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    VALEDICTORY   ADDRESS
                         TO THE

fatoaies m|pebktne at fp'itfJ Allege
    ON THEIR RECEIVING THE DEGREE  OF DOCTOR
               OF MEDICINE  Sc SURGERY,
       Conferred fcy Convocation, 4th  May, 18154*    <fo
      J*>          -------^        I,} , :^ry f
             BY  A. F.  HOLMES, M.D.,^/C/^
      Professor of Medicine, and Dean of the Medical Faculty!
o
  Gentlemen,—At the close of our mutual labors, and before we sever
the relation so long subsisting between us, let me address to you a few
words.  I have said " sever relation;" I do not mean sever our con-
nexion, for that, I hope, may become still closer by the new relationship
in which we now are about to stand.
  When you first placed yourselves under our direction, you had two
objects in view—instruction and graduation—the former as the means of
attaining to the latter ;  the latter as a testimonial of successful pursuit of
the former.  One of these objects, viz., graduation, it was in our own
power to bestow; the other required your active  co-operation; for no
matter what amount of instruction we had in our power to give, it would
have been of little avail had not your minds been prepared and ready to
receive it.  Pursuing, then, the same object, whether  as instructors or
instructed, we might naturally be expected to, and I trust have, become
mutually interested in each other; so that while you in after life, may
look back with satisfaction on the period of study spent with us, and
with kindly wishes for the prosperity of your alma mater, we may here-
after, in hearing of  your eminence in your profession, rejoice that you
« Hail from McGill College."
  The course of study which you have pursued is an arduous one.  Four
years, when looked forward to, seem a long period, but your own expe-
rience has taught you that it  is by no means too long to conquer the
various topics comprised in a good medical education.  And yet, after
all your  labor, whereunto have  you attained ?  You have  only, a* it 
<1
were, arrived at the portal of a vast enclosure*  You have only reached
the starting point of the race you are to  run :  you are furnished with
arms, you have a complete panoply; yet you have not yet proved them,
and will often find them cumbrous and difficult of management, till time
and repetition shall have given you the facility of manipulation which
you see in the hands of your seniors.
  In fact, however prepared to commence the duties of your profession
you lack experience, and this is a branch of knowledge which we can-
not teach you, but which must  be acquired by an  intelligent and perse-
vering use of those tools with which we have furnished you.
  I well recollect, many years ago, when I first  entered on the study of
medicine, how wonderful it appeared to me that my preceptor could  so
rapidly decide upon the remedies required by his  patients;  a few hints
and a glance  or two seemed to  enable him to seize  the whole subject.
It looked like intuition.  The whole  subject seemed to flash upon his
mind without the labored operations usually required  to reason out a
complicated question, and to come to a conclusion.   But, gentlemen,
experience has long ago taught me how this is done, as it will undoubt-
edly in due time teach yoa.
  It is of much importance in pursuing your profession, that you should
estimate it properly.  Medicine is not an exact science; the varied and
often conflicting opinions of its professors give abundant proof of that.
It has even been called disparagingly a " conjectural science," which nb
doubt it sometimes is, and indeed must be, till knowledge becomes  per-
fect.  There are, however, few branches of knowledge  to which we can
apply the appellation of " exact."  It is in mathematics and the portions
of other sciences dependent on them, that we can look for anything de-
serving of the name. In these we may be certain in our deductions, but
in none other.  What branch of knowledge is not shifting and changing 1
If it be a complaint that medicine, which has been studied  for between
two and three thousand years, is still unsettled and imperfect; may we
not say the same of other branches ?  Can we not turn  with confidence
to the other Faculties of our College and  ask, Are you better  off than
we 1  Are your foundations more firm, or  your  principles more stable 1
Look at education in general, a pursuit which must have occupied the
minds of men ever sinse men were united in social relations, and yet  do
we find it at the present day pursued on a well-established basis.   On
the contrary, have not the  "new lights" discovered the incapacity not
only of old established institutions, but even of long-established rules.
