There is an old saying that interest does not bind men together: interest separates men; there is only one thing that can effectively bind people, and that is a common devotion. This, a common devotion, more than any other possible influence, serves to overcome the self-depravities and conceits inherent in us which, uncontrolled, represent the chief defect in our natures. Our loyalties, to be sure, — loyalty to a nation, to a cause, to community, to school, to family, to friend, — are somewhat akin, yet there may be something of personal interest, prejudice, or defense in these particular reactions which makes them not wholly unselfish.
So let us believe, for our present purposes at least, that “devotion” not only implies a higher standard of self-effacement, but still carries something of its quondam religious significance. And it is of the doctor’s consecration to his task that I wish to speak, the kind of unselfish relation to suffering humanity that made Saint Luke the beloved physician no more nor less than it makes many another doctor of name unheard and unsung to-day.
It is this common devotion to their life’s work that serves to bind those of the profession into which you are entering with ties more close and enduring than those which hold any other group of people engaged in a common purpose. Nor should it make any difference where or how you may come to be engaged. The lives of countless Weelum MacLures, in the obscurity of their respective Drumtochtys, have been no less consecrated, could we but know them, than those of the Parés, the Listers, and the Pasteurs on whom the light of history has been turned.
Devotion is an attribute one cannot estimate and record by ordinary standards. How much the practising doctor cares about his patients as individuals apart from their being the source of his livelihood; how much the medical scientist may be interested in promoting science rather than in securing his own promotion; how much the teacher influences his pupils to their best efforts, unmindful of what the curriculum briefly requires of him; how much the student engages in his work for the work’s sake, regardless of his marks and rating — all these things depend on a devotion which places spiritual above material rewards.
This may sound, my young friends, like sermonizing. And valedictory addresses to medical students are prone to be commonplace, “platitudinous with the platitudes of a thousand pulpits,” as Sterne said was true of most sermons. But there are certain things which concern the code of the doctor handed down to us from ancient times, which, though commonplace, deserve reiteration on such occasions as this. They are things often lost sight of in these days when the Hippocratic Oath, as supposedly too antiquated for present-day purposes, is rarely read to graduating classes. I rejoice that Jefferson maintains this custom, for there is nothing that expresses so well, as does this justly famous credo, the ideals which from the first have actuated the doctor and have led to the solidarity of the profession you are entering. No guild has a sounder code of ethics; no Masonic group stronger ties of brotherhood.
For no insufficient reason do we as a profession hark back to the fifth century before the Christian Era when the man we venerate as the “Father of Medicine” first cast superstition aside, dissociated his calling from priestcraft, and based it on the principles of inductive philosophy. So, tempering them to our modern period, we may well hold fast to those hallowed rules of professional conduct which he promulgated and which have stood the test of usage as long as the canons of the Old Testament, which likewise in these fallen days are become somewhat unfashionable.
My object in making professional devotion a text on your graduating day is to emphasize the doctor-and-patient relationship. However many of you may come to be diverted into other channels of professional activity, I take it that the school whose diploma you have gained still holds the practice of medicine as the primary object of your four years and more of training, and consequently that the prospective patient has from the first been kept in view even if distantly.
In these days when science is clearly in the saddle and when our knowledge of disease is consequently advancing at a breathless pace, we are apt to forget that not all can ride and that he also serves who waits and who applies what the horseman discovers. In some of our schools so great an emphasis has come to be laid on the science courses, with the patient long hidden from sight, that the better students, under the influence of teachers who have never had clinical experience, naturally come to feel that somehow the practice of medicine among the people is an inferior calling compared to the secluded life of an investigator, and that to justify themselves in the eyes of the faculty they must manage to “do a piece of research.”
Indeed, when students in some of these schools reach their clinical years their senior teachers are often men whose perspective is largely institutional, and consequently it has become, for lack of time, interest, or experience, no one’s business to give instruction in those aspects of medicine which will be so important to the greater number of you in the future: the relation of doctor to doctor, of doctor to patient and patient’s family, of doctor to community, and of our profession to the others, particularly to the priesthood from which medicine took its origin.
