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KINGSTON: RAMSAY, ARMOUR, fo^ C o , iat2. \, F?ue d-, TO 1 Wit Can: probs porta subm and poset care, togetl gem i ^ perfe( recei^ dema and c tivate as th( neces : howe MEDICAL EDUCATION. LETTER I. to the honourable, the members of the legislative council, and of the house of assembly. Gentlemen, With the termination of the first Provincial Parliament of United Canada, has closed one of the most important Sessions which it has, probablj', ever been the lot of British North America to witness — im- portant, as well in reference to the number of Bills which have been submitted to your deliberations, as to the nature of the Bills themselves ; and it is the earnest desire of every true patriot, that He who dis- poseth all things for the good of his creatures, will, by his providential care, so overrule these, the result of your counsels, that they may work together for the happiness and prosperity of this country, the brightest gem in Her Majesty's diadem. Numerous and highly Important as were the measures which were perfected, that, I am happy to say, of education was not neglected: it received at your hands that attention which its extrenie importance demanded ; satisfied that knowledge is power, and that for elevating and dignifying the character of a nation, all that is requisite is to cul- tivate the moral attributes and mental faculties of the rising generation, as the foundation of a moral and intellectual superstructure. That a necessity existed for such a measure, no one denied ; of the manner, however, in which it was to be carried into effect, some discrepancies of opinion existed, a virtual demonstrallon of n familiarity or acquain- tance with the subject, on the part of all, manifesting itself according to the habits of thought oftlie individual's mind. Closely allied to this subject, is another, which was also brought undei your consideration, namely, Medical Education. To establish this highly important object on a proper foundation, a Bill was intro- duced by the Honourable Member for the County of Terrebonne, em- bodying in its detail a plan, which, it was thought, would have been acceptable to the medical profession generally. Having been referrred to a Committee, it was so essentially altered in its features, as, to a great extent, to negative any useful results which might have been anticipated from it. In this modified shape, however, from some want of technical formality, the Bill was, subsequently, thrown out by the House of Assembly : and hero the matter meanwhile rests. We cannot but congratulate the profession generally, and even the public, also, on such a result ; for while, on the one hand, the interests of the British medical profession here have been materially served by the re- jection, on the other, it has given time for a maturer consideration of the points involved in its details, and, in either case, will have been productive of good. The interests of the medical profession, being of a special char- acter, can scarcely be expected to be understood by the Members of the House generally; consequently, the writer of the present, and succeeding series of letters, hopes that he will not be accused either of vanity or presumption, in laying before you an impartial account of the present state of the medical profession in this country, its wishes, and its wants ; fully persuaded, that with you, and you alone, as the only legally constituted authority, rests the power, and, he also feels satisfied, the inclination, to rectify abuses, where these are shown to exist, and to ameliorate and to improve, when circumstances de- mand it- It is with extreme diffidence that the writer thua ventures before you and the public. The subject, however, is one of such immense importance, that the task, though an exceedingly invidious one, must I % be executed by somebody. He has patiently waited for Rome abler pen to take the field, but has been disappointed. Under the firm im- pression, that anotlier Bill for the regulation of medical education will be introduced at the next Session of the Provincial Parliament, he conceives that at no more propitious time than the present, when the hurry and pressure of business is temporarily suspended, when you arc enjoying a relaxation from private, as well as Provincial duties, could your attention be more properly directed to a subject like the present. The health and happiness of thousands are at issue, afibrding the most ample apology for the loss of time it may occasion you in perusing tlic^e letters. I subscribe myself, in the meantime, Gentlemen, Your most obedient, humble servant, MEDICUS. Montreal, January 13, 1842. CfLa'iW'il'V*"!'" LETTER II. ; I i| Gentlemen, In continuation of the subject which I proposed in my last letter to introduce to your notice, the train of argument which I am required to adopt compcis me to take a short glance at the history of medicine in the early ages of the world, and to observe the manner in which it3 study was, in those days, prosecuted. On this subject, however, I do not intend to occupy i,.uch of your time. Perhaps nothing is more strongly corroborative of the necessity of a proper medical education lliun the fact, that in all newly discovered countries, how uncivilized or savage soever the inhabitants may have been, some traces of an application to medicine