produced many self-reliant, resourceful men. Then with the multiplication of the medical schools and increasing rivalry between them came the two-year course, which for half a century lay like a blight on the medical profession, retarding its progress, filling its ranks with half-educated men, and pandering directly to all sorts of quackery, humbuggery, and fraud among the public. The awakening came about 30 years ago, and now there is scarcely a school in the country which has not a four-year course, and all are trying to get clear of the old shackles and to teach rational medicine in a rational way..

But there are extraordinary difficulties in teaching the medical student his art. It is not hard, for example, to teach him all about the disease pneumonia, how it prevails in the winter and spring, how fatal it always has been, how frightened of it New York and Chicago have become, all about the germ, all about the change which the disease causes in the lungs and in the heart - he may become learned, deeply learned, on the subject of pneumonia; but put him beside a case, and he may not know which lung is involved, as he does not know how to find out, and, if he did find out, he might be in doubt whether to put an ice-bag or a poultice on the affected side, whether to bleed or to give opium, whether to give a dose of medicine every hour or none at all, and he may not have the faintest notion whether the signs look serious or favorable.

So also with other aspects of the art of the general practitioner. A student may know all about the bones of the wrist in fact, he may carry a set in his pocket – and know every facet and knob and nodule on them, he may have dissected a score of arms, and yet when he is called to see Mrs. Jones, who has fallen on the ice and broken her wrist, he may not know a Colles' from a Pott's fracture, and as for setting it secundum artem, he may not have the faintest notion, never having seen a case. Or he may be called to preside at one of those awful domestic tragedies - the sudden emergency, some terrible accident of birth or of childhood that require skill, technical skill, courage, the courage of full knowledge, and if he has not been in the obstetrical wards, if he has not been trained practically, if he has

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not had the opportunities that are the rights of every medical student, he may fail at the critical moment, a life, two lives, may be lost, sacrificed to ignorance, often to helpless, involuntary ignorance.

By far the greatest work of the Johns Hopkins Hospital has been the demonstration to the profession of the United States and to the public of this country of how medical students should be instructed in their art. I place it first because it was the mostneeded lesson; I place it first because it has done the most good as a stimulating example, and I place it first because never before in the history of this country have medical students lived and worked in a hospital as part of its machinery, as an essential part of the work of the wards.

In saying this, heaven forbid that I should obliquely disparage the good and faithful work of my colleagues elsewhere. But the amphitheater clinic, the ward and dispensary classes, are but bastard substitutes for a system which makes the medical student himself help in the work of the hospital as part of its human machinery. He does not see the pneumonia case in the amphitheater from the benches, but he follows it day by day, hour by hour, and he has his time so arranged that he can follow it; he sees and studies similar cases, and the disease itself becomes his chief teacher, and he learns its phases and variations as depicted in the living, and he knows under skilled direction when to act and when to refrain from action, he learns insensibly principles of practice, and he possibly escapes a nickle-in-theslot attitude of mind, which has been the curse of the profession in the treatment of disease.

And the same with the other branches of the art; he gets a first-hand knowledge which, if he has any sense, may make him wise unto the salvation of his fellows. And all this has come about through the wise provision that the hospital was to be part of the medical school, and it has become for the senior students, as it should be, their college. Moreover, they are not in it on sufferance and admitted through side doors, but they are welcomed as important aids without which the work could not be done efficiently.

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The whole question of the practical education of the medical student is one in which the public is vitally interested. Sane, intelligent physicians and surgeons with culture, science, and art are worth much in a community, and they are worth paying for in rich endowments of our medical schools and hospitals. Personally, there is nothing in my life in which I take greater pride than in my connection with the organization of the medical clinic of the Johns Hopkins Hospital and with the introduction of the old-fashioned methods of practical instruction. I desire no other epitaph no hurry about it, I may say than the statement that I taught medical students in the wards, as I regard this as by far the most useful and important work I have been called on to do.

The second great problem is a much more difficult one, surrounded as it is with obstacles inextricably connected with the growth and expansion of a comparatively new country. For years the United States had been the largest borrower in the scientific market of the world, and more particularly in the science relating to medicine. To get the best that the world offered, our young men had to go abroad; only here and there was a laboratory of physiology or pathology, and then equipped, as a rule, for teaching. The change in 20 years has been remarkable. There is scarcely to-day a department of scientific medicine which is not represented in our larger cities by men who are working as investigators, and American scientific medicine is taking its rightful place in the world's work.

Nothing shows this more plainly than the establishment within a few years of journals devoted to scientific subjects; and the active participation of this school as a leader is well illustrated by the important publications which have been started by its members. The hospital trustees early appreciated the value of these scientific publications, and the bulletin and the reports have done much to spread the reputation of the hospital as a medical center throughout the world.

But let us understand clearly that only a beginning has been made. For one worker in pathology - a man, I mean, who is devoting his life to the study of the causes of disease there are

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The method of treatment introduced by Dr. Pettey removes these addictions from the list of almost incurable diseases, and renders them the most certainly and readily curable of all the chronic ailments.

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