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L'axemplaira filmd fut reproduit grice k la giniroait* da: Medical Library McGill University Montreal Las imagea suivantea ont tt6 reproduitea avac la plus grand soin, compto tenu de la condition at da la nattetA de I'exempiaire filmA, et en conformiti avac las conditions du contrat da filmaga. Original copiaa in printed paper covera are filmed beginning with the front cover and ending on the last page with a printed or iiluatratad imprea- sion, or tha back cover when ar/propriata. All other original copiaa are filmed beginning on the first page with a printed or iiluatratad impraa- sion, and ending on the laat page with a printed or iiluatratad impraaaion. Lea axemplairea originaux dont la couvarture en papier eat imprimte s nt filmte an commandant par la premier plat at en termlnant soit par la darnlAre page qui comporte une empreinte d'impreaaion ou d'illuatration, soit par la second plat, aaion le caa. 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Loraqua le document eat trop grand pour Atra reproduit en un aeui ciichA, il est fiimA A partir de Tangle supArieur gauche, de gauche A droite, et de haut en baa, an prenant la nombre d'imagea n^aaaaira. Lea diagrammas suivanta illustrant la mAthoda. ;;•:*/;: t . ,: a 3 I: i : : :•"■ :f\^' t , " M 5 6 iHciJ^ 1^'^^ {Reprinted from the Montbbal Mhdical Journal, November ^ 1889.) INTRODUCTORY ADDRESS Deliverbd at the Opening of the Fifty-Seventh Session OF the Medical Faculty of McGill University, October 1st, 1889. BV B. L. MaoDonnell, B.A., M.D., Professor of Glinioal Medicine. At the beginning of a new session it has always been the custom in this college for the members of the Faculty to select one of their number to address words of welcome to the new- comers and to those who have already embarked upon their medi. cal career. This year my turn has come. On such occasions it is customary for the lecturer to introduce himself with an apology for his general and special unworthiness, but it is not my intention to do anything of the kind. On the contrary, I think myself peculiarly well fitted to welcome and give advice to new students. Firstly because, not being yet stricken in years, though scarcely juvenile, I fancy I can still think and ace as a young man and look upon the world from the stand- point of a medical student ; and, secondly, because it has been my good fortune to have spent ten years of my professional life in daily companionship with students. And indeed it would be a strange thing if I did not, during that time, learn to know how students thought, how they lived and moved and had their being. It is for these reasons that I think my advice m'ay be of some service to those who are about to begin tho worl? of the 67th session. r '•^ ') ■'«. /i / It will be part of my object to show you that, although the course of studies laid out for you is at first sight difficult, yet that the means of overcoming the difficulties and obstacles of the road are within your reach, and that to the industrious student the journey to a degree is interesting and pleasant. There are long marches it is true, and sometimes temporary stoppages' ■generally overcome by slight supplemental effort), but the road lies through a pleasing country, with so much that is interesting by the wayside that the traveller arrives at his destination sooner than the length of time spent in the journey would lead him to expect. This is the problem to be solved by your faculty. How to afford the best medical education possible in the short space of four years ? Our endeavour is to turn out as well edu- cated a practitioner as we can — a practitioner I say, that is one who can practise, a man able at once to earn his own living and to make himself useful in the community. I believe we do turn out a practitioner, in the true sense of the word. The McGill graduate enters upon his career with a fair experience of general medical and special work, and so far we have no good reason to be dissatisfied with the result of our four years' work. The question arises, though, ought we to be satisfied or ought we be constantly endeavouring to effect improvements in the course ? The main difficulty in our way is the limited period of time at our disposal, but this difficulty we could overcome were it not for the attempts to regulate our teaching undertaken by the va- ;S provincial licensing bodies. You have, I dare say, read -^sop, and you remember how the frogs, dissatisfied with the existirg state of practice in the somewhat malarious district in which they resided, fell to grum- bling, and, after considerable deliberation, demanded of Jupiter that some firm legislation should regulate the affairs of the pro- fession. The thunderer, accordingly, sent them a log which met with contempt and disrespect. Annoyed at their conduct, he sent them a provincial board, and matters soon assumed such a condition that the frogs bitterly regretted that they had not well let alone. And so with the Canadian medical profession! 8 Boards were established, at the instigation of the members of the profession themselves, by the provincial governments, with the good intention of reg"ilating admission to practice and pre- venting quacks and charlatans from exercising their dangerous trade. So far so good. But the boards, like Jupiter's stork, were not satisfied. They have in some provinces assumed the rdle of educators, and dictate to teachers what they must teach and to learners what they must learn. They have injured the profession they were intended to protect, and they have hampered and impeded the progress of the medical schools. From their mis- chievous interference this school suffers to an extreme degree. In particular, the College of Physicians and Surgeons of Ontario imposes upon our students certain very vexatious regulations and exacts of them pecuniary taxes, wholly out of proportion to the benefits they may ever expect to derive from becoming licentiates. It would seem that but two objects are aimed at by these regulations and impositions. Firstly, the establishment of a barrier to keep out of the field as many competitors as pos- sible, the originators of the movement having affected an en- trance before the fence was put up ; and, secondly, to render it more and more inconvenient and uncomfortable for an Ontario student to seek his education out of his own province. Failure will attend both these objects, for me fittest will survive in the battle of life by the law of nature, and no legislation will ever enable those unsuited by natural abilities and defective education to take a front rank in the fight. The struggle fo^" existence in the profession must be a fair one from the start, and those who cannot live by their own tah-nts and energies, will seek in vain for any benefit from legislative aid. The claim is made, on the other hand, that provincial boards exclude quacks and charlatans, and so protect the practitioner from dishonest competitors. As I write there lies before me a Montreal paper in which at a glance I see the open advertise- ment of three notorious charlatans. The Ontario Board is act- ive enough as regards the honest practitioner, yet no one can say that irregular practice does not exist in that province. The system of examining by boards for admission to practice is, in one instance, carried to a great length and to an absurd conclasion. The Province of British Columbia has secured the existence of a board. There are some fifty practitioners in that province (I counted 61 in the copy of the register for '87), and united they form the Medical Council of Physicians and Sur- geons of British Columbia. " Now, we have got in, let us keep the others out," seems to be their motto. If they had contented themselves with examining diplomas and rejecting those that came from indifferent colleges, then, perhaps, a useful function would be fulfilled, but, as the law stands at present, there is not one of you who, after graduating, would not become liable to punishment if he dared to give advice in British Columbia. He would be obliged to pass before the members of the Council, or such of them as may be.appointed for the purpose, a satisfactory examination touching his fitness and capacity to practice as a physician or surgeon. In other words, the Provincial Board of British Columbia would have to make it its duty to see for itself whether your teachers understood what they were about when they taught you, examined you and certified on your diploma that you were a fit and proper person to practise medicine. Lastly, a money tax is exacted. The plea can be made by such boards that the public must be protected, and it would be unsafe to allow a legally qualified practitioner from another province to exercise his calling within their borders. But no one can defend the establishment of a money barrier. The $100 tax can have no other object than to limit competition. If we wish the Canadian profession to gain the respect of the medical world, we must use every eftort to rid ourselves of this provincial littleness, this parochial policy. Medi- cine is medicine everywhere, and a legally qualified Canadian practitioner ought to be able to practice in any part of his own country. .^inother charge I bring against tho provincial boards is, that they impede the progress of medical education by compelling teachers and students to devote an excessive proportion of their time to the giving and attending of didactic lectures. The days have long since gone by when didactic lectures ^i\i vv were regarded as forming the principal part of a medical educa- tion. A century ago medical students were apprenticed to practitioners, and everything they learnt was of a strictly prac- tical character. Jenner was apprenticed to a country surgeon near Bristol, and Sir Astley Cooper began professional life, at the age of fifteen, as an apprentice at Yarmouth. In those days the didactic lecture served a useful purpose in supplementing the strictly practical instruction which the pupil received from his master. The school system gradually replaced the appren- tice system, and made the student, we wont say scientific, but it made him a man of books and opinions, and cultivated his memory to the neglect of his powers of observation. A double course of lectures in all the more important branches of study was thought to be necessary, and the number of lec- tures in each coursd was fixed at one hiindred. Opinions have changed, and improved methods are beginning to prevail. It was found that lectures failed to replace practical instruction* The professor has now to give way to the teacher. Students were over-lectured and under-taught. Your faculty would wish to replace a large proportion of the didactic lectures by practi- cal laboratory work and instructive demonstrations, but the boards will not let them. They exact the pound of flesh ; they must have the one hundred lectures twice told.* For my part, I see no hope of a change until such time as the afiairs of our profession are controlled by more enlightened men, and I look to the time when you all shall be graduates, and I confidently hope you will have the good sense to vote with the party in favor of letting the shoemaker stick to his last, and letting the teaching be managed by the teachers. With no immediate hope of a change, we try to do our best to mitigate the evil. Accord- ingly, a few years ago, a system of grading the course was introduced, first in the classes in clinical medicine and clinical surgery, and the plan has been extended to other courses. The excessive time devoted to didactic lectures is the worst * The Ontario Board have added to the course in anatomy fifty more lectures, bringing the number of didactic lectures to the ridiculous figure of 250 1 1 feature in our Canadian system of medical education. There is no country in the world where so many lecture^ have to be at- tended. When your brain is weary with much listening, your fingers cramped with note taking, your ischial tuberosities worn away from much sitting, do not entertain hard feelings against the faculty, but remember the provincial boards. And then when all is done and you itand before the world the possessor of a degree, the boards do not leave you. You have to make up your mind where you are to exercise your talents for the public good. As matters now stand you may register your degree and practise in any part or province of the Dominion — in Quebec, New Brunswick, Nova Scotia, Manitoba, anywhere except in