have been discovered — thus demonstrating its importance and its essentiality to their happi- ness ; the same remark equally applies to the early ages of the world. It appears, in fact, to be a natural and inevitable sequence to society of all kinds, that attempts should be made to alleviate pain, to heal wounds, and to repair the injuries to which the body is constantly incident ; and however rude or imperfect the first attempts may have been, yet we always find them keeping strict progress with the advance of civilization and the march of science. In the first instances, the remedies may have been few, their application simple, and the requi- site knowledge for their proper employment easily obtained j but with the progressive increase of population, and the multiplication of reme- dies and diseases, and the developement of fresh resources, some degree of preparation or study became requisite, not only for the proper discrimination of diseases, but also for the correct appreciation of the principles which ought to guide the practitioners in the application of their remedies. t letter to required medicine which its however, icessity of liscovered may have severed — eir happi- he world, to society n, to heal constantly may have 3 advance nces, the the reqiii- but with 1 of reme- ime degree lie proper ion of the ilication of As far back in the hiHtury of the world as authentic record carircs us, we liavo constant proof of a devotion, more or lcs8 energetic, to the practice of medicine. In those early days, the Priests were the depositories of medical lore, a circumstance which originated among the Jews from Divine command, but which was perpetuated among them, as well as the other contemporary nations, by the superior education which this particular class received, and the consequent superior knowledge on all other subjects which they evinced. This association of Priest and Physician was by no means favourable to the advance of medicine, as a science ; the one was prostituted from its legitimate aims to secure and maintain the ascendancy of the other, and the treatment of diseases was cloaked under the most super- stitious rites and ceremonies. Hitherto but little system was practised in the pursuit of medical knowledge. Attempts, indeed, were fre- quently and successfully made to disunite the two offices just' alluded to, and, although we find in these early periods of medical history, a name, here'and there, who struck out a new path for himself, yet «he mass of practitioners blindly followed in the footsteps of their predecessors — gleaning their information as best they could. About 300 years B. C. the importance of studying medicine, on a proper system, was acknow- ledged in the foundation of the first school at Alexandria, through the munificence of the Ptolemies. Here it was taught in its various bran- ches, and here some of the most illustrious men, whose names adorn the pages of medical literature, received their elementary instruction. We have not, at the present day, any means of ascertaining the exact nature of the curricula which the students had to undergo ; but we do know, that the greatest attention was paid to the study of anatomy, physiology, pathology, the materia medica, and the practice of medi- cine and surgery. Antecedently to this period, the structure of the human body was only known from analogy — from dissections of the lower animals. It was nov/ prosecuted in its only legitimate way, the bodies of executed criminals being assigned by the Government for that purpose. As the natural result of this improved system of me- km ■ if ji (licnl tiiitiun, atui the other branclica of pliilottopliy tauglit in tliJH scIiu'jI, a cIdhlt system of investigation vvns opplicil to the principles of mcilical science, — nunicrous Hccts, from time to time, nprang up, which, in enforcing their own peculiar tenets, directeil general atten- tion to the subject, and, disclosing the fallacies of their opponents, ele- vated, to a higli degree, the medical art. For several centuries afler this period, medicine was prosecuted with equal ardour in the Arabian and Saracenic schools, and, imitating the example set by Alexandria, we have the namea of the Neapolitan Colleges of Monte Cassino and Salerno, both of which acquired some degree of eminence. From the twelfth to the fifteenth centuries, what have been emphatically called the dark age?, set in— a period in which, to use the language of a cele- brated writer of the present day, " ignorance, superstition, and bar- barism tyrannised over learning and genius, — in which knowledge of any kind was to be sought for only among the ruins of old churches and monasteries, — in which fabulous legends supplied the place of truth, and the arts of a crafty priesthood debased, vvhile they enslaved, the minds of men." Aided, in the first instance, by the Crusades, then by the Reformation, but, above all, by the discovery of the art of printing, an art " which derides the havoc of time and barbarism," medicine, together with the other branches of knowledge, revived from the flagging state in which it had lately existed, and a re-action, more than proportionate to its previous depression, took place,— schools were established in most of the principal cities, among ethers in Montpelicr, Bologna, Vienna, Padua, Pavia, Milan, Rome, Naples, Paris, and last, and by no