Unity, Peace, and Concord - by William Osler

"In necessariis unitas, in non-necessariis libertas, in omnibus caritas"

"Life is too short to waste.
In critic peep or cynic bark.
Quarrel or reprimand:
'Twill soon be dark; .
Up! Mind thine own aim, and
God speed the mark!"

EMERSON.


XXI
UNITY, PEACE, AND CONCORD

^ A farewell address to the Medical Profession of the United States, delivered before the Medical and Chirurgical Faculty of the State of Maryland.

ON this occasion I have had no difficulty in selecting a subject on which to address you. Surely the hour is not for the head but for the heart, out of the abundance of which I may be able to express, however feebly, my gratitude for the many kindnesses I have received from the profession of this country during the past twenty-one years, and from you, my dear colleagues of this state and city, during the sixteen years I have dwelt among you. Truly I can say that I have lived my life in our beloved profession — perhaps too much !but whatever success I have had has come directly through it, and my devotion is only natural.  Few men have had more from their colleagues than has fallen to my lot. As an untried young man my appointment at McGill College came directly through friends in the faculty who had confidence in me as a student. In the ten happy years I lived in Montreal I saw little of any save physicians and students, among whom I was satisfied to work — and to play. In Philadelphia the hospitals and the societies absorbed the greater part of my time, and I lived the peaceful life of a student with students. An ever-widening circle of friends in the profession brought me into closer contact with the public, but I have never departed from my ambition to be first of all a servant of my brethren, willing and anxious to do anything in my power to help them. Of my life here you all know. I have studied to be quiet and to do my own business and to walk honestly toward them that are without; and one of my chief pleasures has been to work among yon as a friend, sharing actively in your manifold labours. But when to the sessions of sweet, silent thought I summon up the past, not what I have done but the many things I have left undone, the opportunities I have neglected, the battles I have shirked, the precious hours I have wasted — these rise up in judgment.

A notable period it has been in our history through which we have lived, a period of reconstruction and renovation, a true renaissance, not only an extraordinary revival of learning, but a complete transformation in our educational methods ; and I take pride in the thought that, in Philadelphia and in Baltimore, I have had the good fortune to be closely associated with men who have been zealous in the promotion of great reforms, the full value of which we are too close to the events to appreciate. On the far-reaching influence of these changes time will not permit us to dwell. I propose to consider another aspect of our work of equal importance, neither scientific nor educational, but what may be called humanistic, as it deals with our mutual relations and with the public.

Nothing in life is more glaring than the contrast between possibilities and actualities, between the ideal and the real. By the ordinary mortal, idealists are regarded as vague dreamers, striving after the impossible ; but in the history of the world how often have they gradually moulded to their will conditions the most adverse and hopeless! They alone furnish the Geist that finally animates the entire body and makes possible reforms and even resolutions. Imponderable, impalpable, more often part of the moral than of the intellectual equipment, are the subtle qualities so hard to define, yet so potent in everyday life, by which these fervent souls keep alive in us the reality of the ideal Even in a lost cause, with aspirations utterly futile, they refuse to acknowledge defeat, and, still nursing an unconquerable hope, send up the prayer of faith in face of a scoffing world. Most characteristic of aspirations of this class is the petition of the Litany in which we pray that to the nations may be given * unity, peace, and con- cord.' Century after century from the altars of Christendom this most beautiful of all prayers has risen from lips of men and women, from the loyal souls who have refused to recognize its hopelessness, with the war-drums ever sounding in their ears. The desire for unity, the wish for peace, the longing for concord, deeply implanted in the human heart, have stirred the most powerful emotions of the race, and have been responsible for some of its noblest actions. It is but a sentiment, you may say : but is not the world ruled by feeling and by passion ? What but a strong sentiment baptised this nation in blood ; and what but sentiment, the deep-rooted affection for country which is so firmly implanted in the hearts of all Americans, gives to these states to-day unity, peace, and concord f As with the nations at large, so with the nation in particular as with people, so with individuals ; and as with our profession, so with its members, this fine old prayer for unity, peace, and concord, if in our hearts as well as on our lips, may help us to realize its aspirations. What some of its lessons may be to us will be the subject of my address.

UNITY

Medicine is the only world-wide profession, following everywhere the same methods, actuated by the same ambitions, and pursuing the same ends. This homogeneity, its most characteristic feature, is not shared by the law, and not by the Church, certainly not in the same degree.  While in antiquity the law rivals medicine, there is not in it that extraordinary solidarity which makes the physician at home in any country, in any place where two or three sons of men are gathered together. Similar in its high aims and in the devotion of its officers, the Christian Church, widespread as it is, tad saturated with the humanitarian instincts of its Founder, yet lacks that catholicity — urbi et orbi — which enables the physician to practise the same art amid the same surroundings in every country of the earth. There is a unity, too, in its aims — the prevention of diseases by discovering their causes, and the cure and relief of sickness and suffering. In a little more than a century a united profession, working in many lands, has done more for the race than has ever before been accomplished by any other body of men. So great have been these gifts that we have almost lost our appreciation of them. Vaccination, sanitation, anaesthesia, antiseptic surgery, the new science of bacteriology, and the new art in therapeutics have effected a revolution in our civilization to which can be compared only the extraordinary progress in the mechanical arts. Over the latter there is this supreme advantage, it is domestic — a bedroom revolution which sooner or later touches each one of us, if not in person, in those near and dear — a revolution which for the first time in the history of poor, suffering humanity brings us appreciably closer to that promised day when the former things should pass away, when there should be no more unnecessary death, when sorrow and crying should be no more, and there should not be any more pain.

One often hears as a reproach that more has been done in the prevention than in the cure of disease. It is true ; but this second part of our labours has also made enormous progress. We recognize to-day the limitations of the art; we know better the diseases curable by medicine, and those which yield to exercise and fresh air ; we have learned to realize the intricacy of the processes of disease, and have refused to deceive ourselves with half -knowledge, preferring to wait for the day instead of groping blindly in the dark or losing our way in the twilight. The list of diseases which we can positively cure is an ever increasing one, the number of diseases the course of which we can modify favourably is a growing one, the number of incurable diseases (which is large and which will probably always be large) is diminishing — so that in this second point we may feel that not only is the work already done of the greatest importance, but that we are on the right path, and year by year as we know disease better we shall be able to treat it more successfully. The united efforts of countless workers in many lands have won these greatest victories of science. Only by ceaseless co-operation and the intelligent appreciation by all of the results obtained in each department has the present remarkable position been reached. Within a week or ten days a great discovery in any part of the world is known everywhere, and, while in a certain sense we speak of German, French, English, and American medicine, the differences are trifling in comparison with the general similarity. The special workers know each other and are familiar with each other's studies in a way that is truly remark- able. And the knowledge gained by the one, or the special technic he may devise, or the instrument he may invent is at the immediate disposal of all. A new lifesaving operation of the first class devised by a surgeon in Breslau would be performed here the following week. A discovery in practical medicine is common property with the next issue of the weekly journals.

