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This item is filmed at the reduction ratio checked below/ Ce document est film* au taux de riduction indiqu* ci-dessous. 10X 14X 18X 22X 26X 30X y 12X 16X 20X 24X 28X 32X Th« copy filmtd h«r« haa baan raproducad thanka to tha ganaroaity of: Medical Library McQill Univanity Montreal Tha Imagaa appaaring hara ara tha baat qualit> poaaibia conaidaring tha condition and lagibility of tha orlginai copy and in Icaaping with tha filming contract apacificationa. L'axampiaira film* fut raproduit grica A la ginAroaiti da: Medical Library McGill Univeriity Montreal Laa imagaa auivantaa ont 4t^ raproduitaa avac la piua grand aoin, compta tanu da la condition at da ia nattatA da l'axampiaira fiimi, at an conformitA avac laa conditiona du contrat da fiimaga. Original copiaa in printad papar eovara ara fllmad baginning with tha front covar and anding on tha laat paga with a printad or iiiuatratad impraa- aion, or tha bacic covar whan appropriata. Aii othar original copiaa ara fiimad baginning on tha first paga with a printad or iiiuatratad impraa- aion, and anding on tha laat paga with a printad or iiiuatratad impraaaion. Laa axampiairaa originaux dont ia couvartura an papiar aat imprimia aont filmia an commandant par la pramiar plat at an tarminant soit par la darniAra paga qui comporta una amprainta d'impraaaion ou d'iiiuatration, soit par la sacond plat, salon la caa. Toua laa autraa axampiairaa originaux aont fiimAa mn comman9ant par la pramiira paga qui comporta una amprainta d'impraaaion ou d'iiiuatration at an tarminant par la darnlAra paga qui comporta una taila amprainta. Tha laat racordad frama on aach microflcha shall contain tha aymboi -^ (moaning "CON- TINUED"), or tha symbol ▼ (moaning "END"), whichavar appliaa. Un daa aymbolas suivants apparrttra sur la darnlAra imaga da chaqua microflcha, salon la caa: la symbols — »> signifia "A SUIVRE", la aymbola V signifia "FIN". Mapa. plataa, charts, ate, may ba fiimad at diffarant raduction ratioa. Thoaa too larga to ba antiraiy includad in ona axpoaura ara fiimad baginning in tha uppar laft hand cornar, iaft to right and top to bottom, aa many framaa aa raquirad. Tha following diagrama llluatrata tha mathod: Laa cartaa, planchaa, tablaaux, ate, pauvant Atra filmAa A daa taux da rAduction diff Arants. Loraqua la documant aat trop grand pour Atra raproduit an un saul clichA, 11 aat fiimA A partir da I'angla aupAriaur gaucha, da gaucha A droita, at da haut an baa, an pranant la nombra d'imagaa nAcassaira. Laa diagrammaa suivants iliustrant la mAthoda. 1 2 3 1 2 3 4 5 6 I \ '>r\ V^OuAj-OkArT » ^S* REPRINTED FROM THE " MONTREAL MEDICAL JOURNAL," NOV., 1888. INTRODUCTORY ADDRESS Delivered at the Opening op the Fifty-Sixth Session op THE Medical Faculty of McGill University, r October Ist, 1888. By James Stewart, M.D., '' Professor of Pharmacology and Thorapeutioa, MoGill University. Our meeting to-day is to formally open the fifty-sixth session of the Medical Faculty of this University. Since the opening of this school sixty-four years ago, great and many have been the changes. From small beginnings, we have arrived at a position which is naturally a source of pride to each and all of us, to not only the goodly array of you undergraduates, but to the thousand graduates who are scattered far and near over the earth. Sixty-four years is a long period in the history of man. It nearly represents the active professional life of two generations of men. It would be instructive to contrast the state of medi- cine in 1824 with what it is to-day. Such a record would be an account of an amount of brilliant work which far exceeds in importance all the advances made from the time of the old philosopher of Cos to the beginning of the present century. However interesting such a contrast would be, this is hardly the place to direct your attention to it. Before you graduate you will have had many opportunities of becoming acquainted with what has been the progress of medical science. In the few minutes which I intend to occupy to-day, I prefer rather to make a few general observations which, although rather threadbare, will, I trust, be of use to many of you during your course through this University. 8 Introductory lectures are difficult undertakings. It is im- possible to saj anything that is new. The ground has been run over so often, and by so many able men, that there is really little new in a general way to present. However, even at the risk of being tedious and uttering platitudes, I desire to direct your attention for a short time to some thoughts that have been uppermost in my mind since I was made aware that the choice of addressing you had devolved upon me. My first duty is a pleasant one. It is to bid you all a cordial welcome in the name of my colleagues and myself. To those of you who are this day commencing the study of medicine I would desire to address a few words especially. You are now entering into a study, the greatness and vast importance of which it is, I am sure, impossible for any of you to adequately comprehend. It takes a long, long time for the average medical student to awaken to the vast responsibility he is shouldering. Some students, unfortunately, never attain to that