{Reprinted from the Montreal Medical Journal, November, 1889.) 
INTRODUCTORY ADDRESS 
Delivered at the Opening of the Fifty-Seventh Session 
of the Medical Faculty of McGill University, 
October IkT, 1889. 
By R. L. MacDonnell, B.A., M.D., 
Professor of Clinical Medicine. 
At the beginning of a new session it has always been the 
custom in this college for the members of the Faculty to select 
one of their number to address words of welcome to the new- 
comers and to those who have already embarked upon their medi- 
cal career. This year my turn has come. On such occasions it is 
customary for the lecturer to introduce himself with an apology 
for his general and special unworthiness, but it is not my 
intention to do anything of the kind. On the contrary, I 
think myself peculiarly well fitted to welcome and give 
advice to new students. Firstly because, not being yet stricken 
in years, though scarcely juvenile, I fancy I can still think and 
act as a young man and look upon the world from the stand- 
point of a medical student; and, secondly, because it has been 
my good fortune to have spent ten years of my professional life 
in daily companionship with students. And indeed it would be a 
strange thing if I did not, during that time, learn to know how 
students thought, how they lived and moved and had their being. 
It is for these reasons that I think my advice may be of some 
service to those who are about to begin the work of the 57th 
session. 2 
It will be part of my object to show you that, although the 
course of studies laid out for you is at first sight difficult, yet 
that the means of overcoming the difficulties and obstacles of the 
road are within your reach, and that to the industrious student 
the journey to a degree is interesting and pleasant. There are 
long marches it is true, and sometimes temporary stoppages 
^generally overcome by slight supplemental effort), but the road 
lies through a pleasing country, with so much that is interesting 
by the wayside that the traveller arrives at his destination sooner 
than the length of time spent in the journey would lead him to 
expect. 
This is the problem to be solved by your faculty. 
How to afford the best medical education possible in the short 
space of four years ? Our endeavour is to turn out as well edu- 
cated a practitioner as we can-a practitioner I say, that is one 
who can practise, a man able at once to earn his own living and 
to make himself useful in the community. I believe we do 
turn out a practitioner, in the true sense of the word. The 
McGill graduate enters upon his career with a fair experience of 
general medical and special work, and so far we have no good 
reason to be dissatisfied with the result of our four years' work. 
The question arises, though, ought we to be satisfied or ought 
we be constantly endeavouring to effect improvements in the 
course ? 
The main difficulty in our way is the limited period of time at 
our disposal, but this difficulty we could overcome were it not for 
the attempts to regulate our teaching undertaken by the various 
provincial licensing bodies. 
You have, I dare say, read 2Esop, and you remember how 
the frogs, dissatisfied with the existing state of practice in the 
somewhat malarious district in which they resided, fell to grum- 
bling, and, after considerable deliberation, demanded of Jupiter 
that some firm legislation should regulate the affairs of the pro- 
fession. The thunderer, accordingly, sent them a log which 
met with contempt and disrespect. Annoyed at their conduct, 
he sent them a provincial board, and matters soon assumed such 
a condition that the frogs bitterly regretted that they had not 
well let alone. And so with the Canadian medical profession. 3 
Boards were established, at the instigation of the members of 
the profession themselves, by the provincial governments, with 
the good intention of regulating admission to practice and pre- 
venting quacks and charlatans from exercising their dangerous 
trade. So far so good. But the boards, like Jupiter's stork, 
were not satisfied. They have in some provinces assumed the 
role of educators, and dictate to teachers what they must teach 
and to learners what they must learn. They have injured the 
profession they were intended to protect, and they have hampered 
and impeded the progress of the medical schools. From their mis- 
chievous interference this school suffers to an extreme degree. 
In particular, the College of Physicians and Surgeons of Ontario 
imposes upon our students certain very vexatious regulations 
and exacts of them pecuniary taxes, wholly out of proportion to 
the benefits they may ever expect to derive from becoming 
licentiates. It would seem that but two objects are aimed at by 
these regulations and impositions. Firstly, the establishment of 
a barrier to keep out of the field as many competitors as pos- 
sible, the originators of the movement having affected an en- 
trance before the fence was put up ; and, secondly, to render it 
more and more inconvenient and uncomfortable for an Ontario 
student to seek his education out of his own province. Failure 
will attend both these objects, for the fittest will survive in 
the battle of life by the law of nature, and no legislation will 
ever enable those unsuited by natural abilities and defective 
education to take a front rank in the fight. The struggle for 
existence in the profession must be a fair one from the start, 
and those who cannot live by their own talents and energies, 
will seek in vain for any benefit from legislative aid. 
