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{Reprinted from the Montreal Medical Journal, November, 1896.) 
 
 THE RESPONSIBILITY OF THE STUDENT OF MEDICINE. 
 
 BY ', 1 . 
 
 H. A. liAKLicUB, R.A., M.D., 
 
 Assistant Profes.>ior of Medicine and Associate. Professor of Clinical Medicine 
 McCrill University, Assistant Physician to the Montreal (Jeneral Hospital. 
 
 Another acjulemic year has rolled by, and t()-uay marks the ofliciaj 
 opening of the sixty-fourth session of the Faculty of Medicine. I 
 say official advisedly, for at least three-fourths of your number have 
 already some time since girded your loins after the summer siesta and 
 started in earnest on the steep and rugged path which leads to the 
 tree of knowledge and, let us hope also the fountain of wisdom. 
 I trust, nevertheless, that a few of the things I wish to .say to you 
 may not savor too mucli of , as the French say, f(pms diner moii- 
 tarde — and that my remarks ma^ l»e of assistance both to those 
 who are on the road and to those whose journey begins to day. 
 If one may ju<]ge from one's persi nal experience, a word of advice 
 conies not amiss in such circumstances. I can I'ecollect distinctly the 
 feeling of helplessness, of vague groping and uncertainty, that came 
 over me at certain periods of my medical course — particularly the 
 introduction to a new and unfamiliar class of studies— and many 
 times the advice of a senior college mate or, better still, of one of my 
 teachers served to dispel doultt and bring light out of darkness. 
 
 In the first place, on behalf of my colleagues in the faculty, I extend 
 to you all a cordial welcome, none the less cordial because official 
 and collective. You obtain thereby your place in the sphere of intel- 
 lectual eff •> which we are all units striving toward a common goal- 
 the furthe .^ of the science and art of medicine, and co-incitlently of 
 medical education. 
 
 'j'hnse of you who ai"e entering these class-rooms for the first time 
 may posisibly not have realized the re.sponsibilitie.s— immediate and 
 prospective, and they are not light ones — which such a step entails, 
 The immediate responsibility is that of working earnestly to the best 
 of 3'our ability during the four years of your course, acquiring such 
 knowledge of, and skill in your profession as will make you a credit 
 to the institution that has given you your training and conferred 
 upon you a widely-known and respected degree. The prospective 
 responsibility is the one contained in the oath exacteil from you on 
 your graduation-day — to practice medicine : CaiUe, caste et probe. Of 
 the latter I shall say nothing. It shall be the duty of one of my 
 
 iV 
 
 ./ 
 
2 
 
 colleagues, ripened in years and wisdom, to enforce its soloinn sim- 
 plicity upon a chosen few of you at the end of this session. 
 
 It is of the first of these responsibilities that I wish to speak. You 
 are beginning, or have begun, the study of medicine presumably with 
 the view of eventually practising that profession. For prudential 
 reasons — to take the lowest motive first — it behooves you from the 
 first to make the very best use of your time. Competition — sharp, 
 not to say at times unscrupulous — which has made mercantile pur- 
 suits so uncertain, and in many cases but barely renmnerative — has of 
 late years rapidly invaded the professional classes, and medicine in 
 this respect has suffered perhaps more than any other profession. 
 
 The absence of state-endowed and state-supported institutions, in 
 which a very high standard of education might be maintained irres- 
 pective of revenue, the absence or laxity of state regulation, of pri- 
 vate educational cor[)orations, the cur.se of sectionalism and individ- 
 ualism so chn,i'acteristic of the western hemisphere, and the apathy of 
 the public in the matter of education in general and medical educa- 
 tion in particular — all these factors have tended to produce a mush- 
 roomgrowth of so-called medical schools (fortunately be it said more 
 among our neighbours than in our own country) from which a yearly 
 brood of doctors of medicine has been delivered upon th^ unsuspecting 
 public. To many people one degree is as good as anotlu^r, and it will 
 take them some time, to their cost, and perhaps to yours, before they 
 appreciate the difierence between a graduate of a reputable school and 
 one of the mushroom variety. Moreover, your training will have 
 taught you to despise methods which your competitcjr makes no. 
 scruple of using — and in this respect you will V)e at a disadvantage 
 But gi'anted that in the long run you have little to fear from competi- 
 tion with the ill-trained physician, is it not a fact tiiat even from the 
 best medical schools the supply of graduates is at least equal to the 
 demand ? Ponder this well — if there be any of you who may be 
 tempted to think that a degree is to be won by a minimum of work, 
 and that the profession of medicine is an easy and genteel way of 
 earning a living. For such ihcr^ is no place in a medical school of 
 the highest standing. 
 
