CANADA

MEDICAL JOURNAL.

ORIGINAL COMMUNICATIONS.

Valedictory Address to the Graduates in Medicine, McGill College. Delivered on behalf of the Medical Faculty, at the Annual Convocation, held in the William Molson Hall of the University, on the 3rd May, 1866. By WILLIAM FRASER, M.D., Professor of Institutes of Medicine.

GENTLEMEN,-This day's ceremony forms the climax of your professional studies-admits you to all the privileges and responsibilities of the profession of your choice. It consequently severs the connection which has existed between us as teachers and pupils. On such an occasion it is customary to offer the graduating class a few valedictory words by way of advice. That duty has on this occasion devolved upon me, and for your sakes, I wish it had fallen upon an abler man.

I will however endeavour briefly to point out, in the first place, what you may reasonably expect as the reward of your past labour on entering into practice; and in the second place, the mode in which you are most likely to attain that object.

Few members of our profession realize the princely fortunes so often acquired by those engaged in successful commercial pursuits-and seldom have they conferred upon them those honours that are so frequently bestowed upon eminent lawyers and warriors. On the other hand fewer members of our profession fail to make a fair and reasonable competency, than in either of the professions mentioned. A still greater reward is the usefulness of your services-the high satisfaction derived from the consciousness of being of use-of being able to do a service much in demand-the well doing of which involves great benefits, and averts great evils. There are few offices more appreciated by mankind than those discharged by the medical practitioner. The rewards which you

may therefore reasonably expect from the studies you have gone through and the labours of your prospective practice, are, a fair competency, the satisfaction derived from a sense of the utility of your services, the gratitude of your patients and the respect of the public.

To attain these objects, there are certain fundamental rules of conduct necessary for your self regulation, and due to the public and to the profession.

As regards the first of these-your conduct should be such as is calculated to preserve your own health and command the respect of your fellow men. You whose vocation it is to direct others in the preservation of their health and in the correction of their bodily derangements, are expected to know how to maintain your own. Familiar as you are with those hygienic laws by the observance of which health and life are maintained, nevertheless, I think it right to warn you as young practitioners against the ruinous habit which too many members of our profession acquire, of indulging in alcoholic beverages which is alike injurious to their health and professional prospects. The man who is afflicted with this infirmity can never be relied upon as a medical prac titioner, and his best friends will soon cease to employ him, without his being apparently aware of the cause-often attributing their alienation to other reasons. To no class of men is bodily vigour and mental soundness more necessary than to those of our profession-subject as they are to be called upon at all hours for professional assistance in cases the most intricate and dangerous. Therefore shun the cup that inebriates-that blears the eye and palsies the hand-destroys the intellectual and perverts the moral faculties.

Another point is this. To no class of men is integrity of conduct, truthfulness, dignity and suavity of manner more necessary. A great authority and a good man, Dr. Stokes of Dublin, has lately said in his address on medicine, delivered at the annual meeting of the British Medical Association, held at Leamington, in August last, "That the cause of medicine taken in its broadest sense,-whether as to its social, political, or scientific relations, is to be advanced more by the cultivation of the minds, the morals and the manners of those who are engaged in it, than by all other influences whatsoever." Entirely coinciding with the idea embodied in these great and good words, I commend them to your consideration and practical adoption as a sure way of advancing the profession at large and your individual success.

Before entering on the active duties of the profession, those of you who can afford to do so, should follow the example of the father of medicine, who, after studying at the Asclepion of Cos, travelled into other

countries. In like manner you should visit Europe, to see the practice of its large medical institutions and hear the teaching of those renowned men of Britain, France, and Germany, who have so largely contributed towards the present condition of our profession. It is needless to point out the advantages of such a course, as they are universally acknowledged.

with the rapid

Another duty you owe to yourselves is to keep pace progress which rational medicine is making in our time. The man who neglects this will soon find himself outstripped by his cotemporaries and deservedly so. By means of periodicals and new publications, you should keep yourselves well informed of all that is going on in the medical world. For although you have ceased to be pupils you must still continue to be students-indeed your whole life must be one of study, observation and reflection.

There is another rule of conduct to which I desire to refer. Every medical man has often his patience sorely tried by being obliged to listen to long, tedious, and irrelevant histories of the maladies of valetudinarians and of persons labouring under diseases acutely painful or hopelessly incurable. With all such be gentle and forbearing. Remember the intimate relation existing between the physical and mental, and that derangements and diseases of the former often seriously affect the latter. Harsh and overbearing conduct towards invalids is not suitable to the present state of society. It never did any good and therefore serves no end either as regards the patient or physician.