The claim is made, on the other hand, that provincial board8 
exclude quacks and charlatans, and so protect the practitioner 
from dishonest competitors. As I write there lies before me a 
Montreal paper in which at a glance I see the open advertise- 
ment of three notorious charlatans. The Ontario Board is act- 
ive enough as regards the honest practitioner, yet no one can 
say that irregular practice does not exist in that province. 
The system of examining by boards for admission to practice 4 
is, in one instance, carried to a great length and to an absurd 
conclusion. The Province of British Columbia has secured the 
existence of a board. There are some fifty practitioners in that 
province (I counted 51 in the copy of the register for '87), and 
united they form the Medical Council of Physicians and Sur- 
geons of British Columbia. " Now, we have got in, let us keep 
the others out," seems to be their motto. If they had contented 
themselves with examining diplomas and rejecting those that 
came from indifferent colleges, then, perhaps, a useful function 
would be fulfilled, but, as the law stands at present, there is not 
one of you who, after graduating, would not become liable to 
punishment if he dared to give advice in British Columbia. He 
would be obliged to pass before the members of the Council, or 
such of them as may be appointed for the purpose, a satisfactory 
examination touching his fitness and capacity to practice as a 
physician or surgeon. In other words, the Provincial Board of 
British Columbia would have to make it its duty to see for itself 
whether your teachers understood what they were about when 
they taught you, examined you and certified on your diploma 
that you were a fit and proper person to practise medicine. 
Lastly, a money tax is exacted. The plea can be made by 
such boards that the public must be protected, and it would be 
unsafe to allow a legally qualified practitioner from another 
province to exercise his calling within their borders. But no 
one can defend the establishment of a money barrier. The 
$100 tax can have no other object than to limit competition. 
If we wish the Canadian profession to gain the respect of 
the medical world, we must use every effort to rid ourselves 
of this provincial littleness, this parochial policy. Medi- 
cine is medicine everywhere, and a legally qualified Canadian 
practitioner ought to be able to practice in any part of his own 
country. 
Another charge I bring against the provincial boards is, that 
they impede the progress of medical education by compelling 
teachers and students to devote an excessive proportion of their 
time to the giving and attending of didactic lectures. 
The days have long since gone by when didactic lectures 5 
were regarded as forming the principal part of a medical educa- 
tion. A century ago medical students were apprenticed to 
practitioners, and everything they learnt was of a strictly prac- 
tical character. Jenner was apprenticed to a country surgeon 
near Bristol, and Sir Astley Cooper began professional life, at 
the age of fifteen, as an apprentice at Yarmouth. In those days 
the didactic lecture served a useful purpose in supplementing 
the strictly practical instruction which the pupil received from 
his master. The school system gradually replaced the appren- 
tice system, and made the student, we wont say scientific, but 
it made him a man of books and opinions, and cultivated his 
memory to the neglect of his powers of observation. 
A double course of lectures in all the more important branches 
of study was thought to be necessary, and the number of lec- 
tures in each course was fixed at one hundred. Opinions have 
changed, and improved methods are beginning to prevail. It 
was found that lectures failed to replace practical instruction. 
The professor has now to give way to the teacher. Students 
were over-lectured and under-taught. Your faculty would wish 
to replace a large proportion of the didactic lectures by practi- 
cal laboratory work and instructive demonstrations, but the 
boards will not let them. They exact the pound of flesh ; they 
must have the one hundred lectures twice told.* For my part, 
I see no hope of a change until such time as the affairs of our 
profession are controlled by more enlightened men, and I look 
to the time when you all shall be graduates, and I confidently 
hope you will have the good sense to vote with the party in 
favor of letting the shoemaker stick to his last, and letting the 
teaching be managed by the teachers. With no immediate hope 
of a change, we try to do our best to mitigate the evil. Accord- 
ingly, a few years ago, a system of grading the course was 
introduced, first in the classes in clinical medicine and clinical 
surgery, and the plan has been extended to other courses. 
The excessive time devoted to didactic lectures is the worst 
* The Ontario Board have added to the course in anatomy fifty more lectures, 
bringing the number of didactic lectures to the ridiculous figure of 250 I! 6 
feature in our Canadian system of medical education. There is 
no country in the world where so many lectures have to be at- 
tended. When your brain is weary with much listening, your 
fingers cramped with note taking, your ischial tuberosities worn 
away from much sitting, do not entertain hard feelings against 
the faculty, but remember the provincial boards. 
