The Royal College of Physicians and Surgeons of Canada, 1920-1960 9780773593244

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THE ROYAL COLLEGE OF PHYSICIANS AND SURGEONS OF CANADA

COLLEGE HEADQUARTERS BUILDING, 1960

CAMPBELL TINNING, A.R.C.A.

THE ROYAL COLLEGE OF PHYSICIANS AND SURGEONS OF CANADA 1920-1960

D. SCLATER LEWIS, M.D. Honorary Archivist of the College

MONTREAL

McGILL UNIVERSITY PRESS 1962

Copyright, Canada, 1962, by The Royal College of Physicians and Surgeons of Canada. PRINTED IN CANADA THE RUNGE PRESS LIMITED, OTTAWA

TO MY WIFE

FOREWORD In the thirty years that have elapsed since the founding of the Royal College of Physicians and Surgeons of Canada, it has assumed an important role at home and has achieved a sound reputation abroad. The College was founded at a time when postgraduate education in the special fields of medicine was just beginning in Canada, and there was need for some organization to set up standards for specialist status and for an examining body whose duty it would be to see that such standards were met, not only by those trained at home, but by Canadians trained abroad and by doctors who had received their postgraduate education before coming to Canada. It was the intent of those responsible for the launching of the College that its degrees should signify not only academic achievement but also would indicate to the profession and to the lay public that its Fellows had received a sound practical training. 'While the College was patterned originally upon the Royal Colleges of Britain, its founders displayed a different philosophy by insisting that each candidate should present evidence that he had received an acceptable practical training in his chosen specialty. It differed from all but the Royal Faculty of Physicians and Surgeons of Glasgow in being a joint college of physicians and surgeons. At the request of the Canadian Medical Association, the College assumed the responsibility of granting certification to those already established in specialty practice and subsequently of granting certification on the basis of examination. The program of certification has been an important factor in raising the standards of specialty practice in Canada. In some specialties it has ceased to fill a need and has been discontinued, but in other fields it continues to serve a useful purpose and is likely to occupy the attention of the College for an indefinite period. It became apparent relatively early that, if postgraduate training were really to be controlled, it would be necessary to require that the training be taken in hospitals which had proper facilities and a professional staff competent to undertake postgraduate education. This necessity led to a programme of approval of hospitals for postgraduate education, an onerous but important duty. The College as originally ix

FOREWORD

constituted differed therefore from the other Royal Colleges, and gradually it has developed a pattern which is distinctly Canadian. It seemed to members of Council that the completion of the new building in Ottawa, and thus the acquisition of a permanent home, marked the end of an era, and that the history of the first thirty years should be written. Undoubtedly, as time goes on, the structure of the College will require change, and members of Council will continue to find many problems to solve. Decisions made without knowledge of the past are unlikely to be wise, and for this reason it seemed important to provide a reliable and readily available record. Dr. D. Sclater Lewis, President from 1949-1951, accepted the invitation of Council to write the first history of the College. It has proved a formidable undertaking, but his energy and initiative have uncovered much that could readily have passed into oblivion. The Council's choice of an historian has been fully justified. Robert M. Janes Toronto, July 1961.

x

AVANT-PROPOS La fondation du College Royal des Medecins et Chirurgiens du Canada ne remonte guere qu'å trois decennies. La tradition n'intervient donc pas dans son histoire. Une aussi courte existence protege l'historien contre les interpretations fantaisistes des faits et les affirmations susceptibles de preter å confusion. Rarement la documentation devoile-t-elle tous les secrets des decisions historiques. L'histoire, a ecrit Lacordaire, est le miroir qui reflechit le passe et le soleil qui eclaire l'avenir. L'Auteur a compris qu'il ne saurait exister de peuples non plus que d'institutions sans histoire et que le College se compose aussi bien des morts qui l'ont fonde que des vivants qui le continuent. Sclater Lewis expose la genese du College, il nous rappelle les tractations qui ont marque son etablissement, le peu de foi que nombre de ses protagonistes avaient en sa survivance possible et les objectifs ideaux qui animaient au depart les docteurs Low, Johnstone et Moore, et ulterieurement les docteurs Starr et Primrose de Toronto, Martin et Bazin de Montreal, Rousseau de Quebec, Austin de Kingston et Hale de London, Ontario. L'evenement a demontre que les fondateurs du College n'etaient pas des visionnaires. Aussi convient-il que l'Histoire exalte leur oeuvre et celle de ceux qui en ont assure la survivance. Les anciens meritent souvent un meilleur sort que celui qu'on leur reserve, je veux dire la depreciation du role qu'ils ont joue, quand encore on ne les laisse pas pour compte. La mort de leur vie n'a pas pris toutes les pages, car elle n'en a pas efface le souvenir. Nous n'entendons pas departager la question, å savoir si ceux qui assurent la releve assument trop de servitudes ou non. Notre admiration et notre gratitude restent acquises å ceux qui ont concu grand et beau. L'Auteur, lui aussi, a bien concu son röle. Nous ne saurions trop l'en loner. Son role, il l'a bien rempli: Aider ses contemporains å comprendre le passe pour mieux orienter dans le present leur marche vers l'avenir, n'est-ce pas la tåche de l'historien honnete et sincere, ecrivait le Pere D'Anjou, dans Relations, juillet 1961. Les faits du passe, si on s'attache å les bien etudier, ne comportent-ils pas toujours une signification informatrice. Ces faits, l'Auteur les rememore, il les xi

AVANT-PROPOS

examine sans passion et aussi sans prejuges. Il ne reduit pas son role å une compilation d'archives ou å une systematisation verifiable d'evenements. L'Auteur essaie de les interpreter. Toujours il rapporte les initiatives å qui de droit et se garde bien de deprecier qui que ce soit. Une pointe d'humour qu'il lance ici et lå ajoute du charme å son ouvrage auquel nous souhaitons une grande diffusion. Qu'il ait reussi å marcher å la cadence å laquelle se precipitent hommes et evenements, l'avenir le dira. J.

Montreal, juillet, 1961.

xii

Romeo Pepin

PREFACE The first reference to the collection of data for a history of the College is to be found in the minutes of the Canadian Medical Association for 1930. Its Executive Committee was directed to search the records of the Association and to prepare a list of those who had been active in the founding of the Royal College of Physicians and Surgeons of Canada. Very little seems to have been done and the matter was laid on the table some two years later. In 1939, the Honorary Secretary of the College, Dr. Warren Lyman, had prepared an abstract of the College minutes for the preceding ten years, and he asked if a short history of the College might be used as a preface for the 1940 edition of the Handbook. The College Charter had just been amended to allow the certification of specialists, and the examination structure of the College was being reviewed. Under these circumstances the Committee on Publications felt that a history of the College should be delayed until the results of these activities became more clearly defined. No trace can be found of Dr. Lyman's abstract. Again in the late 1940's, there was correspondence about a history, benveen the President, Dr. W. Fulton Gillespie and Dr. Frank S. Patch, but Dr. Patch was in uncertain health and was unable to undertake the task. This was unfortunate as Dr. Patch was greatly interested in history, had been an honours student in the subject during his college course and had an intimate knowledge of the College from the time of its incorporation. When Dr. Janes suggested that Council authorize the writing of this history in 1958, there were serious doubts as to the condition of the earlier records and papers of the College. Benjamin Franklin states in Poor Richard's Almanac that "three removes are as bad as a fire". As the offices of the College had been moved four times since its incorporation and there had been a serious fire, there seemed to be some justification for this point of view. Fortunately, these fears proved to be exaggerated, and the early College records were found to be in a good state of preservation. The Secretary, Dr. James H. Graham, and the Executive Secretary, Miss Pauline Crocker, were able to find complete sets of minutes of the

PREFACE

Annual Meetings, the meetings of Council and the Executive Committee, and, with the removal of the offices to the new building in November 1959, many boxes of old records made their appearance. From 1933 until 1946 the minutes had been prepared in verbatim form by a public stenographer, and were much more helpful than those usually found in institutional files. A number of past officers had given their papers to the College, and others now came forward with new material for its archives. Special reference should be made to the records of the late Drs. A. T. Bazin, W. F. Gillespie, A. T. Mathers and Frank Patch, and more recently to the gifts of Drs. Duncan Graham, W. G. Penfield, R. M. Janes and John W. Scott. Dr. George C. Hale sent a particularly interesting group of papers dealing with the period when the office was being removed to Ottawa in 1933. Dr. Hale and Dr. T. C. Routley were members of the Nucleus Committee which had been appointed to incorporate the College. They have given most useful information about these early days. The unexpected deaths of Dr. Bazin and Dr. J. C. Meakins prevented more extensive use being made of their funds of knowledge. Dr. David Scott Johnstone was one of the prime movers in the original plan to found a Canadian College of Physicians and Surgeons. In 1959, he was living in Vancouver and provided much information about what might be called the "pre-history" of the College. A special word of thanks is due to Dr. J. B. Ritchie for much, indeed almost all, of the biographical material about David Low and Samuel Moore who were Dr. Johnstone's partners in the campaign to organize the College. I am greatly indebted to Mr. T. J. Giles, Miss Lemieux, Mrs. Mitchell and other members of the College staff for their unfailing help with the records; also to Mrs. King (formerly Miss Doris Thompson), the first Executive Secretary of the College, for help in filling in the gaps during the period from 1933 to 1946; and to Mrs. W. W. Stalker for her secretarial assistance. Special mention should be made of the interest shown by Dr. Janes, Dr. Scott and Dean Lloyd W. Stevenson in the gradual progress of the History; and to Dr. James H. Graham, Miss Crocker, Dr. H. E. MacDermot, Dr. Jessie B. Scriver and Dr. Walter Scriver for many helpful suggestions in the preparation of the manuscript. xiv

PREFACE

Finally I should like to add a word of personal thanks to my old friends Dr. Robert M. Janes for the English Foreword and to Dr. J. Romeo Pepin for his Preface or Avant-Propos which is written in his usual inimitable style.

xv

ACKNOWLEDGEMENTS A number of persons have been most kind in replying to my inquiries about details, and in many cases for quite extensive search through documents in their possession. To these I offer my sincere thanks. Dr. H. M. Stephen, Registrar, Medical Council of Canada. Dr. W. Bramley-Moore, Registrar, College of Physicians and Surgeons of Alberta. Dr. M. T. Macfarland, Registrar, College of Physicians and Surgeons of Manitoba. Dr. A. F. W. Peart, Deputy General Secretary, Canadian Medical Association. Dr. R. Gingras, Vice-Dean, Faculty of Medicine, Laval University. Dr. Edmond Dube, late Dean, Faculty of Medicine, University of Montreal. Dr. C. E. Hebert, Notre Dame Hospital, Montreal. Mr. A. L. Young, Saskatoon. Dr. D. W. Johnstone, Vancouver. Mr. Basil P. Lake, Editor of Debates, The Senate of Canada. Mr. L. J. Raymond, Clerk of the House of Commons, Canada. Mr. Joseph W. Willard, Director, Research and Statistics Division, Department of National Health and Welfare, Ottawa. Dr. G. H. Josie, Research and Statistics Division, Department of National Health and Welfare, Ottawa. Mrs. Clarke, daughter of Dr. David Low. For information regarding the late Edwin Tappan Adney, designer of the College seal; Mr. Glen Adney, his son; Mrs. Alice J. Turnham, Redpath Museum, McGill University; Dr. George F. Clarke, Woodstock; L. S. Loomer, Editor, The Atlantic Advocate, Fredericton; Colonel H. I. Chapelle, The Smithsonian Institution, Washington, D.C., and many others.

xvii

CONTENTS Foreword

ix

Avant-Propos

xi

Preface

xiii

Acknowledgements

xvii

PART I PRE-HISTORY OF THE COLLEGE AND ITS EARLY YEARS CHAPTER I The Royal College of Physicians and Surgeons of Canada

3

CHAPTER II The Canadian Scene

7

CHAPTER III The Period of Indecision

11

CHAPTER IV The Low, Johnstone and Moore Period

15

CHAPTER V The Nucleus Committee

21

CHAPTER VI The Bill before Parliament

25

CHAPTER VII The Meeting of the Provisional Council November 20, 1929

29

CHAPTER VIII The Meeting of the Provisional Council (continued)

35

CHAPTER IX The First Meeting of the College Council

37

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CONTENTS

CHAPTER X The First Year of the College: Its Organization and the First Annual Meeting

41

CHAPTER XI The Second Year

47

PART II THE GROWTH OF THE COLLEGE Introduction

53

CHAPTER XII The Administration of the College, its Officers and Committees

55

CHAPTER XIII The Act of Incorporation and the Constitution and By-Laws

63

CHAPTER XIV The Annual Meeting of the College

67

CHAPTER XV Admission to the College Ad Eundem Gradum

77

CHAPTER XVI Admission to the College without Examination

81

CHAPTER XVII Admission by Examination

87

CHAPTER XVIII Approval of Hospitals for Graduate Training

119

CHAPTER XIX Honorary Fellowships

129

CHAPTER XX The Medals of the College

137 xx

CONTENTS

PART III THE CERTIFICATION OF SPECIALISTS 1923-1957 Introduction

141

CHAPTER XXI The History of the Movement

143

CHAPTER XXII Certification without Examination

155

CHAPTER XXIII Certification by Examination

161

CHAPTER XXIV The Status of the Certificate

165

PART IV OFFICES AND ADMINISTRATION OF THE COLLEGE CHAPTER XXV Offices of the College and its Early Executive Officers

171

CHAPTER XXVI The New Building

179

APPENDIX Short Biographies Officers and Members of the Council 1960-1962 Past Office Bearers and Members of Council Honorary Fellows Lecturers of the College Conferenciers The Annual Medallists of the College An Act to Incorporate the Royal College of Physicians and Surgeons of Canada

189 212 213 219 221 221 222

NOTES

229

INDEX

233 xxi

223

ILLUSTRATIONS College Headquarters Building 1960

Frontispiece Between pages

The Sponsors of the College 40, 41 David Low S. E. Moore D. S. Johnstone A. MacG. Young The Nucleus Committee A. T. Bazin A. Primrose F. N. G. Starr L. J. Austin G. C. Hale A. Rousseau C. F. Martin

40, 41

J. C. Meakins Calixte Dagneau

Duncan Graham L. de L. Harwood

72, 73

B.G. Bourgeois George S. Young

W. G. Penfield A. T. Mathers

72, 73

Charles Vezina F. S. Patch

R. F. Farquharson W. F. Gillespie

104, 105

L. Gerin-Lajoie D. S. Lewis

Edmond Dube John Hepburn J. W. Scott D. A. Thompson

104, 105

R. E. Valin J. E. Plunkett

136, 137

R. M. Janes J. R. Pepin

T. C. Routley W. S. Lyman

150th Anniversary of the Royal College of Surgeons of England

136, 137

168, 169

Laying the Cornerstone of the New Headquarters Building 1960 168, 169 Official Opening of the New Building

168, 169

The Council Room and the Council in Session

168, 169

PART I Pre-History of the College and its Early Years

CHAPTER I

THE ROYAL COLLEGE OF PHYSICIANS AND SURGEONS OF CANADA Much has been said and written about the progress of scientific medicine in Canada during the forty years since the end of the First World War in 1918, and nowhere have the changes been greater than in the field of organized postgraduate study and training. While inspirational addresses at medical convocations in the 1920's made frequent references to the degree being only the beginning of a life devoted to study and service, relatively few of the Canadian graduates had more than a year of general internship. Longer periods of postgraduate training were reserved for those of exceptional brilliance who intended to become teachers in the medical schools of the day. The appearance of the medical Royal Colleges of Australasia and Canada marked the beginning of the rapid changes which have taken place in the postgraduate medical education of these two countries. The Royal College of Physicians and Surgeons of Canada was incorporated by Act of Parliament which received Royal Assent on June 14, 1929. It was the second of the medical Royal colleges of the overseas dominions, the Royal Australasian College of Surgeons having received its Charter in the preceding year; to be followed in 1938 by the Royal Australasian College of Physicians. A College with similar objectives but without the Royal title was organized in South Africa in 1955. The Canadian and South African Colleges are bilingual organizations and have alternate official titles, that of the Canadian College being Le College Royal des Medecins et Chirurgiens du Canada, and the Afrikaans title of the South African College is Kollege van Interniste, Chirurg en Ginekoloe van Suid Afrika. All these colleges followed the general pattern of the older Royal Colleges of Great Britain. They were an expression of the opinion that the time had come for the overseas Dominions to set up their own organizations for the encouragement of postgraduate training, for the assessment of this training, and the granting of suitable diplomas.

THE ROYAL COLLEGE OF PHYSICIANS AND SURGEONS OF CANADA

Each college has developed in its own particular way, and the prestige of each is shown by the widespread acceptance of its diplomas by government, university and hospital authorities, and also by the general public.

THE CANADIAN COLLEGE OF PHYSICIANS AND SURGEONS The 1920 Resolution The first reference to the desirability of establishing a Canadian non-teaching college for conferring degrees in surgery and the specialties appears in the minutes of the Executive Council of the Canadian Medical Association for June 1913. (1) The suggestion came from Dr. F. N. G. Starr of Toronto. The President was asked to appoint a committee to study the question, but the outbreak of the First Great War prevented any further action being taken. At the conclusion of the war there was a renewed interest in the subject, and it is interesting to note that the first suggestions to form Canadian and Australasian Colleges came from places removed from the main centres of population, in Australasia from New Zealand (2), in Canada from the mid-west, and these suggestions were dated respectively August and June 1920. In both cases the American College of Surgeons played an unwitting role in the subsequent incorporation of the Royal Australasian College of Surgeons and the Canadian Royal College. In Canada, the idea of forming a Canadian College came at a time when the old Empire was being replaced by the British Commonwealth of Nations, and also when a national viewpoint was beginning to take precedence over the narrower provincial outlook. For over 100 years Canadians had not had any serious contact with war. It is true that a small group of Canadian boatmen, mostly Mohawk Indians from the Caughnawaga Reserve, had seen service in the Nile Expedition for the relief of Gordon of Khartoum in 1884, in much the same way as a smaller number of Canadians had seen service in Italy as Papal Zouaves some twenty years earlier. Canada had sent a small contingent to the South African War in 1899, when some 8,000 saw active service, but in the First World War 600,000 were in uniform and 400,000 went overseas.

THE ROYAL COLLEGE OF PHYSICIANS AND SURGEONS OF CANADA

The war made Canada a nation. There was a feeling of pride in the country and in the deeds of the Canadian Corps. This pride was reflected in the wording of the following resolution, presented at the Annual Meeting of the Canadian Medical Association in 1920 at Vancouver by Dr. Moore on behalf of the Regina and District Medical Society: WHEREAS, Canada has now assumed the status of nationhood within the British Empire, and WHEREAS, The events co-incident with the Great War have brought about a closer union and deeper appreciation between the medical men of the Old Country and those of Canada, and WHEREAS, It is desirable that the best means of stimulating and promoting advanced study of, and postgraduate work in Medicine and Surgery, be adopted, to the end that as large a number as possible of the medical men of Canada should engage in such studies, Be it RESOLVED, That it is now an opportune time to promote a closer alliance between those great institutions which are furthering and teaching the study of Surgery and Medicine in the Old Country with those furthering and teaching it in Canada. In the furtherance of this idea, it is resolved that a special committee be appointed at this meeting in Vancouver, to consider the problem of founding a Canadian Royal College of Surgeons and Physicians in some way affiliated with those of British origin.