For success in practice depend upon your own merits and the closest attention to business. Whatever your struggles may be, eschew all questionable or charlatanical devices for improving your circumstances by departing from the path of rectitude.

Towards the public your duties are of a special and general character. Prominent among the former is prompt attention to calls for your professional services, and when you have taken a case in hand do your utmost to save life and relieve suffering. In dangerous cases, when you have any doubt as to the correctness of the practice to be followed, hesitate not to call in the assistance of an older and more experienced practitioner.

To the poor be generous of your professional services and kindly in your manner. Although you receive no renumeration from them, your experience will be enlarged and your prospects in many ways advanced by such disinterested and humane conduct.

Let me also remind you of your obligation to be discreetly reticent in all matters coming to your knowledge as professional men.

As respects the public duties which a medical man of the present day is expected to perform, I may particularize disseminating amongst the community amidst whom he practices, a knowledge of those sanitary laws, which have been shown capable, when rightly understood and rigidly enforced, not only of preventing disease, but also of diminishing in severity that which is inevitable. In all climates and under all conditions of life, the purity of the atmosphere habitually respired, a good water supply and drainage are essential to the maintenance of that power of resisting disease, named by Cullen the vis medicatrix naturæ. frequently happens that individuals continue for years to breathe a most unwholesome atmosphere, without apparently suffering from it, and when they at last succumb to some epidemic disease, their death is attributed solely to the latter-the previous preparation of their bodies for the reception and development of zymotic poison being altogether overlooked. That the fatality of epidemics is almost invariably in precise proportion to the degree in which an impure atmosphere has been habitually respired or impure water drank can be proved by the clearest evidence.

That an atmosphere loaded with putrescent miasmata favours the spread of zymotic poison by inducing an abnormal condition of the blood is beyond all question-nay farther, I am disposed to believe there is ample evidence to show, that in the crowded dwellings of the poor, diseases do in this way originate de novo. On the other hand, by proper attention to ventilation, water supply, and drainage, the fatality of Epidemics that formerly terrified the nations may be almost completely annihilated and the rate of mortality in disease in general largely decreased. It cannot be too strongly borne in mind, that the efficacy of such preventive measures has been most fully substantiated in regard to many of the very diseases in which the curvative power of medical treatment has seemed most doubtful—as for example cholera and malignant fevers.

The practical importance of this subject is strikingly illustrated by the following startling facts, brought to light by enquiries prosecuted under the direction of the London Board of Health, viz.: That the difference in the annual rates of mortality between the most healthy and the most unhealthy localities in England, amounting to no less than 34 in 1000, is almost entirely due to zymotic diseases, which might be nearly exterminated by well directed sanitary arrangements. The inevitable mortality, arising from diseases which would not be directly by sanitary improvements is 11 per 1000 in those districts which om zymotic disease. And the average mortality of all England

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in ordinary years, is about 22 per 1000, or just double that to which it might be reduced, so that taking the population of England and Wales (as by the last census) at 20 millions, the average annual mortality must be 440,000, of which 220,000 is inevitable, an equal amount being preventible.

These facts show in the clearest manner the great importance of sanitary reform. In view of the epidemic which has already appeared in some parts of this continent, and which is almost certain to visit this country during the present season. A sense of public duty and a desire to benefit your fellow men, should induce you to take a deep interest in this subject hitherto so imperfectly understood by the majority of the people. By acting thus as preventers of disease you will convince the public of the purity of your motives and the sincerity of your efforts for its welfare.

In order that the profession may advance in all its departmentsSanitary, Medical and Surgical, it is the duty of each of you to record his experience and thus contribute according to your opportunities to its progress. By such work a large experience is made available to the profession at large and the writer is taught accuracy of observation and profoundness of reflection.

With your fellow practitioners cultivate friendly relations, and reciprocate kindly offices. Attempt not to raise yourselves by a brother's fall-nor by wily and unscrupulous insinuations to undermine his reputation and dispossess him of his patient. No man ever raised himself to eminence by such unworthy conduct. Medical etiquette is founded on the same principles, which characterise the conduct of every educated, courteous and honorable gentleman. It has for its basis to do unto others as you would that others should do unto you. And now gentlemen go forth on your mission-your time has comeperform your work faithfully and diligently and you will be sure to reap the reward. For your success and prosperity you have the best wishes of your late teachers, the members of the medical faculty of this university.

Cholera in Canada in 1832 and 1834. By JOSEPH WORKMAN, M.D.,

Medical Superintendent Provincial Lunatic Asylum, Toronto, C.W. In the April number of the Medical Journal, page 479, the following statements are found:

"Cholera in 1832 appeared in Quebec early in the month of June, and almost simultaneously-we believe it was a few hours after-it broke out in the Barracks in Montreal. No personal communication had