 But there is a higher motive, which the majority, if not all of you, 
 will recognize and accept. By working to the best of your ability 
 you are in reality aiding, no matter how little, the cause of higher 
 education in medicine. Wherever you go, in whatever place you cast 
 your lot, you will bear the hall-mark of your Alma Mater, and should 
 be the living embodiment to your surroundings of the high profes- 
 sional ideal which this school has ever aimed at maintaining. This 
 
3 
 
 you cannot be unless j'ou make up your mind from the first to utilize 
 to the fullest extent tlie f^reat advantages that are offered to you 
 throughout your collegiate course. Moreover, by so doing you will 
 materially lighten the kbours of your teachers, and stimulate them to 
 yet greater efforts on behalf of yourselves and those who shall follow 
 in your footsteps. 
 
 The highest motive isont; that should form pai'tof your very nature, 
 if you are rightly constituted. It is the moral obligation to do your 
 duty by your fellow -creatui'os. No student can conscientiously receive 
 the degree of doctor of medicine who knows an<l feels that he has not 
 caused to profit the talent that was entrusted to him. Heaven knows, 
 gentlemen, when you leave these halls — it has been the experience of 
 your predecessors and teachers — your store of knowledge will be 
 scanty enough, even if you have diligently employed your time — a 
 fraction with a very small numerator, and it is with this fraction that 
 you must enter upon your life work — the understanding and care of 
 all the ills the fie.sh is heir to. 
 
 If a due sense of responsibility is incumbent upon you, the majority, 
 who are to become practitioners of medicine, it is all the more im- 
 perative for you, the minority — and I trust it may be a large one — 
 who are even now cherishing the idea of yourselves becoiiung the 
 teachers of a future generation of students, or investigators in one 
 of the many unexplored regions ol medical science. The teacher 
 or investigator to be successful nmst have receiveil the very b(;st 
 possible training, a deep and solid foundation on which to rear a no 
 less solid and harmonious superstructure. In the case of either, 
 failui'e means not cmly personal loss from wasted oppt>rtunities, but 
 incalculable and progressively increasing harm to others through 
 educational incapacity or lack of " geist," and the publication of 
 immature or faulty researches — for there is none like your practising 
 physician or surgeon to accept without a murmur of dissent the dicta 
 of those who speak ex ciit/icdm, be it from the professor's chair or 
 the holy of holies of the 1-vboratory. 
 
 How shall you make the best use of your time ? — avoiding both 
 Charybdis and Scylla ; the whirlpool of overwork, perplexity and ill- 
 health ; and the dangerous rocks of temptation, neglect of work and 
 failure. To a great degree this problem has Iteen solved for you in the 
 published time-table of the curriculum. There are, at fixed hours, 
 arranged with due regard to your physical welfare, lectures, clinics 
 and demonstrations to attend, which will fairly well fill the hours of 
 the day. With regard to these let your chief virtues be punctuality 
 and attention, for your own sake and that of your teachers and 
 
fellow-students. The aim of these various exercises is to teach you 
 to observe and to t/iiv/>: And here let me repeat the oft-given but 
 ever necessary advice concerning note-taking. Your teachers profess 
 to be exponents, not oracles, and do not expect you to mtikv. a steno- 
 graphic report of their dissertations — a lecture is not to be considered 
 in the light of an exercis*; in dictation. Note, if you will, the salient 
 jioints, and at the close of the day you may till in the minor points 
 at your leisure ; it is a good mental exercise and serves to cultivate 
 the memory. Avoid mere memorizing ; it is a debasing exercise and 
 will inevitably lead you to the vain and idolatrous worship of facts 
 Facts are necessary, and tho,se which cannot be established by per- 
 sonal observation must of course be obtained from Itooks, <lemonstra- 
 tions or lectures ; but they are at best means to an end, and of little 
 value apart from the inferences to which they lead and the principles 
 of which they form the basis. 
 