  Again, what is of more importance to the well-being of man than a
proper knowledge of the laws that should govern international relations •
• ill. •■=:«, u science, political economy is but juvenile,and  yet under its die- 
3
 tation, maxims rooted in the prejudices and apparent interests of commu-
 nities are rapidly giving way.   Look, again, at " the glorious uncertainty
 of the law," and ask its expounders if the medical profession deserve to
 be twitted with being the followers of a conjectural science.  •
   In fact, medicine is only on  a  par wTith  knowledge in general.   All
 knowledge is imperfect, and this  imperfection must  be received as an
 element in our proceedings.  We can only act  according to the know-
 ledge we possess.   We cannot foresee  the future, nor  act beforehand
 upon knowledge which our posterity shall possess.  In one sense, at
 least, the children shall be wiser  than their fathers.   How much saving
 would there  have been, could this  impossibility have been otherwise !
 Where would have been those splendid aqueducts which the old PwO-
 mans raised, and whose ruins remain as monuments at once of their pub-
 lic spirit and of their ignorance ?  How many of  the canals  which in-
 tersect our mother country (and  I  may  almost say our own,) would
 have been left unmade could their projectors have foreseen the period of
 railroads 1
   But with all this acknowledgment of the imperfection of knowledge ;
 the liability of that which we suppose we have done well being in future
 exploded and destroyed, we cannot stand still.  It is not by folding  our
 arms and waiting, that we shall acquire what we desire, but by strongly
 willing, and putting forth our power to explore every corner of the vast
 field of knowledge, and to exhaust all means at our disposal.
   I think I have proved that Medical Science is at least not lower than
 the level of other Sciences, but I  think I  may go further and assert that
 there is an apology for medicine which does not exist in regard to seve-
 ral other of our pursuits.  What are the subjects with which medicine
 has to deal?   Those confessedly which are least understood.  They  are
 Life and Death; or, as I should more properly say, life,  for death is only
 the negation of life.  But what is life ]  Who, of all this  assembly or
 of any assembly in the world, can tell me what life is 1   It is  true I  can
 tell where life is ;  I can judge of its presence by its manifestions, by its
 effects ; but this does not give me its nature or its essence.  Now when
 it is the business of medicine to counteract the tendency  to  death, to
 strive to preserve life, how can  medicine  be  otherwise  than imperfect,
 seeing the very subject  of its  operations is not comprehended ?  The
 nature of life itself being unknown, we are unable to  discover in what
 way its influence pervades our various organs,so as to bestow upon them
 their endowments of sensibility, irritability, and sometimes almost of in
 telligence ; and in this want of data, is it  at all  strange that we should
 often be unable to predicate a just decision as to the present or the future
condition of our patients, or of the effects of our remedies upon them. 
4
  Gentlemen,—It is a great thing to know how much or how little  we
really know; for not only shall we be led to supply our acknowledged
want, but we shall be able to apply what knowledge we have much
more effectually  to useful purposes.  When we are in ignorance,  we
are very apt to allow prejudice to usurp the place  of wisdom, and fos-
tering our delusion so as to oppose an effectual bar to our improvement.
How many evils and follies and crimes have originated from this cause 1
Medicine has not been free from them.  It was from the prejudice of an
erroneous theory  that it was once customary to treat a case  of small pox
with blankets and heated air and drinks.  It was from a similar erroneous
prejudice that the cure of wounds was sought by cramming them with
lint, the  treatment of all others most detrimental   to  them.  You
will often, probably, be asked  to give the  reason  of occurrences ;
nor will this inquiry always be kept within reasonable bounds. Nothing
is more  easy to ask than, What  is the reason of a thing ? yet, often,
nothing is more difficult than  to give a  proper  answer. A child may
puzzle a philosopher, and it  is often the ignorant who are most pertina-
cious in requiring an answer; but their very ignorance makes them
contented with the most superficial reasons, and often the most flimsy
are quite satisfactory.  The Hindoo believes the  earth  rests on a
tortoise, without asking what supports the tortoise ; so,  in our practice,
we find that a mere learned name will  often set at rest many difficult
inquiries, and this is both fortunate and unfortunate—fortunate, because
it often saves the labor of cogitation, and the often unpleasant confession
that you do not know;—unfortunate, for it often prevents us from being
candid with our patients, because we feel that our  candour in declaring
we do not know (perhaps what no one else knows) may be interpreted
as if we were improperly ignorant of what it was our duty to know.