A powerful stimulus in promoting this wide organic unity is our great international gatherings — not so much the International Congress of the profession, which has proved rather an unwieldy body, but of the special societies which are rapidly denationalizing science. In nearly every civilized country medical men have united in great associations which look after their interests and promote scientific work. It should be a source of special pride to American physicians to feel that the national association of this country — the American Medical Association — has become one of the largest and most influential bodies of the kind in the world. We cannot be too grateful to men who have controlled its course during the past ten years.  The reorganization so efficiently carried out has necessitated a readjustment of the machinery of the state societies^ and it is satisfactory to know that this meeting of our state society, the first held under the new conditions, has proved so satisfactory. But in the whole scheme of readjustment nothing commands our sympathy and co-operation more than the making of the county societies the materials out of which the state and national associations ore built.  It is not easy at first to work out such a scheme in full detail, and I would ask of the members of this body not only their co-operation, but an expectant consideration, if the planet first does not work as smoothly as could be desired. On the county members I would urge the support of a plan conceived on broad national lines — on you its success depends, and to you its benefits will chiefly come.

Linked together by the strong bonds of community of interests, the profession of medicine forms a remarkable world-unit in the progressive evolution of which there is a fuller hope for humanity than in any other direction.

Concentration, fusion, and consolidation are welding together various subunits in each nation. Much has been done, much remains to do ; and to three desiderata I may refer briefly.

In this country reciprocity between the state licensing boards remains one of the most urgent local needs. Given similar requirements, and examinations practically of the same character, with evidence of good character, the state board should be given power to register a man on payment of the usual fee. It is preposterous to restrict in his own country, as is now done, a physician's liberty. Take a case in point: A few months ago a man who is registered in three states, an able, capable practitioner of twenty years' standing, a hard student in his profession, a physician who has had charge of some of the most important lives of this country, had to undergo another examination for licence.  What an anomaly ! What a reflection on a united profession ! I would urge you all most strongly to support the movement now in progress to place reciprocity cm a proper basis. International reciprocity is another question of equal importance, but surrounded with greater difficulties ; and, though a long way off, it will come within this century.

The second urgent need is a consolidation of many of our medical schools. Within the past twenty-five years conditions have so changed that the tax on the men in charge of the unendowed schools has become ever more burdensome. In the old days of a faculty with seven professors, a school with 300 students was a good property, paying large salaries, but the introduction of laboratory and practical teaching has so increased the expenses that very little is now left for distribution at the end of the year.  The students' fees have not increased proportionately, and only the self-sacrifice and devotion of men who ungrudgingly give their time, and often their means, save a hopeless situation. A fusion of the schools is the natural solution of the problem. Take a concrete example : A union of three of the medical schools of this city would enable the scientific departments to be consolidated at an enormous saving of expense and with a corresponding increase in efficiency. Anatomy, physiology, pathology, physiological chemistry, bacteriology, and pharmacology could be taught in separately organized departments which the funds of the united school could support liberally. Such a school could appeal to the public for aid to build and endow suitable laboratories. The clinical work could be carried on at the separate hospitals, which would afford unequalled facilities for the scientific study of disease.  Not only in this city, but in Richmond, in Nashville, in Columbus, in Indianapolis, and in many cities a "merger" is needed. Even the larger schools of the larger cities could "pool" their scientific interests to the great advantage of the profession.

And the third desideratum is the recognition by our homoeopathic brethren that the door is open. It is too late in this day of scientific medicine to prattle of such antique nonsense as is indicated in the "pathies." We have long got past the stage when any "system" can satisfy a rational practitioner, long past the time when a difference of belief in the action of drugs - the most uncertain element in our art! — should be allowed to separate men with the same noble traditions, the same hopes, the same aims and ambitions. It is not as if our homoeopathic brothers are asleep; far from it, they are awake — many of them at any rate — to the importance of the scientific study of disease, and all of them must realize the anomaly of their position.  It is distressing to think that so many good men live isolated, in a measure, from the great body of the profession.  The original grievous mistake was ours — to quarrel with our brothers over infinitesimals was a most unwise and stupid thing to do. That we quarrel with them now is solely on account of the old Shibboleth under which they practise. Homoeopathy is as inconsistent with the new medicine as is the old-fashioned polypharmacy, to destruction of which it contributed so much. The rent in the robe of Aesculapius, wider in this country than elsewhere, could be repaired by mutual concessions — on the one hand by the abandonment of special designations, and on the other by an intelligent toleration of therapeutic vagaries which in all ages have beset the profession, but which have been mere flies on the wheels of progress.

PEACE

If many seek peace, few ensue it actively, and among these few we, alas I are not often to be found. In one sense every one of us may be asked the question which Jehu returned to Joram : "What hast thou to do with peace ?" since our life must be a perpetual warfare, dominated by the fighting spirit. The physician, like the Christian, has three great foes — ignorance, which is sin; apathy, which is the world; and vice, which is the devil. There is a delightful Arabian proverb two lines of which run: "He that knows not, and knows not that he knows not, is a fool. Shun him. He that knows not, and knows that he knows not, is simple. Teach him." To a large extent these two classes represent the people with whom we have to deal. Teaching the simple and suffering the fools gladly, we must fight the wilful ignorance of the one and the helpless ignorance of the other, not with the sword of righteous indignation, but with the skilful weapon of the tongue.  On this ignorance the charlatan and the quack live, and it is by no means an easy matter to decide how best to conduct a warfare against these wily foes, the oldest and most formidable with whom we have to deal. As the incomparable Fuller remarks : "Well did the poets feign Aesculapius and Circe brother and sister, ... for in all times (in the opinion of the multitude) witches, old women, and impostors have had a competition with doctors." Education of the public of a much more systematic and active kind is needed. The congress on quackery which is announced to take place in Paris, with some twenty-five subjects for discussion, indicates one important method of dealing with the problem. The remarkable exhibit held last year in Germany of everything relating to quacks and charlatans did an immense good in calling attention to the colossal nature of the evil. A permanent museum of this sort might well be organized in Washington in connexion with the Department of Hygiene. It might be worth while to imitate our German brethren in a special national exhibit, though I dare say many of the most notorious sinners would apply for large space, not willing to miss the opportunity for a free advertisement ! One effective measure is enforced in Germany : any proprietary medicine sold to the public must be submitted to a government analyst, who prepares a statement (as to its composition, the price of its ingredients, etc.), which is published at the cost of the owner of the supposed remedy in a certain number of the daily and weekly papers.

