Introductory Lecture on the Opening of the Forty-Fifth Session of the Medical Faculty, McGill University.
Oct 1st 1877
by William Osler M.D.
Professor of the Institutes of Medicine
Gentlemen of the Faculty; -
The duty of delivering the introductory lecture has this year fallen to my lot, and however opinions may differ as to the necessity or advisability of beginning the session with such an address, there can be no doubt of this - that it affords an opportunity, rarely given, of offering to the assembled students words of welcome, advise and encouragement - an opportunity, the responsibilities of which come home to one with the thought of these young and eager lives just entering upon the serious work of life, and to be influenced for weal or woe. Perhaps by what the Introductory Lecturer may say and most certainly by what we as a faculty do.
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Students of Medicine, - My first duty, then, is to bid you on behalf of the Medical Faculty a hearty welcome: and I do so most sincerely, feeling sure that I express the sentiments of every one of your teachers when I say that you come now into the society, not of mere Professors who will lecture at you from a distance, but of men who are anxious for your welfare, who will sympathize with your difficulties, and also bear with you in your weaknesses. I can offer no better welcome that to tell you this. I see among you many with whose faces we are familiar, who return, and not for the first time, to these benches. To such, words of welcome are superfluous; I will only say we rejoice to see you back, we trust with refreshed bodies and invigorated minds, to pursue the work of this session. To those of you who for the first time occupy seats in this classroom, the occasion is a memorable one, to which I trust you will look back in after years with exceeding pleasure as the startup point of a career of usefulness and honour. For you we have a
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special sympathy. Look upon us as elder brothers to whom you can come confidently and fearlessly for advice in any trouble or difficulty.
On such an occasion as the present it is natural that you should expect to hear from me something about the profession of your choice, its position, the prospects it holds out to you, and the relations that you as students bear to it. Probably there are few among you who could give a very logical explanation of the causes which induced you to adopt this in preference to other callings, with one has been the influence of a friend; with another, perhaps, hereditary predisposition, with another that innate enthusiasm for the science which is akin to the natural gift that makes of one man an artist, another a musician, an inborn natural fitness for that special work, which are man's surroundings. Whether fostering or adverse, can neither give nor take away. From these last arise our greatest men; for others it matters little in what way the impulse has come, so long as the feeling now possesses
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you, penetrating every fibre of your being, that this above all others is the profession you can most heartily embrace. If however, any man of you here enters upon it with the idea that it will do as well as another, that other will most probably be better for you. Lukewarmness, bad enough at any time, is simply fatal at the beginning, where it usurps the place of that enthusiasm that should bend that man's whole nature to serve him willingly in the work that he has chosen.
In addressing a few words to you on the position which the medical profession at present holds, I must admit that different men hold very different views on this point. Some will tell you that the profession is underrated, underpaid, unhonoured, its members social drudges - the very last profession they would recommend to a man to take up. Listen not to these croakers: - there are such in every calling, and the secret of their discontent is not hard to discover. The evils which they deprecate, and ascribe it is difficult to say to whom  - in themselves do lie, - evils,
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the seeds of which - were sown when they were as you are now; sown in hours of idleness, in inattention to studies, in consequent failure to grasp those principles of their science without which the practice of medicine does indeed become a drudgery, for it degenerates into a business. I would rather tell you of a profession honored above all others; one which, while calling forth the highest powers of the mind, brings you into such warm personal contact with your fellowmen that the heart and sympathies of the coldest nature must needs be enlarged thereby. For consider the practical outcome of all the knowledge you gotten; the active work  for which your four years' study is a preparation. Will not your whole energies be spent in befriending the sick and suffering? In helping those who cannot help themselves? On rescuing valuable lives from the clutch of grim disease? In cheering the loving nurses of the sick, who often hang upon your words with a most touching trust? And in lessening the sad sense of human misery and pain by
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spreading, as far as in you lies, the knowledge and appreciation of those grand laws of health transgressed so ignorantly and yet avenged so fatally?
