>. c. V^>^ IMAGE EVALUATION TEST TARGET (MT-3) L ^ .// <. signifie "A SUIVRE", le symbols ▼ signifie "FIN". Maps, plates, charts, etc., may be filmed at different reduction ratios. Those too large to be entirely included in one exposure are filmed beginning in the upper left hand corner, left to right and top to bottom, as many frames aa required. The following diagrams illustrate the method: Les cartes, planches, tableaux, etc., peuvent fttre filmto A dee taux de reduction diff Arents. Lorsque le document est trop grand pour Atre reproduit en un seul clichA, 11 est film* i partir de I'angie supArieur gauche, de gauche A droite, et de haut en bas, en prenant le nombre d'images nAcessaire. Les diagrammes suivants illustrent la mAthode. t 2 3 1 2 3 4 5 6 dAciV^i ' \/ Q \j 5u U-i ^' CLS**"*.'^ c-**-t/.4*«»'«-*^ VALEDICTORY ADDRESS DELIVERED AT THE CONVOCATION FOR CONFERRING DEGREES IN MEDICINE, McGILL UNIVERSITY, APRIL 4th, 1895. h"> BY JC Gt ADAMI, M.A., M.D., (Cantab.) M.B.C.S., Eng., Professor of Pathology in the McGill University, Montreal. (JRqninled from the Montreal Medical Journal, May, 1895.) CO N o f CO CM o % VALEDICTORY ADDRESS DELIVERED AT THE CONVOCATION FOR CONFERRING DEGREES IN MEDICINE, McGILL UNIVERSITY, APRIL 4th, 1895. By J. G. Adamjt, M.A., M.D., (Cantab.) M.R.C.S., Eng., Professor of Pathology in the McOill Univenity, Montreal' " Caute, caste et probe." Sponsio AcAnEMicA, Gentlemen of the Graduating Class, This crowded liaW, the honoured figure of our presid- ing Chancellor, the old well-known row of professors on the dais, the Dean and his report of the results of the session's work, the Registrar administering the oath, the capping, the speeches, the cheers, the good humoured chaff — all these have become famii'ar to you in the years tiiat have gone by since first you entered McGill. You have yourselves saluted year after year of your seniors, have seen the graduates of our Faculty pass out from the university into the universe, have sped the parting guests. To-day to you this old familiar scene must appeal with an altered and deeper significance. Now the supreme moment has come to you as in your turn you become the occasion of the ceremony, as you are about to leave us and test y urst'lvo^ against the larger world, each endowed with the 4 " exeat *' of our University. Moments such as this in the lives of each of us are critical moments. Marking, as they do, the transition from one epoch to e lother, they are for each of us, individually, rubricated and historical. All these years you have been preparing yourselves for what is to be your life's work. To-day you stand upon the threshold of the entrance into that work. I would very willingly this day have seen you receive the " send-ofF" from one of my colleagues occupying a hijfher position in the Faculty than I, one who from his experience has a greater right to speak, a greater certainty of appealing to you on this which to you is so critical, and if you are as other men are, so susceptible a moment. Nevertheless, if other words would touch you more surely I trust that the fibres of your mind being high strung, some sentence or two of what I am about to deliver to you on the part of our Faculty may strike a chord thereon, so that in the years of the future there may still surely re- main with you memories of these last moments spent under us here' at McGill, of the first moments of your existence as fully qualified medical men. - It is but natural that standing on the threshold you look forward into the future. What is that future to be ? How are you prepared to face the world ? How are you to carry yourself in it ? What are to be your ideals, what the goal towards which you strive ? These are questions you must all be asking yourselves, and it will be well if you start on your journey armed aright and with clear knowledge of the motives that are to guide you. One thing may, I trow, be taken for granted, namely, that you have selected j'our profession for higher motives than that of making a livelihood ; if you have not, then of all men you are to be pitied. There is a very clear " call," as some sects express it, to medical work. I have never known a successful medical man who has not wholly and entirely loved his work — I doubt if he exists. The true medical man' takes to m^di- m cine instigated by a profound liking ibr the subject— alnlost if not quite by instinct— and that being so. to the true medical man the fact that his profession will assure him a iiiir competency and independent position is and must be a- secondary matter. No profession, as you know full well, makes greater calls upon its followers than that of medicine. In season and out of season you are liable to be called upon — or more truly every hour of the twenty-four from year end to year end is the doctor's season. Not only is your time not your own, but each case that presents itself demands honest thought and the fullest endeavour on ybui* part to put forth all that you possess, irrespective of what the mone- tary result is to be. Love for the work is and must be first. This may be an instinct wholly unassociated at first with any idea of doing good, but the very liking and de- sire to engage in the work must lead you to seek every opportunity of