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 HA982.B65 3822 The achievements, st 
 
 The Achievements, Standards and 
 
 Prospects of the 
 Massachusetts General Hospital 
 
 
 Ether Day Address 
 1919 
 
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The Achievements, Standards and 
 
 Prospects of the 
 Massachusetts General Hospital 
 
 RICHARD C. CABOT, M. D. 
 
 Professor of Medicine 
 Harvard Medical School 
 
 Chief of West Medical Service 
 Massachusetts General Hospital 
 
 Ether Day Address 
 1919 
 

THE ACHIEVEMENTS, STANDARDS 
 AND PROSPECTS OF THE MASSACHU- 
 SETTS GENERAL HOSPITAL 
 
 ETHER DAY ADDRESS* 
 
 By 
 
 Dr. Richard C. Cabot 
 
 October 16, 19 19 
 
 Our celebration of Ether Day this year has something 
 the aspect of a reunion. Those of us who love and 
 serve this hospital have not been together before for 
 three years. But your foreign branch, your foreign 
 representatives, whom you sent to do the foreign part 
 of this hospital's work in France and England, did not 
 forget the anniversary day on which the adherents 
 and friends of this hospital are accustomed to gather 
 up the traditions of their past, to take account of stock, 
 and to ask for such visions of the future as may guide 
 it fruitfully. 
 
 We celebrated Ether Day in 19 17 at Bordeaux; in 
 1918, in London. The tradition has not been broken, 
 at least so far as the loyalty and devotion of our leader, 
 Dr. Washburn, could preserve it. He gathered us 
 together in the chilly October of Southern France, 
 in a bare and draughty building, to commemorate as 
 best we could our home and our roots in this old insti- 
 tution at Boston. Again, in October of 19 18, he gath- 
 ered together in London such servants and graduates 
 of the hospital as he could find, at a meeting honored 
 
 •Address delivered at the Massachusetts General Hospital on the 
 seventy-third anniversary of Ether Day, October 16, 1919. 
 
by the presence and by the appreciative remarks of 
 Sir William Osier. 
 
 Since the trustees have chosen for the speaker of 
 this afternoon one who has no extensive or accurate 
 knowledge of ether, and who can bring with him the 
 prestige of no special achievements in science per- 
 formed in another part of the country, but have se- 
 lected a member of our own family group, it seemed 
 to me proper that the topic for today should be one 
 needing no special fitness on the part of the speaker 
 except knowledge of the hospital and affection for it 
 extending over thirty years. 
 
 Just three decades have passed since I first began to 
 be acquainted with the multifarious and incessant ac- 
 tivities of the Massachusetts General Hospital. Using 
 my own personal knowledge of these 30 years, and 
 supplementing it by the writings and recollections of 
 others, I wish today to pass in review the achievements, 
 standards, and prospects of this hospital. I shall pay 
 special attention to the years since 1871, at which date 
 the official volume narrating the history of this hos- 
 pital terminates. In this survey I shall be guided 
 by the belief that there are three main functions, by 
 success or failure in which any hospital should be judged. 
 It is the business of a hospital: — 
 
 {a) To apply the best of existing medical and sur- 
 gical knowledge to the comfort and healing of body 
 and soul. 
 
 (b) To extend this knowledge through example, 
 teaching and research. 
 
 (c) To extend our vision and our influence beyond 
 the hospital's walls. 
 
 The first two of these purposes comprise what may 
 be called the domestic policy of the hospital and the 
 third its foreign policy. Medicine like charity begins 
 at home. 
 
I 
 
 Devoted Care of Patients 
 
 Our first and foremost duty must be our ward 
 service, the detailed care of such patients as we find 
 day by day in the wards and in the Out-Patient 
 rooms of our hospital. This has been somewhat cyn- 
 ically spoken of as the duty of "maintaining a repair 
 shop." Surely we must maintain a repair shop and 
 an excellent one. The repair of his wounds and ills 
 is what the patient most poignantly desires. But we 
 have never been merely a repair shop. Our attack 
 upon the body's ills has never been merely the mechan- 
 ical and the chemical attack. For mechanics and chem- 
 istry can be applied as well to the body of an automo- 
 bile as to the body of a man. From the very opening 
 of this hospital, September 3, 1821, when the first 
 patient was received, Dr. James Jackson and Dr. J. C. 
 Warren set a standard for the care of patients which 
 in many respects we cannot hope to excel. They 
 realized from the first that it was unscientific as well 
 as inhuman to ignore the sick mind in the sick body, 
 to forget the one function which integrates and rep- 
 resents all the other functions of our organism. As 
 they ministered day by day to diseased bodies we can 
 imagine these first leaders of our hospital traditions 
 confronted with the pathetic question: "Canst thou 
 minister unto a mind diseased?" In their life and 
 practise the first physicians of this hospital answered 
 "Yes." And they answered so clearly and consist- 
 ently that their influence, the tradition of Jackson and 
 Warren, has persisted, I believe, even to this day. 
 