This resolution was the starting point of the Royal College of Physicians and Surgeons of Canada. Dr. Moore, always a poetic soul, was fond of saying that this was the acorn of the proverb "Tall oaks from little acorns grow." (3) He might have quoted from the Epistle of James, "Behold how great a matter, a little fire kindleth." ( Jas. 3:5) The resolution met with very little support and the discussion was brief and on the whole not favourable, because it was felt that the time was not ripe for such a movement in Canada (4). However, the Executive Council of the Association passed the following resolution: RESOLVED, That the president be authorized to name a special committee representing the various provinces, with Dr. H. A. McCallum of London, Chairman, to investigate and bring in a report at the next Annual Meeting, and that the original Resolution be referred at once to each Provincial Medical Association and each University of Canada for consideration, and that they be requested to forward an expression of opinion on the matter to the Chairman of the Committee at the earliest possible date.

The President then named the following committee: H. A. McCallum, London, Chairman S. E. Moore, Regina F. W. Marlow, Toronto A. E. Garrow, Montreal James McKenty, Winnipeg (5)

THE ROYAL COLLEGE OF PHYSICIANS AND SURGEONS OF CANADA

The Executive Council having given, as it thought, a decent burial to the resolution by referring it to a study committee whose members were so widely scattered across the country that it could never meet, turned its attention to other matters, just as in Parliament a difficult subject often may be disposed of by the appointment of a Royal Commission for its study and report.

CHAPTER 11

THE CANADIAN SCENE There were probably a number of reasons why the resolution of 1920 had met with such an uncertain reception. It had come from a local medical society apparently without the support of its provincial Medical Association; it was addressed to the Canadian Medical Association which was in serious financial difficulties as a result of the recent war; and, as later events proved, the founding of a Canadian College would have interfered with plans which certain medical schools had in mind regarding postgraduate training. These doubts can best be explained by a short historical survey of the Canadian medical scene of the day. THE CANADIAN MEDICAL ASSOCIATION While the Association was founded in 1867, it had only been incorporated by Act of Parliament in 1909. Up till that time its history had been one of slow and irregular growth. There was no continuous membership. If one attended the Annual Meeting and paid the fee, one was a member for the ensuing year, but the membership then lapsed until the next attendance at an Annual Meeting. Under the terms of the British North America Act of 1867 which had set up the Dominion of Canada, health and education were placed under provincial control, and so, in organized medicine, the first important medical bodies had been at the provincial level. It was only after the federal incorporation of the Association that the provincial associations entered into a closer affiliation with the central body. In 1910 the Association founded its journal, and the organization seemed to be on a firm footing. It was on this reorganized Association, with its new journal, that the war had fallen with such devastating effects. There were no meetings in 1915 and 1916, and only small meetings in the following three years, so that the first post-war meeting in Vancouver found the Association with few assets and many contingent liabilities, the chief

THE ROYAL COLLEGE OF PHYSICIANS AND SURGEONS OF CANADA

of which arose from unsatisfied agreements with a former publisher of the Association journal. In the face of these financial difficulties, one can readily understand the lack of enthusiasm for a proposal to have the Association embark upon what seemed to be a visionary and probably an expensive venture. However, 1921 marked the turning point in the fortunes of the Association. Dr. Routley was appointed Associate Secretary, and two years later he succeeded Dr. J. W. Scane as General Secretary. Under his management the Canadian Medical Association rapidly left behind its financial difficulties, and the sponsors of the Canadian Royal College were faced only by the task of convincing the Association that there was a need for such a College and that such a College would have a reasonable chance of success. THE MEDICAL SCHOOLS AND POSTGRADUATE TRAINING While a higher qualification of one or other of the Royal Colleges had been a requirement for hospital and teaching appointments in Britain for many years, the possession of a higher degree did not play an important role in Canada in the early years of this century. However, following World War I, certain groups had become interested in the more formal types of postgraduate training. Each group was built around some strong personality and the groups were local rather than national in character. Some wished to rely on the British Memberships and Fellowships; others were more interested in the recently organized American Colleges; while a third group, among the French members of the profession, regarded Paris as the centre of postgraduate education. THE BRITISH ROYAL COLLEGES British medicine had always had its admirers in Canada. Branches of the British Medical Association were scattered across the country; most of these branches existed only on paper, and beyond the receipt of the British Medical Journal the members had little contact with the parent organization. This arrangement came to an end in 1925, when the Canadian and British Medical Associations agreed to become affiliated societies rather than parent and branch associations, and the British Medical Association withdrew from the Canadian field.

Ø CANADIAN SCENE

However, in 1920, the interest in the Royal Colleges was quite evident. The recent war had taken a large number of Canadian doctors to the Old Country. Many friendships had been made among members of the profession in Britain, and high on the list of ideas brought back to Canada was the importance of the Fellowship or Membership of one or other of the British Royal Colleges. As a result of this interest there was a substantial increase in Canada during the next ten years in the number of Fellowships and Memberships of the Royal Colleges. In the early twenties, three prominent surgeons, Dr. Alexander Primrose and Dr. Starr of Toronto, and Dr. Bazin of Montreal, were actively engaged in an attempt to establish a Canadian Branch of the Royal College of Surgeons of England, or at least to facilitate the entry of Canadians by having the examinations of the College held in Canada. The very full correspondence covering the negotiations shows that neither side proved very elastic and the idea of forming a Canadian Branch was put aside. However, primary examinations of the English College were held in Toronto in 1929 and 1931, and in Montreal in 1930, when special examiners were sent from England. A most dramatic description of the first examination in 1929 is to be found in the transactions of the 61st Annual Meeting of the Canadian Medical Association. (6) These examinations were abandoned after 1931 because of the small number of candidates. To the members of this group the original suggestion of forming a Canadian College must have seemed premature, to say the least. THE AMERICAN COLLEGES Another deterrent to the setting up of a Canadian College was the existence of the new American organizations. There was a mixed reaction to the entry of these Colleges into the Canadian field. Those in favour of them thought they were the answer to the problem of identifying members of the profession with superior qualifications. Others thought it unfortunate that both doctors and medical institutions should be compelled to depend on foreign corporations for approval. As a matter of fact, it was not until ten or fifteen years later that the American College of Physicians made any great impression on the Canadian profession, but with the American College of Surgeons it

THE ROYAL COLLEGE OF PHYSICIANS AND SURGEONS OF CANADA

was a different affair. This College had been founded in 1913 by Dr. Franklin H. Martin of Chicago. It was planned as an international organization and a number of prominent Canadian surgeons were amongst its Founding Fellows. Dr. George Armstrong of Montreal had been elected to its Presidency in 1920, and the College was carrying on a vigorous membership campaign across Canada during the postwar years. There is no doubt that annoyance caused by this active invasion of the Canadian field was an important factor in producing the 1920 resolution of the Regina and District Medical Society. To supporters of the American College the founding of a Canadian College seemed quite unnecessary. THE FRENCH MEMBERS OF THE PROFESSION From early times the chief interest of the French-speaking members of the profession had centred in the hospitals and research institutions of Paris. Many of the courses of postgraduate training extended over a number of years, and holders of the higher diplomas were usually appointed to teaching posts at Laval and the University of Montreal upon their return to Canada. Contact with Paris had been cut off during the war of 1914-18, but the cessation of hostilities was followed by a much more intimate contact between the Quebec Medical Schools and France. It is therefore not surprising that there was very little enthusiasm for the formation of a Canadian College. To put the matter briefly, the resolution desiring that a committee be set up to consider the problem of founding a Canadian Royal College of Physicians and Surgeons, in some way affiliated with those of British origin, was presented without previous discussion to a Medical Association which was in serious financial difficulties, in a community just recovering from a major war, where one section of the profession wished to maintain the British connection, another had already allied itself with the American College of Surgeons, and a third had its intellectual contacts with Paris. It speaks well for the sponsors of the resolution that they were able even to get a committee appointed to study the question.

10

CHAPTER 111

THE PERIOD OF INDECISION THE STUDY COMMITTEE As previously noted, the President of the Canadian Medical Association had appointed a committee to obtain the opinions of the provincial Medical Associations and the Medical Schools regarding the desirability of forming a Canadian Royal College, and also to consider under whose auspices it should be set up. Unfortunately, Dr. H. A. McCallum, the chairman of the Committee, died suddenly soon after his appointment, and nothing was done during the year 1920-21. Dr. Marlow of Toronto was appointed chairman in 1921 and carried on the work of the Committee for the next three years. He was an energetic person, and he approached not only the provincial Medical Associations and Medical Schools but also the provincial licensing bodies and certain prominent members of the profession. He also accompanied Dr. Routley and Dr. Fred Tees, a Montreal surgeon, on a speaking trip through the West in 1923, and his plea for organizing a Canadian Royal College was well received. A search for Dr. Marlow's early letters and the replies has been unsuccessful, but Dr. William Bramley-Moore, Registrar of the College of Physicians and Surgeons of Alberta, has very kindly sent an extract from the minute book of his College which gives the following main points in Dr. Marlow's letter: Meeting of the 3rd of January, 1922 College of Physicians and Surgeons of Alberta. A letter was read from F. W. Marlow, Chairman of the Committee on the formation of a Canadian College of Physicians and Surgeons for the furtherance of the following objects: 1. General Advancement of Canadian Medicine and Surgery. 2. The establishment and recognition of advanced diplomas in Medicine and Surgery throughout the Dominion. 3. Stimulation and promotion of postgraduate work in Canada for Canadians. 4. Recognition of high professional attainment and successful postgraduate work by Canadians. 5. The setting of some standards for the qualifications of Specialists. 6. Closer association with British Medicine and Surgery by possible affiliation with the Royal Colleges of England.

11

THE ROYAL COLLEGE OF PHYSICIANS AND SURGEONS OF CANADA

The meeting passed a resolution in favour of the proposed formation of a College, but no further action is recorded in the minutes, beyond the naming of two members to represent the Province of Alberta on any national committee which might be appointed. Apparently Dr. Marlow received a large number of replies to his letters, and Dr. Routley gave a selection of these opinions in his address before the College in 1954. (7) The opinions varied between full support and complete disapproval of the project. Support came from individuals and medical societies, and guarded approval from provincial associations, but the University of Manitoba was the only university to support the plan: "It strongly endorsed the project and offered its unqualified support." This opinion was based on the report of a Committee of Faculty of which Dr. D. S. Mackay was Chairman and Dr. Egerton L. Pope, Secretary. A copy of this report was found in Winnipeg by Dr. M. T. Macfarland, Registrar of the College of Physicians and Surgeons of Manitoba. It is a most interesting and logical document. It contains fifteen sections. The committee recommended that two Royal Colleges be formed, a College of Physicians and a College of Surgeons, but that during the early years they should be presided over by one President and managed by one Executive. The Colleges should be modelled after the Royal Colleges of Britain, as far as possible. (There is no mention of affiliation). The Head Office of the College should be in Ottawa, the Capital of the Dominion. As in the Royal College of Physicians of London, there should be three levels of attainment: the Licenciate, which should be the licence granted by the Medical Council of Canada; followed by the Membership; and, lastly, the Fellowship. The last two should be awarded after further examinations. Election to the Membership or Fellowship without examination was to be allowed in very unusual cases. Founders and Honorary Fellowships were also dealt with, and the report then stated in Section 13, "that the underlying principle of these organizations should be the furtherance of scholastic and scientific attainment among medical men in order that the highest ideals and standards of medical education may be preserved." The feeling of the other medical schools was expressed by Dr. Alexander Primrose who is recorded as saying: "The idea is desirable, 12

THE PERIOD OF INDECISION

but is it feasible? The University of Toronto and McGill [he might have added Laval and others] do not believe the time is ripe for the establishment of such Colleges. It would be a grave mistake to go ahead as it could be doomed to failure." (8) Dr. Marlow himself was not enthusiastic and, in reply to a question, felt that the College could not be operated under the aegis of the Canadian Medical Association. However, on the motion of two MacLeans, one from Winnipeg and the other from Regina, Dr. Marlow was re-appointed Chairman of the Study Committee with power to add, and invited to continue his studies for another year. Dr. Marlow and his committee did nothing in 1923, but in 1924, at the Annual Meeting in Ottawa, he presented a long verbal report which has all the marks of being his own work rather than that of a committee. In the opinion of his committee, he said, neither the Canadian Medical Association nor the provincial licensing bodies of Canada were disposed to support the formation of a Royal College, and he moved, seconded by Dr. G. Stewart Cameron that the whöle matter be referred to the Medical Council of Canada. (9) However, this motion was amended and it was finally decided to lay the matter before the meeting of the Conference on Medical Services in Canada in the following December. This Conference had to do with medical education, licensure and hospital administration. Dr. Bazin was to be the chairman of the Conference. Dr. Marlow's report appears in the form of a long letter to the Conference. (10) It began by stating that the majority opinion was in favour of the ultimate establishment of a college to stimulate post-. graduate training by providing a recognition of this work by the granting of a Fellowship, and that this college should be Canadian, possibly with British affiliation. In his opinion, a new corporation would not be required; the college should be organized in connection with the Medical Council of Canada. He then proceeded, in paragraph 7, to trace the gradual changes which would be required to put the plan into effect: 1. The provincial licensing examinations should be abolished. 2. All provinces should recognize the licence of the Medical Council. 13

THE ROYAL COLLEGE OF PHYSICIANS AND SURGEONS OF CANADA

3. The name of the Medical Council of Canada should be changed to the Royal College of Physicians and Surgeons of Canada. 4. The Licenciates of the Council should automatically become Members of the new College. 5. Legislation would be required to establish the Fellowship which would be awarded at a later date by examination only, except for certain Honorary Fellowships. Other clauses dealt with the later activities of the proposed organization. Dr. Marlow was ill and could not attend the meeting. The letter was read by Dr. Bazin, but there was no discussion. As a matter of fact, the question of forming a college had been brought before the Annual Meeting of the Medical Council of Canada in the preceding September, and the Council had decided to have nothing to do with any such plan. (11) It had taken Dr. T. G. (later Sir Thomas) Roddick fifteen or twenty years to persuade the Dominion Parliament to pass the Act incorporating the Council (1912) and Members of the Council were most unwilling to open the Act for purposes of amendment. The report, therefore, had found few friends amongst the provincial and federal licensing authorities, and it had also run foul of the plans of the group who wished to set up a Canadian Branch of the Royal College of Surgeons of England. Dr. Primrose was the leader of this group, and his continued interest in the British Colleges is shown by his presidential address at the second meeting of the Conference when he gave an excellent account of the early history of the British corporations. (12) December 1924, may be regarded as the end of the first campaign for the setting up of a Canadian College. The hierarchy of the Canadian Medical Association, largely controlled by the eastern universities, had other plans for the recognition of postgraduate training, and was well pleased that the agitation for a Canadian College seemed to have lost most of its momentum.

14

CHAPTER IV

THE LOW, JOHNSTONE AND MOORE PERIOD 1925 - 27 The eastern members of the Canadian Medical Association had been endeavouring for some time to arrange a system of affiliation with the Royal College of Surgeons of England. It was felt that a Canadian branch might be formed, and that all the examinations for admission to the College might be held in Canada. This plan had been proposed by the Education Committee of the Canadian Medical Association, and in 1924 a special committee had been named, under the chairmanship of Dr. Primrose, Professor of Clinical Surgery and Dean of the Medical Faculty of the University of Toronto. In 1925 Mr. H. W. Carson, F.R.C.S., was the official delegate of the British Medical Association at the Annual Meeting of the Association in Regina. At a meeting of Council he was asked his opinion as to the feasibility of forming a Canadian branch of the College. (13) He thought there were many difficulties. There were only 15 or 16 Fellows of the Royal College of Surgeons in Canada, (the number had increased to 34 by 1930) and the cost of holding examinations in Canada would be prohibitive. However, he would take home the suggestion to the Royal College. Dr. Primrose said that the chief reason for the small number of Fellows of the Royal College of Surgeons in Canada was the great expense of the voyage to England and the required courses of study which might take two years. Anything which might reduce the cost would be followed by a great increase in the number of candidates. AIso, he did not think the prospects of a successful Canadian College were at all bright. In the meantime, the American Colleges were expanding and the campaign of hospital standardization of the American College of Surgeons was causing discontent in the non-university centres of western Canada where it was claimed that approval might be given to 15

THE ROYAL COLLEGE OF PHYSICIANS AND SURGEONS OF CANADA

one hospital but be refused to another whose staff believed it to be of equal standing. No mention is made of a Canadian College in the transactions of the 56th Annual Meeting of the Canadian Medical Association in 1925, but the Study Committee seems to have been reappointed, although Dr. Marlow had retired as its chairman. Dr. Low of Regina was now the President of the Association, and he and his friends, David Johnstone and Samuel Moore, must have been very active behind the scenes, because the seemingly dead body suddenly came to life. Apparently they had joined forces with the Committee on Education, because a combined report of the two committees, signed by Dr. S. W. Prowse of Winnipeg, was presented at the 1926 Annual Meeting of the Association in Victoria. (14) It was a very long report covering the whole field of medical education and licensure in Canada. Dr. Routley gave the following excerpts from it in his address at the 1954 meeting of the Royal College: It has been proposed that the English Fellowship examination be held in Canada. Merely rendering the English Fellowship more easily attainable by Canadian surgeons will not of itself immediately rid the profession of a reproach, or the Canadian public of a danger under which both are labouring in a constantly increasing measure. The reproach and the danger respectively lie in the fact that neither by parliamentary enactment, licensing by-law, nor popular tradition, does there exist in Canada any distinction between the general practitioner, the consulting physician, or the consulting or operating surgical specialist. There is probably no member of this Association who does not know of lives being endangered or lost through the essaying of major surgical operations by practitioners who, though legally qualified under our present licensing laws, nevertheless for lack of special training and of surgical experience are absolutely and fundamentally incompetent in matters of surgical diagnosis and treatment. Your conjoint committee therefore proposes: WHEREAS, It seems desirable to the Canadian Medical Association that higher standards and qualifications in the practice of Medicine and Surgery in Canada should be recognized by properly constituted Canadian authorities, Be it RESOLVED, That this Council in Session appoint a special committee whose duty it shall be, 1. To formulate plans for the organization of a College of Physicians and Surgeons of Canada. 2. To study and outline a procedure whereby such a proposed College should receive Royal Assent. 3. To study and recommend the procedure as to the appointment of the original personnel of such a College. 4. To devise ways and means to finance such a project. 5. To report back to Council at the earliest possible date. (15) 16

THE LOW, JOHNSTONE AND MOORE PERIOD

This report had not been submitted in time to be printed along with the other reports to Council, and because of its length and contents it was referred to a sub-committee of Council for study and report later in the day. This committee consisted of: Samuel E. Moore, Regina J. G. MacDougall, Halifax Lorimer J. Austin, Kingston Glen Hamilton, Winnipeg H. W. Hill, London, Ontario