  There are two errors to  be avoided:  an  overweening prepossession
that we are very wise, which  leads to dogmatism and quackery ;  and a
want of self-reliance, which leads to inefficiency.   In our approaches to
one or other of these errors, a great deal will depend on temperament ;
both of them, however, lead to one result, a system of routine—the
one asserting the supremacy of its  knowledge, will not condescend to
alter; the other,  fearful of untried consequences, prefers the beaten
track.   Routine is not the part of a scientific physician, whose decisions
and directions  should always have a basis of reason ; it is manifestly
unfitted for emergencies, and frequently  injurious  in ordinary cases • it
leads to the treatment of mere symptoms, or  is guided by mere names
I have often endeavoured to impress upon you that the jjrfenority of the
physician over the quack existed chiefly in his acquaintance with  the
various  phases of disease incident upon the differences of constitution 
6
state of body, and circumstances in which  it was placed.   I have also
often warned you not to suffer yourselves to be led away by the  mere
name of disease, so as to treat all cases coming under  that name in the
same manner ; but always to regard disease not only as modified by the
circumstances which attend  it, but often requiring a treatment  opposite
to that which at another time might be most advantageous.
  Medicine should  be as far as our  knowledge will allow a scientific
study.   I have alluded in some former remarks  to the  rapidity  with
which an old practitioner will understand the nature of a case and pre-
scribe  its  appropriate remedies ; but  it is not always so.  Many times
with most earnest attention are we obliged to scan the aspects of a case.
Many times do we cautiously balance the plans of treatment most ap-
propriate.   Often do we wait in anxious solicitude the  effects of the me-
dicines we  have thought necessary to prescribe.  We are sometimes un-
able to  decypher  the indications of disease.  Often  we are unable to
foresee the results of our treatment.  The investigations required to
treat a case are often extremely extensive.  We must seek the medical
history of the patient for years back, even to his progenitors; also, his ha-
bits and the circumstances in which he has been placed; all  present
symptoms must be examined and their importance analysed.  Having
thus obtained a knowledge of the disease, we have next to investigate
in what way we shall be best able to remove it. Here we have to weigh
all the circumstances which make one plan preferable to another, and
here we are often led to treat the same disease at different times  in dif-
ferent modes,i.e., inflammation, which sometimes requires severe deple-
tion, while at others we uphold the strength with stimulants and wine.

   Gentlemen,—In the course which you have gone through, you  have
necessarily learned  many things which were elementary; and many
that seemed more directly practical; and you were led, perhaps,to look
upon the former as mere steps for the attainment of the latter, and there-
fore to be disregarded when the purpose was fulfilled.  Your  conclu-
sion, though in some respects correct, would, on the whole, be  errone-
ous, and the examinations you have gone Ihrough will have shewn you
that your professors required quite as much elaboration in your elemen-
tary as in your practical studies.  I desire now to impress upon you that
much of this elementary knowledge is of direct practical bearing, and
must not be laid aside, as  if its end was wholly attained ; but must con-
tinue to be cultivated and refreshed from time to time.
  Let us take, ex. grat., the department of Chemistry. You are perfect-
ly aware that without a certain knowledge of chemical laws and  com-
binations, it is impossible to get accurate notions of many of the  func- 
6
lions, and most  of the materials of the body.  The great operations  of
digestion,respiration, and secretion, and  their products, cannot be un-
derstood  without this knowledge,  nor can the materials which, under
the name of food, enter our bodies, and form the subjects of these opera-
tions, ar.d hence become of such high importance in reference to health.
Chemical research has revealed to us the interesting fact, that our food,
whether  derived from  a vegetable or  an animal  source, is identical in
its nature.  It has shewn us tha' much of our food, though  necessary
for other purposes, is not qualified t j repair our wasted frames, and that
we may even die though supplied with 'abundance of what  is usually
thought nourishment, as was exemplified in the case of the too zealous
Dr. Stark,  who  fell  a victim to  his perseverance in the use of non-
azotized materials.
