you to avoid them until you are better qualified to appreciate them. In the meantime stick to those things that you can see and handle, and your pleasure and satisfaction will be great. Gentlemen of the Graduating Class, I would remind you that the days of your studentship are rapidly drawing to a close; and it is to be sincerely hoped that you will make the utmost possible use of your opportunities for acquiring that practical knowledge which is so essential to your future success. Let your labour be well directed, and then the least gifted among you may expect reward. Buxton says: "The longer I live the more I am certain that the great difference between men, between the great and the insignificant, is energy, invincible determination, an honest purpose once fixed, and then death or victory." It is one of the greatest improvements in the medical teaching of the present day, that practical iustruction is carried to such a high pitch. This is not done to the exclusion or detriment of systematic teaching, but the one is made a help-mate of the other. Thus the facts yon gather from the systematic chairs of medicine, surgery and obstetrics, are all more or less capable of verification and illustration at the bedside. You are admonished then to be much in the wards. It is there that you educate your senses to appreciate the signs of disease. You cannot too soon get into the habit of examining patients for yourselves, for this is really to be your life's work. Touch, handle, listen wherever you can; see everything you can see with your own eyes, do everything you can do with your own fingers. In a word, practice the habit of minute methodized observation. Any notes you may have to make should be jotted down at the time of observation, else they hourly become of less value. Record your observations in the fewest words, and in the plainest terms. I would here remark that while it is not practicable for every student to become a clinical clerk, the cases are in a manner the property of all, so that all are encouraged to report, and the clinical teachers will be ever too happy to render any assistance in their power. Despise nothing, however insignificant, that can in any way improve your knowledge. It is a mistake too often made to run after sensational cases, curiosities which are seen perhaps once or twice in the course of a long practice. The patients who are most likely to consult you in your early days of practice, will in the majority of instances suffer from those ailments, which perhaps in your student days you looked upon as trivial and unworthy of your consideration. "It is only an abscess," one student was overheard to say to another with regard to a case on which some remarks were being made, and which he did not condescend to examine with the others of the class. It became necessary in a very short time after to examine this gentleman for his degree. Among the cases presented by the clinical professor was one identical with that which he had so indignantly spurned. He failed to make it out. Its only an abscess said the examiner and then after reminding him of his indifference, proceeded to give him some friendly advice on the subject of "little things," which I happen to know has not been entirely forgotten. Even, if it be only an abscess, then, gentlemen, don't despise it. I urge you to be open to receive knowledge by every avenue; never despise any method of inquiry, however minute and apparently unpractical, which may throw light upon the nature of disease; every appliance or new mode of procedure introduced with a view to making diagnosis more exact, should at any rate receive fair play at your hands. When medicines are prescribed note accurately their actions, for in this department we are all humble observers. The actions of many drugs and other remedial agents, are, as you know, very imperfectly understood. As Professor Rutherford puts it, this is the department that hangs fire, and so retards our progress. Note especially the actions. of those new remedies which are now on their trial. Above all things I would entreat you during your practical observations not to deceive yourselves. By this I mean, never persuade yourselves that you understand or see what really you do not understand or do not see. In other words do not play tricks with your own senses, else intellectual ruin is your certain fate. When you are asked to see your stethoscope, or ophthalmoscope, or laryngoscope, never desist, never be satisfied, until you have, at all events, made out something of the nature of what you hear or see. Remember what Shakespeare says: In order that the scheme of practical instruction shall be successful, the teacher must have the cordial co-operation of all his class. Speaking on this very subject that prince of clinical teachers, Dr. Murchison, makes the following remarks, and these will suffice to make clear my meaning. "The student who comes forward before the whole class is not only taught himself, but he himself becomes a clinical teacher. His difficulties, his suggestions, and even his mistakes become the means of teaching the rest of the class. The blunders you make show you how to avoid them for the future, and in the meantime furnish me with a capital opportunity for clinical remarks. You are to bear in mind that the best and most experienced Physicians are constantly making mistakes in examining patients, and in the diagnosis of their diseases. Although a mistake sometimes excites a smile or laugh, the students who laugh most are usually those who do not take part in the examinations themselves, and are the least entitled to laugh. It often happens that they who make the most mistakes at first, in a few months turn out to be the most expert observers." Let us help one another then, Gentlemen. In the department of Surgery, for instance, we are now especially in need of all the assistance you can bring us in our endeavour to carry out that system of treating wounds which is destined to supercede all other methods. The originator of this system is to-day but a humble observer, so that it may be in store for any of us to throw that additional ray of light which alone is wanted to perfect that stupendous scheme, in the consummation of which I sincerely believe with a recent American writer, that the name of Joseph Lister is destined to outrank in medicine all of his century, not even excepting the discoverer of anesthesia. In the midst of your anxiety to acquire knowledge, I would ask you never to lose sight of the respect and sympathy due to the sick and afflicted. Now is the time to cultivate that tenderness, not only of touch but of heart that marks the true physisician. Remember how sensitive are the feelings often of those deprived of health, and how much pain is oftentimes caused to them by an inconsiderate word or deed. Even as students then, you have it in your power to lay under contribution the affections of those whom accident or disease has for the time brought in your way. When human skill no longer avails, and death terminates your case follow it to the autopsy-room, and compare there the postmortem appearances with the clinical observations you may have made. It is impossible in our day to over-estimate the value of pathological research, and I am happy that the opportunity here offers to state how far we in this city have advanced in that department of medical instruction. We have it from one whose opinion we all value highly, "That there is no autopsy-room in London in which the post-mortem examinations are so well or so systematically conducted as they are in our General Hospital."* Having in my imperfect way taught you how to work, the next task, which you might with all fairness impose on me, is to teach you how to rest. One method by which you can always obtain mental repose is to vary your "mental diet." Prolonged application to one study is certain to weary the brain, as one set of muscles become tired out by a continuous strain. You will often find great relaxation and pleasure in the perusal of books other than those connected with your professional work. It is said of the great diplomatic chieftain, Earl Beaconsfield, that after a severe mental strain he has recourse to the reading of light literature as a recreation. While I do not advocate novel reading, I believe there are many novels which might be read with profit by us all. "Every kind of Letter from London.-CAN. MED. JOURNAL. literature," observes a thoughtful writer," comes into play some time or other; not only that which is systematic and methodized, but that which is fragmentary-even the odds and ends: the merest rag or tag of information." The exercises connected with your Medical Society, which I would strongly advise all students to join, are of the nature of a recreation. Take a moderate amount of physical exercise daily, always stopping short of fatigue. The body as well as the mind has rights which must be respected. We may cheat ourselves but we cannot. cheat nature. "Because she lets us overdraw our accounst for many years, we fancy the accounts are not kept, but depend upon it she is a zealous creditor, who is sure in the end to exact with compound interest every loan she makes of us; and if we continue borrowing for work the hours that are due to sleep, although we may postpone a settlement for years, the final and inevitable result will be physical and mental bankruptcy." In conclusion, Gentlemen, I exhort you to work earnestly and honestly; to be kind and charitable one to another; and to be temperate in all things. "Come wealth or want, come good or ill, Let young and old accept their part, And bow before the awful Will, And bear it with an honest heart. Who misses or who wins the prize, |