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Lorsqua le document est trop grand pour Atre reprodult en un seul cilchi, II est film* A partir da I'angia supArieur gauche, de gauche A droite. et de haut an baa. en prenant le nombre d'imagea nAcassaire. Lea diagrammea suivants illuatrent la mAthode. 1 2 3 1 2 3 ! 4 5 6 l*v'' 'I'll ' . > ,R.^. f- h. THE PLACE OF CHEMISTRY IN A MEDICAL EDUCATION. THE INTEODUCTORY LECTURE IN THE FACULTY OF MEDICINE OF MoGILL UNIVERSITY FOR THE SESSION OF 1893-94. BY Prop. R. F. RUTTAN. (Reprintei from the Montreal Medical Journal, November, 1893.) 'ii v- THE PLACE OJ^^ CHEMISTRY IN A MEDICAL EDUCATION. The Introductory Lecture in the Faculty op Medicine OP MoGiLL University por the Session of 1893-94. By Pkof. H. F. RUTTAN. We meet to-day in conformity with the well established cuhtom of our Faculty to inaugurate by a lecture the session of 1893-94. To-day we plant the sixty-first milestone which marks the progress and development of our school. I need not tell you with what gratification I find myself, though almost the junior member of the Faculty, in the position which my colleagues have been courteous enough to assign to me — a gratification which would bo complete were it not for the sense of responsibility which the position involves, a posi- tion which my own consciousness assures me might, with gi-eater benefit and pleasure to you, have been conferred on one of the others about mo. One of the chief causes of gratification which the position gives me is that I am able to offer you all on behalf of the Faculty a hearty welcome back to the halls of your Alma Mater, to assure those of you who are now just entering on the threshold of a life of study that this welcome is more than the formal one of a professor to his class, but is that of friend to friend — to remind you that as fellow students in a profession which demands such ^sacrifices of time and self as medicine, we all have the same great object in life, In no profession, perhaps, is this sense of camaraderie so strong as it is in that of medicine, no class of students are so true to each other and to their Alma Mater as medical students, and of no other profession are the members so ready and glad to offer each other assistance, when called upon, as those of the profession to which you aspire. I refer to this, Gentlemen, not in any spirit of self glorification, but that I may the more thoroughly impress upon you the fact that your professors are your best friends, and assure you that if you come to them in time of doubt or trouble, the best fruits of their experience and knowledge will be freely and gladly given to you. I have to congratulate you, Gentlemen of the first year, on entering McGrill University at a period in her history marked by such prosperity as the present. It has been her province in the past to set a high standard in the practical and vital branch of education controlled by this Faculty. This duty has been done in the face of grave doubts and difficulties, and this duty our Faculty is now doing, not without the expendi- ture of much thought and labour, but thanks to our generous friends, without running that risk of financial failure which deters so many schools from adopting the most advanced methods of teaching, and fixing a high ntandard for their degree. To a certain extent the laws of supply and demand apply to medical schools as well as to the price of wheat, and there is a perfectly natural tendency in many men towards a school which will give them a diploma for the least expendituie of time, money, and energy. Many schools have come into exist- ence to meet this demand for a short cut to the degree of Doctor of Medicine. So detrimental to the best interests of the community has this undignified competition for students become in the United States, that it was seriously suggested in a recent report by a Commission of Education that every medical school in the country be required by law to provide forthwith an endowment of not less than three hundred thou- sand dollars. As Oliver Wendell Holmes wittily remarks : " A school which depends for its existence on the number of its students cannot be expected to commit suicide in order to satisfy an ideal demand lor perfection." I say it is partially true that the demand for medical educa- tion obeys laws analogous to those which rule the world of commerce, but this is only partially true. The better class of students, as the hintory of our own institution proves, will always go where a high standard of excoUenco is required, justly feeling that only when associated with men seeking the highest class of medical education they will find congenial friends, and meet with opponents for college honours who will