It cannot be denied that, (excepting the clerical profession, the members of which, in this country at least, can seldom look for the fruit and reward of their labors on the side of Heaven), there are fewer great prizes open to the medical man than to others from whom a long and special training is demanded. He is not raised to command his fellow me; his cause is not immortality in history and some like those of the gallant veterans who where her Majesty's uniform, and risk their lives for their country and Queen; he does not sit among the ridges of Land; the high places of brilliant statesmanship are not for him; while the world at large can reward him with but little beyond a successful practice, in which every dollar he earns represents its equivalent in hard, continuous work. But while the soldier and statesman win honours & fame, the family physician
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will draw to himself the love and gratitude of manifold hearts; he will have no enemies martial or political; and his labours, if directed by a wise and prudent skill, will be for the welfare and benefit of all. Such honours as are open to him lie chiefly within his own profession and the small circle of the scientific world. Among these his name may be a household word, his opinions may be quoted as conclusive, his writings become standard works; and these honours are very real and very satisfactory. I need only quote such names as Harvey & Hunter, Jenner & Virchow, to show you what I mean. But let the student remember that while influence of party may advance a man in other professions above many superior to himself, the hero in medical research must wholly depend upon his own deservings to take a foremost place in the wary and critical field of science he must excel.
And these remarks naturally bring me to a consideration of the state of the profession in this country. Turning from these matters of
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medical politics, let me try to answer the question which has, I am sure, come to each one of you more than once in the past few days, "How shall I best occupy my time?" To answer this I take to be one of the chief uses of such a lecture as the present. To those of you who now begin the study of medicine this is an all important period, for what you do this session will probably be an index of what you are capable of doing, and will certainly have a great influence on your college career. Five subjects will mainly occupy your attention: anatomy, physiology, chemistry, materia medica, and botany. The first three constitute the frame work of medical sciences, a portion of which must this session be put together - and allow me to indicate how much. Attention to mastering the bones, ligaments and muscles. Their general arrangement, individual peculiarities and mutual relations. Do not attempt to do more, but try to accomplish this.
Those who like can take up the structure of animals, zoology and comparative
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anatomy, instead of botany; and I have been surprised that so few men do, for the grasp of principles in a careful study  of the form and nature of animals, and the bearing of this upon human anatomy and physiology is more valuable in my opinion than the benefit derived in materia medica from a previous course of botany. One thing however, do not attempt - to take both; you have not time for that.
Shall you attend lectures in any of the final branches during your first year? Most emphatically, No! It would be as reasonable to ask men to listen to lectures in German when they did not know the language.
The question whether the first year student should see hospital practices is different, and one upon which there is less agreement; some believing that he should defer this until his second session others that he should begin at once. I hold with the latter. An hour spent daily in the outdoor department of a hospital in attentively watching the examples of disease brought in will do much, especially if combined with a little
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instruction, towards educating powers of observation in a student, and giving him a general idea of the names and appearances of many maladies; while every one of you can learn within the next six months to detect fluctuations in an abscess, and how to open it, to recognize crepitation in a fracture; and to master many other little details, which you cannot know too soon. My advice to you then on this point is attend the out door department of the hospital where you can; the time 11.30 to 12.30 is very convenient excepting when you have dissecting to do in the morning.
From these remarks you will see clearly that a very full programme is prepared for you, and it is for each one of you to set about the task with energy and determination. Gradually those difficulties will vanish which at first appeared insuperable. I remember well, when beginning the study of medicine, -- it is but ten years ago -- with what enthusiasm I took my Gray's Anatomy, and attempted to master the structure of a cervical vertebra, and though I succeeded in making a little
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headway, yet the matter seemed so very difficult, - the bones were indeed so very dry - and, turning over the leaves of that ponderous  the subject of anatomy appeared so vast, that my heart sank within me and I felt despondent. You also will have moments when the way appears rugged and the outlook dark, but never fear; others have succeeded in the face of the same difficulties and with patience and perseverance you will do so too. Banish the future; live only for the hour and its allotted work. Think not of the amount to be accomplished, the difficulties to be overcome, or the end to be attained, but that earnestly at the little task at your elbow, letting that be sufficient for the day; for surely our plain duty is "not to see what lies clearly at a distance, but to do what lies clearly at hand.
