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PKESIDENT OF THE XTNIVERSITY OF TORONTO. <]<^J^ TORONTO: ROWSELL & HUTCHIPON, PRINTERS. 1892. :t . , '4 4 -W!, ^ ^imf i ? i "hi: ■""W^sfhll OrWr MEDICAL EDUCATION IN ONTARIO. To the Honourable G. W, Roas, LL.D., Minister of Education : Dear Sir, — In accordance with your request I have perused the open letter addressed by Dr. Geikie to the Honourable Attorney-General, on the subject of " Medical Education in Ontario." In reply, I must invite your attention to the broader questions wliich it involves. In the remodelling of King's College, whereby the provincial endowments for higher education were transferred from the con- trol of a single denomination, and placed on the just basis of a national system in which all citizens enjoy perfect equalit}', the Faculties of Law and Medicine were abolished. This revolution had ah'eady been effected when I entered on my duties as a pro- fessor, in 1853 ; but the incidents connected with it were fresh in the memory of all, and the chief actors were prominent members of the community. I had the privilege of enjoying intimate inter- course with the tLmourable Robert Baldwin, and was admitted to much friendly communication with the Honourable Chancellor Blake, and with other ])ublic men conversant with the political life of the time. From the information communicated to me by them I was left in no doubt that the abolition of the Medical Faculty was largely due to the antagonism between the late Dr. Rolph and certain professional rivals : the Honourable Dr. Rolph being, at the time of its abolition, a member of the government. I was subsequently confirmed in my belief of the influence sO' exercised, by approaches made to me from the same quarter, with a view to the restoration of the Medical Faculty. ' Fresh as I then was from Edinburgh, and familiar with the relations of the science departments to other branches of instruc- tion in that University, I was strongly impressed with the bene- ficial influence which an efficient Medical Faculty exerts in stimulating and fostering all departments of Science. It was, therefore, with mingled surprise and regret that I learned of the abolition of the Medical Faculty at the very time that steps: were being taken to establish professorships in Sciimce, and give to it some due share in the prescribed requirements of a liberal education. The results abundantly confirmed my apprehensions. The department of Natural History exercised slight influence on the studies of the Undergraduates ; and the entire scientific work played a verj' subordinate part in undergraduate studies. The counter-revolution which the lestoration of the Medical Faculty eflected is already abundantly apparent. The depart- ment of Natural Hitstory has expanded into an efficient school of Biology, with its related branches of Physiology, Histology, and Botany, offering to the students in Arts ample facilities, and holding out strong incentives to a thorough devotion to their study. The department of Chemistry has in like manner entirely outgrown the limited aims of earlier years ; and the needful steps are being taken for providing an adequate building, with the appliances for carrying on laboratory and other work, not less important to many of the students in Arts than to those in the Faculty of Medicine. The necessity'' for similar provisions for the department of Geology is now urgently pressed on the atten- tion of the University authorities ; and action is only delayed till funds are available for the purpose. The importance of Chemistry to the medical student is universally recognized. The novel bearings of Biology, in all its branches of research, on the transformation of the practice of jnedicine from empirical routine, to an intelligent scientific appli- cation of well-determined remedial measures to specific diseases, are now widely familiar. But even Geology, has its branch of Palaeontology to which the attention of the medical student is wisely directed ; Psychology, though mainly prosecuted as a branch of philosophy, has its important bearings on abnormal cerebral action, on hypnotism, and many forms of mental aberation ; while Physics has now its special experimental lectures, ^;*. M ^ ■ -^ ^tr* f 1 I. t-. ii»iw»ir1lii«i«IIW K s inchiding the study of Electricity and Magnetism, to meet tlie re(|uironients of tlie extiMided medical curriculum. In all this, instead of the work of Arts students being impeded, the necessary development of the various science departments has largely added to the facilities for their study. In this healthful expansion every true friend of higher edu- cation in Ontario has an interest ; and no class of students enjoy such important practical results as those in Arts : the Science Teachers in your Collegiate Institutes and High Schools ; the Land Surveyors, Mining f]ngineers, the Chemical Analysts, and Diuggists; the Electricians, and all to whom practical scientific training is of value. Yet all this