 In the Annual Report for 1867, the precise but un- 
 inspired style characteristic of our Annual Reports 
 rises to true eloquence for once in their hundred years' 
 extent. That was the year of Dr. James Jackson's 
 death, and in the resolutions upon this event the 
 Trustees say: 
 
"His personal as well as professional qualities, his 
 activity without imprudence, his decision without dog- 
 matism, his conscientiousness that never provoked, 
 his exhaustless sympathies which made him the father 
 or the brother, as well as the physician, of those to 
 whom he ministered, bearing their troubles as his own 
 and alleviating by the charm of his presence the pains 
 he could not remove by his skill, — his unwearied 
 study, his fruitful knowledge, his contributions to the 
 science and literature of medicine, and his relations to 
 the elder and younger members of the profession gave 
 him a position at the hospital as exclusively his own as 
 that which he held in the community." 
 
 Since that time our daily ward service has repre- 
 sented, I think, the conscious attempt to continue that 
 tradition unimpaired. To make possible the conti- 
 nuity of this standard it has been necessary that the 
 trustees should consider always the character as well 
 as the professional attainments of those appointed to 
 serve in the hospital wards. Men of conscience, of 
 culture, of sympathy and integrity have been con- 
 stantly appointed upon our staff. The intellectual 
 and moral standards of this staff have been always its 
 most impressive lesson to the long procession of House 
 Officers and junior physicians who have passed through 
 this hospital. 
 
 Some years ago two very promising young House 
 Officers graduated from this institution and settled 
 with brilliant financial prospects, one of them in Cin- 
 cinnati, the other in Chicago. Within two years each 
 of these men wrote independently to a member of our 
 staff asking if it would not be possible for him to come 
 back here on some terms. They were willing to give 
 up first rate financial prospects for a bare subsistence 
 in this neighborhood, because their contact with the 
 tradition of Jackson and Warren as passed down to 
 them by such physicians as Dr. Frederick C. Shattuck, 
 Dr. James Minot, Dr. E. C. Cutler, and Dr. John 
 
 6 
 
Collins Warren, had spoiled them for commercialism 
 in medicine. They had found here certain ethical and 
 intellectual standards taken as a matter of course. I 
 mean the wise man's honest confession of ignorance, 
 the absence of suspicion, secrecy and backbiting, the 
 rule of fairness to others, the habitual thoroughness of 
 examination, record and subsequent study, the habit- 
 ual courtesy under conditions which tempt us to a 
 bald and mechanical type of intercourse, — all this 
 had sunk into their minds as it has sunk into those of 
 generation after generation of young physicians pass- 
 ing through their period of service in this hospital. 
 
 These high standards in the performance of the day's 
 work involve the double ability to find interest in what 
 seems monotonous and to bring interest into it. The 
 ability to be astonished and to be delighted is one of the 
 most reviving and sustaining characteristics of the 
 tradition passed on by our staff. I shall never forget 
 the lighted eye and kindled accent with which Dr. 
 Frederick C. Shattuck was accustomed when con- 
 fronted with a fine example of disease, to say, "God 
 bless my soul! Did you ever see anything like that?" 
 
 This spirit has been possible because the members 
 of our staff have been accustomed to bring the best of 
 themselves with them to the hospital and not to leave 
 behind them at home all except their technical equip- 
 ment. They have brought with them to the hospital 
 not merely their keen intellects and their well stored 
 memories, but their other human interests. So Dr. 
 Whittier brought always his still burning memories 
 of the Civil War. Dr. J. Mason Warren used often 
 to bring his children with him upon his hospital visits, 
 and many of us remember an amazing and mirth- 
 producing dachshund which followed Dr. Shattuck 
 about the wards. 
 
