346 FAMOUS LIVING AMERICANS hospitals has improved. In consequence there has come about a far-reaching effect. Forty years ago cities with less than fifty thousand inhab- itants were without hospitals. As surgery has never devel- oped apart from hospitals all such communities were without the service of resident surgeons. When there was need for surgical service the patient was carried a long distance to the surgeon or else the surgeon assembled an operative equip- menty called together his assistants, and traveled to the pa- tient. For either of these methods time was required. In consequence, emergency surgery generally went unattended to or operation was done when the patient was in extremis. The methods of that day could not mean any sort of good results in suppurative appendicitis, gunshot wounds of the abdomen, strangulated hernia and a score of other conditions which these illustrations serve to bring to mind. At the present time even communities of five thousand in- habitants have their hospitals and resident surgeons. Barely now do patients go to the city for emergency operations. The people are discovering that for such operations the local sur- geon in a position to operate quickly is more successful than the surgeon who comes out from the city and who therefore is some hours longer in rendering his service. In order that this epoch-marking change should have been possible several things were necessary. One of these was op- portunity for the training of surgeons. It was necessary to supplement the work of undergraduate colleges by the develop- ment of great surgical clinics, to which practitioners of med- icine might go and perfect themselves in surgical technique. There are no state-supported clinics for post-graduate in- struction in this country but for twenty years the Murphy clinic has had a daily attendance of a hundred or more. These men have come from all parts of the country. They have come without formality, remained as long as they cared to^ and, having seen at close range the methods employed, they have gone back home and made use of them in their local hos- pitals. Material for the maintenance of such a clinic is not enough*