Dr.Geikie calls upon you to reduce to the I'estricted and inadequate scale of earlier years, assumed to eomjU'chend a sufhciency for students in Arts, on the plea that " it is not the duty of the state to use public funds of any kind in educating students for a special profession ; any more than for any other calling by which people earn their living." What then are we to think of our Provincial Ao-ricultural Collecjc for the scientific etlucation of farmers ; or our ISormal Schools and School of Pedagogy for Teachers ; or our School of Practical Science for Land Survevois, Civil Enijineers, Chemical Analvsts, Architects, etc. : or a subsidised School of the Fine Arts ; or a C^atiadian Literaiy Institute? Is all special professional training, with the one excejttion of Medicine, deserving of aid and en- couragement from the state : or is it not rather beyond all con- troversy that there is no other department of professional train- ing — not even that of the Teachei', — in which every member of the community has so keen a personal interest as that of Medicine ? I will only say in the words of Dr. Geikie : " Our province is inhabited by .sensible people who can see and judge of such matters for themselves." Dr. Geikie next proceeds to advance charges of gross abuse, and shameful misappropriation of University funds. 1. The Legislature having voted $160,000 in aid of the restoration of the University buildings, after the disastrous fire of February 14th, 1890, Dr. Geikie says: "It may appear in- i^M cre(lil»le, but it is nevertheless trne, that nt this very time, or ahnost iiuinecliately afterwards, other extensive; and very costly huildings were contracted for and pushed as rapidly forward as possible Most unquestional^ly the Leifishitiire of Ontario, which had hastened to vote !if 1 00,000 to aid in repairing the daniajje done by the tire, had no idea that the most of" the sum so promptly and liberally voted would be at once spent in a way which was never for a moment intended, vi/., on dissecting rooms," etc. It is scarcely possible to eharactcri/e in too stroHu' language the reckless conduct of a person in ]3r. Geikie's ])(isiti()n making to the Attorney- General a charge against the authorities of the University, which he admits to be to all appearance incredible ; and yet which he obviously never troubled himself to authenti- cate, while pledging his word for its truth. Tlic facts, which he might have readily ascertained on enepury, are these : The plans for the extension of the Biological building were completed in November of the year previous to the lire ; the contracts ibr the building were accepted, and the recjuisite funds api)ropriated by the Board of Trustees innnediately thereafter, and the building was already in progress and the foundations well advanced be- fore the lire occurred. It is scarcely neces.sar}', therelbre, to add that not a single dollar of the money voted by the Legislature has been spent for this, or any other purpose tlmn the restoration of the buildings desti'oyed by the fire. 2. Again, Dr. Geikie asserts that the Biological buildings of the University are really an addition for the acconnnodation of the medical faculty ; that their extension " was manifestly inten- ded for medical teaching purposes ; " and that " they are to all intents ancf purposes Medical School buildings." To this I shall offer no vague reply ; but a definite statement of facts. In the east wing, rirst completed, there are, according to the Architect's report, about 16,000 square feet of floor space. Of this fully 12,000 square feet — or three-fourths of the whole building — are entii-ely devoted to the use and purposes of the students in Arts. The Lecture-room and the Elementary laboratory, which are ■^^' I the only rooms that the Medical .students share with those of the Facult)' of Arts, have an area of about 4,000 square feet. But both lecture-room and laboratory would reqv ire to be of the present dimensions if the medical faculty wore abolished. Of the thirby-ei<;ht working places in the elementary laboratory nearly all are occu|)ied every day by the First and Second Years' i»rac- tical classes of the Arts Facultv : each class numborin^f over thirty students. The same places are used at other hours for the practical cla.sses in Biology and Histology of the Medical curri- eulum ; but the latter classes are undei- the charge of instructors paid exclusively from the resources of *he medical students' fees. I cannot imagine that any disinterested and impartial enquii-er will .see the slightest impropriety in the facilities provided by the University for its Arts students being also made available, within such restrictions, to the students in its Medical Faculty. H. Next turning to the later extension of the Biological building, which Dr. Geikie affirms to have been erected from funds obtiiined on false pretences: and to be "to all intents and purpo.ses Medical School buildings : " the simple fact is that the transfer of the teaching