And then when all is done and you stand before the world 
the possessor of a degree, the boards do not leave you. 
You have to make up your mind where you are to exercise 
your talents for the public good. As matters now stand you 
may register your degree and practise in any part or province 
of the Dominion-in Quebec, New Brunswick, Nova Scotia, 
Manitoba, anywhere except in Ontario and British Columbia. 
In a few months we shall be able to announce that reciprocal 
relations will be established between the College of Physicians 
and Surgeons of Quebec and the General Medical Council of 
Great Britain, as a result of which a McGill degree may be 
registered in Great Britain. Provided with such a guarantee 
of professional respectability, you may practice in any part of 
Her Majesty's dominion except the two provinces. In all the 
mighty empire of Great Britain there are only two provinces 
where the profession has attempted to protect itself from honest 
competition by calling in the aid of the legislature. 
That examinations are uncertain we all know, but some are 
much more uncertain than others, and none so uncertain as 
those conducted by licensing bodies. The examiners are selected 
from the body of the profession, and no teacher is allowed to 
examine in the subject in which he teaches. It would seem as 
if unfitness were a special qualification. The would-be examiner 
must have shown no special aptitude for the subject. A pro- 
fessor of surgery, for instance, would be qualified for the post of 
examiner in chemistry, but he must not examine in surgery, be- 
cause he knows too much about it. A good country practitioner, 
with a nice comfortable circle of midwifery patients, is, on this prin- 
ciple, made examiner in physiology or anatomy. And what are 
the results ? The examination is a scramble, sometimes the 
weak succeed while the strong succumb. " Quis custodiet 
ipsos custodes." Who shall examine the examiners? 7 
I have gone to some length to show how the licensing boards 
impede progress. Now it shall be my effort to prove to you 
that, in spite of all the obstacles thrown in our way, the number 
of our students has steadily increased with the imposition of 
fresh tests and annoying regulations. 
We ourselves, during the last twelve years, have instituted 
changes in the curriculum which have made Jordan a very much 
harder road to travel than it was in my time, and it really seems 
that the more difficult the course the more there are who wish 
to take it. The class of 1875-6 was the smallest in the last twenty 
years. It was in the spring of 1877 that the first examination in 
practical anatomy was held. (The students have taken a very 
deep interest in it ever since.) Practical chemistry followed 
suit, and higher marks were awarded in these two important 
subjects. Practical courses in microscopy, histology and path- 
ology were established about this period. Enlargement and 
extension of the course has taken place in other directions. The 
proportion of marks qualifying for a pass was considerably 
raised and the tests have been increased. New subjects have 
been added, such as hygiene and gynaecology. The whole 
course has been made longer by the addition of one compulsory 
summer session. Four complete years must be spent at college, 
and there are exemptions in favor of no one. But in spite of 
these changes, and there were not a few who thought our num- 
bers would diminish, there has been a steadily increasing influx 
of students. 
McGill was the first medical college on this continent to de- 
mand four complete years of study. She was the first to abolish 
the exemption in favour of the student who had spent his year 
of so-called study with a doctor, and that in favor of the bachelor 
of arts. And in this movement McGill is only doing what she has 
always done. She is leading. She did fifty years ago what some 
colleges are beginning to do to-day. She began her career with 
a matriculation examination. In the whole of the United States 
there is not a single college whose entrance examination is more 
severe than that which has always been demanded here. Very 
few colleges have any at all. Harvard University, which, owing 8 
to its great reputation and the extent of its endowment, can 
afford to introduce costly reform, insists on a matriculation 
examination of which Latin forms a part. Some other colleges, 
with less ambitious views in the matter of preliminary education, 
content themselves with the three R's ; and, lastly, come the 
unholy army of colleges who demand no examination at all, and 
in its rank are included many so-called first-class colleges. 
Matriculation examinations do not pay. They cost too 
much. The popular voice in the great republic is against the 
severity shown in demanding that one who wishes to enter a 
learned profession should be made to prove that he can read 
and write. 
Students always take an interest in examinations. You know 
that our standard has been raised. But bear in mind that the 
actual amount of work is really reduced because so much more 
practical teaching is done and so much more personal aid afford- 
ed to each student. Moreover, the examinations have been 
arranged with a view to encourage practical observation and to 
put a limit upon what is commonly called the cramming process. 