practice and so, willingly or unwillingly, the good is done. Of old it was said that where there are three medical men there are two atheists. Most assuredly this is not so. It is only true that the habit of independent thought and of striving to determine the why and wherefore of things, which is second nature to the physician, is not in accord- ance with the straitest theology, and tends often towards heterodo.Ky. Nevertheless, no profession demands from its followers the more constant exercise of practical Christi- anity. You hq,ve entered into a profession of which it is the noble tradition dating back centuriies to the school of Salerno, and yet earlier, that the call of the afflicted and needy is to be attended to, and attended to with no second thought. To this extent the exercise of your profession is pure religion. It rests with you to preserve it undefiled. This is the religio ynedici, whatever else be added there- unto by the individual. The medical life is the practical exercise of this religion. If your main thought in looking to the future is that mediwne will bring you money and 9 pogition, that attitude of mind alone makes you traitors to the traditions of your profession — you would better re- nounce the labours and the results of all these years and enter into some trade, adventure or other concern. There you can be_horiest to yourself and your employment. Any- thing hut medicine for such an one. For such an one eato anathema. You have entered into the noblest and freest of all the professions. I say this unhesitatingly. Lav; may be noble but there is no tradition among its followers to do gratui- tous good to other than to lawyers. The life political may lead to the well-being of the whole community, but most of its good is destroyed by the necessity of giving up to party what was meant for mankind. The church, with its lofty work, may question the right of medicine to occupy the noblest place ; yet, while the church holds many, very many men of conspicuously noble life, I doubt myself whether its bonds do not for many render life ignoble. Each of us in the course of our existence comes across some few (but how few !) of conscience so pure, mind so serene and faith so natural that for thorn the great problems of existence seem to solve without difficulty, in fact, seem not to be problems at all. Most of us mortal men, I fear, if we think at all and utilize or strive to utilize the minds that have been given to us, belong to that pur- blind race. Here, thro' the feeble twilight of this world Groping, how many, until we pass and reach That other, where we see as we are seen. And groping and seeing things darkly, our opinions as to these things vary so much that what at one time seemed true, at another seems false. Thus, if a talent or talents of thought have been entrusted to them the time must come to most in the ministry when either the results of thinking lead outside the limits of those articles of faith they have sworn to maintain unswervingly, or the fear of transgression of the bounds inhibits thought and renders the man a caitiff to himself and his prerogative. Lofty I 4 I and noble as are the endw, the bonds, the necessary lionds, for most are weakening. Our profession is jrirt about with no such limitations. We can think freely, we can and should employ any and all means that prove themselves good. As men and free agents we are untrammelled in the exercise of our life's work. The only serious douljts that can come to us in labouring faithfully are as to whether we fulfil our mission and do aright when we save sundry who, continuing tt) exist, will have feeble and diseased progeny, and will lower the quality of the race, or when with unceasing care we oil the lanip of life in those to whoni euthanasia would bring abiding rest. But the remembrance of our duty stills these doubts — our duty is to save. It is not given to us to determine vyho is of value and who is valueless ; that is not in our hands. We have the consolation that while in a few cases we may seem to be aiding and abetting the de- generacy of the race, in general by our work and its infiu- ence, we are raising the standard of existence, lengthening the life of each and making the race healthier. If, then, our profession be noble, it behoves each one of us and of you to do nothing that shall degrade it. Its dignity and high standing depends upon the dignity and standing of each member, and each one that lowers his individual standard lowers medicine. With Baoon, " I hold every man a debtor to his profession, from the which as men of course do seek to receive countenance and profit, so ought they of duty to endeavour themselves by way of amends to be a help and ornament thereunto." Thus while the fullest freedom is yours to do what seems good in your work, as workers, and in the manner of your work your duty to the body corporate of medicine must ever be kept in remembrance, and faithfully acted upon. It may be that at times you will find it hard to act up to your duty and that the trial of your loyalty may be a sore trial. I say this advisedly. It may, for example, seem hard to you that men in trade pan compound medi- cines and sell tlicin far and wide to a <^ullible public and amass fortunes thereby