V. E. Henderson, Toronto J. H. Mullin, Hamilton James Miller, Kingston David Low, Regina D. S. Johnstone, Regina

The report of this committee was very much in favour of having the Association proceed with the formation of a Royal College. This was to be expected. Three of the members — Drs. Moore, Low and Johnstone of Regina — had been the proposers of the original resolution at Vancouver in 1920. In Regina they were called the Mighty Triumvirate of the Saskatchewan Medical Association, but in view of their continued and forcible activities in favour of a Royal College they were known as "the Regina Bronchos" by the eastern members of the Executive Committee. The Council adopted the report and appointed Dr. Low as chairman of a large committee to decide on how a Royal College of Physicians and Surgeons of Canada might be brought into being. The committee consisted of almost sixty persons representing all the provinces, and in the words of the motto on the Canadian Coat of Arms, A Mari usque ad Mare, its membership stretched from sea to sea. One might suspect that those opposing the idea had created this unwieldy committee so that nothing would be done. They underestimated the organizing and political ability of Dr. Low. He addressed a letter of enquiry to the members of his committee, and received thirty-four replies of which twenty-seven were definitely in favour of incorporating a Canadian College at once; five were doubtful; but only two were definitely opposed. The general opinion was that the committee should exclude from its thinking all previous organizations and keep constantly in mind that it had been charged with "the setting up of a College of Physicians and Surgeons for Canada, which shall be entirely and distinctively Canadian, with the sole purpose of offering to Canadian young men (and women) the inducement to go in for advanced courses of training in the science and art of Medicine and Surgery." 17

THE ROYAL COLLEGE OF PHYSICIANS AND SURGEONS OF CANADA

The committee felt that "no licensing powers should be requested; merely the right to grant diplomas which would be the `Guinea's Stamp' of high achievement by which the holder might be distinguished" and that no favouritism should be shown in granting the Fellowship. The committee went on to state that the proposed College should not concern itself with the "approval of hospitals". This was in the province of the Canadian Medical Association. Having agreed on these general principles, the drawing up of a complete and detailed report was taken over by Dr. Low and a small group of Regina doctors. The members of this group were Drs. Low, W. A. Harvie, Moore and Johnstone. They, with the addition of Dr. J. B. Ritchie as secretary, were responsible for the second part of the report. (16) One of the original copies of this report was presented to the College by Dr. Johnstone. It is typed on legal paper and has all the appearance of a legal document. The terms of reference for the committee covered four points: 1. To formulate plans for the organization of a College of Physicians and Surgeons for Canada. 2. To outline procedure whereby such a College should receive Royal Assent. 3. To recommend the procedure to be adopted in appointing the original personnel of such a College. To devise ways and means of financing such a project. 4. The report deals with each of the clauses in order. First, the formulation of plans for the organization of the College. There are 14 sections which deal with the name of the College, the titles of the Fellow, the appointment of the Charter Fellows, the admission of all others by examination only, the qualifications of those who are to be admitted as Charter Fellows. The report continues with a section divided into 9 clauses dealing with the business affairs of the College, the Council, the appointment of examiners and the various officers of the Corporation. In the ninth section the requirements for admission to the examination and the examination content are described. It is interesting to note that the committee recommends that the medical examination might be in general medicine or in paediatrics, while in 18

THE LOW, JOHNSTONE AND MOORE PERIOD

surgery the specialties of ophthalmology, otolaryngology, gynaecology and obstetrics, are to be recognized as sub-specialties of surgery. The committee dealt with the other matters in very general terms, noting that the incorporation must be by Act of Parliament rather than by Royal Charter, and suggesting that the initial costs of incorporation should be met by a loan from the Canadian Medical Association, which should not exceed $5,000 in amount. The committee recommended an entrance fee of $100 and annual dues of $10 payable on January 1 of each year. Time was not of the essence with Dr. Low. His report was too late for the printer and, once again, as in the case of the joint report of the Committee on Education and the Study Committee of the preceding year (1926), his report did not appear in the preliminary printed copies of the Reports to Council. Indeed, the typed copy is dated Regina, June 2, 1927, only four days before the actual day of the meeting in Toronto. While the actual report had not been received, rumours of its contents had become known and a considerable opposition had developed. Once again Dr. Low's political skill came into the picture and much of the opposition was softened by judicious means before the report actually came before Council. A special committee consisting of Drs. F. N. G. Starr of Toronto, H. G. Ridewood of Victoria, Weston Krupp of Woodstock, Ontario, Charles F. Martin of Montreal, and John Stewart of Halifax, was appointed to study the document and to report to Council. The committee recommended the deletion of the rather theatrical preamble but recommended that the main body of the report be accepted. This part of the report was clear-cut and practical in character, and it was adopted by the Association later in the meeting but only after the defeat of a number of delaying stratagems. The voting was said to have been very close. The report had recommended that Council appoint a body of men to be known as Charter Fellows for the purpose of carrying out the incorporation of the College and formulating the by-laws and rules and regulations. The appointment of this group, later called the Nucleus Committee, proved a formidable task. No one seemed willing to accept the chairmanship. Finally, Dr. Starr, the President of the Association, agreed to serve and, in accordance with another recom19

THE ROYAL COLLEGE OF PHYSICIANS AND SURGEONS OF CANADA

mendation, the six remaining members of the Nucleus Committee were to be university professors: F. N. G. Starr, Professor of Clinical Surgery, University of Toronto, Chairman Alexander Primrose, Dean of Medicine and Professor of Surgery, University of Toronto L. J. Austin, Professor of Surgery, Queen's University C. F. Martin, Dean of Medicine and Professor of Medicine, McGill University A. T. Bazin, Professor of Surgery, McGill University George Hale, Professor of Medicine, University of Western Ontario A. Rousseau, Dean of Medicine and Professor of Medicine, Laval University

This committee was instructed to employ the solicitor of the Association to aid in preparing the Bill of Incorporation and the constitution and by-laws, and to prepare by all means in its power for the early introduction of the Bill in the House. Finally, a sufficient sum of money was to be loaned by the Association to finance the incorporation of the College, "this loan to be repaid when the College was a going concern and in a position to do so." The question has often been asked why the control of the new College had passed from the non-teaching to the teaching group. The answer comes from Dr. Low's report, where the Charter Fellows are set down as professors of those branches of medicine whose services would be required to conduct the examinations of the College. Dr. Low and his friends had automatically removed themselves from any further control of the corporation.

20

CHAPTER V

THE NUCLEUS COMMITTEE 1927 - 1929 The seven members of the Nucleus Committee formed an impressive group not only as medical educationists but also as men of national reputation in Canadian medicine. Either by accident or design, Dr. Low had arranged that the committee consist chiefly of earlier opponents of a Canadian Royal College. Drs. Starr, Primrose and Bazin had been active in the interests of the Royal College of Surgeons of England, Dr. Rousseau's sympathies had been directed towards Paris, while Dr. Martin represented a group with decided leanings to the American Colleges. As a matter of fact, Dr. Martin had recently been a central figure in a complete reorganization of the American College of Physicians. (17) In spite of this, the Committee went to work promptly, and at the June 1928 Annual Meeting of the Association, at Charlottetown, the Chairman, Dr. Starr, made the following report: 1. The association solicitor had been engaged to advise in the preparation and presentation of a Bill for the setting up of a College or Colleges under a Federal Charter. 2. On February 23, 1928, the Nucleus Committee had met the medical Members of Parliament in Ottawa. The Members had pledged their whole-hearted support when the Bill was before the House. (18) Dr. Starr then gave an abstract of the subject matter to be incorporated in the Bill, which was largely a repetition of the 1927 report of Dr. Low's committee. Finally, he announced that copies of the draft Bill had been sent to the provincial associations, the licensing bodies and the universities, and that their replies were being awaited. He hoped that the Bill would be introduced at the next session of Parliament. Dr. A. MacGillivray Young was a member of the Executive Committee of the Canadian Medical Association and he was also a Member of Parliament. He was probably the one who had arranged the dinner 21

THE ROYAL COLLEGE OF PHYSICIANS AND SURGEONS OF CANADA

meeting of the Nucleus Committee and the medical Members of Parliament in the preceding February. He had agreed to sponsor the legislation, but said that the document required considerable rearrangement prior to its introduction as an Act of Incorporation. He would be glad to have this done by one of the Departments of Government. The committee, being concerned about expense, gladly accepted this offer and does not appear to have heard anything further about the Bill until some twelve months later, when Dr. Starr addressed the following letter to the members of his committee: Canadian Medical Association, 184 College Street, Toronto 2, March 8th, 1929. Dear Doctor ... , Re: The Royal College of Physicians and Surgeons of Canada With this letter I am enclosing a copy of the Bill as it was returned from Ottawa, after the Clerk of the House had put it into shape. At first I did not recognize it at all, but after going over it a good many times, I think all the principal points are in, and nothing serious has been omitted. I have been in communication with Dr. A. MacG. Young, M.P. of Otawa, about the necessity of recognizing equal standards in the Republic of France. Yours sincerely, (Signed) F. N. G. Starr, C.' Chairman, Nucleus of Charter Fellows.

The enclosed material consisted of two parts, first, the petition to His Excellency the Governor-General in Council, and, second, the proposed Act of Incorporation. The full text of the Petition was as follows: To His EXCF.TS.FNCY The Right Honourable Viscount Willingdon, Knight Grand Commander of the Most Exalted Order of the Star of India, Knight Grand Cross of the Most Distinguished Order of Saint Michael and Saint George, Knight Grand Commander of the Most Eminent Order of the Indian Empire, Knight Grand Cross of the Most Excellent Order of the British Empire, Governor-General and Commander-in-Chief of the Dominion of Canada IN COUNCIL. THE PETITION OF The Canadian Medical Association a corporate body duly incorporated under Chapter 62 of the Statutes of Canada passed and enacted in the year of our Lord 1909, HUMBLY SHEwETH: 1. THAT your Petitioner is desirous that certain of its members and others who have achieved distinction in some branch of the medical profession as evidenced by their holding professorships in recognized Canadian Medical Schools or displaying high ability in one or more special departments of the medical profession should be incorporated under the name of THE ROYAL °The C. is the initial of Mrs. Mabel Campbell, who for 30 years acted as Dr. Routley's secretary at the offices of the Ontario and the Canadian Medical Associations.

22

THE NUCLEUS COMMITTEE

COLLEGE OF PHYSICIANS AND SURGEONS OF CANADA (hereinafter referred to as the College) and should be designated and known as FELLOWS of the said College. 2. THAT your Petitioner contemplates that the original members of the said College (herein referred to as the Charter Fellows) should include and be limited to the professors in medicine, surgery, gynaecology and obstetrics, at the present time actively engaged in teaching in a Canadian University within the meaning of the Canada Medical Act, together with such other persons whom the Council of the College may at any time within two years after the incorporation of the College select and admit as Charter Fellows of the College. 3. THAT your Petitioner contemplates that except for:— (a) Charter Fellows to be selected as aforesaid, (b) Honorary Fellows to be selected by the Council of the College without examination from among Physicians, Surgeons or other persons distinguished by their ability. (c) Duly qualified Physicians and Surgeons practising in Canada, and licensed to practise in at least one of the Provinces thereof holding a degree, diploma or fellowship issued or granted by a recognized University or Medical or Surgical organization of equal status to a Fellowship in the College, to be selected and admitted without examination, admission to the College should be by examination and should be open to all physicians or surgeons being graduates of not less than three years standing of any medical school or university within the meaning of the Canada Medical Act and being duly licensed and authorized to practise the profession of medicine in at least one of the Provinces of Canada. 4. THAT your Petitioner is desirous that the College may be authorized to acquire and hold such real and personal property as is necessary or expedient for its purposes and to sell, lease or otherwise dispose of the same. 5. THAT your Petitioner contemplates that the affairs of the College shall be administered by a Committee of the Fellows to be known and designated as the Council of the College to be elected from time to time by the Fellows thereof and that the said Council be authorized to make and pass by-laws and regulations for conducting and controlling the selection and admission of Fellows and the examination therefor, for the election of the Council and officers thereof and for the doing of all other lawful acts and things that may be deemed expedient for the exercise of its corporate powers. WHEREFORE YOUR PErmoNER HUMBLY PRAYS that your Excellency may be pleased to sanction the passing of an Act for the purposes above mentioned in the form hereunto annexed or in such other form or with such modifications as your Excellency may be pleased to approve. AND as in duty bound your Petitioner will ever pray.

This Petition was followed by the text of the proposed Act under the title AN ACT TO INCORPORATE the Royal College of Physicians and Surgeons of Canada. Dr. Starr was quite correct in stating that he did not recognize it at all, but that the principal points were in, and that the omissions were not serious. Dr. MacGillivray Young was also correct when he said that the contents of the proposed Act had needed considerable rearrangement. The formal Bill commenced with the usual preamble. The subject matter was divided into thirteen sections of which two concerned 23

THE ROYAL COLLEGE OF PHYSICIANS AND SURGEONS OF CANADA

financial matters. One of these gave the College the right to buy and sell property of the College, and limited the annual value of the real estate held by the corporation; another stated that no Fellow of the College, merely by reason of his Fellowship, should be personally liable for its debts or obligations; a third section directed the College to maintain a register of its Fellows. These might be regarded as routine additions to any Act of Incorporation. There were, however, a number of quite definite changes. 1. The period for election to Charter Fellowship without examination was extended to two years, instead of the suggested one year period. 2. The separation of the College into two divisions — the surgical division and the medical division. Dr. Mackay and Dr. Pope had suggested a similar but mandatory plan in their Faculty Report to the University of Manitoba in 1922, but in the present version of the Bill the separation of the Fellows into two divisions was permissive. "The Council may by by-laws provide for the organization of the College into Medical and Surgical Divisions." 3. In Section 12 the General Secretary of the Canadian Medical Association was directed to call together within six months of the passing of the Act all those entitled to become Fellows of the College as set out in a preceding section of the Act. This group was called the provisional Council. 4. The term of office of the Council was set down as four years. 5. The proposed Bill of the Nucleus Committee had gone into great detail about the content of the examinations. Fortunately, the Act relegated all these details to regulations by Council, where changes could be made without difficulty as time went on. A month later the Bill came up for consideration in the House of Commons.

24

CHAPTER VI

THE BILL BEFORE PARLIAMENT THE HOUSE OF COMMONS The Bill was introduced in Parliament under the sponsorship of Dr. A. MacGillivray Young, Member of Parliament for Saskatoon, and given first and second readings on April 4 and 5, 1929. It was then considered by the House in Committee on April 19, and passed after third reading on the same day. Dr. Starr and his Nucleus Committee had done good work. The Hansard Report of the House of Commons Debates has many interesting items. Dr. Young appears as the promoter of the Bill, and he apparently had not been idle, as at least three Cabinet ministers spoke in favour of the Bill at different stages in the debate. (19) As noted previously, education and health are regarded as purely provincial matters, and questions arose as to whether the present Act was within the federal jurisdiction. Dr. Young was a skilful parliamentarian and answered these questions to the satisfaction of the House. The first of these questions was, "Had the provincial medical bodies been informed?" To which Dr. Young replied, "All had been informed and there had been no objections. The measure had been under consideration for some years." Another question had to do with the relation of the proposed College to licensure to practise. Dr. Young replied that the Bill had nothing to do with a licence to practise. The prospective candidates would already be licensed to practise, and the whole object of the College would be to encourage postgraduate education, the Fellowship being the evidence that the successful candidate had actually done so. At this point, Dr. Murray MacLaren, M.P. for Saint John, N.B., pointed out the difference between the College and the Roddick Bill setting up the Medical Council of Canada. The present Bill was intended to stimulate postgraduate education, as was the case with the Royal Colleges of England, Edinburgh and Dublin. "It was to act as an incentive to medical men, both physicians and surgeons, to aspire to higher qualifications and therefore higher standards of service to the public." 25

THE ROYAL COLLEGE OF PHYSICIANS AND SURGEONS OF CANADA

The preamble of the Act then came up for discussion, and a Member questioned the use of the word "Royal" in the title. Had the assent of the Sovereign been obtained for its use? Dr. Young replied that the Solicitor-General did not believe that Royal assent was required in this particular case. This reply did not impress the Member and he continued the argument. While he had no objection to the bill as a whole, he objected very strongly to a possibly unauthorized use of the word Royal. The word was used far too freely in financial circles and in commerce. He was convinced that official approval should be obtained from the Crown. Parliamentary interest, however, passed on to the word College in the title. This again raised the question of the organization being an educational institution. One of the Members of Parliament asked why it should not be called an Association, if it had nothing to do with education? Dr. Young went into the question of the Royal Colleges of Britain and stated that the use of the words "Royal" and "College" in the title followed the precedent set by the names of similar Colleges in the Old Country. Finally, the objection was met by the chief opponent saying, "This College then is really what its Latin equivalent signifies — a Collegium* and not a school." The Minister of Justice here intervened, to say "I do not think that College here means school." During the discussion another physician of ministerial rank took part in the debate. He pointed out that the British Royal Colleges were examining bodies, "but more recently there has been formed in the United States, an American College of Surgeons. I may be wrong, but while we say the proposed Royal College is modelled on the British institutions to which I have referred, really its purpose is to put us on a par with the American College." To this Dr. Young replied "Yes, but not to put us on a par; it will be vastly superior." The Minister replied: "Dr. Young is ultra patriotic. The American College is good, but I also support the idea of a Canadian College." Up to this point, many of the questions had been critical of the project of incorporating the College, but Dr. Young had given satisfactory answers. The chief figures in the debate were specialists in parliamentary procedure. It was a cultural bill, and now the time had come for some member to support it on inspirational and patriotic 'College: a body of colleagues with common functions and privileges, e.g. Sacred College, College of Cardinals, College of Arms.