point. Many practitioners go through life without ever attaining it. Without its attainment you cau neve, reach the higher levels of profes- sional life. I congratulate you on the choice you have made. If true to yourselves, the choice is a wise one. When I look about me among my lay acquaintances and neighbors, it is with a considerable degree of complacency and satisfaction, for there are few, indeed, that I would willingly exchange places with. Although Medicine is a hard mistress, still she gives in return that which neither riches nor titles can buy or obtain. To him who practices his profession with all his heart and soul, there is returned to him a double interest — there is the great humanizing interest and the scientific interest, both of an ennobling charac- ter. Although there is naturally in the practice of our pro- fession much to see that shows the weakness and frailty of man, there is, on the other hand, much that is pleasant and much that is ennobling. It is difficult for a laymen to understand the great interest that attaches to the practice of medicine. He cannot understand what pleasure there is in the observation of what we call " interesting cases." He lacks what we call the scientific spirit. Unfortunately it is not uncommon to find members of our own profession sadly lacking in this respect. Their state is not to be envied. They go through life practising a low art, for, remember, we can make our work either a low art or a high scientific calling. It is all dependent on ourselves. Which of these two roads is to be your pathway through life. Now is the day and now is the hour for you to decide this momentous ques- tion. Just as the boy is the father of the man, so i«> the student the father of the practitioner. The character of your work during the coming session will, ii. U probability, be the character of your work in the years that are to come. How very few students see further than their examinations. Examinations at best are only necessary evils. If teachers were only able to inppire their students with such a love for their work that they would perform it for its own sake, examinations would be un- necessary. Unfortunately, however, this is far from being the case. It certainly can never be reached whue the present per- nicious system of general education is in the ascendant. It is no exaggeration to say that few teachers in our public and higher schools grasp the true aim of education. The character of the material that they send forth is the proof of this. While gov- ernments pay by immediate results, so long will this bad system continue, and so long will we have to do with men for the pro- fessions who cannot grasp the true ideal. If, while you are pursuing your course through this Univer- sity, we are enabled to infuse into you an abiding love for your work for its own sake — if we have been able to make you catch the true scientific spirit, we know all will be well. If we only accomplish the feat of enabling you to merely pass your exami- nations, then our work has been a failure indeed. No matter how brilliant an examination a man may pass, if he has not ac- quired the genius, it may well be called of being a student for the rest of his career, all his hard work is of little use in- deed. Here it may be said that it is not uncommon to find the really brilliant students fail. I know of numeroub instances where a brilliant student career has ended on graduation day, simply because these men were never real students ; while on the other hand, I have seen many who passed their examinations v_ with diflSculty, but who, having acquired an intense love for their work, start forth with renewed vigor, and in a short time distance in the battle of life the showy companions of their college course. You will readily understand the great responsibilities that rests on your teachers. Our aim is that you should all leave us deeply imbued with that abiding interest in your work which will make you all students in the highest sense of that term for the rest of your days. To attain this much to be desired end, it is necessary that we should have your fullest confidence. There is much to encourage us, for when we look at the long list of men that have graduated here we know that many of them are still students. The greatest compliment I ever heard paid to the Medical Faculty of this University was from an observant medical practitioner, a graduate of another school. He said that he had time and again observed that graduates of McGill were enthusiastic lovers of their work. An institution pervaded by such a spirit will do work of the highest character. Such influences are not confined to the lives of its individual teachers, but go on for untold generations. It is this far-reach- ing influence that makes the responsibilities of your teachers so great. Every lecture, every demonstration, and every clinic leaves an impression which will never fade. We claim from you the fullest confidence that in what we do we are doing it solely for your good and future usefulness. Between teacher and student there should be an active co-operation. The day is now fortunately past when a student, especially a medical student, looks upon his teachers with distrust. We are all