without lieing under the necessity of publishinjr at the same time their composition. Verily they have their reward. But do you ever keep in remem- brance the higlier self-denying precept of our profession that whatsoever ■ you discover for the good of suffering humanity must freely become the property of those who, with you, are striving to allay disease. Acting on this same precept shun all alliance, direct or indirect, with those dealing in secret cures or possessing nostrums for the manufacture of gold. It may be that feeling yourselves strong, and finding yourselves unappreciated by your fellows, you may in bitterness believe them to be combined for self-protection to prevent your rise. Do not permit such thoughts to gain the ascendancy, but in humility commune with your own hearts and seek to find what it is in yourselves or in your c(induct towards your brethren that has rendered you unpopular. Depend upon it the fault or failing origi- nates in you. Do not as you honour your profession render yourselves unworthy thereof by advertising to the public, or place yourselves outside the pale by playing upon the tenderest feelings of the^^ty. It is so easy to do that. Do not take steps which, were they successful and were they followed by the rest of your professional brethren, would absolutely prevent students from attaining that knowledge which has been freely imparted to you. Freely have ye received, freely giv^e. Let it never be even suggested that for selfish aims you have sought to bar the gates of knowledge. The doctor must not only be sans reproche, he must be above suspicion. It may be that temptation comes to you to leave the bulk of your fellows and gain a clientele and make a more rapid fortune by pursuing some exclusive method of treat- ment. Alas for poor humanity ! You may be tempted to attract patients and a name to yourself by electro- magnetism. You may be tempted to gain a bubble reputa- i 9 tion, and float into prosperity upon cold wdter ; or finding your prospects along the ordinary path to appear at first inflnitessimally small.on the principle that like cures like you may be tempted to employ the inflnitessimally small to better your condition. To travel yet once more the old familiar ground : In studying the processes whereby the organism reacts towards and seeks to r6pair injury, if you have learnt one lesson it is this, that nature is not exclusive, she does not employ one means of cure. It is not by cells of one order alone, by phagocytes, or by leucocytes in general and only leucocytes, or merely by the reaction on the par;, of the cells of the tissue, or by nervous changes alone or by altered tem- perature, or solely by the chemical and mechanical action of the exudate that repair is efl'ected. Nature employs all means ni her command to antagonize the irritant and to effect healing. The cells of the body fixed and free play their part, the nervous system aids the process, the bodily humours render efficient help, modifications in the vessel walls and blood stream are valuable auxiliaries. The lesson that you have learnt is that nature employs diverse processes, now one more particularly, now another, accord- ing to the needs of the moment, but none exclusively. -If modern research has accomplished nothing more, it has most surely established this fact. And we, if we are possessed of the sincere desire to benefit our' patients, must not, nay cannot, narrow ourselves down to the fanatical employment of one solitary means, or the guidance of one restricted rule ; we must be broad minded. If water will do good at a' certain stage, employ it — if a good honest dose of castor oil, employ it — ^if pillules of a sort are of proved merit, employ them — if stimulation of the nerves, then stiiriulate. He who holds to the exclusive or even the pre- dominating use of but one means of treatment writes himself down — well-— in one or other of a- humiliating alternative of terms. It may seem, gentlemen, that I have spent too great a 'portion 6f the short time 6,t my command in dila<)ing upon 10 this matter of medical morals. But as I said before I have done so advisedly. Knowing you, I do not think that there is a great likelihood of any of you becoming con- scious transgressors of our code. Yet year by year in the yearly growing bitterness of competition, the tendency is becoming more and more marked for the weaker brethren of our profession to seek to copy examples of commercial success — and, frankly, I fear what the future may bring forth. There is all the more need that you as graduates of this University hold high the torch ot professional recti- tude. Apart from, though akin to what is expected of you as medical men, there is ever to be kept in mind what devolves upon you as graduates. According to the usage of the mother country this day the University in conferring upon you its degree of Doctor has with it given to you the title of " gentleman." That title is now^ yours by right. Remember this, but do not be satisfied with the mere title. Be gentle in word, gentle in thought, gentle and kindly in deed, bearing this grand old name without abuse. Let this thought fortify you in the hour of trial if ever it comes to you — that apart from your rank as medical men you are