compel them to exert their full ftowers. But there is another aspect of this question, and that is, that the best medical instruction must necessarily be the most ex- pensive, and the most desirable students are by no means those who can easily afford to pay very high class-fees. Well equipped laboratories, good teaching museums and models, large reference libraries, and above all an able staff of pro- fessors and assistants, are the necessary but costly features of a great medical school. Our benefactors have set the excel- lent example of liberally aiding an already tried institution, instead of launching a new one among the many which are now struggling to float, recognizing the fact that by endow- ing a good medical school they have advanced the thorough- ness of medical education, not only by making that school independent of large or small classes of students, but also by enabling it to provide a larger staff of officers of instruction and well equipped laboratories, without compelling that school to make its class fees almost prohibitory. Before leaving this subject I may add that there is one feature in connection with these recent do^itions to which I would like especially to call your attentioa, for it is the one that will continue to give us the keenest satisfaction, and that is that they were bestowed as unsolicited gifts by those who are accustomed to use their eyes in estimating desert, and that this kindly act signifies a hearty approval on their part of our endeavours to advance the knowledge, train the judg- ment, and perfect the skill of those entering on the profession of medicine. , And so, Gentlemen, it is with a sense of thankfulness for the past, of satisfaction with the present, and of joyful hope for the future that the Medical Faculty begin the sixty-first year of their services to the profession, welcoming their new 6 riends, thanking their henefacioiM, and ox(thun^ing with each other, their old wtudentw, und the (JovernorH of the University, mutual congratulationH and good wirthos. The beginning of a now sesHion, the entrance on a new course of lectures, is always an event of groat interest to pro- foHsorw and students. The chief interest attached to this period of tlie l^niversity year is duo to the ftict that it marks the advent of a now class of students. No introductory lec- ture, therefore, is worthy of the name that does not contain what might be termed its ** Freshman's Corner." Herbert .Spencer, according to his cold, logical, and scientific ideas of things, would regard you young gentlemen as social units in an embryonic condition, lie correctly ])oitits out that all social as well as biological advancement is a progress from the general to the particular, a specializatiou. As your seniors in medicine know well, all embryos, at a certain period in their existence, are more or less alike, and biologists are not able to tell whether a given specimen embryo, at an early period, will become a sheep or a goat, a monkey or a whale. It is only later, when the limbs appear and the head becomes shaped, and we see how it is to go through the world, that it becomes easy to tell what manner of creature it intends to be. Similarly, as boys we were all more or less alike, and though past the boyhood stage, you, for instance, still possess many general but useless characteristics, which you have in common with young lawyers, curates and businese men ; but now that you are about to differentiate into physicians and surgeons, you must allow those useless appendages of your mind and character to atrophy and disappear from disuse, and develop, by calling them into special activity, your powers of reason and observation and knowledge of humanity in sickness and in health, in order that you may become adapted in the kind of your intelligence to your future envii'onment ; that is, to drop the metaphor, you have deliberately and fully chosen medi- cine as your profession. The world demands, at any price, men that are absolutely fitted to their position. You should, therefore, cultivate in every detail those qualities of mind, of person, and of manner, that will enable you to fill the place that the world reserves for the great physician. Your curri- culum of study will not do all this for you. Much must be acquired by personal observation and thought. Tt has been sai ing, gradually forcing itself forward, called into oxiHtonce tho flrat indicatioHH of oxporimentui Bcienco, This dawn of a now era in thought, which ushered in both chentiHtry and medi- cine, found itH moHt powerful exprcHHion in tho Keformation itself. Although chemistry did not entirely free itHolf from the fascinations of the hermetic doctrines until a much later period, another aim came into