o o GIFT OF UNITED STATES NAVAL MEDICAL SCHOOL WASHINGTON, D. C Addresses Delivered at the Closing Exercises (FOURTEENTH SESSION: APRIL 12, 1916) BY MEDICAL DIRECTOR JAMES D. GATEWOOD, U. S. N. PRESIDENT OF THE SCHOOL THE HONORABLE JOSEPHUS DANIELS SECRETARY OF THE NAVY SURGEON GENERAL WILLIAM C. BRAISTED UNITED STATES NAVY AND HUBERT A. ROYSTER, M. D. RALEIGH, N. C. COMMENCEMENT ADDRESS: The Humanity of Surgery ff OF THE ; U N 1 V E K 3 I T Y WASHINGTON ^r- GOVERNMENT PRINTING OFFICE ^SstZ- I F ' "> R 1916 UNITED STATES NAVAL MEDICAL SCHOOL WASHINGTON, D. C. Addresses Delivered at the Closing Exercises (FOURTEENTH SESSION: APRIL 12, 1916 ) BY MEDICAL DIRECTOR JAMES D. GATEWOOD, U. S. N. [PRESIDENT OF THE SCHOOL THE HONORABLE JOSEPHUS DANIELS SECRETARY OF THE NAVY SURGEON GENERAL WILLIAM C. BRAISTED UNITED STATES NAVY AND HUBERT A. ROYSTER, M. D. RALEIGH, N. C. COMMENCEMENT ADDRESS: The Humanity of Surgery WASHINGTON GOVERNMENT PRINTING OFFICE 1916 366836 PROGRAM. Invocation, by Chaplain G. L. Bayard, United States Navy. Address of welcome, by Medical Director J. D. Gatewood, United'States Navy. Presentation of diplomas, by the Secretary of the Navy. Address, by the Secretary of the Navy. Address, by Surg. Gen. W. C. Braisted, United States Navy. Commencement address, "The Humanity of Surgery," by Hubert A. Royster, M. D. Benediction, by Chaplain G. L. Bayard, United States Navy. (3) GRADUATING CLASS. Asst. Surg. John Harper, Medical Keserve Corps, United States Navy. Asst. Surg. Richard H. Miller, Medical Reserve Corps, United States Navy. Asst. Surg. Paul Richmond, Jr., Medical Reserve Corps, United States Navy. Asst. Surg. Forrest M. Harrison, Medical Reserve Corps, United States Navy. Asst. Surg. Lawrence F. Drumm, Medical Reserve Corps, United States Navy. Asst. Surg. George W. Taylor, Medical Reserve Corps, United States Navy. Asst. Surg. Walter A. Vogelsang, Medical Reserve Corps, United States Navy. Asst. Surg. Elphege A. M. Gendreau, Medical Reserve Corps, United States Navy. Asst. Surg. Grover C. Wilson, Medical Reserve Corps, United States Navy. Asst. Surg. Russell J. Trout, Medical Reserve Corps, United States Navy. Asst. Surg. Virgil H. Carson, Medical Reserve Corps, United States Navy. (4) CLOSING EXERCISES. ADDRESS OF MEDICAL DIRECTOR JAMES D. GATEWOOD, UNITED STATES NAVY, President of the School. LADIES AND GENTLEMEN : It happens to be my privilege, as well as duty, to say a few words here. You know this is a situation that recurs. Each year there is an audience composed of interested, heartening, and welcome witnesses ; there is a class made up of those who have met the school require- ments; and there are certain exercises that include the bestowing upon each class member of a certificate showing his successful work. But this situation dissolves. It is preliminary to the departure of each of the central figures, of each member of the class. They all go out to sea, starting voyages of great length and in many directions. Now this reminds one, as a mere simile, of a number of vessels dropping downstream at the same time and going out to sea. You have stood on the sands and watched them and you have noted that as each gets into deep water it proceeds on its own predetermined course, but that, whatever the course, it is always toward the horizon. To you, standing on the sands, each vessel attains the horizon and disappears in its mists. But from the point of view of those on the vessel the horizon is never reached, the great inverted bowl of the sky ever hanging directly overhead, with rim touching the sea just so many miles away. Perhaps in this can be found some reminder of different types of men of men varying in their attitudes toward life. We live by our visions, and the ambitious, venturesome, or progressive, using the light of imagination or guided by reason and judgment, discern dim objects on the horizon of the sea of life toward which they feel impelled to move. But lo! when they satisfy those desires, when they find something greatly coveted, the horizon is still as far away as ever, and other shapes are looming there calling to restless minds. But the onlooker, the man of routine, does not seem to struggle, does not seem to travel, as his horizon is ever the same. His general view of life does not vary. He sees many pass by, and he also notes many wrecks in his time. He studies his vicinity, he goes over and (5) over the same course day after day. He does things in the same way, and numerous harbors of refuge are always near at hand. Each situation has a precedent, and he steers by it. He does not own the routine; the routine owns him. And he is apt to have a kind of blindness, a limitation of the field of vision. Yet I do not wish to be understood as talking against routine and against system. Each life becomes quite valueless without them. But they ought to be owned, they ought to be appropriated as a means. They cause too great limitations, they stifle the imagination, and they kill originality of thought when they are the owners and not the slaves of men. Now, the central idea of all this is travel. We speak of life's voyage, of the sea of life, of man's walk in life, and of the race of life in which one man passes another. We think of the faces of those whom we have loved, admired, and respected but who are no longer with us; and we feel that they have gone on before. We thus unconsciously recognize that we are all travelers, all moving toward the bourne from which no traveler returns. Thus the question arises as to what traveling is. Certainly it is not a mere matter of transportation. Under that idea a trunk could be made to travel with the assistance of a baggage check. In fact, man travels by his mind. The shoemaker, as he passes the thread or hammers in the peg, revisits his home in southern Italy. The writer or student of history sees the temples of Egypt or walks the streets of ancient Greece, or, sitting in the Colosseum, hears the Jidbct of the Roman populace in the days of the Caesars. The poet wanders through the hearts of men and lifts their faces to the stars. And the writer of romance accompanies you through the intricacies of plot, carries you into his world, and introduces you to his people. A man travels by his mind. Futhermore, the member of the human race who puts forward something of continuing importance to mankind lives and travels forever with those he has benefited. The cablegram you receive has traveled thousands of miles along the ocean bed and carried to you something of the mind of Morse. The wireless sending its im- pulses through the ether also sends through space something of the mind of Marconi. Each day thousands of miles of telephone wire carry countless messages that depend for transportation upon some- thing that has come to us through the mind of Bell and others. And each night as the great ship pushes its way through the waters there is something there of the mind of Fulton and a host of others strangers to us, many of them, but travelers are often strangers in strange surroundings. And there is a science and art of traveling as truly worth culti- vating as the science and art of medicine or the science and art of surgery. There is a spirit of patient observation to be cultivated, an understanding of the feelings of others through which one's own selfishness lessens. Even hi our