means least, in Oxford, Cambridge, Edin- burgh, and Dublin. I seek not, Gentlemen, to draw any unfair inference from the facts just adduced ; but I must fearlessly record my firm conviction, that it is to these schools, and these only, with the perpetuation of this mode of teaching medicine, that we must attribute the present exalted state of medical science. Their beneficial elTects were soon apparent. Tlie rivalry which quickly manifested itself, — the fame which each was desirous of acquiring, instigated to close invoatigation of the nature m Iff 9 ;lit in tliJM principles sprang up, oral Qtten- nenta, ele- lurios after lie Arabian Uoxandria, lassino and From the cally called B of a cele- n, and bar- lowledge of J churches le place of y enslaved, I Crusades, )f tlie art of barbarism," evived from ction, more e,— schools g ethers in ne, Naples, ridge, Edin- and treatment of discoses ; a rcHult, which, in its turn, tended to a fuller and more exact dcvclopement of medical principles, — to its con- solidation, as a science, — and to a removal of the numerous errors which entrammclled it. Medicine, as a science, nt the present day, is by no means what it was even a few centuries ago, and it is, consequently, by no means ne- cessary to the object which we have in view, to incjuire into the nature, degree, or extent, of the initiatory studies requisite for its successful practice in those days. But if proper initiatory instruction was then required, on the part of all who wished to enter upon its duties, as is proved by the establishment of schools, it is even still more so now, when the requisite attainments are of a much higher order. What these are, will be seen by in8i)ecting the curricula of the principal schools of Europe, which I reserve as the material for my next letter. I remain. Gentlemen, Your most obedient, humble servant, MEDICUS. Montreal, January li), 18'1'2. ;e from the viction,that of this mode xalted state n apparent, which each )f the nature LETTER III. Gentlemen, The importance of pursuing the study of medicine, on a proper system, being established in the foundation of schools, where its principles may be taught and its doctrines inculcated, and this from early ages of the world, we shall conclude this part of our subject, by inquiring into the nature of the curricula required of young men entering into that prO' fession, in some of the principal Colleges of Europe, namely, Edin- burgh, London, Dublin, Paris, Oxford, Cambridge, Glasgow, Aber- deen, and St. Andrews. I would willingly have extended this sketch to the German schools of medicine, but having no certain data at my command, with respect to them, I am disposed to pass them over. I must, however, state, that the curricula demanded at any of these, do not differ materially from those of Edinburgh or London, and where differences do exist, they will be found in the requirement of in- creased qualifications. Independently of classical knowledge, and hospital attendance, varying in time from one to three years, the candidates for degrees are expected to give satisfactory evidence of knowledge on the following subjects, namely :— Anatomy, Chemistry, Materia Medica, Pharmacy, Therapeutics, Physiology, Theory and Practice of Meilicine, The Principles and Practice of Surgery, Midvvlicry, and Diseases of Women an J Children, Pathology, Botany, Natural History, Medical Jurisprudence and Police, Military Surgery, Mathematics, Natural and Moral Philosophy. K 11 r system, pies may B of the I into the that pro- ly, Edin- w, Aber- tiis sketch ata at my I over. I these, do md where ent of in- ttendance, egrees are following He is also obliged to furnish tickets on Practical Anatomy, Practical Chemistry, Clinical Medicine, and Clinical Surgery. Som« of these classes are dispensed with in some of the Colleges, especially those not immediately bearing on the practical parts of the profession, such as Botany, Natural History, and Mechanical Philosophy ; but the list above given, may be taken as a sample of the curriculum, and the amount of knowledge required. The least time during which the students are permitted to acquire this information, is four years, — that is, four winter sessions, of six months each, during which lectures on these various branches are de- livered, at least five times in the week. The longest period oi study enjoined is twelve years ; at the expiration of either of which periods or terms, according to the respective Colleges which enjoin them, the candidates are admitted to the highest degree in medicine, M.D., on satisfactory examination of their qualifications, and the writing of a Thesis, which is made to undergo a public defence, on the part of its author. At the University of Oxford, the preliminary degrees of B.A., M.A., and M.B., are first required, before the degree of M.D. can be obtained. The degree of B.A. (Bachelor of Arts) requires a four years' study ; in the course of two years afterwards, that of M.A. (Master of Arts) is obtained ; at the expiration of another year's study, the candidate is admitted as M.B. (Bachelor of Medicine) ; and not until three years are completed, is the degree of M.D. (Doctor of Me- dicine) conferred, and these after four separate examinations for the respective degrees. At the University of Cambridge, a somewhat similar plan is pur- sued, a ten years' term of study being also