of Natural History, or Biology in all its branches, to the new building which for the first time supplied need- ful appliances in other respects : rendered the removal of the mu- seum to the same building imperative. The addition of this as part of the original plan was contemplated from the iirst.and would have been no less indispensable had no Medical Faculty existed. So far then from the later extension of the building being for purely medical purposes, the whole main southern range was originally designed, and is now appropriated for the accommodation of the museum. Had it been possible to complete the entire building at once, the whole contents of the museum would have been safely disposed in their new appartments before the calamitous fire of 1890. But althouorh serious damaere was then done to the collec- tion, much of the valuable contents were rescued ; and with the gifts already received from many liberal benefactors, in addition to further promise of valuable contributions, it is confidently an- ticipated that the new Biological Museum, rearranged on the plan I 9 now in vojt^uo in the great Oermftii Universities, will not only be one of the most injportant educivtional imiNeuniH on this continent, and therefore alike helpful to Arts and Medical students ; but that it will also prove a popular and attractive featnie of the Provincial University for the general pu})lic. So fai', therefore, it is obvious that one main portion of the newer Ituilding was desigiied and is approjiriiited for other than medical purposes. In a further portion oi' it temporary accom- modation has been provided for the departments of geology and nuneralogy, until a more adecpiate structure can be erected; and in so far as certain portions of the building are set apart foi' the Medical Faculty, a report was obtained from the architect speci- fying theii' ostinuited cost, and on the basis thus furinshcd, an anniuil rent of lii'l,20() is cha.ged to the Mi^dical Faculty, in accordance with the report of a joint committee of the Board of Trustees and the Senate as what in their estimation " would be a just and adetpiate allowance " as interest for the cost of erection. In addition to this the University is credited with a further sum estimated at !il>l,00() to accrue to it as " proportion of expenses of maintenance and repairs of Biological and Chemical buildings, to be refunded out of Medical Faculty funds." With those facts before you, I leave you to form your own estimate of tlu- value to be attached to Dr. Geikie's statement of what even he acknowledges to " appear incredible." but which he gives you his solemn assurance " is nevertheless true ! " T observe that the letter is signed by its author in his official capacity as " Dean of Trinity Medical (^^ollege," and that he professes to speak in the name of the Faculty. " To the Government and to the Legisla- lature," he says, " we continue to look for redress." Although I have only now obtained sight of the lettei-, on its being for- warded by you to me with the request for a reply to its giave charges, including that of fraudulent misappropriation of public funds, obtained on false pretences : yet I observe by the date that the lettei" has been in circulation unchallenged for upwards of two months. Can it be possible that the respectable body of medical gentlemen constituting the Faculty of Trinity College ^nmmm arc willin<f te share tlio responsibility of sucli reckluss aiut unt'omuled assertion.-^ as I have quoto'l from the letter addressed by tlieir Dean to tiu Attorney-General ? • Oiui further point remains to be noted. Uruler a University Statute, confirmed by the Lieutenant-Governor in (council, all fees paid by medical students are appoi'tioned to the Medic' Faculty. In the interpretation of this statute, fees paid by students for Physiology, Ghemistry.and Biology, have been treated as " f(!es paid by medical students," and this Dr. Geikie denounces as " an abuse worthy of Ottawa!" In reality out of this fund, derived entirely from fees paid by the students in the Medical Faculty, the following expenses are >net : viz., the instructi'>Ti in Practical Chemistry for medical students in their first ycai- ; the special medical (Jhemistiy for students of the second }■ ear ; the Zoology for those of the first year : and the Histology for those of the second year: all this bcang instruction specially designed and adapted for medical students. On the other hand the Medical Fund has not hitherto been charged with any payment for the medical students who avail themselves of th(; didactic lectures in Physiology ; nor for siich lectures in Chemistry — apart from T^aboratory ork, — as they share in connnon with arts students ; as tiiese lectures involve no more than the occupa- tion by the medical student of a seat in the lecture-room ; and lead to no addition to the cost which the University would have to incur for the students in aits, if no Medical Faculty were in existence. Again, out of the same medical