own homes we are all travelers the place where it too often happens that we know one another so well that we do not know one another at all. And now you, members of this class, central figures on this occa- sion, are about to begin your travels in the Navy. Are you thinking of a ship merely as a means of transportation from one port to another, from one seacoast city to another ? I tell you that a man travels by his mind and that it is about the ship you must travel. Your travel on the ship is merely incidental. You must study your ship from bow to stern, from upper deck to keel. You must know bilges, holds, and storerooms. And you must consider long and carefully 'the living quarters. Are they well ventilated under all conditions, are they clean, are they well lighted, are they suitable habitations for men? Is anything wrong, and, if so, what can be done? You must know the water supply, literally know it all the time. You must even know the character of paint in composition and color employed within the ship, for there are relations to the health of crews. There are innumerable things, here, there, and everywhere within the ship that should make constant appeal to the trained mind. You must know everything a good traveler should know, and this includes, in your case, not only the care of sick and injured, and preparation for battle, but also, and primarily, the prevention of sickness, the preservation of the health of men. And shall you not all be travelers together? In the wardroom you will rub elbows with a number. Will you really know them? Will you see the strength as well as the weakness ? Will you know that men can not be judged by their weakesses but rather by their power to lift their heads above others in time of stress and peril? I warn you to be good travelers, to study the personnel, to cultivate the spirit of the Navy, the love of duty that is stronger than the love of life. Will you play the game earnestly and as a very part of it ? Will you cultivate, truly cultivate, the art of traveling the spirit of patient and unselfish observation ? I ask you because your careers will be watched with great interest. Word will come back here where you start. Will it be a good voyage you are about to make ? A man travels by his mind. 4142916 2 ADDEESS OF THE HONORABLE JOSEPHTTS DANIELS, Secretary of the Navy. It gives me great pleasure to welcome you into the Navy. Two years ago, when I had the privilege of welcoming the graduating class, I undertook in a brief address to invite the attention of the young surgeons coming into this high profession to the career of that gre;it Scotch doctor, William MacLure, and I should be glad if all you young men would make the spirit of Ian MacLaren's hero your emulation. Last year I invited your attention to the life story of Dr. Amboyne, the hero of an older but equally great novel, Charles Reade's "Put Yourself in His Place," of whom his patients said: "Talking with you, doctor, is like drinking sunshine." I would like to-day to call your attention to a distinguished physician, a literary master, not the product of the brain of a great novelist, but a man of flesh and blood, who, beginning his profession in London, arose to the highest eminence and did what so few doctors have done left behind him a memorial of his life work, "The Diary of a Late Physician." This great man went to London and for years fought his way to practice, and after he had been in the profession for years had the honor of making $200 a year and a small additional amount by writing. And yet in his philosophy and in his life he held up a very high ideal before your profession. While his Diary must have been suggestive and inspirational to the professional men of his day, its chief value lies in the spirit of sympathy which pervades the recital of each case described. The introduction contains these words : The bar, the church, the Army, the Navy, and the stage have all of them spread the volumes of their secret history before the prying gaze of the public, while that of the medical profession has remained hitherto, with scarcely an exception, a sealed book. And yet there are no members of society whose pursuits lead them to listen more frequently to what has been exquisitely termed, "The still, sad music of humanity." No doubt it was the bitterness and hardship of the early struggle for success which helped to beget in the heart of this physician the tenderness and kindliness which characterized the practice of his profession throughout his long and useful life. In his paper entitled "Cancer," Dr. Warren draws a fine picture of the strength of weakness as exemplified hi the endurance of a young mother of about 27 years of age whose husband, a captain in the incomparable navy of Great Britain, was far away engaged in his country's service. The description of the operation for cancer, (8) located on the face and from which the vi6tim suffered great pain, is interesting in the light of present-day appliances and efficiency. As this beautiful woman came into the room in her residence where the operation was to be performed, this sympathetic doctor de- clares that his heart ached, and goes on to say: "A decanter of port wine and some glasses were placed on a small table near the win- dow." This was the anesthetic. The number of glasses indicated that the wine was to do double duty to strengthen the patient for the operation and to nerve the distinguished surgeon, whom Dr. Warren had called in to use the knife, for his difficult task. The subject of the operation barely touched the glass with her lips, and then implored the physician to hold before her eyes the envelope of a letter which she had just received from her absent husband and which she declared was all that would be necessary to nerve her for the ordeal, and this Dr. Warren did while the surgeon used the knife. Then the Diary continues: "'I am prepared/ said she, and sat down in the chair that was placed for her. One of the attendants removed the shawl from her shoulders * * *. She then suffered Sir to place her on the corner side of the chair, with her left arm thrown over the back of it, and her face looking over her left shoulder. She gave me her right hand ; and, with my left, I endeavored to hold Capt. S 's letter, as she had desired. She smiled sweetly, as if to assure me of her fortitude; and there was something so indescribably affecting in the expression of her full blue eyes, that it almost broke my heart * * *. Sir - , now, with a calm eye and a steady hand, commenced the operation. At the instant of the first incision, her whole frame quivered with a convulsive shudder, and her cheeks became ashy pale. I prayed inwardly that she might faint, so that the earlier stage of the operation might be got over while she was in a state of insensibiliy. It was not the case, however her eyes continued riveted on the beloved handwriting of her husband; and she moved not a limb, nor uttered more than an occasional sigh, during the whole of the protracted and painful operation. When the last bandage had been applied, she whispered almost inarticulately, 'Is it all over, doctor ? ' ' The patient was then lifted by the physician and the surgeon, and carried, sitting in the chair, up to her bed, whereupon she instantly swooned, "and continued so long insensible that Sir - held a looking