To the second and third & fourth year men among you.
And now let me add a word of advice upon the method of studying. The secret of successful working lies in the systematic arrangement of what you have to do and in the methodical
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arrangement of it, performance of it. With all of you this is possible, for few disturbing elements exist in the student's life to interrupt the allotted duty which each hour of the day should possess. Make out each one for himself, a timetable with the hours of lecture study and recreation, and follow closely and conscientiously the programme there indicated. I know of no better way to accomplish a large amount of work, and it saves the mental worry and anxiety which will surely haunt you if your tasks are done in an irregular and desultory way.
the science and art of medicine is progressive; therefore colleges and teaching bodies, representing as they do the embodiment of it, must progress with it, and that on several lines. Not only must the results of practical and scientific labor in the different departments be incorporated in the lectures so that in every subject the teaching may keep pace with the times, but new and better methods of instruction and examination must be adopted, and many other improvements which shall be for the benefit of the student. At this more then at any other time in the history written the last fifty years
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the leading minds in the profession are occupied  with the subject of medical education, and there is an almost universal feeling that in many quarters reform is needed. It is probable that the next decade will see radical changes in the modes of [ . . . ] , while practical work will be understood more & more largely into every department. With all beneficial reform the Medical Faculty of McGill University will sympathize, asking her students to participate therein, believing not in stereotyped forms but instead he onward progress, convinced that
"on our heels of fresh perfection treads, born of us fated to excel us."
To some recent changes I would briefly call your attention, and first to the practical examination in anatomy. Though it is always been customary for the Demonstrator to test the knowledge of the student on the subject, and while the oral part of the subject was made more or less practical, yet it was felt that something more might reasonably be expected of you. Therefore, examinations  have been
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established, modeled after those of the Royal College of Surgeons of London. Nothing will give you greater confide when you enter on practice than an intimate acquaintance with anatomy, and that you can obtain to perfection in our dissecting room. The advantages in this branch are very great, remember that we shall look for proportionate effort on your part.
The abolition of theses is a change which I am sure you will all appreciate. They were relics of the past, and though forward they might have been an important means of ascertaining a man's capacity and judging of his fitness for degree, this is now done in other and more effective ways and the thesis had degenerated, as a rule, into a very inferior medical assay quite devoid of originality. At universities where the degree of Bachelor of Medicine precedes the Doctorate, the writing of such an assay for the Master seems reasonable, but where, as at McGill, the McD is granted it once, it is superfluous. One regret goes with it. "Defense of Theses" it is no more, - a day regarded by candidates with very mixed feelings; an uneasy nervousness about one's own effort, and the criticisms it would call forth; and a natural curiosity
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to hear the comments upon productions of brother students. The day, as a rule, was productive of little good, for the theses were rarely defended and the best that can be said about it is that it was sometimes a pleasant gathering. Many a joke has been made, and much laughter excited over the mistakes of the unfortunate competitors, but occasionally a sensitive spirit has been unintentionally bruised, and it has left him with feelings of bitterness which would long ruin that pleasant and affectionate exuberance of his [ . . . ] life which we would fain have each one of you carry with him to the end of his days.
At the hospital the attendance is increased to 18 months, while very important changes have been made in the clinical department whereby the method of teaching has been more systemized. Instead of having clinical medicine daily for the first three months of the session, and clinical surgery in the last, arrangements have been completed under which the two classes will be carried on simultaneously throughout the six months course. The class taking Clinical Medicine and Clinical surgery on alternate days, heavy in each subject one lecture weekly in the theatre other demonstrations at the bedside. You will find this plan greatly
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conducive to your advancement, and look upon a strengthening of what has always been a strong point in this school, a point upon which the reputation of any school must mainly depend, viz: - the efficiency of its clinical teaching.
And further, if it no longer taken for granted that you will compound medicines during the summer months either at the hospital or with your preceptors, but you are compelled by law to spend at least six months in so doing, and to present a certificate for the same before qualifying for your degree at the university.