fund, derived exclu- sively from the fees of the medical students, such charges are met as those incurred in the purchase of nacroscopes and other instruments for scientific research, and for furthering the experimental basis of Pharmacology and Therapeutics. The re.storation of the Medical Faculty has largely increased the amount of work devolving on the science professors, but none of the fees accrue to themselves in remuneration for the oreat addi- tion to their labour and responsibilities. It is the source on which they draw for the purpose of extending and elevating the teaching of Medical science. For example, on the recom- 8 inendation of tlic Medical Faculty, the Senate has approved of the appropnation out of their fund of $1,000 to defray the expense of a practical course of I^t^cteriology, to be given durinjx the cinrent year by Professor Ranisay Wrifrht, after his ordinary duties are over. This course of post-oiaduate instruction in one of the most important branches of Medical science will occupy the greater l)art of each da}' throughout the month devoted to it, and will be available to all members of the medical profession. The appro- priation above named is required solely for needful appliances for the course. The services of the professor are voluntary given, without remuneration. That some readjustment of some of the arrangements here- tofore adojited in leference to the special medical fund may commend itself to j^our Judgment, under ))resent circumstances, is possible. But the devotion of fees paid by medical students for instruments and other appliances indispensable for the further- ance of scientific research in its special application to medicine ; or for such courses of lectures as those of the Professor of Biology — though his salaiy is derived solely from the University endow- ment, and not from the medical fund, — to form the requisite means for such post-graduate work as I have described, can scarcely suggest to any unbiased mind the idea of a misappro- priation of University revenue. It is inevitable when any great public improvement on existing systems is inaugurated, that the old Ephesian cry of " our craft is in danger ! " should anew be heard. The old profit- al)le venture is not onh' claimed to be a vested interest, but is unblushingly maintained to be ample for all requirements ; if not, indeed, incapable of improvement I Dr. Geikie repeatedly refers to " our self-supporting Medical Colleges," confidentl}' affirms that they satisf}^ all refjuirements of medical education ; ard as he takes on himself to say, " as is abundantly proved, do the v/ork as well as it can be done ! " — " provide and equip every building they require at their own cost, which answer perfectly all the purposes of the highest and best medical education given in any part of the Empire ! " I accept these, and similar statements IE of Dr. Geikie, as made in good faith. Marvellous as they are, I assume that he believes them all. But if so, they show how little conception the Dean of Trinity Oollege has of the requirements of a well-equipped Medical School. I have repeatedly had letters from old students who, after beginning their medical studies at one or other of the Toronto Medical Schools, have gone to one of the great schools of Europe ; and their expressions relative to the contrast between the inadequate and petty provisions in the little buildings alongside of our Toronto Genei'al Hospital ; and the ample appliances they found available for them at Edinburgh, London, Paris, or Berlin, would furnish an amusing commentary on Di. Geikie's self-complacent estimate of his school. Why sir, the Edinbui'gh Hospital, with its Clinical Lecture-Rooms, Oper- ating Theatres, etc., covers a larger area than many Canadian villages ; and alongside of it stands the amply equipped Univer- sity buildings devoted to the departments of Science and Medicine : including Biology, Physiology, and all the branches of science which now contribute so largely to the transformation of medicine into scientific, instead of mere empirical treatment of disease. In truth the great evil of the multiplication of such " self- supporting" Medical Schools is that their pecuniary interests are in conflict with the necessary expansion to embrace the important new apjilications of modern science. Dr. Geikie speaks of the University of Toronto as a keen competitor with such schools for .students ; but the entire record of the University in its efforts to set a higher standard for its Medical Degrees proves that it voluntarily adopted and adhered to requirements which greatly reduced the number of candidates willing to encounter the severe conditions it impo.sed. At the late meeting of the College of Physicians and Surgeons of Ontario, Dr. Bergin, as convener, pi-esented the Report of a Committee appointed the previous year "to communicate with the authorities of the Canadian and English Universities and Medical Colleges, and obtain their views a.