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 A. ID ID K. E S S 
 
 DBLIVERBD BBFOBE THE 
 
 CANADA MEDICAL 
 
 ASSOCIATION, 
 
 AT ST. .JOHN, NEW BRUNSWICK, 
 Angnst 6th, 1873. 
 
 ! 
 
 I 
 
 BY 
 
 J. A. GRANT, M.D.. M.P., 
 
 PRESIDENT. 
 
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 ' 5 i 3 Y 7 
 
JLlDnDItES 
 
 Gentlemen op the Canada Medical Association: 
 
 Exactly six years have elapsed since the first organiza- 
 tion of this Association. Our meetings up to the present 
 have been in the Provinces of Quebec and Ontario, but 
 on no previous occasion have we assembled under more 
 auspicious circumstances, welcomed as we are to so 
 fSavourable a position as the City of St. John, the chief 
 commercial centre of the Province of Now Bruns- 
 wick. From the wide spread character of our New 
 Dominion, we could not expect the presence of many 
 from the distant parts at these meetings ; still, on 
 every occasion, this Province, as well as Nova Scotia, 
 was ably represented, and it is a recognized fact, that to 
 the activity, energy and ability of the gentlemen from 
 the Maritime Provinces, who previously filled the Presi- 
 dential chair, this Association owes in a great measure 
 its present degree of usefulness. Thus we observe that 
 in medical science, as well as in diplomatic affairs, these 
 Provinces have taken no small part in the prosperity of 
 the whole Dominion. 
 
 It was with no ashamed feelings of humility that I ex- 
 pressed at our previous meeting, at Montreal, my lively 
 sense of the responsibility of the duties that devolved 
 
upon me, performed with such marked di.stiiiction by 
 my worthy predecessors. I trust that my efforts, 
 however inadequate, will not flag in the accomplish- 
 ment of what is right and best for that noble profes- 
 sion in which we should be, in the strict sense in the 
 inspired words, "members one of another." We have 
 a common estate in the science of medicine. Wo have 
 a good work before us, and we do well to acknowledge 
 our unity, and activit}'-, in promoting, by these annual 
 meetings, a oneness of feeling in the profession of the 
 Dominion, and the advocacy of medical science in its 
 most progressive form ; side by side with the high-toned 
 and intellectual members of the American Medical As- 
 sociation, alike interested in the advancement of medical 
 science on this continent. Relying on the spirit which 
 prompted you to confer on me the highest honour 
 within the gift of the medical profession of this Domin- 
 ion, I shall endeavour to discharge the duty as your 
 presiding officer, in this position of trust and respon- 
 sibility. Knowing, as I do, the great value of time in our 
 short sessions, and how much work is expected to be ac- 
 complished, I shall confine my remarks more especially 
 to the appropriate subjects of the occasion. At our pre- 
 vious meetings much time was occupied in the discussion 
 of a Dominion Medical Act, an able draft of which was 
 presented by Dr. R. P. Howard of Montreal. After a 
 lengthy debate, the conclusion arri^^ed at was that this 
 measure should rest pro tern. That the Medical Profes- 
 sion of the Dominion should be united by an Act in the 
 Commons, is a point warmly and zealously advocated by 
 
 *' J' 
 
many of the iiblent membere of our profession. B}'^ tho 
 Confedt3ration Act, unfortunately all matters pertaining 
 to education, as well as to public health, do not come 
 within tho jurisdiction of the Dominion Government, and 
 consequently are strictly matters of local legislation. It 
 is much to be regretted : still, by the consent of tho Local 
 Governments, much may yet be accomplished, towards 
 bringing about those radical changes, so necesf ry in 
 order to simplify, in the widest and most comprehensive 
 sense, subjects both educational and sanitary. 
 