By far the most dangerous foe we have to fight is apathy — indifference from whatever cause, not from a lack of knowledge, but from carelessness, from absorption in other pursuits, from a contempt bred of self-satisfaction. Fully 25 per cent, of the deaths in the community are due to this accursed apathy, fostering a human inefficiency, and going far to counterbalance the extraordinary achievements of the past century. Why should we take pride in the wonderful railway system with which enterprise and energy have traversed the land, when the supreme law, the public health, is neglected? What comfort in the though of a people enjoying great material prosperity when we know that the primary elements of life (on which even the old Romans were our masters) are denied to them? What consolation does the 'little red school-house' afford when we know that a Lethean apathy allows toll to be taken of every class, from the little tots to the youths and maidens?  Western civilization has been born of knowledge, of knowledge won by hard, honest sweat of body and brain, but in many of the most important relations of life we have failed to make that knowledge effective. And, strange irony of life, the lesson of human efficiency is being taught us by one of the little nations of the earth, which has so far bettered our instruction that we must again turn eastward for wisdom. Perhaps in a few years our civilization may be put on trial, and it will not be without benefit if it arouses the individual from apathy and makes him conscious of the great truth that only by earnest individual human effort can knowledge be made effective, and if it arouses communities from an apathy which permits mediaeval conditions to prevail without a protest.

Against our third great foe — vice in all its forms -we have to wage an incessant warfare, which is not less vigorous because of the quiet, silent kind. Better than any one eke the physician can say the word in season to the immoral, to the intemperate, to the uncharitable in word and deed.  Personal impurity is the evil against which we can do most good, particularly to the young, by showing the possibility of the pure life and the dangers of immorality. Had I time, and were this the proper occasion, I would like to rouse the profession to a sense of its responsibility toward the social evil — the black plague which devastates the land I can but call your attention to an important society, of which Dr. Prince Morrow, of New York, is the organizer, which has for one of its objects the education of the public on this important question. I would urge you to join in a crusade quite as important as that in which we are engaged against tuberculosis.

CONCORD

Unity promotes concord — community of interests, the same aims, the same objects give, if anything can, a feeling of comradeship, and the active co-operation of many men, while it favours friction, lessens the chances of misunderstanding and ill will. One of the most gratifying features of our professional life is the good feeling which prevails between the various sections of the country. I do not see how it could be otherwise. One has only to visit different parts and mingle with the men to appreciate that everywhere good work is being done, everywhere an earnest desire to elevate the standard of education, and everywhere the same self-sacrificing devotion on the part of the general practitioner. Men will tell you that commercialism is rife, that the charlatan and the humbug were never so much in evidence, and that in our ethical standards there has been a steady declension. These are the Elijahs who are always ready to pour out their complaints, mourning that they are not better than their fathers. Few men have had more favourable opportunities than I have had to gauge the actual conditions in professional private life, in the schools and in the medical societies, and as I have seen them in the past twenty years I am filled with thankfulness for the present and with hope for the future. The little rift within the lute is the absence in many places of that cordial professional harmony which should exist among us.  In the larger cities professional jealousies are dying out.  Read Charles Caldwell's Autobiography if you wish for spicy details of the quarrels of the doctors in this country during the first half of the last century. I am sorry to say the professors have often been the worst offenders, and the rivalry between medical schools has not always been friendly and courteous. That it still prevails to some extent must be acknowledged, but it is dying out, though not so rapidly as we could wish. It makes a very bad impression on the public, and is often a serious stumbling-block in the way of progress. Only the other day I had a letter from an intelligent and appreciative layman who is interested in a large hospital scheme about which I had been consulted. I quote this sentence from it in sorrow, and I do so because it is written by a strong personal friend of the profession, a man who has had long and varied experience with us : "I may say to you that one of the distressing bewilderments of the layman who only desires the working out of a broad plan is the extraordinary bitterness of professional jealousy between not only schoolmen and non-schoolmen, but between schoolmen themselves, and the reflections which are cast on one another as belonging to that clique, which makes it exceedingly difficult for the layman to understand what way there is out of these squabbles."

The national and special societies, and particularly the American Medical Association, have brought men together and have taught them to know each other and to appreciate the good points which at home may have been overlooked. As Dr. Brush said yesterday in his address, it is in the smaller towns and country districts that the conditions are most favourable for mutual misunderstandings. Only those of us who have been brought up in such surroundings can appreciate how hard it is for physicians to keep on good terms with each other. The practice of medicine calls equally for the exercise of the heart and the head ; and when a man has done his best, to have his motives misunderstood and misconduct of a case harshly criticized not only by the family, but by a colleague who has been called in, small wonder, when the opportunity arises, if the old Adam prevails and he pays in kind. So far as my observation goes there are three chief causes for the quarrels of doctors. The first is lack of proper friendly intercourse, by which alone we can know each other. It is the duty of the older man to look on the younger one who settles near him not as a rival, but as a son. He will do to you just what you did to the old practitioner, when, as a young man, you started— get a good many of your cases ; but if you have the sense to realize that this is inevitable, unavoidable, and the way of the world, and if you have the sense to talk over, in a friendly way, the first delicate situation that arises, the difficulties will disappear and recurrences may be made impossible. The young men should be tender with the sensibilities of their seniors, deferring to their judgment and taking counsel with them. If young graduates could be taken more frequently as assistants or partners, the work of the profession would be much lightened, and it would promote amity and good fellowship. A man of whom you may have heard as the incarnation of unprofessional conduct, and who has been held up as an example of all that is pernicious, may be, in reality, a very good fellow, the victim of petty jealousies, the mark of the arrows of a rival faction; and you may, on acquaintance, find that he loves his wife and is devoted to his children, and that there are people who respect and esteem him.  After all, the attitude of mind is the all-important factor in the promotion of concord. When a man is praised, or when a young man has done a good bit of work in your special branch, be thankful — it is for the common good.  Envy, that pain of the soul, as Plato calls, it, should never fora moment afflict a man of generous instincts who has a sane outlook in life. The men of rival schools should deliberately cultivate the acquaintance of each other and encourage their students and the junior teachers to fraternize. If you hear that a young fellow just starting has made mistakes or is a little "off colour," go out of your way to say a good word to him, or for him. It is the only cure; any other treatment only aggravates the malady.