 We should be foolish to ignore here the influence of 
 heredity. If medical science has taught us anything 
 it is that blood tells, that stock is a fundamental factor 
 
 7 
 
in human worth and achievement. Hence, the better 
 members of our staff have passed on the accumula- 
 tions of a hundred years of strenuous, intelligent and 
 conscientious living, the gleanings of two continents, 
 the fruits of humane culture. 
 
 It has never been better exemplified than in this 
 hospital that true greatness is characterized especially 
 by modesty and unpretentiousness, that merit does 
 not have to trumpet its claims by titles or decorations 
 nor to hedge itself around with a wall of aloofness. 
 Our models and teachers in the daily work of the wards 
 have been as ready to learn as to teach, and to learn 
 even from their youngest and crudest assistant. 
 
 The tradition that I have tried to describe is, I be- 
 lieve, a genuine and persistent characteristic of our 
 city. Boston is no longer a literary centre, if it ever 
 was; but the practice of humane and skilful service 
 is, I believe, as strong with us at this hospital today as 
 it was a hundred years ago. It is a tradition that 
 holds fast something of the best yet achieved here, 
 thus by conservation making true progress possible. 
 And because many men have built their lives into the 
 structure of this tradition, giving the best they had to 
 offer, the spirit of this tradition is greater than that of 
 any single man, yet has an individuality all its own. 
 
 II 
 
 In Tables I and II I have jotted down some of the 
 most important items of our achievement, noting 
 first our material expansion and second some improve- 
 ments in the quality of our service. We have become 
 better, I think, as well as bigger. But I will speak of 
 our material growth first, though in some cases our 
 growth in size has meant an improvement in quality. 
 
 Material Expansion 
 
 The first twenty years of the hospital's life saw the 
 beginning and expansion of the Bulfinch building, the 
 
corner-stone of which was laid July 4th, 18 18, a cen- 
 tenary which, so far as I know, we did not notice or 
 commemorate last year. 
 
 The first important additions were the group of 
 buildings comprising the Thayer dormitory for nurses, 
 and those which we ordinarily call the "lower wards," 
 A, B, C, D, E, built during the years of 1874 to J 888 
 and providing a type of service but meagrely secured 
 in the older building, I mean the advantage of private 
 rooms. In 1896 came the construction of the new 
 pathological laboratory and the power house. With 
 this laboratory we secured one of the most important 
 improvements in the quality of our work, the genius 
 of Dr. James H. Wright as director of the new patho- 
 logical laboratory. All that now goes on in that busy 
 and diversified structure had to be done till 1896 in 
 a dark and narrow closet which now makes up a small 
 section of the Warren Library, a closet about ten feet 
 by six. 
 
 Between 1900 and 1903 some of the most important 
 of the buildings now in use were added, including the 
 new operating building, the domestic building, and 
 last, but most important, the new Out-Patient building. 
 By these three new structures I think we can say that 
 the daily work of the hospital took on quite a new com- 
 plexion. I noticed at once an improvement in the 
 patients' diet resulting from the new kitchen arrange- 
 ments of the domestic building. The new operating 
 building made possible much better organization and 
 multiplication of the necessary surgical operations, 
 while the new Out-Patient building, the finest of its 
 kind in the world, brought to the notice first of our- 
 selves and later of the rest of the country, the central 
 significance and value of Out-Patient work. 
 
 In rapid succession followed the building of the der- 
 matological and orthopedic wards, and not long after 
 of the new nurses' home. Finally, in 1915 and 1917, 
 came the last and in some ways most important addi- 
 
 9 
 
tions to our plant, the Moseley Administration Build- 
 ing (191 5) and the Phillips House (1917). 
 
 But this material expansion which enabled us to 
 care for more patients and give them better service, 
 has been still further increased by improvements in 
 organization and in treatment, through which we have 
 cut down the average stay of the individual patient 
 from n weeks as it was in 1855, to 18 days as it was in 
 1898, and approximately 11 days as it is now. This 
 enables us to give greater public service without in- 
 creasing the size of our expensive urban plant. The 
 plans for a country branch of this hospital now taking 
 shape in the minds of the Trustees will enable us to 
 cut the patient's stay in this urban hospital still shorter 
 and so to serve more people. 
 