requisite. In the University of Dublin, the preliminary degrees of A.B. and A.M. are not requisite, though the possessors of these degrees enjoy superior advan<^ges. The previous possession of the degree of M.B., however, is imperative, before that of M.D. can be obtained ; those who hold the degree of A.M., can obtain that of M.D, after six years' study ; those holding that of A.B., not until after seven ; while thoso 12 who hold neither, are obliged to prosccuto their studies for twelve years. At the Marischal College and University of Aberdeen, the pos- session of the preliminary degree of A.M. is imperative ; while in that of St. Andrews, its possession is recommended, though not absolutely enjoined. At Paris, the degree of Bachelor of Letters ia enjoined, before that of Doctor in Medicine, or Doctor in Surgery, can be conferred. In the other Colleges, or schools of medicine, to which reference has been made, although the possession of the degrees of A.M. or A.B. is not demanded, yet it is obvious, on inspecting the curricula required of the students, that the object has been to compel on them as extensively diversified attainments as possible, and to enforce an acquaintance with the collateral l)ranches of medical science, which, though they may prove of but little value at the bedsides of the sick, yet elevate and adorn the medical character. Leaving the Eastern, let us now direct our attention to the West- ern I misphere, and, taking, as our guide, the curricula required at any of the respectable medical schools of the Union (for they are not all so), we shall find them closely following in the footsteps, and imi- tating the example, of their British ancestors. From three to four years' study is required, and collegiate instruction rendered imperaiive. The nature of the studies is more purely medical, and, except in one or two instances, an acquaintance with Natural Pliilosophy, Botany, or any other collateral branch, is not enjoined. Although graduation does not permit the holder of the degree to enter into immediate prac- tice, yet in the greater number of the States, its previous possession is imperative, before the license "ad practicandum" is granted, as it is & prima facie evidence of the fitness of the individual for the duties in which he is to engage. Some of you. Gentlemen, are members of the medical profe-'sion, and are, consequently, familiar with the nature and extent of the preli- minary studies requisite for practising it in a proper manner. The greater portion are not acquainted with these facts, and to these the 13 s for twelve en, the pos- while in that lot absolutely (], before that ferred. ich reference 1 of A.M. or the curricula npel on thetn enforce an ence, which, B of the sick, to theWest- ila required at )r they are not eps, and imi- (1 three to four ed imperative, except in one lophy, Botany, ]gh graduation imediate prac- s possession is anted, as it is ir the duties in cal profusion, nt of the preli- Tianner. The 1 to these the statements which have been made, may appear novel, but if so, not tlie less true. Accustomed, as we all are, from our very infancy, to see ignorant pretenders, of all classes, sexes, and ages, tampering vviili diseases, and employing remedies of various descriptions, according as their own whims or fancies may direct, occasionally innocuous, gen- erally dangerous in such hands, for " fools rush in where angels fear to tread," the mass of mankind are prone to regard medical know- ledge as a thing easily acquired, requiring no particular skill in the application of its remedies, and a smaller quantum of brains for its ac- quisition, th?.n probably any other profession. The deception, let me assure you, is an exceedingly gross one, and involves in its conse- quences the most alarming, the most pernicious, effects. We have seen that years of arduous, laborious study are necessary for the ac- quisition of its principles ; and when we reflect for one moment on the multiplicity of diseases to which the human frame is incident, the Protean variety of their symptoms, and the frequent calls which are made upon the sound judgment, and prompt suggestions of the Phy- sician, whose mind must be prepared for every emergency, no other arguments, I feel convinced, are necessary to prove the extreme im- portance of a proper elementary instruction. We acknowledge the necessity of due preparatory instruction in the other two professions, and descending from these, in the various mechanical pursuits which give occupation to so many thousands of our tradesmen and others, and yet in the medical profession, the practice of which is so closely interwoven with our dearest interests, and which involves a greater amount of human happiness or misery than any, or the whole of these put together, the preliminary acquisition of its principles has hitherto appeared in this country, to be a matter of no consequence whatever. But I am anticipating. I remain, Gentlemen, Your most obedient, humble servant, MEDIC US. Montreal, January 24, 1842. LETTER IV. Gentlemen, 11;,^ The course of my subject brings me now to tiie consideration of the present state of medicine in this country, by far the most ungracious part of the task, which may lay me open to imputations of various kinds; and although tiie circumstances, which, in illustration of my position, I am compelled to state, may