students. We are all striving towards the same end — the les- sening of human suflering. There should always exist among us that esprit du corps which is so characteristic a feature ol university life here. Many are inclined to underrate the influence of this brotherhood, but I feel certain that it is a great factor in the building up and perpetuation of good and honest work. It can be compared to the remarkable brotherhood that exists in many of Her Majesty's regiments, especially the Highland ones. What but their esprit 6 du corps have made these regiments excel in many a field Spartan valor. Sooner than bring a blot on the glorious record of the past they would die to a man. I need hardly tell you that your opportunities here arc great. Value them and make use of them. Work so now that in the future there will be no regret on your part of not having made use of them. Time and again have I heard medical men regret the opportunities lost while attending college. They would give a great deal to be able to go over the same ground again. It is only by making use of your opportunities here that you will be enabled when you are cast adrift to do good work. No matter how small may be your field of work, you have oppor- tunities of doing something for science. It is a great mistake to suppose that the great medical centres are the only fields for the cultivation of medical science. It is usually the custom of those entrusted to deliver intro- ductory lectures to make use of the occasion to say something about, and urge the importance of, their own special subject. I am in great measure relieved from this pleasant duty, for it is pretty well conced id that pharmacology and therapeutics stand in no need of def?)nce. Their importance cannot be denied. In fact they are the end of all the subjects in the curriculum — all other subjects are simply a preparation for the application of agencies to the treatment of disease. The ultimate object of the subject is to teach the legitimate use of means to an end. " The centre around which the lectures are grouped is the physician's prescription. From the utmost verge of the subject, the thread upon which it hangs leads back to the prescription, not of drugs only, but of everything that can alleviate suffering and cure disease. The ultimate end of medical education is to teach how to write a prescription, and in that little act lies the severest test of a physician's attainments. To be examined upon a pres- cription is to give access to every department of medical learn- ing. If the student could satisfactorily explain the how, what, when and whi/ of prescribing, his education would be complete ; but this is not to be obtained during his curriculum merely, it is what the practitioner is still learning at the close of his career. lA The practical application of all the medical sciences culminates in the prescription ; the ultimate object of chemistry, botany, physiology, pathology and the other allied sciences with respect to medicine is to teach the physician how to apply the remedies at his disposal most advantageously to his patients." Pharma- cology and therapeutics is, as it were, surrounded by the medical sciences, so that in whatever direction we may advance we shall find ourselves approaching towards one or other of them. It is not uncommon to meet even with very distinguished members of our profession who deride ia very general terms the use of drugs in general. This incredulity was born in the days when empiricism swayed the medical profession. In the past nearly every form of therapeutic absurdity imaginable has been tested, and often with alleged benefit. Even to this day many people can be found who have a firm faith in homoeopathy, the faith cure, and other similar delusions. It is not surprising, then, that there are therapeutic nihilists in the profession. The Vienna school, with Skoda at their head, have wielded an im- mense influence in perpetuating these errors, not only on th'' continent of Europe, but throughout the whole world. Skodu was a distinguished physician, who lent all his great talents to the refinements of physical diagnosis, almost completely ignor- ing both general and special therapeutics. Strange that his (pi chair should now be occupied by a man equally distinguished, and at the same time one of the ablest and soundest of modern pharmacologists. His great influence has already been felt in the very stronghold of therapeutic nihilism. I refer to Nothnagel. There is a subject of great importance to us here in Canada that I desire to say a few words on. It is the relation existing between the Medical Boards of the different Provinces and the teaching Universities and Schools of Medicme. Every candid observer must admit that there were strong reasons for the insti- tution of the Ontario Medical Board. Whether the motives that actuated the originators of this board were high or not, I am not in a position to judge, but there is no doubt whatever that its establishment has been the means of elevating profes- sional education and the tone of tie profession in that Province. ^'l This despite the fact of the unholy alliance they entered into with the homoeopathies and eclectics. What I wish to direct special attention