26

THE BILL BEFORE PARLIAMENT

lines. This task was assumed by Dr. Peter McGibbon, the Member for Bracebridge, Ontario. He was one of the medical parliamentarians of the old school, a master of the rounded periods of the political oratory of the day. He began by stating that he wished to join with Dr. Young and others in advocating the passage of the Bill. It was time that Canadians had an institution of this kind of their own. In the past we had been too prone to pride ourselves upon the degrees won either in Colleges within the British Empire or in the United States. It was time for Canadian academicians to stand on their own feet. He referred glowingly to the value of the degrees of the Royal Colleges of England, and ended a panegyric on Canadian medicine and education with a statement urging the passage of legislation which would be of inestimable benefit to scientific education in Canada. After a further endorsation by the Minister of Health, the Bill was reported to the House, read the third time and passed at once. THE SENATE During the debate in the House of Commons it had become apparent that the chief objections to the Bill were coming from a section of the country where provincial rights had always been of paramount importance. As a matter of fact, although the Bill was intended to cover all members of the profession, there was nothing in it giving, as is the case with the Act of Incorporation of the Canadian Medical Association, any French equivalents for the English titles either of the College or of its Fellows, nor was there any mention of the fact that any language other than English would be accepted in the examinations. It was felt that the Act might receive harsh treatment in the Senate if attention was drawn to these defects. Fortunately, there was in the Senate at that time a statesman in whom all had confidence, Senator Raoul Dandurand, P.C. He was requested to study the Bill and see how it could be improved, if necessary. Beyond suggesting the insertion of the French equivalents, he found it satisfactory and gave it his blessing. In the Senate the Bill received its first and second readings on April 30 and May 2, 1929, and was passed for its third reading with amendments on May 28. The chief amendments made in the Senate were a change in the Preamble of the Bill removing any mention of the Nucleus Committee 27

THE ROYAL COLLEGE OF PHYSICIANS AND SURGEONS OF CANADA

and naming the Canadian Medical Association as the Incorporator of the College, and also inserting the words "And Whereas His Majesty King George V has been graciously pleased to grant permission to the College to use the title `Royal'." Apparently the Nucleus Committee had been sufficiently impressed by the criticism of the use of the word Royal to wait upon the Governor-General in person and get the appropriate consent. The other amendments were, as noted above, to give the alternative French titles of the College and of its Fellows in medicine and in surgery, and also to insert in Section 8 the use of both French and English in the examinations. (20) With these amendments the Bill was passed by the Senate, and referred back to the Commons where the House concurred in the Senate amendments on the following day. The Bill received Royal Assent on June 14, 1929. At the 60th Annual Meeting of the Canadian Medical Association, on June 17, 1929, Dr. Starr reported that the Bill had passed through the House and the Senate and was now waiting for Royal Assent. (21) The notice had not yet reached him that this assent had been given three days previously. He paid a particular tribute to Dr. Young for his good offices in this regard, and Council then passed the following resolution: "That the Council of the Canadian Medical Association at its 60th Annual Meeting goes on record as expressing to Dr. A. MacGillivray Young our deep sense of appreciation for the services he has rendered to the medical profession in piloting this Bill through the House of Commons." Dr Primrose also drew attention to the outstanding work of Dr. Starr as convener of the Nucleus Committee. This marked the end of the first period in the development of the Royal College of Physicians and Surgeons of Canada. It was now a duly incorporated body with the avowed purpose of stimulating postgraduate study, and, as Dr. MacLaren had said, to promote higher standards of medical service to the public.

28

CHAPTER V11

THE MEETING OF THE PROVISIONAL COUNCIL NOVEMBER 20, 1929 One further step remained in setting up the College. Section 3 of the Act of Incorporation directed the General Secretary of the Canadian Medical Association to call together at Ottawa, within six months of the passing of the Act, all those entitled to become Fellows of the College as set out in Section 2 of the Act. All those present at this meeting would constitute a provisional Council. It would be the duty of this meeting to elect a Council with such 'officials as were deemed necessary. Section 2 of the Act defined the "entitled" persons as "those holding, at the date of coming into force of the Act, appointments as Professors in Medicine, Surgery, Gynaecology or Obstetrics, in a Canadian University." The Nucleus Committee thought that the list of those invited would be limited to the heads of these departments, but on taking legal advice the section was interpreted as meaning all those in whose title the word Professor appeared. This meant a much larger group, to include the Assistant, Associate, Clinical and Emeritus Professors. The list was hastily revised, and finally 147 persons were invited, of whom 72 accepted and attended the meeting. November 20, 1929, was the date finally set for the meeting of the provisional Council. It was the day before the Conference on Medical Services in Canada, a Government Committee which would be attended by many of the prospective Fellows. This delay of six months had two unfortunate consequences. It materially shortened the two-year period during which Charter Fellows might be admitted without examination (Section 1, Clause (c) and Section 5), and it so happened that Black Friday, October 25, 1929, the date of the first collapse of the stock market which ushered in the depression years, had occurred very shortly before the meeting, so that many of those in attendance were in serious financial difficulties. 29

THE ROYAL COLLEGE OF PHYSICIANS AND SURGEONS OF CANADA

In any case, the meeting came to order under the guidance of the General Secretary of the Canadian Medical Association, Dr. Routley. It was an unusual meeting in many ways. As noted above, the chief drive for the setting up of The Royal College of Physicians and Surgeons of Canada had come from the medical societies. Only one university (Manitoba) had shown any particular interest in the project, and medical teachers in general had taken a gloomy view of its prospects of success. On the provisional Council the active supporters of the College had been replaced by a large group of lukewarm friends who knew little about the objects of the College and nothing about the Act of Incorporation. It is therefore not surprising that the atmosphere of the early part of the meeting was more critical than constructive. Dr. Routley had taken the precaution of having a public stenographer to record the minutes, and he has been good enough to donate a copy of these verbatim minutes to the College for its archives. These minutes which extend to some forty foolscap pages are much more informative than the much shorter report which was subsequently sent to prospective Fellows. Dr. Routley opened the meeting by giving a sketch of the gradual development of the idea of setting up a Royal College from the time of the first Resolution at Vancouver in 1920. He then read the Act of Incorporation in full. After having called the roll, he asked the press to leave the hall and then invited the meeting to elect a chairman, but even before the election of the chairman one of the Nucleus Committee (Dr. Martin) expressed the opinion that the list of invitations had been poorly conceived, because as far as his university was concerned the sub-departments of medicine had been left out. He mentioned particularly the specialties paediatrics, neurology and psychiatry. A fellow Dean (Dr. Primrose) supported his contention. The meeting seemed headed for a long discussion of contentious side issues, when Dr. Bazin suggested that it would be well to follow the agenda and proceed in an orderly manner. He said that the Bill "had been sprung on them" and that because of the belated legal opinion, arrangements for the meeting had been imperfect in many ways. It was suggested that Dr. Routley act as chairman, but he refused because he was not a Fellow. Finally, after a good deal of discussion Dr. Bazin was elected by acclamation. 30

THE MEETING OF THE PROVISIONAL COUNCIL

The next item on the agenda was the question of the registration fee, but Dr. C. B. Keenan, a surgeon from Montreal noted for his argumentative ability, said that in his opinion the first thing to be decided was the organization of the College into two independent sections, as laid down in Section 8, Clause 3, of the Act. He felt that there should have been two entirely independent Colleges or, failing that, a complete separation of the medical and surgical divisions with separate sets of officers and separate treasuries. One had to be either a physician or a surgeon, and this lumping together of the two sides of the profession would confuse the public and put the status of the profession back for twenty years. Dr. E. W. Archibald of Montreal had similar views, but for different reasons. At this point, Dr. Routley took a more active part in the proceedings and said that in his opinion the first thing to be decided was the registration fee. This was the first step. If any one thought the fee was excessive he could then leave the meeting. It did not seem reasonable for those who had no intention of becoming Fellows of the College to vote on questions of College policy. No one seemed to notice that this suggestion went much beyond Section 3 of the Act which stated that "The General Secretary shall call together ... all those entitled to become Fellows of the College as set forth in Section 2 of the Act. All those present shall constitute a provisional Council." However, Dr. Routley's suggestion enabled Dr. Starr to move and Dr. Campbell Howard of Montreal to second a motion that the registration fee should be one hundred dollars. This was the amount which had been suggested by Dr. Low's committee in 1927, but, in the meantime, the crash of the stock market had occurred and many thought the fee too high. The question was raised as to whether there would be any annual dues. The chairman assured the meeting that there were to be no further payments, although Dr. Howard and Dr. W. W. Chipman of Montreal felt this was perhaps unrealistic when compared with experiences in other societies and the American Colleges. The discussion once more turned to the question of two Colleges, but finally the motion was carried that "The provisonal Council recommends to the incoming Council that the fee be One Hundred Dollars." At this point, in view of the confused discussion, Dr. Bazin asked Dr. H. A. Bruce of Toronto to take the chair, and moved that the 31

THE ROYAL COLLEGE OF PHYSICIANS AND SURGEONS OF CANADA

meeting resolve itself into a committee of the whole, without executive action, to discuss the details of the agenda, and such other matters as might be brought before it, and then resolve itself back into the provisional Council to carry out the details laid down in the Act. The motion was carried, and Dr. Bazin was elected Chairman of the Committee of the whole on the motion of Dr. Primrose and Dr. Bruce. Once more the question of two Colleges arose, and it seemed possible that the meeting might break up. Various suggestions were made, but finally Dr. Keenan, seconded by Dr. Archibald, moved: "That this body recommend to Council that it immediately arrange to divide the College into two divisions to be known respectively as the Royal Canadian College of Physicians and the Royal Canadian College of Surgeons, that this division be made conformative to the Act, and that each division should have the right to its own fees, to appoint its own examiners and in fact to have as much autonomy as is possible under the Act." This motion was carried. In the course of the meeting reference was made repeatedly to the Act having been passed hurriedly with little, if any, opportunity for the Nucleus Committee to discuss its contents. The members of this Committee seemed to be on the defensive and only Drs. Starr, Bazin, and Primrose took any part in the later discussion. The next item on the agenda was the personnel of Council. Here again the discussion began wide of the mark. A leading professor of medicine gravely asked if a Fellow of the Royal College of Physicians would be forced to practise medicine alone. Another delegate wished to know to which division of the College the obstetricians and gynaecologists would be assigned. It was moved by Dr. Chipman and seconded by Dr. J. C. Meakins: "That for the purposes of classification, gynaecologists and obstetricians shall be ranked in the Surgical Division." Just before the luncheon recess it was decided that the new Council of the College should consist of 18 members. Apparently, there had been some private discussions during the luncheon recess, as much more rapid progress was made in the afternoon session. It was decided on motion of Dr. Primrose, seconded by Dr. Bruce: "That the whole body of Councillors, when elected, be com32

THE MEETING OF THE PROVISIONAL COUNCIL

posed of 18 members who shall elect their own Chairman from among their members." Once more the question of the two independent divisions made its appearance. Dr. Archibald asked whether there would be two Presidents of Council. The Chairman replied that the Council was a comprehensive body and could have only one head. Dr. Keenan did not agree with this opinion, and once more Dr. Primrose and Dr. Bruce moved and seconded a supplementary motion: "That the Council shall elect a President of the College who in turn shall be automatically Chairman of the Council." After more discussion, this motion was carried. At this point, an item not in the agenda was introduced. Dr. Chipman moved, seconded by Dr. Bruce, that Council be directed to elect Dr. Clarence Routley as the first Fellow of the College, and that he be appointed acting Registrar. This was carried unanimously. Dr. Routley appeared greatly surprised at this unexpected turn of events, but after thanking the meeting for its action, elected to be classed as a physician. The Chairman remarked "I am sure that all will agree that our first elected Fellow has shown high ability in the special department of Administrative Medicine." The meeting now proceeded to the eighth item on the agenda — the election of Officers and Council. A nominating committee was appointed by the chair and instructed to bring in a list of 18 Councillors. This committee presented the following slate which was duly approved and these persons were elected as the first Council of the Royal College: MEMBERS OF THE FIRST COUNCIL J. G. MacDougall, K. A. MacKenzie Calixte Dagneau, J. M. A. Rousseau J. E. Dube, L. de L. Harwood A. T. Bazin, J. C. Meakins N. J. McLean, C. R. Gilmour F. N. G. Starr, Duncan Graham E. L. Pope, A. R. Munroe L. J. Austin, W. T. Connell G. C. Hale, Hadley Williams

Dalhousie University Laval University University of Montreal McGill University University of Manitoba University of Toronto University of Alberta Queen's University University of Western Ontario

On the motion of Dr. Bruce, seconded by Dr. Martin, the Committee of the whole now rose and reported back to Council. By motion, the various decisions of the previous meeting were confirmed. 33

THE ROYAL COLLEGE OF PHYSICIANS AND SURGEONS OF CANADA

The provisional Council now authorized the temporary location of the College office in Toronto, but passed a motion, moved by Dr. Chipman and seconded by Dr. Primrose: "That the City of Ottawa be considered as the permanent home of the College, as it is a neutral city, [there was no medical school at the time] the capital city of Canada and bilingual." After a short discussion on the unfortunate lack of representation from those provinces which did not have schools of medicine, the meeting adjourned following the passage of votes of thanks to the Nucleus Committee and to Dr. Routley.

34

CHAPTER VIII

THE MEETING OF THE PROVISIONAL COUNCIL (Continued) The Inaugural Meeting of the provisional Council was held during a crowded week and it was faced by a very full agenda. A lengthy order paper of this kind might have been dealt with by a small and homogeneous group, but trouble soon arose in the larger meeting. One might suspect that rumours were abroad that opposition would develop regarding the election of officers, and much of the confusion of the morning session may have arisen from these rumours. It will be recalled that the meeting progressed much more smoothly in the afternoon, suggesting that some compromise had been reached during the luncheon recess. In any case the provisional Council contented itself with electing the first regular Council of the College, choosing the location of the permanent headquarters in Ottawa, and recommending the appointment of Dr. Routley as the acting Registrar-Secretary. The election of officers, the installation of the President, the naming of committees and other matters were left in the hands of the newly appointed Council, which would meet immediately after the adjournment of the Inaugural Meeting. The meeting, however, had served a useful purpose in that the requirements of the Act had been satisfied, certain policies had been laid down for the guidance of the new Council, and it had provided an opportunity for the expression of opinions by a representative group of those who were entitled to Charter Fellowship. Possibly the criticism of the list of invitations had a background in medical politics, and the fact that Dr. Primrose supported Dr. Martin's criticism suggests that neither of them were willing to entrust the election of officers to this mixed gathering. A similar unwillingness to commit the future of the College to any hasty action is shown by Dr. Bazin's suggestion that the Inaugural Meeting be resolved into a meeting of the Committee of the whole without executive action, and, after the various items on the agenda had been discussed, to meet once 35

THE ROYAL COLLEGE OF PHYSICIANS AND SURGEONS OF CANADA

more as the provisional Council to carry out the details laid down in the Act. It is much more difficult to explain the disagreement about the incorporation of the College as a joint organization of physicians and surgeons, a disagreement which at one stage almost broke up the meeting. The idea of forming separate colleges had never gone beyond the vaguest of discussions suggested by the alternative reading "A College or Colleges" in the title of an occasional committee report, and from 1927 the plan had always been for a joint organization. The proposed legislation had always been in terms of a College of Physicians and Surgeons. In some ways the joint title had been confusing and in its early days a good many persons thought that the College was some new form of licensing body allied to the provincial licensing agencies which had much the same titles. Again no one seems to have pointed out that following a disagreement with the Board of Governors in 1866, the Medical Faculty of Queen's University had withdrawn from the University and had been incorporated as the Royal College of Physicians and Surgeons. This college maintained an independent existence for twenty-six years before it returned to the university in 1892. The chief criticism arose from two surgeons who seemed to be concerned about the freedom of surgery from medical domination. They wanted independence in questions of finance, examinations, and policy. Politics makes strange bedfellows, and it is difficult to understand how two such temperamentally different persons, one so mercurial, the other so logical, should both have joined in their support of separate colleges. In retrospect, it would appear that the chief reason for the joint College was the feeling that it would be more advantageous to have one strong organization rather than two smaller and weaker ones. The provision for medical and surgical divisions would allow of an easier separation when the time came for independent corporations. It is interesting to note that no reference was made to other imperfections in the Act which later required extensive amendments.

36

CHAPTER IX

THE FIRST MEETING OF THE COLLEGE COUNCIL The newly elected Council held its first meeting immediately after the adjournment of the provisional body. The attendance was as follows: L. J. Austin Present: K. A. MacKenzie P. C. Dagneau D. A. Graham F. N. G. Starr A. Rousseau J. E. Dube G. C. Hale L. de L. Harwood H. Williams A. T. Bazin N. J. McLean E. L. Pope J. C. Meakins T. C. Routley — Secretary Absent: J. G. MacDougall C. R. Gilmour W. T. Connell A. R. Munroe

For the time being Dr. Bazin acted as the chairman and Dr. Routley as the secretary. Five of the seven members of the original Nucleus Committee (Rousseau, Bazin, Austin, Starr and Hale) had been elected to Council and their presence gave some degree of continuity to the proceedings. The Council was faced by many problems; some were clear enough, but others only became apparent as time went on. The College owes these men an immense debt of gratitude for the amount of time and energy which they expended in the service of the College and much of its success in later years was due to their wisdom and breadth of view. The first business brought before the meeting was a motion by Dr. Austin, seconded by Dr. Harwood, "that we have nominations and then proceed by ballot to the election of officers." The motion was carried. Dr. Bazin pointed out that the provisional Council had directed them to elect a chairman or president from amongst their numbers and to confirm the appointment of Dr. Routley as acting Registrar-Secretary. The provisional Council had not made any recommendations regarding other officers for the College, and there had been a strong feeling that the medical and surgical divisions should be given the greatest possible amount of independence. 37

THE ROYAL COLLEGE OF PHYSICIANS AND SURGEONS OF CANADA

A very general discussion followed this pronouncement, during the course of which Dr. Austin suggested that there should be two Vice-Presidents and Dr. Graham thought there should be an understanding that the presidency should alternate between the physicians and the surgeons. An unnamed person suggested that the physicians should have the first presidency as they were the senior group and were mentioned first in the title of the College. Dr. Meakins made general remarks about the duties of the various officers, and Dr. Bazin referred to the unfinished business on the agenda of the Inaugural Meeting: namely, the striking of committees, the election of Fellows, and possibly the further consideration of the fees. The discussion had wandered so far into the future that Council seemed to have forgotten the chief item of business, the election of a chairman or president. Things needed a guiding hand, and Dr. Routley made a series of suggestions as to how the work of organizing the College might be carried on, if the Council thought well of them. He asked if it would be satisfactory to have nvo Vice-Presidents, a Registrar-Secretary and two Honorary Secretaries to work in connection with the VicePresidents. He also suggested that the persons who had been invited to attend the Inaugural Meeting be supplied with an abstract of that meeting, be asked which division of the College they wished to join, and be invited to enclose a cheque for the registration fee in their letter of acceptance. Council might also wish to name a committee to decide on who should be admitted without examination during the next eighteen months, and to appoint another committee to draw up the constitution and by-laws. The meeting immediately adopted these suggestions. The chairman then called for nominations for the presidency of the College. Dr. Starr and Dr. Meakins were nominated, and Dr. Meakins was elected by a vote of 7 to 6. On taking the chair, Dr. Meakins made the following remarks: It is hardly in my power to express my feelings in this election and the confidence which you have placed in me. I hardly feel worthy of it. I do not think I ever appreciated so much what responsibility means as I do tonight, after today's session. Our course is full of pitfalls, the stream in some directions runs very swift and it will, require a great deal of patience and forbearance and vision for the future, because we are not organizing for today nor for tomorrow, but for the generations to come. I hope that with your help we may be able to lay the foundation on which a structure will be built such as we can be proud of in the coming years, and of which I hope our children also will be proud. 38

THE FIRST MEETING OF THE COLLEGE COUNCIL

The Council then proceeded to deal with the other suggestions. Dr. Graham and Dr. Starr were elected by acclamation as Vice-Presidents of the Divisions of Medicine and Surgery, Dr. Routley was appointed Registrar-Secretary, and Dr. Hale and Dr. Dagneau were elected as Honorary Secretaries of Medicine and Surgery. It was agreed that the proceedings of the Inaugural Meeting should be sent to the persons who had been asked to attend, and that they should be invited to join the College as Charter Fellows. If they accepted the invitation they were to indicate the division to which they wished to be attached and to enclose a cheque for the registration fee with their letter of acceptance. In accordance with suggestions made at the Inaugural Meeting, the Registrar-Secretary was directed to prepare a list of Emeritus Professors in medicine, surgery, gynaecology and obstetrics, and also those of professorial rank in the sub-specialties of medicine and surgery. These sub-specialties were listed as: paediatrics, dermatology, neurology, psychiatry, therapeutics, and cardiology, in medicine; and urology, neurosurgery, orthopaedics, ophthalmology and otolaryngology, in surgery. All members of this group were to be invited to join the College. According to Section 5 of the Act, Charter Fellowship could be granted without examination to members of the profession who were not included in the above groups but who had shown evidence of outstanding ability in one or more departments of medicine. As this privilege would not lapse for eighteen months, Council postponed consideration of this group until a later date. The Registrar-Secretary was also directed to ask the British Royal Colleges to send lists of Canadian residents who held Fellowships or Memberships in their Colleges. Persons in this group, if their qualifications proved satisfactory, would be entitled to admission as ad eundem gradum Fellows, under the provisions of Section 6 of the Act. The minutes of the meeting record the receipt of the following telegram of congratulation from Dr. Samuel E. Moore of Regina: Kindly convey to the members of the Royal College of Physicians and Surgeons of Canada my sincere congratulations. I hope the corner stone will be so well laid that future generations will look on it with pride.