Ontario and British Columbia. In a few months we shall be able to announce that reciprocal relations will be established between the College of Physicians and Surgeons of Quebec and the General Medical Council of Great Britain, as a result of which a McGill degree may be registered in Great Britain. Provided with such a guarantee of professional respectability, you may practifip in any part of Her Majesty's dominion except the two provinces. In all the mighty empire of Great Britain there are only two provinces where the profession has attempted to protect itself from honest competition by calling in the aid of the legislature. That examinations are uncertain we all know, but some are much more uncertain than others, and none so uncertain as those conducted by licensing bodies. The examiners are selected from- the body of the profession, and no teacher is allowed to examine in the subject in which he teaches. It would seem as if unfitness were a special qualification. The would-be examiner must have shown no special aptitude for the subject. A pro- fessor of surgery, for instance, would be qualified for the post of examiner in chemistry, but he must not examine in surgery, be- cause he knows too much about it. A good country practitioner, with a nice comfortable circle of midwifery patients, is, on this prin- ciple, made examiner in physiology or anatomy. And what are the results ? The examination is a scramble, sometimes the weak succeed while the strong succumb. " Quis custodiet ipsos custodes." Who shall examine the examiners ? ^ idiiklllli^^iHL •,.. I have gone to some length to show how the licensing boards impede progress. Now it shall be my effort to prove to you that, in spite of all the obstacles thrown in our way, the number of our students has steadily increased with the imposition of fresh tests and annoying regulations. We ourselves, during the last twelve years, have instituted changes in the curriculum which have made Jordan a very much harder road to travel than it was in my time, and it really seems that the more diflBcult the course the more there are who wish to take it. The class of 1875-6 was the smallest in the last twenty years. It was in the spring of 1877 that the first examination in practical anatomy was held. (The students have taken a very deep interest in it ever since) Practical chemistry followed suit, and higher marks were awarded in these two important subjects. Practical. courses in microscopy, histology and path- ology were established about this period. Enlargement and extension of the course has taken place in other directions. The proportion of marks qualifying for a pass was considerably raised and the tests have been increased. New subjects have been added, such as hygiene and gynaecology. The whole course has been made longer by the addition of one compulsory summer session. Four complete years must; be spent at college, and there are exemptions in favor of no one. But in spite of these changes, and there were not a few who thought our num- bers would diminish, there has been a steadily increasing influx of students. McGill was the first medical college on this continent to de- mand four complete years of study. She was the first to abolish the exemption in favour of the student who had spent his year of so-called study with a doctor, and that in favor of the bachelor of arts. And in this movement McGill is only doing what she has always done. She is leading. She did fifty years ago what some colleges are beginning to do to-day. She began her career with a matriculation examination. In the whole of the United States there is not a single college whose entrance examination is more severe than that which has always been demanded here. Very few colleges have any at all. Harvard University, which, owing e • to its great reputation and the extent of its endowment, can afibrd to introduce costly reform, irqists on a matriculation examination of which Latin forms a part. Some other colleges, with less ambitious views in the matter of preliminary education, content themselves with the three R's ; and, lastly, come the unholy army of colleges who demand no examination at all, and in its rank are included r lany so-called first-class colleges. Matriculation examinations do not pay. They cost too much. The popular voice in the great republic is against the severity shown in demanding that one who wishes to enter a learned profession should i)e made to prove that he can read and write. Students always take an interest in examinations. You know that our standard has been raised. But bear in mind that the actual amount of work is really reduced because so much more practical teaching is done and so much more personal aid afford- ed to each student. Moreover, the examinations have been arranged with a view to encourage practical observation and to put a limit upon what is commonly called the cramming process. In spite of all these changes, changes which have been at- tempted in so iae colleges and which have had to be abandoned, the class at McGill has steadily increased year by year. Thi s is a thing of which every Canadian ought to be proud, that the greater the difficulties presented the greater the number of those who seek to overcome them. *'' Having pointed out the path that leads to a degree, and ex- plained how difficult a struggle it is to get into the profession by that path, I am going now to tell you how this may be ac- complished. Firstly, I address myself to those who are here for the first time. These are commonly called Freshmen. A silly notion prevails that there is some kind of opprobrium attached to the title Freshman. A Freshman is a fresh man. Observe the word man. It does not mean boy. A man must put away boyish things. He must think and act as a man. He must cease to depend upon others, act for and rely upon himself. Boys may be noisy, sing loudly in the streets and behave generally as boys, but men should not do such things. 9 ■■■ i » i There are members of other classes in the College who would like to make you believe that fresh means silly, idle, presump- tuous, and a host of other bad things ; but it m^ans nothing of the kind. It means vigourous, active, intelligent, energetic. Freshman ! you stand to-day in a position truly enviable, yo