graduates of a University, and that University, old McGill. Thus much, then, concerning the armour wherewith you are to gird yourselves and the gcnl whereunto you are to strive. Now for a few brief words upon your bearing and the setting forth on the journey. Let your first steps be very cautious. Now, when all these years of instruction at school and college have come to an end you may very naturally be thinking that you know much. But instruction is one thing, true knowledge quite another. You may be crammed with principles, with facts and the deductions from those facts ; but you have had little time to recognize the application of those facts little experience, little time to assimilate, and until they are properly digested and assimilated they are of little value. Believe me when I say that you know next to nothing. For- give me for putting it so bluntly. We, your teachers, have 11 travelled over the same road. You will find it out to your cost, and to your patients* cost, during the next year or two — only now do you begin to gain full knowledge. Do not make that most unscientific mistake of thinking that from the voracious caterpillar constantly cramming food into its insatiable maw you emerge forthwith into the perfect and lovely imago. That is not the case — at least, not among the higher insects. You have to pass through the chrysalis stage, a stage of humble suspense, in which the results of all the cramming are refined and rearranged. We have done our best for you — we have fed you with food that we have endeavoured to make assimilable, even if at times it has been as highly concentrated as those little lozenges which are said to contain each one the nutritive ingredients of a whole mutton-chop. Noble minds and generous have come to our aid and have (if they will permit the homely metaphor) supplied us with the neces- sary culinary utensils. But while we may have been able to peptonize some of that food, to give it to you in a more or less digested condition, the final stages of digestion and the process of assimilation have of necessity to be per- formed by you yourselves, the salt of experience aiding. , Do not set out with the belief that, because you know your Osier and your other text-books and can repeat your lecture notes by heart and have followed diligently every operation in the theatre, you are therefore prepared to diagnose and master any and every case that presents itself. This may seem an obvious and unnecessary remark, nevertheless I have followed so many budding house sur- geons and house physicians on this side the water and across that I deem it wise to note it. As you have learnt in your lectures in physiology, so many factors are con- cerned m the proper carrying out of each of the bodily processes, and their interrelations are such that it is ofttimes impossible to predict or fully explain the results of variation in emy single factor. So it is also in pathology, in the study of disease. Every case varies and departs in some point or points from the classical symptomatology, jurtiJa-J* ■■■ 12 and diagnosis, you will tind, is not to be accomplished by- simple rule of thumb. In the words of a great modern poet let me impress upori you that ■ * They see not clearliest who see all things clear. ' Thus it will be that if you observe carefully, consider- ing each case by itself and using your own judgment* apart from what we have said, or X. has said, or Y. has said, though stimulated by these dicta, you will deve- lope, and in the process of development you will dis- cover that X. and Y. and we have ofttimes been mistaken. We have, it may be, told you much that is erroneous, but never mind. We have done our best according to the light that is in us, and if by our mistakes, as by our sound teaching, we have led you to think and to observe and to record, then through you advance is made and the world is the gainer. . ■'■' ^ - - ^ v > : : > ^ Do not think that the giants of the past and the great ones of these latter days have accomplished everything and that there is no advance left for you to achieve. Ours is a progressive art. However small you may be and humble in your own conceit console yourselves : The dwarf perched on the giant's shoulder sees further and sees more than does the giant. As of old our architype Hippocrates exclaimed in the fulness of his experience, " short is our life and our art is long." * You have much before you and little time in which to accomplish it. I will not detain you longer. That you may fare well and through you others may be bettered, that you may earn for yourselves names of honour and of respect from those among whom you minister, that you may earn for McGill, your old Alma Mater, ever increasing reputation and a fame known super wthera, that is our earnest wish. On behalf of the Faculty I say to each one of you, vale ! * * I am a little dubious as to whether Hippooratas is riKhtlyroreditad with the origi- Bal of art longa, vita brevis, for my authority is the " Life'and Opinions of Tristram Shandyi Gentleman," vol. ii., chap, xzxiv- of the two volume edition, and during the last few days I have had no time to verify the statement. Yet if the Rev. Mf Lawreooe Sterne was apt to digress and be diacoraivei he w«» a fair scholar*