prominence, which gave it a distinctly scientific character. Medicine and chemistry were to be conjoined in the most intimate manner, for their mutual benefit and advancement. The leading physicians of the period became the chemists ; as chemists Ihey discovered new remedies, prepared them carefully, and determined their con- stitution, while as physicians they tried and explained their physiological and therapeutic action. It is to this inter- action of medicine and chemistry that this period in tho his- tory of science owes its peculiar characteristics. The result was an enriching of both. Chemistry passed from the cloisters and private laboratories to the aniverslties — passed gradually from the control of vain dreamers and charlatans to that of a learned, and, for the period, scientific profession. Medicine, on the other hand, received from this union the greatest impetus in its history. Doctors became sceptical regarding the infallibility of the works of Galen and Hippocrates, and began to observe and record for themselves. The spirit of independence induced by laboratory experiment and observation extended to their daily practice, and a more careful study of the symptoms of disease followed. The fundamental object of chemistry then became not to make gold, but to prepare and examine medi- cines ; and the knowledge of chemistry thus ao(][uired led to the doctrine that the healthy human body is but a conjunc- tion of certain chemical matters — a receptacle containing chemicals acting in a fixed way. When these underwent change, illness resulted, and the latter, therefore, could be cured only by means of chemical medicines. The spread of this doctrine resulted in the overthrow of the old school of Galen ; but, of course, any successful treatment based on such an hypothesis could only be possible when chemistry had attained a higher development. 10 llowovor, (lio iniportiiiit {\u\\ toiiitiiiuMi tliul. modicino wuh now no lon^oi' ^iiiiUul l»y liiuiilion, hut hy u HiMMUIilh^ liypo- IhoHin wlii(«li took Um oii^in (Voni liiiman olmorvHlion luid oxporinuMit, In hrin^in^ hImmiI MiIh union o\' (^lioniiHtfy lunl inodli'ino, wluoh wiih ho nuiliuilly liolpHil, no ono oll'ootod moi'o than l*ura«'olHnH. His duo nanio wnn l*hili|> llorlinor, lait, on «MUiM'inf>; his nuulical couino, \\o asNuniod llio ratlior inoru pro- tontiouH nanio of IMiillipus Auroliiis TliooplitastUH MonthaHtus I'arafolsus von lloltonhoini. Althougli ho was a pioUnlious (diai'hitan, a man of wldoly oxti'ava|ij;ant and val nunlioino lt» toltoron its haso. Tho oonipiotodis- iM)n\tituio, howovor, of tho dtsoipU^s of Iraditioiuil niudiidno was otVootowo thodisoovorv of numv faots in troatmont and physiology, that havo ronuiinod truo to tho prosont timo. Ho was tho tirst, for instance, to ro«H)j>;ni/.o tho inoorroctnoss of tho dooirino that tho heart wan tho centre of hoat. His acute observation tii'st called attention to the (H)nnootion that exists between j;o»it and urinary calculi. His reputation, however, rests chietly upon tho number and importance of tho new remedies which ho introtluced. lie was tho first to employ as internal medicine the salts of mercury, load, and antimony, sulphate of copper, and the various preparations of ii\>n. All this, too, was done at a period whon it was not tho thing to use chemical motiicinos (and what greater condemna- tion, even in t)ur own timo, could a now departure in thera- peutics receive ?) No; tho orthodox medicines of that period wore of a ditlorent type. To give you a faint picture of modi- eino of ihe fifteenth century, let me quote a few ideas of the great (talen. The following is taken from a chapter entitled, 11 "Tlio lloud iind IIIh PiirtH," in ii hooU of rn(Hli(>ino of'tlm hIx- loniiUi (uuitiiry. (iaiori HiiyoMi : " TImi l.uiid Ih dividod int<» lour piii'tN; ill llin Curo pint luttJi blood Mio doiiilriion, clndur \\w i-i^lit Mido, iiudiiiiclioly in iJnt loll Hido, and llo/i^nm Ixtiinith nilo in Hut liindtM'nioHl, piii'l." In Hnul^Mny and phyHiolo^y NiK'h UUmih aH liumit piovaiind : 'IMio Hploon wan tlio contio of wit; tJi(f Hi/.n of llin hraiii irin-DaHttd and ditci'dawud wilh llio moon; llio riinc.l.ion of l.lio livur ih IJio Hoat of lovo ; Uio liin/L(H woro employed lol'an lli« iioarl., wliip il in a pio(!o of ruHMot riotli, lian/; it altont llio ntxdt, it cnrntli tlio ri^ht i^ya if it ho inllamt d or bloamd ; and if tlio loft oyo ho ^M-iovod ro;^roHHivo ropiihlio to tho Hoiith of uh. iloro wu havo homdiopathic ophthalmology in I ho tif'toonlh cuntiiiy. I havo tlniH dwolt Homowhat at loii^th on tliJH poriod in tho hJHtory of modioinu, on account of tho ofl'oot whioh (diumicul viowH and knowlod/{o had on tho dia^rtioisiH and trcutmont of r()^roH8 w felt by those