In spite of the pecuniary distress from which I constantly suffered, I was happier in Cleveland than ever before or since. I lived in my element, having a fixed purpose in view and enjoying the warmest tokens of real friendship. I was liked in college, and though the students often found it impossible to repress a hearty laugh at my ridiculous blunders in English, they always showed me respect and fellowship in the highest sense of the terms. After receiving the degree of “M.D.” and leaving the college behind me, it seems quite right to stop for a few moments and cast a retrospective glance at my own situation, objectively. I wonder whether any one can justly claim that one has always followed a well-laid plan in life, or whether conditions and environment do not mold our actions, sustain our firmness and fortify our persistence in following or working towards a positive aim. I do not think that in youth the individual shapes the _modus operandi_ of any undertaking. In spite of having a vague idea, or even a strong desire to carry into effect such an idea, environment as well as outside influences must come to the aid, in order to keep alive and to nourish the hope that his preconceived idea or desire can ever be realized. Without such assistance, the young aspirant can easily be diverted and led into spheres of action not intended or desired in the first instance. After we become older, we may honestly imagine that we followed a regularly planned course in life, when we really lived simply according to whatever chances from time to time molded or influenced our activity. During the years from 1850 to March, 1856, it now seems to me that no definite plan determined my action, and that all that guided me was the strong desire to make for myself “an independent livelihood” and to assist all persons who felt that same strong desire. Several times I was tempted to change my field of work so as to obtain this independence. For instance, in Berlin, after leaving the Charité Hospital, offers were made to me by eminent physicians to take charge of private hospitals which were then beginning to be started, especially for surgery. I did not accept these offers, partly because they again placed me in dependence and partly because surgery had been distasteful to me as it was then practiced, without anesthetics, the use of neither ether nor chloroform having become general. So, as we reason from the concrete to the abstract, I doubt that any one, man or woman, can stand up and declare that one has achieved exactly what one hoped to achieve when entering upon the battlefield of active life. There is no doubt that an intrinsic fitness for a certain kind of activity guides us towards such influences as we need to develop this fitness, but that is all.