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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 as required. The following diagrams illustrate the method: Les cartes, planches, tableaux, etc., peuvent dtre filmds d des taux de reduction diffdrents. Lorsque le document est trop grand pour dtre reproduit an un seul clich6, il est filmd d partir de Tangle sup6rieur gauche, de gauche i droite, et de haut en bas, en prenant le nombre d'images n6cessaire. Les diayrammes suivants illustrent la mdthode. 1 2 3 1 2 3 4 5 6 iPPHPffP mmmmmm Cl^^ZZZ^ , Lyc^^ ^ ' ' »^L,. ..,,.„.. Xi- _ OPENITO LECTURE V ^ TO Tm Sf^ttal ^teknts of fueen's CflUege. BT OCTAVIUS YATES, M.D. SESSION 1868-4. PRINTED BY JOHN LOVBLL, ST. NICHOLAS STREET. 1564. *fi OPENING LECTURE TO TBI ptMtal ^kMs flf f ttecn's College, IT OCTAVIUS YATES, M.D. SESSION ises-^. PBINTED BY JOHN LOVELL, ST. NICHOLAS STREET. iHQi. OPENING LECTURE TO THE MEDICAL STUDENTS OF QUEEN'S COLLEGE. GVRTLnnDR :— To thoie of you who bare al> ready oompi<^tcd a part of your curriculum in this or any other medical school, I need not particularly address myself ; but to those who for the first time seek medical instruction within the walls of a UniTersity, a few words of advice and instruction may not be out of place, while I hope they will not be unprofitable to any. I am in abetter position, perhaps, than any of my confreres to gire advice. Having been, not ▼ery long ago, a student of medicine in this University, I may be supposed to know the wants as well as the weaknesses of students better than those, whose reminiscences of col- lege life are less vivid. At the same time the position is the cause of not a little embar- Msment, for I find myself associated with those, my colleagues now, who but a few years ago were my teachers. The circumstance, how- ever, is a source of no little satisfaction to my- telf, and should be to you, gentlemen, as inaug- urating, in this Faculty at lea8t,the rule which I hope may become permanent, of selecting from the gmdimtea of the H^nireraity persons to fill such chairs as may, flrom time to time, become vacant. There can be little doubt as to the propriety or policy of the rule ; for, if from the list of her graduates no one can be selected, qualified to occupy the chair of a professor, the fact of itself must v. to the injury of the University, as being a ta. it confession of the deficiency of the course of instruction pur- sued within her walls. With these introductory remarks, I will pro- ceed to enquire of you who appear to-day as students, For what have you come here 1 Are you fully aware of the difiBculties and dangers that are before you, and are you thoroughly im- bued with that spirit of determined persever- ance on the one hand, and that moral rectitude on the other, by which alone yon can expect to pursue your studies satisfactorily, and then to become useful and honourable members of a useful and honourable profession and of society ? You have all come here, I hope, to work ; for whatever may be said of other professions, that of medicine cannot be picked up at one's leisure or obtained by imbibition. To work then— hearty and laborious workjou must apply your- ■elves. But remember, while pursuing your ■tudiea, and indeed at all times, that the human body is not a machine made up of inert mat- ter, but that it possesses, in addition to its phy- ■ical frame-work, a mind which, though unlike the body in composition and character, yet like It requires recreation and '■jst. That our in- tellectual faculties may be in that state best calculated for profitable stydy the body must be kept in health. For much mental exertion deranges the physical man, while a derange- ■ ment of tbe physical functions renders the indi- vidual incapable of the highest and most profit- able kind of mental labour. You should endea- vour, then, to keep your bodies in a state of health by regularity in bodily exercise and diet, that your time may be employed to tbe best possible advantage. As the lectures in the different branches progress you will be taught the better how to do this, as well as more fully the great connection which exists between the mind and body. With this view of the matter It will readily be seen why the examinations have been divi- ded, into Primary and Final. The subjects are eight, taught by eight professors and a demon- Btratyr of Anatomy | and it is believed that a greater proficiency can be attained by dispos- ing of four of these at the end of the third year, when a more undivided attention can be given to the remaining four at the end of the fourth year ; particularly when we remember that to master thoroughly these final branches, one must be perfectly conversant with the primary ones. I said just now, that to preserve the body, and with it the mind, as a natural consequence, we must observe regularity in bodily exercise and in diet ; I should have said regularity, and temperance in exercise and diet. Temperance, as the world understands the term, is most essen- tial to the student. If a too free indulgence in the use of ardent spirits is practised, depend upon it, it will sooner or later unfit the mind for that degree of culture necessary to success in a lib- oral profession, at the same time that it saps the body of that physical stamina upon which both physical and mental health depsnds. My firm conviction is that while an intemperate use of strong drink is injurioiis to all, even a temperate use of it is worse than useless to