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reputation of our Alma Mater. We are members of one family, and disgrace or discredit falling on any one member must be felt by all. There are a few suggestions that may not be considered out of place, and which will, if followed, conduce to your personal comfort and to success in your career. Attend strictly to your own health. Bacon remarks that a “ sound state of health begets a natural vigour of the faculties.” No class of men require a larger share of bodily vigour than physicians. Who more exposed to the baneful influence of malaria, or the germs of contagious or infectious disease than the physician. In epidemic visitations, whilst other classes of the community can seek protection, by isolation or abandonment of localities infected, physicians are called upon to remain and risk their lives in the service of others. With the heroism and pluck of the soldier they forego all considerations, join the forlorn hope, and advance to the breach with unswerving faithfulness.

Theirs not to make reply,
Theirs not to reason why

Theirs but to do and die. Need I refer in proof of this to the recent scourge of yellow fever in the Southern States, when over cighty medical men perished in giving succor to their fellow man. All honour to their memory. Such is the position that each one of us may at any momeut be called upon to assume, and as sanitarians we know that strict obedience to the laws of health will aid us in resisting the baneful influence of disease. But again, your vocation is to advise and direct others how to preserve their health, and in so doing you will be expected to know how to care for your own.

I must caution you against the baneful influence of the cup of bitterness. As physicians you are all fully aware of the evils of intemperance, how it beclouds the mind renders helpless the body, and leads to disease and carly death. The physician, of all other men, should be at all times in full possession of his faculties, as at any hour of day or night he may be called upon to render assistance, where the life of a fellow-man is at stake. Under such circumstances the public will fully endorse the sentiment of Hamlet :

6 Give me that man That is not passion's slave, and I will wear him

In my heart's core.” In this particular I should advise you to adopt the motto of Othello :

“I have very poor and unhappy brains for drinking. I could well wish courtesy would

invent some other custom of entertainment.” Another duty to yourselves is to keep pace with the rapid advance that is being made in medical and surgical science. The practitioner who is content with what he has learnt during his pupilage, will soon fall behind, and rightly earn the contempt of his fellow.man. Idleness should be no feature of the honest and true physician ; though you cease to be pupils, you must still be students, as your life should be devoted to observation and reflection. Take stock each year of what you have acquired, and see to it that you have added to your store. To your patients let integrity be your password, truthfulness your breastplate, gentleness and sauvity, with forbearance yet firmness, your guiding-star. Harshness and want of sympathy in the ills of others, will not tend to elevate you in the esteem of your fellow-man. Seek not success through any other channel than close attention to the business of your calling. It is your privilege to relieve suffering, and, under heaven, to save life ; close attention, with a full measure of judgment, and putting in force the practical knowledge acquired at the bed-side in the hospital ward, will be certain of success. In any severe case, where you are in doubt or perplexity, if you have any fear of the correctness of your own judgment, seek the assistance and advice of a brother practitioner of larger experience than your own. Never refuse your aid because of the uncertainty of receiving remuneration, be generous to the poor, remember the words of our blessed Saviour, “ Forasmuch as ye did it unto the least of one of these my brethren, ye did it unto me,” and your reward will be sure. The physician is the custodian of many

family secrets. He is the friend in adversity, the counsellor in time of need. If mishap or disgrace invade the family circle the trusted physician is the first to be consulted. How necessary then for the full exercise of discretion and retinence. How dangerous is the babbler. Remember then the oath you have this day taken ; cautiously, honestly, with prudence and chastity pursue your honorable calling.

I may here remark that a proposal has come semi-officially to the profession of this Dominion to join the ranks of the British Medical Association by becoming members of that Society. The objects of that Society are in every way beneficial to the best interests of the profession, the advancement of scientific knowledge, and the elevation of the standard of medical education. I have no doubt the proposal will be seriously entertained by the profession of the Dominion at the next annual meeting of the Canada Medical Association, to be held in the city of London, Ontario, in September next. It is very desirable that the profession in this country should receive that recognition from the institutions of the Mother Country which is its due. It would appear as though the dawn were breaking in our clouded horizon, and although we may not expect to be placed on the same footing as the older institutions of Great Britain, we may hope that we will not continue to occupy the anomalous position we do at present. My chief object in referring to this matter is to call your attention more especially to the existence of this our national association, to which all members of the profession ought to belong. than this, it is much to be desired that branch societies should be established in all the sections of this country. We must be up and doing; medicine is a progressive science; there is a large field open to each one of you for observation, and in observing remember that you must not hide your light under a bushel, but seek to emulate the work of those who have enlarged the boundaries of medicine by reclaiming an unexplored wilderness, and laying bare truths which have long lain hid. It requires but a beginning, for you will find that the work will become so engrossing and satisfactory that you will be forced,

