and then the blame for inadequate provision of both means and men falls not where it belongs, on the politicians who would not look ahead, but upon the administration of the medical department, who work to the point of desperation and despair in times of peace, who keep perpetual vigil, with scant recognition of the sacredness of their purpose, and scant aid in its accomplishment.

Are the lessons of the South African, the Spanish-American and the Russo-Japanese wars to be forgotten almost before they have been recited? Are we prepared to-day to give adequate care and attention to our soldiers and sailors were war in sight? You well know that we are not; every military or naval surgeon knows we are not; the medical profession generally knows it; and our legislators have been told it until we are tired of repeating it. Yet, what is the result? The same indifference on their part, the same ignorance of what it all means; and on the part of the public the same blindness and fatuous confidence that "everything is all right."

For instance, if an adequate medical service is to be built up for war there should be one officer to every 100 of enlisted men. Estimating that an army of at least 400,000 men would be required were we engaged with a first-class power--and what other would dare to engage with us?--this means 4,000 army surgeons. Of these at least one-fourth should be regular and experienced medical officers. In other words, there should be for such an army at least 1,000 medical officers in the regular service, and also at least 3,000 volunteer surgeons, professionally and physically equipped for such work. Should anyone object that this exceeds all the provisions of time past, the reply is ready and all sufficient, namely, that in time past all such provisions have been utterly inadequate; that the conditions of modern warfare have undergone an entire change, that a sick, wounded or disabled man is an encumbrance, and that it behooves us to prevent sickness, and to cure the disabled man as quickly as possible. Furthermore, advances in medicine and surgery have been so great that far more is now expected of the medical corps than ever before, and it is a duty which we owe to those who incur the dangers of fighting for us that we should care for them. We are, therefore, under the very highest moral obligation to give them our best, and enough of it. It must be a small inducement that we offer to men to fight our battles if we permit them to feel that they are not objects of our solicitude when sick or wounded.

There is another feature which we cannot disregard. So long as army regulations require that a man educated in advanced science spend much of his valuable time in acting as bookkeeper or clerk, there will be less inducement to enter the service, and it will consequently not attract men of highest proficiency. That which is required of you is complicated and exacting. You must be good bookkeepers, good sanitarians, and equally good surgeons, physicians and even obstetricians. Above all, you are expected to be able to keep all the men under your supervision ready for the "firing line" at a moment's notice. You have received the highest compliment which the State can pay when you have been adjudged versatile and competent enough to fill all these rôles and do all these things.

Moreover, as you gain promotion other things will be expected of you, even, I hope, the filling of the chairs in this modern Military Medical School. It is in a way the West Point of the medical corps, and it would seem as though there should not be the slightest difficulty in replenishing vacancies in its faculty by detail from your ranks. The collections and the literary labors of your corps constitute to-day treasures exceeded in value by but few if any in this, the Nation's Capital. The library, the museum and the archives of the medical department have been models from which all the nations of the earth have copied.

In this connection there occurs to me, by way of contrast, the story of a French surgeon's experiences when he undertook to teach anatomy in a conquered and reconstructed country.

After the French occupation of Egypt, Mehemet Ali took it into his head to introduce European civilization into Africa, and imported all sorts of artists, scientists and medical men, among them a practitioner of Marseilles, a true Bohemian in the modern acceptance of the expression, who presented himself in most seedy apparel, saying, "I am a doctor of medicine, with plenty of courage, but no clothes; I want to try my fortune." This man was Dr. Clot, who rapidly became a favorite of the Viceroy. He soon learned Arabic so as to speak it fluently, and in six months not only received an army commission, and became a Bey, but took the chair of anatomy in the newly organized school of medicine. Conditions were all against him. Mussulman fanaticism and the prohibitions of the Koran opposed all anatomical pursuits, and so soon as he proposed a dissection there was a general explosion. By Mohammedan ceremonial one who even touches a dead body is thereby rendered "unclean" for seven days. The Ulemas, the Muftis, and all of the other fanatics, demanded of the Viceroy the closure of the school, and declared dissection a sacrilegious profanation. Mehemet refused this, and ordered Clot Bey to commence his demonstrations. Then one day happened the following incident: The professor, scalpel in hand, standing alongside the cadaver, began to open the thorax, when one of the students, either from sheer fanaticism, or more bold than the others, jumped upon him and stabbed him with a poignard. The blade slid over the ribs, and Clot Bey, perceiving that he was not seriously hurt, applied a piece of plaster to the wound, observing as he did so, "We were speaking of the disposition of the sternum and the ribs, and I now can illustrate to you why a blow directed from above has so little chance of penetrating the cavity of the thorax." He continued his lectures, and turned out some skilful practitioners. He became an officer of almost every order in the world, and acquired more than sixty decorations, although he never wore but one, the red rosette of his own country. (Med. Times and Gazette, September 19, 1868.)

While just such an experience may never be duplicated again, the Philippines, or some other country yet to fall under our rule, may afford an opportunity for a similar display of sang froid.