glass over her mouth and nostrils, apprehensive that the vital energies had at last sunk under the terrible struggle. She recovered, however, and under the influence of an opiate draught, slept for several hours. The operation resulted in permanent cure and the account of this operation, of about just 100 years ago, and which, by way of contrast with what you young gentlemen are 10 accustomed to in the way of surgical facilities, must be interesting to you, ends with a statement which the patient made to Dr. Warren just before he discharged her from his care. As a faint crimson mantled her cheek, she expressed regret over the personal disfigure- ment she had suffered, but added falteringly after a pause, "I think Capt. S - (meaning her husband) will love me yet." This single illustration from the diary serves to show that there was carried about by this man something of light and cheer and help, because he recognized what the world needed more than anything else was human sympathy. Sympathy is needed on shipboard, where men are away from the restraints of home influence. You come into a profession of noble traditions. You come into a service where you are not compelled to wait for patients. Samuel Warren waited a fourth of his life for an opportunity to secure them. This month there will graduate in America hundreds of young men who will go into the practice of medicine, and the first thing they will ask them- selves when they get their diplomas is, " Where will I practice and where will I find patients?" and many of them, skilled and learned as they are, must perforce undergo a long waiting period before the opportunity to distinguish themselves will come. You are entering a department of service where there is no waiting period. Your diploma to-day gives you a title, an office, a clientele, patients selected out of the best in all America, for the Navy is the process of elimination as in no other service in the world. It is a selected serv- ice. Among every six men who apply to come into the enlisted ranks we accepted only one, the other five having failed. The Naval Academy would be fortunate if 70 per cent of the young men who got appointments were able to enter, and the process goes on year by year throughout the whole life of the men in the Navy. I heard a captain say not long ago that he was being "pawed over all his life, examined, tested, and thumped, to find out whether he was mentally, morally, and physically fit." It is for you to say, therefore, whether the Navy shall be fit and strong, because no man can enter unless you pronounce him qualified. It is your duty to stand at the door of the Navy and say only the fittest survive, and bring into the service young men of character and physical excellence, and when they come in it is your business to keep them well and strong. In the olden days of the practice of medicine, we employed a physician if we were sick to make us well; that was an ancient theory. In the Navy now we employ physicians to keep the Navy well. We are learning the importance and power of prevention. When you go on the ship, you will be the physician, the friend, the associate, of these selected men, and while the captain of that ship will say the last word, you will have the supreme influence in the 11 lives of the young men if, along with your skill, you have human sympathy and the touch of kindness for the homesick lad. You are coming into the Navy at the tune of its greatest expansion and on the threshold of an efficiency never before known. Sixty thousand men look to you to keep them ready, and you have learned enough to know that men can not be made ready instantly. Michael Dorizas, the Greek athlete and undefeated wrestler of the University of Pennsylvania, asked when he made his special preparation for his bouts, replied : " I never prepare ; I am always ready. " The man who has to get ready is the man who is never ready. Those were inspiring words of Admiral Badger when the Navy was ordered to Vera Cruz. Within 48 hours that majestic fleet, fully equipped, was on its way, with our present Surgeon General as fleet surgeon. He had no orders except to go to Vera Cruz. When asked what he was going to do, he said: "I do not know what we may be called upon to do, but we are ready." In most professions there is a glamor and a glory to men who win its highest rewards. You are coming into a profession in which you will not stand in the forum when you fight your great battles. Sen- ators and advocates and admirals and generals have an inspiration from the applause of the men about them. You will win your con- flicts in the still watches of the night, ministering to the humble sailor, whose mother, far off, loves him as your mother loves you; and you will come through conflicts and victories that will give you a sweetness and a strength that never came to those who had the ear of listening senates. I was glad to read some tune ago that the State of Georgia had determined to put in Statuary Hall, in the Nation's Capitol, where every State may place the figure of two of its greatest men, the statue of Dr. Long, the first surgeon to use an anesthetic. I hope we will see the day when other States will recognize that it is the physician as well as the general, that it is the surgeon in the sick bay as well as the admiral on the bridge, who deserves the highest recognition and rewards from a grateful Republic. But you will get these rewards only if you touch the hearts of your fellows. I am not going to speak to you about progress in your profession. Dr. Gatewood, who is the head of this institution, who inspired you in the days of your preparation here and whose ideals are that we shall take into the Navy no man who has not shown himself qualified in character and capacity, has done this. The average layman thinks medicine is a dry subject. President Wilson once told a doubting pupil at Princeton that there was no such thing as a dry subject; that the only thing that was dry was the mind it came in contact with, and if that mind perceived the significance of the subject, it yielded all the sap that was necessary for the most intense interest. You must bring that enthusiasm aboard ship. The chaplain here 12 and men of his calling who are devoting their lives to preaching the gospel can not do all that you can do because there is something about young men which yields to the advice of a physician when they close their hearts even to ministers. It is because they recog- nize your work is based not only upon spiritual welfare but physical. Three of the greatest contributions that have been made in recent years to the literature of your profession were made by naval officers. During the Russo-Japanese War your distinguished surgeon general, Dr. Braisted, was sent to study conditions in the Japanese fleet and Dr. Spear in that of the Russians. They wrote reports which you should read and which have helped doctors in all the countries en- gaged in the European struggles, and only this year Dr. Fauntleroy made a study of conditions in Europe that is illuminating and invaluable. I trust that as you enter upon your careers you will catch the spirit of Samuel Warren who wrote about his profession and made the world see its nobility and that you will write like Braisted, Spear, and Fauntleroy. I am glad to see Dr. Rixey here, under whose