The second great cause is one over which we have direct control. The most widespread, the most pernicious of all vices, equal in its disastrous effects to impurity, much more disastrous often than intemperance, because destructive of all mental and moral nobility as are the others of bodity health, is uncharitableness — the most prevalent of modem sins, peculiarly apt to beset all of us, and the chief enemy to concord in our ranks. Oftentimes it is a thoughtless evil, a sort of tic or trick, an unconscious habit of mind and tongue which gradually takes possession of us. No sooner is a man's name mentioned than something slighting is said of him, or a story is repeated which is to his disadvantage, or the involuntary plight of a brother is ridiculed, or even his character is traduced. In chronic and malign offenders literally " with every word a reputation dies." The work of a school is disparaged, or the character of the work in a laboratory is belittled ; or it may be only the faint praise that damns, not the generous meed from a full and thankful heart. We have lost our fine sense of the tragic element in this vice, and of its debasing influence on the character. It is interesting that Christ and the Apostles lashed it more unsparingly than any other. Who is there among us who does not require every day to lay to heart that counsel of perfection : '' Judge not according to the appearance, but judge righteous judgment?" One of the apostles of our profession, Sir Thomas Browne, has a great thought on the question:

While thou so hotly disclaimest the devil, be not guilty of diabolism. Fall not into one name with that unclean spirit, nor act his nature whom thou so much abhorrest — that is, to accuse, calumniate backbite, whisper, detract or sinistrously interpret others.  Degenerous depravities, and narrow-minded vices ! not only below St. Paul's noble Christian, but Aristotle's true gentleman. Trust not with some that the Epistle of St. James is apocryphal, and so read with less fear that stabbing truth, that in company with this vice thy religion is in vain. Moses broke the tables without breaking the law; but where charity is broke the law itself is shattered, which cannot be whole without love, which is the fulfilling of it. Look humbly upon thy virtues ; and though thou art rich in some, yet think thyself poor and naked without that crowning grace, which thinketh no evil, which envieth not, which beareth, hopeth, believeth, endureth all things. With these sure graces, while busy tongues are crying out for a drop of cold water, mutes may be in happiness, and sing the Trisagion in heaven.

And the third cause is the wagging tongue of others who are too often ready to tell tales and make trouble between physicians. There is only one safe rule — never listen to a patient who begins with a story about the carelessness and inefficiency of Dr. Blank. Shut him or her up with a snap, knowing full well that the same tale may be told of you a few months later. Fully half of the quarrels of physicians are fomented by the tittle-tattle of patients, and the only safeguard is not to listen. Sometimes it is impossible to check the flow of imprecation and slander; and then apply the other rule — perfectly safe, and one which may be commended as a good practice — never believe what a patient tells you to the detriment of a brother physician, even though you may think it to be true.

To part from the profession of this country and from this old faculty, which I have learned to love so dearly, is a great wrench, one which I would feel more deeply were it not for the nearness of England, and for the confidence I feel that I am but going to work in another part of the same vineyard, and were it not for the hope that I shall continue to take interest in your affairs and in the welfare of the medical school to which I owe so much. It may be that in the hurry and bustle of a busy life I have given offence to some — who can avoid it ! Unwittingly I may have shot an arrow o'er the house and hurt a brother — if so, I am sorry, and I ask his pardon. So far as I can read my heart I leave you in charity with all I have striven with none, not, as Walter Savage Landor says, because none was worth the strife, but because I have had a deep conviction of the hatefulness of strife, of its uselessness, of its disastrous effects, and a still deeper conviction of the blessings that come with unity, peace, and concord. And I would give to each of you, my brothers — you who hear me now, and to you who may elsewhere read my words to you who do our greatest work labouring incessantly for small rewards in towns and country places — to you the more favoured ones who have special fields of work— ^ you teachers and professors and scientific workers — to one and all, through the length and breadth of the land— I give a single word as my parting commandment :

"It is not hidden from thee, neither is it far off. It is not in heaven, that thou shouldest say, 'Who shall go up for as to heaven, and bring it onto us, that we may hear it, and do it ?' Neither is it beyond the sea, that thou shouldest say, 'Who shall go over the sea for us, and bring it unto us, that we may hear it and do it ?' But the word is very nigh unto thee, in thy month and in thy heart, that then mayest do it — CHARITY."

L'ENVOI

L'ENVOI  by William Osler

Remarks at farewell dinner given by the profession of the United States and Canada, New York, May 20, 1905.

"I am a part of all that I have met"
(Ulysses)
Tennyson

I AM sure you all sympathize with me in the feelings which naturally almost overpower me on such an occasion. Many testimonials you have already given me of your affection and of your regard, but this far exceeds them all, and I am deeply touched that so many of you have come long distances, and at great inconvenience, to bid me Godspeed in the new venture I am about to undertake. Pardon me, if I speak of myself, in spite of Montaigne's warning that one seldom speaks of oneself without some detriment to the person spoken of. Happiness comes to many of us and in many ways, but I can truly say that to few men has happiness come in so many forms as it has come to me.  Why I know not, but this I do know, that I have not deserved more than others, and yet, a very rich abundance of it has been vouchsafed to me. I have been singularly happy in my friends, and for that I say " God be praised." I have had exceptional happiness in the profession of my choice, and I owe all of this to you. I have sought success in life, and if, as some one has said, this consists in getting what you want and being satisfied with it, I have found what I sought in the estimation, in the fellowship and friendship of the members of my profession.

I have been happy too in the public among whom I have worked— happy in my own land in Canada, happy here among you in the country of my adoption, from which I cannot part without bearing testimony to the nobility and the grace of character which I have found here in my colleagues. It fills me with joy to think that I have had not only the consideration and that ease of fellowship which means so much in life, but the warmest devotion on the part of my patients and their friends.

Of the greatest of all happiness I cannot speak - of my home. Many of you know it, and that is enough.

I would like to tell you how I came to this country. The men responsible for my arrival were Samuel W. Gross and Minis Hays of Philadelphia, who concocted the scheme in the Medical News office and asked James Tyson to write a letter asking if I would be a candidate for the professorship of Clinical Medicine in the University of Pennsylvania.  That letter reached me at Leipsic, having been forwarded to me from Montreal by my friend Shepherd. So many pranks had I played on my friends there that, when the letter came, I felt sure it was a joke, so little did I think that I was one to be asked to succeed Dr. Pepper. It was several weeks before I ventured to answer that letter, fearing that Dr. Shepherd had perhaps surreptitiously taken a sheet of University of Pennsylvania notepaper on purpose to make the joke more certain. Dr. Mitchell cabled me to meet him in London, as he and his good wife were commissioned to "look me over," particularly with reference to personal conditions. Dr. Mitchell said there was only one way in which the breeding of a man suitable for such a position, in such a city as Philadelphia, could be tested : — give him cherry pie and see how he disposed of the stones.  I had read of the trick before and disposed of them genteelly in my spoon— and got the Chair!