 Might I not add a word of warning to the teachers themselves ? 
 We are pe;haps ad<licted to laying too much stress on the practical 
 side of the subjects we teach, assimilating our work more or less to the 
 style of the modern text-book, which is too often a mere agglomera- 
 tion of facts, true and well-established if you will for the time being^ 
 but devoid of that stimulus to thought which the scholarly and philo- 
 sophical presentation of the growth and development of principles 
 would afford. This defect I freely admit to be more common in 
 the treatment of the final branches of the curriculum than in that 
 of the primary. The ideal series of didactic lectures would be one 
 that dealt with groups of allied morbid conditions, rather than indivi- 
 dual ones, showing their fundamental relations, tracing the sii adnal 
 
 steps by which the members composing them became differentiated, 
 and outlining the trend of modern thought in the solution of the 
 still vexed questions with which they abound. In other words, the 
 tendency of such lectures would be toward synthesis rather than 
 toward analysis. The penchant of the present period of medicine is 
 towards refinement in subtle distinctions and the investigation of 
 minutiae, which too often result in loss of mental perspective and the 
 consequent inability to grasp broad principles. The type of the ideal 
 lecture I have referred to is well illustrated by the admirable lectures 
 on " Convulsive Seizures," delivered a few years ago by the eminent 
 London neurologist, Hughlings Jackson, in which he develops the 
 theory of functional levels in the central nervous system. Such lec- 
 tures not only give one a more accurate conception of individual 
 morbid conditions, but throw a new light on familiar phenomena, 
 and open up new avenues of thought and speculation. 
 
Clinics and clinical lectures on the other hand are, or should 
 bo, intensely objective, their aim being to cultivate the faculty of 
 observation. It is remarkable in what an embryonic state this faculty 
 exists in the average student. Things that "jump to the eyes," as the 
 French say, very commonly pass unobserved, or in transit between 
 the retina and the higher visual centres undergo such refraction as to 
 result in very imperfect images. Indeed a large part of the clinical 
 teacher's work consists in correcting \isuivl, auditory and tactile im- 
 pressions in the .student, and as this work of educating the senses 
 must of necessity be done individually for each student, it follows 
 that a large proportion of time must bo devoted to this part of your 
 technical training. It rec^uircs also individual work, bon-voulolr and 
 patience on the part of both teacher and pupil. Nothing but the 
 most earnest co-operation on your part can make our teaching success- 
 ful, for indifference in the taught represses the zeal of the teacher, qind 
 freezes the genial current of his .soul. 
 
 There ai'e in this city ample, very ample, facilities for the acquire- 
 ment of a good clinical training in large and well-appointed hospitals. 
 It is safe to say that in no other city on this continent is the student 
 in medicine afforded such opportunities of seeing disease from a close 
 and intimate point of view, and of coming into pei'sonil contact with 
 the sick. As senior students you are practically allowed the freedom 
 of the wards during certain hours of the day, and all of you have at 
 one time or another a certain number of cases to report on and observe 
 from day to day. In the out-patients department you have daily 
 opportunities of studying the minor complaints, both medical and sur- 
 gical, which will form the largest part of your future practice, and of 
 familiarising yourselves l)y repeeted examinations, with norr>n I physi- 
 cal signs. Finally, there are the special departments and the i; txi.crnity 
 hospital, in which systematic instruction is given to groups of sludents 
 in rotation. 
 
 These are great and exceptional advantages, and if you ai'e in- 
 clined to think that they are l>ut your due, remember that in many 
 hospitals not only is the opportunity of personally examining and 
 reporting ca.ses absolutely unknown — I had almost said undreamed-of 
 — but access to the wards is only po.ssible in the company of the chief 
 of service or hig interne, and the student must rest satisfied with study- 
 ing disease from the lofty point of view of the amphitheatre. This 
 school can point with pardonable pride to the fact that it was among 
 the first in America to inaugurate thorough and systematic bedside 
 teaching in the hospital, and to insist on personal and individual 
 clinical work. And here I may be pardoned for enterino- upon a 
 
6 
 
 digression. The system of teaching I have referred to is commonly 
 known as the " Edinlturgii metliod." In reality, it is the German 
 method — thou<j;li it ((ventually came into force in the famous Scotch 
 school. CJraves, in the introduction to his " System of Clinical Medi- 
 cine" (pul)lished in 1S43), speakins? of methods of clinical teaching, 
 draws attention to the lack of personal work on the part of the 
 student in the medical .schools of (ireat Britain, and contrasts these 
 with the schools of Franco and (Jermany. In France the system 
 adopted was certainly an improvement on tin; methods in vogue in 
 his own country, but there were still many defects. For the German 
 method, however, he has nothing hut praise, and describes somewhat 
 in detail the manner in which the "praktikant" is required to exam- 
 ine, report and even pre.scrihe for cases in the hospital, undergoing (m 
 all these points a strict cross-examination by the physician in the pres- 
 ence of his fellow-students. 
 