administration the Medical Corps of the Navy made giant strides. When the Saviour was upon the earth, men called Him by many titles King, Master, Teacher, Lord, and Brother but we love best of all to call Him the Great Physician; and I think it is His highest title and that which brings us nearer to Him. In His day people were healed by the touch of His hand and even by touching the hem of His garment. He has gone from the earth and we do not have His divine-human touch to-day, but there is something akin to it in the love of fellow man which you will exhibit and in your helpfulness of men to clean living and clean thinking. The faith they have in you will win half the battle, for they will have the faith that you can heal them by even the touch upon the friendly hem of your skill and experience. It is this ideal I would present to you young gentlemen who have come into this profession, and if you will live up to it, as I am sure you will, and follow in the steps of other strong men of the Navy who give their lives to healing, when you come to the time of retirement you may look bagk on your lives with satis- faction, and when you come to that final hour may say truly, as Jeanie Deans said: "When the hour of death comes, that comes to hi^h and low, then it isna vrhat we hae dune for oursells but what we o * hae dune for ithers that we think on maist pleasantly." ADDRESS OF STTSG. GEN. W. C. BBAISTED, UNITED STATES NAVY. Gentlemen, it is always with a feeling of the deepest obligation, and, if I may say it without misinterpretation, noblesse oblige, that I have risen to address this class and its predecessors on the occasion of the graduation from the Naval Medical School. I have been through what you are going through, I have trod the many steps that lie ahead of you, and if my experience in the service, my pleas- ures and my sorrows, my hopes and ambitions, my regrets and dis- appointments if these, I say, can in any way be offered to you as a guide and mentor in your coming life work, I want to offer them freely. We all know as we grow older that youth profits but little from the advice of age ; it is a sign of the latter when the realization is borne in upon us that millions and millions have passed along the same road over which we have been deviously toiling, and it is only given to the young to idealize the future. We all have at some time sought the rainbow and the pot of gold, as have those of countless ages before us. Despite the proverbial impossibility, let us hope that many have reached their rainbow, and in poverty or in wealth, in restless energy or placid seclusion, attained their share of happi- ness and contributed their mite to the fund of human good and advancement. You are this day, gentlemen, upon the threshold of a career in life. Your life work and your rewards are mapped out for you with a degree of accuracy and certainty that is generally impossible on graduation from the usual professional course. It is therefore easier to provide helping tenets or guide posts for that path that lies before you. First of all, I regard as essential your own appreciation of your future its permanency, its possibilities, what you owe to it, and what opportunities are afforded you to prove your right to exist therein and to discharge that obligation to the world at large that is the duty and inheritance of every living being. Crystallize fixed ideas of ambition; you will find that perseverance, pertinacity, appli- cation, pursuance of laudable ideals, will attain their object with a facility attributable both to the excellence of the individual and the aid afforded by conditions where all are more or less working for a common good. We are in a way a small community living within walled bounda- ries, an advanced fortress protecting the public weal. We have our (13) 14 own courts, our own system of supply and subsistence, our own rules and regulations, and of this community of some 68,000, you and I and our colleagues in the corps are the sole guardians of the public and individual health. You are one among 347. It should be your aim to make those other 346, and the rest of that 68,000, realize that you mean business. You already have a name in the corps. By your personality, by your activities, your fellow officers will soon be classing you as a drifter or as a worker. Service repu- tations once established are, justly or not, often the permanent indices of a man's ability or desirability. And you will find that a good name is easily acquired, a poor one difficult of erasure. Com- mand the respect of your fellow officer? and of your future patients. Establish the foundations of a good name early, and the later main- tenance of it is easy. Competition for preeminence offers far greater rewards for success than the same energy expended in private prac- tice, where you are one struggling among 150,000 others. Merit is more easily recognized, and recognition of this by your fellow officers gives in the end reward ample in itself, in the lasting consciousness of their admiration, respect, and esteem. Material rewards to excel- lence and mediocrity may seem at times to be the same, but this is not so, as shown in the passage of years hi the value of the posi- tions assigned, and the opportunities afforded the worker for ex- ploitation of his talents. Be altruistic with your time and labors. Subserve self to loyalty to service and to country. The common good is your aim. Your increased efforts are not rewarded finan- cially more than those of your slothful shipmate. You are not battling for pelf let us hope the ethics and higher ideals of the medical profession make this a rarity your living is not haunted by the specter of the wolf that may be behind the door hi days of sickness and reverse. Therefore, all the more is your time available for thoughts and actions for the bettering of the conditions of the personnel under your charge, or for scientific research or study. And in the formative state you are now in, your earliest steps should take you into the path that tends ever upward in ideals and profi- ciency. Realize constantly that it is to-day that counts. Idleness and lethargy, industry and initiative, the spirit of "just enough," the spirit of "never enough" choose between them. The process of selection and elimination has long ago started with each one of you, and you represent the survival of the fittest. Of those that matriculated with you at your university or medical school, many have fallen by the wayside. Your emergence from that ordeal alone, with the coveted diploma, is in itself a creditable achievement. In preparation for the formation of this class, 57 appli- cants received permission to appear for examination. You eleven represent a 20 per cent survival of that 57. You have found during 15 your six months here that selection is still potent, and the price of application, of early training or aptitude, of hereditary or acquired ability, is paid more promptly than you will often find, in the deter- mination of your service rank by your school standing. For you, gentlemen, the future holds all variety in service duties and opportunities. You will see the four corners of the earth; you will be operating surgeons, executives, and commanding officers of magnificent hospitals and hospital ships ; you will be the only attend- ant by some poor