 Table I — Some Significant Dates 
 
 1869 Lady visitors to female patients. 
 
 1870 Lady visitors to male patients. 
 
 1 871 Dr. R. H. Fitz, microscopist. 
 1873 Nurses Training School organized. 
 
 1889 Dr. R. H. Fitz, pathologist. (Appendicitis 1886.) 
 
 1896 Dr. J. H. Wright and Pathological Laboratory. 
 
 1903 New Out-Patient Department; also Children's Serv- 
 ice and Skin Ward. 
 
 1905 Dr. J. H. Pratt and Dr. John B. Hawes aggressively 
 attack Tb. 
 
 1905 Social Service. 
 
 1907 Dr. F. A. Washburn's Administration begins. 
 
 1907 X-Ray Department. 
 
 1908 First Continuous Service begins (Dr. F. C. Shattuck). 
 
 1909 Practitioners' Courses. 
 
 191 1 Surgical Residents (Paid). 
 
 1912 Staff Reorganized; Executive Committee created ; Dr. 
 
 D. L. Edsall arrives. 
 
 191 3 Department of Syphilis (Drs. Abner Post and C. 
 
 Morton Smith). 
 1913 Department of Industrial Diseases (Dr. Wade Wright). 
 1913 Clinic Secretaries. 
 
 191 3 Medical Resident (Dr. W. W. Palmer). 
 191 3 Out-Patient Department fee raised to 25 cents. 
 
 10 
 
191 5 Dr. Washburn proposes Consultation Clinic for per- 
 sons of moderate means. 
 191 5 Case Records begin to be circulated. 
 
 1917 Phillips House. 
 
 1918 Dr. Edsall organizes research. 
 
 191 8 Trustees plan hospital for persons of moderate means. 
 
 Improvements in the Quality of Service 
 
 (a) Diversification of Service. It is characteristic of 
 the personal devotion traditional in our profession that 
 the doctor is wont to try to do himself everything or 
 nearly everything that needs to be done for the patients. 
 Thus in my uncle, Dr. Samuel Cabot's time, when 
 the use of the clinical thermometer was introduced, all 
 temperatures were taken by the physicians themselves. 
 No nurse was allowed to use so delicate an instrument 
 of precision. So until very recently it was thought a 
 heresy akin to scandal to suggest that patients could 
 be admitted to the hospital wards or to the Out-Patient 
 Department by any one except a physician. Yet this 
 portion of our routine has long since passed over to 
 nurses. 
 
 In a similar way a considerable portion of our labo- 
 ratory work has passed into the hands of paid technicians 
 assisted by volunteers, and Fourth year medical stu- 
 dents are now employed as clinical clerks, for a con- 
 siderable portion of the year, to do work previously 
 thought proper only for a graduate physician. 
 
 The management and marshalling of patients in the 
 dispensary clinics, which used to be performed by 
 frantic and hasty medical assistants, is now quietly 
 and deftly performed by our volunteer clinic secretaries. 
 
 In the treatment of patients we have summoned to 
 our aid not merely the nurses who have always done 
 so much of it, but special therapeutic assistants in the 
 departments of hydro-therapy, mechanotherapy, mas- 
 sage, and in the dietetic management of diabetes. 
 Cure by occupation is also well established in our wards, 
 owing largely to the devotion of Miss Brackett. 
 
 Something of the variety and volume of service now 
 
 11 
 
given in this hospital can be seen from Table II (Per- 
 sons serving the Hospital). The volume of service is 
 seen in Table III. 
 
 Here I should like merely to note in connection with 
 the therapeutic assistants in the field of hydro-therapy, 
 that this branch of service began in June 1824, when a 
 cold and warm salt-water bathing house was erected 
 on the seashore, which then directly touched our walls. 
 