prove unpalatable to a myriad of demi-Doctors, the outpourings of whose wrath it is no difRcult matter to predict, yet the cause in which I am writing — a cause in- volving the sacred interests of humanity — urges me to the duty. I shall, however, make no assertions, but shall appeal to facts, and shall state the truth, irrespective of persons, and fearless of consequences. We have seen, in the last two letters, the care which has been evinced, from very early ages of the world, to secure to young men that knowledge of their profession, which would enable them to un- dertake the practical duties of it, with credit and honour to them- selves, and benefit to the sick entrusted to their charge. Scholastic education ha3 been shewn to possess the sanction of antiquity, a fact which is, at the same time, virtually demonstrative of the insufficiency or inadequacy of all other modes of imparting the requisite degree of initiatory instruction. We have seen the system practised in England, Scotland, Ireland, France, and the United States, and, in fact, in every other civilized nation under the sun. Let us now look homewards, and see how far we keep up with this spirit of improvement, in incul- cating the principles of the medical profession, in the only manner the utility of which has received the confirmation of the experience of ages. tration of the t ungracious 3 of various ition of my to a myriad s no difficult -a cause in- the duty. I cts, and shall sequences. ;h has been ) young men them to un- our to them- Scholastic uity, a fact insufficiency site degree of in England, fact, in every homewards, !nt, in incul- r manner the experience 16 Tiic Ordinance which at present regulates the practice (there is none regulating the study) of medicine in this Province, is the 28tli Geo. III. cap. 8, the object of which is, " to prevent persons prac- tising Physic or Surgery within the Province of Quebec, or Midwifery in the towns of Quebec or Montreal, without a license." It prescribes an examination, before a Medical Board, of all, except those who hold a degree from "any Universitjr," which, according to the opinion of the Attorney-General, refers exclusively to British diplomas, or have been commissioned or warranted as Surgeons in Her Majesty's Army or Navy, and exempts altogether from the necessity of obtaining a license, the Physicians or Surgeons of Her Majesty's Army or Navy, on active service within the Province. L prescribes no particular time, nor does it indicate any particular course of study ; in fine, ac- cording to the Ordinance, the time of study may be either six days or six years, — the candidate for license may be either six years old, or sixty ; its whole requirements being, that he present himself before one of the Medical Boards of the Province, and if he replies to the few questions proposed to him, which chance may so direct as to be on subjects with which he may be, to a certain extent, familiar, he must be received.* But the working of this system is best seen by those who compose the Medical Boards of the Province. To them it is notorious, that the candidates come before them with the minimum quantity of knowledge, requisite to enable them to pass. There have been a (ew honourable exceptions to this statement, but they are so few, as to corroborate the fact, rather than invalidate it. Nor is it at all surprising. Appren- ticed, as I grant they usually are, a circumstance the result of custom, more than of necessity, they are admitted to the privilege of compounding * This is so literally true, that presenting before the Medical Boards, has been, 1 by students, proverbially termed, " taking their chance." The stigma ■)( passing improperly educated persons, might, by some, be at- i tached to the Boards of the Province ; but, we must observe, that these Boards have j not tlie power of either elevating or demanding a high standard of medical acquire- i ments. They may demand, but whence are these attainments to be derived l The I faulty system of education, compels the reception of inferior qualifications, which, 1 though the Boards may regret, for many and obvious reasons, ihcy cannot prevent. \ 1 16 furmulse, which is the Houice of all tltcii' knowledge in Pharmacy and the Materia Medica ;' their linovvlcdge of Chemistry, gleaned from books, and practically exemplified, to a certain extent, in the way just specified, is as meagre as can possibly be, in most cases, amounting to the grossest ignorance of its simplest principles ; their knowledge of Anatomy, studied from books, aided by a few plates, as old and antique as may well be iniagined, serves them to know, at best, the carotid artery from the femoral, and is utterly unfit for assisting them in the performance of any, the most trifling, operation in Surgery. Their knowledge of Medicine and Surgery, derived from the same source, however well stored with theory their minds may be, readers them worse than useless at the bedsides of the sick, from a deficiency of practical information, and serves to confuse, more than enlighten, as to the nature and proper treatment of the disease before them. The other branches of medicine, as Therapeutics, Physiology, Pathology, Sic., are laid aside, as requirements by no means necessary to enable them to pass, and as fit subjects for study at future periods, which very fre- quently never