 In tho Province of Ontario, for the first time in this 
 country, the three bodies — Allopathic, Eclectic and 
 Homojopathic — sat in one council and deliberated upon 
 medical affairs. This union was considered somewhat 
 unique, by many staunch old conservatives in tho profes- 
 sion. However, when the fact became known that dur- 
 ing those nine years, not a single homoeopathist or eclec- 
 tic passed as such in Ontario, the reason of the union 
 can readily be comprehended. An uniform standard of 
 medical education was established, written and oral ex- 
 aminations demanded from each student, and being com- 
 pulsory, was the means of directing in the proper chan- 
 nel many who might otherwise have found an easier 
 entrance into the medical profession. Recently the Chief 
 of the Homoeopathic body has seen fit to withdraw from 
 the Council of Ontario, and we anticipate that extra 
 medical legislation may arise, in order to gratify those 
 who consider their professional claims,somewhat ignored. 
 I merely mention the facts, in order that the profession 
 in these provinces may apprehend the nature of that 
 
^ r 
 
 6 
 
 union so heterogeneous and characteristic. The great 
 aim and object of this Association is to cultivate and ad- 
 vance medical knowledge; to elevate the standard of medi- 
 dical education ; to promote the best interests of the pro- 
 fession, and to direct public opinion, as to the duties and 
 requirements of medical men; to encourage a fraternity 
 of fooling in the profession in the most comprehensive 
 sense. With these objects in view, on the present occa- 
 sion three Addresses will be delivered ; one in Surgery, 
 by Dr. Kingston, of Montreal ; one in Medicine, by Pro- 
 fessor Howard, of McGill University; and one in Ob- 
 stetrics, by Dr. Bayard, of St. John. In addition, a Gold 
 Medal is offered for the best Essay on Zymotic diseases. 
 We anticipate a lively discussion on many points of in- 
 terest, which will doubtless arise 0"+ of those papers. 
 We look forward to a greater degree of activity in fViture 
 in the Association, as general medical topics will occupy 
 the deliberations of all interested in work, such as must 
 tend to advance the best interests of our profession in 
 this country. 
 
 1 
 
 ♦-:' 
 
 The subject of medical education is a topic which at 
 every meeting of this Association, has received well- 
 merited consideration. Although somewhat worn, it is 
 of such vital importance that it cannot be too frequently 
 discussed, more especially when we observe the present 
 manifest disposition of the rising generation to rush 
 through a course of collegiate study, and enter into. the 
 practice of the medical profession, devoid of that literary 
 training, so requisite in order to develop those powers 
 
^1 
 
 
 •' 
 
 «':' 
 
 of thought ttn<l observation so nccehsnry, particularly 
 when muttt^TH of life and death are concerned. -«^ 
 
 " A profertsion that does not equal the ago of itH edu-' 
 cational machinery, that iH unable or unwilling to reprc-' 
 aent its modes of thought, and its forwai-d tendencies in 
 its demands from those who seek admission into iia- 
 ranks, ceases to be a profession, because it loses its claims 
 to a scientific character." . 
 
 Great chaTiges are j^early taking place in the progress* 
 of human thought and human industry, and in each de- 
 partment of science, only thooe methods are recognized, 
 which rest on an educational basis. A defective pre- 
 liminary education, is the first and undoubtedly the great 
 error in the present system of medical education. 
 There should be one standard of preliminary educa- 
 tion exacted in all the Provinces, from those who desire 
 to enter the medical profession. A greater degree of 
 uniformity now exists, than prior to our discussions on 
 this subjec- . So long as there is a diversity of interest 
 in matters educational, difficulty will attend the bringing 
 about of that uniformity which would be arrived at by a 
 Dominion Medical Act. Important changes arc usually 
 slow in their development, yet wo look forward to the 
 time when we shall have one chief educational centre, so 
 guiding and directing the medical proforision of this en- 
 tire Dominion, as to build up an enlightened o])inlon, 
 such as the members of this Association have at heart. 
 While recognizing the progress of medical education in 
 each Province, and the marktHi ability of those active in 
 imparting a sound medical training, we must await the 
 
spODtaneouB action of all, alike interested, to extend the 
 principles of confederation we now enjoy, so as to unite 
 us as a profession, strengthen our position as a body, 
 and thus increase our sphere of usefulness. 
 