 To return to the theme ; I wish to insist on the point that in clinical 
 work you ai'e to be actors, not pa.ssive spectators or supernumeraries 
 on the .scene. Avoid perfunctory performance of your ho-spital duties, 
 and when you are reporting a case do .so with as much zeal as if it 
 were your first patient in practice. Thei*e is no better training than 
 that obtained by thorough and independent examination at the 
 bedside, controlled sulisequently by your teacher's criticism. The 
 eliciting of information, the careful sifting and arrangement of the 
 patient's statements — one of the most difficult arts to acquire, and 
 not unlike the cross-examination of a legal witness ; the thorough 
 and systematic physical examination — which tests your knowledge 
 of normal signs and appearances ; and finally the process of reasoning 
 called into play in making a diagnosis from the data obtained — all 
 these are mental exercises of great value, and re(|uire the exercise of 
 your best intellectual powers. The committing of the whole to paper, 
 in the shape of an orderly and well-written report — so seldom met 
 with— cultivates precision of thought and diction — " writing maketh 
 an exact man." 
 
 To make rational inferences from correct observations is in a few 
 words the gist of the problem involved in the diagnosis of disease. 
 At timiis this is an easy matter, given an accurate history and un- 
 equivocal signs of di.sease : at others, the indications are so scanty or 
 ob.scui'e as to tax the ablest clinician's powers of observation and 
 reasoning. You may have wondered how in certain cases a correct 
 diagnosis has been reached from i.solated and seemingly trivial 
 signs. There is, however, nothing marvellous in this, it is not intuition, 
 nor is there any mystery about it — nothing more than the fjicility 
 
acquiruii hy long expta-iciico hiisoil on ol)sorvation, of forging the 
 inisHini,' links in tho clmin of cvidfuci'. You rcnicniber Voltaire's 
 story of ln»\v Xiulig was cnabltMl to give an accurate; (leacription of 
 the (|U('t'n's strayc*! siiaiiit^l and of the runaway steed of the king, 
 without ever having seen eitliei- of these animals, but l»y oVmerving 
 the ciiaracter of their footpiints, and the niai'ks they or their trappings 
 had left on the trees and stones of the path hy which they had made 
 their escape. In many instances this is the method hy which the 
 diagnostician arrives at his conclusions — the "mtthod of Zadig," or in 
 more modtu'n phraseology, the method of Sherlock Holmes. 
 
 There is anotluM* aspect to an hospital training — its humanizing in- 
 fluence. It is not possible that two or more years spent in rlaily 
 association with the sick and the injured sh(nild not have some 
 influence foi- good on your character, and develop in you, at least, the 
 quality of iiu'rcy which is not strained. There are foibles to be 
 overlookefl and idiosyncrasies to be understood and respected ; t^'M-e 
 are sullen patients and gai-rulous ones, melancholic patients and cheer- 
 ful ones, and tearful ones — most trying of all— to each and all of whom 
 you mu.st aeconnnodate yourselves. Kinilness, gentleness and cour- 
 tesy — with firmness in the background for emergencies — are never 
 out of place, and should be meted out in the same measure to No. 15, 
 Ward X., as to Mr. Dividends of Capital street. 
 
 I need hardly insist on the importance of faithful attendance 
 in the various laboratories — university and hospital — including the 
 dissecting-room. The hope and the promise of the medicine of the 
 future lie in the extension of laboratory teaching, not only from the 
 educationist's point of view, but from the stand point of the diagnos- 
 tician and the therapeutist. The discovery of the diphtheria antitoxin 
 is still fresh in our minds — a discovery, it cannot be too often re- 
 peated, entirely the product of the bacteriological laboratory. Again, 
 in all the clinical laboratories of the great medical centres of the 
 world, investigations are being carried on which are yearly adding to 
 the more intimate knowledge of disease, and more or less directly to 
 further advances in therapeutics. Notably of quite recent interest is 
 the discovery by Widal, that in the action of human blood serum on 
 cultures of the bacillus of typhoid fever, we possess a reliable means 
 of (establishing or denying the presence of that disease in the indivi- 
 dual from v'hom the sei'um has been obtained, — a most valuable 
 addition to the hitherto accepted criteria in obscure cases. 
 
 From the purely educational point of view a thoi'ough training 
 in laboi'atory work is not less to be recommended. For a clear 
 expim oi this aspect of the question, and of the value of the ex- 
 