In spite of all these changes, changes which have been at- 
tempted in some colleges and which have had to be abandoned, 
the class at McGill has steadily increased year by year. Thi s 
is a thing of which every Canadian ought to be proud, that the 
greater the difficulties presented the greater the number of those 
who seek to overcome them. 
Having pointed out the path that leads to a degree, and ex- 
plained how difficult a struggle it is to get into the profession 
by that path, I am going now to tell you how this may be ac- 
complished. Firstly, I address myself to those who are here 
for the first time. These are commonly called Freshmen. 
A silly notion prevails that there is some kind of opprobrium 
attached to the title Freshman. A Freshman is a fresh man. 
Observe the word man. It does not mean boy. A man must 
put away boyish things. He must think and act as a man. 
He must cease1 to depend upon others, act for and rely upon 
himself. Boys may be noisy, sing loudly in the streets and 
behave generally as boys, but men should not do such things. 9 
There are members of other classes in the College who would 
like to make you believe that fresh means silly, idle, presump- 
tuous, and a host of other bad things ; but it means nothing of 
the kind. It means vigourous, active, intelligent, energetic. 
Freshman 1 you stand to-day in a position truly enviable, you 
have the world before you, and opportunities for study such as 
your fathers never possessed. See that you use them properly. 
The first year is the most important period in your professional 
career. It must not be spent in idle amusement. Be careful, 
then, how you form your habits, and be especially careful of the 
companionship you make. Friendships with senior students are 
of mutual advantage. The youngster derives help and support 
from the senior, and the senior in teaching his younger brother 
improves greatly his own knowledge. I would like to see the 
students here follow the example of their English brethren, and 
spend more of their time in asking each other questions and 
teaching one another. 
Remember, Freshmen I that having once become medical 
students you must sustain the character of the school, and the 
reputation of the school is merely the sum of the reputations 
of each member of the school. 
Do not be over-anxious about examinations. Any person 
of ordinary intelligence and common industry can pass. 
Don't deceive yourselves. There is no luck in examina- 
tions. The student who was plucked because his luck was 
bad was the man who provided himself with so little know- 
ledge that an unexpected call upon his scanty store made 
him a bankrupt. There are a few students whose natural 
capabilities are such that the intellectual life is unsuited to them, 
but that number is very small. I believe that there are very 
few who cannot pass. And above all things, do not work with 
the idea that your only object in coming here is to pass exami- 
nations and get a degree. You are not so many cannons and 
your teachers are not gunners who ram home a charge of Ana- 
tomy, another of Physiology and Chemistry, and fire you off as 
a salute on convocation day. 
The knowledge you gain here must be the nucleus of your 10 
life studies, and, moreover, you must regard your studies as 
being undertaken not with the object of merely acquiring a store 
of facts, but as the means of training the powers of observation. 
" The habit of observation is the foundation of the art of 
medicine." And it is upon your own observations and expe- 
riences that you will have to depend, and not upon those of 
other people. Other people's experiences are like other people's 
clothes; they may keep off the cold, but they don't fit and are 
very unbecoming. All through life the primary subjects must 
be kept at your fingers ends. It is not an exaggeration to say 
that nearly all the errors in diagnosis commonly met with in 
practice can be traced to defective knowledge of anatomy 
and physiology. A good physiologist or a good anatomist does 
not necessarily make a good physician or a good surgeon, but 
no man can properly practice medicine without a sound working 
knowledge of the primary branches. 
Do not be contented with a minimum of work, just enough to 
enable you to scrape through the examinations. In dealing out 
your share of work give good measure. Make it a rule to do 
always more than is asked. Don't stop working the minute the 
clock strikes. Remember the words George Eliot puts into the 
mouth of Adam Bede: " I hate to see a man's arms drop down, 
as if he was shot before the clock's fairly struck, just as if he 
had never a bit of pride and delight in 's work. The very 
grindstone 'ill go on turning a bit after you loose it." 
Use your text books' more, and depend more upon them. 
Select a good one, and stick to it. Read over the subject of 
the lecture you have heard that day. Cultivate a spirit of en- 
quiry. Think out the problems set before you, and try to find 
out the reason for everything. Do not be satisfied with what 
you hear your teachers say unless you perfectly understand 
what they mean* We are too apt to talk above the heads of 
our class, and a good deal of the subject matter of the lecture 
or demonstration is not quite taken in and understood. Always 
ask if you don't understand. We all like to have students 
point out to us their own difficulties, and thereby give a direc- 
tion to our teaching. 11 
Try to be careful, methodical, systematic. Make sure of one 
step before you take another. Give all your energies to facts 
and observations. Never mind the theories, they can take care 
of themselves. Waste no time. " Time is the stuff that life is 
made of." It is not the student who sits up late and burns 
most oil who succeeds best, any more than it is the person who 
eats most who becomes most healthy. Try to acquire the 
habit of utilizing odd moments. You cannot all take a prize, 
but you can all take a good degree. 