The last business of the meeting was the appointment of three committees: the first, a special committee consisting of the President, 39

THE ROYAL COLLEGE OF PHYSICIANS AND SURGEONS OF CANADA

the two Vice-Presidents and the Registrar-Secretary, to obtain a register for the College, and to report on the form of the crest, seal, diploma, robes and stationery of the College; the second, to prepare the constitution and by-laws, under the chairmanship of Dr. Bazin; and the third, under the chairmanship of Dr. Austin, to draw up the regulations to govern admission to the Fellowship, the conduct of examinations, and the study of the credentials of prospective candidates. The Council now adjourned. It had been a long and exhausting day.

40

The Sponsors DAVID LON' D. S. JOHNSTONE S. E. MOORE A. AlACG. YOUNG

F. N. G. STARR, CHAIRMAN

The Nucleus Committee

L. 3. AUSTIN

A. T. »AZIN

A l.EXANIIKII 1'1l1\11111ti1.

(;.1.. 11\1.1'.

III II'SSI;A I'

CHAPTER X

THE FIRST YEAR OF THE COLLEGE ITS ORGANIZATION AND THE FIRST ANNUAL MEETING The College now had a President, two Vice-Presidents, two Honorary Secretaries, a Registrar-Secretary and a Council, duly elected in accordance with the Act of Incorporation. Three committees had been appointed to complete the organization of the College, and eighteen months remained for the election of Charter Fellows who were to be admitted without examination. The special committee, consisting of Dr. Meakins, President, the two Vice-Presidents, Drs. Graham and Starr, and the Registrar-Secretary, Dr. Routley, was responsible for the arrangement of the business affairs of the College. There were three immediate problems for this committee; the design and preparation of a college seal, the forms of the various diplomas, and the robes of the College. THE COLLEGE SEAL The name of the designer of the seal does not appear in the minutes of the College and it had long since been forgotten by the surviving members of the first Council. Miss Crocker, the Executive Secretary, found entries in an early account book showing that Messrs. Henry Birks & Sons, of Montreal, had prepared the dies and that E. T. Adney had been paid for designing a seal. Who was this person? Inquiry unfolded a most interesting story. Edwin Tappan Adney proved to be an unusual individual. Born in Ohio, the son of a college professor of physics, he might be called a wandering artist in the old sense of the term. He had been a commercial artist with Harper Brothers in New York, then a newspaper artist and correspondent with Harper's Weekly and The London Chronicle in the Klondyke gold rush, later a lecturer on the national circuit, describing his many experiences, and later still an architectural designer in Montreal. All through his life there had been one special interest — the North American Indians and their way 41

THE ROYAL COLLEGE OF PHYSICIANS AND SURGEONS OF CANADA

of life. As a young man he had spent his summers amongst them, and in later life he moved about the country making studies of their traps, encampments, and canoes, so that now, ten years after his death, he is recognized to have been one of the great authorities not only on the Indian birch bark canoe and its construction, but also on the structure of the boats used in the early Canadian fur trade. A superb collection of his models of Indian canoes, equipment, and encampments, is housed in the Mariners' Museum, Newport News, Virginia. A smaller collection is preserved in the New Brunswick Museum at Saint John, N.B. This was the man who designed the seal of the College.

Description of the Seal In a circle, A Maple Tree (Canada) on which slung couche, a Gothic shield of arms: On a chief parted, in dexter, a chamomile or feverfuge flower with stem and leaves (Medicine); in sinister, saltirewise, a surgeon's scalpel and forceps (Surgery); in base, staff and serpent of Æsculapius. At the foot of the tree, scroll with words: MENTE PERSPICUA MANUQUE APTA.

Within an outer circle surrounding the whole, the words: SIGILL. COLLEGII REGII MEDICORUM ET CHIRURGORUM CANADENSIS. At top, A Royal Crown; at base, the figures "1929".

The presence of "a chamomile or feverfuge flower" in the design, as well as the old pharmacopceial spelling of the words, suggests the influence of the President of the College who had recently been the Professor of Therapeutics at Edinburgh, but others apparently took part in the design. For example, in the original sketches, surgery had been represented by an Egyptian knife and needle and thread. This was changed to the forceps and scalpel of the present seal, at the suggestion of Dr. Graham. The Graham papers also contain an interesting letter from Dr. Playfair McMurrich, Professor of Anatomy, University of Toronto. It is dated February 14, 1930. He had been asked for a College motto and he made three suggestions. The first came from Hippocrates, 42

THE FIRST YEAR OF THE COLLEGE

which he said might be freely translated as "Help me if you can, but do not harm." He did not think this would be very useful, as no one would be able to read the Greek script, let alone understand it. His second suggestion came from one of the Epistles of Horace: "Make and keep well." The third he said was not clothed with any authority but it appealed to him — Mente perspicua, mannque apta, which might be construed as "With a keen mind and skilful hand." This is the origin of the College motto. Unfortunately the early sketches of the seal have disappeared, but the first design had carried English wording which read as follows: "Seal of the Royal College of Physicians and Surgeons of Canada, 1929", and at the root of the tree a scroll bearing the words: "With a keen mind and skilful hand." It was changed to Latin, to avoid the use of French and English wording on the seal. In his presidential address, Dr. Meakins gave an accurate description of the seal, but the College by-laws from 1931 until 1940 described the surgical instruments as "a surgeon's scalpel and scissors." In 1939, Dr. Thomas Gibson of Kingston pointed out that the surgeons had been provided with instruments to cause bleeding, but with nothing to stop it. He suggested that the instrument described as "scissors" was in reality a pair of artery forceps. The Honorary Secretary, Dr. Lyman, wrote a diplomatic letter to the effect that the official description in the by-law could not possibly be inaccurate and that the instrument in question was undoubtedly an heraldic representation of a surgeon's scissors. However, the by-law describing the seal was corrected at the next Annual Meeting. THE DIPLOMAS The Council accepted the wording of the French and English versions of the diplomas at its meeting in August 1930, but, once again, the question of expense made its appearance. The number of Fellows was small and the cost of engraving separate plates for each language would have been substantial. The bilingual difficulty was solved once more by falling back on the use of Latin, but all three versions of the diplomas are given in the by-laws. Any resident of a district where two languages are commonly used is aware of the widely differing views of rival translators as to the 43

THE ROYAL COLLEGE OF PHYSICIANS AND SURGEONS OF CANADA

exact meaning of words. The Latin version of the diploma had been prepared by the head of a university department of classics, and therefore by an authority in the language. Members of the Special Committee were upset when another classical authority disagreed with the translation. This disagreement may have arisen from the use of alternative words in translating the term "Royal" on the Seal and the Diploma of the College. The inscription on the seal reads Sigill. Collegii Regii Medicorum et Chirurgorum Canadensis while the diploma commences with the words Sciant Omnes Collegium Regale Medicorum et Chirurgorum Canadense." The wording on the seal follows the Latin form used by both of the medical Royal Colleges of Edinburgh, where the adjective Royal is translated Regius. On the other hand, the Royal College of Physicians of London uses the alternative word Regalis. Notes in the Osler Library at McGill University suggest that Dr. Meakins was responsible for the translation on the seal. Being a Fellow of the Royal College of Physicians of Edinburgh, he followed the Scottish style while the translation for the diploma was provided by someone more devoted to the London interest. In 1945, the same question of expense arose when the certificates of specialism were being prepared. The finances of the College were now more firmly established, and sets of plates were engraved in each language, and the use of Latin in later College documents has been abandoned. THE ROBES OF THE COLLEGE Designs for the gowns and caps of the Officers, the Council and the Fellows of the Medical and Surgical Divisions of the College were submitted by Messrs. Ede and Ravenscroft, robemakers to the Royal College of Surgeons of England, and the designs were accepted by Council at its meeting on May 26, 1930. A full description of the robes is given in the By-laws (Article 2, Section 4). THE CONSTITUTION AND BY-LAWS The by-laws were prepared by Dr. Bazin, probably with the assistance of Dr. Pope, and it is interesting to follow the gradual changes which took place in their content. The earliest memoranda were 44

THE FIRST YEAR OF THE COLLEGE

almost transcripts of the by-laws of the Royal College of Surgeons of England, even to the extent of requiring the announcement of the date of the Annual Meeting in a set list of newspapers. The list stopped at Winnipeg in the Canadian by-laws. As the work of the committee progressed, the by-laws assumed a more independent form. Council made certain amendments at its meeting in May 1930, and, after the solicitor had rearranged the order of the various Articles and made minor changes, the by-laws were finally approved at the Annual Meeting of the College in November 1930. The first printed copies were distributed in the summer of 1931. COMMITTEE ON FELLOWSHIP, CREDENTIALS AND EXAMINATIONS Dr. Austin's committee, consisting of Dr. Graham, Dr. Connell, with Dr. Meakins and Dr. Routley serving ex officio, drew up the regulations regarding the admission of Fellows of the British Colleges on an ad eundem graduan basis, and also prepared the public announcement inviting applications from members of the profession at large who considered themselves eligible for admission to the College without examination under Section 5 of the Act. The formulation of the rules and regulations governing the examinations for the Fellowship was placed in the hands of Drs. Austin and Connell, and most of their recommendations were incorporated in the by-laws. They included the division of the examinations into primary and final stages, and the provision of modified examinations for older graduates. They also suggested the following criteria for the admission without examination of the Charter Fellows under Section 5: 1. Those who had had a specialized practice for at least 10 years. 2. Graduates of at least 15 years standing who were endeavouring to limit their practices and who were regarded as consultants in their districts. 3. Teachers below the rank of professor, with a 5-year period of appointment, and who presented a certificate from the head of their department. The Council and the special committees had met six or seven times during the first year, and with the setting up of the offices in the quarters 45

THE ROYAL COLLEGE OF PHYSICIANS AND SURGEONS OF CANADA

of the Canadian Medical Association in Toronto, the arranging of banking facilities, and the appointment of Messrs. Thorne, Mulholland, Howson and McPherson, of Toronto, as auditors, the work of the first committees was almost completed and the College was prepared to enrol its Fellows. THE FIRST ANNUAL MEETING The First Annual Meeting of the College was held at the Chateau Laurier Hotel in Ottawa on November 26, 1930. The meeting was preceded by a dinner, and was attended by 44 Fellows. The chief speakers were the President, Dr. Meakins, and Dr. Austin. The President gave a progress report on behalf of Council. He referred first to the choice of the Charter Fellows and stated that the original list of 147 professors of the main clinical subjects had been enlarged to include Emeritus Professors and those holding professorial rank in the medical and surgical specialties. This had increased the group to a total of 272 persons, and of these 166 had applied for Fellowship. Under Section 5 of the Act, Council was authorized to elect those who had given evidence of high ability in one or more departments of medicine. Only 22 persons in this category had been admitted to the Fellowship during the year, and there had been very few applications, in spite of announcements in the English and French medical journals. Thirty-one Fellows had been elected on the basis of Fellowship or Membership in the British Colleges. This made a total of 219 Fellows of whom 161 had completed the admission formalities by the payment of the required fee.* The President also reported that the Canadian Medical Association loan for the organization expenses of the College had been repaid during the year. These expenses had been much lower than expected, amounting to $758.20 instead of the $5,000 set aside for this purpose in the 1927 report of Dr. Low. The year ended with a credit balance of $13,884.84. The minutes end: "After a brief address by Dr. Austin, the remainder of the evening was spent in a social way." °1930 was the first of the depression years, and many letters are preserved asking for delay in the payment of the registration fee. The College office was adamant; no matter what criticisms may be made about the status of some of the Charter Fellows, there was no complimentary list or "free riders" as was often the case with other colleges at that time.

46

CHAPTER XI

THE SECOND YEAR During the second year (1930-31), the Council held four meetings. The regulations for the examinations were completed and the examination fees were laid down. The Code of Ethics of the Canadian Medical Association was adopted as the code for the College. The first Council had shown great powers of organization, but one disturbing cloud was appearing on the horizon. Section 5 of the Act stated that Council, at any time within two years of the date of incorporation, might admit without examination persons who in its opinion had given evidence of high ability in one or more departments of medicine. In his first Annual Address, the President had drawn attention to the fact that only 22 persons had availed themselves of this privilege, in spite of repeated notices in the medical press. The President and officers of the College became greatly concerned about the rapid approach of the expiry date of this section of the Act. It was felt that Council would be criticised for not having laid sufficient emphasis on the temporary nature of this privilege, and that many eligible members of the profession would be upset when told later that the privilege had lapsed and that admission to the College was now by "examination only". Members of Council were consulted by mail and the President was directed to send out a letter drawing attention to the fact that after June 14, 1931, it no longer would be possible to enter the College without examination. To avoid any suggestion of favouritism, it was decided that the letter should go to every registered practitioner in Canada, rather than to any group of persons selected by the Council. The letter was dated January 21, 1931, and was sent from the office of the President. It gave a short history of the formation of the College, an abstract of the Act of Incorporation, and then dealt at some length with the selection of Fellows without examination under the appropriate section of the Act. It gave June 14, 1931, as the expiry date for the privilege of election without examination. In conclusion, it was stated that those who might wish to have their qualifications 47

THE ROYAL COLLEGE OF PHYSICIANS AND SURGEONS OF CANADA

examined by Council should write to the office of the College in Toronto for suitable forms of application. March 2, 1931, was given as the date of the next meeting of Council. The results of this letter were astonishing, and by March 2 the Council found itself faced with some 669 applications for admission to the Fellowship. The applications came from far and wide; from all parts of Canada, and from England, Australia, New Zealand, India, and even central China. Those in the latter groups were chiefly government servants and foreign missionaries. In order to benefit by local opinion, the Registrar-Secretary distributed the applications to Members of Council on a geographic basis, and even at this early date Council was being besieged by individuals wishing to press their claims for admission. One councillor reports that for two days the Members of Council met in a hotel, behind locked doors, and had their meals sent to the room. Council was going through one of its more dramatic moments. According to the President, Dr. Meakins, it was relatively simple to assess the merits of applications from physicians, but those from surgeons offered many problems. Applications continued to arrive, and it became impossible to complete the selection of the Charter Fellows before the expiry date. Council therefore made a ruling that all applications which bore a postmark up to and including June 14, 1931, should be considered as falling within the terms of the Act. The final decision on some of these applications was delayed for a considerable period. In his report at the Second Annual Meeting, Dr. Meakins made the following reference to the letter of invitation: This letter was couched in such terms as not to be an invitation for application for Fellowship but asked the medical profession to assist Council in carrying out their duty by submitting for their consideration such qualifications as might be deemed sufficient to warrant the Council bestowing fellowship without examination. The spirit which prompted the writing of this letter was a feeling on the part of Council that the entire medical profession should have full knowledge of the creation of the College so as to eliminate the possibility, at the expiry of the two-year period, namely June 14, 1931, of any member of the medical profession in Canada holding that he had been ignorant of these matters and that the time had elapsed during which his name could have been considered for election to Charter Fellowship before he was aware of this privilege. As might have been expected this letter to the profession of Canada did not escape criticism. There were those who were of the opinion that it 48

THE SECOND YEAR

would open the ranks of the College to a great number and for this reason decided to have nothing to do with it. On the contrary there have been many who have asserted, — some in writing, — that the Council has been too strict in their criteria for election and that the letter should never have been written if they had not intended to make the Charter body of Fellows a very large one. In addition to these criticisms, there is no doubt that the letter did not attain its object because many who received it did not read it, or if they did, neglected to appreciate its import. As a consequence of this letter your Council received one thousand and thirty (1030) names for consideration. These were carefully reviewed by your Council in full session, and from them there were selected one hundred and six (106) to be Fellows of the College in Medicine and one hundred and thirty-six (136) to be Fellows in Surgery. It was quite obvious on perusal of these qualification forms that there had been a misunderstanding on the part of many as to the real status of the College. It seemed to be confused with the licensing bodies of the different provinces many of which are known as the College of Physicians and Surgeons of such and such a province. This was unfortunate but could not be helped as the distinction had been fully intimated in the letter although it had not been so stated specifically. (22)

The election of the Charter Fellows was now completed. Those whose entries had been automatic because of teaching rank numbered 246, while 242 had been selected by Council under Section 5 of the Act on the basis of their established position in the profession. The total Fellowship was now 488 of whom 212 were physicians and 276 were surgeons. The time limit had proved embarrassing, but the difficulties which had faced the Canadian College were as nothing compared with the problems of the Royal College of Surgeons of England, when their new Charter of 1843 had founded its Fellowship. Here the College was directed to elect within three months not less than 250 nor more than 300 Members of the College to be Fellows, and was authorized to elect a further unspecified number within one year of the date of the Charter. The first Fellows, some 300 in number, were selected chiefly from amongst the surgeons, assistant surgeons and lecturers of the metropolitan and provincial hospitals, and in 1844 a second group of 242 Fellows were elected, many of whom were members of the Naval and Military Services and of the Army in India. (23) It is interesting to note that the number of Members elevated to the Fellowship by the British College was of much the same order as those elected to the Charter Fellowship of the Canadian College some ninety years later, and also that the English College was flooded with similar letters of protest. 49