the student. It is a stimulant, which, uuder cer. tain circumstanced and in certain diseases, may be useful, but when the student requires it to enable him to get through with his allotted Work, it is high lime iLal he quit bis studies altogttber. The world Is fbll of instances in which even young men have destroyed bright prospects upon the great stumbling-block, Intemperance. I dare say, gentlemen, that there is not one araongyou who cannot call to mind an instance of this kind. I could point to many professional men, who but a few years ago were what the world calls talented young men, but who are now either sleeping in untimely graves, forgotten, except perhaps by a mourning mother, or sister, or wife, or walking the earth, wrecks in mind and body, the shame of their relatives and friends. They may, however, accomplish some good by their example, for they stand as signal.posts olong the great highway, to warn us all of the pit into which they have fallen I But the medical practitioner, of all others, should abstain from a too free use of ardent spirits, for there is hardly a calling in which the mental and physical faculties require to be so constantly in readiness. If the mariner, in the neighbourhood of a rocky shore, requires to keep a sharp look-out, with which a too free use of ardent spirits is sure to interfere, so should the meAcal man, whose services are liable to be required at any moment, day or night, in cases of life and death. The lawyer can shut his office at three or four in the after- noon and snap his fingers at business until next day ; the merchant can put away bis ledger, and never dream of being called out at night to minister to the crying necessity of a suffer- ing fellow mortal ; and the mechanic, when his daily task is done, can retire to the undisturb- ed rest which is to fit him for the duties of the coming day. If these indulge in an extra glass at night it has no immediate effect upon you or me, though, if continued, the habit will quite likely have a melancholy effect upon themselves, their families, and society. But the medical man is expected to be ready at every moment, " in season and out of season," by day and by night, " in fair weather and in foul," to go out at the call of his patient; and he should be so ready that he may perform the responsible duty, in such cases devolving upon him, as becomes one into whose keeping the life of another is placed. But perhaps he, who is thus at work, in ail hours and in all weathers requires stimulants to "keep him up." None but those wedded to the habit of too free indulgence will urge such excuse, at least so I think, and I am not alone in my opinion. Dr. Carpenter, one of many authorities, in his " Treatise on Human Phy- siology," (a work recommended to you for reference in that branch), sums up the effect 6t alcoholic drinks in the following words:— ) ' Extended r perience hag abowu that, not* withstanding the temporary augmentation of power which may resuit from the occasional use of ardent spirits or fermented liquors, the capacity for, prolonged endurance of mental or bodily labour and for resisting the extremes of heat and cold as well as other depressing agencies, is diminished rather than increased by their habitual employment. On these grounds the author has felt himself fully justi- fied in the conclusion, that for physiological reason" alone, habitual abstinence from alcho- lic liquors is the best rule that can be laid down for the great majority of healthy individuals." I have dwcltupon the effects of intemperance, principally physiological but in some respect moral, because I am satisfied that the practice of temperance should be commenced, as far as the medical man is concerned, during student life. If this is not done, habits may be formed which it were next to impossible to overcome, and which might blast tbs prospects of a future graduate utterly and for eve". I am firmly con- vinced that you will never feel occasion for regret if you adopt and follow it strictly with- out exception. But you will require to observe also a syste- matic arrangement of your studies. Success, to a far greater extent than is generally imagined, depends upon this. If you imperfectly master one subject and leave it for another, to drop it in turn for a third, you willfaever get on satis- factorily ; but if you have a certain allotted portion of your work pet down for a certain hour, you will soon find that you can keep up with your lectures easily and profitably. I will now indicate to you what you are to study,. I repeat the question ; " For what have you come here to-day?" One might reply "I have come to study the Science of Medicine ;" another, " I have come to learn the Healing; jlrt." Both of you would be wrong ; neither v^v-. be- come a good and scientific practitioner. If you analyze the subject correctly you will readily agree with what I have just said. The terms are far from being synonymous, but they cannot well be separated. Empirics and quacks, upon whose illiterate and conceited minds thr thought even of the science of medicine never dawned, acquire a certain kind and amount of the art of healing. Take, as an illustration, the science of chemistry. It has evidently arisen out of th« art of the alchymist, but every new discovery in the science of chemis- try can by no means be regarded as an advance in alchymy. The chemist is able to explain upon truly scientific principles every step in bis art. The alchymist only learns by experi- ment