McGill Medicine: The First Half Century, 1829-1885 9780773565524

Table of contents :
Contents
Illustrations
Abbreviations
Preface
Acknowledgments
Introduction
1 The Founding of McGill University and Its Faculty of Medicine
2 The Faculty of Medicine, 1829–50: The Formative Years
3 The Faculty of Medicine, 1850–74: The Established Years
4 The Faculty of Medicine, 1874–85: The Osler Years
5 Epilogue
Appendices
1 Letters from the Secretary to the Registrar, 1834, 1835; Graduation Program, 1841
2 Faculty of Medicine, 1829–85
3 Graduates in Medicine, 1833-85
4 Prize Winners and Medallists, 1854–85
5 Examination for M.D., 1854–55
Biographical Sketches
William Caldwell
William Robertson
John Stephenson
Michael McCullough
Andrew Fernando Holmes
Oliver T. Bruneau
George W. Campbell
James Crawford
Robert Lea MacDonnell
Archibald Hall
William Fraser
William Sutherland
Sir John William Dawson
William E. Scott
Robert Palmer Howard
Duncan Campbell McCallum
George Edgeworth Fenwick
Reverend William Wright
Robert Craik
Gilbert Prout Girdwood
William Gardner
Francis Buller
George Ross
Sir Thomas George Roddick
Thomas Wesley Mills
Alexander Dougall Blackader
Sir William Osier
Francis John Shephard
George Wilson Major
Richard L. MacDonnell
Wyatt Gait Johnston
Notes
Index
A
B
C
D
E
F
G
H
I
J
K
L
M
O
P
R
S
T
U
V
W
Z

Citation preview

McGill Medicine Volume I: The First Half Century, 1829-1885

Joseph Hanaway and Richard Cruess describe Canada's first medical school - its origins and development and the extraordinary staff whose progressive ideas made it one of the best medical teaching and research centres in North America. The McGill medical school opened in 1829. Founded by four Scottish physicians, teaching style in the school followed the socalled Edinburgh tradition, which for decades emphasized anatomy and clinical observation and ignored progressive educational theory and scientific advances. It was out of this conservative environment that four remarkable young professors emerged who would lead the reform in the medical school that marked a new era in medicine at McGill. William Osier, Francis Shephard, Thomas Roddick, and George Ross introduced laboratory training to teach students the scientific method in a learning-while-doing environment and a more sophisticated approach to clinical medicine and surgery. By 1885 the school was beginning to offer a science-based curriculum that included hands-on learning in specially constructed laboratories, a major reform in Canadian medical training. McGill Medicine: Volume I records not only the history of Canada's premier medical school but also the evolution of scientific medical education in Lower Canada. JOSEPH HANAWAY is clinical assistant professor of neurology, Washington University, and visiting professor of neurology, University of Missouri School of Medicine. RICHARD CRUESS is retired dean of medicine, McGill University.

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McGill Medicine Volume I The First Half Century 1829-1885 JOSEPH HAN AWAY RICHARD CRUESS

McGill-Queen's University Press Montreal & Kingston • London • Buffalo

© McGill-Queen's University Press 1996 ISBN 0-7735-1324-8 Legal deposit first quarter 1996 Bibliotheque nationale du Quebec Printed in Canada on acid-free paper

Canadian Cataloguing in Publication Data Hanaway, Joseph, 1933McGill Medicine Contents: v. I. The first half century, 1829-1885. Includes bibliographical references and index. ISBN 0-7735-1324-8

I. McGill University. Faculty of Medicine - History. I. Cruess, Richard L. II. Title. R749-M34H35 1996 61o'.71'171428 C95-920944-1 ENDPAPERS: Composite picture of the Faculty of Medicine, McGill University, 1882,. Front row, left to right: Howard, Wright, Scott (standing, with watch-chain showing), Dawson, Campbell; seated: MacCallum, Craik, Fenwick Back row, left to right: Roddick, Ross, Osier, Shephard, Gardner, Girdwood, Buller, MacDonnell (Notman and Sandham, McCord Museum of Canadian History, Notman Photographic Archives) Typeset in Trump Mediaeval 10/12.5 by Caractera inc., Quebec City

McGill University and its various faculties have achieved stature in the world because of the activities of its various professors and administrators. The fifteen years in which David L. Johnston was principal and vice-chancellor of McGill University were, for the Faculty of Medicine, years of outstanding achievement. The entire university was faced with both financial and political problems which are probably unique in North America. In spite of this, excellence was pursued, outstanding individuals were recruited, and a variety of faculties including medicine prospered. At all times Johnston projected a clear vision of university goals and objectives with an extraordinary personal touch that was felt by students, faculty, administrators, support staff, and graduates, to all of whom he gave an extraordinary amount of time. As his years as McGill's academic leader are now a part of the history of the University and the faculty of medicine, this dedication is a very appropriate part of this book.

Therefore the authors take great pride and great pleasure in dedicating this work to David Lloyd Johnston.

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Contents

Illustrations

vii

Abbreviations xi Preface xv Acknowledgments

xvii

Introduction xix I The Founding of McGill University and Its Faculty of Medicine 3 2 The Faculty of Medicine, 1829-50: The Formative Years 16 3 The Faculty of Medicine, 1850-74: The Established Years 36 4 The Faculty of Medicine, 1874-85: The Osier Years 65 5 Epilogue

100

Appendices 103 I Letters from the Secretary to the Registrar, 1834, 1835; Graduation Program, 1841 105 2 Faculty of Medicine, 1829-85 114 3 Graduates in Medicine, 1833-85 117 4 Prize Winners and Medallists, 185 4-85 131 5 Examination for M.D., 1854-55 134

viii Contents Biographical Sketches

William Caldwell 143 William Robertson 144 John Stephenson 145 Michael McCullough 147 Andrew Fernando Holmes 148 Oliver T. Bruneau 149 George W. Campbell 150 James Crawford 151 Robert Lea MacDonnell 152 Archibald Hall 153 William Fraser 156 William Sutherland 157 Sir John William Dawson 159 William E. Scott 161 Robert Palmer Howard 161 Duncan Campbell McCallum 163 Notes

189

Index 215

143

George Edgeworth Fenwick 164 Reverend William Wright 165 Robert Craik 166 Gilbert Prout Girdwood 167 William Gardner 169 Francis Buller 170 George Ross 171 Sir Thomas George Roddick 172 Thomas Wesley Mills 176 Alexander Dougall Blackader 177 Sir William Osier 179 Francis John Shephard 183 George Wilson Major 186 Richard L. MacDonnell 186 Wyatt Gait Johnston 186

Illustrations

1 James McGill

(MC.M., M.U.A.)

4

2 House of Recovery, 1818 (O.L.) 7 3 The four founders of the Faculty of Medicine of McGill (M.U.A.) 9 4 Original building of the Montreal General Hospital on Dorchester Street, 1826 (M.U.A.) II 5 First announcement for medical teaching at the Montreal General Hospital (M.U.L.) 12 6 First advertisement for the Montreal Medical Institution (M.U.L.) 13 7 The Montreal Medical Institution, 20 St James St (O.L.) 14 8 Final advertisement for the Montreal Medical Institution, October 27, 1829 (M.U.L.) 15 9 Burnside Place, country cottage of James McGill (N.A.) 17 10 Title page, Statutes, Rules, and Ordinances of the Faculty of Medicine, 1832 (M.U.A., O.L.) 22

x Illustrations II Typical course and registration cards for the Faculty of Medicine (M.U.A.) 23 12 Course card in Chemistry for Frank Shephard 1870 (O.L.)

Signed by Robert Craik, M.D. 24 13 Medical degree of William Leslie Logic, M.D., 1833 (O.L.) 27 14 Title page, graduation thesis of William L. Logic, M.D., 1833 (O.L.) 28 15 McGill College, 1859

(N.A.)

30

16 Montreal from the Mountain, 1852

(N.A.)

31

17 Duncan Campbell MacCallum, M.D., 1882

(N.A.) 32

18 South side of Montreal General Hospital, 1848 (N.A.) 33 19 Ad for the Montreal School of Medicine and Surgery, 1843 35 20 Faculty of Medicine building, 15 Cote Street, 185172 (M.U.A.) 37 21 Annual announcement of the Faculty of Medicine, 1852-53 (M.U.A., O.L.) 42 22 Annual announcement of the Faculty of Medicine, 1870-71 (M.U.A., O.L.) 45 23 Lecture schedule for the Faculty of Medicine, 187071 (M.U.A., O.L.) 46 24 William Scott, M.D., 1867 (N.A.)

52

25 William Fraser, M.D., date unknown 26 Robert Craik, M.D., 1875

(O.L.)

53

(N.A.)

56

(N.A.) 55

27 Gilbert Prout Girdwood, M.D., 1882

28 Reverend William Wright, M.D., 1882 (N.A.) 29 }ohn William Dawson, B.A., 1862 30 Robert Palmer Howard, M.D., date unknown (O.L.) 61

(N.A.)

58

57

xi Illustrations 31 George Campbell, M.D., C.M., 1881 (N.A.) 62 32 George Fenwick, M.D., 1877 (N.A.)

63

33 Faculty of Medicine buildings, 1890 (N.A.) 66 34 William Osier, M.D., C.M., 1884 35 Microscope, 1874 (O.L.)

(O.L.)

67

70

36 Francis Shephard, M.D., C.M., 1882 37 George Ross, M.D., C.M., 1882

(N.A.)

(N.A.)

74

76

38 Lecture Schedule, Faculty of Medicine, 1880-81 (M.U.A., O.L.) 79 39 Thomas George Roddick, M.D., C.M., 1880 (N.A.) 40 Carbolic Acid Spray Apparatus

(O.L.)

80

83

41 Operation Using Carbolic Acid Spray (O.L.) 85 42 Frank Buller, M.D., 1882

(N.A.)

88

43 William Gardner, M.D., C.M., 1880 (N.A.) 44 George Major, M.D., C.M., 1882

(N.A.)

89

90

45 Alexander Dougall Blackader, M.D., C.M., 1882 (N.A.) 91 46 Plan of the new physiological laboratory, McGill College, 1880 (O.L.) 94 47 Title Page of Osier's Students' Notes on Normal Histology, 1882 (O.L.) 96 48 William Osier, M.D., C.M., 1881 (N.A.) 98 49 Robert Palmer Howard, M.D., 1880 (N.A.)

162

50 Thomas George Roddick, M.D., C.M. (O.L.)

172

51 Francis Shephard, M.D., C.M., 1924 (O.L.)

184

52 Richard L. MacDonnell, M.D., C.M., 1882

(N.A.)

End papers Composite of the Faculty of Medicine by William Notman and Henry Sandham, 1882 (N.A.)

187

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Abbreviations

A.F.I.p. - Armed Forces Institute of Pathology An. Ann. Fac. Med. - Annual Announcements of the Faculty of Medicine App. - Appendix B.M.J. - British Medical Journal Brit. Am. J. Med. Phys. Sci. - British American Journal of Medical and Physical Science Br. Am. Med. Phys. J. - British American Medical and Physical Journal Bull. Hist. Med. - Bulletin of the History of Medicine Can. Hist. Rev. - Canadian Historical Review Can. Lan. - The Canada Lancet Can. J. Surg. - Canadian Journal of Surgery Can. Med. J. &. Month. Rec. Med. Surg. Sci. - Canadian Medical Journal and Monthly Record of Medicine and Surgical Science Can. Med. Record - The Canadian Medical Record Can. J. Med. Sci. - Canadian Journal of Medical Sciences

xiv Abbreviations

Can. Med. & Surg. J. - Canada Medical and Surgical Journal Calgary Assoc. Clinic Hist. Bull. - Calgary Associate Clinic Historical Bulletin c.M.AJ. - The Canadian Medical Association Journal Deutsche Med. Wchnschr - Deutsche Medizinische Wochenschrift Dom. Med. J. - Dominion Medical Journal Golden/Roland - Golden, RL and Roland, CG Sir William Osier. An annotated Bibliography with Illustrations. San Francisco - Norman Publishing, 1988. J. Tech. Meth. and Bull. Int. Ass. Med. Mus. - Journal of Techniques and Methods and Bulletin of the International Association of Medical Museums M.D., C.M. - Doctor of Medicine and Master of Surgery Mc.M. - McCord Museum McGill Univ. Mag. - McGill University Magazine McGill Univ. Publications Series - McGill University Publications Series Mont. Gen. Hosp. Publ. - Montreal General Hospital Publications Montreal Med. Gaz. - Montreal Medical Gazette Mont. Med. J. - Montreal Medical Journal M.U.A. - McGill University Archives M.U.L. - McGill University Library Med. Rec. - Medical Record M.-B. Gov. - Minutes, Board of Governors of McGill University M.-Fac. Med. - Minutes of the Faculty of Medicine M.G.H. - Montreal General Hospital Med.-Chi. - Montreal Medical - Chirurgical Society M.M.I. - Montreal Medical Institution N.A. - Notman Photographic Archives

xv Abbreviations

O.L. - Osier Library Quebec Med. J. - Quebec Medical Journal Rec. Med. Surg. Sci. - Record of Medical and Surgical Science R.V.H. - Royal Victoria Hospital Statutes - Statutes, Rules and Ordinances of the Faculty of Medicine 1832 Revised 1843. Surg. Gyn. Obs. - Surgery, Gynecology and Obstetrics The Med. Chr. - The Medical Chronical W.O. - William Osier

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Preface

Seven years ago, while discussing McGill's present reputation in medicine as a research and teaching institution, we posed the question, What is the background for this tradition? We decided to investigate what was known of the history of the Faculty of Medicine, and found that no one from the faculty had written more then a chronology and that the last attempt was in 1902, when many of the extant archival materials were not available (this is not to discount Dr Stanley Frost's comprehensive history of McGill University published in 1980 and 1984, in which there is considerable information about medicine in general). Our investigations not only revealed greater detail in the chronology of events but also a broader vista of the evolution of medical thought and parallel educational events leading to the present tradition of scientific education at McGill. Our first goal was to describe the sequence of the faculty's development from 1829 to 1885. Archival materials for the years before 1860 were meager and biographical information lacking. Diligent searching of archival sources, however, has uncovered enough for us to reconstruct an account of the courses taught, the style of teaching, the facilities, customs, and even comments about the teachers. The archival holdings after the i86os are extensive and biographical material on the staff readily available so that we have included, particularly in chapters 3 and 4, increasing amounts of

xviii

Preface

information about the staff whose careers and accomplishments directly affected the teaching of students and house surgeons. In this manner we have expanded the chronologic theme by introducing the men who brought about change and the ways in which they did it. The second goal was to trace the evolving philosophy of medical teaching at McGill from the Edinburgh tradition of authoritative didacticism with passive student involvement to more education in science and a concern with efficient teaching. This gradual process of change involved increasing the role of the student in his own education in a learning-while-doing environment rather than solely in the lecture room. Third, we wished to provide reference information on the Faculty of Medicine from 182,9 to 1885 that is not easily accessible. This was done in two parts: ( i ) a listing of all medical graduates, members of the faculty with their positions and degrees, and academic prize winners to 1885, and an example of the oral examinations given by the Faculty of Medicine in 1854; and (2) a selection of biographical sketches of members of the faculty, which, in most cases, represent all that is known and readily available from the newspaper obituaries, eulogies in medical journals, and biographies in reference volumes and local histories. Although some are brief and not all provide information about medical and surgical contributions made by the individual while at McGill, all provide an insight into the men who taught in the faculty to 1885. This first volume covers the history of medical teaching and the development of the Faculty of Medicine from 182,9 until 1885, when the faculty acknowledged the need for renovation and expansion of facilities to provide laboratories for student use in the preclinical courses. By 1886 a new era of the faculty's educational history had begun. The second volume (1885-1930) traces the further development of pre-clinical and hospital facilities, greater student involvement in the basic subjects through World War One, and the subsequent shift in emphasis to teaching and research in the hospitals.

Acknowledgments

The extraordinary reference collections at McGill in the Osier and medical libraries, the university and the newspaper archives of the library, and the Notman Photographic Archives have been the primary sources of information. These resources were opened to us by many individuals. We want to give special credit to Professor Faith Wallis for finding the William Logic degree, which had been misplaced for almost twenty years, to the late Dr Edward Bensley for his remarkable memory and numerous suggestions on details, to Wayne Label for his research and willingness to help in the Osier Library, to Frances Groen who made valuable suggestions about the location of sources, to Gordon Burris, who supervises McGill University's archives, to Dr Phebe Chartrand, the intrepid archivist, for digging up original photographs and information about McGill and the Montreal General Hospital, to Brian Owens for his interest in helping in the initial stages of the writing, to Jane Kinglin and Rob Michel who helped with frequent archival requests, to Joan Rowe and her staff in micrographics, to Stanley Triggs, Curator of the Notman Archives, for details about the collection, to Nora Hague for locating photographs and knowing the remarkable collection, to Heather McNabb for her administrative excellence and finally to Tom Humphries for his expertise in photographing archival materials. How will we forget the tattered volumes carefully handled by Tom? We also owe thanks to Stephen Salmon of the National Archives of Canada for biographical spade work.

xx Acknowledgments

The readers are generally not given credit for their timeconsuming and difficult work. We are very much indebted to the late Harold Segall, M.D., C.M., who read two drafts and made important suggestions, to Professor Stanley Frost, the Director of the McGill History Project, who kindly read an early draft and made suggestions to clarify the text, to Mary Kennedy who also read and helped with revisions of the final drafts and a special thanks to Robert Fortuine, M.D., C.M., for editorial comments of great value. To Philip Cercone, Director of the McGill-Queen's Press, we owe a great debt for setting us on track about institutional histories, to Peter Blaney, Joan McGilvray, and Frances Rooney we owe a debt for helping us through the final stressful stages of the manuscript, and to Chris Hanaway, a Latin scholar, for an excellent translation of the Sponsio Academica. Financial support for two years for one of the authors (J.H.) came from the Hannah Foundation of the Associated Medical Services of Toronto, whose grant #276-48 and project approval allowed him to travel to Montreal numerous times during the first few years to work on details in the libraries and archives at McGill. Finally, we owe more than we can express to Joan Collins of the Department of Neurology at Washington University in St Louis, MO, and to Pam Best and Alice DePung whose knowledge of word processing made text revisions an adventure, and to the interest and editorial skill of Marcia Sweet. Richard Cruess, M.D. Joseph Hanaway, M.D., C.M.