And lastly, the amount of material at our command will enable us to extend the pathological teaching of the school. The system we have followed heretofor was good, but incomplete. It is impossible to instruct students how to perform postmortems and at the same time to demonstrate fully to them the lessons [ . . .]. I propose this [ . . . ] establishing demonstrative class, in imitation, however feebly, of the course conducted by [ . . . ] in Berlin, in which the material collected may be made thoroughly instructive to the [ . . . ] men among you.
I trust the Medical Society, established during the past summer session, may receive your hearty support. To those of you who take advantage of it the benefit will be inestimable. It affords opportunities which after graduating
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you can never have, of learning how to prepare papers and to express your ideas correctly, while it is also a training in the difficult science of debate.
To a man who has made his start in life, who having chosen this path is now following it day by day, there is something hurts during in the site of a number of young men, such as those who are gathered here, just entering in the race which they will run with such varied powers, with such different results, and the busy arena of the world. For he knows that on an occasion like this their hearts must be beating with thoughts of the future, and of all that it may be to them. What high hopes swelled the breasts before him! What earnest resolves are hidden behind the brave young faces! What steadfast aims are set as the goal which shall reward the worker for each "passionate right endeavor" that he makes! Surely such thoughts are to each man among you as a trumpet call, summoning young recruit to fall into his rank in the battlefield of life. And further, like some familiar melody running though the clay of martial music, the thoughts of some most needs mingle with all others, till the
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student's fondest hope is the hope that he may be the pride of those who have cherished him from his childhood, his finest resolve the resolve to do nothing unworthy of their trust in him, his holiest ambition to satisfy their loving desires for his welfare advancement.
Two younger ones in such an assembly is this who are but just entering on college life, the dissents of liberty is paramount. No longer subject to the narrow rules schoolboy days, into the penalties that enforce them, released from the [ . . . ], But no less real, restraints of home; bound only by the laws of his alma mater, which demand little from him that he would not willingly give, the youth feels himself for the first time his own master, and the sense of freedom rouses the growing manhood within him and gives impulse to that self-reliance and independence of action that in after years braced the man for the responsibilities of life, with the power to choose is no longer a delightful novelty, but it anxious care.
So much for the inspiring feelings which animate the student at the beginning of a fresh course; but I'm sure many can bear me out and saying these are
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not all. The fear of failure underlies every effort, and this year must be specially present to those who run the competitive race of University career, in which a man naturally desires not only to reach the standard which sell secure him his degree, but also to take high place among his fellows. This fear of failure abides with some, paralyzing their energies and growing more burdensome as time wears on and their test days near. But let the student take courage; for though in the nature of things only one man can carry off the highest honors, I doubt if there be one among you who cannot come out well if you will only work as he ought.
Why is it some barely pass who should come out with flying colors? Why do others fail altogether? Not as a rule from want of mental capacity; not from a lack of the bodily stamina necessary for severe course of study; but rather from a failure in steadfast perseverance. Men begin well; they are diligent in their attendance at lectures, they throw their hearts into their practical work, they read early and late; but after a time the old
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Temptation comes over him, a temptation as old as human nature itself, one that assails every age and every path in life, the temptation which the old Israelites felt when "the soul of the people was much discouraged because of the length of the way." Men get tired of continuous study, their hearts grow sick under the monotonous daily grind. The more buoyant spirits feel their youth and health - strong within men, they relax their rules, they go into society, they begin to spend their evenings in ways more pleasant than in the dry digestion of books; the hard bit of reading is blurred over, the looking up of the lectures of his is put off. "What matter", they think, "it can soon be made up." And so the man becomes an idle man, halfhearted in all that he does and the grand powers within him lie fallow for want of that earnest perseverance, persistent exercise of them which alone can bring out their latent strength and make the student all that he ought to be.