PART II The Growth of the College

PART 11 INTRODUCTION The second Annual Meeting in 1931 marked the end of a very active period in the affairs of the College. Much had been accomplished since the meeting of the provisional Council in 1929. The election of the Charter Fellows had been completed. A suitable code of by-laws had been prepared. Temporary offices had been set up in Toronto, and the Fellows had elected a new Council. The College had been fortunate in having capable and energetic leadership, but, as Dr. Meakins had remarked, it had been a voyage through narrow and uncharted waters. A new executive now took office. Dr. Starr was the President, Dr. Connell of Kingston and Dr. Dagneau of Quebec were VicePresidents respectively of the Divisions of Medicine and Surgery. The office of Divisional Honorary Secretary was discontinued. Dr. Routley was reappointed as Registrar-Secretary but had indicated his desire to retire when the offices of the College were removed to their permanent location in Ottawa. After the great activity of the first two years, the College now entered on a much quieter period. It was one of consolidation. The preliminary organization had been along the lines of general principles. The details had now to be filled in. Preparations were made for the conduct of the final examinations, but in view of the financial depression of 1931 to 1933, the candidates were few in number. The routine of elections to Council had proved unsatisfactory and required extensive change, and finally new quarters for the office had to be obtained in Ottawa. Up to this point it has been possible to present the history in chronological order, but with the new problems of the College and the broadening of its interests, the later history can be presented with greater advantage by describing separately the various activities of the organization. Under this arrangement it is proposed to deal with the composition of Council and its various committees, the election to the Fellowship, the examination and training requirements, the approval of hospitals, the certification of specialists, and so on. The late forties and early fifties were years of great expansion with a corresponding increase in the number of those who came in personal 53

THE ROYAL COLLEGE OF PHYSICIANS AND SURGEONS OF CANADA

contact with College work. In the succeeding chapters the mention of names is limited chiefly to officers of the College and those in charge of the various committees. For lack of space, the names of many who have given years of quiet but devoted service may have been omitted. To these the author presents his apologies and regrets. It is much too early to attempt a definitive history of the College. A relatively strict adherence to documentary evidence is desirable. Personal judgments may be biased and should be avoided. One of the Bulwer-Lyttons has put it very well in the couplet: Ne'er of the living can the living judge, Too blind the affection or too close the grudge. (24)

54

CHAPTER XII

THE ADMINISTRATION OF THE COLLEGE ITS OFFICERS AND COMMITTEES THE COUNCIL The College is organized on the conciliary system. The business affairs of the College are administered by a committee of the Fellows, known as the Council of the College, whose members have a four-year term of office. To maintain a balance between the Divisions of Medicine and Surgery, the presidency alternates between the two divisions. The President and Vice-Presidents are elected by Council from amongst its members, with a two-year term of office. The executive officers are appointed by Council. Originally the Council consisted of eighteen members, a senior physician and a senior surgeon from each of the nine medical schools in Canada; provinces without medical schools had no representation. The first by-laws noted the importance of a suitable geographic distribution of the members of Council, and in 1931, the number of Councillors was increased to twenty-four to allow for the election of representatives from the other provinces. The original by-laws required all nominations to be made by the Fellows at large. There were a number of nominations for the election in 1931, but the voting power was in the east, and geographic distribution was forgotten, with the result that while British Columbia and New Brunswick each received one of the six extra seats, the rest went to the already well-represented English Universities of central Canada. Council attempted to correct this irregularity in 1933, by amending the by-laws and by submitting a slate of candidates in which geographic distribution was observed. This system gave satisfactory results until an agitation arose regarding adequate representation of the specialties on Council. This once more upset the geographic distribution and in 1956 the country was divided into electoral districts, with a set number of representatives from each. This has been a partial solution of the regional question, but there still remains the problem of the specialists, who now form over one-half of the total Fellowship of the College. 55

Ø ROYAL COLLEGE OF PHYSICIANS Ø SURGEONS OF CANADA

There has been a gradual change in the character of Council since the foundation of the College. The median age of the original Council was 59 years, but recently this figure has fallen to 49 years. As would be expected, all members of the first Council were Charter Fellows, and it was not until 1945, some fifteen years later, that the first Fellow by examination was elected to Council. In 1951 four Fellows by examination and three ad eundem gradum Fellows were members of Council, but the last Charter Fellows at present on the Council will not cease to hold office until 1962. Dr. J. Elmer Plunkett was appointed Honorary Assistant Secretary in 1939. He was the first Fellow by examination to appear on the list of the executive officers of the College. As would be expected, the College drew heavily on the Canadian Medical Association for its early officers. Eight of the first eleven Presidents of the College had been, or later became, Presidents of the Canadian Medical Association, and Dr. Routley was the secretarial head of both bodies. It was not until 1954 that the mid-year meeting of Council was held at a time and place independent of the Annual Meeting of the Association. The early policy of the College regarding the choice of nominees for the official slate of candidates is found in a letter from the President, Dr. Graham, to Dr. Hale of London, dated April 13, 1935. He notes a motion of Council to the effect that the President shall appoint a Committee on Nominations to study the personnel of Council, to obtain suggestions from the medical faculties, and prepare a suitable slate of nominations. He added that in general, about eighteen members should be university teachers coming in contact with students, and that there should be one physician and one surgeon from each medical school. Apparently it would be the duty of these teachers to stimulate interest in the primary examinations of the College. Much of the material for the College history has been drawn from the minutes of the Council Meetings. During Dr. Routley's tenure of office, the minutes recorded the decisions of Council in a well-edited form, but after the opening of the Ottawa office, the minutes were taken in verbatim form by a public stenographer, and the names of the rank and file of Council appear more frequently in the discussions. Colloquial expressions of opinion are noted — members did not think they were speaking for the permanent record. This period lasted until 1947, 56

THE ADMINISTRATION OF THE COLLEGE

at which time the office staff took over the recording of the minutes. It is fortunate that these verbatim minutes are in existence as much of the correspondence of the period has disappeared. Under the watchful eye of Dr. Plunkett, the new Honorary Secretary, and Miss Crocker, the recently appointed Executive Secretary, the minutes once more assumed the objective character of the official minute book. During the first ten years, the attendance of members of Council was very irregular. A survey of the records indicates that the affairs of the College were conducted by a very small group. In 1935 an attempt was made to broaden this group by appointing much larger committees, but this apparently was not a success, because in 1937, the committees were reduced to their previous size. Part of this apparent lack of interest arose from the inability of the College to pay for the expenses of travel. Indeed it was only after the introduction of the annual dues in 1936 that any substantial charge for travelling makes its appearance in the financial statements of the College. This change in policy was followed by a marked improvement in the attendance at meetings of Council. In its early days all committees of the College were composed of members of Council, but at the last meeting of Council in 1939, it was decided to adopt a broader policy and to allow Fellows who were not members of Council to serve on the committees of the College. This change was necessary to meet the demands of the new task of certifying specialists. Dr. George S. Young, the retiring President, was largely responsible for this change which allowed a much larger number of persons to take an active part in the College affairs. Dr. W. G. Penfield introduced a moderate number of new names on his committees in 1940. The number was increased very largely during the Presidencies of Dr. A. T. Mathers and Dr. F. S. Patch, and in 1956, Dr. R. M. Janes reported to the Annual Meeting that the College now had seventeen committees besides Council, and that over 200 Fellows served on these various groups. THE COMMITTEES OF THE COLLEGE The following is a list of the more important committees of the College arranged in the order of their formation. 57

THE ROYAL COLLEGE OF PHYSICIANS AND SURGEONS OF CANADA

1929 1.

CONSTITUTION AND BY-LAWS

This became the Committee on Legislation and By-laws in 1938, when the first amendment to the Act of Incorporation was under discussion. 2.

FELLOWSHIP EXAMINATIONS AND CREDENTIALS

This was re-named the Committee on Examinations, Applications and Credentials in 1938. In 1945, it was divided into the Committee on Examinations and the Committee on Credentials. In 1950, the Committee on Credentials was divided into two sections, the Committee on Credentials and the Committee on Certification, but two years later the work was re-distributed, one section was made responsible for the credentials of medical applicants at both the Fellowship and the Certificate level, and the other for those applying for the Division of Surgery. 1932

3.

ELECTIONS

This was actually a sub-committee of the Committee on Bylaws, and was appointed to draft new regulations for the election to Council, after the first regulations had proved unduly cumbersome. It was not re-appointed in 1934. 4. HOUSING

A temporary committee to arrange for the transfer of the offices to Ottawa. 5. PROGRAMME OF ANNUAL MEETING

A standing committee. 1933 6.

RECIPROCAL RELATIONS WITH THE ROYAL COLLEGE OF SURGEONS OF ENGLAND

This Committee was disbanded in 1935. 7.

EDUCATION

Its name was changed to the Committee on Educational Standards in 1940, and it was dissolved in 1947. At first the efforts of this committee were directed towards bringing the College to the attention of hospital authorities, then to the provision of refresher courses in connection with the primary examinations, and after 1940, the enlarged Committee on Educational Standards was engaged in the study of the exam58

THE ADMINISTRATION OF THE COLLEGE

1934

inations and training requirements of the College, which finally resulted in the abolition of the primary examinations. 8. SPECIALISTS At first this was a joint committee of the College and of the Canadian Medical Association, but in 1938, it became an independent committee of the College with a sub-committee for each specialty. This committee organized the whole plan for the certification of specialists. Its duties were gradually taken over by the Committee on Credentials.

1936 9. PUBLICITY AND PUBLICATIONS This committee was appointed when the future of the College seemed to be in danger. It was not a standing committee. Its first duty was to arrange for the prompt appearance of notices dealing with the refresher courses and the dates of examinations. In later years it arranged for press releases regarding the Annual Meetings, and from 1938, for the preparation of the College Handbook. This book appeared each year until 1955. The earlier editions contained the Act of Incorporation as amended in 1939 and 1945, the Code of Ethics, the Report of the Annual Meeting, and the Register of Fellows. Dr. Bazin, Dr. D. E. Robertson, and the Honorary Secretary, Dr. Lyman, were responsible for the earlier editions of the handbook, but in later years, it became the special charge of the new Honorary Assistant Secretary, Dr. Plunkett, and in 1947, with the enlargement of the office staff, the publicity and publications of the College became the responsibility of the College office and the committee as such disappeared. In 1948 the handbook was discontinued in its extended form, and the Act of Incorporation, the By-laws and the Code of Ethics, the Register of Fellows and the transactions of the Annual Meeting were published as separate volumes. 1936 10. FINANCE A standing committee which was appointed when the system of annual dues was introduced. The first members were the President, the Honorary Secretary and the Honorary Treasurer. In recent years the membership has been in59

THE ROYAL COLLEGE OF PHYSICIANS AND SURGEONS OF CANADA

creased and has not been limited to members of the Council. The Honorary Treasurer is always a member ex officio. Originally its chief concern was with the College investments, but of late under the chairmanship of Dr. P. E. Ireland it has also functioned as a Budget Committee and has played an important role in directing the fiscal policy of the College. 1937

11. NOMINATIONS

This committee was named from year to year by the President, until 1950, when it became a standing committee with a stated personnel. 1945 12. 1947 13. 14. 1952 15.

THE EXECUTIVE COMMITTEE OF THE COUNCIL ANNUAL PRIZES AND AWARDS APPROVAL OF HOSPITALS ETHICS

Until the appointment of this committee in November, 1952, complaints had been considered by the Council as a whole, or later, by the Executive Committee. 16.

NEW BUILDING

THE EXECUTIVE COMMITTEE OF COUNCIL During the organization period of the College, Council delegated its authority to a sub-committee consisting of members residing in Quebec and Ontario so that the business of the College might not be delayed in the intervals between its meetings. Eleven of the eighteen members of Council resided in this area. This large sub-committee ceased to exist in 1931. Nothing further was heard of an Executive Committee until 1941 when the pressure of affairs made it seem desirable to have some smaller committee to transact the day to day business of Council, but the members were unwilling to delegate their authority and the motion to appoint an Executive Committee was defeated. In 1942 Council passed a general motion which directed the President to appoint such a committee, but a year later he reported that he had completely forgotten to make any appointments. No one seemed greatly upset by this statement, and it was not until November 1945, that Dr. Patch announced that Council had authorized the appointment of an Executive Committee which would consist of the President, the two Immediate Past-Presidents, the Vice-Presidents of the Medical and 60

THE ADMINISTRATION OF THE COLLEGE

Surgical Divisions, the Honorary Secretary and the Honorary Treasurer. He announced that at least one member of this Committee must always be French. There were no exact terms of reference, and in the early days the amount of responsibility taken by this committee varied a good deal with the temperament of the President. Some officers held frequent meetings and transacted much of the College business. With others, the meetings were short and practically all the business of the College was put before Council. The First Executive Committee R. F. Farquaharson, President, Chairman F. S. Patch, A. T. Mathers, Immediate Past-Presidents R. J. Collins, W. Fulton Gillespie, Vice-Presidents J. E. Plunkett, Honorary Secretary R. E. Valin, Honorary Treasurer

The appointment of this new committee was well timed. War conditions interfered with the regular meetings of the Council and in 1946 the Executive met six times. During this year the offices and secretariat of the College were reorganized and the character of the Annual Meeting was completely changed. The sudden death, in 1949, of Dr. Gillespie, an Immediate Past President, upset the membership of the Committee and in 1950 the by-law was amended by the deletion of the second Past-President and the appointment of a member, to be chosen from the Council at large. The illness and death of Dr. John Hepburn in 1956, once more upset the roster of the Committee and a further amendment was introduced to allow the replacement of a member unable to serve, by a member of Council drawn from that division of Council which would have been represented by the absent person. The Executive Committee is responsible to Council, and its more important rulings are subject to confirmation by Council and in certain cases by the Annual Meeting of the College; but with the growth of the College, the Executive Committee has taken over an increasing amount of the routine business of the organization, and Council is able to devote its attention to matters of general policy.

61

CHAPTER XIII

THE ACT OF INCORPORATION THE CONSTITUTION AND BY-LAWS While the Act of Incorporation had been criticised at the meeting of the provisional Council in November, 1929, it proved to be much more satisfactory than had been expected. The Act was amended in 1939, to empower the College to conduct examinations in the specialties and to issue appropriate certificates, and in 1945 Section 5 of the Act was amended to allow the Council to admit, without examination, persons of distinction. The original Act had limited this privilege to the two years following the incorporation of the College. On each occasion there were also minor changes in the requirements for admission to the examinations. At first, for example, a candidate was required to hold a licence to practise medicine in at least one of the provinces of Canada. In 1939, the licence of the Medical Council of Canada was added as an alternative to provincial licensure, but in 1945 all licensing requirements for the Fellowship examinations were removed. The years of training were also changed. In 1929 the candidate was required to be a graduate of three years standing, while in 1945 the training period was increased to five years. In the original Act, Council might admit without examination Fellows of other Colleges of equal standing in Great Britain and other countries of the Commonwealth or the Republic of France, but in the Act of 1945, the ad eundesn gradum Fellowship was to be granted only to those with five years training and who were in active practice up to the date of their application for Fellowship. At the Annual Meeting in 1939, the President, Dr. George S. Young, announced that the Amendment to the Act had been introduced in the Senate by the Honourable Dr. J. H. King, and in the House of Commons by Dr. A. MacG. Young. In 1945, the amending Act was sponsored in the Senate by the Honourable C. J. Veniot of Bathurst, and in the House of Commons by Dr. M. E. McGarry of Margaree Forks, Cape Breton. These amendments were given Royal Assent on 3 June, 1939, and 18 December, 1945. 63

THE ROYAL COLLEGE OF PHYSICIANS AND SURGEONS OF CANADA

The 1945 Amendment dealt with the internal economy of the College and was passed without comment, but the 1939 Bill which empowered the College to conduct examinations and to grant certificates of specialism, was delayed for almost two months. Certain of the medical schools felt that the certificate of the College would interfere with their postgraduate and mastership degrees, and considerable changes were required to meet their objections. Once more Senator Raoul Dandurand's name appears in the record as giving assurance that the universities were now satisfied with the proposed Bill, and he stated that, in his opinion, it would be a good thing for the College to be granted this power. It would, he said, give the public some assurance of the knowledge and competency of the doctors holding these certificates. A committee of the College, headed by Drs. Bazin and Patch, had been in charge of the negotiations between the College and the universities. THE BY-LAWS A study of the changing by-laws of a corporation gives a surprisingly good picture of its historical background. The by-laws of the College are no exception. One can note changes in College policy and the reactions of the College to the varying problems which it has been called upon to meet, in the thirty years since its incorporation. Periods of activity and of inaction follow each other, reflecting not only the changing conditions of medical thought, but also the personality of the President of the College and of the Chairman of the By-Laws Committee. Some officers were good on matters of broad general policy and not concerned about details; others were of a legal turn of mind and drafted changes which put in regular form the work of committees which perhaps had been functioning unofficially for some time. The original by-laws were drawn up by a committee headed by Dr. Bazin, and they were his special care until 1939. The College was progressing slowly, and the only important changes during this time were the alteration in the system of elections and the institution of the annual dues. It was not until 1942 that the by-laws referring to the certification of specialists were finally adopted, to be followed in 1943 by the addition of a clause covering the misconduct of specialists. 64

THE ACT OF INCORPORATION

The first by-Iaws had contained a detailed description of the content of the primary and final examinations, but when the primary examinations were discontinued in 1944, the new by-laws merely stated that all examinations of the College were to be conducted according to regulations promulgated from time to time by the Council. Minor changes in examination policy no longer required an amendment of the by-laws. In 1945 Dr. MacKenzie of Halifax, Chairman of the Committee on Legislation and By-laws, made an extensive report on the by-laws dealing with the duties of Council. However, Council was preoccupied with the problems of specialism and with the impending amendment of the Act of Incorporation, so that no action was taken until five years later. In 1949 changes were required in the section dealing with the time and place of the Annual Meeting, and in 1951 the Order of Business of the Meeting was rearranged and convocation became an independent ceremony. In 1950 Article 5, Section 2, dealing with the duties of Council, was amended along the lines which had been suggested by Dr. MacKenzie in 1945, and the number of clauses was increased. Many of the additions dealt with the duties of the various committees and also the policy to be followed in naming the members of these committees. Most of these changes were made necessary by the rapidly expanding work of the College. In 1951 Article 6, Section 3, was amended. It dealt with the nomination for and election to Council. For twenty years the by-laws dealing with the elections of the College had required only moderate changes. They showed all the meticulous detail so characteristic of the first chairman of the Committee. They abounded in calendar dates and in minute directions regarding the counting of the ballots. They required the Honorary Secretary to open the ballots, in the presence of the auditors, after October 1 and prior to October 3; thus October 2 would appear to have been the only legal day for the operation. Yet, with all this detail, there was no mention as to who should actually count the ballots. The amendments in 1951 took into account possible changes of date and place for the Annual Meeting. 65

THE ROYAL COLLEGE OF PHYSICIANS AND SURGEONS OF CANADA

As noted previously (p. 55), the by-laws governing the elections were again changed in 1956 to assure an adequate geographical distribution of members of Council by dividing the country into electoral districts with a set number of representatives from each district.

