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and of its social life, which has been carefully cherished by the teachers, they are known as good citizens, brave soldiers, loyal and devoted public servants, and, even better than that, as gentlemen. You come therefore to an alma mater of honourable repute; it must be your care to maintain and, if possible, to add to this reputation. In congratulating you on your choice of a school I do so on the strength of what, since I had the honour of being connected in a humble way with St. George's, I have ob- served here for myself. I have been especially struck with the energy I have already referred to and that foresight in the management. In every department I find these. Naturally the institution of a lectureship on tropical medicine has appealed to me more especially; but this is, I see, only one evidence of the spirit that runs through the entire management. Laboratories, museum, teaching appliances, and teaching are all of the best and most advanced description; and I am especially pleased to remark that the students, so far as my opportunities have enabled me to judge, are not slow to avail themselves of their exceptional opportunities. The mere fact of my being asked to address you on this occasion, I believe, is but another evidence of the desire of the authorities to advance, to extend, and to improve the training they offer. They seem to be impressed with the desirability of something being done for one of the neglected departments of medical education, for tropical medicine, and as they know the interest I take in this subject I have an idea that this is the reason why I have This been asked to come here to-day. I fancy I am expected to ventilate the matter. being so, the first remark I would make is, that the systematic teaching of tropical medi- cine, ere many years are over, will be universal in our medical schools. Those who can read the signs of the times and who are best able to judge regard this as inevitable. Why? Because our country is the centre of a great and growing tropical empire; and, second, because tropical disease in many respects is widely different from the diseases of temperate climates, which, practically, are the only diseases about which at present the student receives instruction. There are dozens of diseases more or less special to the tropics-diseases which demand special knowledge for their diagnosis and success- ful treatment. Rather over a fifth part of the medical graduates of Great Britain and Ireland practise in warm climates or, being in the army or navy, may be called upon at any time to do so. Surely if tropical practice is so different from practice here it is highly desirable that this vast army of medical men should be properly It may be said, and has been said, that as the prin- equipped for their special work. ciples of pathology and therapeutics are the same the world over they apply in India as well as in England. Quite true. But we have not to do merely with the principles of pathology and therapeutics. As a practical profession we are more concerned with their application, which is quite another matter. Similar objections might be, and formerly often were, raised about giving special instructions in such branches as eye disease, skin disease, and so forth, but the advance of our art and the requirements of the public have long ago swept aside these objections. So it is now with the teach- ings of tropical medicine as a special subject, and so in the near future it will be. principal reason why hitherto there has been so little done in this matter is this. Can- didates for medical degrees know very well that they will not be asked any questions about tropical disease by their examiners, and so they have not demanded instruction on this subject. And the reason why questions are rarely put on tropical medicine is that the leaders of the profession, those who man our hospitals, who fill the teaching chairs, who examine for degrees, who grant licences to practise, who make the regula- tions for the education of the youth of the profession, are, in almost every instance, men who have never practised in warm countries, and who themselves have never felt the necessity for a wider and more practical knowledge of the diseases peculiar to these climates. Not having themselves felt the want, they have been slow to acknowledge that such a want exists, and slower still to apply the remedy. But ask those who are best qualified to express an opinion on this subject. Ask the medical men who have themselves felt the responsibilities of practice in the tropics, and more especially those of them who have endeavoured to follow recent developments in tropical pathology, Ask them if they do not think that the medical man who goes out to battle with tropical disease should have some special instruction and training for the very special and responsible work he has before him, and if they do not think that the medical authorities should take care that the men who do so go out to practise should be pro- Unfortu- merly qualified so far as teaching can qualify. I am sure of their answer. nately, most of the men of tropical experience live and practise away from the great medical centres. They are hardly represented on the medical teaching, graduating,

