CHAPTER V Every ambitious man has been impressed by certain lessons (Part 1)

CHAPTER V Every ambitious man has been impressed by certain lessons which have served to guide him through life. A very early lesson occurred on one of my first days in New York City. I wanted to cross Broadway at Fulton Street, but waited a long time before there appeared to be any sort of chance to get past the crowding vehicles. While I was waiting another young man came along with a newspaper in his hand, started straight across the street behind one team, followed a long way down to get in front of another one, and then a long way back to escape another. He made several extensive zig-zags before arriving upon the other side, but he got there while I was doing nothing. It occurred to me that all sorts of getting through life depend largely upon disregard of the expenditure of energy required for getting to any one objective point so long as a fellow gets there. Another one of the things which impressed me greatly and served as a guiding influence was when a man leaned against a loaded canal boat with his feet against the dock. From his actions I judged that he knew what he was about, and it was not many minutes before the boat began to swing clear from the dock. The fact that anything so small as a man could overcome the inertia of anything so large as that great boat by simple calm persistence, while the man was quietly smoking his pipe, made me feel that one could accomplish almost any- 358 TO-MORROWS TOPICS 239 thing that he desired, in overcoming the inertia of his pro- fession, by simply making pressure at any one new point persistently until the whole profession moved. It has been necessary, however, to study many ways for keeping up the pressure. Sometimes it has been through choice of diction which might be called sensational, — something of which I would not approve for a moment in the speaking or writing of anyone else, — particularly if his views were different from mine. Trained in accurate method and precise statement by teach- ers at college and in the medical school, I found myself (when launched into the profession) making new adaptation to con- ditions, by presenting subjects in a way that would take hold, — when speaking or writing. That seemed to be the essential thing, although quite different from anything which had been inculcated by revered teachers. The profession was not then ready for the clear calm science that is demanded of speakers and writers to-day. It happened to be the transition period of emergence of the profession into new doctrines of antisepsis and asepsis. Many other brand new subjects, hissing hot from the laboratory and clinic, required to be hammered quickly into the rivet holes of rapidly up-going professional thought at that time. Four of us in particular who chose similar methods of presentation of subjects at national society meetings, were counted upon to keep the surgical section awake, and the remark was commonly made that "We cannot have a good section meeting unless M., P., D., and M. are there." Dear old P. and I suffered from the results of our method of advancing ideas, because we were not facile enough at protecting ourselves against the violent personal criticism which was hurled at us in return. D. and M. were much more expert at fighting for their own legitimate rights, and became teachers who later occupied more important posi* 340 TO-MORROW'S TOPICS 41 >ne of us ^M les. The ^ tions than were attained by P. or by me. neither one being good at a battle for anything excepting principles. all-around fighting capacities of D, and M. always excited my deepest admiration, and they won out in the presence of that conservative element in the profession which has always approved of more dehberate and slower methods of estab- Hshing new ideas. Pretty well up to the later eighties it was not unusual for readers of papers at medical society meetings to assume a disarming air of modesty in their open- ing words, and later a manner of invincible authority as the subject deepened. Meanwhile the audience became drowsy with trustful confidence in its own opinions. Good men in the audience occasionally slept. When they awakened at the end of the reading of a paper, it was like suddenly awakening when a clock stops. They congratulated and complimented the reader of the paper in his presence, but after the meeting was over and the reader absent they proceeded to clip him out of their frames of thought. One very early determination of mine was to keep men in audiences awake at least, by open controversy in their presence. Another early determination was to bestow little of compliment upon any paper which implied its own inherent compliment; weak points only were to call for discussion. After a meeting had adjourned my plan was always to stand up for the absent man and discourage any adverse criticism when he was not present to make re- sponse. This plan of procedure was more or less revolu- tionary and different from established custom at that time. A great change has lately come over the profession. Speakers and writers who now engage the most earnest and eager attention of colleagues are the ones who can present subjects in that spirit which has made pure mathematics the symbol and the sum of all that is farthest-reaching, most definite, most fundamental, and best corroborated among intellectual I I TO-MORROW'S TOPICS 241 activities. From the mountain-top of a higher criticism doctors now gaze in admiration over the far Hung valley of a new idea, but instead of becoming enraptured with its beauty j they analytically ask what grows there. Another feature of my habits of work is perhaps not a desirable one for young men to follow. It represents an individual