66

CHAPTER XI V

THE ANNUAL MEETING OF THE COLLEGE THE BUSINESS MEETING The minutes of the College would suggest that the earlier meetings were very much a family affair. The first meeting had consisted of a dinner, with an attendance of 44 Fellows of whom 16 were either officers of the College or members of Council. The second meeting commenced at four o'clock in the afternoon, and the third was held at an even later hour. None of these lasted more than an hour and a half. Private meetings of Council had immediately preceded these sessions, and notes would suggest that the President handed over the chair of the meeting to the Vice-President of his Division while he retired to an adjoining room to complete his presidential report. On at least one occasion the proceedings of the meeting were interrupted to receive His Excellency the Governor-General and to confer on him an Honorary Fellowship. Convocation remained an integral part of the Annual Business Meeting until the year 1951. The presentation of the newly elected Fellows took very little time in the early days. They were few in number. In 1933 there were only three, a like number in 1935, and in 1936 there were five, but by 1938 the number had risen to fourteen. At the meeting of Council in the following June, Dr. Bazin drew attention to the lack of dignity of the proceedings. It seemed to him that "as an Annual Meeting of a Royal College, it had been a very ragged affair." It was too hurried and he suggested that something should be done to make the meeting, especially the convocation, as dignified a proceeding as possible. It was his last year as a member of Council, and he presented a tentative plan for the conduct of the meeting. As was the case with all his suggestions, every detail was covered. Those taking part in the meeting were to enter as a procession, first the Honorary Secretary, then the candidates for Fellowship, the members of Council, the officers of the College, and, lastly, the President. He described the seating arrangements on the platform, and, for the first time, it was suggested that the candidates for the 67

THE ROYAL COLLEGE OF PHYSICIANS AND SURGEONS OF CANADA

Medical and Surgical Fellowships should be presented to the President by the Vice-Presidents of their respective divisions. The plan was adopted, and with certain changes to allow for the conferring of diplomas on the college lecturers and the presentation of the college medals, it is still the order of procedure governing the convocation ceremony. Until 1940 Convocation was one of the last items on the Order of Business of the Annual Meeting (By-law 1931, Article 5, Section 1), but in that year His Excellency the Governor-General the Earl of Athlone was to receive an Honorary Fellowship, and immediately after the reading of the Notice of Meeting Dr. L. C. Montgomery moved, seconded by Dr. R. F. Farquharson, "That the proceedings of Convocation take precedence over other business." By this temporary motion convocation became the first item of business at the Annual Meeting. It followed immediately upon the completion of the scientific programme of the day. This became routine procedure, but, as was so often the case in the College, the by-law covering the official order of business was not amended until some ten years later. The College met in Ottawa until 1948, with the exception of the year 1945 when all meetings were cancelled because of wartime travel restrictions. As the attendance at the meeting increased, hotel accommodation became increasingly difficult, and in 1949 and 1950 the holding of an emergency session of Parliament and of a large government committee caused last-minute cancellation of all hotel space in Ottawa. This required hurried changes in the location of these meetings, and since that time the Annual Meetings of the College have been held in the larger cities across the country. The attendance at the Annual Meetings and the number of successful candidates increased rapidly after the war, and in 1949 almost 450 Fellows attended and there were 54 newly elected Fellows to be received. Owing to a prolonged debate on the section of the Code of Ethics dealing with Secret Commissions, the meeting went far beyond the allotted time, and in 1953 it was decided to re-arrange the programme; to hold the Annual Business Meeting on the first day and to devote the afternoon of the second day to the delivery of the lectures of the College and the holding of the convocation. This re-arrangement allowed more time for the discussion of College policy at the 68

THE ANNUAL MEETING OF THE COLLEGE

Annual Business Meeting and for the development of a more dignified convocation ceremony. The large attendance at these sessions has reflected the great interest of the Fellows in the affairs of the College. THE SCIENTIFIC MEETING At first it had been planned to limit the proceedings to those of a strictly business and social nature; the Annual Meeting would receive and adopt reports, receive the newly elected Fellows, confer Honorary Fellowships and, from time to time, induct the new officers and members of Council. In the evening the annual dinner would be addressed by some distinguished person. It was felt that there were already too many scientific medical meetings and that the addition of a scientific programme would be unnecessary. Forty-four Fellows had attended the inaugural dinner, and in 1931 one hundred and forty-eight Fellows, accompanied by their wives, attended a reception at Government House, the guests of their Excellencies, Lord and Lady Bessborough. However, the attendance in 1932 dropped back to fifty-one Fellows, all of whom, with one exception, had come from either Ontario or Quebec. In the course of a discussion, Dr. C. A. Peters of Montreal remarked that unless some scientific interest were added, the Annual Meeting would never attract a representative gathering to transact the business of the College. Apparently, Dr. Starr had come to the same conclusion because he included a short scientific paper on Radon Seeds in his presidential report. Dr. Graham and a small committee were now directed to prepare a scientific programme for the next Annual Meeting. It was suggested that the programme should precede the Business Meeting, the topics should be of general interest and should represent both medicine and surgery and if possible the basic sciences. The essayists should be Fellows of the College and the papers should be of a philosophical character and distinctly above the level of those usually presented at medical meetings. From one to one and a half hours should be set aside for this scientific programme. The first programme was presented at the Annual Meeting in 1933. The subject was the autonomic nervous system. The speakers were Dr. Penfield, Dr. John Beattie, Professor of Anatomy, McGill Univer69

THE ROYAL COLLEGE OF PHYSICIANS AND SURGEONS OF CANADA

sity, and Dr. R. I. Harris. In 1934, the parathyroid gland provided a topic which was dealt with by Professor J. B. CoHip who had recently isolated the parathyroid hormone, and by Drs. Farquharson and Gordon S. Fahrni. In 1938, Professor William Boyd, Dr. E. W. Archibald and Sir Frederick Banting presented a series of papers on cancer research, and the sulphonamides were the subject in 1939. As a result of this change, the attendance had almost doubled by the year 1939; 109 Fellows came to the meeting. The greater number still came from the central provinces, but an increasing number of smaller cities were represented at the roll call. THE LECTURES OF THE COLLEGE The symposium type of programme was continued until 1939, but it became more and more difficult to select topics which allowed of a medical and surgical approach. It was felt that a change in the type of programme would be desirable. The President, Dr. Penfield, suggested that the symposia should be replaced by two lectures, one in medicine and the other in surgery. These lectures should be presented at the Annual Meeting and the lecturers should be men of distinction, not necessarily Fellows of the College. In addition, there should be a lecture in French presented under the auspices of the College before some French learned society. The essayists would receive the title of Lecturer of the Royal College of Physicians or Surgeons of Canada and would be presented with suitable diplomas at the Convocation ceremony. Until 1960 these lectures were an important part of the afternoon devoted to the Convocation of the College, although, following the suggestion of Dr. Louis Berger of Laval, the lectures in French were made an integral part of the College programme. The names of the lecturers are listed in the Appendix (p. 221). The introduction of these lectures had met with some opposition. Reading between the lines, it might be suspected that much of it came from petty jealousies but the discussion was kept on a financial level. Could the College afford the added and undetermined costs of the new lectures? Finally it was decided that it would be only fair to pay the travelling expenses of the lecturers, but it was pointed out that the Con f erenciers being drawn from the Province of Quebec would have 70

THE ANNUAL MEETING OF THE COLLEGE

little advantage from such an arrangement. The lectures would be delivered in the immediate vicinity of their homes and would not form a part of the scientific programme of the Annual Meeting, and it was therefore decided that, in lieu of expenses, the Coi ferenciers should be given an honorarium of one hundred dollars. Dr. A. H. Gordon and Dr. W. E. Gallie were the first lecturers under the new plan. The Honorary Secretary, Dr. Lyman, did not read the terms of reference very carefully and sent off cheques for $100 to each of the lecturers in addition to cheques for their travelling expenses. A week later, this error was drawn to his attention and he was instructed to ask for the return of the extra cheques. His request brought back one of the more amusing letters in the files of the College. It was written around Tennyson's lines: "It is better to have loved and lost than never to have loved at all." Dear Warren: It is better to have had and lost than never to have had at all. This applies to your kindness in sending me a cheque for $100, which I felt at the time that I did not deserve and now realize that the opinion is unanimous. It was with great grief that I felt compelled to return it, but it gave me great pleasure when I had it. It was a nice cheque. I hope Gallie enjoys returning his, too. (signed) A.H.G.

Dr. Gallie's letter has not been preserved. THE ENLARGED SCIENTIFIC PROGRAMME The next step in the development of the present scientific programme was taken in 1946, during the Presidency of Dr. Farquharson. The Fellows by examination were now approaching 50 per cent of the Fellowship, and indeed by 1950 the survivors of the original Charter Fellows (1929-31) had dropped to 35 per cent of the total. It was felt that there were now a sufficient number of younger men engaged in active research to warrant the introduction of a more general scientific programme, which would last for one and a half days. At first the scientific programme was divided into two sections — one devoted to medicine and the other to surgery; but a new problem soon made its appearance. The Society of Obstetricians and Gynaecologists of Canada had been formed after the Second World War. Almost 100 of its members were Fellows of the Canadian Royal College and naturally wished to maintain their connection with the College. On the other hand, certain members of the new Society wished to form 71

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a Canadian branch of the British Royal College of Obstetricians and Gynaecologists, while still others wished to set up an entirely independent Canadian College of Obstetricians and Gynaecologists. At the Inaugural Meeting of the College in 1929, the gynaecologists and obstetricians had elected to be Fellows of the Surgical Division of the College, and Council had always regarded them as members of the surgical group. The new Society emphasized the opinion that the specialty occupied a position midway between medicine and surgery, and deserved special consideration. It was an important point, and negotiations were carried on between the Society and the College for almost two years. Prominent among the Society representatives were Dr. H. B. Van Wyck and Dr. W. G. Cosbie of Toronto, Dr. J. Ross Vant of Edmonton, and Dr. Arthur Magnan of Montreal; and for the College, Dr. R. M. Janes and Dr. John Hepburn of Toronto, and Dr. Edmond Dube, Dr. Leon GerinLajoie and Dr. N. W. Philpott of Montreal. The final terms of agreement called for certain changes in the training requirements and the examinations, and the setting up of a third section of the scientific programme devoted to gynaecology and obstetrics. The first meeting of this new section took place in December 1950. The speakers on the early scientific programmes were drawn from among the older Fellows and the presentations were of a formal character, but this was soon replaced by shorter papers, a large proportion of which were devoted to reports of research being carried on by the younger Fellows and their associates. In 1960 there were further changes in the Annual Meeting. An extra day was added to the scientific sessions, the Convocation was made even more formal as an evening function, and the lectures became the chief features of the combined sessions of the College on the last two days of the meeting. THE REGIONAL SCIENTIFIC MEETINGS In the early days of the College there had been two major criticisms of the Annual Meeting: the very small scientific content of the programme and the long distances to be travelled by the Fellows resident in the West and the Maritime Provinces. Dr. A. T. Mathers of Winnipeg completed his presidential term of office in October 1943, and drew attention to these defects in his 72

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THE ANNUAL MEETING OF THE COLLEGE

final address. He made two suggestions for their cure. First, the College should increase the scientific interest of the meeting by the addition of a full clinical day to the programme, and second, the College should hold regional conferences to bring the educational advantages of the clinical sessions to those whose distance from Ottawa prevented a regular attendance at the Annual Meetings. He regretted that the pressure of war work had prevented him from doing more about these suggestions during his presidency. His first suggestion was acted upon in 1946 when the two-day scientific programme was introduced but no action was taken on the second suggestion about regional conferences until the presidency of another westerner, Dr. Scott, in 1958. During the intervening fifteen years, the more general use of air travel and certain changes in the federal tax regulations had done much to lessen the costs of attendance in terms of time and travelling expenses and considerable advances had been made in the educational features of the Annual Meeting; but the Council was faced now with another problem. At the end of 1943, only 374 specialists had been granted the certificate of specialism of the College and most of these specialists were already of Fellowship standing. However, by 1958 over 5000 specialists had received the Certificate by examination and the responsibility of the College to these certificated specialists had become a definite question. Many members of the Council felt that sheer weight of numbers would prevent their being invited to attend the formal Annual Meetings in most cities and regional meetings were suggested as a possible solution. Suitable terms of reference would allow for the invitation of both Fellows and Certificated Specialists in certain areas to attend the meeting and also to take part in the programme. Such arrangements would offer a much wider field for the educational side of the College effort. The first Regional Scientific Meeting was held in Halifax, Nova Scotia, in the autumn of 1959 under the chairmanship of Dr. Robert C. Dickson. The scientific sessions lasted for two days and guest speakers, Fellows and Certificated Specialists presented papers which had been grouped according to specialty interest. The meeting ended with a dinner at which the President, Dr. Scott, was the principal speaker. The meeting was an unqualified success. 73

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The second or South-Western Ontario Regional Scientific Meeting was held in London, Ontario, in 1960, under the direction of Dr. Angus D. McLachlin. The same general policy was followed in arranging the programme and the results were excellent. The new President, Dr. D. A. Thomspon of Bathurst, New Brunswick, was the principal speaker at the closing dinner. It is peculiarly fitting that the next regional meeting will be held in Regina, Saskatchewan, the city in which the idea of founding a Canadian Royal College first saw the light of day in 1920. Dr. C. H. Crosby is to be the chairman. Samuel Moore and his friends David Johnstone and David Low, had they lived, would have viewed with pride the tall oak which has grown from their little acorn (see p. 5). Council has been gratified by the success of these meetings and proposes to continue and gradually extend their scope, and part of the expense involved is to be recovered by grants from the new Educational Endowment Fund. This fund was established during the presidency of Dr. Scott and has been under the chairmanship of Dr. H. K. Detweiler of Toronto. More than one hundred and ten thousand dollars had been pledged in support of this fund by Fellows of the College at the time of the 1961 Annual Meeting. In addition the R. S. McLaughlin Foundation is making a substantial annual grant to defray the costs of the McLaughlin-Gallie Visiting Professorship. It is the intention of the College to make the collection of moneys for this fund a continuing effort, and as the capital increases to broaden the activities of the College in research as well as in the field of education. THE ANNUAL DINNER OF THE COLLEGE Dr. R. E. Valin took complete charge of the hotel arrangements for the annual dinner during his term of office as Honorary Treasurer, from 1932 until 1949. He set a standard of excellence which has never been surpassed. A menu of one of these early dinners was found amongst the papers of Dr. Bazin. It began with oysters and ended with an expensive dessert. The charge was two dollars, a striking evidence of the shrinking purchasing value of the dollar. The rest of the programme has always been extremely simple. After the toast to the Crown, the President introduced the guest of 74

THE ANNUAL MEETING OF THE COLLEGE

honour. Records of these introductory remarks commence with the year 1940. In introducing the Governor-General, the Earl of Athlone, Dr. Penfield spoke in a most interesting way of the aims of the College, with frequent references to the British Royal Colleges. Dr. Mathers was the next President. He was one of the more erudite of the College presidents and excelled in these introductory remarks. After brief personal references to the guest of honour, his chief effort was directed to the provision of a philosophical background for the address of the evening. Dr. Mathers had a gift of dramatic expression, and even now, twenty years later, his remarks can be read with enjoyment. Dr. Gillespie had qualities of a different character, one might say he had a simple way of expressing his thoughts and yet he gave interesting glimpses of a broad cultural background and an intimate knowledge of music and the arts. He was the first president to bring a few words of French into these introductions. Dr. Dube was perfectly bilingual and Dr. Hepburn's broad Scottish accent carried him far with the Quebec group. The list of speakers contains many celebrated names. The College has been honoured on a number of occasions by the presence of the Governor-General of the day. His Excellency, Lord Bessborough was the guest speaker in 1932, Lord Tweedsmuir on two occasions (1936 and 1938), the Earl of Athlone in 1940, Lord Alexander of Tunis in 1946, and the Right Honourable Vincent Massey, C.H., in 1953. The Right Honourable R. B. Bennett, Prime Minister of Canada, was the guest of honour in 1933, to be followed in later years by Sir Robert Falconer, Past-President of the University of Toronto; Robert C. Wallace, Principal and Vice-Chancellor of Queen's University; Dr. AIan Gregg, Director of Medical Sciences of the Rockefeller Foundation; Dr. C. J. Mackenzie, President of the National Research Council of Canada; Lord Webb-Johnson, Past-President of the Royal College of Surgeons of England; Sir William Wilson Jameson of the British Ministry of Health; Dr. H. B. Van Wyck of Toronto; Professor Charles de Koninck and M. l'Abbe Arthur Maheux of Laval; and Professor C. T. Currelly, Curator of the Royal Ontario Museum of Archaeology. Many of these speeches have been of an extraordinarily high cultural and philosophical character. 75

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Since 1950, a pleasant feature of the dinner has been the presence of official representatives of the American College of Physicians and the American College of Surgeons, as guests of the College, and in 1961 the College welcomed the first representative of the newly organized American College of Obstetricians and Gynecologists. By the year 1951 the attendance at the College meetings had risen to 480. Many of the Fellows were accompanied by their wives. The dinner was the only official social gathering of the Annual Meeting, but attendance at this dinner was limited to Fellows of the College and official guests. Five women had been elected to the Charter Fellowship in 1931; but by 1960 the number had increased to thirty, almost all admitted by examination. Article 3 Section 7 of the by-laws stated that all privileges and distinctions of the College were "open to women equally as to men." These ladies had the privilege of attending the dinner by right of their Fellowships; but the question of providing entertainment for the wives of Fellows soon became a subject of discussion at the meetings of Council. At first small private dinners gave the answer, and later a separate dinner was arranged. These separate dinners never became popular, and finally, in 1955, during the presidency of Dr. John Hepburn, the two dinners were amalgamated and the annual dinner became a mixed gathering. This arrangement has been well received and it has solved a problem which had been before Council for several years.