arrive. Such, Gentlemen, in a few words, is by no means an over M'GiU Col- iph over the ', attempted to mention the is the only ofessedly im- r of Medicine ne years, and it furnish tes- f courses on acy ; Theory ases of Wo- and Thera- vo six-month month course dical subject, set apart for at the nature teral branch- ges of Great Britain, and of Aonie in the United States, being enjoined, while all those classes arc rendered imperative, the principles of which are called into every day operation. In a young and rising Colony, no more than this can, or oiighl, to l)e demanded ; but this much should ho. The object sought for, is to elevate the standard of medical know- ledge, — to impart useful, not ornamental, education,— to unfold the principles of medical science to all who feel disposed to take advantage of the opportunity thus oflTered, — and to aflbrd no longer a plea, or an excuse, for the criminal ignorance of them, which was so conspicuous every where. But although the means of acquiring a rudimentary knowledge of their profession was thus placed within the reach of all, cxperienco has amply proved the lamentable fact, that although a few do avail themselves of the privileges thus opened to ihem, yet the mass of young men entering the profession, prefer the imperfect system prescribed by the law, to collegiate education, which vvould entail the trifling outlay of a (ew pounds. As long as collegiate education is not rendered imperative, so long will this system he persevered in, a system which perpetuates a degree of ignorance more befitting the un- tutored savages of a newly discovered clime, or the semi-barbarism of antideluvian periods, than the vaunted civilization of a Christian country, in the nineteenth century. But, Gentlemen, in 1831, the Provincial Legislature of Lower Ca- nada, took the matter up ; and let us now see what they made of it. In that year, an Act was passed — 27th Will. IV. Cap. 1— entituled " An Act to repeal a certain Act therein mentioned, and to provide more effectual regulations concernifig the practice of Physic, Surgery, and Midwifery." One would altnost have supposed, that a modern Legis- lature, careful of the interests of the constituents, by whom they were returned as Members, and necessarily cognizant of the innumerable evils which flowed from the deficient state of medical education, would, in proposing a remedy for a disease, pregnant with such disas- trous consequences, have devised the means of at once eradicating ihe complaint, by enforcing a strict compliance with a proper preparatory instruction, on the part of all who wished to enter upon its duties. In 22 roaJing over tho Act, however, the most caroleis observer cannot but be struck with tho culpable inJiflerence dlsployed on this point. While the greatest care seems to have been taken to make the Me- dical Boards of the Provihcc elective (than which no method could possibly have been selected more open to abuse, especially with re- spect to talent, and that, too, in a situation where it is so much needed) ; while it takes especial care to impose penalties on all persons prac- tJHing without a licenso, and in this manner protects their own ignorant pretenders from the encroachments of their, too frequently, more skil- ful, but unlicensed, opponents ; while tho most stringent regulations ore made in reference to the poor apothecaries, and ample care is taken that they receive a proper preliminary education (of the same nature as that for the physician !— the only diilerence in the education of the two being, that the former has to serve a three years*, the latter a fivo years', apprenticeship) ; the very object which ought to have been steadily kept in view, — the all-important subject, which should to have constituted the main feature of the Bill, a proper system of initiatory instruction, is studiously avoided. Nor, Gentlemen, can we be at the slightest loss in assigning a rea- son for this seeming negligence, for it is only seeming. The Legis- lature well knew, that in rendering collegiate instruction imperative, they would have been directly advancing the interests of tb? M'Gill College ; but they, at the same time, forgot, or rather affected not to remember, the long-established commercial axiom, (and education may, in this senRe, be viewed in a commercial light,) that where the demand is created, the supply speedily follows, and, consequently, that where one medical school existed, there, in no long time, might fifty have been rearing their heads. Narrow-visioned policy ! which strained at a gnat, and swallowed a camel, — which, while withholding a proper preliminary education, perpetuated, through its neglect, the direst con- sequences upon a hapless community. To you. Gentlemen, the medical profession generally, for their own honour, and the public, also, for their own interest, anxiously look for an amelioration of this state of things. The middle of the ir cannot but I this point, lako the Me- lethoU could »Ily with re- ich needed) ; eraons prac- Dwn ignorant r, more skil- t regulations imple care is of the same he education ) years', the hich ought to ibject, which >roper system nineteenth, finds the standard of medical knowledge in this country, no higher than it was in the middle of the eighteenth, century : no im- provememt has taken place,— not the slightest change. The attempt has been