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 ON 
 
 THE MEDICAL PKOFESSION 
 
 AND 
 
 MEDICAL EDUCATION 
 
 IN CANADA. 
 
 in 
 
 BY 
 
 DONALD MACLEAN, M.D., L.R.C.S.E. 
 
 fr\ 
 
 Addreu delivered at hii Inatallation as FrofeiMr of the 
 Institutes of Medicine. 
 
 Qobbn's University, January 10, 1865. 
 
 KINGSTON : 
 1865. 
 
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 ON 
 
 THE MEDICAL PEOFESSION 
 
 AND 
 
 MEDICAL EDUCATION 
 
 IN CANADA. 
 
 BT 
 
 DONALD MACLEAN, M.D., L.R.C.S.E. 
 
 Address delivered at his Installation as Professor of the 
 Institutes of Medicine, 
 
 Queen's University, January 10, 1865. 
 
 m 
 
 KINGSTON ; 
 
 1865. 
 
L 
 
THE MEDICAL PK0PES8I0N 
 Aim 
 
 MEDICAL EDUCATION IN CANADA 
 
 GlNTLIlUN, 
 
 The acience of medicine has, for apwards of 
 twenty-fiTe centuries, been regarded as one of 
 tlie most exfiited studies to which the human 
 intellect can derote itself. 
 
 During this time an innumerable multitude 
 of great minds have laboured with the most 
 untiring zeal to increase, and, if possible, to 
 perfect their acquaintance with the structure 
 and fkinctions of thtst piece of mechanism, the 
 mere contemplation of which causttd the sweet 
 singer of Israel to exclaim " I am fearAilly and 
 wonderfully made." 
 
 During idl these ages this science has num- 
 bered among its students and lorera many of 
 the profoundest of thinkers and the best of 
 men; and their labours, combined with the 
 no less earnest and enlightened exertions of a 
 mighty host of fellow-workers in all the 
 collateral and correlatire departments of 
 science, hare, in our day, culminated in a result 
 which far exceeds in beauty and grandeur the 
 utmost expectations or eren the most sanguine 
 of the early fathers and founders of the science. 
 
 It is now many centuries since Galen, the 
 great physician and philosopher, gave expres- 
 sion to the dignity and beauty of the fundamen- 
 tal branches of medical study in the following 
 terms : — " In explaining these things I esteem 
 myself as composing a solemn liymn to the 
 great Architect of our bodily frame, in which 
 I think there is more piety than in sacrificing 
 whole hecb, imbs of oxen, or in burning the 
 most costly perfumes, for first I endeavour to 
 
 ooaf)i 
 
know Him myself, and afterwards by the same 
 means to show Him to others, to inform them 
 of His wisdom, gpodness and power," But the 
 science of our day is no more like the science 
 of his day than hyperion is to a satyr. If 
 Oalen could rise from his grave, with what 
 rapture and amazement would lie behold all 
 the beautiful revelations which modern inves- 
 tigators, with the aid of modern implements, 
 have succeeded in eliminating. 
 
 It is now three hundred years since the great 
 dramatist penned the following beautiful lines : 
 
 " What a piece of work is man ? 
 How noble in reason I How infinite 
 In faculties I In form and moving 
 How express and admirable I 
 In action how like an angel I 
 In apprehension how like a Godl 
 The beauty of the world ! 
 The paragon of animals I" 
 
 At this late period of the 19th century to 
 enter upon any argument in favour of the 
 dignity and importance of a science, which is 
 founded upon the anatomy and physiology of 
 this wonderful organism, would assuredly be a 
 work of supererogation and an insult to the 
 judgment of my audience. I may, however, 
 allude very briefly to one of the uiost inter- 
 esting relations in which the fundamental 
 subjects of medical science can be con- 
 sidered, one from which, more than from any 
 other, the science derives dignity, beauty, 
 and importance. I refer to the relationship 
 which exists between theology and metaphy- 
 sics on the one band, and anatomy and phy- 
 siology on the other. Perhaps this peculiar 
 and important relationship of medical science, 
 or rather of physiology, on which, of course, 
 all medical science is founded, could not be 
 better illustrated than by quoting the words 
 first, of a profound religious philosopher, then 
 those of the greatest metaphysician of this 
 century, and lastly, the opinions of one of the 
 greatest of living physiologists on the same 
 subject. First, the theologian uses the follow- 
 ing strong terms : " Even the gorgeous majesty 
 of the heavens, the object of a kneeling adora- 
 tion to an infant world, subdues no piore the 
 
 I 
 
mind of him who comprehends the one mecha- 
 nical law by which the planetary systems 
 move, maintain their motion, and even origin- 
 ally form themselves. He no longer wonders 
 at the object, infinite as it always is, but at the 
 human intellect alone which in a Copernicus, 
 Kepler, Oassendi, Newton, and La Place, was 
 able to transcend the object, by science to 
 terminate the miracle, to reave the Heaven of 
 its divinities, and exorcise the universe. But 
 even this, the only admiration of which our 
 intelligent faculties are now capable, would 
 vanish were a future Hartley, Darwin, Con- 
 dillac, or Bonnott, to succeed in displaying to 
 us a mechanical system of the human mind as 
 comprehensive, intelligible, and satisfactory as 
 the Newtonian mechanism of the heavens." To 
 this the great metaphysician to whom I have 
 referred adds the following : " Should Physio- 
 logy ever succeed in reducing the facts of 
 intelligence to phenomena of matter, philoso- 
 phy would be subverted in the subversion of 
 its three great objects — God, Free-will, and 
 Immortality. 
 