aborigine in childbed I do not dare to say of any question that may by the wildest flight of imagination impinge upon the boundaries of your profession, that you may not be called upon some day momentously to decide it. You must be adept in all things, alert in all ways in the practice of your profession, in adding to your knowledge of it, and in keeping pace with current advance therein. The independence of isolated stations makes it necessary that the naval medical officer be a specialist in all things relating to medicine in the widest application of the word. To the average young man surgery seems to offer the most attractive field in planning his life work. It is in many ways the most spectacular and to the imagination the most romantic. You will find that the gratification of this ambition will occur in your naval duties with a much greater certainty than in private practice, where it is achieved only after years of struggle for the opportunity to demonstrate your ability, or by the most exceptional occurrence of an early assignment as member of some hospital visiting staff. Your entrance examinations into this service and our knowledge of you since have demonstrated to us that you are each of you qualified to shoulder such responsibilities to the credit of yourselves and the corps. In the capacity of junior you will find that your seniors will be most liberal in affording you material and opportunities. The specialty of surgery is, however, the most crowded for those very reasons, and there are many other valuable directions that may better call for specialized exercise of your activities. For although I am insisting always that you can not remain a specialist within the usually accepted meaning of that term, that is, to the extent of losing intimate touch with other branches of your profession to the benefit of your particular work, this by no means precludes the fol- lowing of a particular line of endeavor, provided your state of general preparedness does not suffer thereby. The Navy constantly has need of specialized activities, and the man with special knowledge, the man who has by inheritance or by application something that his neigh- bors have not, will inevitably be turned to in time of need. Pre- paredness or unpreparedness, familiar terms to-day, mean as much to you and your future as they do to the life of our Nation. For the distinction of special effort or special place your preparedness must 16 make itself known; do not hide your light under a bushel. Let us all know to whom we can turn for an investigation on this subject, a report on that, who is a particularly good laboratory man, clinician, hygienist, alienist, aurist, oculist, roentgenologist, etc. The current number of our Naval Medical Bulletin, April, 1916, affords an interesting elucidation of this theme. Seven of the nine special articles, all emanating from the pens of members of your own corps, relate to subjects and activities concerning which your training up to the present time has told you little or nothing. "The occupational distribution of physical disability" represents the viewpoint of and lessons learned by the industrial student and economist; "The exclusion of the mentally unfit from the military services," points out your duties from the alienist's standpoint in conserving the health and morale of our personnel; "A greater field of activity for medical officers of navy yards" is a resumS of unusual ideals and activities not only projected but achieved; "The hospital steward" and "The new hospital corps forms" pertain to your share in supervision of the Hospital Corps; "Studies pertaining to light on shipboard" is a representation of the most advanced work and thought on illumination under working conditions aboard our modern battleships; and "Fumigation of the U. S. S. Tennessee by the cyanid method" tells its own story. It is as a result of their own industry, application, research, that these officers can contribute to the general good these data on economics, recruiting, navy-yard duty, executive details, lighting problems, etc., and by their efforts have accentuated their own value to the corps and the corps value to the service at large. I have but touched on the possibilities. Our special hospital for the tubercular; the tropical medicine opened up by our Philippine possessions; the many naval hygienic problems as regards food, light, air, clothing, water supply, submarine life, diving, quarantine, etc.; specialized work at the Naval Academy hi athletics; our pa- ternalism at Guam and Samoa, with responsibilities innumerable these all represent activities and possibilities that depend but upon your own initiative to achieve distinction and place in universal admiration and regard. In so far as is consonant with routine service needs and possibili- ties I am always glad and willing to assist in the gratification of such ideals. You will always find that the bureau has only the public good in mind and that the only favorite that is played is ability. An equalization of duties, undue favors to none, broadening oppor- tunities to all, these are, of course, what we constantly strive for as helping the individual in preparation for the many-sided service life and as supplying to the needs of that service prepared and resource- ful officers. 17 And now what is your personal standard of life and morals in the new relations into which you are now entering? There is an old conjunction of the words "an officer and a gentleman," which, I hope, will always be to you more than a mere cant phrase, or care- lessly accepted fact. To be a gentleman, kind, manly, courteous, upright, is what we all owe to our position in this great crowded com- munity, the world, where we are constantly elbowing our way up or down the surging path of life. And in this new life and among these new surroundings and responsibilities, where your life and actions are more arbitrarily fixed than in that larger community, still more so will you find it necessary to observe these tenets. Make your lives sober and dignified. Make it a subconscious spur with you constantly that you acquire and keep the respect of your fellow offi- cers and of the enlisted men. It is well to be liked by your ship- mates, but to be respected personally and professionally is what is more difficult of achievement, but more lasting in effects. The "hail-fellow-well-met," the ever-welcome "rounder," the "good fellow," is generally likeable or even lovable, and his name or his stories or his exploits may be hailed with glee and his assignment to a mess welcomed with joy, but in time of illness or of stress it is probable that this type will not be as freely granted the confi- dence that the more serious-minded student would receive. Your lives will have little hidden from the close association of wardroom contact, and at one time or another you will be called upon to attend these intimates in times to them of greatest stress or danger, either to themselves, or their wives, their mothers, or their chidren, and in the trust and faith these show in your personal and professional integrity will be your greatest reward. It may not be amiss at this point, the closing of the year's work in the Medical Department, to review for your information the progress we have made in the past two years hi our work. Last year and the year before, in retrospect, I paid due tribute to the efforts of Surg. Gen. Kixey and others in the work or reorganization and rehabilita- tion of the Medical Department of the Navy, stating that no one man ever had accomplished more or probably would accomplish more hi this respect than Admiral Rixey. During the past two years, the present Secretary of the Navy, in many instances on his own sugges- tion and hi others by his support of the Bureau of Medicine and Sur- gery, has advanced our service in the following items: 1. He has recommended to Congress the increase of the Medical Corps from 347 to nearly 500, the first increase in 20 years, and most urgently needed. 