   The daily, nay constant, waste and repair of the tissues of our bodies
furnishes another example of the importance of chemical knowledge  to
enable us to  understand ourselves.  Every one,  unavoidably, becomes
experimentally acquainted with the need of food to support the strength
and power of the body ; but few, perhaps, out of the profession, are aware
tha: this is effected by the continued addition to our tissues, through the
medium of the blood, of those particles of food that are fitted  to nourish
them, and  that, after these particles have served their purpose, and have
become effete, they are again removed through the same channel of the
blood, and  consigned to their appropriate emunctories.   This  wonderful
process of waste and repair continues  from year  to year, renewing  us
completely, and making us  living Paradoxes—the same, yet  not the
same—same as to identity, different  as to material—the same being
from childhood to old age; yet every particle altering continually.
   But to furnish you with another example.  What more beautiful  il-
lustration can be afforded of Divine contrivance than the chemical ap-
paratus which nature gives us for sustaining our animal heat, and enab-
ling us to  bear the colds of these northern regions, or  even to enjoy
health and comfort, when the thermometer is 50 ° or 60 ° below zero
as was experienced by the searchers of the North West Passage.  This
important  process is effected by the  passage  of our food, after certain
elaboration, into the blood, and  then, as it  circulates through every
fibre of  the body,  by its gradual change in  consequence of union
with oxgyen:  so that  it undergoes a  process of oxidation quite the
same,  as  the  change that takes place  in  the  fuel  of our stoves
and common fire places, making  us, in fact,  examples  of spontaneous
combustion, though  not precisely in the common understanding of that
term,  which is applied to designate  a much doubted  fact, that may
hereafter, perhaps, obtain its confirmation from the mode in which na- 
7
ture keeps up her fires in the body, the flues of which are perhaps liable
to become over-heated by undue accumulation of fuel, as well as the
more visible ones which we run through our dwellings.
  But yoit may say these examples, though striking proofs of the need
of chemistry to enable  us to understand  the  functions of the  healthy
body, are not practical, inasmuch as they do not  refer to the diseased
body.  They are highly important as physiological  truths, but they arc
not pathological.  This is true, but if you understand not the physiolo-
gical, how can you understand the pathological 1  Could you venture to
undertake  a nice operation of surgery without  knowing  the parts
amongst which you are to cut ?  So how could you venture to meddle
with diseased organs, the elements  of whose functions you are unac-
quainted with 1
  But I need not rest my argument  on this ground.  I can  show you
that changes which are strictly pathological can only be recognized by
chemical manipulations, and being recognized, can only be remedied by
chemical appliances.  You have all heard of the  Humoral pathology, or
of what, in the not very grammatical though very expressive phraseology
of the day, are called  blood-diseases.   This humoral pathology, by the
bye, furnishes a not  uninstructive episode  in the history of medicine.
Received as manifest truth for many ages, it fell  at last into disrepute,
became the butt of ridicule to the moderns, and was referred to chiefly
as shewing the absurdities of the ancient schools of medicine.
   This once supposed rt exploded dogma" has, however, again begun to
raise its head, and counts among its abettors many of the best and safest
of our practitioners ; and this change is comparatively recent, for it was
several years after I had completed my medical studies before this old
doctrine began to reappear.  My mind is apt to dwell upon this change
as one evidence, among many others,  of the imperfection of our boasted
reason, and of the  propriety of using modesty and  caution in asserting
even the most generally received of its conclusions.
   It is true that in the  olden  time  the humoral pathology  was but a
speculation, though certainly a happy one'; it was not based upon expe-
riment, the proper ground of philosophical deduction, and therefore fell.
The humoral pathology of  the present day may be expected to become
an  ascertained fact, inasmuch  as it  is  based not on hypothesis, but on
multiplied experiment and observation.