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or legislating bodies, and so it comes that their opinions do not make themselves felt, and that a much-needed reform is delayed. It is more especially of recent years, partly in consequence of the enormous expansion of our empire and partly in consequence of the advances in tropical pathology which have signalised the last two decades, that the claims of tropical medicine have become urgent. Formerly the little that was known about tropical disease could be carried in a waistcoat pocket. But of late years so great has been the advance that nowadays the subject is quite as extensive and quite as special, so to speak, as ophthalmology, dermatology, gynecology, or as any of those de- When the partments of medicine which claim and receive special teaching. More so. practitioner in this country is puzzled about a case it is an easy matter for him to call in someone known to be familiar with the class of case he is in trouble about. But in the wilds of Africa, in the islands of the Pacific, in lonely stations in India or China there is no consultant to fall back upon. The practitioner there has himself alone to depend upon. And woe to his patient and, if he has a conscience, to his future peace of mind if he is not up to date in his knowledge.

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The course of instruction in general medicine usually received in this country is utterly inadequate to qualify for tropical practice. I say so emphatically, basing my assertion on my own experience, my own mistakes, and what I have seen and still daily see of the mistakes of others. Let me illustrate this by a few examples. Take that great scourge of mankind, greater, perhaps, than tubercle itself--namely, malaria. This is eminently a tropical disease. Every day the tropical practitioner is fighting it. Yet what does the student and future tropical practitioner actually know about malaria when he is stamped as qualified to practise his profession even in the haunts of this disease? He may possibly recognise a tertian or a quartan ague, and he may know that quinine will cure them. Ten chances to one his malarial patients know all that quite as well as he does himself. But could he, any more than his patients, tell a malarial remittent from an enteric fever; could he diagnose a pernicious malarial attack from cholera, it may be from thermic fever, from apoplexy? He has heard of the malaria germ, but has he seen it; could he recognise it; has he been taught to find it for himself; to make use of the fact of its presence or absence in the circulation as an infallible means of diagnosis? What would an examiner nowadays do with a student who could not recognise and demonstrate the tubercle bacillus? He would pluck him. And if I would pluck him. At all

an examiner, I were an examiner and found that a student, intending by-and-by to practise in the tropics, could not recognise and demonstrate the malaria parasite, I would do the same. For I know that the malaria parasite is just as important to him and his pro- spective patients as the tubercle bacillus is, and that the ability to recognise and demon- strate it is just as necessary for the tropical practitioner. In those terrible sudden forms of malaria which now and again will be sprung on him perhaps the only reliable means of diagnosis lies in ability to recognise the malaria parasite. Life hangs on it. Dr. Andrew Davidson, whose experience in tropical medicine has been very great, and whose judgment and knowledge are on a par with his experience, on my telling him I was to speak about these things to-day, and sympathising with my views, at my request sent me some memoranda on the subject. He relates a case which well ex- emplifies the necessity for knowing something about malarial disease before attempting to treat it. He writes: "I had not landed many weeks in Madagascar when I was called upon to see a patient who, I was told, had been suddenly seized with what was looked upon as an apoplectic fit. This was in the afternoon, and when I saw him about an hour afterwards he was lying unconscious, the body in a state of complete resolution. The skin was cool, the pulse and respiration were slow, and there was no stertor. His condition suggested cerebral hemorrhage or thrombosis. It was, indeed, for, as it turned out, the thrombosis, certain patient was suffering from the apoplectic form of pernicious malarial seizure, in which, as we now know, certain capillary areas in the brain are permanently or temporarily blocked by malarial parasites and pigment. The disease is by no means a rare one in malarious countries. It had long before been described by Torti. I had read in Graves's Lectures of the soporose or comatose seizure, in which fever is a prominent symptom. Here there was no fever, and the possibility that it was a malarial attack never entered my mind. What the precise brain lesion might be I could not decide. But something had to be done, and I saw nothing better than to place a drop of croton oil on the tongue, apply a blister to the nape of the neck, and warn the relations to prepare for the worst. I was gratified to hear next morning that

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