2. He has provided in his personnel bill a substantial increase in the upper grades of the Medical Corps. No increase in these grades 18 has been made since 1870, notwithstanding the tremendous growth of the service as a whole. 3. He has established two of the finest Hospital Corps Training Schools in the world for the training of male nurses, and made pro- vision for the increase in this corps by nearly 1,000 men, an increase urgently demanded by the increase hi the Navy, and has also pro- vided a possible chance for members of this corps to reach commis- sioned rank, thereby raising the efficiency and esprit of nearly 2,000 enlisted men in the Hospital Corps of the Navy. 4. He has made provision for a new hospital ship for the Navy, which will enable us to build the first ship of this kind, designed especially for this purpose, and which will be a model for our country and the world. This one effort will, if granted by Congress, be of inestimable value to the Navy and to all other countries. It will provide our fleet and our service with a floating hospital for the care of the sick and injured of the Navy that will rival any metropolitan hospital in existence. 5. He has established schools for the training of the native women of Samoa and Guam in nursing, that already are giving most excellent results and are a most important humanitarian educational effort for these helpless people, promising, when completed, to be one of the noblest efforts made for the uplifting of any similar class of people. 6. He has increased our appropriations to meet our necessities and to enable us to carry on our great work that extends not alone to the Navy proper, but to thousands of human beings attached to the ser- vice in various ways and extending to all parts of the world. 7. He has permitted us to take an active part in the regeneration of Haiti by furnishing medical officers and nurses to care for the sani- tary needs of the great work that is now in progress in Haiti and which ranks with one of our greatest humanitarian efforts. 8. He has supplied already, and gradually will furnish our defici- encies in the many large hospital and medical organizations on shore, such as contagious units at Mare Island, Puget Sound, New York, and Newport, and has furnished adequate and commodious homes for our nurses at Mare Island and Boston, thus adding to the content and efficiency of the women nurses. South of Norfolk and San Fran- cisco our coast line is practically unprovided with hospitals for peace and war, but with a policy defining permanent naval stations his attention has already been turned to the needs of the medical department. That we may not be unprovided in this respect hi emer- gency; he has authorized our efforts with the Red Cross and we are now beginning the organization of five Red Cross hospital units (mobile hospitals of 250 beds each, with personnel and equipment complete) that can be called at notice to any point of this coast line where needed. 19 9. He has authorized a Medical Reserve Corps of the best medical talent that our country can furnish, to be ready to come to our assistance in tune of need, and to prepare this group of the Medical Corps he is initiating a correspondence school that shall give these officers a training and working knowledge of their work when called upon. Realizing the great lesson to be learned from the present European war, he has detailed a number of our best officers for duty in Europe as observers, and the excellent results already show in the report of Surg. Fauntleroy, whose work has added greatly to the professional knowledge of all who are interested in medico- military matters and is a credit to our service. 10. The above are only a few examples showing the interest and activity of our secretary in this branch of the service. Did tune per- mit I should like to continue in detail to show you his interest and help as shown in innumerable questions of sanitation and organiza- tion which makes the work of the Medical Department of the Navy one of the most important branches of the service. Our work is most highly specialized, dealing as it does with so many questions, not alone with the healing of disease but with all that pertains to the orderly and successful running of this great department of the Government. The work of the Bureau of Medicine and Surgery touches ultimately that of every other bureau in the department and makes us one of the busiest and most active corps. I have frequently asked myself how is it that the head of the Navy is so sanely interested in our work, and seems to comprehend our needs often before they are presented to him, and I think the solution lies in the fact of his education along medical lines. This comes, I feel sure, from the association with medical men of great worth and ability. Where has he had this association that has taught him the importance of medical work in the welfare of the nation '? From all I can learn, it has come from the intimate friendship and association of his family medical advisers, one of whom has honored us by his presence here to-day, and to them I feel we owe and the nation owes a deep debt of gratitude for the impress they have made on this one man. How nobly and how splendidly have these medical men of Raleigh stood sponsor for their profession. They have built better than they knew and in this light I want to thank Dr. Royster and his associates in Raleigh for the great benefits that have come in this way to the Navy through them. Theirs is the credit, and I trust our grateful appreciation is their reward. In conclusion, gentlemen of the graduating class, I wish you every success in your new life and trust, as the years go by, we shall have only congratulations to give you for work well done. ADDBESS OF HTTBEBT A. BOYSTEB, M. D., Raleigh, N. C. "THE HUMANITY OF STJBGEBY." At the first blush it would seem to be asking too much of a civil surgeon to instruct, advise, or entertain the naval surgeon. Their purposes, environment, and training lie in very different directions. Yet they have, of course, a common interest. That interest is the service of humanity. Upon that basis we can unite hi an attempt to redress certain popular misconceptions of surgery, in a consideration of some of those vital things which control us all hi the practice of our art, and in an application of these, if possible, to the particular affairs which constitute your own sphere of work. In the early days surgeons were looked upon as mere mechanics. In fact the derivation of the term surgery, or chirurgery, from two Greek words, meaning "handwork," signifies its original application. The surgeon was the barber and was