WILLIAM OSLER, M.D., LLD., D.Sc., F.R.C.P., F.R.S. Regius Professor of Medicine, Oxford University; Professor of Medicine, McGill University, 1874-84; VOL. XXXVIII. G FEBRUARY, 1905 THE PROFESSION.* By SIR JAMES GRANT, M.D., K.C.M.G., Ottawa. No. 6 ENTLEMEN,-A response to the noble sentiment "The Profession" is a source of pride and pleasure. At no period in the history of the profession, was there such unmistakable evidence of progress and advancement all along the line of scientific research, "Small talk may be said to be part of the social equipment of a successful doctor," but, on the present occasion, I will advert to a few of the leading problems of scientific thought within the past few months. The Wellcome Research Labora tory at Khartoum, established at the Gordon Memorial College, the result of the able advice and assistance of Lord Kitchener, is a great advance in the Far East towards promoting the study of technical education, bacteriology and physiology, all leading to a more comprehensive knowledge of tropical diseases, in fact infectious diseases, of man and beast, peculiar to the Soudan. This is certainly a broad and comprehensive scheme of work, which will be productive of great service to the State. Dr. Balfour, of Edinburgh, is in charge, and already research work has commenced in the line of malaria, and the anopheles in which Dr. Ross established a world wide reputation. It is most important that Egypt and the Nile should thus become the cradle of science, and advanced civilization which will, in time, add greatly to the work now in hand, by the schools of tropical medicine. The Medical Department of the St. Louis Exposition has brought to light exceedingly interesting and instructive data by master minds in the profession. The value of the Physiological Principle in the study of Neurology by Dr. Putnam, of Boston, is an exceedingly able and comprehensive paper. The Anatomical Principle, in the study of diseases, is quite as evident for the department of neural pathology, as for any other. The signs of readjustment of disease constitute about all we can learn in the study of disease. Neither disease nor health is a definite condition, in fact, both are movements towards some relatively endurable equilibrium. The biographical principle, as applicable to the problem of disease, is no longer set aside by the conservative physician. Doubtless, the able contributions made by physiologists, psychologists and biologists have thrown much light upon the clinical problems of compensation and adaptation. According to Putnam in no department of pathology is it so difficult to arrive at satisfactory conclusions, by the aid of the anatomical method alone, as in the Reply to he toast of "The Profession," at the banquet of the Ottawa Medico-Chirmagical Society, Russell House. Ottawa. Jan uary 5, 1905. department of neural pathology. The remarkable paper is an object lesson to the profession, and worthy of the most careful consideration. The next paper to which I shall refer briefly is by Dr. Webster, of Chicago: "Some Fundamental Problems in Obstetrics and Gynecology." He considers carefully and ably the following subjects, determination of sex, structure of the ovary, function of the ovary, antagonism between maternal organism and ovum, and lastly the functions of the placenta. Dr. Clarence Webster is a Canadian and, when a student in Edinburgh, distinguished himself by original researches on Uterogestation, and made an extensive and instructive pathological collection, which, unfortunately, was destroyed by fire. For a time he held an important position in McGill University, and a few years ago was called to fill a chair in Gynecology in Chicago. As to sex, Dr. Webster states that all attempts to regulate the production of sex in the human fœtus in utero have certainly met with failure. He favors the idea that in the great majority of cases the placenta is the sole route by which micro-organisms and toxins reach the foetus. The entire paper is historic in character, and gives evidence of most careful and matured deliberation. To our profession, the paper of Dr. Robert Saundby, of Birmingham, on "The Indications for Operative Interference in Diseases of the Stomach" is of great moment. He states that all chronic stomach diseases, not amenable to medical treatment, and which cause serious interference with nutrition, are within the field of surgery. Robin, of Paris, says that "No physician of experience in diseases of the stomach would accept the opinion expressed by Maylard, at the Paris Congress, that every case of severe and persistent dyspepsia, justified an early exploratory incision." The paper of Saundby, British Medical Journal, Dec. 17, 1904, is a careful exposition of this subject, and an undoubted evidence of advancement in surgical science Recently death has called from the ranks of the profession, two able men, Finsen and McCallum, to whom I shall refer briefly. The former, when laid at rest in Copenhagen, was followed to the grave by representatives of three Emperors, and three Kings, besides many regal personages, thus attesting the place he occupied, by the men of the world, learned, titled and professional. For years he was an invalid and devoted himself almost entirely to laboratory work. The regurgitation of his heart could be heard several feet off, according to Dr. Hopkins, of New York, and he carried in his abdomen several gallons of fluid, for which he was tapped several times. How under such trying circumstances, he conducted his "Institute" was a puzzle to many. In lupus, rodent, ulcer, carcinoma, birth marks, eczema, and cicatrices after operation for malignant disease, the opinion expressed by those able to judge was that his treatment had no equal. By the death of Dr. Duncan Campbell McCallum, November, 190+, not alone Montreal, but Canada, lost one of her ablest and most common sense