Gentlemen I we begin our 57th session at a period in the 
history of the profession of unusual activity and progress, but 
with us in this college a period of sadness and mourning. This 
is the first introductory lecture for many a long year at which 
our late Dean is not present. Prof. Howard was in this room 
a year ago to welcome the new comer, but since our last meeting 
we have had to mourn his death. 
It seems fit that I should speak of him to-day, but more in 
his relation to students than in his relation to the University 
and to the medical profession of Canada. I wish to point out 
to you how you may derive benefit from the example he set you. 
There is probably no student beginning his studies to-day who 
has before him greater difficulties to face than had our late 
Dean when his medical career began. He was a poor man. 
There were no powerful friends to advance his interests; there 
was nothing to depend upon but his own energy, his own perse- 
verence and his wonderful capacity for hard work. His great 
love for his profession, and more particularly for the scientific 
part of it, showed itself in every day of his active life. His 
devotion to clinical studies made him a marked man in this 
University long before she honoured herself by granting him a 
degree. After his entry to practice his path was beset with 
many difficulties. The doors of the General Hospital were slow 
to open to him. He hid not derive from that institution the 
fostering help it has afforded so many men who have since be- 
come eminent in the profession. The University herself at first 
overlooked his talents and energies, and he was not the first of 
his classmates to receive a teaching appointment. He had not 12 
been long in the school before he gained that loving respect and 
admiration from the students which he retained to the last day 
of his life. In the faculty his strong personal influence was 
always exerted in favour of reform and improvement. In all 
his relations with the students Dr. Howard showed towards 
them a fatherly affection and interest. Valuable as was his time, 
manifold his engagements, no student ever failed to gain audi- 
ence with him, and with audience sympathy and good counsel. 
Those of you who had the benefit of attending his last course of 
lectures will remember, as do all his old pupils, the kindness 
and forbearance, and the patience with which he spent often 
more than his lecture hour over again in answering questions 
and showing the pathological specimens in which he was so much 
interested, to the knot of eager students gathered about him. 
I can only say of him as a lecturer, what Baillie said of William 
Hunter: " No one ever possessed more enthusiasm for his art, 
more persevering industry, more acuteness of investigation, 
more perspicuity of expression, or, indeed, a greater share of 
natural eloquence. He excelled very much any lecturer whom 
I have ever heard in the clearness of his arrangement, the apt- 
ness of his illustration, and the elegance of his diction." 
Whatever may be the fortunes of this college, whatever may 
be the success to which it shall attain, the period during which 
the reins of government were held by Dr. Howard, must always 
be regarded as one of progress and enlightenment. The rise of 
the school which I have attempted to demonstrate to you, is 
mainly the result of his energy and labour. Though older in 
years than any of his colleagues, Dr. Howard was as young as 
the youngest in his ideas of medical practice and of medical 
education. Advancing years brought with them no diminished 
vigour nor flagging interest in the welfare of the college he so 
dearly loved. He was ever ready to accept new ideas and to 
carry out the improvements which the advance of education 
from time to time demanded. The late years of his useful life 
were mainly devoted to the advancement of projects directly 
affecting the welfare of the Canadian medical student, the es- 
tablishment of the Campbell Endowment Fund, and the organi- 13 
zation of the Royal Victoria Hospital. By means of the 
revenue derived fron the former we were enabled to build, 
equip and carry on the magnificent laboratories in which you 
will learn in a practical manner the rudiments of your profes- 
sion. In a few years too, the student will study disease in a 
hospital which will reflect credit on the noble benefactors and 
on the country in which they live. For these great benefits 
the student is indebted firstly to the generosity of the bene- 
factors, but such gifts were largely the outcome of the life 
work and energies of our late Dean. 
The new session we begin in sorrow, but our sorrow must not 
weaken our efforts. Let the death of our leader stimulate us 
to unwonted energy. Let us do what we would like him to see 
us doing. Let us prove ourselves worthy pupils of Howard, 
and show the world that we can at least attempt to imitate the 
virtues of his character. Let us be as zealous, as honest, as 
upright, as conscientious as that noble example of all that con- 
stitutes the gentleman and the Christian who has been so recently 
taken from us.