 There is a point to which I would now desire to call 
 the attention of this Association, viz., tLd advisability 
 of having thoroughly trained female nurses. In private 
 as well as hospital practice we constantly experience a 
 great want in this respect. In each of the large cities 
 having extensive hospital accommodation, some system 
 might be inaugurated by which those desirous of becom- 
 ing skilled nurses might avail themselves of the facilities 
 offered, and in course of time, supply a deficiency 
 now generally felt in the practice of the profession. Such 
 skilled nurses to obtain certificates of qualification and 
 fitness for the position of honour and trust. Every town 
 and city in the Dominion would gladly encourage the 
 employment of such talent, and in that sphere woman 
 would occupy her true position, as the administerer 
 of the prescribed medicines, capable as she is of those 
 soothing, delicate and kindly attentions, so necessary at 
 the sick bedside, and so cheering and gratifying to the 
 patient. Miss Nightinoale has thus fully expressed her 
 ideas : 
 
 '* I think the Anglo-Saxon would be very soiry to turn 
 woman out of his own house, or out of civil hospitals, 
 hotels, institutions of all kinds, and substitute men- 
 housekeepers and men-matrons. The contrast between 
 even naval hospitals, where there are female nurses, and 
 military hospitals, where there are none, is most striking 
 in point of order and cleanliness." 
 
 ] 
 
 i 
 
 Al 
 
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 4 
 
 1 
 
 1 
 
ft 
 
i 
 
 In points of sanitary domestic economy, woman car- 
 ries off the palm, and, by her tidiness and cleanliness, 
 establishes a degree of order seldom seen without her. 
 The cheering look, the tender hand, the watchful eye, 
 and the innate powers of observation, are such, that 
 many little necessaries for the sick patient are carefully 
 ^ thought of, that might escape the sterner powers of the 
 
 skilled and educated physician. 
 
 The Sisters of Charity, who officiate as nurses in the 
 Catholic hospitals of the Dominion, have, by their skill, 
 dexterity and general neatness, earned a well-deserved 
 reputation. Why should not the Protestant Institu- 
 tions of Canada have a sisterhood alike charitable an<^ 
 philanthropic ? 
 
 The subject of medical evidence in courts of law is one 
 possessing no ordinary degree of interest. The value 
 of such evidence in questions involving the causes of 
 death, by unknown means, has been long recognized as 
 having attained, with the various achievements of science, 
 a remarkable degree of accuracy. 
 . ' The position of the scientific expert is one of great 
 importance. His deductions are based or a sound know- 
 ledge of human structure ; of the laws which regulate 
 the organic functions ; of the chemical laboratory in the 
 system, possessing an action and reaction peculiarly its 
 own ; and of the disturbing forces, which induce death, 
 under extraordinary circumstances. The courts of law 
 at home and abroad consider such testimony of great 
 value, and upon it frequently hinge matters of life or 
 death. In carrying out such investigations both a tho- 
 