Dr. Thomas Percival thought these matters of sufficient importance to write a book about them for the benefit of his son on his entry into medicine; but for the most of you who have never heard of Percival and his code1 they are left to be learned in the bitter school of personal experience; and many a promising career may come a cropper from misunderstandings of professional ethics the chief tenet of which, after all, is proper observance of the Golden Rule, not only in our dealings with our patients and our professional brethren, but with society in general.
In our present day when so great emphasis is being laid on keeping people well by periodic health examinations and preventative medicine, all this about medical practice may sound very old-fashioned. But say what one will, the time inevitably comes to each and every one, now in the best of health, when he must needs cry out for some experienced and sensible doctor who can alleviate if not cure his particular ailments, be they physical or mental; and the kind of sagacity and resourcefulness he will expect and need is less laboratory-born than bred of long and sympathetic familiarity with the anxieties and complaints of ailing, damaged, and worn-out human beings. These things were perhaps best learned in the days of student apprenticeships; and our present efforts under the guise of a tutorial arrangement recall something of the old-time elbow-to-elbow familiarity of teacher and pupil and show a growing appreciation of the advantages of a long-abandoned system.
We have gained much for science but have lost much for practice by the course we are following, and I look forward to a time when the pendulum will swing back, not to a day when the spirit of research will be any less active, but to a day when suitable representatives of the clinical departments will be delegated to correlate the teaching in the science courses so that their bearing on what is to come may be constantly kept in mind. A course in pure science unrelated to the patient belongs rather in the college than in the medical school.
It is a common complaint that, in their exercises, clinical teachers fail to draw the lessons they should from the laboratory courses. It is doubtless true that they lag in their familiarity with and the adaptation of the newest disclosures of science; and it is perhaps a lame excuse that science as yet has no obvious bearing on the greater portion of the doctor’s daily problems. But in rejoinder the clinician might well ask whether it could possibly harm a teacher of the preclinical sciences to have served a house-officership; or dampen his investigative ardor should he spend even an occasional hour or two in contact with patients in the wards or ambulatory clinic.
Both parties to this mild family disagreement among the faculty must endeavor to see the matter clearly and without prejudice. Through the concentrated application of the scientific method in the fifty years past, medical progress has been nigh incredible. We must therefore make every effort to support and encourage the scientific spirit, for who can foretell what prodigious strides may be taken in another half century? But the capacity for productive research is a rare quality akin to genius, and the future investigator among you will doubtless be found, or find himself, irrespective of this or that curricular arrangement. Whether it is necessary or worthwhile for the majority, who are destined to put to practical purposes the knowledge already gained from the laboratory, to be given such an exclusive preliminary science drill as they are now given in many schools, is a matter of doubt, and a happy solution of this puzzling question will some day perhaps be reached.
You who are graduating here to-day, wherever you land, — in laboratory, in hospital clinic, in practice, — will have occasion to lament the insufficiencies of your preparation. This has been so from the beginning and will be so to the end of time. However secure the foundation may appear to have been laid, you will come to build on it an individual kind of superstructure which could not possibly have been anticipated. “Could I only have had a better grounding in biophysics instead of wasting my time in a clinic!” groans the young laboratory worker who endeavors to solve some baffling problem. “Could I only have had a little more dissection, I should not have mistaken a median nerve for a tendon when I sewed up that cut wrist!” groans the youthful surgeon. “Had I only learned to puncture a bulging eardrum instead of electing a useless laboratory course, I might have saved this poor child from a meningitis!” groans the young practitioner. “If we could only have foreseen this, that or the other, we would not have spent our time as we did,” we groan in unison.
From vain regrets good Lord deliver us. Experience has to teach us many things we have never learned from the schools. You will remember Parés account of an episode in the little hamlet of Suze sometime in 1537. “See how I learned to treat wounds made by gunshot: not out of books.”