8 
 
 porimontn) mfithod in medical education, I must refer you to the 
 interestinj; uddresH delivered tliree years ivufo. on an occasion similar 
 to the present one, by one of the niendters of this Faculty.' But 
 "the head and the hoof " (to use an e.xpressicm of Kiplinf?) of the 
 orgument in favour of the educational value of lal)oratory work is to 
 he found, just as iit the analogous case of individual clinical work, in 
 the fact that such work teaches lutw to observe and to think correctly. 
 I have outlined somewhat sketchily the programme of your studies 
 as laid down in the curriculum — what may he called the fixtures of 
 the medical course. There remains a consideral)le portion of time 
 which is not officially provided for. It may he asked how, in view of 
 the amount of intellectual pahulum you are daily required to ingest 
 and digest, thi; sorely taxed brain can po.ssibly be stimulated to 
 further ettbrt. This is a matter that must be left to the individual 
 worker, and each one must be a law unto himself, remembering the 
 adage — U ne faut pas forcer son Udent. It is to he assumed that a 
 portion of this time is to be devoted to independent study, and this 
 usually takes the form of reading. If done at fixed hours and not 
 in a desultory way, this may be productive of much good. The 
 object of such reading should be in the first place to revise the 
 work of the day and crystallize the knowledge acijuired. This the 
 excellent text-books in every department of your work should 
 enable you to do without much expenditure of mental energy. 
 The student of even average ability should find no difficulty in 
 keeping up with the daily work in reading if he bears in mind two 
 cardinal points — to have regular hours and to refrain from memoriz- 
 ing. For the advanced student, who is supposed to have already an 
 elementary knowledge of the subjects he is studying, and possesses or 
 has ac(|uired facility and despatch in his work, there are at his dis- 
 posal in the library of the faculty, numerous l)ooks of reference with 
 which an instructive hour may be spent, comparing the opinions of 
 the niastei's in our profession. I would dissuade you entirely from 
 devoting much time to the perusal of current uiedical literature. It 
 is safe to say — and it is a humiliating confession to make — that fully 
 nine-tenths of the material published in the medical press of this 
 country, and perhaps of others, is worthless from an educational point 
 of view — not to say from any point of view, — and you have neither 
 the time nor the mental perspective recjuired to sift the wheat from 
 the chaff. With the student perhaps even more than with the busy 
 practitioner it is " orane vjnotum pro Tnivlfico." Far better, if you 
 
 • The Place of Chemistry in a Medical Education, by R. F. Kuttan, M,D., Mo7it- 
 real Medical Journal, November, 18t»3. 
 
 \ 
 
 1 
 
 |?#, 
 
9 
 
 \ 
 
 1 
 
 want aoinefchinjf a littlo out of the wiiy of routine work, are the essays 
 of HolnieN and of Austin Flint, ami many others equally refreHhiii<{ 
 and instructive. 
 
 Finally, to those who pei-chanco may still have leisure — though 
 that is barely credible — 1 would say, dip a little into the history of 
 nu'flicine. What can be more int»!restinj( than to try tt) oppreciate 
 the genius and sound common-sense of ^iippocrates, to trace the grad- 
 ual growth of modern ideas from the fantastic superstitions and gro- 
 tes(|ue practices of the Middle Ages, to realise the condition of mind 
 of those who propounded the " vitalistic," the " Hrunonian," the 
 ' inHammatory " and other e(|ually extraordinary and exclusive 
 theories of disease ; or again, to read the lives of the great mastt.'rs of 
 the profession — Vesalius, Am'broise Pare, Harvey, Sy<lenham, Boer- 
 haave, Laennee, Jenner and many others etpially distinguishetl, ancient 
 ond modern ? At the risk of being called a medical 'I'oniuemada, I 
 would suggest as the next addition to the curriculum of studies, a 
 course of lectures on the history of medicine. 1 firmly believe that 
 the extra labour entailed upon the student, would be amply compen- 
 sated by the result — the; cultivation of the philosophical spirit, the 
 stimulation of a <h;eper interest in the fundamental discoveries in 
 medicine, and a proper appreciation of the genius of the pioneers in 
 our art, coupled with a <lue spirit of humility and modesty with res- 
 pect to our own efforts. 
 
 We are only too apt to take for granted as elementary truths, 
 discoveries that in years gone by were the battle ground of the 
 fiercest controversies, and to think that the present period of medi- 
 cal science is the only one that can lay claim to the gratitude of 
 suffering humanity. In the introduction to his " Grundi-iss der Ges- 
 chichte der Medicin," Baas emphasises as follows the value cf the 
 study of the history of medicine : " An acquaintance with the history 
 " of his science is, how(>ver, especially indispensable to the practical 
 " physician, if he wouM thoroughly comprehend i»nd penetrate the 
 " secrets of his profession. To him, indeed, it is the bright and polar 
 " star, since undoubtedly it alone can teach him the principles of a 
 " medical practice independent of the currents, the faith and the 
 " superstition of the present. Moreover, it offers him as scientific gain, 
 " thorough knowledge of the past, the measure for a just and well- 
 " founded criticism of the doings of his own time, places in his hand 
 " the thread by which he unites past conditions and efforts with those 
 " of the present, and sets before him the mirror in which he may 
 " observe and compare the past and the present, in order to draw 
 " therefrom well-grounded conclusions for the future. An acquain- 
 