regarded as of a lower order than the physician, under whose guidance he acted. We have not yet entirely outlived this impression, for even at the present day it is held by some that it requires a higher degree of intellectual capacity and a sounder judgment to be an eminent medical consultant than it does to be a great surgeon. Moreover, the surgeon has been called a "butcher"; it is said that he "loves to cut"; he is commonly spoken of as one who "thinks no more of operating on human flesh than of sawing on so much wood." Perhaps these criticisms are natural. But let us ask ourselves if they are just. Have we endeavored to counteract such impressions, or have we deserved the criticism ? Who does not now know that the surgeon, besides bearing all the burdens connected with operative technic, shares equally with the physician the responsibilities of diagnosis and af tertreatment ? The modern surgeon who is not skilled in clinical diagnosis fails to measure up to the standard set by his advancing science. Further, the surgeon who is lacking in general knowledge of disease and in the use of remedies will never ripen into true greatness. This has been well expressed by Ashhurst in these words: "The importance and even necessity of a thorough knowledge of practical anatomy can, indeed, scarcely be overrated; yet it is more essential for the surgeon to be well versed in pathology and therapeutics (or hi other words, to be an accomplished physician) than it is for him to know the attachments of every muscle in the body, or all the possible variations of arterial distribution." (20) 21 Let no one suppose this is a plea for loose methods at the expense of scientific surgery. It simply means the blending of mind and hand, the joint partnership of judgment and action, with proper faith in each. We can not leave out the human equation if we are to round out a life of usefulness. We must be men before we are surgeons. Character must be the foundation for skill; for what you are will show in what you do. Is it true that in our rush of work we are losing somewhat the human touch, the personal interest? No matter how we shall answer this question, we can truthfully confess, believe me, that the eminent surgeons of the generation just pre- ceding us were men of great individual power, and that they deserved more credit for the results they achieved than we do for the success we have attained. They helped us to grow out of the mechanic into the modern operator, to advance from the bonesetter to the diagnostician. And they have left us much to emulate. " We think our fathers fools, so wise we grow; Our wiser sons, perhaps, will think us so." One of the common misconceptions in regard to surgery is that the knife is considered its symbol. That most dreaded of all instru- ments is chosen to typify the whole surgical art, and such expressions as "going under the knife," "nothing but the knife will do," or the "horror of the knife," are frequently heard both from the laity and from medical men. The truth is that the knife, while of course one of the most important instruments, is really used less than are many other instruments. A being of stern visage brandishing the scalpel would not be a true picture of the surgeon; rather should he be represented as one of calm countenance with a handful of hemostats or a needle and thread instruments far less gruesome, but more widely employed and requiring greater ingenuity in then- use. Besides, there are many operations done wholly without the knife. The singling out of this alarming implement as the popular embodiment of surgery is but a sign of the fascination for most minds of the terrifying and the dramatic. It smacks of the old days of the barber surgeon. The most satisfying thought to one in the practice of surgery is the consciousness of having directly rescued or prolonged the lives of one's fellow creatures. In no branch of the profession is the relation of cause and effect so manifest or the personal responsi- bility so obvious as in surgery. A patient under medical treatment may be managed with consummate skill, may be carried over diffi- culties and snatched from dangers, and yet so many factors enter in as to preclude us from saying that any one dose turned the tide or any one act alone produced the result. Not so with the surgical case. In every operation a life is immediately at stake and the operator himself is the accountable agent. The very risk is alluring 22 and, therefore, the gratification the greater. To remove a tumor, which is slowly but surely killing the sufferer; to evacuate a pus collection, breeding poison and death; to correct a deformity and see the joy over the outcome; to ligate a bleeding vessel and thus actually keep life's blood in the body no human feeling compares with these sources of profound mental satisfaction, which are the surgeon's daily heritage. Those who practice surgery are either ennobled or degraded by it. Their characters are developed and sweetened or else made coarse. There is no halfway ground. Looked upon as so much slashing, surgical operations do but brutalize those that perform them; viewed hi the light of God-given occasions for exercising skill and healing humanity, they are the means of uplifting and purifying. The heroism often exhibited by patients can not but have its effect upon the surgeon's character. Who can behold uninfluenced a calm mental and moral attitude toward physical suffering? Who of us has not seen the sufferer himself do his part as well as we did ours and at times surpass us in courage? To have ministered to even one of these is worth a lifetime of worry. In the case of a well-poised surgeon this reflection upon the hu- manity of his patient will detract in no wise from his own boldness or self control. It should rather give him more sensible conscious- ness of the right and a larger conception of his duty to do it. After all, "nerve" may be defined as knowing what you are doing. An operator who possesses that confidence born of upright judgment and intimate knowledge feels at home under all conditions in which he places himself. Mere assumption of bravery is a counterfeit; recklessness is not "nerve." The renowned Valentine Mott in his later days stepped into the amphitheater where one of his younger colleagues was doing a herniotomy and saw the operator at one stroke cut through the tissues down upon the sac. With a shudder the old surgeon exclaimed, "Lord, save the man!" and walked away from the table. Glancing back again after a few minutes, he remarked, "He did." Surgeons everywhere have been called upon to perform services of the most heroic kind; and, be it said to their credit, they have been found for the most part sufficient for their tasks. Even in civil life examples are not lacking. My own state presents an instance of the highest type in the person of Edmund Stmdwick, who by one deed would have the title of hero. Not in all the annals of history have I read of nor is it in my mind to conceive of firmer devotion to duty or of more daring fortitude than he exhibited. When near sixty years of age he was called to a distant county to perform an opera- tion. Leaving on a 9 o'clock evening train, he arrived at his station about midnight and was met by the physician who summoned him. 23 Together they got into a carriage and set out for the