 *' True wisdom would then consist, not in 
 speculation, but in repressing thought during 
 our brief transit from nothingness to nothing- 
 ness. For why ? Philosophy would have be- 
 come a meditation, not merely of death, but of 
 annihilation; the precept ' know thyself,' 
 would have been replaced by the terrific oracle 
 to (Edipus — ' Mayst thou never know the truth 
 of what thou art,' and the final recompense of 
 our scientific curiositywould be wailing, deeper 
 than Cassandra's, for the ignorance that saved 
 us from despair." 
 
 The theologian and metaphysician meant to 
 say, we beiicv« in God, Free will and Immor- 
 tality ; we do not believe that the physiologist, 
 no matter how far or how successfully he may 
 pursue his researches, can ever succeed in 
 subverting the three great objects of philoso- 
 phy, in which are centred all our hopes of 
 another and better form of existence: still, say 
 they, inasmuch as philosophy can receive no 
 assistance and religion no additional evidence 
 from the study of that wonderful structure 
 which undoubtedly, and, to say the least of 
 it, furnishes the conditions necessary for the 
 
manifestation of intoUoct ; tlicrcforo it id 
 certainly useless, and it may bo even danger* 
 0U8, to devote mucli attention to it. Let us 
 confine ourselves to sp'-culative philosophy, 
 and ignore the material substratum altogether. 
 
 But the physiologist to whom wo have 
 referred, and who may bo taken as the repre- 
 sentative of bis class, views the matter in a 
 different, and, wo think, moro correct light. 
 Ho uses the following argument : — " It is to be 
 greatly regretted that evidence drawn from 
 structural arrangement has hitherto, by very 
 high authority, either been totally cast aside, 
 or held in very light esteem. It is still more 
 deeply to be regretted that those who should 
 liave known better have conceded the argu- 
 ment, that from no consideration based upon 
 anatomical or structural arrangement could 
 proof be obtained of the existence of an imma- 
 terial principle. Even by such, physiology has 
 been designated as leading to materialism, and 
 with an- injustice which cannot be too empha- 
 tically reprobated, the dcandal has often been 
 quoted that where there are three physicians 
 there are two atheists." 
 
 In one part of bis works we find this physio- 
 logist Inculcating upon his brethren the pro- 
 priety of leaving no ambiguity in the expres- 
 sion of the conclusion to which their own 
 science brings them. " Especially is it for thn 
 physiologist," he says, " to assert and to uphold 
 the doctrine of the oneness, the immortality 
 and the accountability of the soul, and to 
 enforce those paramount truths with whatever 
 evidence the structure of the body can furnish." 
 
 In another be says, " certainly it is desirable 
 that some new method should be introduced 
 which may give point and precision to whatever 
 metaphysical truths ezist,and enable us to dis- 
 tinguish, separate and dismiss what are only 
 rain and empty speculations." 
 
 So far from philosophy being a forbidden do- 
 main to the physiologist, it may be asserted 
 that the time has now come when no one is en- 
 titled to express an opinion in philosophy, ex- 
 cept he has first studied physiology. 
 
 It has hitherto been to the detriment of truth 
 that these processes of positive investigation 
 bare been repudiated. If from the construction 
 
of the humnti brnin we mny demonstrftto the 
 existence of a soul, is not that a gain 1 for there 
 arc many who are open to arguments of this 
 class on whom speculative reasoning or a mere 
 dictum fall without any weight. " Why," he 
 asks, "should we cast aside the ffolid facts 
 presented to us by material objects. 
 
 In his communications throughout the uni- 
 verse with us, God ever materializes. He 
 equally speaks to us through the thousands of 
 graceful organic forms which are scattered in 
 profusion over the surface of the earth, and 
 through the motions and appearances presented 
 by the celestial orbs." 
 
 I have quoted thus extensively from the wri- 
 tings of this physiological philosopher on ac- 
 count of the paramount importance of the sub- 
 ject and the eminence of the author. His ar- 
 guments appear to me to refute the terrible 
 charge which has so frequently and by such high 
 authority been preferred against the study of 
 physiology, and at the same time to assert the 
 high relationship occupied by this science in 
 reference to theology and philosophy. 
 
 In conclusion (on this subject) permit me to 
 observe, that the very fact that there exists a 
 certain large and influential class of physiolo- 
 gists, whose studies have led them to adopt and 
 promulgate the doctrines of materialism — phy- 
 siologists who are foolish and presumptuous 
 enough to believe that the time is not far distant 
 when by the aid of the scalpel, microscope, and 
 other means of research, they will have suc- 
 ceeded in proving that there is nothing in the 
 whole universe except what is palpable to and 
 in some way or other appreciable by our senses ; 
 that in short there is no soul in man and no 
 God in heaven — I say the very fact that such a 
 class of physiologists exists should furnish us 
 with an additional stimulus to exertion in the 
 cause of truth. 
 