made, but, unsupported by Legislative authority, it hoa proved almost abortive. The provisions of a Medical Bill, regulating the interests y * the medical profession, shall form the materials of my next and last letter. In the meantime. Gentlemen, I remain your most obc liont, humble servant, MEDIC US. Montreal, February 3, W,2. signing a rea- The Legis* n imperative, .f the M'Gill fTected not to iucation may, B the demand , that where fly have been strained at a ing a proper le direst con- ■ ;t I dly, for their >st, anxiously liddle of the LET'»^ER VI. Gentlemen, The conclusion of my subject, brings me now to the consideration of the details c " a Medical Bill, such a one as would accord with the feelings and necessities of the medical profession generally, and, at the same time, tend to elevate the standard of medical knowledge through- out the Province. Both the Canadas labour under similar disadvan- tages in this respect; consequently, the provisions of the Bill should be such as to affect both ; and its title should be the following : " An Act to Regulate the Study and Practice of Physic, Surgery, and Midwifery, within tht Province of Canada." The preamble should repeal all existing laws or Acts which at pre- sent affect the study or practice of the same within the Province, espe- cially 28th Geo. III. cap. 8, which bears on the practice in Lower Canada, and 59th Geo. III. cap. 13, 59th Geo. III. cap. 2, and 8th Geo. IV. cap. 3, which influence it in Upper Canada. Sec. 2. — A competent classical education to be imperative on every one desiring to practice as a Physician^ Surgeon, Man-Midwife, or Apothecary. * Sec. 3. — No person to be admitt*: 1 to examination for license to practice as a Physician, Surgeon, Man-Midwife, or Apothecary, unless he has attained the age of twenty-one years. Sec. 4<. — All persons desiring to practice as Phys'sians, Surgeons, or Man-Midvvives, must submit to an examination, before a Medical Board, on the following subjects : Anatomy, Physiology, Chemistry, Pharmacy, Materia Medica, Therapeutics, Theory and Practice of Medicine, Principles and Practice of Surgery, Midwifery, and Di- seases of Woiaen and Children. 26 Sec. 5.— All persons desiring to practice as an Apotliccary, must submit to an examination before a Medical Board on the following subjects : Materia Medica, Pharmacy, and the Principles of Che- mistry. Sec. 6. — For the provisions of this Act, Medical Boards to be appointed by the Governor-Grenoral, or person administering the Go* vernment for the time being, in the cities of Toronto, Kingston, Mont- real, and Quebec. Sec. 7. — The Medical Boards to consist of, at least, nine Medical practitioners, five of whom shall constitute a quorum. To meet, at least, once every three months, after a fortnight's . yiification of the same, in, at least, two papers published in the respective cities. Their duties shall be to examine the testimonials and qualifications of every pereon wishinv,d bottles, with the word "Poison," in large letters, ij»arked thereon, r.nuer a penalty of £2 IDs. for the Cwat offence, and JE5 for every subsequent one. 37 wo of Mate- )ry and Prac- lal Anatomy, nic years, the liecary, shall )me licensed 3stimonials of at least, four : One course lica. r Midwifery, f JBIO for the iecary, with- under a pen- iquent one. out a license, br every sub- medicines, or jBS for the stances, such ie, unless the hysician, or sides, a certi- le person re- , and £5 for ances in ce- tera, n.arked , and JE5 for Sec. 18. — No person whatever, under any pretence, to inoculate any child or adult with the natural virus of the small-pox, unless af\er previous vaccination with cow-pox virus, under a penalty of JS5 for the first offence, and £1 lOs. for every subsequent one. Sec. 19. — To facilitate the study of Anatomy, all dead bodien unclaimed by friends or relatives, within three days, from the month of November to May, and within two days, from the month of May to November, whether dying in Hospitals, Jails, or other public Institu- tions, or found dead, publicly exposed, to be given up to a public lec- turer on Anatomy, for the purposes of dissection ; and that a warrant, signed by a Justice of the Peace, in favour of the applicant for the same, addressed to the Coroner of the District, or chief officer of the Hospital, Juil, or public Institution, be sufficient to obtain it. Sec. 20. — The penalties imposed in this Act to be recovered by the deposition of, at least, two witnesses, before any of Her Majesty's Justices of the Peace, within, at least, three months after the commis- sion of the offence, with imprisonment until the fine is paid ; one moiety of the fine to be given to the informants, the other moiety to be the property of Her Majesty, her heirs, and successors. Sec. 21. — This Act to remain in force, until repealed by a subse- quent Act of the Legislature. A few comments on some of the sections of this proposed Bill, and I shall conclude. Section 9. — I should scarcely has c deemed it necessary to make the slightest allusion to this section, had not the proposal been seriously entertained by several Members, to admit American diplomas into tnis country on a par with British ones, — that is, without subjecting the parties holding them to an examination. The impropriety and the im- policy of snch a measure, could be clearly demonstrated to every un- biassed