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there is need of a new and fresh overturning. The last few years have seen such rapid movement and progress in every department of medicine that we stand practically in a "New Era in Medicine," and the new era makes new demands both upon medical colleges and the medical profession to which, if we be blind, we shall be derelict in our duty, both to ourselves and the public.
Let us for a moment take a bird's eye view of these changes. First of all, a wholly new department of medical scienceBacteriology-has been created. Rejected at first by most, and only doubtfully and hesitatingly believed in by many, except some prophets of the dawn endowed with finer vision than the rest, it has achieved within the last ten years a positive and now practically unquestioned place in medical science. Its revelation of the causes of many diseases and its explanation of their phenomena are as startling as they are well substantiated. That suppuration and erysipelas, tetanus and leprosy, consumption and cholera are parasitic diseases due to the invasion of the body by various forms of micro-organisms is a discovery of the first importance, and much too near for us to appreciate as yet its far-reaching influence. Bacteriology has but begun its infant career. It must speedily grow into one of the most weighty of the scientific departments of medicine, and bids fair to revolutionize our practice as much as it has our theories.
The old Materia Medica and Therapeutics have been rewritten within the last few years in the Pharmacology of the present day. The actual daily use of medicine has been. marvelously changed of late by experiments made to discover the real physiological and therapeutical action of remedies; their effects upon the heart, the arteries, the brain, the respiration, the kidneys; their medicinal and their toxic doses and effects; and from these facts to deduce a right and rational use of drugs. Besides this the extraordinary number of new drugs and the numberless new methods of their
administration, the present scientific use of massage and of electricity in its various forms, the increasing use of Swedish movements, of heat, of cold, of mechanical means for soothing and stimulating nerves and muscles, and for spinal extension are all additions of the last few years.
Allied to this there is virtually a "New Chemistry," not only in the sense in which the term is used by Professor Cook. Organic chemistry, by its analytical methods, has given us many of the new drugs already alluded to, and by its synthetical combinations has even produced them in the laboratory instead of waiting for Nature's slow distillation or long growth; and, by its substitution compounds, has given us different series of remedies of immense value, all built upon a single base.*
Chemistry and pharmacology, with physiological physics, embryology, and experimental physiology, have developed a new Physiology.
Even Anatomy, a field of stubble scarce worth a gleaner's searching eye as was supposed by many, has rewarded the industrious toiler by rich and full sheaves. Even in gross anatomy, to name no other, the mapping of the convolutions of the brain, and determining their functions, by Ferrier, Horsley, and others; the study of surface anatomy in its relations to the interior, by Holden; the careful study of the intestinal canal by Treves, have been of immense service: while embryology and histology and comparative anatomy have reformed a large part of the science.
These scientific departments are the foundation upon which are built surgery, medicine, obstetrics, and gynæcology, the practical departments of the healing art. These, too, like Samson of old, have burst the withs and ropes of the past
* If any one doubt the existence of a new-visaged and promising chemistry and pharmacology, let him only read the recent lectures of Dr. Lauder Brunton, in the British Medical Journal, On the Relation between Chemical Composition and Physiological Action.
and risen up in renewed strength, and have gone forth conquering and to conquer.
In Surgery and Gynecology the effects of experiments upon animals, of bacteriological studies, and of the antiseptic method, have been almost past belief. The mortality of amputations has been reduced from twenty-five to fifty per cent. down to from four per cent. to zero, and compound fractures, instead of yielding a holocaust of fifty to sixty per cent., are now, if rightly treated, scarcely more dangerous than simple fractures. The abdomen, instead of being forbidden ground like the lost Eden, with the peritoneum for its "flaming sword which turned every way to keep the way of the tree of life," might almost be called a playground in which surgeons disport themselves to their heart's content, inventing new operations as children invent new games; not an organ contained in its once sacred interior, or in that of the pelvis, is free from attack, and, for the most part, happily, with as great relief to the patient as pride to the surgeon. The brain, till five years ago the most dreaded organ in the body, is now not only freely exposed without serious danger, but portions of it excised, abscesses opened, the ventricles irrigated, and tumors removed. Bones are sawn or wired, joints are opened, the chest is invaded, and the lungs are resected. These and other operations successfully done are witnesses to the new era in general surgery and in gynecology, while in each special branch of surgery the same could be shown to be true had I only the time.
In Medicine and Obstetrics the same progress is noted in newer and better treatment of many of the ordinary diseases and the usual obstetrical conditions. The diminution of the mortality rates is simply extraordinary; and often the new methods of treatment are as simple and grateful as they are successful. To name but one department of each: Our acquaintance with diseases of the nervous system has grown so rapidly that a text-book of thirty years ago is apt to
elbow Galen and Avicenna for sympathy in its neglect, while the mortality of the puerperal state has been reduced almost to a vanishing point by the introduction of antiseptics.
Of the many specialties in medicine I cannot take time to speak, save to note the fact that they all have been created or remodeled within the last twenty years.
In view of these facts, am I not justified in calling this "The New Era in Medicine"?
It will be the duty, the privilege, and the joy of the teachers in this flourishing and progressive school of medicine to give to you the details of this fascinating medical romance in the course we are now entering upon, and I envy you the privilege of engaging in this study thirty years later than I. I have not used the word "faculty," but "teacher"; first, because I wish to recognize and I wish you to recognize the worth and zeal of the junior teachers associated with us, both in the college and the hospital; younger men who freely give of their time to aid you, and largely for the pure love of science. The best and highest reward that ever comes to them, as to us, or to any mortal, is the inward glow of satisfaction from good work done in scientific research, through which results an enlargement of the domain of truth. "I labor less," said Fresnel, "to catch the suffrages of the public than to obtain that inward approval which has always been the sweetest reward of my efforts. Without doubt, in moments of disgust and discouragement, I have often needed the spur of vanity or emolument to excite me to my researches. But all the compliments I have ever received from Arago, de la Place, or Biot never gave me such large pleasure as the discovery of a theoretic truth or the confirmation of a calculation by experiment."
The word "teacher" also designates us all as members of one of the noblest guilds in the world. For twenty-four years I have also myself gloried in the name and work of a teacher, and desire no better title. It is said that when
Agassiz's will was opened it ignored all his other proud titles and began majestically: "I, Louis Agassiz, teacher
The new era in medicine so inadequately described now confronts the profession, and especially you, gentlemen, who are to practice it, and whose lives will be spent, remember, among the glories of the twentieth century, with the now undreamed of progress of that happy time. It confronts you as a mighty master, with uplifted hand, pointing you upwards and onwards; onwards to the laborious, but great and splendid, work awaiting your touch, and upwards to the prizes for the foremost and worthiest. But it makes also its demands-its inexorable demands-upon you. Satisfy them you must, or fail.
Let us look for a few minutes at what these demands upon the profession are.
A physician's life consists of three periods: his preliminary education, his medical college course, and his active life as a practitioner. These may be called the Pre-collegiate, the Collegiate, and the Post-collegiate periods, and I purpose speaking in a plain and practical way of each.
1. The Pre-collegiate period, or that of preliminary training. The ideal medical college would perhaps insist that this be nothing short of a complete liberal education, such as is given in our American colleges and universities. It is an encouraging feature of the times that the proportion of such college graduates now in our medical schools is steadily on the increase, and that one of our numerous medical societies is composed wholly of those who have received not only the degree in medicine, but that in arts as well. Native talent and hard work will always tell, but such talent when trained and set at work will accomplish vastly more. But this is a world of imperfections and limitations in which the Utopia of the ideal-best must give place to the cold, matter-of-fact attainable-best. Desirable as it might be that all of the profession should have such a complete preliminary training,