^' to the necessity, if any, for a higher standard of preliminary and medical education." Important changes, based on this report were sought to be introduced into the curriculum ; and on the I 10 persistent urgenc}' of Dr. Geikie and others to defer its discussion, and toadjoui'n all consideration of its recommendations, Dr. Bergiu — the originator and active promoter of this etibrt at elevating the standard of medical education in Ontario; after urging tliat, V. hether designed or not, the postponing consideration of the Report, as pi-oposed, t'" next session wo'dd be to kill it for years to come ; — is further reported as saying : — " I feel that we have too many Medical Schools ; and I feel that all the opposition tliat we have to attempts to advance the interests of the medical profession of this country comes from the schools ; and if they desire it, a!id continue in this course, the result will be that the profession will as one man rise up and demand that the School Men be excluded from this Council because of their opposition to every advance in medical and pi'eliminary education." When, in 18(S7, the Legislature restored to the University of Toronto its Medical Faculty, its authorities were most anxious to prevent, if possible, the multiplication of schools; and it is importan-j that you should know that ])recisely the same invita- tion to co-operat(; in the revival of the Medical Faculty was extended to the Trinity and to the Toronto Medical Scliool. Dr. Geikie refers to such a combination of forces as was thereby aimed at for the creation of one efficient Medical Scliool, as an attempt at the impossible : and in doing su incidentally admits the fact that such a union was freely oli'ered to him and his colleagues. Addressing the Attorney-General, he says: "You speak of ' Union of Colleges : ' and this was suggested in 1<S87 ; but Medical Colleges large enough to requite the services of a complete staff of Professors and other Teachers, can no more be rolled together than can lai-ge congregations, or public schools ; \ and it is never wise to attempt the impossible I " The remark ' only furnishes another proof of Dr. Geikie's failure to compre- '• hend the condition and requirements of a thoroughly equipped medical school. In reality the united school would have been, small in comparison with any of the great schools of Europe. That of Edinburgh, for example, numbers fully 2,000 medical if ■f~- V 11 students. The co-operation of the ablest men in both schools, superadded to the lesources of the University and its efficient staff of instructors in Science, would have hastened the develop- ment of what — unless the Legislature of Ontario vield to the misrepresentations of interested and unscrupulous deramers, and strangle it in its cradle,— is destined I confidently believe, to become one of 'le greatest Medical Schools on this continent. , , How far the proposition for united action on this new and comprehensive basis was fully considei'ed and dealt with by the members of the Faculty of Trinity Medical College I have no means of determining ; but of Dr. Geikie's action, and of the motives that guided him, we are left in no doubt. In his letter to the Globe, of date March 23rd, 1S87, he says : " I think it will be ample time to give the subject full consideration when we learn that the Government of Ontario, with the cordial support of our Provincial Legislature, has fully decided to create, equip, and endow liberally, a new medical teaching body ; and to pro- vide for it a staff of the best teachers the country can furnish, each of whoir shall have a salary secured to him of not less than $2,000 a year for each of the principal chairs ; and a suitable retiring allowance when, from age or ill-health, he is no longer able to discharge his duties. Till this is done the project is a mere ' castle in the air.' When it has assumed this tangible form I am quite sure ' Trinity Medical School ' will accord to it a most careful and respectful consideration." I leave. Sir, to yourself and to the Attorney-General, to judge how far this avowal of the Dean of Trinity Medical School in 1887, harmonizes with the "disinterested" protest of the same person in 1891, against the application by the state of public funds of any kind in protnoting medical education. It is sufficient for me to invite your attention to the evidence I have adduced to show that while by the co-operation of the instructors of the University Medical Faculty with the Professors and Lecturers in Arts and Science, enormous advantages are secured to the Medical Students of Ontario ; and they have for the first time opportuni- l persist and to —the .standi whetl" Kepoi to cor "I that the i from cour3 up a Cour and 12 I have the honour to be, dear sir, Yours repectfully, I>ANIEL WILSON. Universitv ok Toronto, February 22iul, 1802. W-'^itHT Ijj atl to be sought in \ istruction pertains 'ai-ge on the funds ir, Sully, [EL WILSON. >.»r .'!) i liV"*P**"*V"*^^"^i^*«NPlV**IV>"*^V"'*""«IIP*^"7*""B^^>^^^«"