to is this : that in more than one direction all our Provincial Boards are drugs on the wheels of medical pro- gress. Owing to their narrow policy, progress in the teaching at the University and schools is greatly retarded. All our Canadian Boards require two courses of six months each of the following subjects : Anatomy, Practical Anatomy, Physiology, Theoretical Chemistry, Materia Medica and Therapeutics, Prin- ciples and Practice of Medicine, Principles and Practice of Sur- gery, Midwifery, Clinical Medicine, and Clinical Surgery ; two courses of not less than three months each upon Medical Juris- prudence, and so on. Now if we compare those requirements with those, say, of the University of Edinburgh, we will find a very marked difference. I take the University of Edinburgh because it is universally allowed to be among the first of the teaching bodies in Great Britain. The following are its require- ments : One course of one hundred lectures on the following subjects : Anatomy, Practical Anatomy, Chemistry, Materia Medica, Physiology, Practice of Medicine, Surgery, Midwifery and Gynaecology, General Pathology ; two courses on Clinical Surgery and Clinical Medicine ; and one course on Practical Chemistry, Practical Materia Medica, Practical Physiology, and Practical Pathology. Now you will at once notice the marked difference there is between the requirements of these different bodies. While Edinburgh requires only one course of purely didactic lectures, our Provincial Boards require two. Now, I would not like to go so far as to say that the Edinburgh curriculum is a perfect one and that of the Canadian Boards all imperfection. There can be no doubt whatever that in the main Edinburgh is right and our Boards are wrong. There are several subjects where one course is all sufficient to present the matter to the student. In this list I would name Descriptive Anatomy, Physiology, Chemistry, Materia Medica and Therapeutics, Sur- gery and Midwifery. I hope you have noticed that I have in- cluded my own subject in the list of those I would like to see cut down. The only subject in the list of so-called didactic 8 subjects which I think demands two courses is that of the Prin- ciples and Practice of Medicine. The subject is now such a complicated and vast one that it is quite impossible to present even its salient features in one course of six months. To put il practically, a word that is especially dear in this utilitarian age, it is your future " bread and butter" subject. If we pass on to other subjects, I am sure you will all admit that one course on descriptive anatomy is sufficient for the full presentation of that subject. This, with '^^wo courses of practical anatomy, would surely even satisfy the most exacting. As to physiology, one general course is quite enough. This, with a course on practical phy<4iology as now conducted by Prof. Mills, would cover the ground very well. You will all readily admit that one course of theoretical chemistry would be sufficient for the already over-burdened Btudent. As to materia medica and therapeutics, the course should be divided up into pharmacology, clinical therapeutics, and practical materia medica. I would be quite satisfied with a three months course on general pharmacology , a three months course on practical materia medica and experimental pharma- cology, and a weekly lecture in the hospital on general thera- peutics. To a certain extent I am glad to say that I am able to adopt this arrangement and still keep up to the requirements of our Boards. I feel confident that before many yerrs this or some similar plan will become general. One course of didactic lectures on sugery, in addition to two courses of clinical surgery, is sufficient even for this important subject. If anything is to be added, let it be on clinical surgery and not on the general lectures. The importance of midwifery surely demands that it should be treated as liberally as either medicine or surgery. There should be clinical midwifery ; by that I do not only mean the usual attendance on six cases of labor, but the regular clinic at the bedside of the lying-in woman, after the manner instituted by Dr. Cameron in the Montreal Maternity. One or two courses of clinical midwifery, with one course of didactic lectures, would certainly be supenor to the requirements at present demanded by the Boards, which oonsists aimply of two courses of didactic lectures and the simple attendance on six cases of labor. There is no such requirement as clinical midwifery in the sense that this is now understood. For what reason two courses of three months each in different years on medical jurisprudence should be required passes my understanding. Now, a number of our Boards err in the opposite direction in regard to the all-important subject of general pathology. It would appear from their requirements that it is not necessary to be acquainted with this subject at all, except in so far as it may be treated of in the other subjects of the course. I have not done yet finding fault with our Boards. Among the subjects a student is required to attend his first year are Anatomy, Chemistry, Physiology and Materia Medica. As far as anatomy and chemistry is concerned, this arrangement is all