Introduction

All truly great institutions owe their status to those who, having gone before, willingly made sacrifices for the future. Such were the founders of McGill who settled in an undeveloped country. They had faith in their ideals and were inspired to commit themselves to found a school to train physicians for Lower Canada. Students and staff alike struggled to accomplish the founders' ideals. Poor academic preparation of staff as well as students, inadequate facilities, and terrible winter weather conditions did not discourage stalwarts of this calibre or impede the survival of the Faculty of Medicine. Had it not been for the unshakable faith of a handful of Scottish-trained physicians, the Faculty of Medicine would surely have failed. The vision of these medical pioneers continues to guide the university. The initial years were a struggle to survive financially and to maintain the standard of education learned in Europe. Each of the original staff of the medical faculty had been educated in Edinburgh in the didactic tradition of teaching a fixed body of medical knowledge in the lecture room. We have no detailed information about pre-clinical or clinical teaching at McGill before 1832 since records were not maintained. We can, however, infer from secondary sources that didacticism persisted through this period and that students were taught mainly by lecture with only a smattering of the advanced science of the time. Lectures were given at the medical school as well as

xxii Introduction

the hospital. It is misleading to think that teaching was adequate in the hospital just because the founders opened the doors to allow students to examine patients because it simply was not. By the end of the i86os the didactic Edinburgh tradition was beginning to be questioned in light of the scientific progress in Europe. The status quo in the i86os and early 18705 was maintained by the medical staff of generalists, who felt that a broad approach to the accepted body of knowledge was the only sound course to medical practice. There were no specialists in clinical practice, and the concept of a full-time faculty member who was paid by the university to teach and do research did not exist. Students continued to learn in a passive way, listening to hours of lectures a day with no practical experience or participation except in the anatomy laboratory. In the hospital a similar situation existed, with students more or less witnessing staff physicians' attendance and surgical procedures at a distance. Although this was the tradition of Edinburgh, passed on to McGill, medical education in France and Germany was influenced by what was, in the i86os, newly established medical science. The men who were contributing to this scientific revolution in Europe emphasized objective evidence of disease correlated with pathology. This was obtained either on the ward with better examination techniques or microscopically or by chemical analysis in the autopsy room or laboratory. On the ward, inspection was being replaced by more thorough examination aided by the techniques of palpation, percussion, and auscultation. Specialization, initially considered a compromise and a narrowing of academic focus, by the 18705 was recognized as an efficient way to acquire substantial knowledge of a subject. The McGill staff of that decade established that students could learn the expanding volume of medical information only if changes were made to make the system of teaching more efficient. Henceforth new faculty appointments were of candidates who had received practical instruction in the clinical and pre-clinical sciences in Europe and had experience in the practical instruction of students in the laboratory setting. The teachers who transformed pre-clinical teaching did so by exposing students to laboratory work where scientific concepts were learned more efficiently. Teaching on the ward, however, seriously lagged behind that in the medical school and had progressed little in the previous decade.

xxiii Introduction

The needed reform took place in an unforced way under the influence of a brilliant group of recently trained staff who introduced the European advances to the faculty. The credit for initiating the changes goes to William Osier, Francis Shephard, George Ross, and Thomas Roddick, whose prodigious energy and modern thinking in their specific subject areas convinced the faculty of the need for fundamental reform in medical education at McGill. This required discarding the founders' traditions of didacticism and passive student involvement and adopting greater participation by students in laboratories and in the hospital. It took many years to accomplish this goal, and by 1885-86, when laboratory facilities were finally available in the new addition to the medical school, the idea had taken hold. By the i86os the faculty was sufficiently established so that financial and enrolment concerns began to give way to questions of matriculation and graduation standards. The latter were of concern because secondary school students in Lower Canada at that time had little or no scientific training to prepare them for medical school. Students received instruction in the classics, English, history, languages, and some mathematics. This situation existed in the United States and Canada for decades until pressure from the universities eventually persuaded the educational establishment to improve the quality of secondary education. McGill's Faculty of Medicine was the only higher education available in Lower Canada from 182,9 to 1843, when the undergraduate college opened. Because the evolution of secondary education was independent and a very slow process, changes at McGill were made by instituting the matriculation requirements used in Great Britain setting definite secondary school course requirements for entrance. McGill, being a proprietary school, depended entirely on tuition for running costs, so that it is not certain how strictly it adhered to these standards. On the one hand, while there was no hindrance to increasing the difficulty of the pre-clinical courses, such as in anatomy and histology, for fear of losing students because McGill had no competition, students were needed for the income, and one senses that few applicants who could read and write were turned away despite the standards published in the annual announcements. Graduation standards did not change for many decades.

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McGill Medicine The First Half Century, 1829-1885

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i The Founding of McGill University and Its Faculty of Medicine

The story of McGill University began indirectly in iSoi. 1 The Provincial Parliament of Quebec, bowing to mounting pressure from educational reformers such as Jacob Mountain, the first Anglican Bishop of Quebec, established the Royal Institution for the Advancement of Learning for the care of Protestant schools of royal foundation and institutions of higher education in the province. It was a paper concession designed to appease Mountain, James McGill2 (fig. i), and other Protestant leaders. Unpopular in the predominantly Catholic province, the Royal Institution was set up so that, if backed by the government, it could promote, supervise, and establish a system of Protestant education in Quebec. The government, however, had limited intentions for the Royal Institution, which had no charter, board of directors, or funding. James McGill, a shrewd and successful businessman who valued education, deplored the fact that many wealthy men died in Montreal without financially benefitting the community. A friend, the Reverend John Strachan, often mentioned to him Lower Canada's urgent need for a university. McGill knew that the Royal Institution's hopes, if left to the provincial government, were small. Influenced by Strachan's suggestion, McGill in 1811 bequeathed his property, Burnside, of approximately forty-six acres worth £5,000 and another £10,000 for the endowment of a university to bear his name. He stipulated that the university be

4

McGill University and Its Faculty of Medicine

Figure i The Honourable James McGill, 1744-1813. This portrait, by Louis Dulongpre, hangs in the McCord Museum.

established within ten years of his death; otherwise, the property and money would revert to his wife's children.3 In so doing, he showed his clear understanding of the inactivity and potential political opposition of the provincial government. Despite his perceptive and timely bequest, McGill included a disastrous clause in the will which resulted in a protracted legal battle and delay by his son-in-law, Francis Desrivieres. The clause allowed

5 The Founding

Desrivieres to occupy the house with its lands and revenues until a college was erected. Desrivieres, a devious and clever individual, with evasive correspondence and planned delay, continued to live in the house for almost twenty-five years, fifteen years longer then his father-in-law had intended. McGill died December 19, 1813, in Montreal.4 Now that the money was bequeathed to establish a university, it took heroic efforts on the part of Reverend John Strachan, an executor of the will, to oppose the Desrivieres family's refusal to acknowledge the intent of the will. Francis Desrivieres, who in 1819 was enjoying a higher standard of living than ever before, considered himself safe, reasoning that if he held on to his father-in-law's Burnside property, for four more years it would revert to him through provincial government inaction. He underestimated John Strachan, however. Strachan and other McGill supporters achieved incorporation of the Royal Institution and a board of governors in 1819, and in 1820 the McGill executors acted again and went to court to secure the McGill bequest and to force Desrivieres to vacate the McGill estate. On March 31, i8n 5 the Royal Institution obtained a charter for McGill University from King George iv which nominally established the university but no statutes, students, or staff. Inactivity unfortunately set in again for a few years: in October 1822, the court of the King's Bench declared in favour of the Royal Institution, but Desrivieres appealed to the Privy Council in London, thereby delaying the inevitable. The Royal Institution, to bolster its case that McGill College existed, in 1824 requested that the governors appoint a principal and four professors as outlined in the royal charter. There not being a plethora of qualified university professors in Lower Canada, the governors named four men of good reputation who agreed to accept the appointments. The principal was George Jehosaphat Mountain, an Anglican archdeacon and son of the president of the Royal Institution. Three other Anglican clergymen were named, C. T. Wilson as Professor of Mathematics and Natural Philosophy, John Strachan as Professor of History and Civil Law, and Joseph L. Mills as Professor of Moral Philosophy. The Professor of Medicine was Thomas Farques, M.D., a Quebec City physician educated in Edinburgh.6 This was a faculty in name only because none of them lived in Montreal, they were not to be paid, and there was no facility for student teaching.

6 McGill University and Its Faculty of Medicine

In iSiS7 the Privy Council finally declared in favour of the original judgment granting the Burnside estate to the Royal Institution. The principal, the Reverend G.J. Mountain, eventually persuaded the board to lay claim to the property one year later in June 1829, but not until an extraordinary bit of luck occurred that led to the inauguration of the university. Fortuitously, a small medical school had been in existence since 1823, the Montreal Medical Institution, which was to become the first faculty of McGill University. To understand the origin of the Montreal Medical Institution, we must go back to 1817. Montreal's population had grown to 20,000, and despite the apparent intention of the authorities to establish Protestant education similar to that in Ontario, in reality, schools and even hospitals were adapted almost exclusively for the French-speaking Catholic population. With the end of the War of 1812 and European wars by 1816, influx from the British Isles increased, bringing large numbers of working-class migrants to Montreal. Five thousand immigrants reached the city in 1816. In 1817 a local crop failure added to the economic depression of Lower Canada and to the problems of these immigrants. Many displaced and desperate immigrants who came to Canada were forced by the 1817-18 winter to stay in Montreal under bad hygienic conditions. Famine also threatened. In response to this suffering, with money raised by public appeal and the Prostestant clergy, the Female Benevolent Society (F.B.S.) S of Montreal formed a welfare organization in 1815 to provide food, education, and health care for these unfortunate people. To cope with the health problems of the immigrants, in 1818 the society rented a four-room cottage, the House of Charity (later called the House of Recovery) (fig. 2), in the Recollet suburb9 near the present Chaboillez Square for the care of Protestant indigent immigrants who could not be treated in Catholic institutions. The army donated straw bedding, and Dr T.P. Blackwood,10 a retired military surgeon, donated his services to get the institution started. The Hotel-Dieu, the first and largest hospital in the city, accommodated only thirty patients. Its staff could not manage the increasing numbers of requests for admission and by 1817 it would not take fever patients.11 According to the third annual report of the society, thirty-seven patients were treated in 1818, which was considered a great

7 The Founding

Figure 2 The House of Recovery in the Recollet suburb of Montreal, 1818. The centre building is presumably the hospital.

success. Stimulated by this, in 1819 a group of citizens headed by John Molson, Sr, submitted a petition to the provincial government12 for funds for the establishment of an English public hospital: To His Grace the Duke of Richmond, etc., the petition of the subscribers, inhabitants of the City of Montreal, Lower Canada, Humbly Sheweth: That the present hospital for the sick attached to the Hotel-Dieu in this Town is capable of containing only thirty patients, and the inconvenience arising to the nuns from their constant attendance on the sick, and the inadequacy of their funds for that prupose, renders some remedy for this evil absolutely necessary,- and by an order of the superintendent of 1817, which excluded all cases of fever of whatever denomination from being admitted, the advantages resulting from this Institution are necessarily extremely limited: That the rapid increase of population in this District (it being at least doubled within the last ten years), the strong tide of emigration that has extended itself to Canada, and the increased number of sick naturally attendant on such causes, imperiously call for some asylum where they

8 McGill University and Its Faculty of Medicine may receive that aid and relief their impoverished and unsheltered condition urgently demand: That of those emigrants who have lately arrived in this District there are at present upwards of two hundred sick, destitute of every comfort and almost of every necessity of life, who are solely dependent for medical assistance on the humanity of the Medical Gentlemen of the town, whose professional aid must be in a great measure rendered nugatory, from the destitute and helpless condition these poor people are at present in. Besides, from their being scattered in miserable hamlets about the town, exposed to every inclemency of weather they cannot receive that attention they otherwise would, were they collected in an establishment for the purpose. That the attention of the Honorable the House of Assembly was directed to a similar object some years ago when the sum of eleven thousand pounds was voted for erecting a public hospital in Montreal, an establishment of the kind, adequate to meet the numerous demands which would be made upon it from this populous District would require to be capable of containing at the least two hundred patients: That your petitioners have presumed to bring this subject again under your consideration, and humbly solicit that you would be graciously pleased to direct such sum or sums as in your wisdom you may think proper, to be appropriated for the erecting and endowment of a public Hospital in this city. The petition would probably have passed the assembly had it not run into religious and a political opposition. When the floor debate started an Irish attorney Michael O'Sullivan denounced the proposal of the English Protestants. O'Sullivan, an Irish Catholic, unfortunately let his religious bias from the old country influence his opinion and objected to John Molson's petition purely along religious lines. O'Sullivan criticized the petition strongly, objecting to the idea of an English Protestant hospital, and felt that the money requested should be given to expand the Hotel-Dieu. He compared the nursing care offered by the sisters at the Hotel-Dieu to that of the nurses at the proposed hospital, referring to the latter as mercenary hirelings. The bombastic O'Sullivan overstepped propriety when he suggested that the proposed teaching of students in the English hospital would be a fatal decision. The four doctors who supported the proposal and most of the supporters were irate. William Caldwell (fig. 3), one of the senior physicians, was so

9 The Founding

Figure 3 The founders of the Montreal Medical Institution. Upper row, left to right: John Stephenson, M.D., 1794-1842; William Caldwell, M.D., 1782-1833. Lower row, left to right: William Robertson, M.D., 1784-1844,- Andrew Fernando Holmes, M.D., 1798-1860.

upset that he wrote an unsigned rebuttal in the Canadian Current, April io; 1819, in which he denounced O'Sullivan's statements and referred to him as a coward.14 O'Sullivan demanded the name of the author which he was given and challenged Caldwell to a

io McGill University and Its Faculty of Medicine

duel on He Perot at Windmill Point at the west end of the island of Montreal the following morning.15 As was the custom of the time, the opponents faced each other at a set distance, ready to fire their pistols at a signal. The lead balls were one ounce. Although O'Sullivan and Caldwell wanted to harm each other, their aim was so bad that they exchanged five shots each missing the mark except the last. On the fifth shot, Caldwell was struck in the right arm where he suffered a fractured bone and O'Sullivan was struck in the right side of the chest by a ball that penetrated to the spinal column. The issue between them was satisfied and both miraculously survived to live many years. Caldwell's right arm remained stiff and weak until he died of cholera in 1833. O'Sullivan carried the ball and experienced chronic pain until he died many years later, when an autopsy revealed its location. Despite O'Sullivan's protest, public support in Montreal grew, and a group of businessmen led by John Molson built this into a commitment to establish the hospital. They initially leased a large building in the city on Craig Street, two doors east of St Lawrence, which accommodated twenty-four patients. The institution was ambitiously called The Montreal General Hospital, and the first house surgeon was John Stephenson, M.D. (fig. 3), a recent Edinburgh graduate who was to play an important role in the future of McGill University. The hospital opened on May i, 1819. These small steps were the beginnings of the Montreal General Hospital, eventually leading to the Montreal Medical Institution, which was to become the first faculty of McGill University. The success of the fledgling hospital was attested to officially in the minutes of the last report from Craig Street in i82i:16 "The Directors seeing the benefits thus resulting from the institution and finding that the limits of the establishment were inadequate to the necessities of the populous district proposed in the course of last winter to continue it on a more extended scale."17 The foresight and philanthropy of the Montreal community now became apparent. Money was raised in a single month, in 1820, to purchase property on the southeast corner of Dorchester and St Dominique streets. A further private subscription was sought for the hospital and over £i,2,oo18 was raised to construct a building on the Dorchester Street site (fig. 4), where it remained until I955, 19 when it moved to its present location on Cedar Avenue on the south side of Mount Royal. The cornerstone of the old hospital was laid in 1821,20 and one year later21 the doors

ii The Founding

Figure 4 The original Dorchester Street building of the Montreal General Hospital, opened for patients in 1822. (1826 sketch by J.P. Drake)

opened to the first part completed, with seventy-two beds (fig. 4), which had cost £5,856 8sid. A charter was granted in January 1823, at which time there was a staff of five: William Caldwell, William Robertson, Andrew Holmes, John Stephenson (fig. 3), and Henry P. Loedel.22 Loedel resigned before the school opened and died the following year. When the staff of the Montreal General Hospital began to solicit support for a hospital, they hoped to establish a medical school in which students would be taught. Doctors Holmes and Stephenson, who returned to Montreal after their overseas study in 1820 and 1821, were especially eager to teach, having been trained in Edinburgh. Stephenson in particular felt the absence of the stimulating culture and medical society he had previously experienced in Edinburgh, London, and Paris to such a degree that

12 McGill University and Its Faculty of Medicine

Figure 5 The first an ouncement of medical traning at he Motreal General Hospital, submit ed August 9,182 ,ap eared in the Montreal Gazet e on August IO. he resolved to devote himself to the development of higher education and cultural development in Montreal.23 One can sense how the two young graduates, Holmes and Stephenson, together with the older men, Robertson and Caldwell, could unite in their resolve to establish medical education at the general hospital much as it was at the Royal Infirmary in Edinburgh. The initiative to teach students, according to the minutes24 of the hospital board, was that of John Stephenson, who offered to advertise lectures to be held at the hospital in anatomy, practical anatomy, surgery, and physiology. The advertisement first ran in the Montreal Gazette on August 10, 1822 (fig. 5), and lectures commenced two months later.25 Doctors Holmes and Stephenson were then appointed by the hospital board in October26 to investigate the feasability of establishing a permanent medical school, and their proposal27 was submitted on November 2 to Lord Dalhousie, the Governor-General of Canada.28 The plan was enthusiastically approved. The first public announcement was made February 15, i82329 of the intent of the staff of the Montreal General Hospital to deliver lectures on medical subjects in a separate medical institution. Class sessions were first held during 1823-24, and although there is no official record preserved of that year, the course schedule

13 The Founding

Figure 6 The first advertisement for the Montreal Medical Institution appeared in the Montreal Herald on October n, 1823, and in the Quebec Gazette (above) two days later.

was advertised widely in the fall of 18233° announcing the subjects to be taught at the institution (fig. 6). The second session of the Montreal Medical Institution the following year, opened with twenty-five students.31 The first building was at 20 St James Street (fig. 7), 32 a long block east of Place d'Armes. From this location (1824-29), the school moved to a larger site at the west end of the old Bank of Montreal. A.H. David, M.D., in his reminiscenses published in i882, 33 described the building as extending from Place d'Armes to Fortification Lane on a lot just west of the old Bank of Montreal building. The front entrance was on the square and the anatomy laboratory and rear entrance on Fortification Lane. The Montreal Medical Institution (fig. 7) and McGill College by 1828 faced legal challenges that threatened their existance. The Governor General, in response to an 1826 petition for a charter, declared eighteen months later, through the solicitor general, that the medical school could not grant degrees to qualify its candidates for a license to practice medicine or have any legal existence until it was formally associated with a higher seminary of learning (a college or university) and had an endowment.34 The Governor General, who had initially been in favour of establishing

14

McGill University and Its Faculty of Medicine

Figure 7 The Montreal Medical Institution, 20 St James Street, near Place D'Armes, 1824. (Sketch by Dr James C. Simpson)

the school in 182,2, indicated by this ruling that the government intended to set strict standards for the establishment of medical schools. The legislature was apparently aware of the proliferation of "quackery," and hoped to address this problem by requiring university affiliation and an endowment for all schools seeking to grant medical degrees. For the times this was a relatively enlightened attitude. Failing a personal appeal to the legislature for recognition in 1828, the officers of the Montreal Medical Institution (fig. 8) wrote to Sir James Kempt, the Administrative Director, suggesting that "the appointment of members of the said institution as professors of the university to be established at Burnside, near the city, one of the colleges of which is established by Royal Charter, dated March 31, 1821, and called the McGill College."35 In June, 36 with a charter, a principal, and faculty, and despite the Desrivieres appeal to the Privy Council, the Royal Institution was finally granted the bequest of James McGill of the Burnside property. Thus the Royal Institution could now accept the offer of the Montreal Medical Institution, which according

15 The Founding

Figure 8 The final advertisement for the Montreal Medical Institution (Montreal Gazette, October 27, 1828). In June 1829 it became the Medical Faculty of McGill University.

to government requirements could now be associated with a university. A second suit had been entered by the McGill executors for the endowment funds given by James McGill to the Royal Institution for the establishment of the college, but this was not settled until 1837.37

2, The Faculty of Medicine, 1829-50: The Formative Years The hardest conviction to get into the mind of a beginner is that the education upon which he is engaged is not a college course, not a medical course, but a life course, ending only with death, for which the work of a few years under teachers is but a preparation.1

After acceptance of the proposal of the Montreal Medical Institution by the Royal Institution to become a faculty of the college, it was decided to open as soon as possible to strengthen McGill's position in its appeal for the endowment funds. The governors agreed that the official opening would be on the afternoon of June 24, 1829, and that it would be duly advertised in the press. Invitations were sent to prominent citizens of the community and the meeting was held in the largest room of the Burnside estate of James McGill (fig. 9) in the northwest outskirts of the city (fig. 10). Principal Reverend George Jehosaphat Mountain presided at this historic first meeting of the governors of McGill to open the college and inaugurate teaching. The proceedings were reported at length in the Montreal Gazette.2 After the formal opening ceremony establishing the college and the Faculty of Arts, the gathering dispersed. The governors met later in the afternoon with the members of the Montreal Medical Institution, who presented their plans: The public business having been closed, the Governors of the Corporation held an interview with the members of the Montreal Medical Institution, who had been requested to attend the meeting for that purpose. During the interview it was resolved by the Governors of the Corporation that members of the Montreal Medical Institution (Doctors Caldwell, Holmes, Robertson and Stephenson) be engrafted upon the college as its medical

iy The Formative Years

Figure 9 "Burnside Place," James McGill's country cottage, as drawn by W.D. Lambe in 1842. The house, near the burn, or creek, on his property, was south of the present site of the Roddick gates and approximately halfway between Sherbrooke and St Catherine Streets. Burnside Street, now deMaisonneuve, was named after McGill's cottage.