My affiliations with the profession in this country have been wide and to me most gratifying. At the University of Pennsylvania I found men whom I soon learned to love and esteem, and when I think of the good men who have gone — of Pepper, of Leidy, of Wormley, of Agnew, of Ashhurst — I am full of thankfulness to have known them before they were called to their long rest. I am glad to think that my dear friends Tyson and Wood are here still to join in a demonstration to me.

At Johns Hopkins University I found the same kindly feeling of friendship and my association with my colleagues there has been, as you all know, singularly happy and delightful With my fellow workers in the medical societies— in the American Medical Association, in the Association of American Physicians, in the Pediatric, Neurological and Physiological Societies — my relations have been most cordial and I would extend to them my heartfelt thanks for the kindness and consideration shown me during the past twenty years.

With the general practitioners throughout the country my relations have been of a peculiarly intimate character.  Few men present, perhaps very few men in this country, have wandered so far and have seen in so many different sections the doctor at work. To all of these good friends who have given me their sufirage I express my appreciation and heartfelt thanks for their encouragement and support.

And lastly, my relations with my students— so many of whom I see here — have been of a close and most friendly character. They have been the inspiration of my work, and I may say truly, the inspiration of my life.

I have had but two ambitions in the profession : first, to make of myself a good clinical physician, to be ranked with the men who have done so much for the profession of this country— to rank in the class with Nathan Smith, Bartlett, James Jackson, Bigelow, Alonzo Clark, Metcalfe.  W. W. Gerhard, Draper, Pepper, DaCosta and others, The chief desire of my life has been to become a clinician of the same stamp with these great men, whose names we all revere and who did so much good work for clinical medicine.

My second ambition has been to build up a great clinic on Teutonic lines, not on those previously followed here and in England, but on lines which have proved so successful on the Continent, and which have placed the scientific medicine of Germany in the forefront of the world. And if I have done anything to promote the growth of clinical medicine it has been in this direction, in the formation of a large clinic with a well organized series of assistants and house physicians and with proper laboratories in which to work at the intricate problems that confront us in internal medicine. For the opportunities which I have had at Johns Hopkins Hospital to carry out these ideas, I am truly thankful. How far I have been successful, or not, remains to be seen. But of this I am certain : — If there is one thing above another which needs a change in this country, it is the present hospital system in relation to the medical school.  It has been spoken of by Dr. Jacobi but cannot be referred to too often. In every town of fifty thousand inhabitants a good model clinic could be built up, just as good as in smaller German cities, if only a self-denying ordinance were observed on the part of the profession and only one or two men given the control of the hospital service, not half a dozen. With proper assistants and equipment, with good clinical and pathological laboratories there would be as much clinical work done in this country as in Germany.

I have had three personal ideals. One to do the day's work well and not to bother about tomorrow. It has been urged that this is not a satisfactory ideal. It is; and there is not one which the student can carry with him into practice with greater effect. To it, more than to anything else, I owe whatever success I have had — to this power of settling down to the day's work and trying to do it well to the best of one's ability, and letting the future take care of itself.

The second ideal has been to act the Golden Rule, as far as in me lay, towards my professional brethren and towards the patients committed to my care.

And the third has been to cultivate such a measure of equanimity as would enable me to bear success with humility, the affection of my friends without pride and to be ready when the day of sorrow and grief came to meet it with the courage befitting a man.

What the future has in store for me, I cannot tell— you cannot tell. Nor do I care much, so long as I carry with me, as I shall, the memory of the past you have given me.  Nothing can take that away.

I have made mistakes, but they have been mistakes of the head not of the heart. I can truly say, and I take upon myself to witness, that in my sojourn among you:-

"I have loved no darkness 

Sophisticated no truth,

Nursed no delusion 

Allowed no fear."

Soft tissue calcification in Hand Radiographs

I am preparing some slides for a talk on hand radiology.

The University of Washington Department of Radiology website has a nice page the approach to this.

Distal Radius Fractures

The American Academy of Orthopaedic Surgeons (AAOS) website has a patient information page on distal radius fractures that is useful not only to patients, but as an introduction to medical students and others healthcare.

Phase III Lecture: Approach to Hand Conditions

This is the lecture I gave to Phase III Medical Students on 2016-08-12.

Approach to Hand Conditions from Alphonsus Chong

A WAY OF LIFE

An Address to Yale Students
Sunday evening, April 20th, 1913



By

WILLIAM OSLER



LONDON
CONSTABLE & COMPANY LTD.
1913


What each day needs that
shalt thou ask,
Each day will set its proper
task.

Goethe.



FELLOW STUDENTS -

Every man has a philosophy of life in thought, in word, or in deed, worked out in himself unconsciously. In possession of the very best, he may not know of its existence; with the very worst he may pride himself as a paragon. As it grows with the growth it cannot be taught to the young in formal lectures. What have bright eyes, red blood, quick breath and taut muscles to do with philosophy? Did not the great Stagirite say that young men were unfit students of it? - they will hear as though they heard not, and to no profit.  Why then should I trouble you ?  Because I have a message that may be helpful. It is not philosophical, nor is it strictly moral or religious, one or other of which I was told my address should be, and yet in a way it is all three. It is the oldest and the freshest, the simplest and the most useful, so simple indeed is it that some of you may turn away disappointed as was Naaman the Syrian when told to go wash in Jordan and be clean.  You know those composite tools, to be bought for 50 cents, with one handle to fit a score or more of instruments. The workman- ship is usually bad, so bad, as a rule, that you will not find an example in any good carpenter's shop ; but the boy has one, the chauffeur slips one into his box, and the sailor into his kit, and there is one in the odds- and-ends drawer of the pantry of every well-regulated family.  It is simply a handy thing about the house, to help over the many little difficulties of the day. Of this sort of philosophy I wish to make you a present - a handle to fit your life tools. Whether the workmanship is Sheffield or shoddy, this helve will fit anything from a hatchet to a cork-screw.

My message is but a word, a Way, an easy expression of the experience of a plain man whose life has never been worried by any philosophy higher than that of the shepherd in As You Like It. I wish to point out a path in which the wayfaring man, though a fool, cannot err ; not a system to be worked out painfully only to be dis- carded, not a formal scheme, simply a habit as easy - or as hard - to adopt as any other habit, good or bad.