mind, did not the already too great length of this letter warn me to be brief. I may, however, advance several arguments, with- out entering into explanatory details. In the first place : Although a few American Colleges do impart a complete system of medical in- ■aPT" 28 I struction, yet the generality of them do not, and this remark especially applies to all the Border Universities (1), those which would most cer- tainly be visited by our students, from their proximity and cheapness. A number of graduates from these Universities, as they style them- selves, have applied for license to the Montreal Medical Board, and the records shew the rejection of a large numerical majority, from utter ignorance of the simplest principles of the profession, and consequent incompetency. Secondly : A chartered College exists within the Colony, fully capable of imparling the requis-ile degree of elementary knowledge ; and in no long time, others would be established also. It has been objected to the M'Glll Collogo, that the lectures are in the English language, and, consequently, are not comprehended by the Canadians. To expose tlic frivolousness of this objection, it is, I think, sufficient to observe, that tlie classes this winter shew a large majority of Canadians among the gentlemen attending them, who have thus voluniarily come forward. Thirdly : The protective arm of the Le- gislature, which ought to foster their own Institutions, and hold out no in- ducement to seek that instruction in a foreign country, which their own is fully capable of imparting to, at least, an equal, if not a superior, degree. Fourthly : The usage of almost all Governments, which re- cognise as valid no diplomas but their own. Three gentlemen holding the M'Gill College diploma, are now practising in Louisiana, United States, and all the three had not only to take the oath of allegiance, but to submit to an examination before the Medical Board in that State ; and, in 1838, five English Physicians were put on their uial at Boulogne, for practising without a license, and condemned to the pay- ment of a trifling fine, equivalent to an interdiction. According to this decision, no foreign Physician can practice in France at all/anless he undergoes an examination before the Facultv of Phvsicians at Paris. Section 18. — The best directed efforts to suppress this loathsome and fatal disease, will be utterly unavailing, as long as the practice o^ inoculating is permitted to continue, ft has been made the subject of 1 ^f" 29 Legislative interference in the Imperial Parliament ; and the penalties of the Statute were actually imposed on one medical man, who con- travened its enactments. Section 19. — It surely requires little to be sold to prove the impor- tance of such a step as is here indicated on the part of the Legislature. If a knowledge of the functions and structure of the human frame is demanded from the Physician and Surgeon, and if an intimate ac- quaintance with these can only be obtained by means of dissection, measures should be adopted to secure this end, in the least offensi" way possible. Such a method is adopted in Great Britain ; and,whiiu it has been found there to subserve well the end for which it was in- tended, it would, if introduced into this country, also tend to obviate the disngroeable and dangerous practice, by which an imperious ne- cessity now compels the student to acquire the material for this impor- tant branch of his studies. I have now. Gentlemen, brought these letters to a conclusion, and leave the whole matter in your hands, under the full persuasion, that it will meet with that attention which its extreme importance demands. I have, I believe, fully demonstrated the urgent necessity of Legislative interference in establishing a higher standard of acquirements, on the part of those who intend to engage in the important duties of the me- dical profession. You alone, Gentlemen, have the power, and, after the arguments which have been advanced, I doubt not, the inclination. This end will be amply attained in the sketch of the Bill which I have just submitted to your calm and deliberate judgment. In establishing some of the positions which I had to assume in the course of my argument, I was compelled to make some painful dis- closures ; but, in doing so, however much I regretted the necessity, I sedulously endeavoured to appeal to facts ; and have now the satis- faction of adding, that, although nearly a fortnight has elapsed since my last two letters were publicly laid before you, not a single state- ment has been, either directly or indirectly, impugned. This tr jit acquiescence on the part of the medical profession, in the statement: H: 30 which have been made, and the inferences which have been deduced from them, cannot surely be regarded as unimportant. It has invested my feeble efTurts in the cause which I have undertaken, with a corro- borative influence and weight, which I scarcely permitted myself to hope they would so readily have acquired. It reniaini) to me, Gentlemen, to subscril)e myself, Your most obedient, humble servant, MEDICUS. Montreal, January 17, 1842. a B B iA "U" ifta :_^' Page 11, line 24, for " not until three years are cok.:pleted," read, " not until three additional years are completed:" Page 16, line 22, for "fdr such a result is not commom," read, "such a result is not uncommon." m. t