characteristic, however, and so long as there is plenty of work to be done along lines of least resistance I cannot take time now to mark out other and better methods. This is a tendency to drop any given Hue of research as soon as a result has been achieved, but before the subject has been well rounded out with data. People commonly expect a man to take charge of his own ideas and not bother the world with them until the world can obtain his completed product. In my professional work each new subject has developed into such wonderful proportions that the greatest degree of satis- faction has been found in simply following a line of thought to some conclusion, publishing the conclusion and then allow- ing others to look after details of completing the product. This happy-go-lucky spirit is not commendable excepting in some of its compensations, but it allows one to gather pollen from widely separated flowers and to make something good out of the mixture. My beloved friend. Dr. Andrew D. White, holds that the highest function of an educator, or of one who passes as such, is to set men at thinking. People then work things out in their own way along lines which have been shown by an innovator. When physicians say critically that I should round out and complete any new subject which is taken up, the response is that my function ends with setting them at thinking. Their better minds will produce better end- results than mine would have produced. The extent to which my work had been impressionistic rather than classifiable in a scientific way was not apparent 242 TO-MORRO\^S TOPICS until some friends proposed to send a rccxxd of data to the Xobel Committee. This was done by Dr. R. in die jrear 1907. Akhough my work mig^t be reckoned in terms of influence relating to the sa'ing of lives, it seemed mere play when com- pared with the work that had been done by odier American surgeons. The prize which went to Dr. GuUstrand some time later indicates the sort of work of which the Xobd Committee would really approve. Work like that of Dr. Gnllstrand could be definitely classified. He is said by ophthalnxdogists to have advanced the science of refracticm very considerably with his work on the dioptrics of the eye, which constitutes one of the volumes of Tigersted*s Cyclopedia of Physiological Methods. His results could be stated in almost mathematical terms, and they made a contrast with my diffuse work which had been aimed toward establishment of the principles of the fourth era in surgery for instance. H one has de'oted years to the accumulation of backing for a single phrase which would result in the saving of lives the matter could not be stated in a convincing way for a committee. The method of measure- ment of a certain type of corneal refraction, however, may be shown graphically upon a chart. It is a difficult matter for any prize committee to judge of the effects of work which has not been reduced to definite data. I have served frequently enough on committees to know the value of careful arrangement of accurate statement which leaves little to the imagination. In our profession it becomes a matter of necessity for investigators to devote close and concentrated attention to any new subject for awhile in order to comprehend all of its various features. It is somewhat similar to the process fol- lowed by the lawyer who is preparing a brief. The lawyer has authorities whose quotations may be assembled rather definitely and rapidly upon any given point. In medicine how- TO-MORROW'S TOPICS ever, one must usually try out a combination of ideas of authorities together with his own ideas for a longer period of time than is required by the lawyer for making a point. Hence the charge is often made against the investigating doctor, that he is riding a hobby. The mental process which subjects him to criticism is similar to that which is considered to be com- mendable for a lawyer. An inmate of an insane asylum ^ observed one day sitting astride of a saw horse. A visitor asked him what he was doing, and the reply was that he was riding a hobby horse. The visitor asked him the difterence between a hobby horse and a real horse, to which he replied that one could get off from a real horse. Now in our work perhaps the most desirable thing is a sort of hobby method which may be described by a mule word, made up of the old French hobi and the Latin equtis. An hobequs then is the thing we are to ride persistently until all its paces have been shown. We then dismount and vault into the saddle of an- other one. The psychologist would describe the hobequs as a phenomenon of attention concentrated upon one subject with- out regard for relative values until the subject has been mastered. One doctor is always afraid that such a thing ridden by another doctor may turn out to be a runaway. Such fears are proper and well grounded upon experience. An hobequs might be termed a trained variety of mono- ideism. Mono-ideism is born when for any reason a subject comes so clearly into consciousness that side lights are reflected away from it. This represents the wild form. Dr. Shaw says that the wild form is ruthless in the pursuit of its ends. All considerations of fairness, of propriety, of regard for the feelings of others are ignored, and toleration is a forgotten word. Incoming ideas must be made to conform to the par- ticular dominant one, and if they cannot be made to harmonize .they must be scouted as irrelevant. Mono-ideism apart from 244 TO-MORROW'S TOPICS the motive which guides it automatically as an obsession may 1 allow a man to remain quite normal in his other relations to the people about him. Examples of the wild form are to be observed daily among politicians, economists, warriors and artists. The