10 
 
 " tance with the views and knowledge of epoclis already submerged in 
 " the shoreless ocean of time, frees the mind from the fetters and 
 " currents of the day, witli its often repressive restraint, widens the 
 " horizon for a glance into the past, and an insight into the present 
 " of human activity, 'deepens the view for a comprehension of the 
 " ideas which guided the earlier and the more recent physicians, and 
 " gives, on the other hand, to our daily professional labour a higher 
 " consecration, by inserting it as a most useful and necessary link in 
 " the chain of development of past and future humanity. The signifi- 
 " cance of the work of the individual, and his true value and true 
 " position with regard to all humanity, are first revealed to us clearly 
 " in and through history." (Translation by H. E. Handerson.) 
 
 The tasks that are to be performed require, as 1 have said, the exer- 
 cise of the best intellectual powers. What are the factors which may 
 make you good students ? I cannot do liettcr than to quote some- 
 what in extenm from a masterly address, delivered some time ago to 
 the medical students of the University of Minnesota, by one who is 
 well-known to most of you— at least by name : ' 
 
 " In the first place ac(|uire early the Art of DeUiehment, by which 
 " I mean the faculty of isolating yourselves from the pursuits and 
 " pleasures incident to youth. By nature man is the incarnation of 
 ' idleness, which quality alone, amid the ruined remnants of Edenic 
 ' characters, remains in all its primitive intensity. Occasionallj- we 
 " do find an individual who tak';s to toil as others to pleasure, but the 
 " majority of us have to wrestle hard with the original Adam, and 
 " find it no easy matter to scorn delights and live laborious days. Of 
 " .special importance is this gift to those of you who reside for the 
 " first time in a large city, the many attractions of which offer a 
 " serious obstacle to its acquisition. Thediscipiiue necessary to secui'e 
 " this art brings in its ti'ain habits of self-control and forms a valu- 
 " able inti'oduction to the sterner duties of life . . . Ask of any 
 " active business man or a leader in a profession the secret which 
 " enables him to accomplish much work, and he will reply in one word, 
 " 81/steni ; or as I shall term it the Virtue of Method, the harness with- 
 " out which only the horses of genius travel. "J here ai-e two aspects 
 " of this subject ; the first relates to the orderly arrangement of your 
 " work, which is to some extent enforced by the roster of demonstra- 
 ' tions and lectures, but this you would do well to supplement in 
 ' private by a schedule in which each hour finds its allotted duty. 
 " Thus faithfully followed day by day system may become at last 
 *' engrained in the n»ost shiftless nature, and at the end of a semester 
 
 ' Teacher and Student. By Wni. Osier, M.D., &c., &c. 
 
\ r:\^ .. 
 
 n 
 
 a youth of moderate ability may tind liimself fur in advance of the 
 student who works spasmodically and trusts to cramming. . . • 
 And thirdly add to the Virtue of Method, the Quality of Tlioroiiijh- 
 vesK, an element of such iuiportance that I had thought of making 
 it the only subject of my remarks. Unfortunately, in the present 
 arrangement of the curriculum, few of you as students can hope to 
 obtain more than a measure of it, but all can learn its value now, 
 and ultimately with patience become living examples of its Iwmefit. 
 Let me tell you briefly what it means. A knowledge of the funda- 
 mental sciences upon which our art is based — chemistry, anatomy, 
 and physiology — not a smattering, but a full and deep ac(|uaintance, 
 not with all the facts, that is impossible, but with the groat principles 
 based upon them. You should, as students, become familiar with 
 the methods by which advances in knowledge are made, and in the 
 laboratory .see clearly the paths the great m.^sters have trodden, 
 though you yourselves cannot walk therein. With a good prelimin- 
 ary training and a due apportioning of time you can reach in these 
 three essential studies a degree of accuracy which is the true prepara- 
 tion for your life duties. It uieans such a knowledge of diseases and 
 of the emergencies of life and of the means for their alleviation, that 
 you are safe and trustworthy guides for your fellow-men. . . . 
 The Art of Detachment, the Virtue of Methotl, and the Quality of 
 Thoroughness may make you students, in the true sense of the word, 
 successful practitioners, or even great investigators ; but your char- 
 acters may .still lack that which can alone give permanence to 
 powers — the Graca of Humility. . . . In the.se days of aggres- 
 sive self-assertion, when the stress of competition is so keen, and the 
 desire to make the most of oneself so widespread, it may seem a 
 little old-fashioned to preach the necessity of this vi)"tue, but I insist 
 for its own sak<^, and for the .sake of what it bi'ings, that a due 
 humility should take the place of honour on the list. For its own 
 sake, since with it comes not only a reverence for truth, but also a 
 proper estimation of tiie difficulties encountered in our .search for it. 
 More perhaps than any other professional man, the doctor has a 
 curious — shall I say morbid i — sensitiveness to (what he regards) 
 personal error. In a way this is right ; but it is often accompanied 
 hy a cocLmreiie.'^K ot opinion (to use a Johnsonian word) which, if 
 encouraged, loads to so lively a conceit that the mere .suggestion of 
 mistake under any circumstances is regarded as a reflection on his 
 honour, a reflection equally resented whether of lay or of profes.sional 
 origin. Start out with the conviction that absolute truth is hard to 
 reivch in matters relating to our fellow-creatures, healthy or diseased. 
 