practitioners-a man of sound judgment, careful observation, and reserved deliberation. He held with honor several chairs in McGill University, in all of which he discharged the duties and responsibilities devolving upon him with marked ability. Of the entire staff of my Alma Mater, McGill, of fifty years ago, not one is left. As a physician he was a trusted friend and counsellor, who always brought cheer and encouragement into every household in his rounds of professional duty. Culture is an important factor in the life history of the physician, and cannot begin too soon. The brain like the stomach requires a change of diet to keep it strong, active and vigorous. In this progressive age, the profession should keep in touch, not only with the current literature of the day, but as well, be fortified by the intellectual friction of the older masters. A western physician, travelling abroad, met the distinguished Charcot in Paris to whom he spoke in high terms of his preceptor. What has he done, I have not seen any of his writings. He never wrote anything I am aware of, but he had a most extensive practice. Said Charcot, is that the proper estimate of professional excellence? Many are proud to be called practical with no spare time to write. Such men do not rise to the highest standard of the profession. Large incomes and bank books are of little account, when contrasted with the careful record of passing events, in the life history, and discharge of the honorable duty and responsibility of the trusted physician. Nothing leads more to establish a good reputation than method and system in defining disease and its manifestations, all of which I would most strongly recommend to my young friends. In conclusion let me ask you what were our great grand parents doing about one hundred years ago. In 1805 England feared a Napoleonic invasion. Pitt was then at the helm of affairs, and Prime Minister of England at 24 years of age. His val, Fox flourished about the same time and died shortly afterwards. In the exact line of literature, seldom has there been a time, when so many master minds flourished. Sir Walter Scott, Wordsworth, Lamb and Coldridge, had then established their intellectual power, and almost marvelous personality. The very schoolroom was then honored by Macaulay, Carlyle, and Shelly, who have since given the world a literature, the pride and admiration of all thinking people. Before resuming my seat, let me recall an event in the life of Michael Angelo. In Venice, he said, his mission was to take "The Angel" out of a large block of marble, placed in front of him, which he hoped to accomplish. Our mission is to remove disease as far as possible, which is frequently like the angel of Michael Angelo, concealed from view, but gradually and steadily, through the advancement of science, is placed in clearer light. I THE RELATION OF MYOCARDIAL AND ARTERIAL By HOBART A. HARE, M.D., of Philadelphia. Professor of Therapeutics and Materia Medica, Jefferson Medical College. know of no better theme on which to address you this evening than the somewhat well-worn, but, nevertheless, interesting subject of cardiac disease, excluding valvular lesions. It is a theme of interest, because with advancing years, every one of us who lives to early old age will prob ably develop in some degree, at least, certain changes in his heart muscle and in the blood vessels themselves which will sooner or later modify his capacity for work and even, perhaps, for the enjoyment of life; and, again, it is a noteworty fact that no pursuit in life so commonly brings on these pathological states as does that of the physician. Our ranks are yearly thinned at the top by the onslaughts of cardio-vascular degenerative changes, and we find men like Pepper and Da Costa dropping suddenly out of the forefront from true angina, having suffered, as only such cases can suffer, from attack after attack of the malady before the fatal one appeared upon the scene. The reason for these facts is not so far to seek as would seem at first glance; for it is certain that it is in those who earn their bread by their mental powers that these affections are wont to develop, whereas in those who live by manual labor, angina is very rare. In a large hospital and dispensary experience of twenty years I have no recollection of seeing more than a few cases of true angina pectoris in the working classes, although false angina, neurotic or due to aneurism has been more common. On the other hand, every one knows that the class that works with its hands presents to us constantly the most extraordinary degree of atheromatous changes in the sense of thickening of the vessels, the deposit of calcareous matter in their walls and the development of cardiac hypertrophy or cardiac breakdown. It would seem that the coarse changes just spoken of, rarely produce the actual high tension seen in the mental worker, in whom, as a rule, at least in my experience, the deposition of lime-salts in the vessels of the periphery is as rare as vascular spasm is common. The primary cause of the frequency of cardio-vascular lesions in the well-to-do is, aside from high living and lack of exercise, the stress which is thrown upon the circulatory system by great and prolonged nervous and mental effort, which not only disturbs the nerve' supply of the circulatory system but calls upon those organs to provide blood to a brain which, because of its activity, requires a large supply of blood delivered to it in rapid flow and under high pressure--a pressure which is far in excess of that produced by severe physical effort, which is usually followed by a period of sound sleep and complete rest; whereas, the former is as commonly followed by disturbed rest or insom *Read before the National Association of United States Pension Examining Sorgeons. Atlantic City, N.Y., June 6 and 7, 1904. From the Medical Examiner, Dec., 1904. |