who regu- late our medical curriculum, to bo able largely to increase the valuable laboratory work in cliomiHtry, and in greater propor- tion to reduce didactic lecturer. This change, however, can be ctlocted only when a higher (juality of chemical work is done in medi(!al schools than is now possible. Wo are bound to our present system of teaching by two forces — the standard fixed by the licensing boards, and the absen(!0 of preliminary train- ing in science on the part of the groat majority of our matri- culants. Higher chemistry should bo taught in our medical schools, and much loss of it. It is positively cruel to require a medical student in his Hrst year, whose time is so fully recjuired for those things which boar directly on his future work, to go through tho drudger}' of mastering the eloraonts of chemistry. To obtain a knowledge of chenilcal nomen- clature, and the nature of chemical processes, is not ver}' interesting, and is hard work ; and to do oven this thor- oughly certainly occupies for him one of the two precious years ho has at his disposal for the preliminary btudies, and in his second year but little time is left for either acquiring a knowledge of medical technical chemistry, or for the training which laboratory work affords him. It is not doing justice to chcmistr}', nor to the professois who teach it, that this condi- tion of affairs should exist. Tlio student naturally regards chemistry, up to within a few months of the end of his study of it, as something uncanny, made up of barbarous names and very crawly formulee — as a science presenting all tho difficul- ties of algebra, without its compensating accuracy. It is only too late when he finds out that formula9 and nomenclature are not chemistry, but bear about the same relation to it that the German irregular verbs bear to the poetry of Goethe's Faust. The remedy for this is obvious — he should be required to know the elements of chemistry before entering medicine. The only chemistry taught in medical schools should be organic and technical medical chemistry, or what the late Dr. Carnelley has called bio-chemistry, which, as the name suggests, is the science which treats of chemistry in relation to life and its attendant phenomena. It treats in brief of the action of dead matter on life, and the reciprocal action of life anti i'esi havl althi scieil thesJ 21 on dead matti ; and, of course, includes what is usually called physiological, pathological, jind Huiutaiy chemiHtry. All the training which chemistry can afford in the experimental method of inquiry could be given in a chemical laboratory by experiments in medical chemistry, as well as, if not better than by using our present systom. In fact, any portion of the field of chemistry does almost equally well as a training ground. In the course given here, the ro-actioiis of the common acids and metals are used for this purpose, not because the informa- tion obtained is of value to medical students in particular nor because that portion of the field of chemistry affords any better subject matter for experiment, but because it is us good a field as any other, and it is a very favourite hunting ground of the Board Kxaminers. Apart from laboratory training, what every medical man requires is a clear view of the broad principles of chemistry, that he may intelligently follow advances in medicine made by chemical research, and a limited acquaintance only with the facts of chemistry. A knowledge of two classes of f:icts is required: first, those which are essential to a perfect under- standing of the principles of the science, very few in number, and second, those which bear directly on his profession. It is the first class of facts that should be partially acquii-ed be- fore entering medicine, in order to give both professor anJ pupil time to dwell on the more congenial, important, and interesting facts that bear directly on the principles of the healing art. Apart from its value as a means of training the student in those habits of thought especially useful to him in his pro- fession, chemistry has another claim to a high position in a modern medical education— a claim based on what she has shown herself able to do in aiding physiology and pathology in the solution of the fundamental problems of medicine. Time will not permit me to discuss even the more import- ant advances recently made, and a mere enumeration of the results obtained would be tedious in the extreme. I shall have said enough on this subject when I remind you that although the great powers of the chemical and physical sciences to aid medicine have only recently been appreciated, these sciences, and especially chemistry proper, have shown the oxiHtonco of flolds of roMoarch of unimugine