But more

from the very love of well-doing, to persevere with all your energy to the end. For what does not the science of medicine in some way bear upon ? It analyses the wonderful processes observed in all organized beings-generation, development, growth, nutrition, decay, disease and death. It solves important questions for the legislator, and discloses mysteries to the jurist. To ourselves, it elevates and brings forth the better feelings of our nature, enlarges our sympathy, strengthens our hope, induces self-denial, and leads on to the practice of the greatest of Christian virtues—true charity. Follow on, then, gentlemen, in the honourable career opening before you ; may you be worthy sons of this University, full of usefulness and proficiency. You all have the path open to you of shedding lustre on Alma Mater, and in your career may you be full of joy and peace and happiness and good report. GENTLEMEN, FAREWELL,

FIVE FATAL CASES OF CIRRHOSIS OF THE LIVER,

WITH AUTOPSIES AND REMARKS.

BY GEORGE ROSS, A.M., M.D.,

Professor of Clinical Medicine, McGill University.

The following cases of cirrhosis of the liver occurred in rapid succession in the practice of the Montreal General Hospital. They all differ much in their clinical features, exemplifying several of the characteristic phases apt to be assumed by this disease. To some of these attention will be drawn at the conclusion of the Reports.

CASE No. 1. IntemperanceDyspepsia— Dropsy-Paracentesis-Death from Peritonitis.—T. C., æt. 50, was admitted 10th Sept., 1878. Family history good, never had syphilis. For twenty years past has been a very heavy drinker of spirits. For eight years has suffered very frequently from sharp and stabbing pains in the hepatic region and behind the right shoulder. Would sometimes be free from these for a week at a time. During last winter these pains were much worse. In May last

began to complain of various digestive disturbances—fulness and feeling of distress at the epigastrium—loss of appetite, flatulence and diarrhoea—the latter being rather troublesome, the evacuations composed principally of mucus containing streaks of blood. There was no vomiting. He also had hemorrhoids. Towards the middle of June he noticed his feet swollen, and about the same time his belly began to enlarge.

On admission the patient was found much emaciated, grey and aged-looking—a thin drawn face with no very marked fulness of the cutaneous capillaries—anæmic but not particularly sallow. Extensive ascites, with very great enlargement of the superficial abdominal veins. No albumen in the urine ; other organs normalOn the 17th September he was tapped by Dr. Fenwick with a small aspirator needle, twenty-eight pints being removed. This was followed by fever and abdominal tenderness for a few days, and rapid re-accumulation of the dropsy. Was again tapped, seven days after, in the same way, twenty-four pints were drawn off. During and after this period he was further treated by a pill of digitalis squill and pil hydrarg : potass. bitart, and an occasional dose of elaterium. In spite of this he again required tapping on October 16th, twenty-eight pints being obtained. The operation was done this time by the ordinary large trocar. He was very faint almost immediately after, but beyond this no bad symptoms. Patient continued very weak from this time. On the 27th was again tapped to 23 pints. To alleviate the faintness, this paracentesis was done with a fine trocar, the size of the ordinary exploring instrument. It had been made expressly for the purpose, was provided with a phlange and attached to a rubber tube to conduct away the fluid to a bucket.

It answered perfectly well, and the serum ran slowly off whilst he lay quietly in bed. A few hours after, however, he had a severe rigor, followed by great pain in the abdomen, and constant vomiting. In spite of active treatment by poultices, hypodermic morphia, and stimulants, he rapidly sank and died on the morning of the 29th October.

The autopsy revealed nothing beyond advanced cirrhosis of the liver with evident signs of recent peritonitis.

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