 Table II — Persons Serving The Patients at 
 the Massachusetts General Hospital (1919) 
 
 Trustees 12 
 
 Consultants 12 
 
 Committee Members 46 
 
 Physicians and Surgeons 216 
 
 Research Physicians 9 
 
 Nurses 455 
 
 Orderlies and Maids * TJ 
 
 Technicians 8 
 
 Social Service : Paid 24 
 
 Volunteer 61 
 
 Clinic Secretaries and Laboratory Volunteers 32 
 
 Therapeutic Assistants 5 
 
 Library Staff and 0. P. D. Records 15 
 
 Household Staff v 112 
 
 Engineers, Carpenters, Gardeners, and 
 
 Chauffeurs, etc 17 
 
 Clerical Staff 20 
 
 Total 1,121 
 
 Table III — Population Served by the 
 Massachusetts General Hospital (1919)* 
 
 Ward Patients (1917) 6699 
 
 Out-Patients, new (1917) 31 104 
 
 Out-Patient visits (1917) 203524 
 
 Case Record Subscribers 1803 
 
 Physicians (2 weekly public exercises) (about) 100 
 
 Students: Social work (a week) 15 
 
 Medical Undergraduates (yearly) .... 270 
 
 Medical Postgraduates (yearly) (about) 300 
 
 Nurses (yearly) 224 
 
 Total (omitting Out-Patient visits) 40,515 
 
 *Except as noted in first three items. 
 
 12 
 
Concentration of Attention and Attack Upon 
 One Disease at a Time 
 
 In 1905, through the energy and ingenuity of Dr. 
 J. H. Pratt and Dr. John B. Hawes, Jr., the hospital 
 assumed a new attitude towards one disease — tubercu- 
 losis, an attitude which, I think may be characterized 
 as aggressive. Instead of waiting passively for disease 
 to present itself at our doors in the persons of individual 
 patients, we began to seek it out in its own lairs with 
 the hope of crushing it altogether. The attack upon 
 tuberculosis was followed not long after by the attack 
 upon syphilis as a separate disease and by the organ- 
 ization of our syphilis clinic under Drs. Abner Post 
 and C. Morton Smith. I venture to believe that this 
 clinic has no equal in this or any other country, and 
 that its success is due to the amount of attention and 
 interest concentrated upon a single group of patients 
 whose problems are so much the same that unusual 
 skill can be accumulated in dealing with them. 
 
 Following the example of Dr. Pratt's tuberculosis 
 class, Dr. F. G. Brigham organized five years ago our 
 first class for diabetics, which has since been a very 
 useful and instructive feature of oui work. Since 
 the poliomyelitis epidemic (19 16) this disease is also 
 treated in a clinic by itself. Hay fever and asthma are 
 now receiving the advantages of a special clinic and 
 staff, the advances in our organization corresponding 
 with the advances in our ability to treat these 
 diseases successfully. 
 
 The clinic for industrial diseases established by Dr. 
 Wade Wright just before the war emphasized two prin- 
 ciples: first, that just exemplified, the concentration of 
 attention upon one group of diseases in isolation from 
 the rest, and second our increased awareness of the in- 
 dustrial world and the mischief wrought by it, an 
 awareness shared by the hospital with the rest of society 
 at the present time. 
 
 13 
 
Social Service 
 
 In 1905 came the organization of Social Service work, 
 which after a precarious and checkered career has now 
 become an established part not only of this but of all 
 other first-rate hospitals in this country, and has re- 
 cently taken root, through the efforts of your foreign 
 service branch, in France. 
 
 The Circulation of Our Case Records 
 In This And Other Countries 
 
 Since 191 5 the benefits of some of the knowledge 
 gained in our hospital have been spread to cities and 
 countries very far from our gates. It has always been 
 the policy of this hospital to serve the physicians not 
 connected with its staff so far as this service was con- 
 sistent with the best welfare of its patients. But now 
 by means of published records of our work sent out 
 each week throughout this and other countries, we are 
 enabled to extend our service very much further than 
 was possible before 191 5. 
 
 The standards of this hospital, its standards of 
 record systems, of physical examination, of patholog- 
 ical examination after death, and of diagnostic reason- 
 ing are thus made of value outside our walls. 
 
 Table IV — Subscribers to "Case Records" 
 
 United States 1491 
 
 (Massachusetts 96) 
 
 Canada 65 
 
 South America 16 
 
 West Indies 1 1 
 
 Canal Zone 2 
 
 Hawaii 4 
 
 Philippines 6 
 
 Europe 18 
 
 Asia 11 
 
 Africa 2 
 
 Australia 101 
 
Clinic Secretaries 
 
 I have already mentioned the advantages in the 
 administration and organization of our Out-Patient 
 clinics that have resulted from the introduction of 
 clinic secretaries. This was primarily the work of 
 Mrs. Roger I. Lee, then Miss Ella Lyman, who was the 
 first to demonstrate to the hospital authorities that a 
 young, well-bred but unskilled girl could accomplish 
 something of signal usefulness in the medical routine 
 of the institution. There is nothing like this so far as 
 I know in any other hospital, but doubtless like the 
 other inventions of this institution it will be imitated 
 elsewhere. 
 