   But to return.   Blood diseases are so named because  they consist in
an  alteration in the materials of which the blood is made up.  That fluid
consists, as you know,  of certain constituents in certain proportions vari-
able within certain limits, without affecting health ; but beyond these
becoming less fitted  for the performance of its normal  duties; and, be- 
9
sides these changes among its own constituents in regard to proportiona
and to qualities, the blood is the great sewer, if I may so speak, through
which the drainage of the body is effected.  It is, moreover, liable to
receive poisonous contaminations from without the body, introduced in
a variety of ways.  In these different modes, then, the condition of the
blood may be altered, and origin will be  given to the so-called blood
diseases ;  the number of which seems rapidly increasing, as for instance,
in the lectures of Dr. Todd we find alterations in the blood assigned as
the cause  of those derangements which seem most to  favor the notions
of the solidists, and to depend upon the condition of the moving fibre, viz,
Spasmodic diseases.
  The blood then, you perceive, is liable to alterations, which, by calling
in the aid  of chemical manipulation, may be ascertained, and lead to the
application of remedies more appropriate than  could otherwise be  ap-
plied.  It  is true that this field of investigation has been opened so re-
cently that great results have not  yet been  effected,  but  they loom in
the distance inviting us by their magnitude to  carry forward the work
With energy and perseverance.  Discoveries in this field are not  unfre-
quent, promising abundant fruit to future investigation, and  probably
leading to most satisfactory conclusions both as to pathology and practice.
Take as an example the recent discovery by Bernard of a normal func-
tion in the liver, not before suspected, the conversion of a portion of food
into sugar.  That eminent chemico-physiologist by analysing the  blood
entering the liver and that emerging  from  it as well as the substance of
the liver itself, has proved that in health, sugar is constantly produced,
recognizaMe in the blood till it  has passed the pulmonary  circulation,
after which, in the normal state, it is  no longer to be found.
  Do you  not at once see one of the direct  practical bearings of this new
factl  Will it not serve  to clear up the great obscurity  which  has long
hung over the very fatal disease called  diabetes, and  not  only tend to
elucidate its nature but by fixing on the precise points where the hither-
to considered abnormal material of sugar  is produced, and  the point
where normally it disappears, enable  us to ascertain  what the precise
change is  which prevents its disappearance at that point, and allows it
still to circulate with the blood ;  and when  that change is recognized
may we not expect to be able to apply with effect remedies suited for the
case?
  The practical importance of knowing the chemical  state of the blood
is now recognized even in the nomenclature which is  being introduced
to designate its condition.   Such terms as  spanaemia,  uraemia, pyaemia,
toxicaemia, &c, with the even more analytical names  of hypinosis  and
hyperinosis serve to shew the direction which the inquiries  of patholo- 
9
gists are taking.  1 might also call you to survey the new views taken
of the pathology of gout and rheumatism, as well as the whole tribe  of
zymotic diseases, as a reason for not neglecting chemical pathology, but
I shall confine myself in this connexion to asking your attention  to the
glimmer of light which has been thrown upon the natureand prevention
of Tubercle, that scourge of humanity under the form of consumption, and
other allied  maladies.  This is conceded to  he a blood disease, and seems
to arise from deficient elaboration of the nutrient  particles poured into
the blood, and intended to be there developed into  the nourishing mate-
rial of the hotly, but in some hitherto unknown way perverted  into the
tubercular deposit.   Recently observed  facts, aided by minute chemical
and  microscopical research seem to point to over abundance in the supply
of oxygen to the blood as a cause of the development of tubercle, while
its prevention, if not cure, would seem to have some relation to the dim-
inished arterialization of the blood.
  But I must not omit to point out what  may seem plainer evidence of
the practical importance of chemical knowledge, viz., the direct adminis-
tration of medicines to produce certain chemical changes.   You  arc,  of
course familiar  with the class of remedies which act entirely on chemi-
cal principles.  They bear a part, indeed, in the classifications of materia
medica—the antacids, the lithontriptics, the antidotes have always been
known to act, not as vital  but  as chemical  agents, and they have long
been, and still continue, in use to remedy what I  may call the grosser
chemical diseases of the body.  But the recognition of the  blood-origin
of diseases, and the investigation into the precise changes which consti-
tute thcin, or, in other  words, form their  '• proximate causes,'' will lead,
and  has already led to  the search after remedies which have the power
of altering  these conditions. 'Many lemedies which now  we  employ
empirically, or winch arc called specifics, we shall  probably come to use
in order to fulfil precise indications, and to induce particular changes.