 II 
 
■■ 
 
 It 
 
 roughly scientific knowledge and a perfectly disintereet- 
 ed mind are necessary. The great aim and object in 
 view is to bring to the surface the principles of truth 
 and honour, no matter how trying the attendant circum- 
 stances. Medical men should bear in remembrance the 
 responsible and dignified position they are called upon 
 to fill in medical enquiry. It is not upholding the status 
 of our profession to find its members become partisans 
 in courts of law. Cases of malpractice are not fortun- 
 ately of frequent occurrence and when such do arise the 
 professional man should never be found occupying an 
 unenviable position, as the instigator of enquiry for 
 purely selfish and personal motives. The whole profes- 
 sion suffers by disregard to ordinary professional courtesy. 
 In courts of law our opinions wield a recognized power 
 and influence, and it is gratifying to observe that in the 
 various medical schools, the subject of medical jurispru- 
 dence is receiving well deserved consideration. Through 
 the various medical Societies any professional irregulari- 
 ties in the law courts should be reported and, by this 
 Association a power exercised, that would be productive 
 of the most beneficial results. Eegularities as well as 
 irregularities should be noted by those interested in the 
 welfare of the medical profession. In Canada wo are 
 yearly enlarging and increasing our medical periodicaLs, 
 which give evidence of improvement by the abundance, 
 variety and general excellence of the various contribu- 
 tions and selections. How is our Canadian Medical 
 literature to be supported ? This is a question which 
 must strike forcibly the most ordinary obser\'er. In 
 
 i 
 
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i 
 
 11 
 
 the larger cities as well as tlie rural districts there are 
 those who from their position, experience and knowledge 
 of matters medical, could do much towards building up in 
 this country such an expression of opinion as would tend 
 materially to strengthen and consolidate the very best 
 interests of our profession. It is generally acknow- 
 ledged that there are more medical journals than receive 
 remunerative support, and that much labour, zeal and 
 self-sacrifice are necessary on the part of both editors 
 and publishers in order to promote the vitality of this 
 form of medical literature. Such efforts are worthy of 
 the highest commendation, for by means of local medical 
 journals, m:any facts are brought to light, which other- 
 wise might have passed, unrecorded. In Canada, as in 
 Great Britain, hospital reports, are yearly acquiring a 
 greater 'egree of importance, and our medicaV students 
 are being stimulated thus towards the cultivation of one 
 of the most necessary branches of study, viz., to observe 
 rightly and report intelligently. The country as well as 
 the city practitioner should contribute regularly to our 
 journals. The city with its extensive hospitals, large lib- 
 raries,well-organized medical societies, has yery great ad- 
 vantages ; and yet it has been remarked by an able writer 
 in favour of the country medical man,that^'on^ma^ thought 
 is usually best cultivated in comparative solitude.^' A high 
 degree of excellence in medical journalism can scarcely 
 be expected in so new a field of enquiry, and considering 
 the efforts put forth to fan into vitality such able journals 
 as the London Lancet and London Medical Times and 
 Gazette, Edinburgh Medical Journal, and others of like 
 
r 
 
 celebrity, we should not be discouraged. In the recording 
 of medical facts, it is prudent and right that such should 
 be communicated plainly, avoiding, as far as possible, 
 newly-coined words and obstruse phraseology, which in 
 no way whatever will be acceptable to the plain, common 
 seme practitioner. It is common sense which is most 
 required at the sick bedside ; it is this sense after all 
 which achieves the greatest degree of success, educated, 
 enlightened, and elaborated through the various scienti- 
 fic achievements and astounding discoveries, of this age of 
 progress. Every physician in regular practice in city 
 and country, should not only take one or more medical 
 journals, but contribute as well. A large and lucrative 
 practice, a high and influential position, are not alone 
 sufficient to perpetuate a worthy name and reputation. 
 Those are perishable and will die out, when well-timed 
 and well recorded facts, will last and establish true and 
 genuine worth. Zimmerman remarked " that the greatest 
 medical writers of any age were the best physicians.'^ Those 
 who communicate their views should rather be encourag- 
 ed than decried. It is quite unnecessary to urge upon 
 those who read the best medical journals, the importance 
 of such publications. It is high time that those who 
 fancy they can learn nothing from medical journals, 
 should retire and leave the field to those more willing in 
 every respect to keep pace with the progress of medical 
 science in its various departments. Let us then as an 
 Association encourage and uphold our journals and con- 
 tribute in every possible way towards building up and sus- 
 taining so worthy and so requisite a branch of literature. 
 