 Consultation Clinic For Persons Of 
 Moderate Means 
 
 Just before the war, owing to the progressive attitude 
 and foresight of Dr. F. A. Washburn, the hospital took 
 the radical step of establishing in the Out-Patient 
 Department a clinic at which persons on the payment 
 of $5.00 were able to get the combined services of the 
 different medical specialties now necessary for a thor- 
 ough diagnosis and rational treatment of disease. It 
 is becoming increasingly obvious that no single phy- 
 sician is wise enough to furnish all the data necessary 
 for a modern diagnosis. The co-operation of labora- 
 tory experts, X-Ray experts, specialists in the different 
 fields of medical diagnosis, is often necessary if a com- 
 mon disease such as rheumatism or stomach trouble 
 is to be traced to its causes and properly treated. This 
 clinic for persons of moderate means, unable to pay 
 the services of all the specialists needed for the proper 
 study of their cases, was an innovation in medical 
 service and pointed the way to another of the most 
 important extensions of policy ever made in the history 
 of this hospital, namely: 
 
 15 
 
The Rounding Out Of Our Hospital Plan 
 And Policy So That We May Serve All 
 Classes 
 
 In their last two reports the Trustees of this hospital 
 have taken a step involving, I think, signal foresight 
 and courage. They have resolved to put this hospital 
 as far and as fast as they can at the service not merely of 
 the poor, as it was before the erection of the Phillips 
 House, or of the poor and the rich as it now is, but of 
 all classes including the numerous persons of moderate 
 means who now receive a most unsatisfactory type of 
 medical service. The poor and the rich can get-up-to- 
 date treatment; the great body of those financially 
 intermediate cannot. 
 
 The Organization of Research Under the 
 Direction of Dr. Edsall 
 
 I have passed over without mention the brilliant 
 discoveries of Morton, of Henry J. Bigelow and R. H. 
 Fitz which brought reputation to this hospital in the 
 earlier years of its existence. It is not likely that the 
 quality of their scientific work will be exceeded in the 
 future. But it may be pointed out that the work of 
 these men resembled in some ways the gains of the 
 earlier Harvard football teams. It was done by bold 
 and brilliant individualists. It was not organized or 
 put into the hands of those whose chief purpose centred 
 here. 
 
 The beginning of this new organization of research 
 work is due, like many of the best things that have 
 happened in this hospital of late, to the advent of Dr. 
 David L. Edsall. Touching the high points in the hos- 
 pital's history we might say that the tradition of 
 service established by Jackson and Warren, the bril- 
 liant discoveries of Morton, Bigelow and Fitz, and the 
 better organization introduced by Washburn and 
 Edsall represent the peaks of our achievement. 
 
 16 
 
Prospects 
 i. closer relations of trustees and staff 
 
 What now of the future? One of the best promises 
 of our future growth is contained in the striking in- 
 crease in activity and interest manifested by the Board 
 of Trustees in recent years. I say manifested, for what 
 I speak of is wholly what the staff is able to see. The 
 staff has always known that the trustees were at the 
 helm, guiding our vessel wisely. But until within 
 recent years we have seen and known but little of them 
 and their activities. Now we are in constant touch 
 with them and we know that they are carrying out the 
 old tradition of the hospital in their present proposal 
 to appeal for new hospital funds. 
 
 In 1816, although the foundations of the hospital 
 had not then been laid, the Trustees decided to make 
 an appeal in behalf of the institution over which they 
 nominally presided. After issuing letters and circulars 
 they "divided themselves into four committees and 
 abandoning their private affairs for a season they went 
 through the streets day after day soliciting subscrip- 
 tions from all," and in this way raised $846,000 within 
 a few days. Doubtless we shall soon see committees 
 of our trustees taking to the streets on a similar errand 
 of mercy. 
 