Most of you, I take it, will — as Jefferson graduates have done before — come to recruit the ranks of the practising doctor in this great state. Personally I have been too much astride the fence to take sides strongly in regard to the relative satisfactions of a life so devoted or one dedicated to teaching and investigation. With a background of family practitioners, I have, by the fall of dice, come to lead a life different from theirs, not so sequestered as that of some, but sufficiently so to let me estimate the recompenses and weigh the satisfactions which come from an existence of the two kinds. Certainly the self-sacrificing career of the practising physician, respected and beloved of his community, is no less, perhaps even more, character-making and ennobling than the secluded life of a pure laboratory worker, whatever be the importance of his researches and discoveries. In either case, “success dwells in the silences though fame be in the song.”
We live in an era of specialization, but specialization can be overdone and there is no inherent reason why the qualities of investigator, teacher, and practitioner should not go hand in hand, be represented in a single individual, and he be none the worse for the mixture. So it was, for example, in the case of the incomparable Hunter; so it was, to come nearer home, in the case of two of the great peripatetic teachers, Nathan R. Smith and Daniel Drake, who were associated with the birth of this school of whose diploma you may be justly proud. And should you in your “waiting time,” when patients seem few and your outlook uncertain, wish to gain courage and receive stimulus, read the lives of these men and learn what perseverance may accomplish. Contrast your opportunities and training with those of Drake, brought up in a log cabin at May’s Lick, over the mountains in what was then the wilderness of Transylvania; and who in the midst of teaching, of founding medical schools, of practice, came to be recognized as the leading climatologist and epidemiologist of his day. All this you will find in the volumes of medical biography, which deserve a place on your library shelves alongside your journals and textbooks.
- Excellent courage our fathers bore —
Excellent heart had our fathers of old;
None too learned, but nobly bold
Into the fight went our fathers of old.
But, even better than this, stouten your hearts by reading of the doctor in fiction, and emulate Lydgate, at least up to the point which will warn you against marrying the wrong woman. Familiarize yourselves with the writings of healthy-minded doctors like Oliver Wendell Holmes and John Brown, of Rab and His Friends. If you need an antidote for the cynicism of Arrowsmith, buy or borrow Sarah Orne Jewett’s nigh-forgotten story depicting her own father as A Country Doctor; for there are still John Leslies in the country districts and room for many more — plenty of room, too, for Nan; and if she is really serious about it she’s worth to the world a thousand Leoras. Perhaps best of all, if you would learn what unalloyed professional devotion may be and what rewards it may bring, read or reread the last chapters of Ian Maclaren’s Beside the Bonnie Briar Bush and let the example of Weelum MacLure, to whom I have already alluded, become a part of you.
Still, you need not resort to biography or fiction to learn something of the spirit of devotion that is the mainspring of our profession. You have plenty of examples, living and dead, here in you own school. Being a surgeon, and more familiar with Jefferson’s century-long story of surgery than with her story of physic, let us look there for illustrations, the more fittingly since a talented and enterprising surgeon was your founder; and it took no less a person than a fighting
McClellan to succeed in such a venture under the very shadow of, and with no little opposition from, the oldest and most celebrated school in the country, his own Alma Mater. She it was who provided his successor in the chair of surgery on the reorganization of your school in 1841; and the name of Thomas Dent Mütter, who, alas, from overwork died all too young, is held in thankful remembrance through the museum he founded and the lectureship he established — a lectureship which has been of help to many young men, as I, who had the privilege of holding it just twenty-five years ago, can testify.
On Mütter’s enforced retirement in 1856, the school for the first time reached out for an example of it’s own product, and chose a man who had graduated with its second class and who, meanwhile, had gathered as a teacher experience almost as rich and varied as that of Daniel Drake himself, under whose influence he had come in Cincinnati. Young men in those days were less fearful of transplantation than we, and the twenty-eight years during which Samuel David Gross subsequently served here in his fourth chair of surgery saw him rise to the top of his profession. We may well believe that the increasing flood of students, who during those years went out into the world as Jefferson graduates, were deeply influenced by his scholarly example and teaching.