faculty, it being understood and agreed upon by and between the said contracting parties that, while the powers of the Charter would be altered one of their number only should be a university professor and the others lecturers; that they should immediately enter upon the duties of their offices. All of which arrangements were agreed to. June 24, i829. 3

This auspicious event established one of the first colleges (The University of McGill College) and the first university medical school in Canada. The teaching staff of the Faculty of Medicine in 1829 consisted of four intrepid Edinburgh University-trained physicians: William Caldwell, M.D. (1782-1833), William Robertson, M.D. (1784-1844), John Stephenson, M.D. (1797-1842), and Andrew Fernando Holmes, M.D. (1797-1860) (fig. 3). William Caldwell, the oldest, was born in Scotland and educated at Aberdeen and Edinburgh universities. William Robertson, also Scottish, was born in Perthshire and received his M.D. at

18 The Faculty of Medicine, 1829-50

Edinburgh. Both emigrated to Canada to practise medicine, while Holmes and Stephenson, Montrealers, went to Edinburgh for medical education. All four had attended the institution considered the most advanced medical school in Great Britain during the first quarter of the century. Their training, therefore, eminently qualified them to practise medicine in Montreal and to establish a medical school. The Edinburgh University influence on medical education at McGill can be traced to Giovanni Battista Da Monte (Montanus) (1498-1552) of Padua, one of the fathers of clinical medicine.4 Montanus restored the Hippocratic tradition of teaching at the included, particularly in chapters 3 and 4, increasing amounts ofincluded, particularly in chapters 3 and 4, increasing amounts o the patient's condition rather than elaborate theory without observation was the only way to determine a patient's illness. Andreas Vesalius taught anatomy at Padua in the mid-sixteenth century and published his landmark atlas, De Fabrica Corporis Humani, in 1543. The school thus became renowned both for clinical and anatomical teaching. This custom was carried to Ley den by Johann Heurnius (15431601) and later by his son, Otto, but Franciscus de la Boe or Sylvius (1614-72) firmly established ward teaching. Herman Boerhaave (i668-i738) s followed his predecessors with an unusual genius for teaching and writing which further established bedside teaching in medicine. He restored the patient as the main focus of the bedside examination with later consideration of the theories. This approach attracted physicians from all over Europe and North America, including John Rutherford (1695-1779), one of the founders of the Edinburgh University School of Medicine (1726). William Cullen (1710-90), also a student of Boerhaave, later established clinical medicine and bedside teaching at the Royal Infirmary in Edinburgh. In addition, strong traditions of anatomy and physiology were established in Edinburgh and the "Institutes of Medicine" was established based on Boerhaave's famous work, Institutiones Medicae.6 It was this "Edinburgh Tradition" of medical education, that Holmes, Stephenson, Robertson, and Caldwell brought to Montreal in the 18205. These men, convinced of the value of examination of patients at the bedside, opened the doors of the Montreal General Hospital to the students for this purpose and allowed them to enter the wards to see patients without staff

19 The Formative Years

attendance. The patients were to be assessed by history and observation, but student involvement did not extend to any role in patient management. McGill medicine was, in essence, a clone of Edinburgh in the New World. Although details about the actual courses are lacking until 1832,, the schedule can be outlined from reports published in the newspapers in 1823 (fig. 6). Teaching was by lecture almost exclusively and students, depending on their year, spent four to seven hours per day listening to didactic presentations. Many students came for one or two years and only a few completed the course to qualify. Since five years of training was required by Quebec to get a license to practise medicine without further examination, the school did not seek permission to officially grant a degree until 1831. In October i83i 7 , a memorandum was sent to the legislature requesting permission, under the Royal Charter, to grant degrees to the candidates who had fulfilled the requirements of the medical school. A week later8, the solicitor general notified the university that according to the charter it must first receive royal sanction of its Statutes, Rules, and Ordinances.9 Without wasting time10 John Stephenson presented the "Statutes" to the authorities in Quebec City to be sent to London. Royal sanction was granted11 in unprecedented time, and the reply received July 23." As evident by the front page of the Statutes, they were not passed by the governors of McGill until a meeting in February 1832, an obvious formality because they had been sent to London the previous November. Stephenson took a major role in getting the Statutes accepted and in many other faculty functions. In recognition of his leadership he was appointed registrar of the faculty in 1833. Good fortune has preserved a few copies of the 1832 Statutes, Rules, and Ordinances in the McGill Archives (fig. 10). This extraordinary document is a clear statement of the duties of the staff, length of the school year, frequency of lectures, the courses to be taught, the attendance requirements for the hospital, and requirements for graduation. Under the Statutes the student applying to McGill in the 18305 had to be at least nineteen years old in order to reach the graduation requirement of twenty-one years or older. Once officially registered, he was required to obtain course tickets from the individual teachers (fig. n) at a cost of £3

Figure 10 Title page of the Statutes, Rules and Ordinances of the Faculty of Medicine, 1832.

Figure n Typical course and registration cards used by McGill students for course and hospital attendance.

22 The Faculty of Medicine, 1829-50

(Halifax Currency) per course and £3 155 for anatomy and chemistry. The initial year would be spent studying anatomy and physiology, chemistry and pharmacy, materia medica and therapeutics, and the institutes of medicine.13 This was the first real scientific education most of the students had had in Lower Canada beyond the classics, languages, and history. Nevertheless, from this unsophisticated beginning, many important medical educators later emerged. The student, after starting classes, had to have the course tickets countersigned within three weeks to be valid at the end of the session. There is no ledger of recorded marks in the archives for this time,14 but examination attendance was required for ultimate course credit. If not from Montreal, the student had to find lodging downtown as near the school as possible at the cost of approximately $8.00 to $16.00 per month for room and board.15 He had to be prepared for an arduous winter of trudging about the city in deep snow as classes commenced the first Monday of November, at which time winter weather was usually beginning. Each student had to obtain a matriculation ticket (fig. 12) for zos from the registrar and have his name, address, religion, and age recorded in a register. The first student to meet all the faculty's requirements, including five years of course work, was William Leslie Logic, who graduated and was granted a degree of Doctor of Medicine and Surgery on May 24, 1833 (fig. 13). l6 Being the first physician to graduate from a Canadian medical school and one of the first university graduates in Lower Canada, the local press treated this event with appropriate attention.17 Logic, born in Montreal in i 8 i o o r i 8 n , matriculated as a first-year student in the Montreal Medical Institution in the fall of 1828. When a year later this institution became the Faculty of Medicine of McGill, Logic became a McGill student. After studying five years as required by provincial statutes, he passed his exams, submitted his thesis on the croup or Cynanche trachealis (fig. i4J 18 and was recommended for a degree by the faculty. The ceremony, reported by the Montreal Gazette and the Canadian C our ant, was held in the museum of the Natural History Society of Montreal on St James Street in the block east of Place d'Armes. The Honourable James Reid, Chief Justice of the District of Montreal, presided, and Dr William Robertson represented McGill in the absence of Principal Mountain. The room was

23 The Formative Years

Figure 12 A course card used by Frank Shephard when he was a first year medical student (1869-70). The card is signed by Robert Craik, M.D.

crowded with Protestant clergy, members of the legislature, the bar, and the Catholic Church, and several ladies. Formal speeches were given, and the academic robes worn by the staff and Dr Logic added a solemnity to the historic event. After receiving his degree, Logic submitted his qualifications to the Medical Board of Examiners of the District of Montreal for a licence to practice medicine but was refused without further examination. Logic, having legitimately fulfilled the requirements of the medical board, was caught in a political skirmish between the board, which was hostile to McGill, and the medical faculty. This was eventually resolved in court in his favour in i83419 when the board was ordered to grant him a licence.20 The board, however, did not conform to the judgment until one year later,21 by which time Logie had moved to Louisiana where he could speak French and

24 The faculty of Medicine, 1829-50

where he obtained a licence to practise medicine in January 1834. Vindication did not lure him back to Montreal for the license he so justly deserved; he eventually did move to Geneva/ New York, in 1850, where he died22 in i879. 23 The withholding of Logic's licence was purely political. The board was a non-McGill group of reformers and French-speaking physicians who objected to McGill's influence in Lower Canada.24

25

The Formative Years

Figure 13 William Leslie Logie's handwritten degree of Doctor of Medicine from McGill, 1833, the first medical degree in Canada. The original document hangs in the dean's office at McGill. On the back of the degree are statements attesting to Logie's qualifications from the secretary of the faculty and from William Robertson.

The decision to refuse Logie's request for a license, was arbitrary, made despite the law and simply to prove a point. The challenge to the medical board brought by William Logic, in addition to exposing an unsavory political conflict between the board and McGill, also revealed areas of possible misinterpretation in the medical act and the McGill statutes which allowed such arbitrary decisions. Considering the controversy over Logie's request for a licence without further examination, the faculty at McGill was threatened before the problem was resolved.

Figure 14 Title page of William Logic's graduation thesis from McGill, 1833.

27 The Formative Years

Article 6 of the provincial Medical Act of 1831 exempted from the board's examination all those already licensed as physicians and surgeons or those holding degrees from a university or college provided that the degree had been obtained from said university or college in conformity to the rules of those institutions and after a minimum of five years study.25 There was a question whether all five years had to be spent at one institution. Logic, technically speaking, may have been at fault because he spent only four years at McGill and one at the Montreal Medical Institution. A second and more controversial provision required that the diploma conferring the degree be produced and verified "to the satisfaction of the board." This gave enormous power to the board to reject a diploma because "satisfaction" was not defined. It is obvious that the board was being overly technical in obstructing Logic's rights and was not concerned with his status as the first graduate from a Canadian medical school. The McGill statutes (Chapter II, Statute 4) 26 stated that students must attend lectures for three years and the hospital for two years. Unless done simultaneously, the primary subjects and hospital attendance done in sequence would require five years. In contradiction, Statute 6 stated that any person who attended two years of lectures at another recognized medical school could enrol at McGill College, attend one full course of lectures, thus completing the required period of study, and be eligible for a McGill medical degree after three years. The board raised the statutory conflicts in its defense, but the judge ruled against the board. The conflict was resolved by McGill's closing during the years of the open rebellion against the anglophone establishment from 1836 to i838 27 and the expiration of the provincial Medical Act28 in May 1837, which dissolved the medical board. The new medical board, dominated by McGill faculty members when McGill reopened in 1839, made sure that graduates no longer were denied licences.29 There exist virtually no archival records for the Faculty of Medicine available between 1833, when Logic graduated, and 1843, except for a list of graduates, a few letters, and the graduation program from 1841. The enrolment remained the same (at about twenty-five students); three candidates graduated each in 1834 and in 1835 (see Appendix i) and four in 1836. The

28 The Faculty of Medicine, 1829-50

handwritten order of graduation ceremonies of 1841, a letter recommending three candidates for degrees, and an oath to be read by each graduate (Appendix i) have been preserved and provide an insight into the unpolished spirit of the times. There is no record of the content of medical and surgical training during this period. We assume that ward teaching was poor and that despite Laennec's development of the stethoscope and his pioneering book of i8i9 3 ° correlating clinical findings and chest pathology, this type of bedside examination was still not being used at McGill. On examining the 1843 Revised Statutes, it is clear that the standards set forth in 1832 had been maintained. The same courses were taught five days a week for six months and had to be taken for two years.31 A major change in the Statutes32 allowed a graduate to be eligible to practise in Quebec only after three years study - all or partly at McGill - with one year instead of two required at the Montreal General Hospital. By 1849, however, the importance of a second year of clinical training again became apparent. This was instituted by the faculty without fear of losing student enrolment, a problem which commonly interfered with progress in medical education in major schools in the United States.33 Medical lectures at McGill were given at 20 St James Street from 1829, when the Montreal Medical Institution became the Faculty of Medicine of McGill College until 1841, when the faculty moved to a building on the west side of St Georges Street, three doors north of Craig Street. When the school reopened in 1839 with increased enrolment, the cost of operating the faculty had increased; it was in need of £500 from the governors of McGill. The money was voted by the governors, who essentially approved the request with no funds. Turned over to the Royal Institution, the appeal failed to gain support, again because of lack of funds; it was further refused by the provincial authorities on technical grounds. Undaunted, the board of the Royal Institution and the McGill governors resubmitted a request for funds to the provincial government to support its medical school. The request was successful in that from 1841 £250 to £500 a year were granted.34 By 1845, however, the faculty needed more funds from McGill, but the Royal Institution refused. Chronic financial problems probably forced the move west to St

29 The Formative Years

Figure 15 McGill College, 1859. Principal Dawson planted the elm trees along the front drive between 1855 and 1859.

Georges Street in 1841 and definitely forced the move to the newly completed McGill buildings (1843) in 1845 where the school had rent-free quarters. The buildings at McGill consisted of the Arts Building as we know it today and a separate east building now known as Dawson Hall (fig. 15). The main building had been constructed in part for

3O The Faculty of Medicine, 1829-50

the Faculty of Medicine with at least two lecture rooms and a separate anatomy dissection room. An attempt was made to expand this space during planning and construction, but few concessions were made, so that the faculty did not move until forced to by need in 1845. The buildings were surrounded by open fields on three sides, and the only approaches were by a central drive from Sherbrooke Street (figs. 15 and 16) and by a road on the east side of the grounds near the present University Street (fig. 16). During winter, the roads to McGill were frequently snowbound because of drifts and poor snow removal. On occasion, roads around the college and in the city were impassable, making attendance to the classes so difficult that they were cancelled. Despite the miserable conditions in winter, this happened rarely. The necessary move from downtown to McGill by the Faculty of Medicine eased the financial burden on the school but created enormous inconvenience for students and staff who had to struggle to the college in the morning and back and forth to the hospital (fig. 16). The early morning lectures, the noon trek to the hospital, and the late evening dissections in the anatomy laboratory were impositions to which even the heartiest objected. The only remaining description of the facilities and trials of medical students at McGill prior to 1860 is D.C. MacCallum's (fig. 17) vivid account of his days as a medical student from 1847 to i85o. 35 He recalled that the medical lectures were given in the Arts Building and the clinical lectures in the operating room amphitheater at the hospital. Chemistry was taught by Professor Hall in a building on Fortification Lane known as Skakel's School.36 In 1849 William Sutherland was appointed Professor of Chemistry and taught his course temporarily in the Mechanics Institute on St James Street. The arduous school day began at 8 A.M. with midwifery in an unheated lecture room in the Arts Building. The students generally lodged below Dorchester Street, far away from the college, because there was no nearby housing (fig. 16). There is a romantic story of Professor Michael McCullough, who drove to his lectures in a large sleigh and was so sympathetic with the students that he frequently would pick up as many as his horse would draw;37 students would be hanging off the side of the sleigh and standing on the runners.

Figure 16 Montreal from the mountain, 1852. McGill's two buildings can be seen in the foregound, with James McGill's Burnside Place in the centre of the drawing, below Sherbrooke Street. Drawn by E. Whitfield, 1852, lithography by Endicott & Co., New York.

Figure 17 Duncan Campbell MacCallum, M.D. Professor of Clinical Surgery, 1856-60, Clinical Medicine, 1860-67, and Midwifery and Diseases of Women, 1868-83. Photo by William Notman, 1882.

Y South side of the Montreal General Hospital before 1839. The east, or Richardson, wing was finished in 1832. (N. Bosworth, ed., Hotchelaga Depicta. Montreal: Wm. Craig, 1839)

Students attended morning lectures from 8 to 12 o'clock and then went to the Montreal General (fig. 18) for the clinical lectures and hospital work, returning to McGill by 2:00 P.M. for lectures that lasted until 8 P.M. The walk from the college to the hospital was on crushed limestone roads which were frequently muddy, incredibly dusty in good weather, and poorly plowed in winter. To make hospital visits, eat lunch, and walk back in two hours was impossible on Tuesdays and Saturdays, when clinical lectures were given at the hospital from 12 to i P.M. This unreasonable and impractical arrangement frustrated many potential students. To the five to seven lectures per day for the first and second year students was added the dissection time in anatomy in an unheated, unventilated, and poorly lit dissecting room. Although the dissecting room was open from 8 A.M. to 10 P.M., the only available time for some students was at night. MacCallum was Prosector in Anatomy during a great part of the academic year of 1847 to 1848, and he described making demonstrations by

34 The Faculty of Medicine, 1829-50

candlelight in the company of partially dissected cadavers and numerous rats coursing in the walls and on the wooden floor of the dissecting room. The squealing and thumping in the foulsmelling room provided a macabre scene he likened to an oldfashioned haunted house. Only his sense of duty kept him going.38 To add to McGill's logistical problems, it eventually had competition from other medical schools. In 1843 a rival medical school, The Montreal School of Medicine and Surgery, or 1'Ecole de Medecine et de Chirurgie de Montreal (fig. 19) was founded by Thomas Arnoldi, Francis Badgley, Peter Munro, William McNider, and William Sutherland, who initially offered lectures in both English and French but by 1847 solely in French.39 These men formed their medical school as a direct challenge to the McGill monopoly and control of medicine at the Montreal General and did not hide their dislike of McGill's dominance.40 A loose association with McGill was forced on 1'Ecole in 1847, when the newly formed College of Physicians and Surgeons of Lower Canada required that a licence to practice would be given only to those holding university degrees. It was agreed, according to its established policy, that one year of attendance at McGill was required for a degree by 1'Ecole students and that 1'Ecole stop granting certificates of qualification. By 1849 this requirement became unacceptable because it caused a dependency which 1'Ecole strongly opposed as an independent French medical school. Its faculty, in a controversial move, renewed its agitation to alter its act of incorporation to be able to grant degrees. By so doing, the agreement with McGill was annulled, and Arnoldi, Badgley, and Sutherland resigned in protest.41 McGill strongly opposed PEcole's attempt, and the plea was defeated in the legislature. Although 1'Ecole refused to close and moved closer to 1'HotelDieu and the Montreal General, it ceased to be a threat to McGill. It eventually became the medical faculty of Victoria College in Cobourg, Ontario. Student discontent over the remoteness of the buildings of the Faculty of Medicine reached a crisis level in March 1847, when the students petitioned the faculty board to return lectures to a downtown location. Nothing was done due to lack of funds until the spring of 1851,42 when the formation of another rival, the St Lawrence School of Medicine, seriously threatened the McGill

35

The Formative Years

Figure 19 First ad for the rival Montreal School of Medicine and Surgery, Montreal Gazette, Friday, October 6, 1843.

enterprise. By this time the enrolment was over sixty, and 105 students had graduated since 1833. Even then, McGill did not have the money to purchase a building or facility downtown. This was eventually done by three concerned members of the faculty.

3 The Faculty of Medicine: 1850-74: The Established Years What I mean by the thinking function of a university, is that duty which the professional corps owes to enlarge the boundaries of human knowledge. Work of this sort makes a university great, and alone enables it to exercise a wide influence on the minds of men.'