 II. BRING THE WORLD'S BEST HERE 
 
 Judging from our path as we look backwards over it, 
 we may hope to continue a reform begun in the medical 
 service and in the department of pathology, namely, 
 the infusion of new blood into the hospital by bringing 
 here the best men obtainable from outside our city. 
 It is not enough for the hospital to do its ward work 
 conscientiously and to organize teaching and research 
 within its walls; it must also extend its influence and its 
 vision extra-murally. One of the first results of such a 
 vision will be to bring us new blood. Dr. Edsall ever 
 
 17 
 
since his coming has personified in our executive com- 
 mittee and in all our councils a wide awareness of what 
 is going on in other medical centres of this country. 
 He has never let us fall behind or get left out of any 
 of the important movements towards better service 
 occurring elsewhere. 
 
 May we not hope that some arrangement may be 
 made here such as has been made at the Mayo Clinic, 
 whereby our awareness of whatjs going on in the med- 
 ical centres of this and other countries may not be left 
 to chance or to the transplantation into our midst of a 
 single enlightening personality like Dr. Edsall? As we 
 recently sent Mrs. Myers, the head of our medical 
 library, on a trip to familiarize herself with the other 
 medical libraries and record rooms of the country, as 
 we recently took advantage of Dr. Paul D. White's 
 journey to England to have him bring back to us the 
 best of knowledge and of new instruments for the study 
 of the heart, so we ought to hope that in some way the 
 hospital will provide for a constant stream of new in- 
 formation from outside our walls. 
 
 III. STUDY OF INTAKE 
 
 We have begun at last to study intake. A new and 
 enlightening policy of the trustees now focuses our 
 attention upon the question: — "Are we now taking 
 into the hospital such persons as we can best serve?" 
 Hitherto we have been passive in this matter. We 
 have indeed selected among those who came to us, but 
 we have never reached out to inquire whether there 
 were any others who needed us as much as those whom 
 we are now serving, or perhaps more, but who are not 
 aware of our existence or cannot gain admission here. 
 Perhaps we shall soon be bold enough to make this 
 hospital really known as it should be known to those 
 who need it. The word "advertise" is not in line with 
 our traditions, but we must accomplish the same re- 
 sults without the word. 
 
IV. MEDICAL ORGANIZATION FOR THE PUBLIC GOOD 
 
 Our recent achievements and plans make it possible 
 to hope that in the future we shall organize medical 
 service for the public's good without any fear of an 
 indignant medical minority. We have seen so much 
 of late of the tyranny of minorities in other fields that 
 I think we are awakened as never before to their dangers. 
 If we serve the community as we should, we shall cer- 
 tainly arouse the indignation of some of the less en- 
 lightened of our professional brethren. We have done 
 so already and served the public none the less. We 
 must be prepared to do so again. 
 
 V. EXCHANGE OF STAFF MEMBERS WITH OTHER 
 HOSPITALS 
 
 This year for the first time so far as I know in our 
 history a member of the staff of this hospital has been 
 giving medical instruction in another hospital, the 
 Peter Bent Brigham. This may well enough become 
 a fruitful precedent. Why should, we not have ex- 
 change professors and exchange hospital services along 
 the lines already laid out in the hospital last referred to? 
 Surely such an exchange would increase our vision, 
 extend our influence outside our walls and bring new 
 life within them. 
 
 VI. EXTRA-MURAL RESPONSIBILITIES 
 
 It seems to me almost inevitable that we shall take 
 more and more part in the life of the community out- 
 side our walls. The patients who come to us present 
 a sample of conditions as they exist in the community 
 outside. As a bucket let down into an artesian well 
 or into the ocean brings up from the bottom a sample 
 of what is widely distributed there, so a patient with 
 lead poisoning, with tuberculosis, with a court record, 
 with a truancy record, brings us into touch with con- 
 ditions which we should not ignore. We can serve the 
 
 19 
 
community by assisting the schools, the courts, the 
 industrial plants, and the public health authorities to 
 quell the diseases of which we see samples in our Out- 
 Patient clinics or in our wards. 
 
 VII. END RESULTS 
 
 We still know far too little about the progress of our 
 patients after they leave our wards. The rebukes and 
 warnings of Dr. E. A. Codman in relation to our igno- 
 rance of our end results are for the most part deserved. 
 From the point of view of science as well as of humanity, 
 in order that we may improve our prognosis and our 
 treatment, we ought to know more about our results. 
 This will cost money and time, but without it we shall 
 not be keeping up with our traditions. 
 