But if the elder Gross and his contemporaries may seem somewhat shadowy figures to you, the mantle he wore as doyen of American surgery has now for long rested on the shoulders of his successor, a man endowed with perennial youth, who seems likely to hold that emeritus position among us for time untold. And as Dr. Keen’s spirit dominates time, so the unquenchable spirit of your beloved teacher, “Jack” Da Costa, dominates a disability which would long since have driven a lesser man to retirement and inactivity. It is, furthermore, this same spirit of “never give in” that keeps the star of a frail gentleman shining brilliantly in a galaxy of Philadelphia surgeons, a man whose personal dexterity enables him to save more lives, and those the precious lives of children, each day, week, and month, than may be given to others to save in a year or in a lifetime. If the Recording Angel keeps score of the numbers any one of us as individuals may possibly have snatched from the very jaws of death, certainly Chevalier Jackson’s name tops the list.
Favored is the school that may carry the tradition of men who have shown such professional devotion as these, and whose spirit has conquered time, age, ill health, and circumstance. A wise doctor who knew his patients well once said that in his experience the best work in the world was often done by people suffering from some bodily affliction; and this is a heartening idea you may well pass on in your turn to some of those who may in future years consult you and for whom you may have little to give but encouragement and comfort. You indeed will have to mix many of your prescriptions with a basis of hope, and too little stress is laid, in most courses in therapeutics, on the beneficial effect of optimism and cheer in combating disease.
We are tending to become a standardized country, and it is perhaps on standardization that industrial progress is founded. But standardization of our educational systems is apt to stamp out individualism and defeat the very ends of education by leveling the product down rather than up. The qualities that really count in this world are quite beyond pigeonholing, quite beyond measurement by scales, tape, or mental tests, quite beyond rating by any known system of examination, all of which fail in giving us an estimate of that most precious of all qualities, personality.
The capacity of the man himself is only revealed when, under stress and responsibility, he breaks through his educational shell, and he may then be a splendid surprise to himself no less than to his teachers. There is no profession in which such surprises are more likely to happen than in that you are entering, no profession which offers greater opportunities for the development of character, provided you will consecrate your lives unselfishly to your tasks as others you would wish to emulate have done before you. In so doing you will meet responsibilities as they come, with intelligence and courage; you will play fair with your fellow men, remembering that the practical religion of the physician is not the promising of bliss in the future but the giving of health and happiness on earth; and, above all, you will hold fast to that noble phrase of Hippocrates: “Where there is love of humanity there will be love of the profession.”
I am going to read to you, in closing, a paragraph from a book which I can warmly recommend for its philosophy and humor. You will observe from its title that I may have had it in mind in choosing the text of this, in comparison, most feeble address. It is Stephen Paget’s Confessio Medici. He says therein: —
- Every year, young men enter the medical profession who neither are born doctors, nor have any great love of science, nor are helped by name or influence. Without a welcome, without money, without prospects, they fight their way into practice, and in practice they find it hard work, ill-thanked, ill paid; there are times when they say, “What call had I to be a doctor? I should have done better for myself and my wife and the children in some other calling.” But they stick to it, and that not only from necessity, but from pride, honor, conviction; and Heaven, sooner or later, lets them know what it thinks of them. The information comes quite as a surprise to them, being the first received from any source, that they were indeed called to be doctors; and they hesitate to give the name of divine vocation to work paid by the job, and shamefully underpaid at that. Calls, they imagine, should master men, beating down on them: surely a diploma, obtained by hard examination and hard cash, and signed and sealed by earthly examiners, cannot be a summons from Heaven. But it may be. For, if a doctor’s life may not be a divine vocation, then no life is a vocation, and nothing is divine.
Consecratio Medici, Graduation Address, Jefferson Medical College, Philadelphia, June 5, 1926.
Reprinted with permission of Yale University, Harvey Cushing/John Hay Whitney Medical Library.