The pressure to move downtown increased after 1847. Professors Campbell, McCullough, and Sutherland, realizing that McGill had to move to compete, privately purchased a lot a few blocks from the Montreal General at 15 Cote Street in 1850, two blocks west of St Lawrence Street between St Antoine and La Gauchetiere2 streets, and had a medical building constructed (fig. 20). The building was constructed for £1,200 and leased to McGill for £100 a year.3 Opened in 1851, it was the only way the Faculty of Medicine and McGill could remain viable because the Royal Institution still had no funds. (Unfortunately, Cote Street was destroyed by the new convention centre and no longer exists.) The Cote Street building was wedged between two buildings (fig. 20) and was an inconspicuous, two-storey, brick structure with large front windows. On entering the front hall, to the right was the anatomy and pathology museum, at that time an important feature in any well-established medical school, and to the left, the 3000-volume library. At the end of the first floor hall was a large lecture theatre. The dissecting room, with five windows facing west, occupied the front of the building on the second floor and in the rear was another large lecture room.4 The lecture was the main method of teaching medicine, and the only practical facility was the dissection room, there being no laboratories for student work in histology, physiology, or chemistry. The staff were well-educated general practitioners under the

37

The Established Years

Figure 20 The Faculty of Medicine building, 15 Cote Street, 1851-72.

leadership of A. F. Holmes, the senior faculty member, and Principal John William Dawson. The medical school remained in this building (enlarged in 1860) until 1872, developing in twenty-one years from a fledgling to an established albeit nonprogressive educational institution. Although the lecturers were appointed professors in the 1832 statutes, a dean was not appointed until i854. 5 The faculty was enlarged, the library and museum grew, and the student body rose from sixty-nine in 1851 to a peak of 184 in 1866-67.

38 The Faculty of Medicine, 1850-75

The first schedule of courses was published in 1823 when the Montreal Medical Institution commenced teaching students (fig. 6). Schedules of courses after the Montreal Medical Institution became the medical faculty of McGill in 1829 did not survive until published in the annual announcements in the 18505. One can infer that the standards were maintained from the Statutes of 1832 and 1843, which listed required courses but no hourly schedule.6 Courses in clinical medicine and surgery were taught by senior members of the staff until 1845 when a professor of clinical medicine and surgery7 was appointed to teach these subjects in the hospital. Practical anatomy was also listed and presumably was taught by Stephenson or Campbell, the professors of surgery. There being no medical journals in which to publish schedules and changes at McGill until i844,8 the newspapers were the only source of this information. The next McGill publication, the Revised statutes of i843,9 lists medical courses but reveals little change from 1832. In 1845 clinical medicine and surgery, medical jurisprudence, and botany were added to the curriculum, and chemistry and pharmacy were separated as well as anatomy and surgery. The first available schedule of courses and lecture hours is in the annual announcement of iSsy. 10 LECTURES.

The Lectures will be delivered in the following order Materia Medica, 8 A.M. Institutes of Medicine, 9 " Midwifery, 10 " Surgery, 11 " Clinical Medicine and Surgery, Noon. Anatomy, 2 P.M. Practice of Medicine, 3 " Medical Jurisprudence, 4 " Medical History, including Botany, 4 " Chemistry, 7 "

The following delightful sketch from the 1857 annual announcement is the first published history of McGill's growth and course changes from 1824.ll Although the author made a number of errors/2 it gives a brief view of the early years at McGill written at the time. In taking a retrospective view of its past and present condition, the Faculty of Medicine of McGill College is reminded that twenty-eight years have

39 The Established Years elapsed since it was first established. Its lecturers were then the authorized teachers of medicine in British North America. Previously to incorporation with the university, they had lent their services to similar pursuits and were associated together in "The Montreal Medical Institution." of which they were founders, and this as an independent school, was continued for five years after the date of its commencement in 1824. At this interesting period, it counted but four chairs and these were limited to practical medicine, chemistry and materia medica, midwifery, anatomy and surgery. The two last named were subsequently divided, and soon chemistry and materia medica were taught separately, as also anatomy, while Surgery was united to Midwifery. In 1842 the latter connexion was severed, and each constituted an independent subject. Three years afterwards, clinical medicine and surgery, the institutes of the medicine, medical jurisprudence, and botany were superadded and in the next session clinical medicine was separated from clinical surgery. And in this position it is now, with a curriculum so adapted, that it can afford a complete education in medicine to its matriculants. Beginning as the pioneer school in this province, various adverse circumstances have had to be contended against; but, notwithstanding these objectionable influences, increasing, encouragement has continued to mark its progress.

Records of student hospital duties and of bedside teaching methods have not been preserved. According to brief accounts by William Osier and Frank Shephard/3 students were allowed to move around the hospital freely to examine patients, and the Montreal General was the only teaching hospital in the continent open to students.14 Records of admission procedures have not survived this era.15 It is assumed that students examined admitted patients on a rotational basis and observed them with the attending physicians. The clinical lecturing was performed by the clinical professors of medicine and surgery two days a week at noon in the hospital operating room. The students could do little, with no laboratory or x-ray data, but observe passively the natural history of their patients' diseases and shadow the staff or house officers on daily rounds. According to Holmes16 the stethoscope was being used at McGill by 1850, and we can assume that physical diagnosis with auscultation and percussion was being taught by that time. In addition to local residents, a large number of patients were immigrants, and all were expected to pay 55 or approximately $1.25 per week. Most patients who did not discharge themselves were admitted for many weeks. Discipline was strict, and smoking,

4o The Faculty of Medicine, 1850-75

improper language, and irregular behaviour were grounds for discharge. The Latin medical diagnoses of patients admitted to the hospital are listed in registers dating back as far as 1823. Admission diagnoses most commonly recorded were: debilitas (debility), diarrhea, dyspepsia, typhus, cholera, gelatio (frostbite), congelatio (also frostbite), white swelling (tuberculosis of the knee joint), ambustio (burn or scald), psora (eczema or any significant skin eruption), dolor capitis (headache), node enlargement, synochus (fever of undetermined origin), febris (fever), apoplexy (stroke), delirium tremens, cancer, noli me tangere (rodent ulcer or basal cell carcinoma), dropsy, rheumatism, contusio (major trauma), syphilis, and phthisis or consumption. Medical therapy in the 18405 and 18503 was limited, nonspecific, and untested. Symptoms were treated as there was very little knowledge of the pathophysiology of diseases of internal organs that could not be seen or evaluated - except for the lungs and abdomen, where palpation, percussion, and auscultation could be used. Doctors used traditional treatments because there was no practical medical science to explain the causes of most disease, on which to kindle interest in tools for investigation (bacterial stains for example), and to develop specific treatments (diphtheria antitoxin developed by Behring and Kitesato, iSpo). 17 Therapy did, however, produce a reaction in the patient, who knew that something was being done. Almost everyone was treated - regardless of diagnosis - with bleeding, emetics, purgatives, laxatives, tonics, and local applications to produce counterirritation. If a certain combination did not work, it would be repeated in larger doses. It is truly a wonder that patients with serious diseases of the heart, lungs, and gastrointestinal tract survived blood letting and violent purging to rid the body of disease-causing elements. Many probably did not and died quietly from blood, chemical, and fluid deficiencies. Mercury compounds were used for syphilis, quinine extensively to treat fevers, including malaria (which occurred in Upper Canada during Osier's childhood)/8 digitalis for heart disease, and opiates for gastrointestinal diseases and pain. Major surgeries numbering about thirty operations annually were performed in the theatre with all students present. Each operation, therefore, was an event for all to watch. Surgical teaching was otherwise done not at the bedside but in the amphitheatre or clinic. Further opportunities to learn were given to bright students chosen as dressers, or to students who remained at the

4i The Established Years

hospital for the summer session. Those who wanted to be dressers applied to their favourite physicians and were chosen according to their academic rank. Surgical diagnoses in the'Montreal General Hospital registers during the same period were selected because of the nature of the illness usually requiring a surgical procedure. The staff all practised surgery at this time, and the patients were intermixed, with no separation between medical and surgical admissions, until the i88os. The most common surgical conditions on admission were fractures, sprains, abscesses, cancer open on the surface, urinary obstruction or stricture, cynanche tons (tonsillitis), combustio (trauma or burns), head injury, gelatio (frostbite), vulnus (laceration or wound), and gangrene. Surgery was also limited, if not more than medical therapy, by the ever-present threat of infection. The most common procedures were amputations for almost all compound fractures, infected or wounded limbs, or infected joints such as the knee and ankle,lancing abscesses; paracentesis,- removal of superficial tumours and cancer; cataract removal; removal of bladder stones,- tonsillectomy (earliest at the Montreal General was November 28, 1838); ligation of major arteries in trauma; setting and casting fractures,and casting bad sprains. Students also were assigned to the outpatient clinic where they assisted the house surgeons and staff in examining patients. They would interview patients, assist in minor surgery, and change dressings. The brighter students were encouraged to publish interesting case material in the local journals with the staff. Osier's first case reports at McGill were just such patient reports with D.C. MacCallum published 1871.19 The earliest annual announcement of the Faculty of Medicine available in the McGill Archives (1852-53) (fig. 21) is an unsophisticated calendar of events and statement of policy. The meager information in these pages testifies to how little thought and consideration the staff gave toward informing matriculants of school requirements. The daily schedule of lectures was not even included. Students were on their own at McGill, and had to obtain for themselves information about the hospital, provincial examinations, and licensing. The annual announcements between 1860 and 1870, however, are progressively more informative and provide insight into the Faculty of Medicine that cannot be found elsewhere.20

42 The Faculty of Medicine, 1850-75

Figure 21 Title page of the earliest Annual Announcement of the Faculty of Medicine found in the M.U.A., 1852-53

In 1860 the board of governors purchased the Cote Street building for £1,200 from the owners, Doctors McCullough, Sutherland, and Campbell, and paid an additional £8,160 to renovate the building for a greater number of students.21 The university officials, who had been unhappy with the move to Cote Street, continued to encourage the faculty to return to the McGill grounds, but it was still too far from the hospital and there was no proper building to house its needs. Despite this purchase the faculty continued to operate as an independent proprietary institution, legally associated with McGill but managed by its own staff. 22

43 The Established Years

There were ten faculty members in 1860 who taught nine courses, and the teachers in the basic disciplines of anatomy, chemistry, the institutes of medicine, and materia medica had little more than a textbook knowledge of the subjects. The custom remained for the beginning student to take the basic disciplines for two years. Then in a semi-graded fashion the student would go through the clinical years after having some pre-clinical background. Hospital attendance was required for twelve months (medicine, surgery, and obstetrics and gynecology). Specific entrance requirements were not published in the announcements until 1865. By that time, a student who entered McGill from secondary school would have to pass a matriculation exam in classics, mathematics, and English or have an arts degree from a recognized college or university. Prior to 1865, some knowledge of the classics/3 a good recommendation, and a few years of apprenticeship were the informal requirements mentioned in the annual announcements. A high school diploma was not mandatory. There is no information on how strictly the faculty adhered to its own regulations regarding admission. Having been accepted, the student paid zos to the faculty to register and £3 for each course. Each major course was taught for six months and there was only one session per year. Technically, a student could complete medical school in three years, taking each basic course twice and the clinical courses at the same time, but this was only allowed if the student had a year of apprenticeship to substitute for a fourth year. To graduate, the McGill student had to be at least twenty-one years old, have proof of attendance to all the courses and the hospital, submit an original thesis, pass comprehensive exams, pay a fee of £5 5 s for the degree, and swear to a Latin oath of principles:24 SPONSIO ACADEMICA,

In Facilitate Medicinae Universitatis Collegii McGill. Ego, A B , Doctoratus in Arte Medica titulo jam donandus, sancto coram Deo cordium scrutatore, spondee, me in omnibus grati anirni officiiserga hanc Universitatem ad extrenmm viiye- halitura, perseveraturum ; turn porro artem niedicam, caute, caste, et probe exercitaturum, et quoad in me est, omnia ad legrotoruin corporum salutem conducentia cum fide procuraturum ; quse denique, inter medendum, visa vel audita silere conveniat, lion sine gravi causa vulgaturum. Ita prnesens mini spondenti adsit nuinen.

44 The Faculty of Medicine, 1850-75

The oral comprehensive examinations (Appendix 5) were divided into primary and final subjects, and were given when the candidate was ready to graduate. To meet the requirements of general practice in Lower Canada, where there was no legal division between physicians and surgeons, in 1862 the degree offered at McGill, which had been an M.D. ; was changed to a conjoint Doctor of Medicine and Master of Surgery (M.D., C.M.) to assure the licencing authorities that a candidate had been trained in both subjects.25 Transfer from one medical school to another was common. Students who wanted to obtain a degree quickly would attend McGill for one session for the anatomy course and then go to another less strict proprietary school in New England or elsewhere in Canada for a degree in one year or more. The enrolment for the basic courses was always greater than for the clinical years because of this practice. For this reason, until 1874 senior faculty were given the professorships in the basic disciplines where their income would be higher.26 Other ambitious students who recognized the prestige of a McGill degree and who had had an apprenticeship would take a degree in a two-year u.s. school (Harvard and the University of Pennsylvania offered degrees in two years), then spend one session at McGill and apply for a degree. The issue of a graded curriculum (i.e., taking pre-clinical prior to clinical courses) was not discussed in the announcement of 186061 and generally speaking was not considered in most other medical schools in North America until after the u.s. Civil War (1861-65). A clear statement was probably not made about course sequence because it was not considered an important issue until 1870. By 1870, according to the annual announcement (fig. 22), there were 150 students, thirteen faculty members, and a library of 4000 volumes. Lectures continued to be the main method of teaching in the primary subjects, illustrated with blackboard drawings and traditional charts from Europe. Classroom demonstrations in chemistry were routinely performed by Dr Robert Craik because there was no laboratory space. According to the course description, however, he had adequate demonstration equipment and an ability to make it interesting.27 Students attended five classes per week (for six months) in each of the major subjects (fig.23). Botany, zoology, and jurisprudence were taught three days per week, and the clinical lectures were held Wednesdays and Saturdays at 12 noon. This would appear to be a staggering course load for the students, but not all the subjects were taken each year. Summer courses were offered in

45

The Established Years

Figure 22 Title page of the Annual Announcement of the Faculty of Medicine, 1870-71. A coat of arms first appeared on the announcement of 1862-63.

the clinical fields for the first time in iSyi 28 (from July 4 to September 23), and Dr George Ross gave a special course of twelve lectures in hygiene and public health. The Montreal General Hospital, with 130 to 140 beds and sixty to seventy visits daily in the clinic where all types of medical problems were seen, was adequate for the small student body at McGill. The obstetrics and gynecological patients were seen at the Lying-in Hospital.29 The operating room still doubled as a lecture hall and amphitheatre where surgery was performed before a student audience. Anesthesia had been in use since i847,3° but

46

The Faculty of Medicine, 1850-75

Monday. Tuesday. Wednesday. Thursday. INSTITUTES OF MEDICINE,

-

.

HOSPITAL. CLINICAL

-

LECTURES,

- - - -

PRACTICE O F PHYSIC,

- -

9

11 |

11

11

12

12

12

j

'

12

j

2 !

2 |

I

3

3

2

2

3

3

4 4

MEDICAL JURISPRUDENCE,

5

CHEMISTRY,

7

4

4

11 |

11 ;

12

12

j

7

12 5

4

2

j

3 \ 5 4

5 "

j

12

4

7

5

5

j

5

Saturday.

9 {

5

!

BOTANY & ZOOLOGY, - - -

- -

9 |

5

- - - j

ANATOMY, MATERIA MEDICA,

9 j

5

SURGERY, MIDWIFERY,

9

Friday.

5 \

5 7

7

Figure 23 Lecture schedule for the Faculty of Medicine, 1870-71. Taken from the Annual

Announcement of the Faculty of Medicine.

antisepsis, which had been introduced by Craik and William Fraser in i869,31 was not taken seriously until eight years later when Roddick demonstrated its benefits with convincing statistics. Each major course cost $12, jurisprudence $10, clinical medicine and surgery $6, and botany and zoology $5, all fees payable in advance. For matriculation a candidate was now required to pass a McGill examination in specific subjects recommended by the Council on Medical Education and Registration of Great Britain32 or to have an Arts degree from a recognized college or university. The announcement describes the requirements: 10th. The Mntriculation Examination shall he that recommended by the Council for Medical Education and Registration of Great Britain, and adopted in the amended Medical Act for Upper Canada. Examinations, in conforinity therewith, will he held the first Saturday in November and the last Saturday in April of the current Session. Applications may be made to the Registrar of Faculty till the evening of the previous day. The requirements of the new standard for matriculation aro :—" Compulsory—English Language, including "grammar and composition; Arithmetic, including vulgar and decimal frac"tions; Algebra, including simple equations; Geometry first two books of " Euclid; Latin translation and grammar; and one of the following optional " subjects :—Greek, French, German, Natural Philosophy, including mechan" ics, hydrostatics, and pneumatics." After 1869, Greek will be one of the compulsory subject*. Graduates in arts of recognized Universities are not required to submit to the matriculation examination.

47 The Established Years

To obtain a McGill M.D., C.M. degree the minimal requirement remained four sessions of six months each (four years) for beginning students or three sessions at McGill and one at another recognized medical centre or a recognized year of apprenticeship. A candidate from another institution who had a degree and who wanted a McGill degree had to attend at least one six-month session at McGill. This arrangement made it easy for transfer students to come to McGill from other schools providing extra students and allowed staff trained in Scotland and England to obtain a local degree for licencing purposes.33 Following the purchase of the Cote Street building in 1860, minor changes had been made to strengthen admission and graduation requirements. The basic philosophy of the proprietary system persisted in faculty appointments, promotions, and teaching with little change for two decades. The minimum preparatory education was required, and few applicants who could pay were refused, despite the examination. The concept of the graded curriculum, which by now had also been recognized in the United States,34 was clearly stated and the sequence from pre-clinical to clinical courses over four years was recommended. The announcement stated that clinical courses should be taken by first year students only under special circumstances. Clinical experience continued to be offered in summer courses in medicine in addition to the required attendance of twelve months at the Montreal General and six months at the Lying-in. Fees were still charged by the course rather than by the year, and the staff were paid according to the number of students enrolled. Attendance cards (fig. 12) were kept by the students because proof of attendance was still required for graduation. The dissolution of the independent proprietary system was inevitable. Progress in chemistry and the biological sciences made the system too expensive for up-to-date education by the owners of most schools which were teaching for profit. By 1872, when the Faculty of Medicine moved back to the McGill grounds, it retained its independent proprietary status but survived because of an increasingly progressive attitude to the pre-clinical subjects. By 1870 McGill had changed none of its traditions. The anatomy course and laboratory and the experience at the Montreal General, despite their deficiencies, were considered the strong points of the curriculum. This reputation was relative, however, and a closer look revealed serious deficiencies because of isolation from the progressive changes in leading European medical centres

48 The Faculty of Medicine, 1850-75

and a faculty of general practitioners without specialty training. The Edinburgh tradition on which the faculty was founded and which had for decades been its strength was now an impediment to progress, and reform was seriously needed. The pressing issue by the late i86os, acted on by the governors of McGill, was the need for a new medical building with increased space and laboratory facilities. The number of students at the Cote Street facility rose steadily, and despite renovations in 1860 space remained inadequate, By 1866 the student body numbered more than 180 and additional accommodation was again needed. A new building was the only solution, and it was believed that a move back to McGill would not be so great a detriment as it would have been in 1850 when transportation and city development were inadequate. The city had expanded westward by the late i86os, and roads and transportation had improved. Also, a building on the McGill grounds could be constructed with no constraints on its design or expansion. Thus on October i, 1869, Dean G.W.Campbell wrote the governors of McGill the following letter proposing the move:35 " The great desire of the FacuMy is to improve flits means of instruction by having a larger and more suitable building erected for its use in the University grounds above Sherbroofce Street. Principal Dawson is well acquainted with the very inadequate provision which Its present building affords for the necessary operations of the Faculty. If the Governors of th« University agree to this proposal the Faculty will bind itself to pay annually to the Treasurer of the University the interest of the money expended In the erection of the building, over and above the sum obtained from the sale of the property on Cote Street, at present occupied by the Faculty. Of course the Faculty would expect that the Governors would remit this annual rent whenever they consid:red that the funds of the University were In a sufficiently prosperous condition to enable them to do PO, without detriment to Its other Interests. It Is very desirable that a determination should be come to upon this subject at as early a period as possible, for the building should be ready to receive the Library and Museum of the Faculty by the 1st of September next, so that It would be desirable If possible to have the foundations in before the winter is fairly on us. I remain, Sir, Your obed'ent servant, Geo. W. Campbell, Dean."