You all know how  useful  the tartrate of antimony is in inflammation  of
the pulmonary  tissue.   It  is generally used, but its mode of action is also
generally unknown. But when you hear that it has been ascertained by
chemical experiment that antimony is potent  in diminishing the quan-
tity of fibrin in the blood, you will feel more satisfied in prescribing it,
than if you gave it  empirically as an agent  which you  had found to be
useful.  So, again,  in regard to nitrate of potash, which has been given
in large doses as a remedy for rheumatism : it is a powerful solvent of
fibrin, and we know that  in rheumatism that element of  the blood is
largely increased.   The effects of iron in augmenting the red corpuscles
become evident by the pallor of disease  giving  way to  the  roseate hue
of health. 
10
  I have dwelt so long on chemistry, that I can but glance at another
elementary study, viz., Physiology, which you should no* neglect on the
plea that it is not practical;  for, as the chemistry of tho body is liable to
become deranged, so is it of the physiology.   The kuowletlge of healthy
structure and function is indispensable to a knowledge of their disordered
states, and furnishes assistance in our most practical researches.  Let us
select for an illustration the cell-theory of growth.   It  is well-establish-
ed  that, commencing in a cell  of the  simplest  kind, our subsequent
growth  and full development is by multiplication of such cells  and their
varied modes of union and expansion.  Now this  would seem  at first to
be a fact curious and interesting  in  itself, but having  little bearing on
medical practice ; but when we look into tho nature of abnormal growths,
usually  called tumors, we find  their progress a copy of that of  the
normal tissue, and you then find your physiological knowledge applica-
ble to the diagnosis of such tumors.  As the natural tissue  possesses pe-
culiarities in its  cell  structures, so do abnormal  growths distinguish
themselves by varieties in the appearance of their cells.   Nothing can
therefore be of more practical benefit than to acquire facility in the  use
of the instrument by which alone such researches can  be carried on—I
mean the microscope.  That instrument is no longer to be  regarded by
the physician as simply furnishing curious and important information as
to the minutiae  of creation, but as a valuable assistant in obtaining a
practical knowledge of many of our common diseases.  Indeed the re-
sults of the use of that  instrument in giving  precision to the diagnosis of
several diseases are of the highest importance.  But I shall  allude but to
one of its discoveries, a very curious though  not a  pleasant one, the exis-
tence of minute parasites, both vegetable and animal, both on and with-
in our very textures.  The existence of  the  larger parasites, such as the
various worms and others that may be nameless, has been of course known
in all ages, but the fact that vegetable growths occur upon our  skins and
within our bodies, or that minute animals  in  large  numbers occupy at
times our very  flesh  and blood,  has been revealed only  recently and
through the aid of the microscope.  It  is  now  known that one of the
troublesome diseases of the scalp known as scald head (favus)  is a vege-
table fungus growing on the spot; that another  (porrigo decalvans) is
produced by a similar growth within the tubuli of the hair.   Intractable
cases of disorder  of  the stomach have been found  owing  to  a minute
fungus (sarcina ventriculi) growing within that organ  Cases have oc-
curred where the blood on examination  was  found loaded  with animal-
cula, and others where microscopic worms (trichina spiralis) occupied a
large portion of the muscular structure.
  I have thus endeavored, and I trust successfully, to impress upon your 
11
minds that the knowledge received in the elementary classes  cannot
lose its value even when you have  acquired  perfect acquaintance with
that taught in the more advanced  or practical departments ; but that
through your future clinical career you will need the aid  of that know-
ledge which  formed the first steps of your professional improvement.
  I had intended to have addressed to you some ethical  remarks in re-
gard to your  feelings and deportment towards your patients and towards
your brethren of the profession, as well as to point out as a duty to your-
selves that you  should cultivate your talents, and use the opportuni-
ties  you  will enjoy for your own improvement,  which  will then  be
sure to result in the desire and effort to add to the general stock of know-
ledge, but I  forbear and shall conclude  by congratulating  you  on the
honorable position to which you have now attained, and by hoping that
the avenue this day opened to you may lead  to a long course of useful-
ness to others, and of satisfaction and eminence to yourselves.
Moore, Owler & Stevenson, Printers, Montreal. 
 
 
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