 One great object of our ambition should be 
 not only to counteract their malignant and 
 wide-spread influence in the world, but also 
 to convince them of their errors, which most 
 assuredly we can only hope to accomplish by 
 meeting them on their own ground and 
 demonstrating, as Dr. Draper believes we will 
 yet be able to do, the existence of the soul from 
 
the structure of the human brain. These 
 considerations should have a tendency to 
 impress the student of medicine with a deep 
 sense of the dignity and sacredness of h<.s call- 
 ing. 
 
 For the reasons before stated I do not at 
 present stop to consider any of the very 
 numerous additional arguments in favour of the 
 dignity, the importance, and the grand compre- 
 hensiveness of the science of medicine; but in 
 the next place I wi^^ to make a few remarks 
 respecting the present condition and social 
 standing of the medical profession in Canada; 
 after which, I shall consider briefly the present 
 system of medical education, and in conclusion 
 T shall venture to suggest certain steps which 
 might be taken with a view to the improvement 
 and elevation at once of our standard of edu- 
 cation, and the social position of our noble 
 profession in these Provinces. To all who are 
 interested in the welfare and efficiency of the 
 medical profession, (and who is not?) these 
 are questions of the utmost importance, never- 
 theless I shall not at present attempt a full or 
 detailed discussion of them. This is neither 
 the time nor the place to do more than take a 
 very cursory view of them. 
 
 And first, with regard to the present condition 
 and social standing of the medical profession 
 in Canada. 
 
 I am sure it will be readily conceded on all 
 sides that the title, Doctor of Medicine, does not 
 insure to its possessor that degree of respect or 
 that honourable distinction in society, which 
 the highest honour in medicine that any 
 University has in its power to bestow ought to 
 insure. 
 
 The degree of Doctor of Medicine, be it re- 
 membered, is not merely a license to practice 
 the profession, it is at the same time a very high 
 University honour, which ought to stamp its 
 possessor as a man of .unquestionable moral 
 character, of high literary attainments,as well 
 as one who is capable of discharging the duties 
 and assuming the responsibilities of a practi- 
 tioner of medicine. 
 
 In short, the term. Doctor of Medicine, ought 
 to imply that its possessor is at once a skilful 
 and experienced physician, and a thoroughly 
 
.9 
 
 educated gentleman, worthy of all confidence 
 and respect. But at present I am sure no one 
 can claim this position for the profession in 
 Canada. 
 
 Instead of commanding confidence and re- 
 spect, the title of " Dr," excites suspicion and, 
 very generally, contempt ; instead of imply- 
 ing literary eminence and D'oral recitude, it 
 implies rather ignorance and depravity, com- 
 bined with impudent assurance and unprinci- 
 pled recklessness. I doiibt very much if the 
 medical profession ever in any country occu-' 
 pied a more humble position in public opinion 
 than it at present occupies in Canada. 
 
 If a coroner's inquest were held on every case 
 of death in this Province, say for the next six 
 months, and if the verdict in every case ex- 
 pressed candidly ♦'a? public opinion as to the 
 cause of death, ;p comparatively few cases 
 would the verdict read, " died by the visitation 
 of God ;" in the great majority it would be, 
 died by the visitation of the Doctor. The causes 
 of this deplorable state of affairs are mainly 
 two — first, the state of the law, which so far 
 from preventing quackery or providing a rod of 
 punishment for it, is calculated rather to nurse 
 that evil ; and secondly, the low standard of 
 medical education in the Canadian Medical 
 Schools. 
 
 With regard to the first of these causes, it is 
 evident that so long as the law is such as to 
 permit of every unprincipled impostor assert- 
 ing the title and usurping the position of the 
 regular legally qualified practitioner, it is vain 
 to expect for our profession . nything but con- 
 tempt and degradation. 
 
 We cannot expect the people to distinguish 
 between regular and irregular practitioners, 
 between those who have and those who have not 
 a right to the title, Doctor of Medicine. All 
 receive an equal share of public confidence and 
 public contumely — the learned, accomplished 
 and skilful graduate of a University, and the 
 ignorant vulgar quack who has barely sufficient 
 education to write his own name, and who does 
 not know one medicine from another. If indeed 
 there is any difference between these two classes 
 ' jn the matter of public opinion, that difference 
 will very often be in favour of the latter,whose 
 
 B 
 
10 
 
 stock in trade consists of unblushing assurance 
 combined witii a proportionate amount of low 
 canning and deceit. 
 
 But I feel that it would be a waste of time for 
 me to enter upon a lengthy dissertation on the 
 evils of quackery, and the necessity of legisla- 
 tive interference for its punishment and sup- 
 pression. No one whose opinion is entitled to 
 respect doubts the necessity for remedial mea- 
 sure of some kind. The only doubt is respect- 
 ing the nature and mode of applying the 
 remedy. The question is similar to that which 
 Macbeth in his extremity asked a member of 
 our profession in regard to his English foes, 
 " what rhubarb, senna, or what purgative drug 
 will scour them hence ?" 
 