The governors accepted the proposal. Construction began in 1871 after extensive arrangements for financing, including sale of the Cote Street property and of Burnside Hall, and an agreement

49 The Established Years

by the Faculty of Medicine to pay the interest on the loan and to furnish the building. The building was completed in 1872 on the site of the present R Cyril James Building. At a cost of $27,ooo,36 it provided advanced facilities for students and faculty, laboratories and classrooms, and above all, room for expansion to the north. The new facilities addressed one of the faculty's major problems but left unsettled many others concerning the philosophy of teaching and the traditions of the faculty. These problems were not easily resolved, and it took more then a decade for change to begin. The major issues affecting the faculty of medicine by 1870 were 1 A serious lack of funding of higher education in Montreal and Canada. Private citizens who were capable of funding and building a general hospital were not interested in medical education. The fundamental reasons for poor financial support were the lack of credibility of the medical profession and practicality of the undergraduate university curriculum,37 the lack of a tradition for public support of higher education, and the unwillingness of private enterprise to support training in the lucrative field of medicine. It took Dawson years to convince the community that modern facilities for students meant better trained physicians. 2 A part-time faculty whose livelihood was not the Faculty of Medicine but the general practice of medicine and surgery. The staff were dedicated men who spent the majority of their time in practice and only a minority teaching students. A professor in the primary subjects was required to deliver five lectures a week for six months, which was no small task for a busy practitioner, who would be paid approximately $500 for the effort. While the pay was reasonable, the prestige of being associated with the medical school more than compensated for the time spent teaching. 3 A tradition of appointments to professorships in the pre-clinical subjects based not on any gift for teaching or subject knowledge, but on seniority. Prior to 1874 in the proprietary medical schools like McGill, the most lucrative courses were the primary disciplines because of the greater number of enrolled students. The most senior faculty were rotated to these positions regardless of their background or ability. This custom

50 The Faculty of Medicine, 1850-75

4

5

6

7 8 9

continued until 1874, when William Osier became the first faculty member appointed based on his recent training and experience in modern science. The custom of didactic, passive, textbook lecturing was the Edinburgh University tradition. McGill was virtually a copy of the Faculty of Medicine in Edinburgh for its first thirty-seven years. Initially this was its strength, but by 1870 had become its weakness in the face of changing patterns and methods of education in Europe. Lack of interest in scientific medical education and a complete lack of laboratory facilities and equipment for student training. This typified medical schools in North America. William Dawson had been pushing for a major commitment in practical scientific education since 1855, long before pressure from Europe forced reform in North America. This paradox was not addressed until the mid-18705. Little or no interest in pathology and its teaching. Post mortems were performed either by the house officers or attending staff at the General Hospital, most of whom knew little or nothing about gross pathology and had no practical training in microscopic anatomy or pathology. Nonexistence of research at all levels, and yet a recognition of its importance in medical education. Lack of faculty interest and training in public health and hygiene beyond a series of lectures.38 A lax teaching program at the Montreal General where there was no formal program for clinical education. There were not enough clinical professors to make up for the lack of daily supervision at the bedside. There was no attending schedule, insufficient housestaff, poor record keeping and requirements, no nursing and the faulty prevailing attitude that to watch the master perform a number of times was enough experience for the student.

To emphasize the complete lack of student laboratory facilities, Shephard mentioned in his Reminiscences39 that the only time he saw or used a microscope during his medical training at McGill (1869-73) was when the professor of the institutes of medicine, Dr Eraser, had T.G. Roddick, his house officer at the General Hospital, take a microscope to the school library to demonstrate the circulation of blood in a frog's foot. More important than the

51 The Established Years

lack of equipment was the fact that the staff had no expertise in scientific medicine. To overcome the former, only money was required, but to overcome the latter was going to take a major reform and a break from the Edinburgh tradition. Another problem for McGill and the medical profession in Montreal by 1870 was the so-called McGill medical monopoly. In its dominant position, McGill could pick and choose its staff, excluding anyone it wanted regardless of the consequences. More important, however, was the lack of any competition or opposing points of view until 1872. In addition, McGill controlled the staff, administration, and Medical Board of the Montreal General, had a major influence in the Montreal Medical and Chircurgical Society,40 and had produced a large number of local graduates who supported their alma mater. Even the widely read Canada Medical and Surgical Journal, founded by George Fenwick in 1872, was pro-McGill. McGill College, unlike Harvard and the University of Pennsylvania, started with the medical school as its first faculty. Although the Faculty of Medicine at McGill remained independent until 1905, there was always respect between the governors and medical school. Harvard and the University of Pennsylvania, however, had separate proprietary institutions that strongly resisted university dominance. Progress at McGill was delayed more by a lack of funding than by politics, but despite these shortcomings with the faculty and methods of teaching, Abraham Flexner many years later summed up the system thus: "One can decry the system of those days, the inadequate preliminary requirements, the short courses, the domination of didactic lectures, the meager appliances for demonstration and practical instructions, but the results were often much better than the system."41 The teaching staff for the basic disciplines in 1870 were William Scott, anatomy, William Fraser, the institutes of medicine, Robert Craik, chemistry, William Wright, materia medica, George Fenwick, forensic medicine, and William Fuller, Demonstrator in Anatomy. Anatomy was taught by Professor William Scott (fig. 24) (182382), a general practitioner who was trained in medicine at Edinburgh and who took his McGill degree in 1844. He was a formal Englishman with no academic experience beyond medical school who lectured directly from Wilson's Textbook of Anatomy. He never illustrated on the blackboard or went to the dissecting room

52 The Faculty of Medicine, 1850—75

Figure 24 William Scott, M.D., was Professor of Anatomy from 1856 to 1883. Photo by James Engles, 1867.

but used dissected specimens and bones for demonstration purposes. Although the students accepted these customs, they were far from inspiring. Anatomy demonstrations and the laboratory were conducted by William Fuller (d. 1927), who had no natural gift for teaching or organization, but who introduced frozen sections

5 3 The Established Years

Figure 25 William Fraser, M.D., Professor of Institutes of Medicine, 1849-72. Photographer unknown.

and made painted plaster models of dissections. Despite the fact that the laboratory was not systematized, dissection of the neck, limbs, and paravertebral muscles were required. Dissections of the brain, chest, abdomen, and pelvis were optional because surgery in these areas was rarely performed for fear of almost certain death from infection. Most students went through medical school and into practice never having seen a dissection of the major cardiovascular, pulmonary, gastrointestinal, urological, reproductive, or central nervous systems. Despite dull lectures and a poorly administered laboratory, cadaver material was always available and the emphasis on practical anatomy attracted students to McGill from eastern Canada and the northern United States.42 The institutes of medicine, combining histology, physiology, and pathology, were taught by William Fraser, M.D. (1814-72,- fig. 25), a self-made Highland Scot who acquired a medical education in Glasgow with discipline and hard work and no great ability. The

54 The Faculty of Medicine, 1850-75

term "institutes/'43 taken directly from Edinburgh University, referred to the fundamental principles of medicine. At this time in Edinburgh and London, the physiologist's major research tool was the microscope and not the kymograph as in Europe. Physiology and histology were thus intimately related in Scotland, and pathology logically followed. At McGill this orderly sequence was followed but suffered because the professor knew little about pathology. His knowledge of physiology was derived from books, he had no oratorical ability, and he spoke methodically and slowly. To make matters worse, Eraser had no interest in or knowledge of laboratory work in histology or physiology. Despite these deficiencies, he held the chair for twenty-three years until 1872,, when he died at the age of fifty-eight just before the faculty moved to the new building on the university grounds.44 Eraser, like Scott and others, brought nothing new to the faculty, only didactic tradition and textbook knowledge which was already giving way in Europe to practical training at all levels of medical education. Chemistry was taught by Robert Craik, M.D. (1829-1906; fig. 26), who graduated first in his class at McGill in 1854. After a succession of appointments, he was promoted to Professor of Chemistry (1867-79). Craik, unlike Scott and Eraser, was a brilliant student and an excellent lecturer who initially kept up to date and performed chemical demonstrations before the classes using elaborate apparatus. He was more than the traditional didactic teacher because he did what he could to provide practical knowledge. However, since there was no facility for a student laboratory, there was little he could do but perform classroom demonstrations.45 Fortunately for the students, in 1869 Gilbert P. Girdwood, M.D. (1832-1917; fig. 27), began to teach a course in practical chemistry in an upstairs apartment. Above all others, he provided the students with an introduction to practical science in medicine. He was a brilliant chemist, physician, and scientist, and was considered one of the leading professional chemists and scientists in Canada in the last quarter of the nineteenth century. Girdwood guided chemistry at McGill through its evolution from the lecture room to the student and research laboratory, but only after 1883 when the university made a commitment to provide laboratory space for his own use. Girdwood, through his research, was the first McGill physician to gain international fame for his laboratory accomplishments.46

Figure 26 Robert Craik, M.D., Professor of Chemistry, 1867-79. Professor of Public Health, 1892-1901, Dean, 1889-1901. Photo by William Notman, 1875.

56

The Faculty of Medicine, 1850-75

Figure 27 Gilbert Prout Girdwood, M.D., Professor of Chemistry, 1879-1902. Photo by William Notman, 1882.

William Wright, M.D. (1827-1908; fig. 28), while Professor of Materia Medica (1854-83) and maintaining a private practice, became a clergyman in the Church of England. According to students and staff, Wright's teaching was out of date. The more obscure the topic and the less related to medicine, the more time

57 The Established Years

Figure 28 Reverend William Wright, M.D., Professor of Materia Medica, 1854-83. Photo by William Notman, 1882.

he would spend on the subject, not being able to make the distinction between pure botany and practical materia medica. The students became dissatisfied with Professor Wright because he failed to prepare them for the provincial examinations. This eventually led in 1882 to a petition to the faculty by first- and secondyear students for his removal. Professor Wright became indignant and eventually resigned his chair in i883.47 John William Dawson (1820-99; fig. 29), Principal of McGill, taught botany and zoology to medical students. He was one of the great academic figures in Canadian science who had a brilliant career as a teacher, scientist, author, and administrator, and his influence on the Faculty of Medicine was both direct and indirect. He strongly advocated, as principal and teacher, progress in science

Figure 2,9 John William Dawson, Principal of McGill College, 1855-93. Photo by William Notman, 1862.

59 The Established Years

from the lecture to the practical laboratory. A colonial pragmatist, he believed that progress in the university was going to be achieved through the study of scientific phenomena and not through the study of the past. In his 1855 inaugural address as principal of the university, he warned that an overemphasis on the studies of classical antiquity would preoccupy the minds of graduates in such a way as to make them more suitable for a museum case than actual life. He felt that there was little question that the widespread dissatisfaction with university education stemmed from its apparent lack of applicability to the ordinary pursuits of life and thus was influential in discouraging public sympathy and support for higher education.48 The lecture continued as the principal method of medical education at McGill. However, there were a few like Robert Palmer Howard who, supported by Principal Dawson, recognized the value of practical laboratory instruction in place of or as an adjunct to the lecture. They recognized that students were over-lectured and under-taught, and that few professors were qualified to teach. The quality of teaching during the clinical years was poorer than in the primary years. The professors were teaching what they knew best but mainly by lecture and hurried bedside rounds. The house surgeons at the general hospital at this time were George Ross, M.D., C.M. (1845-92), and Thomas Roddick M.D., C.M. (1846-1923), Holmes gold medalists49 in 1866 and 1868, who quite obviously added to the prestige of hospital training at McGill. Little is known about the daily routine of the students, but they did have regular lectures and demonstrations in the hospital and limited bedside training. Students examined patients in the clinics and on the wards but had little supervision and no responsibility for patient care. The two house surgeons could not possibly attend to and care for 150 patients, operate the clinic, and in any effective way help the students. The house surgeons would stay at the hospital for approximately six years, taking on private patients while doing hospital work until they became sufficiently established to afford a medical practice, drive a horse and carriage, and purchase a house. They also attended to the practices of vacationing physicians, so it was not unusual to see a horse and carriage arrive at the front door of the hospital to take them into the city for house-calls. Their duties also were to assist at all operations and to give anesthesia after its introduction in 1847.

6o The Faculty of Medicine, 1850-75

The policy of selecting only the top students from the fourth year for a position at the Montreal General Hospital assured McGill of a faculty of outstanding intellectual ability. However, it closed the door to many able graduates who could not obtain a McGill position. This system provided young staff of outstanding ability but tended to stifle progress because it encouraged conformity with local tradition rather than the generation of new ideas. The Professor of Medicine and the dominant figure on the clinical staff in the i86os was Robert Palmer Howard, M.D. (182,389; fig. 30), who was an exception because he was not awarded a house position on graduation from McGill in 1848. An impressive student, he headed for Europe after graduation to pursue an interest in the relationship between pathology and clinical medicine. His interest in the basic mechanisms of disease and in clinical investigation distinguished him from his fellow physicians. He performed his own post-mortems, illustrated lectures with pathological specimens, and had a thorough knowledge of the medical literature of the day. With the capacity to inspire students to think and utilize the meager tools available - the autopsy room and the medical literature - he became the major force behind reform in the faculty before the iS/os. 50 George W. Campbell, M.D. (1810-82; fig. 31), was born in Scotland of well-to-do parents, graduated from the University of Glasgow, studied in Dublin, and was licenced in Edinburgh. He decided to make his way to Canada and soon became an attending surgeon at the Montreal General Hospital. As a surgeon in the pre-anesthetic and pre-antiseptic era, he was fast, decisive, and could operate in his ordinary shirt and cuffs (the custom of the time) and come away unstained. A dominant, rugged person more inclined to action than words, his lectures were practical, with strong anatomical and pathological correlation and without attention to trivial speculation. The students who were exposed to him knew his approach well by graduation.51 The clinical surgery professor, George Fenwick, M.D. (1825-94; fig. 32), was in charge of surgical teaching at the Montreal General. He graduated from McGill in 1847 and became a renowned surgeon and journal editor. Fenwick, unlike Campbell, paid little attention to the details of his life outside medicine, he was always late for appointments if he kept them at all, and he sent bills only when he needed money. He was a competent teacher who made contributions to knee excision and fusion. More important, he

61 The Established Years

Figure 30 Robert Palmer Howard, M.D., Professor of Medicine, 1860-82, Dean, 1882-89. Photographer unknown.

edited two significant medical journals: Canada Medical Journal with F.W. Campbell until 1872 when they separated because of editorial conflicts, then the Canada Medical and Surgical Journal, which he founded, while Campbell established the Canada Medical

Figure 31 George Campbell, M.D., C.M., Professor of Surgery, 1842-75, Dean, 1860-82. Photo by William Notman, 1881.

63 The Established Years

Figure 32 George Fenwick, M.D., Professor of Clinical Surgery, 1868-75, Professor of Surgery, 1875-90. Photo by William Notman, 1877.

Record. In his prime, Fenwick was considered the best practicing surgeon in Montreal.52 Surgical education and practice at the Montreal General before the 18705 was still primitive and limited because of the high mortality from infection. Prior to the germ theory and work of

64 The Faculty of Medicine, 1850-75

Joseph Lister (introduced at McGill in 1869 by Craik and Fraser), there was no recognition of the role of sterile technique and cleanliness in surgery. The surgeons operated in street clothes or in blood-stained frock coats left at the hospital; the hair and face were never covered. Instruments, patients, and hands were rarely washed except after surgery to clean off the blood. The wooden operating table and floor were stained with years of blood, pus, and discharges and were only cleaned to wipe them dry between operations. The hospital had no established, standardized, routine or requirements for the operating rooms, these being up to the discretion of individual surgeons, most of whom were grossly undertrained for what they attempted to do. Major surgery still included amputations, excision of joints, removal of superficial tumors, removal of bladder stones, ligation of arteries after trauma, and rarely trephining the skull for a depressed fracture. Even with these limited procedures, mortality was high. The chest and abdomen were still never opened intentionally because of certain death from infection. With thirty major procedures performed a year at the general hospital, a student in one six-month session might see a maximum of fifteen operations. There was little change in these figures for years. Compound fractures usually resulted in amputations. Amputation sites usually became infected and (provided the patient survived) had to be left opened over a long time to allow the wound to heal. Paradoxically, the appearance of pus was considered a good sign and necessary for the healing process.53 Thus the faculty, with few exceptions, were nonprogressive practitioners, and there was little hope that the existing staff could make the effort to break from tradition. McGill by 1870, despite its reputation, had reached a low point because of the general practice qualifications of the staff and the adherence to outdated tradition. Campbell, Howard, and Dawson undoubtedly recognized the potential for the faculty in the university plan, but they did not know in 1870 that two medical students and two house surgeons were going to lead the reform needed to gain this potential. Within the 1870-80 decade William Osier, Frank Shephard, George Ross, and Thomas Roddick were to lead the change of an entrenched system and introduce an attitude of progress.

4 The Faculty of Medicine: 1874-85: The Osier Years But the problem of all others which is perplexing the teacher today is not so much what to teach, but how to teach it, more especially how far and in what subjects the practical shall take the place of didactic teaching. All will agree that a large proportion of the work of a medical student should be in the laboratory and in the hospital.1

William Dawson had been preaching and promoting reform in the educational process for twenty two years. His direction was toward more practical and applied sciences and away from the theoretical and didactic trends of the time. Although not a physician, he recognized the great potential of the Faculty of Medicine in his plan for the university as a centre of higher education in the practical sciences. He supported the construction of the new medical building with adequate laboratory space for students and faculty. Despite the lack of faculty and equipment the commitment was obvious,- the new building (fig. 33) opened in 1872 with empty rooms, but obvious potential. The Faculty of Medicine needed considerable reform to approximate the level of excellence in Europe, and at least the first step had been taken by occupying a new building. Although the board of governors had purchased the medical school in 1860, it had little influence on the faculty, which maintained its proprietary status and independence even when it moved to the university grounds.2 Despite new facilities, the staff remained entrenched in their old ways of teaching, unable to the change. William Osier (fig. 34) graduated M.D., C.M. in 1872 and wen to Europe for postgraduate training. Little did he know that his remarkable serendipity was to have so profound an effect on his career and on medical education at McGill, in Canada, the United States, and eventually in Great Britain. Before making a decision

66 The Faculty of Medicine, 1874-85

Figure 33 Faculty of Medicine buildings, 1890. The building in the foreground was built in 1872; the wing behind was added in 1885-86. Photo by William Notman, 18905.

about his course of training, he took the advice of a friend who, considering Osier's experience in microscopy, recommended that he get a solid grounding in physiology in John Burdon-Sanderson's laboratory in London.3 He studied there and made extensive notes on experiments.4 Osier learned normal histology and cell and tissue physiology during a four and one-half month course followed by seven and one-half months studying blood. During this time he made one of his greatest contributions to scientific medicine by observing platelets in detail and publishing one of the first descriptions of this third element in the blood.5 Although Osier later received training from some of the best clinical teachers in Europe, it was his early research on platelets that secured his position at McGill. The changing attitudes and the focus of medicine at McGill are revealed in an excerpt from Robert Howard's introductory lecture to the Faculty of Medicine of October 1873: "In connection with this new subject of scientific interest, the older students present, as well as my colleagues, will be pleased to hear that Dr Osier, who graduated here in 1872, had just made a discovery of great interest and that promises well for the future of our young countrymen ... I wish some friend of the University would endow a chair of physiological and pathological histology and our young

Figure 34 William Osier, M.D., C.M., in 1884. Osier was Professor of Institutes of Medicine, 1875-84. Photographer unknown.