I

A few years ago a Xmas card went the rounds, with the legend "Life is just one 'derned' thing after another," which, in more refined language, is the same as saying " Life is a habit," a succession of actions that become more or less auto- matic. This great truth, which lies at the basis of all actions, muscular or psychic, is the key- stone of the teaching of Aristotle, to whom the formation of habits was the basis of moral excellence. "In a word, habits of any kind are the result of actions of the same kind ; and so what we have to do, is to give a certain character to these particular actions" (Ethics). Lift a seven months old baby to his feet - see him tumble on his nose. Do the same at twelve months - he walks. At two years he runs.  The muscles and the nervous system have acquired the habit.  One trial after another, one failure after another, has given him power. Put your finger in a baby's mouth, and he sucks away in blissful anticipation of a response to a mammalian habit millions of years old. And we can deliberately train parts of our body to per- form complicated actions with unerring accuracy. Watch that musician playing a difficult piece. Batteries, commutators, multipliers, switches, wires in- numerable control those nimble fingers, the machinery of which may be set in motion as automatically as in a pianola, the player all the time chatting as if he had nothing to do in con- trolling the apparatus — habit again, the gradual acquisition of power by long practice and at the expense of many mistakes. The same great law reaches through mental and moral states. " Character," which partakes of both, in Plutarch's words, is " long-standing habit."

Now the way of life that I preach is a habit to be acquired gradually by long and steady repetition. It is the practice of living for the day only, and for the day's work, Life in day-tight compartments. "Ah," I hear you say, "that is an easy matter, simple as Elisha's advice ! " Not as I shall urge it, in words which fail to ex- press the depth of my feelings as to its value. I started life in the best of all environments - in a parsonage, one of nine children. A man who has filled Chairs in four universities, has written a successful book, and has been asked to lecture at Yale, is supposed popularly to have brains of a special quality.  A few of my intimate friends really know the truth about me, as I know it ! Mine, in good faith I say it, are of the most mediocre character. But what about those professor- ships, etc. ? Just habit, a way of life, an outcome of the day's work, the vital importance of which I wish to impress upon you with all the force at my command.

Dr. Johnson remarked upon the trifling circumstances by which men's lives are influenced, "not by an ascendant planet, a predominating humour, but by the first book which they read, some early conversation which they have heard, or some accident which excited ardour and enthusiasm." This was my case in two particulars. I was diverted to the Trinity College School, then at Weston, Ontario, by a paragraph in the circular stating that the senior boys would go into the drawing- room in the evenings, and learn to sing and dance— vocal and pedal accomplishments for which I was never designed ; but like Saul seeking his asses, I found something more valuable, a man of the White of Selborne type, who knew nature, and who knew how to get boys interested in it. 1 The other happened in the summer of 1871, when I was attending the Montreal General Hospital.  Much worried as to the future, partly about the final examination, partly as to what I should do afterwards, I picked up a volume of Carlyle, and on the page I opened there was the familiar sentence — "Our main business is not to see what lies dimly at a distance, but to do what lies clearly at hand." A commonplace sentiment enough, but it hit and stuck and helped, and was the starting-point of a habit that has enabled me to utilize to the full the single talent entrusted to me.

1 The Rev. W. A. Johnson, the founder of the school.

II

The workers in Christ's vineyard were hired by the day; only for this day are we to ask for our daily bread, and we are expressly bidden to take no thought for the morrow. To the modern world these commands have an Oriental savour, counsels of perfection akin to certain of the Beatitudes, stimuli to aspiration, not to action. I am prepared on the contrary to urge the literal acceptance of the advice, not in the mood of Ecclesiastes— " Go to now, ye that say to-day or to-morrow we will go into such a city, and continue there a year, and buy and sell and get gain ; whereas ye know not what shall be on the morrow"; not in the Epicurean spirit of Omar with his "jug of wine and Thou," but in the modernist spirit, as a way of life, a habit, a strong enchantment, at once against the mysticism of the East and the pessimism that too easily besets us. Change that hard saying "Sufficient unto the day is the evil thereof" into "the goodness thereof," since the chief worries of life arise from the foolish habit of looking be- fore and after. As a patient with double vision from some transient unequal action of the muscles of the eye finds magical relief from well-adjusted glasses, so, returning to the clear bin- ocular vision of to-day, the over- anxious student finds peace when he looks neither back- ward to the past nor forward to the future.

I stood on the bridge of one of the great liners, ploughing the ocean at 25 knots. "She is alive," said my companion, "in every plate; a huge monster with brain and nerves, an immense stomach, a wonderful heart and lungs, and a splendid system of locomotion." Just at that moment a signal sounded, and all over the ship the water- tight compartments were closed.  "Our chief factor of safety," said the Captain. " In spite of the Titanic," I said. "Yes," he replied, "in spite of the Titanic." Now each one of you is a much more marvellous organization than the great liner, and bound on a longer voyage. What I urge is that you so learn to control the machinery as to live with "day-tight compartments" as the most certain way to ensure safety on the voyage.  Get on the bridge, and see that at least the great bulkheads are in working order. Touch a button and hear, at every level of your life, the iron doors shutting out the Past— the dead yesterdays. Touch another and shut off, with a metal curtain, the Future — the unborn to-morrows. Then you are safe,— safe for to-day ! Read the old story in the Chambered Nautilus, so beautifully sung by Oliver Wendell Holmes, only
change one line to " Day after day beheld the silent toil." Shut off the past ! Let the dead past bury its dead. So easy to say, so hard to realize ! The truth is, the past haunts us like a shadow. To disregard it is not easy. Those blue eyes of your grandmother, that weak chin of your grandfather, have mental and moral counterparts in your make-up. Generations of ancestors, brooding over " Providence, Foreknowledge, Will and Fate— Fixed fate, free will, foreknowledge, absolute," may have bred a New England conscience, morbidly sensitive, to heal which some of you had rather sing the 51st Psalm than follow Christ into the slums.  Shut out the yesterdays, which have lighted fools the way to dusty death, and have no concern for you personally, that is, consciously. They are there all right, working daily in us, but so are our livers and our stomachs.  And the past, in its unconscious action on our lives, should bother us as little as they do. The petty annoyances, the real and fancied slights, the trivial mistakes, the disappointments, the sins, the sorrows, even the joys— bury them deep in the oblivion of each night. Ah ! but it is just then that to so many of us the ghosts of the past,

Night-riding Incubi 
Troubling the fantasy, 

come in troops, and pry open the eyelids, each one presenting a sin, a sorrow, a regret. Bad enough in the old and seasoned, in the young these demons of past sins may be a terrible affliction, and in bitterness of heart many a one cries with Eugene Aram, " Oh God ! Could I so close my mind, and clasp it with a clasp." As a vaccine against all morbid poisons left in the system by the infections of yesterday, I offer "a way of life." "Undress," as George Herbert says, "your soul at night," not by self- examination, but by shedding, as you do your garments, the daily sins whether of omission or of commission, and you will wake a free man, with a new life. To look back, except on rare occasions for stock-taking, is to
risk the fate of Lot's wife.  Many a man is handicapped in his course by a cursed combination of retro- and introspection, the mistakes of yesterday paralysing the efforts of to-day, the worries of the past hugged to his destruction, and the worm Regret allowed to canker the very heart of his life. To die daily, after the manner of St.  Paul, ensures the resurrection of a new man, who makes each
day the epitome of a life.