12 
 
 " that slips in observation are inevitable even with the best trained 
 " faculties, that errors in judgment must occur in the practice of an 
 " Art which is largely the balancing of probabilities ; — start, I say, 
 " with this attitude of mind, and mistakes will be acknowledged and 
 " regretted ; but instead of n slow process of self-deception, with ever- 
 " increasing inability to recognize truth, you will draw from your 
 " errors the very lessons which may enable you to avoid their repeti- 
 " tion. . , . The truth that lowliness is young ambition's ladder 
 " is hard to grasp, and when accepted, harder to maintain. It is so 
 " difficult to be still amidst bustle, to be quiet amidst noise ; yet, " es 
 " bildet ein Talent sich in der Stille " alone, in the calm life necessary 
 '' to continuous work for a high purpose. The spirit abroad at present 
 " in this country, is not favourable to this Teutonic view, which galls 
 " the quick apprehen.sion and dampens the enthusiam of the young 
 " American. All the same it is true, and irksome at first though the 
 " discipline may be, there will come a time when the very fetters in 
 " which you chafed shall be a strong defence and your chains a robe 
 " of glory." 
 
 But you will be inclined to say, '' We have had enough of the 
 Gospel of Work, it is time we had a little of the Gospel of Play," and 
 this brings me naturally to discuss the more material side of your 
 existence as students of medicine. At the risk of being' very prosaic, 
 let me give you a few words of advice as to the manner of life that is 
 most conducive to the welfare of a student. If you wish to do good 
 work you must have appropriate environment, you must live with a 
 certain degree of comfort and take a reasonable amount of physical 
 exercise. In the much-to-be-x'egretted absence of a University resi- 
 dence, in which the conditions of existence would be arranged on 
 a proper hygonic l)asis, you must necessarily fall back on the boarding- 
 house. There are model boarding-houses — and there are others. This 
 city may fairly lay claim to having a " Latin Quarter" of its own, but 
 while this is not far beliind its Parisian analogue in sordidness, it 
 lacks all of the pictures(iuen(!ss and attractiveness of the latter. It 
 is poor economy, for the sake of a small saving, to confine oneself in a 
 small not over-cltan and dingy room in a dai'k and dismal stx'eet, when 
 relative comfort at least is to be obtained by a trifling extra expenditure. 
 Murger's " Bohemia" is a most interesting study of one phase of 
 student-life, but his students did no work to speak of, and their sole 
 object seems to have been to amuse themselves in their own peculiar 
 way, and as regards the material needs of life to confine themselves 
 to what he aptly calls " the strictly superfluous." The main desiderata 
 in a student's working more or less, in caneal sufficient cubic space 
 
13 
 
 and plenty of tVes. ir. I would not insist on such apparently 
 obvious matters, did I not know from personal experience with 
 students — and by no means medical students alone — that such con- 
 siderations of health are constantly nefjlected. Many a brain-racking 
 headache owes its origin to no other cause, and " faces" which are 
 presumably " sicklied o'er with the pale cast of thought," may find 
 their pallor changed to the rosy hue of health by a simple change of 
 residence. It must not be forgotten, too, that living in crowded 
 (juarters and a. vitiated atmosphere exposes — or rather predisposes — 
 the individual to the approach of one or the other of the various 
 infections, and especially to the modern " great plague" — tulterculosis, 
 As regards exercise, the rnotto Suiim cuique is the only one that is appli- 
 cable. Suffice it to say that in some form it is essential to the main- 
 tenance of perfect health, and there are so many ways in which it 
 may be taken that there is only the embarrassment of choice. I need 
 only repeat here the warning against excessive athleticism, which not 
 only defeats its own object, but often works irreparable mischief in 
 its victim. . ■ 
 
 I cannot conclude without drawing your attention to a subject 
 which has always interested me very much, and which many, I am 
 sure, will agree with me in considering of prime importance — I refer 
 to the relation of general culture to a medical education. 
 