that certain results follow certain opera- tions ; he could not explain the mode of opera- tion as the chemist can do, for the science of his art bad no existence. Tlie wide difference between the art and science of music may bo referred to as another illustration. The art of music, like all other arts, can only be learned by practice. Practiced long centuries ago, perhaps by rude and unl^tered peasants, the art gave birth to the science, starting neces- sarily from some superior mind moved to it by thu practice of the art. As the art of the chemist can only be learned by practice, whilst the science can only be acquired by reasoning upon chemical philosophy and by studying the principles of the practice, so the art of music can be learned only by practice whilst the sci- ence must be obtained by a study of the princi- ples. If, then, we would never imaging that a man could be a good musician or chemist without understanding thoroughly the science, of how much greater moment should we hoid it to be, that, in a profession which has to do, not with musical instruments and the production of harmonious sounds, or the handling of test tubes and retorts and the production of beauti- ful colours and wonderful compounds, but with the moving and breathing body of man, "fearful- ly and wonderfully made," we should take care that we are well grounded in the science of the art we profess to practice ; and not, like the empiric, grope our way in the dark, regardless of consequences, if reputation or the pocket is not made to suffer. We should be careful about it, not merely because our reputation and with it our pocket will sooner or latter suffer by a neglect or deficiency in this particular, but above all, because the responsibilities we as- sume as practitioners of medicine are tremen- dous I Let us suppose a case. A man, for a long time on unfriendly terms with his neigh- bour, at last in an unlucky moment gives a death blow. The murderer is arrested, tried, found guilty, hanged. Another, in a social point of view perhaps worth a thousand of the murdered man, falls sick ; we are sent for to attend him, and through our ignorance or blundering he does not recover. Society mourns his loss, the widow ind orphans cannot be comforted ; but an indulgent public says " poor man, art could not save him." What, do we say within ourselves ? We have saved our reputation with the public, we even get our money to the last farthing ; but in onr consciences there remains a sting which even the " wasting tooth of time" shall not remove. We cannot qniet our uneasy couBciencei by Um thpufbt^ tbftt w did tho bait wa oould ; hit blood ii upon our if norantbeadi. " Ignoranct in the medical practitioner i» ai the lin of blood- guiltinesi." The difference in tbeie two caiet doM not need to be pointed out. Strife then, gentlemen, in preparing yourielTea for the practioe of the medioal profeiilon, ao to oom- bi .0 the art with the aoience, that when jou find youraelvea unable toiave your patient, you can, at Icaat, feel the happy oonaoiouaneaa that it was not through your ignorance that he died. But there are cases that eren the best edu- cated and moat experienced medioal men do not understand ; new diseases and unaccountable features aud developments of disease never seen or beard of before.The only sound hope for such cases is in a thorough application of soientiflo medicine. And if the science fail, if the treat- ment founded upon general principles fall, and the patieAt die, we must seek for an examina- tion of the pathological condition of the parta thought to be Involved. By this means art is eatablished, and a science at fault corrected. And this leadB me, for a moment, to consider the importance of autopsic examinations. A great obstacle to this is the unreaHonable squeamisbness of friends who entirely lose sight of the fact, that, while the dead suffer not, the living reap the benefit. To poit mortem examinations the medical practitioner.more than the8tudent,owesa deep- er insight into the pathology of disease than ia generally supposed. The late lamented President of this Faculty has often assured me, that when a young man, he would willingly have walked twenty miles to be present at one ; and be has often expressed astonishment at those students, •nd practitionera as well, who make boast of their indifference to this part of a sound med- ical education. In his peculiar style he char- acterized such men &s "conceited fools, too ignorant to know that they can learn anything more." And 1 may mention that the same Tenerable physician and surgeon, who for years was lool socie'y. In either caiie, the oonfl- dettoe reposed in your profssslonal knowledge would be grievously misplaced, were you rash- ly to ventuio an oplulon without a clear under- standing of those psychological phenomena resulting from mental disease, which take every varying form, from the babling oV the idiot to the raving of the murderous maniao. Your culpability would then bo only equalled by your presumption. I will presuppose that you are well grounded in the science of medicine, or at all evenUthat you are laying well the ground-work of the science. You understand perfectly the anato- my of the human bodj , if shown two drugs you can give the name, can describe the manner of preparation and mode of action of each, and if asked the diagnostic marks of difiRsrenoe be*- tween two diseases or tumours named to you, you can give them readily end correctly, but if you are taken