III

The load of to-morrow, added to that of yesterday, carried to-day makes the strongest falter. Shut off the future as tightly as the past. No dreams, no visions, no delicious fantasies, no castles in the air, with which, as the old song so truly says, "hearts are broken, heads are turned." To youth, we are told, belongs the future, but the wretched to-morrow that so plagues some of us has no certainty, except through to- day. Who can tell what a day may bring forth? Though its uncertainty is a proverb, a man may carry its secret in the hollow of his hand. Make a pilgrimage to Hades with Ulysses, draw the magic circle, perform the rites, and then ask Tiresias the question. I have had the answer from his own lips. The future is to-day,— there is no to-morrow !  The day of a man's salvation is now — the life of the present, of to-day, lived earnestly, intently, without a forward - looking  thought, is the only insurance for the future. Let the limit of your horizon be a twenty-four hour circle. On the title page of one of the great books of science, the Discours de la Methode of Descartes (1637) is a vignette showing a man digging in a garden with his face towards the earth, on which rays of light are
streaming from the heavens; beneath is the legend, "Fac et Spera. " Tis a good attitude and a good motto. Look heaven- ward, if you wish, but never to the horizon— that way danger
lies. Truth is not there, happiness is not there, certainty is not there, but the falsehoods, the frauds, the quackeries, the ignes fatui which have deceived each generation — all beckon from the horizon, and lure the men not content to look for the truth and happiness that tumble out at their feet. Once while at College climb a mountain -top, and get a general outlook of the land, and make it the occasion perhaps of that careful examination of yourself, that inquisition which Descartes urges every man to hold once in a lifetime, — not oftener.

Waste of energy, mental dis- tress, nervous worries dog the steps of a man who is anxious about the future. Shut close, then, the great fore and aft bulk- heads, and prepare to cultivate the habit of a life of Day-Tight Compartments. Do not be discouraged, — like every other habit, the acquisition takes time, and the way is one you must find for yourselves. I can only give general directions and
encouragement, in the hope that while the green years are on your heads, you may have the courage to persist.


IV

Now, for the day itself! What first ? Be your own daysman !  and sigh not with Job for any mysterious intermediary, but prepare to lay your own firm hand upon the helm. Get into touch with the finite, and grasp in full enjoyment that sense of capacity in a machine working smoothly. Join the whole creation of animate things in a deep, heartfelt joy that you are alive, that you see the sun, that you are in this glorious earth which nature has made so beautiful, and which is yours to conquer and to enjoy. Realise, in the words of Browning, that "There's a world of capability for joy spread round about us, meant for us, inviting us." What are the morning sensations ?— for they control the day.  Some of us are congenitally unhappy during the early hours ; but the young man who feels on awakening that life is a burden or a bore has been neglecting his machine, driving it too hard, stoking the engines too much, or not cleaning out the ashes and clinkers. Or he has been too much with the Lady Nicotine, or fooling with Bacchus, or, worst of all, with the younger Aphrodite— all "messengers of strong prevailment in unhardened youth." To have a sweet outlook on life you must have a clean body. As I look on the clear-cut, alert, earnest features, and the lithe, active not Socrates and Plato would find the race improved. I am sure they would love to look on such a gathering as this. Make their ideal yours — the fair mind in the fair body. The one can- not be sweet and clean without the other, and you must realise, with Rabbi Ben Ezra, the great truth that flesh and soul are mutually helpful. The morning outlook — which really makes the day— is largely a question of a clean machine — of physical morality in the wide sense of the term. "C'est I'estomac qui fait les heureux," as Voltaire says; no dyspeptic can have a sane outlook on life ; and a man whose bodily functions are im- paired has a lowered moral resistance. To keep the body fit is a help in keeping the mind pure, and the sensations of the first few hours of the day are the best test of its normal state.  The clean tongue, the clear head, and the bright eye are birth-rights of each day. Just as the late Professor Marsh would diagnose an unknown animal from a single bone, so can the day be predicted from the first waking hour. The start is everything, as you well know, and to make a good start you must feel fit. In the young, sensations of morning slackness come most often from lack of control of the two primal instincts—biologic habits — the one concerned with the preservation of the individual, the other with the continuance of the species.  Yale students should by this time be models of dietetic propriety, but youth does not always reck the rede of the teacher; and I dare say that here, as elsewhere, careless habits of eating are responsible for much mental disability. My own rule of life has been to cut out unsparingly any article of diet that had the bad taste to disagree with me, or to indicate in any way that it had abused the temporary hospitality of the lodging which I had provided.  To drink, nowadays, but few students become addicted, but in every large body of men a few are to be found whose incapacity for the day results from the morning clogging of nocturnally-flushed tissues. As moderation is very hard to reach, and as it has been abundantly shown that the best of mental and physical work may be done without alcohol in any form, the safest rule for the young man is that which I am sure most of you follow — abstinence. A bitter enemy to the bright eye and the clear brain of the early morning is tobacco when smoked to excess, as it is now by a large majority of students. Watch it, test it, and if need be, control it. That befogged, woolly sensation reaching from the forehead to the occiput, that haziness of memory, that cold fish-like eye, that furred tongue, and last week's taste in the mouth— too many of you know them— I know them— they often come from too much tobacco. The other primal instinct is the heavy burden of the flesh which Nature puts on all of us to ensure a continuation of the species. To drive Plato's team taxes the energies of the best of us. One of the horses is a rag- ing, untamed devil, who can only be brought into subjection by hard fighting and severe training. This much you all know as men: once the bit is between his teeth the black steed Passion will take the white horse Reason with you and the chariot rattling over the rocks to perdition.