right, but as for physiology and materia medica it is all wrong. To take materia medica first, a student is required to attend lectures on a subject which deals with the actions of agents on organs and tissues, the anatomy and physiology of which he is entirely ignorant of. Fortunately, here we have been able to get rid of this difficulty by making materia medica a second and third year subject. But how long will it be before a similar change will become general in this country ? Take physiology again — a subject of intense interest and fascination — the very groundwork of scientific medicine. Now it for the most part consists in the application of chemistry and physics to the study of life, and yet the student is required to take up this subject before he has had a training in either phy- sics or chemistry. If the subject was first entered during the second year, how much easier would it be for both teacher and student. Coming as it does in the first year, it seriously inter- feres with both the teaching of chemistry and anatomy. Now, how are all these faults in our Boards to be remedied ? How are these wrongs to be righted ? The teaching bodies are powerless in the matter. In fact, any representation for a change in the curi-iculum of studies from such a quarter is looked 10 upon with suspicion. For the most part, the Boards are com- posed of men who are not teachers, and who, consequently, are not in a position to judge of the needs of students. Many of them argue in this way : the more lectures the longer the courses, the fewer men there will he to graduate. I am sure that if here in McGill we had our own way in these matters it would not be long before these abuses would be swept away, as far as we are concerneci We are hoping for better things, and much depends on our g luates. If, after leaving us, they would move collec- tively in this matter, I am sure the desired changes would soon come about. Come sooner or later they must. It is far from creditable to the medical men of this country that such a state of affairs should be in existence. When we consider how much there is to know in medical science, and, after all, how little any one man can know, be his talents and industry of the highest order, it is surely our bounden duty to see that at any rate no obstacles are placed in the way of the student. It has recently been computed that upwards of 25,000 original medical articles are published yearly ; this is about the rate of seventy articles a day, being more matter than ten ordinary men can even read, let alone digest. This will give you an idea of the enormous activity in the medical world, and yet you are supposed to know almost everything when you gra- duate. At the great congress which met in Washington two weeks ago, no less than fourteen special medical associations were represented. So specialized was the work in many of these sections, that the work of one section was frequently unknown ground to the members of another section. An attempt was made to have general meetings, where all might be interested. This proved a great success as far as the general interest that it excited, but I question very much whether, after all, there was an intelligent following by many, of the subjects discussed. It is hard to conceive how the laryngologists, or the gynaecolo- gists, or the orthopaedists, or the genito-urinary surgeons could intelligently follow the discussions on cerebral localizations. To many of them the discussion must have been about as intelligent as it would be to a well educated laymen. 11 I I will not pursue this subject any further, as I do not wish to enter into the large subject of specialism. I have only referred to it in order to give you a glimpse of the great profession that you have now entered, and to direct the attention of the pro- fession at large to the fact that the students of this country are seriously handicapped by the regulations of the Provincial Medi- cal Boards. It is a great mistake to hamper the teaching bodies. If medical education is to progress, it is essential that it should not be subject to the will of every budding medical politician. In this University we especially, I think, feel the obstructing influences of the Medical Boards. We are not only the oldest medical school in Canada, but the most progressive. At present, as in the past, our curriculum has been ahead of all others. It is, in fact, frequently copied by our neighbors — a sign which we are pleased to see, for you all know that " imitation is the sin- cerest flattery." Depend upon it, we are not going to rest. Our motto is " Ever onwards ! Ever upwards !" I will now conclude what I have to say by reminding you that the years of your probation here will quickly pass away, and that soon you will be called upon to go forth to join the ranks of those who are battling with disease. Great is the field of labor, and every true and honest workman is welcome therein. The contest is a great and very unequal one, but every day it is lessening. Every day the light of science is brighter. May it be your part to aid, however humble, in making it still brighter, but to do this you must — work ! Then " work while it is called to-day, for the night cometh when no man can work."