 The first difSculty which meets us here is tliat 
 of defining exactly the limits of the evil, in 
 other words, the number of the enemy and the 
 character of the weapons against which we have 
 to contend. 
 
 For it must be remembered that ignorance 
 and empiricism exist within as well as without 
 the limits of the medical profession, as these 
 are at present defined by the law. I mean to 
 say that many of the most notorious members 
 of the empirical fraternity are armed with a 
 legal qualification to practise medicine. 
 
 Any law therefore which would merely render 
 the possession of a medical diploma or degree 
 necessary would fall veryfar short of accom- 
 plishing the object aimed at, for any person 
 with $100 at his disposal who wished to make 
 money out of sufiering humanity would find no 
 difficulty in complying with this legal require- 
 ment so long as institutions calling themselves 
 Universities or medical schools exist within a 
 day's journey of any part of the province, 
 though not actually in it, where a medical 
 license may at any time be obtained without 
 examination, without attendance on lectures, 
 and without any pecuniary outlay beyond the 
 small sum which I have mentioned. Besides 
 requiring the possession of a degree or diploma 
 by the practitioner the law, to be eflFective, must 
 determine also the schools and colleges whose 
 standard of literary and professional qualifica- 
 tion is sufficiently high to entitle the holders 
 of their degrees to rank as Doctors of Medicine 
 in Canada. 
 
11 
 
 I cannot see that there could be any objec- 
 tion to allowing the graduates of respectable 
 foreign Universities to come to Canada and 
 enter into competition with the graduates of 
 our own Universities, if they have iho desire 
 and the courage to do so. 
 
 But they should certainly be required to 
 furnish satisfactory evidence that they are boita 
 fide graduates or licentiates of bona fide Univer- 
 sities or medical schools, and that they are in 
 every respect qualified to maintain an honour- 
 able competition with the alumni of our own 
 Universities, a competition by which all parties 
 concerned would derive benefit and the cause 
 of science be promoted. 
 
 I have been presupposing the existence in 
 Canada of a high and efficient standard of 
 medical education ; and now let us consider 
 for a moment whether or not we at present 
 possess a sufficiently elevated and respectable 
 staiviard of qualification for the degree of Dr. 
 of Medicine ; in other words, let ns consider 
 whether the present system of medical educa- 
 tion in Canada is or is not all that it might 
 and ought to be. I think the most superficial 
 consideration of this, question will suffice to 
 convince any person who is open to conviction 
 that there is the most imperative demand for 
 reform in medical education in the Canadian 
 schools ; and to prove this it is not necessary, 
 as it certainly is not desirable, to enter upon a 
 critical examination of the qualifications, the 
 merits and demerits of the many members of 
 the profession who hold degrees from Canadian 
 schools ; nor is it in the slightest degree neces- 
 sary to draw odious comparisons between them 
 and the graduates of British or European 
 schools. 
 
 It is but fair to mention in referenee to these 
 practitioners that however inferior their qualifi- 
 cations may have been at the time of graduation, 
 many of them have subsequently taken every 
 means of extending their acquaintance with 
 the science of medicine and of increasing their 
 usefulness as practitioners of the healing art. 
 Many of them have devoted a great deal of 
 time and money in the acquisition from other 
 sources of the knowledge and experience which 
 they ought to have acquired from their alma 
 
12 
 
 mater. But the insufficiencj and imperfection 
 of the present system of medical education in 
 Canada and tlie necessity which exists for its 
 improvement and rdform do, not require to be 
 prored or illustrated by any such invidious 
 inquiries or comparisons ; for any person, with 
 even a very moderate acquaintance with 
 human nature, who will talce the trouble to 
 make himself acquainted with the present mode 
 of administration of our medical schools', will 
 have no difficulty in forming: an estimate of its 
 inherent imperfections and the necessity for its 
 reform. If any additional proof were wanting, 
 it can be obtained to an overwhelming extent 
 from history, from the history of the English 
 and Scotch Universities. In this fact consists 
 our chief comfort and ground for hope. Only 
 a few years have elapsed since the medical 
 schools of Scotland were oppressed and their 
 progress inpeded by exactly the same causes 
 which new oppress those of Canada and impede 
 their progress. This fact, together with the 
 fact that the Scottish schools have succeeded 
 in obtai -"ng the removal of all those causes of 
 oppression and impediment, should not only 
 afford us comfort in our present unsatisfactory 
 condition, but should also stimulate us to make 
 every exertion, and to rest not till we have the 
 satisfaction of seeing our Canadian schools 
 freed from all the existing obstacles to their 
 progress in the path of usefulness and great- 
 ness. 
 
 In Canada there are several medical schools 
 between which of course there is maintained a 
 good deal of competition, and herein consists 
 the greatest obstacle to the efficiency and suc- 
 cess of medical education in these Provinces. 
 For each school being naturally desirous of 
 enrolling the largest number of students, and 
 turning out the largest number of graduates, and 
 there being no uniform standard of examina- 
 tion, either preliminary or final, and the pro- 
 fessors, who in this respect have everything in 
 their power, having considerable pecuniary 
 interests at stake, the result is, that no matter 
 bow ignorant an applicant for admission to 
 the medical classes may be, he is permitted to 
 enter ; and in like manner the aspirant to the 
 honour of a medical degree is almost sure to 
 
13 
 
 be successful, no matter how far he maj fall 
 short of even the professed standard of the 
 school. 
 