68 The Faculty of Medicine, 1874-85

friend might be invited to accept the appointment and devote himself solely to the cultivation of his favorite subject."6 This is the first statement by a member of the faculty expressing need for staff and facilities for scientific training. Osier went on to continue his postgraduate medical education in Berlin, where he was influenced by Rudolph Virchow and his new approach to medicine through pathology.7 This was the second opportunity that was to have a lasting influence on his career and his approach to medicine and teaching at McGill. Osier, who had never attended a clinicopathologic conference similar to those chaired by Virchow, was profoundly moved. He marveled at Virchow's demonstration of gross and microscopic pathology, their clinical correlation and Virchow's attempt to explain the mechanisms of disease on a cellular level.8 Osier thereafter regarded pathology as the most meaningful basis for teaching medicine at the bedside and in the classroom. Osier completed his postgraduate tour in Vienna. His third opportunity was exposure to medical specialization - in dermatology, pediatrics, otology, laryngology, and obstetrics.9 Although not particularly interested in any of these subjects, he saw the benefit of the trend toward specialization, away from the general medicine that prevailed in Montreal. He wrote later in his essay, "Medicine in the Nineteenth Century": "The restriction of the energies of trained students to narrow fields, while not without its faults, has been the most important single factor in the remarkable expansion of knowledge"10 Osier returned from Europe the summer of 1874 infused with new knowledge of the science of the time. But there was no staff position available. On July 6, however, Joseph Morley Drake, the professor of the institutes of medicine, resigned because of heart disease.11 Osier was immediately offered a lectureship in the institutes,- he accepted, much to the pleasure of Howard and Campbell, who wanted him on the faculty. He moved into rooms at 20 Radegonade Street, near Beaver Hall Hill, and immediately set about to revise the teaching of the institutes of medicine in a more practical way. Although there were no microscopes for a practical laboratory, there was space in the new building. Osier lectured while Drake remained available should the new appointment prove unsatisfactory. It took no more than one term, however, for the faculty to appreciate Osier's accomplishments and plans. How pleased Campbell, Howard, and even the

69 The Osier Years

principal must have been to see the competent, dedicated young man begin to lead the reform of the basic disciplines at the medical school, reform which in a few years would be beyond their dreams. From the beginning of Osier's appointment, he was more interested in improving the teaching in the faculty than in private practice, making him the first full-time member of the medical staff. In the spring of 187512 Osier was officially and unanimously appointed Professor of the Institutes of Medicine in recognition of his industry. He knew that the faculty could not afford to purchase the microscopes needed for a practical course in histology. Impatient at the faculty's impecuniosity, and rather than wait a year or more for the dean to obtain money, he took a job as an attendant in the smallpox ward at the Montreal General for an extra stipend of $600 a year. The exposure was sufficient to give him a minor case of smallpox. The stipend was just enough to purchase twelve Hartnach student microscopes (fig. 35) 13 from Paris at $45 per instrument. It is not certain when the microscopes arrived, but Osier must have received them prior to the fall semester of 1875, because his "Introductory Comments and Synopsis of the Laboratory Course in the Institutes of Medicine" was published in i876.14 Aware of the importance of greater student participation and the need for practical experience Osier wrote:15 The theoretical age in medicine is passing away and is being replaced by a practical one. Already in large centers like London, a revolution has been effected, due in great measure to the wisdom and foresight of the men controlling the great examining bodies who now demand of all students presenting themselves for degrees and diplomas, satisfactory evidence of a certain practical acquaintance with every department of medicine and surgery ... This is as it should be, and though the reputation which the medical department of McGill University enjoys throughout the country has been obtained by the practical character of its teaching offered, much remains to be done.

The laboratory course was comprehensive, as Osier's outline makes clear: Demonstration i: General description of the microscope. How to clean it. How to tell its magnifying power. How to draw with it. Examination of dust, cotton fibers and air bubbles.

yo The Faculty of Medicine, 1874-85

Figure 3 5 E. Hartnach microscope of 1874. This is the model ordered by Osier for McGill. The Billings Microscope Collection, 2nd ed. (Washington: Armed Forces Institut of Pathology, 1974) 61-2.

Demonstration 2: Protoplasm. Amoeba. Cyclosis in anacarus. White blood corpuscles. Demonstration 3: Red blood corpuscles of frog, fish, bird and man. Hemoglobin crystals in rat's blood. How to examine blood stains. Demonstration 4: Epithelium; squamous, cylindrical, glandular and ciliated.

7i The Osier Years Demonstration 5: Connective tissues. Corpuscles, white fibrous and elastic tissues. Adipose tissues. Pigment. Demonstration 6: Tendon, cartilage, bone and teeth. Demonstration 7: Muscle. Voluntary and involuntary. Demonstration 8: Blood vessels. How to inject. Demonstration 9: Method of handling tissue. How to cut sections. Liver. Demonstration 10: Lung. Demonstration n: Alimentary tract Demonstration 12: Kidney. Demonstration 13: Lymphatic vessels and skin. Demonstration 14: Nerve fibers, cells. Central organ. Demonstration 15: Examination of sputum and vomit. Discharges from the uterus and vagina. Demonstration 16: Pus and tubercle. Demonstration 17: Examination of urine. Casts. Demonstration 18: Examination of urine. Inorganic deposits. Demonstration 19: Morbid gross. Cancer cells. Demonstration 20: Parasites. Animal and vegetable.16

This is the outline of the first course in microscopy in Lower Canada in which the students learned to use the instrument and prepare the actual tissues. Considering that it was offered more than no years ago, the students were exposed to the forefront of histology and cellular physiology as taught by Burdon-Sanderson in London. Once Osier was comfortable with his plans for the reform of the institutes of medicine and the practical laboratory had been started, he turned his interest to applied pathology. This led him to the Montreal General, where he was pre-eminently qualified in pathology. He took advantage of the opportunity to perform autopsies unofficially for other physicians in his unobtrusive manner and to record the findings, many of which were published. Howard was so impressed with the great value of pathology and Osier's work at the hospital that he helped create the position of pathologist to the Montreal General,17 which was conferred on Osier in 1876. Exactly when he performed his first post-mortem is not certain, but it must have been in late 1875 or early 1876. Once officially appointed, Osier began to record his postmortem findings in a series of five ledgers. Three of the five record books he filled survive in the Osier Library/8 volumes i (May i876-May 1877), 2 (May 4, i877-March 14, 1879), and 3 (March 14, 1879-

72 The Faculty of Medicine, 1874-85

September 12, 1880). To attest to Osier's industry, by the time he departed McGill for Philadelphia in 1884 he had performed 780 to 790 autopsies, all recorded by hand in the hospital pathology record books.19 The pathology appointment encouraged Osier to systematize the recording of autopsies in the hospital record books and to teach students morbid anatomy. He offered the first pathologic demonstrations ("practical pathology") to medical students in Lower Canada in 1876 in weekly Saturday afternoon sessions and introduced systematic clinicopathologic correlation to McGill.20 These were an instant success not only because of Osier himself, but also because he published many of the cases discussed at these Saturday conferences. Between May 1876 and May 1877 he had performed approximately 100 autopsies and reported seventy select cases in the first hospital pathology report in Canada in 1878." Osier published a combined second report of fifty selected autopsies between October 1877 and 1879 and articles by members of the faculty in i88o.22 In addition to these publications during his ten years at McGill, Osier published 221 separate pathologic reports and provided the museum with a large number of teaching specimens/3 many of which had been used as demonstrations before the Montreal Medical and Chirurgical Society. According to Maude Abbott in 1937, 141 original Osier specimens survived in glass and fixative,24 but time took its toll and Al Rodin found only fifty-five in the museum in i98i. 25 Osier, with his recent experience in Berlin, where the study of pathology was advanced, saw the immense practical value of clinicopathologic correlation in teaching medical students to understand human disease. He also recognized the value of pathology as a source of potential research into disease processes. It should be recalled that in 1876 there were few laboratory tests other than urinalysis and the blood count. It is, therefore, easy to understand the great attraction of Virchow's approach to pathology: the study of the gross morphologic and cellular mechanisms of disease. Thus, in eighteen months, at the age of twenty-seven, Osier had improved the practical training in the pre-clinical years. It is to the credit of the faculty and the dean that they encouraged him in his pioneering ideas, concepts that paradoxically had to come from the old but very progressive European schools to change the new and very conservative Canadian institutions. Aside from

73 The Osier Years

Osier's innovations in histology and pathology, the general course and style of teaching medicine remained unchanged during this period. McGill was fortunate in that Osier's main interest was bringing pre-clinical instruction up to European standards, and that he had the time and energy to do it. Soon after his appointment in 1875, he was advocating more faculty appointments in the primary disciplines. Seeing the need to radically revise gross anatomy instruction to improve its practical application, he introduced and supported his able classmate Frank Shephard's (fig. 36) appointment as Demonstrator in Anatomy, which was made in April i875. 26 Having won the prize for academic excellence in the primary subjects on graduation, Shephard was an ideal candidate. At the time he was still in Europe, where he had studied anatomy and teaching methods in several centres. William Fuller resigned and became Professor of Anatomy at the Bishop's University Medical College.27 In 1875 notable changes occurred in the Faculty of Medicine. A brilliant quartet of doctors who were to have a profound effect on medical education at McGill was appointed to positions of influence. Frank Shephard returned from Europe to accept the position of Demonstrator in Anatomy. In addition to Osier and Shephard, two other significant appointments were made. William Eraser's premature death provided a position for George Ross in medicine, and Dean Campbell, also Professor of Clinical Surgery, resigned to create a position for Thomas Roddick. These four men, two in the basic disciplines and two in clinical medicine, were put in positions to influence the attitude of progress and change needed at McGill. In 1875 Shephard was twenty-four years old, and he brought to anatomy an unprecedented background and enthusiasm. The importance of his influence on medical education at McGill cannot be overstated. Prior to his appointment, the position of Demonstrator in Anatomy had been merely a stepping stone into the faculty from the house positions at the Montreal General and not a post requiring any special knowledge. Shephard, like Osier, had recent specialized training in the field, rather than only a medical student's experience. In the course of his European tour, he had attended anatomy courses and dissected in London, Vienna, and Germany and seen different approaches never used at McGill. He became convinced that anatomy could best be learned in the dissecting room and not the lecture theatre. He expanded

74 The Faculty of Medicine, 1874-85

Figure 36 Francis John Shephard, M.D., C.M., Professor of Anatomy, 1883-1913, Professor of Surgery, 1883-1913, Dean, 1908-14. Photo by William Notman, 1882.

the practical aspect of the course by revising the laboratory, and in a short time made it more demanding and interesting than the lectures given by Professor Scott (who objected to Shephard's new methods but not to the point of confrontation). Undaunted, Shephard monitored attendance, systematized the dissections, held

75

The Osier Years

review sessions, and introduced required dissection of the brain, thorax, abdomen, and pelvis, areas heretofore examined by students only if they had a special interest. Following the lead of Osier, Shephard made anatomy, which already had high academic status, even more dynamic. The staff were so impressed with Shephard's enthusiastic revival of anatomy in 1876 that they provided him with two assistant demonstrators, William A. Molson and Richard L. MacDonnell,28 and allowed him to give a laboratory examination in 1877. The emphasis on anatomy prevailed for about eighty years, through the time of Charles P. Martin, mainly because of tradition and the requirements of the provincial board examinations of Ontario and Quebec which called for more than 200 hours of lecture and laboratory time. These young men established new academic traditions from the Old World. They changed the emphasis from one centred almost entirely on clinical medicine and general practice to one promoting pre-clinical science and specialization. Instead of the practitioner's acting as part-time histologist or anatomist, the new breed of teachers were experts in the pre-clinical sciences who also treated patients. The most important change in faculty attitudes was the realization that the primary disciplines deserved to be taught by recently trained, dedicated, knowledgeable staff. The control of medical education, previously dominated by the clinical staff, was to shift toward the primary disciplines if progress was going to be made. Instead of rotating the senior staff to the lucrative primary subjects irrespective of their qualifications, the concept of the specialist with restricted interests, who brought the most to the faculty and students, was introduced. Unlike President Charles Eliot at Harvard, who dictated the changes needed in the medical school, Osier on his return in 1874 showed the faculty by example, sacrifice, and incredible industry innovative methods of medical instruction. Eliot gained control of the medical faculty and forced the needed reforms, whereas Osier, a junior faculty member, inspired the faculty with his example. The evolution was subtle but inexorable. In the i88os attitudes toward clinical teaching had also changed with the introduction of surgical and medical specialties and of advanced European concepts of objective evidence of disease with the aid of auscultation and percussion correlated with pathologic findings.

76 The Faculty of Medicine, 1874-85

Figure 37 George Ross, M.D., C.M., Professor of Clinical Medicine, 1872-92. Photo by William Notman, 1882.

George Ross, M.D., C.M. (1845-92,- fig. 37), exemplified the changing attitude toward clinical medicine with emphasis on physical examination. He was an outstanding medical student at McGill and became an astute diagnostician in the clinical faculty during Osier's ten years in Montreal. Reading Ross's case reports and articles provides insight into the type of person and clinician he was. His cases were carefully presented and included details of the clinical examination using the basic techniques of auscultation and percussion without benefit of laboratory aids except

77 The Osier Years

urinalysis. In the medical cases reported in the second volume of the Montreal General Hospital Reports,29 he described what appeared to be a case of the Guillain-Barre syndrome diagnosed as acute spinal paralysis. He methodically analyzed the symptoms in terms of known neurologic localization using the scanty literature in neurology, and made astute conclusions that were valid. Ross was often aloof and arrogant because he was impatient with students who could not grasp the value of a careful, basic, physical examination. His intolerance did not gain him a wide circle of friends, but he was respected as an excellent clinical teacher who lived up to the expectations of his Holmes gold medal. He was the first faculty member in 1882 to restrict his practice to internal medicine. Ross's literary reputation was as an astute critic, editing the prestigious Canada Medical and Surgical Journal from 1879 to 1888, when it became the Montreal Medical Journal, which he edited from 1889 to 1892, when he died prematurely at age fortyseven.30 The only members of the staff to show an active interest in reforming medical education at McGill were Osier, Shephard, and Ross. As evidence of this, they went to Harvard University for a week in April 1877 to spend time in various departments, studying teaching techniques and the school's general educational system.31 President Charles Eliot in i87i 32 had changed Harvard's policies, which improved standards. The Harvard school year ran from the end of September to the end of June as compared to six months at McGill. Three years were required for graduation,McGill had required four for twenty-one years. Examinations at Harvard were written, while McGill still used mostly oral examinations. At Harvard the students had to prove their mastery of each year's subject matter before proceeding to the next year. Examinations at McGill were only given after the second and fourth years because the subjects in first and third were repeated. Harvard differed markedly from McGill in having advanced teaching methods and facilities in the basic disciplines of physiology, chemistry, and pathology, each requiring extensive laboratory experience. Ross studied the teaching on the medical wards with an interest in practical experience and emphasis on the basic subjects which he found. In addition to routine bedside instruction and lectures, there were clinical conferences where students were given unknown cases to present to a group for diagnosis and

78 The Faculty of Medicine, 1874-85

treatment. Accuracy and knowledge of the basic disciplines were stressed. Osier as well as Ross observed that the teaching of clinical medicine was excellent. In 1880, according to the annual announcement of the Faculty of Medicine,33 there were 166 students, eighteen faculty members and six to seven thousand books in the library. The matriculation or entrance requirements were now discussed in detail, although probably not strictly adhered to, registration, courses, and qualifications for a degree were also explicit, and the faculty had also established greater barriers to transfer students. The school year and the matriculation requirements, as well as the course schedule and requirements remained the same as in 1870 (fig. 38). The institutes of medicine now constituted a thorough exposure to histology, physiology, and pathology, with laboratories in microscopy and instruction in the post-mortem. Anatomy required extensive dissection and practical examinations34. The teaching of clinical surgery under Thomas Roddick, now that antisepsis had been introduced, changed, since most parts of the body could be operated on with less fear of infection. It took many years, however, to train young surgeons to take advantage of this advance. Graduation requirements had not changed. Eighteen months were now required at the Montreal General Hospital and six months at the Lying-in with at least six deliveries by each student. The senior thesis was finally dropped because it had become a poor student essay without originality. The comprehensive examinations were replaced by yearly ones. A survey of the annual announcements between 1860 and 1870 reveals changes in enrolment but little change in teaching methods and course content. Between 1870 and 1880, in contrast, the announcements attempt to but cannot reflect the truly extraordinary change in course content and attitude brought about by young faculty members. The luster of the Faculty of Medicine was brightened when Thomas George Roddick, M.D., C.M. (1846-1923,- fig. 39), gradu ated. He was first in his class, and he was given a house surgeon's position at the Montreal General Hospital with expectations that he would one day be a great credit to the faculty. Like Ross, Roddick made no distinct medical discoveries; however, his name will be forever preserved in the history of Canadian surgery because of his role in the promotion of antiseptic surgery, learned from Joseph Lister.35 One of the few accounts of him as

z zR- 5 O DvE R

OF

L E C T U R E S , W1JNT.EK SfcssuJJM

loao-oi.

Figure 38 Lecture schedule, Faculty of Medicine, 1880-81. Taken from the Annual Announcement of the Faculty of Medicine, 1880-81.

Figure 39 Thomas George Roddick, M.D., C.M., Professor of Clinical Surgery, 1875-90, Professor of Surgery, 1890-1906, Dean, 1901-08. Photo by William Notman, 1880.

81 The Osier Years

a teacher came from Casey Wood, M.D., C.M., who had been one of his house surgeons.36 Wood described him as an earnest, kindly, energetic instructor who was friendly to students and could talk to any level. He was a man of action, and appropriately chose surgery as his specialty. Despite eventual fame, he never flaunted his authority to patients or house officers and inspired many able students who passed through the Montreal General. Shephard called him a natural diagnostic genius, particularly with fractures. He enjoyed surgery and teaching students and generated confidence as a role model. It is interesting to trace the development of antisepsis at McGill, considering its enormous importance in surgical education and practice. Lister's concept of antiseptic surgery had been tried by Robert Craik and William Fraser as early as 1869, only four years after Lister began his work with carbolic acid. Craik, whose senior thesis was on the germ theory,37 was probably the only man at McGill who appreciated what Lister was trying to accomplish. Craik initially used sponges and ligatures soaked in carbolic acid and made a dilute solution of about 10 percent acid for rinsing out the abdominal cavity and various wounds - a technique itself probably harmful to patients. Lister never used a solution stronger than 1:40 (2.5 percent), which showed his respect for the toxic effects of the solution as well as its benefits. In 1870 Craik reported the use of carbolic acid in a number of cases: "Being a firm believer in the germ theory and being thoroughly convinced of the efficacy and harmlessness of carbolic acid in such cases even when applied to serous and synovial membranes, I determined to apply it thoroughly in this case."38 He described successful cases and went on to say: "In conclusion, I would remark that to carry out antiseptic treatment thoroughly, it is almost necessary that one should be a firm believer in the germ theory, otherwise some necessary precaution is apt to be omitted which may vitiate the whole process."39 Craik's opinions were elegantly stated in the proceedings of a Medical and Chirurgical Society meeting in 1870, where exchanges took place among him, Fraser, Howard, William Hingston, and John Reddy. Each gave his experience and expressed doubts about the germ theory. Roddick was the secretary at the time and had little to say since he lacked experience. It is curious to look back at this meeting and to read Craik's statement defending Lister's theories. He never developed the

82 The Faculty of Medicine, 1874-85

matter further, apparently being satisfied that he was using good technique. Not using the spray technique introduced by Lister in 1871 probably explains Craik's lack of impressive results and interest in further promoting its benefits. Fraser, whose results also were not impressive, however, understood the implications of Listerian antisepsis and stated it clearly in his annual introductory lecture to the Faculty of Medicine 1870: "I believe that carbolic acid, as now employed in surgical practice by Mr Lister, will, to a great extent, if not completely, prevent pyaemia in surgical cases."40 Like Craik, Fraser dabbled in antisepsis before the spray was introduced and did not have the results to demonstrate its enormous importance to the medical community. Roddick's involvement with antisepsis was casual at first. In 1872, while on a vacation in Scotland, he visited the Royal Infirmary in Edinburgh to see Lister's technique and results.41 He described in a communication to the Canada Medical and Surgical Journal in 1873 that Lister used carbolic gauze and a 1:40 solution in every operation, either as a spray or a lotion applied directly to the wound or incision.42 Lister even washed the walls of his operating room and wards with carbolic acid. Although Roddick and Shephard were proponents of Lister's approach, neither could promote it or scientifically demonstrate its efficacy until they were appointed to the staff of the Montreal General Hospital in 1875 and 1879 respectively, and had access to the operating room. This explains the long lag between Roddick's first exposure to antisepsis in 1872 and his acknowledgment of the results of the procedure. In the summer of 1877, established at the hospital and experiencing his own high operative infection rate, Roddick returned to Scotland for practical training with Lister and then went to London where Lister had just accepted an appointment at the King's College Hospital. This time Roddick determined to learn and to promote antisepsis because the results of general surgery at the Montreal General were appalling.43 He enthusiastically returned to Montreal in September 1877 with a complete antiseptic outfit, including a boiler, charged or carbolic gauze, and a spray apparatus (fig. 40). He was in town no more then a few hours before being asked to assist in a case of a compound fracture of the leg. The full carbolic spray treatment was applied in this case, and recovery occurred without infection. Roddick provided descriptions of the preparations and procedures he used for antiseptic surgery in 1873, 1877, and 1878. As