With a fresh, sweet body you can start aright without those feelings of inertia that so often, as Goethe says, make the a useless day. Control of the mind as a working machine, the adaptation in it of habit, so that its action becomes almost as automatic as walking, is the end of education — and yet how rarely reached ! It can be accomplished with deliberation and re- pose, never with hurry and worry.  Realise how much time there is, how long the day is. Realise that you have sixteen waking hours, three or four of which at least should be devoted to making a silent conquest of your mental  which is grown gradually the power to wrestle successfully with any subject, is the secret of successful study. No mind however dull can escape the brightness that comes from steady application. There is an old saying, "Youth enjoyeth not, for haste " ; but worse than this, the failure to cultivate the power of peaceful concentration is the greatest single cause of mental breakdown. Plato pities the young man who started at such a pace that he never reached the goal. One of the saddest of life's tragedies is the wreckage of the career of the young collegian by hurry, hustle, bustle and tension— the human machine driven day and night, as no sensible fellow would use his motor. Listen to the words of a master in Israel, William James: "Neither the nature nor the amount of our work is accountable for the frequency and severity of our breakdowns, but their cause lies rather in those absurd feelings of hurry and having no time, in that breathlessness and tension, that anxiety of feature and that solicitude of results, that lack of inner harmony and ease, in short, by which the work with us is apt to be accompanied, and from which a European who would do the same work would, nine out of ten times, be free." Es bildet ein Talent sich in der Stille, but it need not be for all day. A few hours out of the sixteen will suffice, only let them be hours of daily dedication — in routine, in order and in system, and day by day you will gain in  power over the mental mechanism, just as the child does over the spinal marrow in walking, or the musician over the nerve centres. Aristotle somewhere says that the student who wins out in the fight must be slow in his movements, with voice deep, and slow speech, and he will not be worried over trifles which make people speak in shrill tones and use rapid movements.  Shut close in hour-tight com- partments, with the mind direct- ed intensely upon the subject in hand, you will acquire the capacity to do more and more, you will get into training; and once the mental habit is established, you are safe for life.

Concentration is an art of slow acquisition, but little by little the mind is accustomed to habits of slow eating and careful digestion, by which alone you escape the "mental dyspepsy" so graphically described by Lowell in the Fable for Critics.  Do not worry your brains about that bugbear Efficiency, which, sought consciously and with effort, is just one of those  elusive qualities very apt to be missed. The man's college output is never to be gauged at sight ; all the world's coarse thumb and finger may fail to plumb his most effective work, the casting of the mental machinery of self-education, the true preparation for a field larger than the college campus.  Four or five hours daily— it is not much to ask ; but one day must tell another, one week certify another, one month bear witness to another of the same story, and you will acquire a habit by which the one-talent man will earn a high interest, and by which the ten-talent man may at least save his capital.

Steady work of this sort gives a man a sane outlook on the world. No corrective so valuable to the weariness, the fever and the fret that are so apt to wring the heart of the young. This is the talisman, as George Herbert says,

The famous stone
That turneth all to gold,

and with which, to the eternally recurring question, What is Life?  you answer, I do not think— I act it ; the only philosophy that brings you in contact with its real values and enables you to grasp its hidden meaning. Over the Slough of Despond, past Doubting Castle and Giant Despair, with this talisman you may reach the Delectable Mountains, and those Shepherds of the Mind— Knowledge, Experience, Watchful and Sincere. Some of you may think this to be a miserable Epicurean doctrine— no better than that so sweetly sung by-
Horace :—

Happy the man— and Happy he alone,
He who can call to-day his own,
He who secure within can say,
To-morrow, do thy worst — for I have
lived to-day.

I do not care what you think, I am simply giving you a philosophy of life that I have found helpful in my work, useful in my play. Walt Whitman, whose physician I was for some years, never spoke to me much of his poems, though occasionally he would make a quotation ; but I remember late one summer afternoon as we sat in the window of his little house in Camden there passed a group of workmen whom he greeted in his usual friendly way. And then he said: "Ah, the glory of the day's work, whether with hand or brain ! I have tried

To exalt the present and the real,
To teach the average man the glory of
his daily work or trade."

In this way of life each one of you may learn to drive the straight furrow and so come to the true measure of a man.

V

With body and mind in training, what remains ?

Do you remember that most touching of all incidents in Christ's ministry, when the anxious ruler Nicodemus came by night (John 3:1-2), worried lest the things that pertained to his everlasting peace were not a part of his busy and successful life ? Christ's message to him is His message to the world - never more needed than at present: "Ye must be  born of the spirit." You wish to be with the leaders— as Yale men it is your birthright - know the great souls that make up the moral radium of the world. You must be born of their spirit, initiated into their fraternity, whether of the spiritually-minded followers of the Nazarene or of that larger company, elect from every nation, seen by St. John.

Begin the day with Christ and His prayer - you need no other.  Creedless, with it you have religion ; creed-stuffed, it will leaven any theological dough in which you stick. As the soul is dyed by the thoughts, let no day pass without contact with the best literature of the world.  Learn to know your Bible, though not perhaps as your fathers did. In forming character and in shaping conduct, its touch has still its ancient power.  Of the kindred of Ram and sons of Elihu, you should know its beauties and its strength. Fifteen or twenty minutes day by day will give you fellowship with the great minds of the race, and  little by little as the years pass you extend your friendship with the immortal dead. They will give you faith in your own day.  Listen while they speak to you of the fathers. But each age has its own spirit and ideas, just as it has its own manners and pleasures. You are right to believe that yours is the best University, at its best period. Why should you look back to be shocked at the frowsiness and dullness of the students of the seventies or even of the nineties? And cast no thought forward, lest you reach a period when you and yours will present to your successors the same dowdiness of clothes and times. But while change is the law, certain great ideas flow fresh through the ages, and control us effectually as in the days of Pericles. Mankind, it has been said, is always advancing, man is always the same. The love, hope, fear and faith that make humanity, and the elemental passions of the human heart, remain unchanged, and the secret of inspiration in any literature is the capacity to touch the cord that vibrates in a sympathy that knows nor time nor place.

The quiet life in day-tight compartments will help you to bear your own and others' burdens with a light heart. Pay no heed to the Batrachians who sit croaking idly by the stream. Life is a straight, plain business, and the way is clear, blazed for you by generations of strong men, into whose labours you enter and whose ideals must be your inspiration. In my mind's eye I can see you twenty years hence - resolute-eyed, broad-headed, smooth-faced men who are in the world to make a success of life ; but to whichever of the two great types you belong, whether con- trolled by emotion or by reason, you will need the leaven of their spirit, the only leaven potent enough to avert that only too common Nemesis to which the Psalmist refers : " He gave them their heart's desire, but sent leanness withal into their souls."

I quoted Dr. Johnson's remark about the trivial things that influence. Perhaps this slight word of mine may help some of you so to number your days that you may apply your hearts unto wisdom.

Approach to Hand Surgery

Lecture Slides

OSSE Teaching from Alphonsus Chong