 Any attempt to attach blame in the matter 
 to any particular University would be equally 
 invidious and futile. Far better would it be 
 for all to acknowledge the existence of the 
 evil, and, appreciating its magnitude, to con- 
 sider how it is to be remedied. 
 
 For our guidance in this matter we have an 
 excellent precedent furnished by British schools 
 in general, and the University of Edinburgh in 
 particular. In a lecture delivered on the 13th 
 April, 1861, before the medical students of the 
 latter University, by Prof. Christison, on gra- 
 duation under the Medical and Scottish Uni- 
 versity Acts, and since published, when de- 
 scribing the condition of the medical schools 
 before these Acts, he says, " well founded 
 rumors were often heard against certain Uni- 
 versities in Scotland from which a medical 
 degree could be had by any body for a private 
 certificate of character and a fee." " Moreover," 
 he adds, " the several medical bodies of the 
 Empire from time to time charged one anothei 
 with undue laxity of examination, and not 
 always without good cause." 
 
 In 1S35 a Royal Commission was appointed 
 " to .inquire into the state of Municipal Corpo- 
 rations in Scotland," of which the University 
 of Edinburgh was one. Sir Wm. Hamilton in 
 reviewing the report returned by this Commis- 
 sion in reference to the latter Corporation, 
 says, " The University of Edinburgh in its 
 medical department had been latterly in a 
 gradual process of decline, and the question 
 which the visitors had first and principally to 
 determine was, whether the Medical Doctorate 
 was to be still further eviscerated of all literary 
 qualification ; and yet the degree issued under 
 the same name to be still entitled to its former 
 privileges." 
 
 Again, after pointing out somewhat more in 
 detail the evils of the then system of medical 
 education in Edinburgh, evils which certainly 
 p esent a very close resemblance to the present 
 imperfections and irregularities of our Canadian 
 system, he adds : " Thus from want of a certain 
 controlling power acting for the public and the 
 
14 
 
 Unireraitj, the public is deprived of that olais 
 of approved medical practitioners, to secure 
 whicli, ezclusivelj, this and other tFniversities 
 were relatively privileged ; while our tUma 
 mattr, degraded by her members, selling for 
 their private interest her highest medical 
 honours at a lower literary price than is exacted 
 not only by other academical bodies, but even 
 by the inferior licensingr incorporations, is, in 
 fact, constrained b> her own ofBcers to convert 
 her ' Seminary of Science' into an asylum of 
 ignorance, covering the country with her 
 anual issues of ' graduated dunces,' of * Doctoret 
 indocti.' In thus reducing the standard of 
 medical literary competency far below the 
 academical level of England, Ireland, or any 
 other country of Christendom, the supine or 
 interested regulators of this school have, unfor- 
 tunately, been allowed to accomplish the one 
 natural result. Medicine has now ceased in 
 Scotland to be a learned profession ; and though 
 even in Scotland learned medical men may 
 still be found, there is here no longer any 
 assurance, not to say of superior erudition, but 
 any guarantee against the lowest Ignorance 
 afforded to the public in a medical degree." 
 Now I do not presume to £ay that the analogy 
 between the condition of matters at that time 
 in the University of Edinburgh and the condi- 
 tion of matters in the Canadian Medical Schools 
 at present is complete. I sincerely hope and 
 believe that we have not yet fallen quite so 
 low. Still the fact cannot be denied that the 
 manner in which our medical schools are at 
 present administered, and the relation in which 
 the medical profession stands to the public, 
 are such as afford in the first place every 
 opportunity, and in the second place every 
 temptation, to fall into exactly the same errors 
 and commit exactly the same species of fraud. 
 So long as the competition between the 
 medical schools of Canada has reference merely 
 to the number of students and graduates, with- 
 out any regard to the standard of education 
 and fitness for practising the profession, the 
 tendency must unavoidably be downwards, 
 and ere long we will find ourselves in the dis- 
 reputable position in which the Royal Com- 
 mission found the Univemitj of Edinburgh. 
 
15 
 
 The following testimony of one of the witnessed 
 examined before the Commission, applies, I 
 think, with peculiar force to the Canadian 
 schools. Inter alia this witness says : " To what 
 extent the demand of higher qualifications for 
 medical honours at Edinburgh College might 
 a£Pect the pecuniary interests of its professors, 
 lam not prepared to say; but I am sure ic 
 would raise the value of their diplomas, and 
 settle beyond a doubt the real merit of their 
 school of medicine. I am far from wishing to 
 underrate the Edinburgh Professors, but I must 
 be permitted to remark that under their pre- 
 sent system of conferring degrees, the number 
 of students that flock to them for instruction 
 is no more a test of the value of their lectures 
 than the resort of young couples to Grt^tna 
 Green, is a proof of the piety of the blacksmith 
 who gives them his nuptial benediction. • • • 
 But though some men go to Edinburgh in order 
 to obtain a rank in their profession which they 
 could not otherwise acquire, and to which from 
 the deficiencies of their education and the 
 mediocrity of their attainments they have no 
 right to pretend, the great majority of students 
 go to learn their profession, and where they 
 are well taught there they will go, whether 
 they expect to be decorated with degrees or 
 not. If the Edinburgh Professors do their 
 duty, and in comparison with other teachers 
 are well qualified to afford instruction, they 
 may lose graduates, but they will not lose 
 students by the change." 
 
