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Technical and Bibliographic Notas/Notat techniques et bibliographiques

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iJW

VALEDICTORY ADDRESS.

DKMVKREI) TO THE GKADI'ATES IN MEDICINE AT THE ANNTAL

CONVOCATION OF THE MEDICAL FACULTY OF MiGILL

UNIVERSITY, APRIL 2ni), 1807.

II. S. BIKKKTT, M.I).,

Professor of Liiryngolo^.V, McGill University; Laiyngologist, Montreal Genernl

Hospital.

(Reprinkd from Montreal Medical Juur.ml, May, 1807.)

VALEDICTORY ADDRESS.

DELIVERED TO THE GRADUATES IN MEDICINE AT THE ANNUAL CON-
VOCATION OF THE MEDICAL FACULTY OF McGILL UNIVERSITY.

APRIL 2nd, 1897. ■• . "

• BY

H. S. BiKKETT, M.D.,

Professor of Laryngology, McGill University : Laryngologlst, Montreal General

Hospital.

Gentlemen o ? the Graduating Class :

For the past four years it has been the duty of the Members of the
Faculty to lecture to you within the College walls of the University,
and in the theatres of the hospitals, but to-day such duties cease, and
the relation of pupil and teacher no longer exists ; we are confreres
and to me has been delegated the privilege of congratulating you
upon your preferment, and of welcoming you to the ranks of an hon-
ourable profession.

Your progress during the past four years has been our earnest care,
and no effort has been spared to fit you for the responsibilities which,
from this day forth, you are yourselves to assume. You have been
brought to the goal of your first ambition, and it now remains for
each of j-ou to determine your future career.

There is much to be borne and much that is wearisome in the cor-
ditions of life upon which you are about to enter. The weight of the
burden can be lightened by the view you may take of the work. Do
not look to your profession as a mere source of pecuniary gain and
personal preferment, for it offers you the highest opportunities for the
advancement of your intellectual powers, the promotion of social good
and the alleviation of physical woes of suffering mankind. By con-
centrating every faculty to the careful fulfilment of such work, the

(lull prosaic sido of life will 1k> lightt'iUMl by a consciousness of a noble
duty t'fibetually accoinplisluMl, which will throw around your ordinary
duties a halo and relievo tiie tedium of your solitary hours. Those
men who have entered upon tin; study of medicine from love of it,
make the best students and doctors, — the physician to be successful
must think his profession the finevit in the world.

Our profession is an arduous, yet fascinating one. Our responsi-
bilities are great. " We are trusted as no other men arc. By the
force of circumstances, as well as by the relations of mutual confi-
dence which grow up between the patient and his medical adviser,
enormous power for good or evil lies within our hands, and on our
discretion depends fre<)uently the happiness and well-V»eing of families."
You are to become the trusted friend of the family, and whatever is
entrusted to your care must be regarded as sacred ; a breach of such
trust will mark you as unworthy of the pro^'ession. Therefore do
not make the ailments of any patient or their private affairs a topic
wherewith to entertain others whilst making your <laily rounds.
There is no more objectionable individual than a gossiping doctor.

The (|uestion at the outset which undoubtedly has occurred to each
of you is, " What am I going to do " ? To some of you are open posi-
tions as house-surgeons in the ho.spitals, either in this city or else-
where, and I would strongly urge the seeking of such positions.
Once installed, you will find opportunities unexcelled of more pro-
perly fitting you for the great responsibilities of your calling. Here
your mind will be trained to be observant, careful and exact in noting
the details of cases under your direct charge.

The benefit of this cannot be overestimated, and it will stand you
in good stead when out in general practice. Many a prominent phy-
sician and surgeon of the day owes his position to the proper use
made of the opportunities afforded him in his capacity as house-
physician and surgeon.

(Jthers of you mu.st be satisfied with the opportunities afforded of
starting into general practice at once ; unless under exceptional cir-
cumstances, it will be impossible for .such to be fully occupied from
the start. In this way the time at your disposal will at first be con-
siderable, and you will form habits during this critical period which
will leave their iihpress on your future life. Indolent and careless
habits .so ea.sily grow upon one, that they have marred many a prom-
ising career, while habits of research and thoroughness, coupled with
a love of the profession, are sure not only to lead to success but tc
gieatly facilitate your future work. If you have few cases, let them

'7.

bo carofiilly Htudiod, and do not put away your text liooks with the
parchiiiont you liavo received to-day.

SoMK! of you may anticipates a trip abroad to visit thct various hos-
pitals of (Jreat Britain and the Continent. Just a word on this sul)-
ject. You are as yet ine.xperienced, the advantages of such a trip
cannot at pre.sent lie fully appreciatiMl, as you are not in a position to
sift the chaH' from the wheat. The result is a lot of valuable time
wasted and money spent to no advantaj^e.