patient's home six miles in the country. The night was dark and cold; the road, was rough; the horse became frightened at some object, ran wild, upset the carriage and threw the occupants out, stunning the country doctor (who it was afterward learned was addicted to the opium habit) and breaking Dr. Strudwick's leg just above the ankle. As soon as he had sufficiently recovered, Dr. Strudwick called aloud, but no one answered; and he then crawled to the side of the road and sat with his back against a tree. In the meantime the other physician, who had somehow managed to get into the carriage again, drove to the patient's house, where for a time he could give no account of himself or of his companion; but, coming out of his stupor, he faintly remembered the occurrence and at once dis- patched a messenger to the scene of the accident. Dr. Strudwick was still leaning against the tree, calling now and then in the hope of making some one hear, when the carriage came up about sunrise. He got in, drove to the house, without allowing his own leg to be dressed, and, sitting on the bed, operated upon the patient for strangulated hernia with a successful result. "Greater love hath no man than this." The records of military surgery are so full of valorous deeds and gallant sacrifices that it would be superfluous to point them out. They are the rule rather than the exception. Your training here, I am sure, has brought you to value the opportunities which may come to you for proving your courage as well as your skill and your humanity. Honored names are those which stand out on the list of American naval surgeons, honored for their worth, their work, and their wisdom. Examples are not wanting over the whole world to demonstrate the important parts played by surgeons of various navies in the history of their profession and of their country. I can not refrain from mentioning Richard Wiseman, who exercised so wide an influence over British military surgery in the seven- teenth century. We are told 1 that, having finished his apprentice- ship at the Barber Surgeons' Hall, he entered the Dutch naval service, in which he soon saw active duty, for Holland was then at war with Spain. His extensive experience prompted him to teach that bullets should be extracted at once and that primary amputa- tion was the best course to pursue in many cases, but by no means in all. This is the good doctrine that he preached: "Consider well the member and, if you have no probable hope of sanation, cut it off quickly while the soldier is heated and in mettle. But if there be hopes of cure, proceed rationally to a right and methodical healing of such wounds; it being more to your credit to save one member than to cut off many." And again, "Amongst the cruisers in private 1 British Journal of Surgery, January, 1916. 24 frigates from Dunkirk it was complained that their chirurgeons were too active in amputating those fractured members. As in truth there are such silly brothers, who will brag of the many they have dismembered, and think that way to lie themselves into credit. But they that truly understand amputation and their trade well know how villainous a thing it is to glory in such work." What an admirable tribute to the humanity of surgery! How nearly he expresses what we feel to-day; that it is more blessed to save than to destroy! From his own words we know that Wiseman did not lay claim to great physical bravery, for he confesses that on one occasion a "sudden cry that our ship was on fire put me in such dis- order that I rather thought of saving myself than dressing my patients." And later, while serving with the English army, he spoke of making excuses to a wounded man so successfully that he "was at liberty to fly from the enemy who was entered into the town." We may not judge him too harshly until we disprove the relation of discretion and valor or the connection between running away and another day. On the deck and in the field, as in the operating room, it sometimes required more courage to get out than it does to stay in. No more appealing reflection can come to you than that of the university of science. She speaks in every language, she dwells in every land, she waits on every age. It has been written: "All that is best in the great poets of all countries is not what is national in them but what is universal." May we not make equal claim for our own science and say the same for the great surgeons of the world ? In the work which you have chosen you can not, you will not, know friend or foe; with disease, destruction, and death all around you, your concern will be for help and hope to all those under your care. Patriots? Yes; but, above all, seekers for truth and servants of humanity. Even from its most unsatisfactory side, surgery must be looked upon as a humane art, for its aid is usually invoked as a last resort. When all other means have failed, it has been customary to advise surgical interference, and relief must come, if it does come, under most adverse and unpromising conditions. How much better if surgery were made an early resort, if not a first resort, in cases where it is surely demanded. Too late! the saddest expression in our language. In surgery these words mean hopelessness and de- spair. Operations done too soon are curiosities ; so rare in fact as to be inconsiderable. Operations done too late are the popular reproach of our art. All the merciful instincts of our nature demand that a disease inevitably dependent upon surgical treatment be submitted to such procedure at a time when the outlook will admit of a success- ful issue and not temporized with until the last chance is passing away. The disease must not be allowed to kill the patient before 25 the operation can save him. Keep it ever in mind that surgical mortality is due chiefly to havoc wrought by the pathological changes already present and only in comparatively rare instances to the opera- tion itself. It is humane surgery, therefore, to act when a life can be preserved and not to delay until it is placed in jeopardy. There is such a thing as preventive surgery the high-water mark of all our future efforts. Let us feel, then, that in the practice of surgery there are situa- tions calling for the exercise of a larger and deeper portion of humanity than the surface markings seem to indicate. The keynote of sur- gery is hopefulness, or, as expressed by another, " magnificent optimism," and its devotees constantly exhale this spirit. It is unjust to think of the surgeon as one who " loves to cut" at all hazards and who cares not for consequences. The very essence of our calling impels us to strive for permanence and perfection. Humanity teaches us that it is an exalted privilege to relieve suf- fering; it also bids us know that it is much nobler and more com- passionate to cure the complaint. Surgery's mission is to heal, to restore, to remove forever the offending lesion. It is with this spirit that I beg you to become imbued as you depart on your missions of service. Whether you go to the east or to the west, whether you be on land or on sea, whether your lot be cast in war or in peace, I welcome you into the splendid company of those whose days are spent in "Battling with custom, prejudice, disease, "As once the son of Zeus with Death and Hell." 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