 The visitors " having had much deliberation 
 and received a good deal of evidence on the 
 subject of the preliminary education which 
 should be required of candidates for degrees in 
 medicine," announce the conclusions at which 
 they arrived in the following terms : — 
 
 " It has appeared to us to be a matter of 
 great importance that the persons who are to 
 practice medicine should be men of enlightened 
 minds, accustomed to exei^ise their intellectual 
 powers, and familiar with habits of accurate 
 observation and cautious reflection ; and that 
 they should be possessed of such a degree of 
 literary acquirement as may secure the respect 
 of those with whom they are to associate in 
 the practice of their profession. We therefore 
 
16 
 
 thought it an indispensable qualification for a 
 medical degree that the individual should have 
 ■ome reasonable acquaintance with the Greek 
 and Latin languages, and with mathematics 
 and philosophy ; and though strong doubts 
 have been expressed by many of the Medical 
 Professors as to the expediency of rendering 
 this an essential condition, from an appreben- 
 sion that it might prevent many persons from 
 taking the benefit of the instruction in medical 
 science to be obtained in the Universities, we 
 have found pur opinion on this point confirmed 
 by every one of the eminent physicians and 
 surgeons not belonging to the Universities, 
 whom we examined, as well as by some of the 
 Medical Professors themselves ; while we have 
 also been fully satisfied by a due consideration 
 of the matter itself, and of the evidence before 
 us, that there is no ground for the apprehension 
 entertained." 
 
 Another subject of university administration 
 which the commissioners investigated was the 
 examination for degrees, with regard to which 
 they returned the following report : — 
 
 " The examinations for degrees in medicine 
 have hitherto been conducted by the members 
 of the Medical Faculty, and each candidate has 
 been required to pay a sum of ten guineas, 
 whish is divided equally among the examining 
 Professors. We are of opinion that this system 
 is liable to very serious objections. The emol- 
 uments of the Professors who examine ought 
 not to depend on the number of candidates for 
 degrees ; at present the fees drawn by the 
 several Professors from this source are very 
 considerable, in consequence of the great num- 
 ber of candidates ; and it appears from the 
 evidence that the number of degrees conferred 
 has been continually increasing during many 
 years, in a proportion much greater than cor- 
 responds to the rate of increase in the number 
 of students attending the medical school of 
 Edinburgh. No explanation has been given of 
 this extraordinary increase in the number of 
 degrees, and we are satisfied it cannot be ac- 
 counted for fi*om any external causes. We are 
 of opinion that the present system has a ne- 
 cessary tendency to render the examinations 
 less strict than they might otherwise be, and 
 
 I ' 
 
 I ill! 
 
id 
 
 13 
 
 kd 
 
 17 
 
 practically to lower the standard of qualifioa- 
 tiona in the estimation of the Faculty." 
 
 It is, besides, scarcciy to be doubted that 
 there must be a natural reluctance in Profess- 
 ors to reject candidates, to many of vrhom the 
 fees paid to the examiners may be a very s^oua 
 sacrifice. Although most of the Professors in 
 the Medical Faculty are adverse to any exten- 
 sion of tiie subjects of examination, and are 
 strongly impressed with tlie idea that the im- 
 portance and value of the University as a school 
 of medicine ought to be estimated by the num- 
 ber of degrees annually conferred, an entirely 
 different opinion has been strongly expressed 
 by all the other physicians and surgeons whom 
 we have examined, being persons very exten- 
 sively engaged in the practice of their pro- 
 fession. It should seem to us that the value 
 of the degree must bear a propori.." to the 
 nature of the qualifications required foi' it ; and 
 we have already observed, that it does not 
 appear to us that either the reputation of the 
 University as a school of medicine, or the num- 
 ber of students resorting to it for instruction, 
 will be regulated merely by the number of 
 those who may obtain degrees." 
 
 For all who are interested in the administra- 
 tion of the Canadian medical schools there is 
 here much valuable instruction. If it was in- 
 consistent with the interests of the University, 
 the progress of medical science and the welfare 
 of humanity,for the Edinburgh medical Profess- 
 ors to be possessed of absolute power in the 
 matter of the examinations for degrees, the same 
 must be said of that system as it exists at pres- 
 ent in the Canadian schools. Of course it is to 
 be hoped that human nature is, to some extent 
 at least, improved and elevated since the fore- 
 going observations were written ; still it would, 
 I fear, be assuming too much to expect that 
 even at this enlightened and highly civilized 
 jieriod Professors will not be found who are 
 weak, selfish, and short-sighted enough to 
 allow their personal interests as well as their 
 personal feelings, their likes and dislikes, to 
 influence them in the discharge of their dutiss 
 as examiners. 
 