While no one may see far into the future, the maxim, "In time of peace prepare for war," is as true of the medical department as of any. Were it a state secret no one would breathe it here, but it is lamentably true and publicly known that even now we are not prepared as we should be. The awful lessons of the Spanish War have been forgotten. West Point officers have until comparatively recently received no instruction in camp sanitation. Some of us worked hard a while ago to have at least elementary instruction in it introduced into their curriculum. As an illustration I believe that to-day they are taught more about horse's feet and how to keep them in good condition, than about those of their men. Line officers, especially volunteer, have never been too ready to locate their camps where water and drainage were the best, and the awful mortality of the Spanish War was mainly due to preventable disease, while this was due to stupid and inexcusable disregard, on the part of officers of the line (mainly volunteer) of the advice of their medical officers.

But, after all, gentlemen, the discouragements you will meet with will be far fewer than those with which your predecessors had to contend, while the pleasant side of your lives will be far pleasanter than was theirs. In fact, I think your lives have in many respects fallen in pleasanter places than have ours. Discipline and order protect you to a large extent from quackery and idiocy. The fads of the day disappear before the appearance of the flag and the sound of the drum. So-called Christian Science finds no place in your curriculum, and it will be long, I trust, before the army chaplain tinctures the military hospital with sectarian therapeutics or an Emanuel church cult. If by entering the army one may escape disgusting influences of this character, then it may become such a refuge that it shall thereby be made both inviting and invincible.

It is pleasing to those of us who co-operated in the movement, to have the assurances of the Surgeon General that the establishment of the Medical Reserve Corps has been of actual benefit to the regular Army Medical Department. While the military rank to which its members found themselves suddenly elevated was not so lofty as to cause any attacks of vertigo, none having been up to the present day reported, it at least gives us satisfaction to realize that help may thus be afforded from private life, and that a closer rapport has been effected.

And now it is well nigh as difficult a task to appropriately conclude these remarks as to begin them. Men come and go; a few leave imprints of their footsteps; the vast majority make no impression that lingers.

"Some when they die, die all; their mouldering clay Is but an emblem of their memories; The space quite closes up through which they passed."

Fain would I believe that many of you would make enduring records. Yet each can do his best, and I doubt not each will do it. You have so much to encourage you, so comparatively little to hamper or hold back. Glorious is your work, glorious may be your fulfillment of it. We have lived in a goodly time; you will enjoy one still more goodly. With scientific progress, whose like the world has never known, and with an altruism which makes the world constantly better, you will be able to do things never done by your predecessors.

"'Tis coming up the steeps of time, And this old world is growing brighter! We may not see its dawn sublime, Yet high hopes make the heart throb lighter! Our dust may slumber underground When it awakens the world in wonder; But we have felt it gathering 'round! We have heard its voice of distant thunder. 'Tis coming! Yes, 'tis coming!

"'Tis coming now, that glorious time Foretold by seers and sung in story, For which, when thinking was a crime, Souls leaped to heaven from scaffolds gory! They passed. But lo! the work they wrought! Now the crowned hopes of centuries blossom, The lightning of their living thought Is flashing through us, brain and bosom; 'Tis coming! Yes, 'tis coming."

THE EVOLUTION OF THE SURGEON FROM THE BARBER

If one attempt to scan the field of the history of medicine, to take note of all the fallacies and superstitions which have befogged men's minds, and brought about what now seem to be the most absurd and revolting views and practices of times gone by, and if one search deliberately for that which is of curious nature, or calculated to serve as a riddle difficult of solution, he will scarcely in the tomes which he may consult find anything stranger than the close connection, nay, even the identity maintained for centuries, between the trade of the barber and the craft of the surgeon. Even after having studied history and the various laws passed at different times, he will still miss the predominant yet concealed reason for this state of affairs. This will be found to be, in the words of Paget, the "maintenance of vested rights as if they were better than the promotion of knowledge." He will wonder also why women were licensed to practise surgery in the fourteenth century and prevented in the nineteenth, or why specialties were legally recognized in the sixteenth century only to lose their dignity and identity a little later.

In thus attempting to consider the relations which have existed in time past between barbers and surgeons I must ask you to remember that there was a time when bleeding was deemed necessary for the cure of almost all ailments, and that after the Church had condemned the shedding of blood by any of her officials it was most natural to turn for assistance to the barbers, who were supposed to be dexterous with sharp instruments, with basins and with towels. Thus it happened that when the barbers found themselves permitted to perform this sole act they naturally ventured further and practised many parts of minor surgery independently of the ecclesiastics.

Moreover there persist to-day in Europe many relics of the old customs, and the barber surgeon is still a common figure in Germany, and particularly in Russia, where the really educated surgeons are still too few for a vast and widespread population. It must be remembered also that the Church gradually imbued men's minds with a horror of a dead body, and of the profanation which followed having anything to do with it, and surrounded the study of anatomy with every possible obstacle and obloquy; even to such an extent that to be known as having dissected a human body was to be exposed to indignity, assault and even death. It was, therefore only intense yearning for knowledge, on the part of earnest men, which then permitted anatomical instruction to be given or encouraged.