 Bacon said somewhere that " the physician should begin with 
 philosophy, the philo.sopher end with medicine ;" and there is much 
 truth in this statement, if we take the term philosophy in the largest 
 sense — the spirit of philosophical entpiiry and the philosophical 
 method of thought. Judged by this criterion and weighed in this 
 scale, I fear that the majority of us would be found sadly wanting. 
 And yet this spirit and this method form the very ground work of 
 that other method, the experimental method, which is the one on 
 which the science of medicine is, or should be, based, and which is 
 indispensable to further progress in that science. All experiment is 
 futile, unless it be productive of conclusions, and conclusions are apt 
 to be erroneous unless they are drawn by a mind trained in the 
 methods of induction. Current and standard medical literature are 
 full of e.xainples of erroneous conclusions, drawn from apparently 
 correctly observed facts and carefully performed experiments. Such 
 a training implies a more or less extended period of study prior to 
 the inception of purely professional work, and the only means at 
 present known of obtaining this training are supplied by tlie higher 
 institutions of learning, those that afford t!;e opportunity of ac(}uiring 
 what is generally kuown as a liberal education. Unfortunately but 
 
14 
 
 \.- . . 
 
 few of those who enter the field of medical study in this country come 
 provided with the reiiuired intellectual baggage. Such is the hurry, 
 or necessity, in the Western Hemisphere of starting on the actual 
 bread-winning path of life, that few will, or think they can, devote 
 the time necessary to the acquirement of a purely intellectual training- 
 In Europe the conditions are vastly different, for a University edu- 
 cation is considered as the necessary, and, in most countries, as the 
 obligatory preliminary to a professional training. Take France as an 
 illustration ; in that country no individual may aspire to the degree of 
 doctor of medicine, unless he have previously obtained the baccalaureate 
 degree in arts or in science, and in the other states the requirements 
 are on a similar basis. Contrast this with the condition of affairs in 
 America, where the Johns Hopkins University is the only one requiring 
 from the candidate for a medical education a degree of Bachelor of 
 Arts or Bachelor of Science. 
 
 Apart from the advantage accruing to the individual from a general 
 mental ti'aining acquired before initiation to technical studies, there 
 is also a manifest advantage to the school itself. Many of the subjects 
 of study which are, owing to present necessities, included in the curri- 
 culum of the medical school, are at the same time taught in the 
 academic department — notably elementary botany, chemistry, physics, 
 and even physiology. Were the medical student enabled to show a 
 previous acquaintance with the rudiments at least of these branches 
 of .study, the time now employed in elementary work might be em- 
 ployed profitably in obtaining a knowledge of the deeper problems, 
 and especially those having a direct bearing on human life. 
 
 The University, of which this Faculty is one of the component 
 parts, has at all times recognized the force of the arguments ad- 
 vanced in favour of preliminary training as an introduction to profes- 
 sional studios, and has at last been able to perfect a plan which 
 meets at least some of the requirements of the case. According to 
 this plan a student may proceed in the course of six years to the 
 double degree of Bachelor of Arts and Doctor of Medicine, obtaining 
 at the same time a general intellectual culture and the special pro- 
 fessional training. This is manifestly a step in the right direction, 
 and while it is in reality only a compromise with the ideal, it is 
 one for which all — teachers and students alike — should be devoutly 
 thankful. 
 
 It is the earnest wish of the members of this faculty, and of their 
 collaborators in the other faculties of the university, that year by year 
 an ever greater number of the candidates for the studvof medicine 
 may learn to appreciate the value of a liberal education, and to utilize 
 
 I, 
 
15 
 
 to the. iuUest extent the great advantages — the price of much labour 
 and thought — that an, now offered to them 
 
 But in any case, waiving the purely professional conception of gen- 
 eral culture, is not a liberal education a thing to be aspired to for its 
 own sake, for the satisfaction of the inner man — that consciousness of 
 our own acquirements and powers which follows us through life, 
 whether we will it or no ? The leisure hours of an active profes- 
 sional career will be made more enjoyable from a capacity to return 
 to intellectual pursuits, the taste for which has been carefully fostered 
 during an earlier period of life, and should we seek companionship and 
 intercourse with our fellow-men, we shall not experience that feeling 
 of isolation which comes from exclusive engrossment in one's own 
 particular sphere of mental activity, however meritorious it may be. 
 
 I.