83

The Osier Years

Figure 40 Typical carbolic spray apparatus used by Lister. Water was boiled by an alcohol flame and steam released under pressure from jets (there are two on this model). Carbolic acid in the glass jar was sucked up in the tube and sprayed out mixed with the steam.

crude as it was more than 100 years ago, the excitement of such a procedure to avoid infection stimulated him to perfect and promote it.44 The operating room changed with time, as did operative procedures. Walls were eventually washed, as were tables and floors, and better materials were used for the walls, floors, and ceilings to make them more easily cleaned. Student teaching, however, changed slowly because the open operating rooms were used for surgical demonstration until the turn of the century. In preparation for surgery, according to Roddick's technique, the operating area was covered with a towel soaked in a 1:20 carbolic acid solution. Sponges were prepared and instruments placed in a

84 The Faculty of Medicine, 1874-85

1:20 solution and a 1:40 carbolic solution was prepared to be used for hand washing by the doctors and nurses during surgery. The operating room staff periodically made carbolized catgut in large lots by adding gut to a mixture of water and carbolic acid added to an olive oil solution. Antiseptic gauze to be applied directly to the wound was soaked in a heated carbolic mixture under pressure to cause even distribution of the chemical. Drainage tubing was prepared, and special bandages were made of oiled silk soaked in carbolic acid. They were applied directly to the wound surface over the gauze to protect the wound from infection.45 With all this preparation in a clean operating room, it is no wonder that there was a significant reduction in the surgical infection rate. The spray apparatus was a boiler tank of about a gallon (fig. 40), heated by an alcohol flame to produce steam that carried with it carbolic acid drawn out of an attached bottle. This saturated the target as well as everything else in the operating room. The spray was directed at the surgical site and was kept going throughout the operation (fig. 41). According to reports, everything - patients, doctors, nurses, bedding, walls, ceiling, floors - was saturated and dripping with carbolic acid by the end of the procedure. The personnel, soaked to the skin, frequently developed dermatitis from the acid and occasionally nephritis from inhalation. The system was revised frequently and updated by Lister, who opted more for general aseptic technique and abandoned the spray in 1887 in favour of dry sterile bandages and improved surgical technique. He eventually favoured lodoform in place of carbolic acid, but as chance would have it, Roddick had a skin allergy to lodoform and was unable to use it. Once Roddick was accustomed to using the Listerian technique in Montreal, he set out to promote uniform antiseptic technique by providing comparative operative statistics. First he wanted to standardize operating room procedure with regard to dressing and cleanliness so that if antiseptic principles were applied, good results could be expected. He wrote: The fact is, as a staff of hospital surgeons, we had no well established or uniform method of treating wounds or amputations. The form of dressing applied depended in a great measure upon the caprice of the operator thus one would use water dressings and leave the wound open; another would attempt to seal it up hermetically with a view of promoting

85 The Osier Years

Figure 41 Operation with carbolic acid spray used for antisepsis. (Sir William Watson Cheyne, Antiseptic Surgery, Its Principles, Practice, History, and Results, London, 1882).

primary union, the result being often great tension, great constitutional disturbance, and rapid septopyemia, and in the space of a few days would have tried several different dressings. Now we have a definite method of procedure, and we know from experience that if all of the prescribed precautions be taken, a certain given result will follow.46

Roddick reported his results in 1878 at the Canadian Medical Association meeting in Hamilton, Ontario,47 and repeated this with more convincing statistics in 1879.48 That year he also wrote "Some Remarks on Lister's Antiseptic Methods," to be published in Osier's Montreal General Hospital Report in 1880. He recorded that prior to the introduction of antisepsis in 1877, four amputations at the thigh and four out of six leg amputations resulted in death from infection. This is an 80 percent mortality rate with amputations of the leg done by one surgeon. The following table reveals the results for the two years following the introduction of Listerian methods i877~79:49

86

The Faculty of Medicine, 1874-85 MAJOH OPERATIONS.

Amputation " " « Excision of « " " Removal of " « Ovariotomy

of Thigh Leg Arm Foot (Syme's) Elbow Hip Knee Astragalus Breast..., Tumour (various) Testicle

KECOV.

:» 4 y 2 4 2 4 2 12 17 2 1 62

DIED.

1

1

2

In sixty-four major operations, the mortality was only 3.12, percent, which challenged the best results in British hospitals. Comparable statistics at St Bartholomew's Hospital, London, were 3.4 percent and at the Royal Infirmary in Glasgow 3.2 percent for the same period. The impact of Roddick's convictions and surgical results from antisepsis reached far beyond the improvement in statistics. Although Listerian techniques had been used sporadically and haphazardly for years, it was Roddick with his talks and publications who promoted its benefits. He also encouraged the hospital authorities to set standards for operating room cleanliness and dressing techniques that were proved to reduce infection. This was not accomplished for years until the older surgeons retired and trained operating room nursing staff appeared.50 Shephard was also a great believer in Listerian antisepsis and supported Roddick fully using his own modification of the technique. Another benefit of Roddick's promotion of antisepsis was that many operations were now possible that could not previously be safely performed. Abdominal bowel surgery, hysterectomy, nephrectomy, appendectomy, tumour surgery, and many other procedures which students had never witnessed were eventually performed in the succeeding fifteen years. Before 1877 these procedures had meant almost certain death for the patient. The operating room changed with the use of carbolic acid spray,gone were the blood-splattered floor and table and the crusted frock coats, replaced by tile, glass, and metal cabinets, white

87 The Osier Years

gowns, and a clean table.51 Roddick eventually became an international surgical figure. No one in McGill's almost fifty-year existence had done more to improve medical and surgical treatment and dramatically influence the teaching of surgery. To him goes a portion of the credit for alerting the Canadian medical community not only to the extraordinary value of antisepsis but also the value of uniform operating room procedures. w great progress and change in the Faculty of Medicine. In May, Shephard finally convinced the faculty to accept an examination in practical anatomy as a requirement for passing the course.52 This was an important step in the emphasis of the laboratory role in the teaching of anatomy. Other curriculum changes led to the establishment of a required course in hygiene and extension of the medical and surgical rotations to six months each, with eighteen months hospital experience required for graduation.53 In 1877 McGill appointed its first surgical specialist, Dr Francis Duller (fig. 42). Buller, an accomplished ophthalmologist, was appointed Lecturer in Diseases of the Eye and Ear. He studied the specialty in Germany and from there went to London in 1872, where he was Chief Registrar of the Royal London Ophthalmic Hospital for four years. He introduced direct ophthalmoscopy to England before going to McGill in 1876. Appointed to the Montreal General and to McGill the next year, he was to give ophthalmology an independent status in Lower Canada. Osier was appointed Registrar to the Faculty of Medicine in 1877, a position of considerable influence with students. He was a founder and first president of the McGill Medical Society and gave the annual introductory lecture to students that year where he took the opportunity to speak about the educational reform needed at McGill: "At this, more than any other time, within the past 50 years, the leading minds in the profession are occupied with the subject of medical education and there is an almost universal feeling that in many quarters reform is needed. It is probable that the next decade will see radical changes in the modes of tuition while practical work will be introduced more and more largely in every department."54 Osier also took the opportunity to exhort the students about their daily work, an approach which was to became his trademark in later years: "Banish the future,- live only for the hour and its allotted work. Think not of the amount to be accomplished, the

The Faculty of Medicine, 1874-85

Figure 42, Frank Buller, M.D., Professor of Diseases of Eye and Ear, 1883-1905. Photo by William Notman, 1882.

difficulties to be overcome, or the end to be attained, but set earnestly at the little task at your elbow, letting that be sufficient for the day; for surely our plain duty is, Not to see what lies dimly at a distance, but to do what lies clearly at hand." 55

89 The Osier Years

Figure 43 George Major, M.D., C.M., Lecturer in Otology, 1882-83. Photo by William Notman, 1882.

Following Buller's appointment in iS/y, 56 George Major, M.D. (fig. 43) was appointed laryngologist to the Montreal General in 1882, William Gardner, M.D. (fig. 44) gynecologist, and Alexander Blackader, M.D. (fig. 45), Lecturer in the Diseases of Children, both in 1883. Blackader also was given a clinic for diseases of children at the hospital. The appointments in the surgical specialties greatly expanded surgical teaching, which by 1882 had separated itself from internal

9O

The Faculty of Medicine, 1874-85

Figure 44 William Gardner, M.D., C.M., Professor of Gynecology, 1883-1910. Photo by William Notman, 1880.

medicine.60 Students now were taught better techniques of physical examination, including palpation; auscultation, and percussion, the examination of the eyes, ears, and throat, and the use of the reflex hammer and thermometer. Despite these advances, teaching methods were still primarily didactic, but student participation on the ward and in the primary subjects was improving. Educational progress was inevitably impeded by problems. One which beset the anatomy course was the source and procurement

Figure 45 Alexander Dougall Blackader, M.D., C.M., Professor of Therapeutics and Pharmacology, 1891-1921, Professor of Diseases of Children, 1896-1921. Photo by William Notman, 1882.

92 The Faculty of Medicine, 1874-85

of cadavers. When Osier and Shephard had been students at McGill from 1869 to 1872, anatomy was indisputably one of the unique features of the medical school because of a fresh and ready supply of cadavers for dissection. A provincial act assured the supply of cadavers for the medical schools, but because it was not enforced, most bodies were obtained illegally by "body snatchers" or "resurrectionists," as the French students called themselves. Because of its bearing on teaching anatomy, the story of this remarkable practice is of great importance. A cadaver, depending upon its age and date of death, could bring between $30 and $50 from the medical school, with no questions asked. The bodies were stolen at night, frequently dug up from newly prepared graves or taken out of mausoleums in the winter, where the cadavers awaited burial when the ground thawed. They were taken to the back door of the medical building and received by the diener who gave the procurers a receipt. Most of the bodies were from the Cote des Neiges Catholic cemetery west of Montreal, but no graveyard for miles around was left undisturbed. The customary routine was for the procurer to send a representative to McGill the following day for the money, so that no one ever saw the perpetrator. This enterprise was so well organized that a guard at the Cote des Neiges Cemetery received kickbacks from two student resurrectionists from McGill for each grave that he marked. Apparently some students paid their tuition and board with money earned from their cadaveric retrieval. The story of the bodysnatching was revealed in Shephard's anatomical reminiscences of 1875-83.6l One senses humour in Shephard's account; however, a chronic and very sensitive problem is also implied, the resolution of which was important to the Faculty of Medicine. The community knew of the practice, and whenever a body was missing, the relatives, at times a detective, and even friends would appear at McGill to identify the cadavers. Shephard was prosecuted a number of times for "an offense against decency," usually paying a $50 fine. A sympathetic judge never pursued further legal action. Because of the great success of this enterprise, bodies were brought from county cemeteries and even groups of bodies were stolen from mausoleums in the winter. On one occasion, the dead house of a convent was robbed of the cadavers of students and nuns who had succumbed to typhoid fever. The absence of the

93 The Osier Years

\vered in the convent before the medical students could deliver them, and the bodies were buried in snowbanks where they were recovered after a substantial reward was offered. The parental outcry after this particular episode brought the matter quickly to a climax. The Archbishop of Quebec, recognizing that the scandalous body-snatching had become a serious problem, appealed to the anatomists, and in particular to Frank Shephard, to state what was necessary to legalize the provision of cadavers for anatomical purposes. It was very simple. All unclaimed bodies from public institutions were to be turned over to the departments of anatomy,- if bodies were stolen, a fine would be imposed and provincial support would be in jeopardy. Only direct and close relatives with certified evidence could claim bodies from the anatomy laboratories and all remains of dissection were to be appropriately buried. The law, backed by the Catholic Church, was written, introduced, and duly passed by the Quebec Legislature. Body snatching ceased. This was the desired effect and a milestone for medicine in Canada. Francis Shephard's significant role in this legislation guaranteed the integrity of McGilPs anatomy tradition.62 Osier, although trained in the British school of physiology where the microscope was the main tool for the scientist, recognized the need for a general physiology laboratory like Carl Ludwig's in Marburg, Germany (Ludwig developed the kymograph) or Henry Bowditch's in Boston. Osier was convinced by observations during his visits to Harvard in 1876 and 1877 that a well-equipped student laboratory was needed to advance medical education at McGill. Following his return from Harvard with Ross and Shephard in 1877, he approached the faculty and Dean Campbell in November i878, 63 introducing a proposal to renovate the third lecture room in the medical school into a physiology laboratory that would be equipped for practical demonstrations. Money was made available in 1879, and the laboratory completed in 1880, the first of its kind in Lower Canada. Osier published a description o the room and the equipment in the Canada Medical and Surgical Journal in i88o.64 In addition to the special tables, benches, sinks, and the eleven microscopes, there were microtomes, warming stages, hemocytometers and hemochromometers, a spectroscope, a kymograph, batteries, induction apparatus, animal head and body holders, and other equipment (fig. 46).

Figure 46 Diagram of the new physiology laboratory at McGill, 1880 (Osier, W. Can. Med. Surg. J. 9:198-201, 1880).

95

The Osier Years

In the six years following Osier's return, the rudiments of modern histology, anatomy, pathology, chemistry, and now physiology had been introduced. Only materia medica, taught by Professor William Wright, remained to be changed. This came about a few years later, in an unprecedented way, to complete the reformation in preclinical medicine at McGill. Robert Craik resigned the professorship of chemistry in 1879, ending the era of teaching only by lecture.65 The only logical choice for a successor was Gilbert Girdwood, a practical chemist with an established reputation, capable of conducting student laboratories in chemistry. With the appointment of Girdwood,66 a university chair of chemistry was established whose occupant was to be a full-time teacher and researcher responsible for undergraduate and medical student instruction. This arrangement secured Girdwood for McGill and provided adequate funds to make up for the loss of his income from medical practice. The annual announcement of the Faculty of Medicine 1880-81 reveals changes in chemistry from the demonstration course of Craik to one where students were supervised in the laboratory by Professor Girdwood (the practical course).67 In 1881 Osier convinced the faculty to appoint Thomas Wesley Mills, M.D., C.M., a promising physiologist, as an assistant to teach in the recently established laboratory. This began the official split of histology as an anatomic science and physiology as a functional one. Despite the assistance, Osier was teaching four courses: practical physiology, normal histology, morbid anatomy (pathology), and clinical microscopy. He was also busy completing his laboratory manual, Students' Notes in Normal Histology (fig. 47), the first work of its kind in Canada, published in i882. 68 The account below illustrates how Osier kept up with contemporary scientific progress. One of the most important advances in understanding human disease was Robert Koch's (1843-1910) discovery of the tubercle bacillus as the cause of tuberculosis, announced on March 24, 1882, to the Physiological Society of Berlin. Tuberculosis had been known for many years, but Koch clearly showed its pathophysiology and epidemiology, and identified the organism and a stain to demonstrate it. Osier, who quickly recognized the significance of Koch's advance, immediately experimented with his staining technique, known as the acid-fast stain. In July 1882 a note was placed in the Canada Medical and Surgical Journal69 describing

96 The Faculty of Medicine, 1874-85

Figure 47 Title page of Osier's Student's Notes in Normal Histology, 1882.

a class demonstration by Osier of the acid-fast organism of tuberculosis from the lung of a patient who had died of the disease.70 Osier subsequently became a strong advocate of the theory of the infectious nature of tuberculosis and a strong supporter for research in antituberculosis treatment. The final break with the didactic old guard era of McGill's medical teaching came late in i882 71 when first- and second-year medical students, in an unprecedented move, petitioned the Faculty of Medicine for the resignation of William Wright, M.D., the Professor of Materia Medica, and demanded an answer after

97 The Osier Years

Christmas vacation. The students claimed that Professor Wright's lectures were overly detailed, that the description of drugs was suitable for students of pharmacy and not for medical students, that Wright indicated no distinction between unimportant and important drugs, and that he made no attempt to classify the drugs according to their therapeutic principles. This historic confrontation with the establishment not only marked the increasing importance of student opinion in the education process but also demonstrated the faculty's recognition of weaknesses in its staff and its willingness to correct them. The faculty investigated the matter and asked Dr Wright to modify his teaching as a concession to the students. Wright was indignant that the faculty investigated the students' charges, but agreed to the faculty request.72 By midJanuary i883, 73 a few weeks after the course had begun, no changes had been made, so the students re-petitioned the faculty and stopped attending lectures until substantive changes were made.74 The first-year class, in support, threatened to withdraw from the faculty unless Professor Wright was asked to resign.75 Wright failed to recognize fault in his subject presentation. Correctly sensing the faculty's ire, however, he officially resigned in April,76 thereby ending his teaching career and a pedagogic era of McGill medicine which had lasted thirty-three years. In May i88377 the faculty announced the death of William Scott, M.D., who had taught anatomy in the faculty for thirty-eight years. He was the last remaining link to the founders and early faculty members. Scott's position and didactic style had been offset by Francis Shephard, who made up for the lecture deficiencies with improvements in teaching in the anatomy laboratory. In the case of materia medica, which was a creation of William Wright, there was no challenger until the students rebelled. With Scott's death and Wright's resignation, the "heroic" era of McGill medicine ended - an era which paradoxically established the Faculty of Medicine but which also delayed its progress for at least a decade. Major changes in 1883 allowed the faculty to appoint additional young staff and especially those individuals who eventually developed their specialties. On Wright's resignation,78 James Stewart, M.D., C.M., was appointed to teach materia medica, and Frank Shephard was given the Chair in Anatomy.79 Duncan MacCallum resigned the Chair of Midwifery and Diseases of Women and Children80 citing the increasing demands of his private practice. The faculty, realizing the large responsibility of the Chair of Obstetrics and Gynecology and Pediatrics together, created separate

Figure 48 William Osier, M.D., C.M., Professor of Institutes of Medicine, 1875-84. Photo by William Notman, 1881.

99 The Osier Years

departments of gynecology, midwifery, and diseases of infants. Blackader had already been granted an informal position for the diseases of children. To fill the new chairs William Gardner, M.D., C.M. who had been Assistant in Gynecology, was transferred from the Chair of Jurisprudence to Gynecology, and A.A. Browne, M.D., C.M. was promoted from Instructor of Obstetrics to the Chair of Midwifery and Diseases of Infants. Further commitment to specialization was evidenced by the faculty's promotion of Dr Buller81 from a lectureship in ophthalmology and otology to a professorship. Unfortunately, because the faculty lacked funds, it was a position without remuneration. In June 1884, while on a European trip, Osier (fig. 48) was offered and accepted the Chair of Clinical Medicine at the University of Pennsylvania in Philadelphia. Why he accepted this position was never openly stated, but in retrospect it takes little imagination to see the reason. He had no doubt accomplished what he wanted to do at McGill, and much of the challenge was gone. He was at the peak of his productive career at the age of thirty-five and had staggering commitments to many local medical and nonmedical organizations. He had instituted many innovations in medical teaching, including the first course in microscopy, and the first student handbook in histology in Lower Canada. He was the first pathologist at McGill and the Montreal General and taught the first course in pathology to medical students in Lower Canada. He edited the first publication of pathology reports from a Canadian hospital and was the first full-time faculty member, appointed for his scientific and research experience rather then for clinical expertise. He was also the youngest faculty member to be appointed to that time. Having accomplished all this, it can be surmised that Osier wished to apply his accumulated basic knowledge and experience to teaching students the diagnosis and treatment of human disease. This required a professorship in clinical medicine, which was impossible for Osier to obtain at McGill because the chairs were occupied. McGill might have kept him a few years longer with a professorship in pathology or by providing more assistance in histology, but without the professorship in medicine he was ready to assume. Thus, the Faculty of Medicine lost its "potent ferment" 82 whose endeavours, along with the contributions of Shephard, Roddick, and Ross, significantly changed The Faculty of Medicine during the decade ending 1884.