 The Canadian medical schools are very fre- 
 quently accused of making " annual issues of 
 
18 
 
 graduated duncea," or doctores indocti, too fre- 
 ({iiently aud decidedly, I fear, for the charge to 
 be altogether without foundation ; still thoro 
 is comfort and encouragement in the fact that, 
 even by those who urge this grave charge, it is 
 at tha same time admitted that there always 
 are some worthy and well qualified graduates 
 to be found in these annual issues. 
 
 I think no one will deny that in these schools 
 a good and efficient medical education may be 
 acquired ; but, on the other hand, it must be ad- 
 mitted that the present system of examinatioiv 
 is not such as to insure that all the candi- 
 dates avail themselves of the opportunities 
 afforded of acquiring the necessary proficiency 
 in the great science of medicine ; it is not even 
 sufficient to insure that the candidate for ad- 
 mission to the medical classes possesses the 
 intellectual ability and preliminary literary and 
 scientific attainments indispensable to the effi- 
 cient and successful prosecution of his medical 
 studies. It must be admitted that, as Sir Wm. 
 Hamilton remarked respecting the Edinburgh 
 College, students are often attracted to the 
 Canadian Universities chiefly by the bribe of the 
 degree, and that many of them are too illiterate 
 and professionally too incompetent to stand the 
 test of impartial examination. When the literary 
 qualifications for our Canadian medical degrees 
 are raised to a respectable and efficient stand- 
 ard, and when our academical examinations 
 are rendered unbiassed criteria of professional 
 competency, then will the number of our medi- 
 cal graduates afford an index of the relative 
 eminence of our medical schools ; then, but not 
 till then, will competition for the greatest num- 
 ber of students and graduates be productive of 
 good, for intrinsic excellence and large numbers 
 will under these circumstances bear a direct 
 relation to each other. From all that has been 
 said, and from all the evidence that has been 
 adduced on this subject, there can hardly be a 
 doubt that there is the most urgent demand for 
 reform in the mode of administration of the 
 Canadian medical schools. Until this is ac- 
 complished, it is vain to look for real prosperity 
 or greatness in these institutions, and it is 
 equally vain to expect any improvement in the 
 social position and moral status of the medical 
 
19 
 
 profession. And here the question naturally 
 arises, wliosc aid are wo to invoke in tliis worlt 
 of reform and elevation ? No doubt mucli 
 might bo done by those most interested, viz., 
 by tlioso members of tlio profession who at pre- 
 sent have the administration of the medical 
 schools entirely in their own hands. Hut to 
 achieve anything like a satisfactory result, the 
 most harftioniouH and uniform action would be 
 necessary ; and I fear the old well-known pro- 
 verb which characterizes our profession as fond 
 of a dififorencc of opinion, is too true to admit 
 of any hope from that quarter. 
 
 It is not necessary, however, to indulge in 
 any surmises on this question. It has been 
 most satisfactorily answered for us by history. 
 History has taught us that there is but one 
 source from whicli wecan hope for deliverance, 
 viz., " from the supreme civil power." To this 
 power alone we look for the elevation of our 
 profession in Canada to its proper social level 
 as a truly honourable and learned profession. 
 That this power will ere long interfere on our 
 behalf can hardly be doubted. 
 
 The consummation of that grand scheme of 
 confederation which at present engrosses tlie 
 attention of the greatest statesmen here and at 
 home, that scheme which promises to give birth 
 to a mighty giant among the nations, and which 
 holds out to us and to all the sister provinces 
 the confident assurance of a great and glorious 
 future — the consummation of this scheme, I 
 say, will surely bring with it from the supreme 
 civil power the much needed measure of medi- 
 cal reform. 
 
 What we want is an Act which will effect for 
 British North America what Mr. Walpole'e 
 medical Act effected for Great Britain. Dr. 
 Christison, in the lecture already quoted, enu- 
 merates the benefits derived from Mr. Walpole's 
 Act, as follows : — 
 
 First, he says, we have got for the govern- 
 ment of medical affairs a National Medical 
 Council of 24 members, nominated partly by 
 Universities, partly by corporations, and partly 
 by the Crown. 
 
 2. We have got a register of lawfully quali- 
 fied practitioners ; and if any snch person do 
 not find himself there, it is his own fault. 
 
ill 
 
 ! i. 
 
 rlli 
 liii 
 
 I 
 
 20 
 
 ;i. W'' have in the Qcncrnl Medical Council 
 A body r|<pointed to keep the register {>nr» ; to 
 Ray who has A right to admission, anu nndor 
 what title. In this line of duty the council has 
 already shown itself powerful to keep out 
 qurt'-ks, to punish impostors, and to curb nn- 
 fouiuled claims by the constituted medical bodies. 
 
 4. Wn have got the local privileges of pruc- 
 tice of all our medical institutions widened, 
 from a right over out! division of the kingdom 
 or a district of a division merely, to a similar 
 ri^ht over all Her Majesty's dominions. 
 