cultivated form of mono-ideism is like cultivated varieties of almost anything, larger and more useful for man's purposes. When well trained as an hobequs it becomes a fine plagiarist and appropriates anything which may serve for purposes of nutrition. Under the influence of scientific method it discards nothing as being irrelevant until accurate test has been made. It becomes docile, and allows a man to dismount quietly at any time, thereby averting the dangers which belong to the violent bucking of an irritated wild mono- ideism. My first hobequs belonged wholly to somebody else. While I was on the house-staff at Bellevue Hospital (1883-1884) Dr. Lange and Dr. Stephen Smith, of the visiting staff, were seriously teaching the new antiseptic surgery. At the New York Hospital, Dr. Weir first and then Dr. Bull had adopted the theories and were carrying them into practice, but aside from these leaders, and younger men who were assisting them, there were few men in New York who fully understood the principles that were involved. (Perhaps there were more sur- geons who understood the principles than there were surgeons who knew how to carry them into practice. ) Immediately upon completing my term of service at Bellevue Hospital I ran over to Europe to see the founder of antiseptic surgery— Mr. Lister, and also Mr. Cheyne and the German surgeons who were advancing the subject at that time. Upon my return, a year later, finding bitter controversy still going on, I sat down to a task of duty and in a few days had completed the material for a little book entitled "How We Treat Wounds To-day," J TO-MORROW'S TOPICS 245 which represented new antiseptic methods and was opposed to the common methods of procedure of established surgery at that time. Before offering the manuscript for publication a medical editor of note. Dr. Shrady, was asked if he would kindly make comments. He advised me in a fatherly way not to publish the book, and said that while its material would be of service, the manner of presentation would hurt me per- sonally with the sort of men upon whom a young man was to depend for advancement in professional position. (He was quite right about that. ) The manuscript was then taken to Dr. Weir, who said : "Publish the book but be prepared to take the consequences of your show of syllogistic fists." The book was published by the Putnams and went to every part of America, — in fact to every comer of the world. It was promptly adopted by the Surgeon-General of the United States Army. Whatever I have done has almost constantly been against advice of men who were consulted, but their attitude has been generally friendly, and merely expressed the idea that they did not wish to see me harmed. When talking with men of various occupations in business and in the professions, this appears to be such a common experience that one would arrive naturally enough at the conclusion that the right way to do things is one's own way, and a man is then to stand the consequences, — always good-naturedly. When this book on wound treatment was published in 1885, many surgeons who wished to be most kind said that antiseptic surgery was fanciful in theory and impracticable in application. The ones who did not wish to be friendly said that all of us who advocated the system were charlatans or quacks, trying to make capital out of a theory that was capti- vating to men with little practical sense. A few years later there was not only universal acceptance of the antiseptic theory, but it was superseded by aseptic surgery, which included 9046 TO-MORROWS TOPICS I more fully the idea of keeping bacteria out of wounds rather than destroying them once they were in. At the present day young men in the profession cannot realize that the small handful of us who fought for antisepsis and asepsis in New York in the early eighties were subjected to violent attack. It represented nature's method for preventing too rapid prog- ress. The history of warfare for the establishment of new subjects like those of antisepsis and asepsis must be repre- sented many times in days that are to come. Otherwise medi- cine would make progress beyond all other sciences. It is a demonstration of the omnipotence of the balance of nature. Few men realize this fundamental feature of omnipotence of the balance of nature as applied to progress in the sciences, although naturalists are quite familiar with the subject in its relation to the contests belonging to organic life. A few of the typical press notices called forth by the publi- cation of my first little book are here quoted to show how the subject was looked upon at that time. 1. "This book is rich in bombast, but destitute of any prac- tical value." Medical Bulletin, November, 1886. 2. "The book is so thoroughly practical that it must be com- mended to those who wish to acquire an exact knowledge of the details of antiseptic treatment." — Boston Medical and Surgical Journal, 1886. 3. "This beyond doubt is as contemptible a book as was ever written for medical men. , , . The style to be expected from an ardent partisan with little knowledge and bad taste," — Medical Herald, November, 1886. 4. "Mais ce rapide apercu ne peut donner qu'une idee fort insuffisante de ce precieux petit traite. et nous nc saurions trop en recommander la lecture." Rez'ue de Chirurgie, Decem- ber 10, 1886. 5. "A prominent example of superlatively bad style and TO-MORROWS TOPICS 247 sophistical reasoning." Southern PractitioHcr, December, 1886. 6. "The plan of the volume is capital. Every page abounds in practical hints from an evidently practical surgeon." Lon- don Medical Press and Circular, June 30, 1886. These press notices represent pretty well the two-sided atti- tude of the profession toward everything that I