 . 
 
 1 
 
13 
 
 ;J 
 
 .: In conclusion, T would merely advert briefly to the 
 subject of Sanitary Science, identified as it is with na- 
 tional progress, and surrounded at present with more 
 than an ordinary degree of interest. We are daily 
 in possession of telegraphic news as to the preva- 
 lence in the Southern States of a much dreaded disease. 
 Under such circt^mstances, I cannot permit this opportu- 
 nity to pass without calling upon all interested to bring 
 about, in every possible way, such san'tary measures as 
 will tend to lessen the spread of cholera, should we be so 
 unfortunate as to have a visitation of that disease. In the 
 absence of danger, sanitary measures are frequently lost 
 sight of, and even a moderate expenditure is a suflScient 
 cause for the delay observed in carrying into opera-tion the 
 necessary precautions. While there is no occasion for 
 alarm, tliere is a necessity for action on the part of health 
 authorities. Mr. Simon, the Medical Officer of the Privy 
 Council of England, says: ^.r ■., ^ -^ . ,i ; , ■ • « 
 
 « 
 
 *' The dangers which particularly have to be guarded 
 against, as favouring the spread of cholera conta- 
 gion, are particularly two : first, and above all, there 
 is danger of water supplies, which are in any degree 
 tainted by house refuse or other like kinds of filth, as 
 where there is overflow, leakage, or filtration, from 
 sewers, house drains, cesspools, foul ditches, or the like, 
 into streams, springs, wells or reservoirs, from which 
 the supply of water is drawn, or into the soil of which 
 the wells are situate, — a danger which may exist on a 
 small scale at the pump of a private house, or on a large 
 scale, in the source of supply of public waterworks ; 
 
I 
 
 and, secondly, there is the danger of breathing air which 
 is foul with effluvia from the same sorts of imj^urity." 
 
 Filth percolating into well water is a very fertile source 
 of disease. The report of Dr. Ballard, of Islington, 
 concerning the propagation of enteric fev^er, by milk 
 polluted with enteric fever poison, through leakagv3 into 
 the well which supplied the cattle with water, is conclu- 
 sive evidence as to the occasional origin of so trying a 
 disease. 
 
 The subject of sanitary legislation is one of vast import- 
 ance inasmuch as by preventable diseases, thousands of 
 lives are lost which might be saved annually. We require 
 fresh air, pure water and clean food ; this brought about, 
 even in a moderate degree, would confer an inestimable 
 blessing on society at large. So strongly impressed are 
 the members of the American Medical Association, on this 
 subject, that at their last meeting, at St. Louis, in June, 
 a strong resolution was passed recommending the estab- 
 lishment of a "National Sanitary Eireau," with relation 
 to the general Government at Washington, similar to the 
 Bureau of Agriculture. It is quite evident, considerable 
 new life must be thrown into this subject, and should 
 sanitary regulations be thoroughly and systematically 
 carried out, by skilled operatives, the advantage which 
 would accrue to this Dominion would be beyond compu- 
 tation. An enlightened opinion would thus be built up, 
 through the exercise of which, we might possibly effect 
 such sanitary changes, as would be most conducive to 
 the best interests of the general public. 
 
15 
 
 Gentlemen of the Canada Medical Association, — Wo 
 liave assembled here for very important purposes, the 
 eyes of the community at large are upon us; watching, 
 cheering and guiding us along, in the pcrforniuuce of duty. 
 At best we have only a few short years before us, and 
 in the multiplicity and diversity of work, a single life 
 can accomplish but little. Let that little be well done, 
 keeping steadily before us the remarkable and striking 
 aphorism of Hippocrates, which has been paraphrased by 
 one of our greatest lyrics : — 
 
 ''Art is lontf and time is fleetiu"'': 
 
 And our hearts, though stout and brave, 
 
 Still like muffled drums are beating 
 Funeral marches to the grave.'' 
 
 4