 VIII. THERAPEUTIC RESEARCH 
 
 I cannot but hope that the organization of research 
 under the leadership of Dr. Edsall will result in making 
 the general plan and trend of American medical re- 
 search less one-sided. We have had a tremendous 
 amount of investigation into the causes and nature of 
 disease. We needed it all and more. But surely we 
 should balance it by more investigation of prognosis 
 and therapeutics. Investigation into the treatment 
 of disease languishes in this country. Who can 
 undertake it better than the research group now 
 developed at this hospital under the leadership of 
 Dr. Edsall? 
 
 IX. FURTHER UNIVERSITY CONNECTIONS 
 
 Can we not unite ourselves with some of the academic 
 departments of Harvard University, both for their 
 benefit and ours? The departments of sociology and 
 psychology, of physics and chemistry surely have some- 
 thing to give us and something to learn from us. Are 
 we not neglecting some of the opportunities presented 
 by our closeness to this great university? 
 
 20 
 
X. BETTER CARE OF CONVALESCENTS 
 
 The Trustees' plan for a country branch and the 
 present concentration of interest in convalescence through 
 (a) occupational therapy, (b) physical therapeutics, 
 and (c) the special interest of Dr. John Bryant, leads 
 me to hope that we shall take the lead in solving the 
 largely neglected problems of convalescence. It is 
 unfortunately true that in our ward work we lose some 
 of our interest in the patient when he begins to con- 
 valesce. This means a loss of efficiency in the institu- 
 tion as well as an injustice to the patient. The conva- 
 lescence of our patients might be shorter as well as more 
 complete if we put more energy and more attention 
 upon it. 
 
 I have passed in rapid and sketchy review what 
 seems to me most important in the standards, achieve- 
 ments and prospects of this hospital. As we grow in 
 size and in numbers shall we be able to keep the Jackson- 
 Warren spirit? Or as we develop into a huge and 
 diversified industry shall we become as mechanical and 
 as soulless as a factory? 
 
 We shall avoid it, I think, by the organization of 
 small, relatively independent units within the hospital. 
 The homelike and humane spirit of a small institution 
 such as this hospital was in the first half century of its 
 existence, can be kept, I hope and believe, if we can 
 organize the different parts of the institution into rel- 
 atively self-sufficient units in each of which the ad- 
 vantages of smallness and intimacy can be preserved. 
 
 Shall we be able to conserve what is best in our tra- 
 ditions and yet to grow with our time?' 
 
 I believe so, because we shall take the best of what 
 is new from outside our walls and domesticate it here, 
 as we have domesticated Dr. James H. Wright and 
 Dr. Edsall, always aware that because we have done 
 good work in the past we all the more need reforming. 
 
 21 
 
I believe we have never done work as good as we are 
 now doing, and yet I trust that we shall never in future 
 do work as poor. 
 
 Shall we be able to keep in organic unity the three 
 proper activities of a hospital? 
 
 I believe that we shall not lose the tradition of high 
 standard of daily work because we shall never lose our 
 connection with humane culture, maintained through 
 the interest and visits of our trustees, of our lady vis- 
 itors, and of our volunteers. I believe that we shall 
 not lose the spirit of scientific research because we shall 
 realize that only by teaching and research, only by 
 ever closer connection with academic institutions can 
 we free ourselves from the evils of routine and of stag- 
 nation. "I read," said Thomas Arnold, "enough to 
 keep my mind in the state of a running stream; for it is 
 ill drinking out of a pond whose stock of water is merely 
 the remains of the long past rains of the winter and 
 spring, evaporating and diminishing with every succes- 
 sive day of drought." 
 
 We shall keep the scientific spirit, the spirit of the 
 running stream because it is necessary to avoid stag- 
 nation in our routine ward work. 
 
 We shall keep our vision and our influence upon the 
 world outside our walls through the establishment of 
 exchange services and exchange professorships, through 
 the initiative of our social service department and 
 through the cosmopolitanism of the best members of 
 our staff. 
 
 22 
 
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 The achievements . standards_and 
 
 prospects of the Massachusetts 
 
 A.