But it would not be fair to attribute all failures to this cause. There are some men who fall short, not so much from want of applica-
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as from lack of hopefulness. They do not remember their reading as they wish; they do not grasp scientific principles as they expected; the difficulties thicken, they grow somewhat bewildered by the extent and variety of knowledge required and at last give up in despair that engrossing effort which alone can carry them through. "What is the use," they say, as they shirk the harder points, and lay the blame on the system of instruction which should fall on their want of confidence in themselves. They are commonly men of no brilliant talent, yet their brains would serve them faithfully enough if they would only put forth their mettle. Let such believe the truth of that fair average abilities, will use, often carry owners far above the heads of abler men - the genius rarely makes a successful practitioner, but the careful plotting student who feels that he must grind up the subject with plotting pause before he can make it part of himself, and you ask on this impression, develop the elements of lifelong success in his academic course.
To each of you, gentlemen, I would give the same advice - the ceiling of discussed and weariness and study, this disheartening
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Sense of want of progress, is natural; be prepared for it, immediately command; the mere effort will draw out the energy you hold in reserve, and you may find, perchance, as many as student has found before you, that the duties taken up with distaste become attractive in the doing of them, if only from that sense of victory over the lower self which is, I suppose, one of the most exhilarating and comfortable feelings and men can have.
Never lose sight of the and in object of all your studies, the care of disease and the alleviation of suffering. Some of you will soon be placed in the chamber of the sick, by the bedside of the dying and the issues of life and death may be in your hands. Think of this now, and while you have time use your talents aright. Your lives will be a constant warfare against the common enemy, implacable, often irresistible, who spares neither age nor sex and who too often, as the memories of the past week remind us, turns and bitterly avenges the victories of those with many a time snatched victims from his grasp.
Gentlemen, our meeting today
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is a sad one, for sorrow is in all our hearts one*wit endeared himself to us all has passed to that shadow land, which sooner or later awaits each one of us. Stricken down in the flower of his manhood, checked away at the onset of his professional laborers, it is inexpressibly sad that this fine life, so full promise should have been suddenly removed. This day week his cheerful, honest face was seen in the hospital wards, - today the mourners follow his body to the great. I need not recount to you who have appreciated his uniform prudence in the hospital is many good qualities, nor need speak of the talents to which our University awarded her highest honors; I will rather dwell on the deep regret of the profession at the loss of one home we were proud to number among us, and asked the students to imitate that zeal and faithfulness which marked his short career, and which will long make his memory be loved and honored among those he served.
In conclusion, gentlemen, let me urge you all to work diligently in an pursuit of that
*Dr. Cline, surgeon, M. G. H.
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through knowledge of the science of medicine, which alone will make the practice of it satisfactory. And above all things do not regard the profession as a mere means of earning a livelihood, and so enter upon it simply as a business. It is indeed pitiable sight to see the medical man neglectful of the higher interests of his profession, and given over wholly to the pursuit of wealth.
Remember, you enter upon a glorious heritage; you will reap or you have not sown, and gather where you have not strained, and the knowledge which it is your privilege today to acquire so easily has costs others much. We are all of us debtors to her profession; let us then, being mindful of those that come after, endeavor to add our little payments to the pile.
And now, remembering that we have other duties towards you then teaching the details of your profession, I would on this occasion earnestly impress upon you the necessity of living upright, honest, and sober lives. The way the medical student is
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beset with many temptations, and too often the track he leaves his marked by as many [ . . . ]; A zigzag path, "To right or left, eternal [ . . . ]." Above all things be strictly temperate. I will I will not say that you are in duty bound to give up the use of stimulants altogether, though my convictions on this point are very strong, - but this I do say, that the slightest habit not overindulgence is as the small flaw in some dyke that forms the barrier to a nightly flood, which widening that flow day by day, sooner or later [ . . . ] Every fear promise, and brings inevitable ruin.
To the thoughtful among you the speculative aspect of modern science will sooner or later prove attractive. Do not get entangled too deeply. I would rather give each one of you good old Sir Thomas Browne's advice: not to let these matters stretch your pia mater. Leslie, you will not only be better, but happier man, if you endeavor to do your duty day by day, not from any outside aim however high, but simply because it is right,
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Content to let the reward come when it will.
"Reconnect [ . . . ] Then Yesterday, it aims and [ . . . ]
Worked than Today for worthy things?
Then calmly wait Tomorrow's hidden season
and fear not
(from Series I. Collected Reprints.)