to the bed-side of a patient and are there asked the question, Wbat-is the mat- ter 7 you find that you have been cast beyon-! your depth and are utterly at a loss to give a reasonable answer. You have, in other words learned the nienct of mtdicint but you have yet to acquire the art of heaUng. Be aniious and diligent, then, to perfect yourselves under the instruction of those who have already learned and who are appointed to teach you, this im- portant branch of your education. Fortunately, for that express purpose, we have the Kingston Hospital, connected by act of Parliament with this University, where you will have an opportunity of seeing a great variety of diseases and injuries, and of follow- ing the treatment adopted in each case. But there is a right and a wrong way o< iollowiug Hospital practice. I have seen students, al much personal inconvenience, attend Hospital to witness an amputation. A few onts of ths knife, a few strokes of the saw, and the leg lies under the table, when they erroneously Imagine that the operation is completed and so go away. They look upon the ligation of the arteries, the closing of the wound, and the after treatment as of ,no use or importance to them. But in this they are vastly mistaken. Oftentimes upon these small matters, as they are thought to be, the success of the operation and the life of the patient depend. Take a different case i an acute disease. Tho student seems par- ticularly interested, and liitens attentively to the cUnicaJ jnatniotJanBgiTen. He Bate? tiwr // « ^. ^ l-_ ftttendittg physioian's di'^nosia of the diseue, the reasons for its formation, and the remedies ordered ; and he foolishly imagines that he has learned all that there is to be learned about the treatment. Pleasure, or indolence, or igno- rance prevents his return to watch for the result and to note the eflfeot of the remedies applied. I hope you will eagerly embrace every opportunity, not only to be present at the examination of medical and surgical cases, but to follow attentively the 'treatment to the end, whatevur it may be. Do not forget that thoughtful oburvation is a means to an end and that the end is experUnce, which is nothiug more than an accumulation of many observa- tions on the same subject, and it is by the massing of observations of success a^d failure, guided by a sound knowledge of the general principles of medicipe, that we come to know how to practice this art of healing. Finally, gentlemen, all our labour and study but conduct to this, the discovery of truth, and the application of it to the relief of human snflFering. Both the science and the art of medicine are necdssary to this end. Let me beg of you to bend every neive to master the truth, and being masters of it you will be pre- pared to ward off the death, or shorten the career of disease, or assuage physical anguish, or (when art and science and all that we can do avail no more) to smooth the passage to the grave, and thereby confer as great a blessing upon your fellow, as mortal is capable of con- flarring. You are all of you probably aware, that when you entered upon the study of medicine, you joined what some people look upon as an anomalous class of society ; for there are those, even in this community, who regard the medi- cal student as a lawless and godless person. To the student I need not say that such an opi- nion is botL grievously untrue and grossly libellous, while to others I need only point out the high and elevated mission of the medical man, to convince them that reckless and lawless conduct in the student is inconsistent with the benevolence and correct conduct of the prac- titioner, and to remind them that the student is only preparing himself for weighty responsibi- lities. This opinion has probably been formed through an erroneous idea of the nature of the studies. Many people have the idea, too, that certain branches of. medical education are cal- culated to beget feelings of irreverence and irreligion; but this idea also is totally erroneous. Instead of destroying natural sensibilities. ieasesiag the ssntinsentg of religion which I •Tery one ia a Ohriatiao community should en- I tertain, the study of anatomy is rather calcu- lated to increase the feelings of reverence for the Creator and to teach the student of it to look "from Nature up to Nature's God," the Author and Finisher of all. To say that an acquaintance with the many blood-vessels of the body along which coursed, in the full tide of health, the rich blood moved by the finger of Ood, or with^the origin and distribution of those thread-like nerve fibres along which once flashed, " swifter than a weaver's shuttle," the will to speak— to say that these beget in the mind of any one a disregard or irreverence for Him, who created and adapted them for the performance of their marvellous functions, is to publish a libel upon the common sense, to say nothing of the religious sentiment, of a ratio- nal and intelligent creature. On the contrary, the evidence that the anatomist and physiolo- gist finds forced upon his reason by an investi- gation and study of these sciences, wherein he sees the wiidom of adaptation, should be enough to convince, even an infidel, by " confirmation strong as holy writ," of the existence of a Great First Cause and the directing and sus- taining power of an omnipotaot hand. Let me urge you, then, knowing that certain people ignorantly entertain these erroneous ideas of your character, to show the world that you are no re