After four or five years work in general practice, or after holding
a hospital appointment as resident for a year or so, you are thc^n in
a position from the e.vperience ac(|uiri'd to spend a couple of years
very protitaldy abroad.

Unfortunately however there are cases amongst the graduating
class of each year which necessitate some to cross the Atlatitic and
obtain further degrees to enable them to become registered pi-acti-
tioners of certain Prf)vinces of the Dominion. This state of things is
a deploi'able one, and let us hope the day is not far di.stant when one
license will give the profe.ssion the privilege of practising any where in
Her Majesty's Dominions.

That any one should cro.ss the Atlantic simply with tlie idea that
having acquired further degrees he is therefore entitled to be more
deserving of practice is a delusion ; the laity looks to the personal
ability of the practitioner and not to any additional degrees he may
have secured.

A danger which confronts u.s in the present time is the ambition of
the recent graduate in medicine t(* take up a. speciality, and how often
one is asked by the newly created M.D., "What speciality might I
take up ? "

Specialism is not a branch of medicine separated by a definite line
of demarcation, independent of and (piite distinct from the field of
general practice, but should l)e regarded as supplemi'utaiy to thi.s.
A field open to the general practitioner who, in his riper experience,
will add to his store of knowledge by such further researches in the
region of science as will enable him to deal in a skilful manner with
diseases of certain organs which i-efpiire specific treatment. The
specialist is thus a co-workei- with the general practitioner, not an
antagonist striving for his own .selfi.sh aims, l»ut working harmoniously
to their mutual advantage. The recent graduate who imagines that
all that is necessary to ([ualifyas a specialist is to spend a few months
abroad, or, as some do, a few weeks, attending the clinics of hospitals
not far from home, makes as ad mistake. To the.se short-term special-
ists is attributable much of the harm done tospecialis.u. Tluv briiiir

(liscnidit upon thomselvoa and court the (lispleasuro of the general prac-
titioner. With no foundation of general practice, rtnd a Itrazened know-
ledge of the speciality they profess to have studied, they launch out,
and I can hardly tind words forcilihi enough to denounce their ndseiahle
attempts at treatment in which they more often fail than s\icceed.
Men of one idea, and that too often warped l»y inte»est, they jvscrihc
to causes for which their speciality has the remedies, all the ills that
human Hesh is heir to. Then follow the usual results, diagnosis
wrongly formed, treatment ini.sdirected, damage irreparably done and
the lives of many rendered miserable; hut "When thoroughly
grounded in the principles and practice of your profession, and having
acquired experience from some years of practical work, it will then
he time enough to turn particular attention to some one branch of it.
I do not wish to discoui'age you, if your taste and talent sf) incline
you, from acquiring knowledge and skill in one particular line, for
the range of work has become so enlarged that it is impossible foi- one
to perfect himself in all its various branches. So, if in time you find
you po.ssess a particular skill in .some certain line of work, and your
skill receives such acknowledgment from your fellows as to justify
3'ou in relin(|uishing general work for a specific line of action, then I
consider you woulil be (piite justified in confining yourself to that
special work." (Dr. H. Kelly.)

Determined then to practice some special branch of medicine, let it
be after con,siderable experience in general practice, and after at least
two years abroad, studying hanl and honestly in special hospitals.
No one can acquire a solid foundation in any speciality in less time,
for if the foundation be weak the whole super structure must neces-
sarily be defective.

Enter your new field with a broad mind, detei*mined to investigate
and treat local trouble as generally dependent upon a manifestation
of disorganisation of the whole system, and not as sjnnptoms to be
viewed and treated only through the means of the speculum, laryngo-
scope and ophthalmoscope. Then when fully and properly qualified,
you will be esteemed by your brother specialists and win the confi-
dence of the general practitioner.

As a practitioner either in the country or the city, let your moments
of leisure be occupied in reading as much as possible the current
medical literature, in attending meetings of the medical socieMes, and
indulging in some form of profitable recreation. Contribute your
share, however small in the advancement of medicine and surgery, by
reporting your cases, either before the medical .societies, or in reput-

able in«flical jonrnala Your work may be criticised, but do not let
that <liscouri.,'^o you, but rather incite you Ui better things.

Seek oppor , unities to visit your Ahna Mater, and the various hos-
pitals where you will, and to conit; in contact with men of experience
in the professional wf)rld. The interchange! of idejus will tend to
broaden your mind and will keep you from falling into a hum-drum
way of doing your work. Medicine is a pn)gressive science, and to
be successful practition(!rs, you must kcictp abreast of the times. To
those of your confvf'reH who are in good standing, be ever rt^ady to
extend the hand of good fellowship. PJe considerate of their errors of
diagnosis, and do not seek to make capital out of it to suit your own
ends. Wlien attending cases which present unusual symptoms, and
which batHe your skill, do not hesitate to .seek further advice, it will
les.sen your responsibility and will be of b(!iietit to the patient. This
will not in anyway depreciate your standing in his eyes, but will
rather strengthen your position.