 5. We have got a legislative discouragement 
 of quackery. We cannot indeed with the Medi- 
 cal Act put down quacks summarily as meiy 
 hoped to do. But it is a discouragement that 
 no such person dare call himself by any of the 
 numerous professional titles which denote a 
 regular practitioner qualified to be rcs:istered. 
 
 (j. We have got in the Medical Cmincil a 
 council of education entitled to ace that practi- 
 tioners are educated and examined competently 
 for the efficient exercise of their profession. 
 
 We cannot at present stop to consider in 
 detail all the blessings which have been con- 
 ferred upon the British nation in relation to its 
 medical institutions and practitioners by thi.s 
 Act, nu' can we at present stop to inquire 
 whetixir an exactly similar act would be in 
 every respect adapted to the circumstances and 
 ri.'quiremtints of the medical institutions of the 
 British North American Confederation ; but I 
 may here be permitted to remark that if our 
 hopes of confederation are realized, and if at 
 the same time a measure of medical reform is 
 obtained, the whole confederation ought to have 
 an equal share in its salutary influences. 
 
 Principal Dawson, in an eloquent and highly 
 interesting lecture recently delivered, has point- 
 ed out that the greatest evils would undoubt- 
 edly follow from the local f ' rr'i.«nt!i of the 
 confederation having it in theu '■ o settle 
 each ofii.' tor itself the legal - um? •, » ' diver- 
 sity degrees. Such a coun ' • ' -ys, 'would 
 tend to the erection of different standards in 
 the different Provinces, and to give to the 
 degrees of our Universities a merely local value. 
 The degrees of all existin^^ Universities should 
 be degrees for all British America. The stand- 
 
 Hi ls 
 
21 
 
 nrd of profefl^i' nal cduoal! n In the different 
 (irovinces Bhoiili )3 far ng ponsible be assimil- 
 ated and raised sufficiently high to prevtiit the 
 interference of unediicatc'l practitioners, niui, 
 if possible, to secure for our degrees tliiit recog- 
 nition in Ureat Hritaln which the separate pro- 
 vinces hare as yet been unable to obtain. In 
 order to these ends the general government 
 should assume the supervision of this matter, 
 or should at least retain the power to revise all 
 local legislation in regard to it. Perhaps the 
 best method to secure the desired result would 
 be the appointment of an Educational Council 
 similar to the Medical Council in Great Britain, 
 and to charge this bodr with the oversight of 
 all matters relating to professional education 
 and the value of degrees therein." 
 
 Those opinions, coming, as they do from very 
 high authority, are entitled to the utmost re- 
 spect ; and it is to be hoped that they will be 
 permitted to have due weight with the legisla- 
 torn of the land, or rather with the framera of 
 tht! new constitution. 
 
 In pointing out, as I have now attempted to 
 do, the humiliating position at present occupied 
 by the medical profession in Canada, and the 
 inherent imperfections of our present system of 
 medical education, I have been influenced by a 
 deep sense of the importance of the subject and 
 by a sincere desire to discharge a duty not 
 only to the medical school with which I have 
 now the honour to be connected, but also 
 to the profession of which I have now the ho- 
 nour to be a humble member. Assuredly the 
 time has come when the old hackneyed ques- 
 tion "to be, or not to be" may with propriety 
 be asked respecting the medical profession 
 and medical schools in Canada. Our noble 
 '.rofession I is it hereafter to be or not to be 
 entitled to that designation ? Is it to be or not 
 to be, an honourable, enlightened profession 
 worthy of the age in which we live ? Is it or 
 'is it not to exercise that mighty influence in the 
 cause of truth and civilization which it is in 
 every respect well calculated to exercise? Are 
 our medical schools to be " seminaries of sci- 
 ence," institutions for preserving, teaching and 
 extending that learning which constitutes " a 
 foot in the tripod of a country's erudition, or 
 
I 
 
 i 
 lih 
 
 22 
 
 are they to be asylums of ignorance," mints for 
 the manufacture and utterance of counterfeit 
 coinage ? Let us hope, my friends, that these 
 questions will ere long be answered for us to 
 our entire satisfaction : let us hope that upon 
 the medical profession and medical schools, ns 
 well as upon all the institutions of these pro- 
 vinces, a new and glorious era is about to 
 dawn. Let us moreover, as teachers, practi- 
 tioners and students of the great science of me- 
 dicine, endeavour to appreciate and perform the 
 part which it behoves each one of us to per- 
 form in relation to that science. 
 
 Let us spare no exertion and grudge no 
 sacrifice in our endeavojirs to secure the eleva- 
 tion of the medical profession and medical 
 schools of Canada to their legitimate social 
 position and their proper degree of eflSciency 
 and prosperity. 
 
 Let us remember that each one of us, the 
 humblest as well as the most eminent, has his 
 own proper part to play ,hi3 own peculiar share 
 of influence to exert, not only in the relations 
 of life generally, but also in the special relation 
 of teacher, practitioner, or student of medicine. 
 
 " Let us then be up and doing. 
 With a heart for every fate, 
 Still achieving, still pursuing, 
 Learn to labour and to wait."