5 Epilogue

The fundamental questions and challenges in medical education at McGill and in North American medical schools in the last quarter of the nineteenth century were philosophical and pedagogical. The major concern was how to teach efficiently what was known and how to teach students to think scientifically.1 The methods transferred from Edinburgh in the first half of the nineteenth century were no longer adequate. Academic authority and passive student involvement gradually became obsolete as the volume of medical knowledge increased and newer methods and tools of study became more available. This was accomplished by introducing students to laboratories constructed for student teaching and by decreasing lecture time. As the new philosophy of education - learning while doing - was being adopted, it required a fundamental change in both the structural facilities of the school and in the philosophy of teaching. When the commitment was made, money from public donors had to be raised to expand and renovate facilities, as was done at McGill in 1885 and 1886. With the new facilities for student participation in a hands-on way, the medical school began to change its focus on teaching from merely imparting information in a passive way to one of teaching students how to gather information and interpret it in a scientific way; in other words, to begin to think scientifically. The laboratory experience provided reinforcement for the necessary lectures in all subjects and provided students with a different

ioi Epilogue way to approach the learning process. These sweeping ideas, however, were not instituted anywhere overnight because of many obstacles. To accomplish these goals took an increase in funding, new facilities, better prepared students, better trained teaching staff, better text books and journals, and time. Even with the best intentions, decades passed before this system was satisfactory long after Osier left McGill. The proper training of house officers and students in the hospitals, however, was neglected as the faculty single-mindedly pursued improvement in pre-clinical teaching. This aspect of training was not addressed for at least two decades. William Osier must be considered the catalyst for the transformation at McGill. He introduced the concept of progress through science to the faculty in 1874 when he began his teaching career in the institutes of medicine and insisted on a properly equipped laboratory and scientific protocol. In his 1876 pathology course he also introduced the opportunity for students to correlate histology and gross anatomy with a knowledge of pathology to learn the nature of disease processes. In a similar manner, Francis Shephard, as the Demonstrator in Anatomy, insisted that anatomy was best learned by dissection and not only in the lecture room. Gilbert Girdwood likewise transformed chemistry in the mid-i88os from a passive lecture course to one where learning took place in the laboratory. By 1880 physiology, hitherto neglected, was given its first impetus by Osier, who lobbied for a laboratory, equipment, and an instructor to train students. The emphasis on change and progress through science created an air of enthusiasm in the faculty. It also convinced the public that medicine had a future in the university setting and encouraged benefactors to support medical education. Lord Strathcona, who saw the need early, gave $50,000 in 1882 to be matched by the faculty,- this was accomplished by 1883. The annual announcement of I885-862 listed those who had given a total of over $50,000. Thus began public and alumni support of medical training at McGill. The enthusiasm for this reformation in the pre-clinical subjects led the faculty in 1886 to raise money to construct a new wing larger than the 1872 building. The new facility, one of the largest in North America and the British Empire, provided modern student laboratory space. The entire effort represented a profound statement by McGill of the importance of the preclinical subjects.

IO2 Epilogue

Other developments in medicine at McGill also were to transform medical education and practice. Surgical treatment, which had been restricted by post-operative infection since its inception, made substantial progress with the promotion of antisepsis by Thomas Roddick starting in iSyy. 3 The previous introduction of anesthesia in 1847-48"* had broadened the scope of surgery and reduced human suffering, but infections had been omnipresent, and their prevention never understood. The discovery and application of antisepsis had a remarkable ripple effect. With surgery expanded essentially by one discovery, the field of surgical pathology was stimulated and teaching of the anatomy of the chest, abdomen, pelvis, and brain became more relevant. The development of new surgical procedures and ultimately of new surgical specialties raised surgery from its previous "barber surgeon" status to the academic equivalent of other medical disciplines. The influence of the change in medicine at McGill during the years 1874-85 caused a great change in the medical ethos of Lower Canada. Science and medical education were now inextricably intertwined, despite the unsophisticated framework. By the time of Osier's departure in 1884, the reformation had only begun. The high standards Abraham Flexner found on his visit to Montreal in I9O9 5 were the direct result of the scientific reorientation which had started in the 18705.

Appendices

APPENDIX ONE

Letters: Secretary to Registrar Faculty of Medicine, 1834, 183$; Graduation, 1841: Order of Ceremonies, Letters, and Medical Pledge University of McGill College 24 May 1834 I do hereby Certify that the Medical Faculty of McGill College in conformity with the Statutes, Rules and ordinances Thereof have examined Mssrs. Roderick McDonald, Edward Patrick McNaughton, & John Finlayson &. have found that their literary & professional qualifications render them fit & qualified to be admitted to the Degree of Doctor in Medicine & Surgery.

To Dr. Holmes Registrar

J. Stephenson, M.D. Sec. Med. Faculty

icy

Letters, 1834, 1835; Graduation, 1841

I do hereby Certify that the Medical Faculty of McGill College in conformity with the Statutes, Rules and ordinances thereof have examined Mssrs. Joseph Workman, Frederick Webber Hart & Peter Dansereau & have found that their Literary & Professional qualifications render them fit and capable of being admitted to the Degree of Doctor in Medicine and Surgery. J. Stephenson, M.D. Sec. Med. Fac. May 1835 To A.F. Holmes, M.D. Registrar

IO9 Letters, 1834, 1835; Graduation, 1841

ORDER OF THE CEREMONIES 24 May 1841 1 Preamble 2 3 4 5 6 7 8

Entrance of Teachers and Candidates. Principal or V.P. to direct the Secretary to read to the Public the Second Chapter of the Statutes of the College. The Secretary to read the same The Principal or V.P. to enquire of the Register for the Secretary's Certificate of qualifications of the Candidates. Registrar to produce and read the same. The Secretary to present the Candidates to the Principal or V.P. Registrar to read the Declaration or Pledge to the Candidates presented and to require them to sign the same. The Principal or V.P. to address the Candidates and admit them to the Degree of Doctor in Medicine and Surgery.

in Letters/ 1834, J 835; Graduation, 1841 University of McGill College 24 May 1841 I do hereby certify that the Medical Faculty of McGill College in conformity with the Statutes Rules and Ordinances thereof have examined Messrs Terrence Sparham, Charles Decelles, & Samuel MacMurray and have found that their Literary and Professional qualifications render them fit and qualified to be admitted to the Degree of Doctor in Medicine and Surgery

To A.F. Holmes, M.D. Registrar Med. Fac.

J. Stephenson, M.D. Secretary Med. Fac. McG. College

H3 Letters, 1834, 1835; Graduation, 1841

University of McGill College Medical Faculty Pledge We do hereby declare that we will demean ourselves honorably in the Practice of the profession of Medicine and Surgery, that we will strictly our Patients' secrets keep, that we shall practice, caute, caste, probeque,- furthermore, that we shall never by act, word, or deed do any thing to injure the University granting this degree. Signed [crossed out] To be read by each candidate, one after the other

APPENDIX TWO

Staff of the Faculty of Medicine of McGill University, 1829-8$

Positions McGill Years Chem. 1824, Mat. Med. 1829, 1824-60 Bot 1824, Med. 1844, Dean 1854-60 Inst Med. 1824, Anat. 1824, 1824-42 John Stephenson, M.D., Edin. Surg. 1824-42 Med. 1824-33 1824-33 William Caldwell, M.D., Edin. 1824-44 William Robertson, M.D., Edin. +OBS 1824, Med. 1833-44 +OBS 1833-36 1833-36 John Racey, M.D., Edin. +OBS 1835-42, Surg. 1842-75, 1835-82 George Campbell, M.D., Dean 1860-82 Glascow & McGill Mat. Med. 1836, Chem. 1842, 1836-68 Archibald Hall, M.D., Edin & OBS 1854-68 McGill Dem. Anat. 1841-42 1841-42 James Dick, M.D., McGill Anat. 1842-56 1842-56 Olivier T. Bruneau, M.D., McGill +OBS 1842-54 1842-54 Michael McCullough, M.D., McGill Inst. Med. 1842, Clin. Med. 1842-52 Stephen Sewell, M.D., Edin. 1850-52 & McGill Dem. Anat. 1842-44 1842-44 Arthur Fischer, M.D., Edin. Clin. Med. 1845-49, I 852-55, 1845-55 James Crawford, M.D., Edin. Clin. Surg. 1845-55 1844-45 Alexander Long, M.D., McGill Dem. Anat. 1844-45 Inst. Med. 1845-50, Clin. Med. 1845-50 Robert L. MacDonnell, M.D., 1849-50 Trinity Med. J. 1845-49, Inst. Med. 1845-72 William Fraser, M.D., McGill 1849-72 Dem. Anat. 1845-51, Med. J. 1845-83 William Scott, M.D., McGill 1851-52, Clin. Surg. 1852-56, Anat. 1856-83 Chem. 1849-67 1849-67 William Sutherland, M.D., McGill Med. J. 1849-50 1849-50 Frances Badgley, M.D., Edin. Med. J. 1850-51 1850-51 Frances Arnoldi, M.D., Edin. Dem. Anat. 1850-52, Med. J. 1850-83 William Wright, M.D., McGill 1852-54, Mat. Med. 1854-83 1852-89 Robert Palmer Howard, M.D., Dem. Anat. 1852-54, Med. J. 1854-56, Clin. Med. 1856-60, McGill Med. 1860-82, Dean 1882-89 Bot. 1855-93, Zoo. 1883-93 !855-93 John William Dawson, L.L.D. Dem. Anat. 1854-59, Clin. 1854-83 Duncan MacCallam, M.D., Surg. 1856-60, Med. J. 1859McGill 60, Clin. Med. 1860-67, OBS 1868-83 Robert Craik, M.D., McGill* Dem. Anat. 1856-60, Clin. 1856-1901 Surg. 1860-67, Chem. 186779, Dean 1889-1901, Pub. Hlth. 1892-1901 Name and Degree Andrew F. Holmes, M.D., Edin. & McGill

ii5 Staff, Faculty of Medicine, 1829-85 Name and Degree Horace Nelson, M.D., McGill George Fen wick, M.D., McGill Joseph Morley Drake, M.D., McGill* William Fuller, M.D., C.M., McGill Gilbert Prout Girdwood, M.D., C.M., McGill George Ross, M.D., C.M., McGill** William Osier, M.D., C.M., McGill Thomas George Roddick, M.D., C.M., McGill** Robert Godfry, M.D., C.M., McGill William Gardner, M.D., C.M., McGill Francis Shephard, M.D., C.M., McGill Frank Buller, M.D., Victoria U, M.D., C.M., McGill William Molson, M.D., C.M., McGill Richard MacDonnell, M.D., C.M., McGill Thomas Wesley Mills, M.D., C.M., McGill George Major, M.D., C.M., McGill Alexander Blackader, M.D., C.M., McGill James Stewart, M.D., C.M., McGill

George Wilkens, M.D., C.M., McGill Robert J.B. Howard, M.D., C.M., McGill**

Positions McGill Years Dem. Anat. 1861-64 1861-64 Dem. Anat. 1864-67, Med. J. 1864-90 1867-68, Clin. Surg. 1868-75, Surg. 1875-90 Clin. Med. 1868-72, Inst. Med. 1868-74 1872-74 Dem. Anat. 1868-74 1868-74 Pract. Chem. 1870-79, Prof. Chem. 1879-1902 Clin. Med. 1872-92

1870-1902 1872-92

Inst. Med. 1874-84, Registrar 1874-84 1877-84 Dem. Anat. 1874-75, Pr°f- Clin. 1874-1908 Surg. 1875-90, Prof. Surg. 1890-94, Dean 1901-08 Hygeine 1875-78 1875-78 Med. J. 1875-83, Hyg. 1878-83, Prof. Gyn. 1883-1910 Dem. Anat. 1875-83, Prof. Anat. 1883-1913, Prof. Surg. 1883-1913, Dean 1908-14 Instr. Opth. 1877, Prof. Opth./ Otol. 1883-1905 Asst. Dem. Anat. 1877, Phys. to MGH 1877-98, Senior Phys. 1898-1915 Asst. Dem. Anat. 1877-83, Dem. Anat. 1883-91, Prof. Hyg. 1886-89, Prof. Clin. Med. 1889-91 Lect. Physio. 1881-84, Prof. Physio. 1884-1910 Otology 1882-93 Lect. Dis. Chil. 1883-96, Prof. 1896-1921; Chairman Ped., 1921-32; Prof. Ther. &. Pharm. 1892-1921 Mat. Med. 1883, Prof. Materia Medica & Therapeutics 1883, Prof. Med. 1892-93, Chair Med. & Clin. Med. & Chief RVH 1893-1906 Prof. Med. J. 1883, Lect. Hist. 1883, Prof. Hist. 1884-1907 Asst. De. Anat. 1883, Inst. Dis. Child 1885-88

1875-1910 1875-1914 1877-1905 1877-1915 1877-91

1881-1910 1882-93 1883-1921

1883-1906

1883-1907 1883-88

116 Appendix Two Name and Degree David Penhallow, PhD Wyatt G. Johnston, M.D., C.M., McGill Arthur Browne, M.D., C.M., McGill R.F. Ruttan, M.D., C.M., McGill

Positions Prof. Bot. 1883-1910 Dem. Path. 1884-92, Dem. Bact. 1895-1902 Obs. 1883-87

McGill Years 1883-1910 1884-1902 1883-87

Chem. 1885-1902, Prof. 1902-28 1885-1928

Members of the staff appointed after 1885 are not included. * First in class +OBS = Midwifery and Diseases of Women and Children * * Holmes Medal

APPENDIX

THREE

Graduates of the Faculty of Medicine of McGill University, 1833-85

GRADUATES IN MEDICINE. Honorary. •OLIVIER T. BRUNEAU, 1843. •MICHAEL McCULLOUGH, 1843. *JAMES DOUGLAS, 1847 *JAMES SAMPSON, 1847. •CHRISTOPHER WIDMBR, 1847.

*DANIEL AKNOLDI, 1848. *WOLFREI> NELSON, 1848. *JosnpH MORIN, 1848. *WALTER HEJ-CRY, 1853, JOHN HAMILTON RAH, 185^.

Ad Eundem Oradum. *GEORGB W. CAMPBELL, M.D., Glasgow, 1843. •ANDREW F. HOLMES, M.D., Edin.. 1843. *STBPHBN C. SEWELL, M.D., Edin., 1843. •ARCHIBALD HALL, M.D., Edin., 1848. *THOMAS. W. Joxns, M.D., Edin., 1854. *JAMBS CRAWFORD, M.D., Edin., 1854. •JAMBS BARNSTON, M.D., Edin., 1856. JOHN RBDDY, M.D., Glasgow, 1856. AUGER D. L. CAREY, M.D., 1864. EDWARD WORTHINGTON, M.D., St. And., 1868 COLIN SEWELL, M.D., Edin., 1869.

In Course. — 1833.— •William Logic.

Roderick Macdonald. •John Finlayson. Joseph Workman. •Pierre Dansereau. •J>e? compounds respectively ? 18 Is it deposited from new wine? 19 Why is it deposited after fer- 44 How may glycerine be separated from the acids ? mentation ? 20 Describe the process by which 45 What is this process called ? 46 Describe the process for isolathe acid is isolated. ting glycerine. 21 What are the products of the destructive distillation of 47 What are the elements of fats ? wood ? 48 Are fats nutritious ? 49 Arc they sufficient alone to sup 22 Mention the liquid products. port life ? 23 What is pyroligneous acid ? 50 What else is necessary ? 24 For what is it employed? sufnYi25 What are the other names for 51 Is azolized food alone, ent to support life 7 Methylic alcohol ?

139 Examination for M.D., Session 1854-55 r.nrroufA t UEI»AUTMtx r. 52 What kiud of foo.1 contains the 73 From whai is strychnia obtained 74 How is it separated / largest amount of nitrogen 1 53 Hour comes it thut animals can 75 Do yon remember any oilur process / live oil vegetable* ulouel 54 What are the nutritiousaxotisced 76 With what acid is it combined / substances found iu vegeta- 77 From what is quinine obtained / 78 With what opids is it combined / bles? 79 What other alkaloids are as55 What it Logtiu ? sociated with it in Cinchona/ 56 What aro the other constitu80 What effect has creosote on alents ot milk? 57 What causes it to coagulate ? bumen/ 53 Is the lactic uci.l formed spon- 81 In virtue of this property for what purpose is it employed iu taneously ? 59 What uthb ferment 7 surgery 1 60 Describe the process by which 82 What other substances are used lactic acid may bo isolated. as humiostatics t 61 Is butter similar to the other 83 Mr hat is tannin? futs? 84 From what is it obtained / 62 What are- its coastitueuts ? 85 Wltut special character do 63 What acids does it contain ? plants which contain tauuin 64 With whdt substance are they possess/ united as a base ? 86 What other substance closely 65 What are the chief salts formed allied to tannin is found iu in milk 1 plants f 66 Does milk contain all the ele- 87 HOW does Gallic acid diff.r from ments necessary for the growth tannin/ and nutrition of the body / 88 Is taauin soluble i: water 1 67 How in this proved / 89 What is the action of tannin in 68 What purposes do the phosthe process of tanning leather phates ;n m Ik serve to fulfil ? 90 How is Gallic acid produced 69 For the nourishment of what from tannin / tissue-sure they more partie- 91 What other acid is at the same ulurly essential / time produced 1 70 Iu what condition does the 92 If a heat of 160° be applied to phosphorus exist in the tissues/ albumen, what is the result / 71 DAMS it exi*t in the brain in an/ 93 When albumen has been coaother condition than as a congulated, how may it be restituent of albumen/ dissolved '. 73 What are the fatty acids of the 91 What organic substance has brain / this power? Medical Jurisprudence— Examiner, Dr. WRIGHT. 1 What are the first symptoms of 5 What are the signs of partial insanity 1 intellectual insanity ? 2 Are the habits, of the individ- 6 Is the existence ol a delusion ual always radically changed ? ulvvuys up|tfirent ? 3 Are the moral and intellectual 7 What are the varieties of parfaculties always equally and tial moral insanity 1 simultaneously affected 1 8 In which sex is pyromania 4 How id intellectual iusmity most frequently found ? divided t 9 At what perio:l of life'

I4-O Appendix Five EDITORIAL DEPARTMENT.

10 Are homicidal impulses of frequent occurrence ammgt he insane 1 11 What is the proportiont 12 In whom is this impulse most often found ? 13 What ratio does the frequency of suicidal impulses bear to this? 14 What circumstances would lead you to infer that a murder was the result of a homicidal impulse ? 15 In such cases is there generally only one wound, or are there many 1 16 Is the impulse preceded or not ty premonitory symptoms ? 17 What is the condition of th«s system at the time of the impulse t 18 What disease of the nervous system is frequently oo-existeut 19 What is the legal test by which insanity is judged to be present or absent t 20 If it can be proved that the person is aware of the distinction between r.ghtand wrong, does it tbllow that he is not insane? 21 What may constitute the insanity in* su -h a case ? 22 What is generally the condition of the will in insane persons ? 23 Is the inability to distinguish between fight and wrong.proof positive of insanity ? 24 On what rany this inability depend ) 25 How would you distinguish a cu^c oi real, from one or feigned insmity t 26 Do insane persons sleep much 1 27 Are they readily fatigued '? 28 How is this power of endurance accounted tor ? 29 For what purposes 1might pr