In all your actions bo manly and straightforward.

" To thine own wlf he true,

" And it niu.st follow ns tlie niglit tli*; day

" Tiiou ean'.st not tlieii l)e false to any man."

Let not those of you who are the first in the class think that your
qualifications are greater than those who have been less fortunate, or
that your gifts entitle you to greater success in after life than the
rest. It is not always the most brilliant student wlio makes the most
successful practitioner. The so-called " plodding " and slow student
often has qualities hidden through the pressure of studies during his
college course, which will shine only when opportunities present
themselves, and often enable him to outstrip his more brilliant college
friend. But whatever has been the success of each of you, let me
caution you against making an improper use of such qualifications.

Do not think that with the closing of to-day's functions our interest
in your welfare ceases ; it goes forth with you as you leave this hall,
and ever will continue through your career.

Do not let the knowledge you hove acquired within the prescribed
time of the college course lead you to imagine that you have exhausted
the science of medicine. There is no greater stumbling block on the
road to learning than self-satisfaction. Strive therefore to increase
the store of knowledge you now have, by continuous study and prac-
tical work, and your labour will not be in vain.

You may congratulate yourselves upon graduating at this present
period in the history of medicine and surgery, for no era has been
marked by greater progress and advancement. Look into the field of

stiiyrry, an«l «oo what l)rilliaiit rt-Hiilts have been accoinpIinluMl hy the
Hkilt'ul .suix»'«>»i how through hin cMorts many ((hscurc disoaHcs of the
hiflilfu orpins of thf Inxly liavi^ hccti inadt^ clear and operations suc-
cessfully perforniefj whicili liave lieeii the means of saving' many lives,
in cases, which only a few years ago, wouKI have be«'n re^jartled us
hopeh^ss.

Consider th(> physician of the present «lay and how infinitely super-
ior are his metho<ls of diajj^nosinj^ and treatinj^ diseases than those
formerly accepte*!. Think what opportunities liave heeii afforded you
hy the more recent advances of medicine, such as th(( ci^rtainty of
rec«»}^nisinif tuberculosis in its incipient sta<;(\ of treatin;^ malaria more
intellij^ently, and of havinj^ methods (so recently elaborated by one
(>f your teachers) at your disposal, of diajjjtiosinf,' typhoid ftiver in its
earliest staphs. It is owin^' to the untiring; work of the bacterioloj^ist
that we have placed in our hands such means of so successfully treat-

u\'^ our cases.

What (grander work of the last two years has Ijeen accomplished
than that of tlu! l)acteriolo<,'ist in givinj,' to us a means whentwith to
battle more effectually than ever aj^ainst a disease so dreaded iiiid so
awful in its results as diphtheria. The introduction of antitoxin
therefore makes another mark in the progress of medicine.

It is our privilege and yours to reap the benefit of and to carry on
the grand work accomplished by the many faithful workers in the
field of medicine and surgery, and to apply thefr results, now no
longer on their trial, but proved and accepted, to the welfare of
patients entrusted to our care. Be not contented to rest here upon
the labour of others ; strive by your own endeavours to further the
advance of .science, and in dijing so pursue your researches, in that
field for which by your inclinations and (|ualifications you are best
suited.

In conclusion, (ientlemen, I would ask you to remember always
the nobility of your profe,s.sion and let your just appreciation of its
high standard be demonstrated in the honesty and faithfulness of
your work. Consider the benevolence of its aim, the elevating char-
acter of its studies, in the pursuit of which all the best faculties of
our nature are called into action. Let it be your ambition to excel in
it, fearlessly encountering the difficulties it presents. Strengthen
yourselves both mentally and morally' by the di.scipline it aff(M'ds in
patient and sustained laboui", and press forward in your new career
with all dil iice, not with a vain-glorious spirit, aspiring to out-d(j
your fellow.^, but rather with a desire to bring honour upon your
profession. '

Let your 'vork be honest and it cannot escape reward. Knowled^*'
is power. Tlieret'ore (finlmice every opportunity of enlarj^inj^ your
iiiiml, not only to gratify your own literary or .scientific ta,Hte.s, liut to
IteneHt iiiuiikind.

Let iiiu on behalf of your covfrh't's and in the naiiic of the Univor-
sity. wish you a happy and prosperous career, and may health wait
on you in carrying out tlie duties with which you have this day bcien
entrustf(l.