76

CHAPTER XV

ADMISSION TO THE COLLEGE

AD EUNDEM GRADOM Under Section 6 of the Charter, Council was empowered to admit without examination physicians and surgeons who were practising in Canada and licensed to practise in at least one of the provinces, who held diplomas given after examination by organizations in the United Kingdom of Great Britain and Northern Ireland, the Irish Free State, any of the British Dominions and the Republic of France, or other countries as Council might direct, if, in the opinion of Council, the diploma or fellowship was of equal status to the Fellowship of the College. This wording was unfortunate in that it prevented the admission to the College of a substantial number of teachers of pathology and the pre-clinical subjects who, while they held degrees in medicine and acceptable diplomas, were not required to hold licences to practise at that time. At this meeting on August 25, 1930, Council decided to accept the diplomas of the following Royal Colleges as being of equal value: The Royal College of Physicians of London The Royal College of Surgeons of England The Royal College of Physicians of Edinburgh The Royal College of Surgeons of Edinburgh The Royal College of Physicians of Ireland The Royal College of Surgeons in Ireland It was decided that the holders of these diplomas would be eligible for election if their postgraduate training met with the requirements of the Canadian College. The names of Canadian holders of these various diplomas were obtained from the parent colleges, and during the first year, letters of invitation were sent to 125 of these persons. Only 65 replied and made application for admission to the College, and 26 of them were approved. According to Dr. Meakins, approval was based not so much on the period of formal training as upon the subsequent professional history of the applicant; in other words, had he 77

Ø ROYAL COLLEGE OF PHYSICIANS AND SURGEONS OF CANADA

continued as a specialist, or had he reverted to general practice after his return to Canada? While the College was in its infancy, the majority of Fellows or Members of the older Royal Colleges appeared content to rely on their London or Edinburgh qualifications, and only 20 men were added to the register of Fellows on an ad eundem gradum basis during the next eight years. However, in 1942, the number of applications began to increase rapidly, and reached its maximum in 1947, when 46 were elected as ad eundem gradum Fellows. There were a number of reasons for this change. The College had gradually increased in importance, the Government seemed definitely interested in the institution of Health Insurance, and many of the older men decided that the Canadian Fellowship might be of considerable value in the impending changes in medical practice. Most of the younger men were in the armed forces overseas and during their long wait in England many of them had taken the examinations of the British Royal Colleges. These men now began to return home. During their absence, two years had been added to the required years of postgraduate training, and in 1946, the President, Dr. Farquharson, warned these prospective applicants that election to the College was not automatic. They must have fulfilled the new requirements for postgraduate training. Council now became increasingly preoccupied with this problem and in 1947, passed a further resolution that no candidate who had graduated in medicine in Canada after 1942, and whose Fellowship or Membership abroad was dated later than 1947, would be eligible for election on an ad eundem gradum basis. This regulation had an immediate effect on the number of applicants, because the majority of these persons were recent graduates whose training during the war did not meet with Canadian requirements. Immediately following the war, a substantial number of British professional men came to Canada, and many of them held diplomas of the British Royal Colleges. The new regulations were a hardship for a certain number of these persons, and as a result of pressure from Britain, arrangements were made for non-Canadian graduates whose experience fulfilled the Canadian regulations, to take a modified examination. These candidates were excused the written part of the Fellow78

ADMISSION TO THE COLLEGE AD EUNDEM GRADUM

ship examination, but were required to take the orals. Very few applied for these modified examinations and this privilege was discontinued in 1955. Elections to the College on an ad eundem gradum basis under Section 6 of the Charter have almost come to an end, and distinguished persons arriving in Canada for teaching appointments have been admitted by the more frequent use of the Amended Act of 1945.

79

CHAPTER XV1

ADMISSION TO THE COLLEGE WITHOUT EXAMINATION THE 1940 GROUP The period of grace for admission without examination expired in June 1931. 'While in theory the axiom "no admission without examination" had much to recommend it, Council came to realize that it had many disadvantages in practice. The first official reference to this problem appeared at the meeting of Council on October 28, 1938, when Dr. Gallie, the Vice-President of Surgery, remarked that there were a number of distinguished persons who had not applied for Charter Fellowship and now were unwilling to take the examinations. How could they be admitted? This question received rather luke-warm support, but Council directed the Committee on Examinations, Applications and Credentials to consider the matter and to see if there were any way in which these persons might be admitted without examination. This motion raised a question which was to become the subject of heated and at times acrimonious debate in Council for the next fifteen years. It is quite obvious from the minutes that Council was divided in its opinion. A majority felt that the number of those treated unjustly was quite small, but there were others who felt that there was a real danger of lowering the standards of the College, and that it would be difficult to close the doors once they had been opened. Dr. Bazin was the chairman of the Committee on Examinations, Applications and Credentials, and the other members were Drs. B. G. Bourgeois, C. R. Gilmour, A. H. Gordon, F. S. Patch, W. G. Penfield and Arthur Vallee. Dr. Gallie was not a member of this committee, and having raised the question, he took no further part in the discussion. He retired from Council in the following year. There were, however, a number of members of the committee who had quite definite views on the matter. Two of them, Dr. Bazin and Dr. Gilmour, had been members of the Council from 1929 to 1931, when the Charter Fellows had been 81

THE ROYAL COLLEGE OF PHYSICIANS AND SURGEONS OF CANADA

elected. They felt that the progress of the College was being hindered by the criticism of a small but vocal group outside the College who felt that they had been treated unjustly in 1931. As a president of the College, Dr. Bazin had undoubtedly heard a good deal of this criticism. Most of the complaints came from the provinces without medical schools which had not been represented on the first Council of the College. Dr. Gaulle may have had in mind some of his earlier graduates who had not taken the examinations of the College and who subsequently had risen to positions of importance. The admission of these men would have been useful to fill the age gap between the relatively older Charter Fellows and the younger group of men who entered the College by examination at a later date. Dr. Penfield who had come to Canada in 1928, raised a point of general policy. He was impressed by the small representation in the College of the French members of the profession. Many had not applied for Fellowship in 1931 because, while of professorial rank, the key-word Professor did not appear in their academic titles. In the consideration of this problem he had the active support of Dr. Bourgeois and Dr. Vallee. Dr. Bazin and his committee began their study of these difficult questions by consulting the solicitors of the College, Messrs. Fennell, Porter and Davis of Toronto. They asked for a series of rulings: Firstly, could the files of those who had been refused admission in 1931 be reopened and the decisions of previous Councils be reversed? Apparently this had been done in a small number of cases in 1932. The solicitors did not approve of this suggestion. The second question had to do with Dr. Penfield's group of prospective Fellows. It ran as follows: "A candidate, at the date of incorporation of the College was eligible for election to the College because of his professorial rank in a Canadian University, but he did not avail himself of the privilege. May his application now be received and might he be admitted without examination?" The solicitors believed that this man might be elected to the ordinary Fellowship, but could not be classed as a Charter Fellow. Finally, the solicitors were asked if the Act would permit the College to change its by-laws in such a way that selected candidates 82

ADMISSION TO THE COLLEGE WITHOUT EXAMINATION

might be elected after a special examination, or indeed, merely after a scrutiny of their credentials? To both these inquiries, the solicitors replied that the College could reduce the examinations to a mere formality if it so desired, but it must extend this privilege to all candidates during the time when the by-law was in force. In their opinion, the admission of persons of distinction without examination would require an amendment to the Charter. These opinions were presented to Council at its meeting in October 1939. Unfortunately the Charter had just been amended and these changes had not been included. An early amendment was therefore out of the question. These inquiries, however, had served one very useful purpose. The way was open now for the admission of prospective candidates from Laval and the University of Montreal, and one candidate was admitted at once. Dr. Penfield now became the President of the College. As a result of his negotiations with Dr. Albert LeSage, Dean of Medicine, University of Montreal, and Dr. Charles Vezina, soon to become the Dean of the Faculty of Medicine of Laval University, Dr. Penfield was able to make the following announcement at the Annual Meeting of the College on October 28, 1940: After careful discussion the Council [has] voted that the designation of `Assistant' appearing in the calendars of the Universities of Montreal and Laval, as of June 14th, 1929 [shall] be interpreted as being equivalent to the rank of Assistant Professor, with the proviso that any candidates, who on that date were `Assistants' in Medicine, Surgery, Gynaecology or Obstetrics, [shall] be now eligible for admission under authority of Section 2 of the Act of Incorporation.

Dr. Penfield then announced that, under this ruling, Council had elected to the Fellowship nine members of the teaching staff of the University of Montreal and seven from Laval University in Quebec. Many of these Fellows later rose to positions of importance in the College. Nothing further could be done about the groups in which Dr. Bazin and Dr. Gallie had shown an interest. The election of these persons would require an amendment of the College Charter. 83

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THE AMENDED ACT OF 1945 Between 1940 and 1943 the uncertainties of the war prevented any active interest being taken in the admission of Fellows without examination, but apparently the question was not forgotten, because the Council sought further legal advice, this time from a solicitor in Ottawa. He replied in a letter dated December 15, 1943, that Council could not decide to go forward with obtaining an amendment of the Act on its own responsibility. The decision must rest with the Annual Meeting of the College. In his opinion, however, the admission of distinguished persons could be done by changes in the by-laws, provided one could define the class which the College wished to admit. For these persons the College could eliminate the written examinations and have orals only, where the examiners could ask any questions they desired and then state that the candidates had given satisfactory answers. Apparently, Council was unable to define the class of persons which it wished to admit and nothing further seems to have been done about the second paragraph of this opinion, which indeed seemed at variance with the opinion of the regular solicitors of the College. The Committee on Educational Standards continued to study the question, and in October 1944, it brought in a definite recommendation for an early approach to the problem of obtaining a series of amendments to the College Charter. These amendments should deal with the length of postgraduate training, and should also change Section 5 of the Act to allow for the admission without examination of persons of distinction who were graduates of twenty years standing. Finally, Section 8 should be amended, to do away with the necessity of conferring with Canadian Medical Schools and national organizations of specialists when the College contemplated any change in the specialist regulations. These recommendations were approved at the Annual Meeting of the College. The Amended Act became law in December 1945, and at the second meeting of the newly appointed Executive Committee, on March 16, 1946, it was decided to ask Council to prepare a list of persons who might be elected without examination under the Amended Act. The Executive Committee suggested that the names should be chosen under two headings, (a) holders of senior teaching appointments, and, (b) persons of outstanding local reputation who were not attached to 84

ADMISSION TO THE COLLEGE WITHOUT EXAMINATION

a school of medicine. It was felt that the second group would consist of persons who had been overlooked in the initial choice of Charter Fellows, while those in group (a) would be eminent specialists who could be used as examiners in the newly instituted examinations for the Fellowship in the specialties. At its June meeting Council assigned the task of preparing this list to the Committee on Credentials, which had been appointed as an independent committee earlier in the year. This committee consisted of: F. S. Patch, Montreal, Chairman R. F. Farquharson, Toronto R. J. Collins, Saint John, N.B.

A. D. McLachlin, London Edmond Dube, Montreal

and as corresponding members representing the specialties: J. R. Fraser, Montreal R. I. Harris, Toronto W. V. Cone, Montreal J. F. Burgess, Montreal

H. S. Little, London A. T. Mothers, Winnipeg G. E. Richards, Toronto

The preparation of this list proved to be a difficult and thankless task. Council had always been divided about the necessity of the amendment, and there may have been some justification for the fears that the standards of the College would be lowered by an influx of undistinguished persons. For example, in 1939 over 100 names had been presented as being of suitable calibre for admission without examination, when the total Fellowship of the College was less than 600 persons. Indeed, one member had sent in a list of 32 names from a district which was already heavily represented on the Fellowship. It is only fair to state that a search of the register shows that only one of the 32 was elected to the Fellowship. In principle, the Council was agreed that the number of admissions should be small. Indeed, members of one group of Council were firmly convinced that no one should be admitted without examination. At each meeting of Council, the Committee on Credentials would present a carefully prepared list of candidates. During the consideration of this list, members of the Council would suggest further additions on a geographic basis and when the list was put to the vote, the motion would be defeated and the whole matter referred back to the Committee for further study. It was not until June 1948, that Council approved the admission of 22 physicians and surgeons, but even here three members demanded that their dissenting votes be recorded. Of 85

THE ROYAL COLLEGE OF PHYSICIANS AND SURGEONS OF CANADA

these 22, only 5 were persons who had applied unsuccessfully for Fellowship in 1931. No further elections took place until 1951, when it was felt that the College should recognize the entry of Newfoundland into Confederation by the election of a small number of distinguished members of the profession from the new province. This suggestion was well received, but there was the usual opposition to a further motion that Fellowship without examination should be granted to a number of heads of specialty departments who had been co-opted to conduct examinations for the Fellowship as modified for a specialty and also for the specialist examinations for the certificate. This second suggestion had been brought forward by the Committee on Examinations in a report to the Executive Committee on February 3, 1951. Even within this small executive group, discussions became acrimonious, but the scales were turned by Dr. Hepburn, Chairman of the Board of Examiners for Medicine, who remarked "if they are good enough to be examiners surely they are good enough to be Fellows". The Executive Committee then agreed to the proposal and decided (1) that the choice should depend upon the value of the candidate to the College, (2) that the number should be small, and (3) that there should be no more admissions to the College under Section 5 of the Act. Council approved of these decisions, and at the 1951 Annual Meeting 14 physicians and 12 surgeons (including 3 surgeons from Newfoundland), were admitted to the Fellowship. Of this second group, 11 had been refused Fellowship in 1931. The College cannot be accused of having opened the gates to the Fellowship under the Amended Act to any great extent. Only 70 persons had been admitted in the ten years preceding 1958, while during the same period the Fellowship of the College had increased from a little under 900 in 1948 to 1,795 in March, 1958.

86

CHAPTER XVII

ADMISSION BY EXAMINATION The founders of the College had laid great emphasis on the fact that once the body of Charter Fellows had been completed, further admissions should be by examination, after a suitable period of postgraduate training. These examinations would be a severe test of the candidate's knowledge, ability and judgment. The Fellowship would differ from both the British and the American Fellowships. Like the Fellowships of the American Colleges, the diploma of the Canadian College would indicate that the holder was a well-trained physician or surgeon, but, unlike the American Colleges of the time, it would be gained by examination. The Canadian Fellowships would resemble the higher diplomas of the British Royal Colleges as far as the examination features were concerned, but would differ in that the Canadian diploma would indicate a man whose training was relatively complete, while the examinations for the British qualifications, being held after a shorter period of postgraduate training, were often regarded as an evidence that the successful candidate was of suitable calibre to undertake further training in some special branch of the profession. Three things were necessary to attain the objectives of the College. The College must lay down regulations for postgraduate training, it must provide a means of assessing the training of prospective candidates, and, finally, it must conduct the required examinations. It is proposed to deal with these activities in that order. REGULATIONS FOR TRAINING The Act of Incorporation of 1929 laid down two basic requirements. The candidate must be a graduate of three years standing of an approved university and be licensed to practise in one or more of the provinces of Canada. The Charter went no further; everything else was left in the hands of the College. The regulations for admission to the primary examinations merely required a certificate from some university authority that the candidate 87

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had completed his academic course in anatomy and physiology. While these regulations were criticised from time to time, they remained unchanged until the primary examinations were discontinued in 1944. For admission to the final examination, the candidate was required to have passed the primary examination of the College, or the primary examination of the Royal College of Surgeons of England. The candidate was required to produce evidence of having engaged in the study (or study and practice) of the profession for not less than three years subsequent to the date of obtaining the degree in medicine, one year of which had been spent in attendance on the medical or surgical practice of a hospital approved by Council. There was no mention of resident training. This is confirmed by a letter of February 1935, sent to all members of Council by Dr. Bazin, the Chairman of the Committee on Credentials, in which he asks for confirmation of his ruling on the question as to whether the year of attendance meant an actual interneship or merely the attendance at organized ward rounds and clinics at an approved hospital or hospitals. He had ruled as follows: I. All the Act requires is graduation of three years standing. 2. The regulation for admission to the examinations, Section 3, page 2 (1932) states: The candidate must have been engaged in the study (or practice) of the profession for not less than three years. During one of these years the study and practice must have engaged his full time.' An interneship or attendance at the clinics of one or more hospitals would cover this requirement. The attendance at more than one hospital would have the advantage of giving a broader clinical experience. 3. Council has no list of approved hospitals. Each application is approved on its own merits. In this particular case the suggested hospitals are approved.

This ruling was accepted without comment by Council. These regulations remained in force until 1939, when Dr. MacKenzie stated in the report of the Committee on Education that the regulations had become obsolete, and that the period of required training was much too short. Council agreed with this opinion, and an enlarged committee, now named the Committee on Educational Standards, was appointed to study the question along with the whole examination structure of the College, and for the first time Council agreed that only the chairman of this Committee need be a member of Council. 88

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Dr. Penfield appointed the following committee: Committee on Educational Standards Surgical Sub-Committee F. S. Patch, Montreal, Chairman A. T. Bazin, Montreal, Chairman E. W. Archibald, Montreal Medical Sub-Committee B. G. Bourgeois, Montreal 'J. C. Meakins, Montreal, Chairman 'W. E. Gallie, Toronto "D. S. Lewis, Montreal F. S. Patch, Montreal, ex officio K. A. MacKenzie, Halifax Edmour Perron, Quebec

This Committee remained in office for six years. It soon reached the opinion that the minimum period of postgraduate training should be increased to five years, but its final report was not adopted until 1944, when the following regulations came into effect: 1. A candidate shall be a graduate of not less than five years standing of a medical school or university approved by Council. 2. The Candidate shall produce documentary evidence of having been engaged in supervised study and/or practice in medicine and surgery and related sciences for an aggregate period of at least five years after graduation. (A portion of the five years may be spent in anatomy, physiology, biochemistry, or pathology; a portion in a medical or surgical clinic, or as assistant to an individual physician or surgeon of recognized ability; a portion in a medical or surgical laboratory; a portion in an adequate course of full-time study at a recognized clinic at home or abroad).

These regulations were the first steps towards the detailed regulations of the present day. They were in very general terms, a fortunate circumstance because many prospective candidates were returning from war service, where opportunities of training on a set pattern had been difficult to obtain. These are the last regulations which bear the unmistakable marks of Dr. Bazin's handiwork. He now retired from the College hierarchy, after fifteen years of outstanding service. For the next three years the drafting of the regulations was in the hands of the Committee on Credentials, under the chairmanship of Dr. Farquharson. The general policy governing the admission to the examinations was becoming more clearly defined. The new regulations, dated January 1947, contained a more detailed division of the five years of postgraduate training. A definite reference to hospital residency now made its appearance. There must be a year of rotating interneship, and two years of training in medicine or surgery, or the appropriate specialties, in a hospital or hospitals organized for training. A further period of two years of study or training is laid down, a portion of which time must be spent in the 'Not a Member of Council. 89

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study of the basic sciences necessary for the proper understanding of medicine, surgery or the approved specialty. With this greater detail there was an escape clause: "If the training has been interrupted or taken on a part-time basis, it must be satisfactory to Council." The clause allowing credit for time spent as assistant to a physician or surgeon of recognized ability had been subjected to much abuse, and this preceptor type of training disappeared from the regulations for the Fellowship. The first examinations for the specialist certificates were held in 1946, and the examinations for the Fellowships as modified for a specialty in 1947. Applications for permission to take these new examinations raised many questions which were not dealt with in the older regulations, and two sub-committees of the Committee on Credentials were appointed to re-draft the regulations for both the Fellowship and the Certificate. These regulations were now called the Essential Requirements for Graduate Training. To add to their troubles, these committees were directed to include in their reports suitable standards for the approval of hospitals for graduate training. Members of one of these groups were centred about Toronto, and the others were residents of Montreal. Personnel of the Toronto Sub-Committee: Duncan Graham, Chairman

Internal Medicine, Physical Medicine and Public Health Roscoe R. Graham Thoracic Surgery, Plastic Surgery, General Surgery H. H. Hyland Neurology and Psychiatry A. E. MacDonald Ophthalmology R. I. Harris Orthopaedic Surgery Paediatrics H. S. Little William Boyd 1 Pathology Louis Berger f Radiology G. E. Richards Personnel of the Montreal Sub-Committee Urology F. S. Patch, Chairman Wesley Bourne Anaesthesia J. F. Burgess Dermatology and Syphilology W. V. Cone Neurosurgery J. R. Fraser Obstetrics and Gynaecology

These sub-committees presented their reports in November 1948. The conditions for admission to the examinations were largely unchanged, but the regulations were set down in greater detail. To allow for ready reference, the training requirements for each Fellow90

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ship or specialty were given in a separate section. The essential requirements for the specialty certificates covered much more ground. The regulations had now grown from a four-page leaflet to a considerable book. The sub-committees had worked independently and considerable changes were required to bring about a degree of uniformity in their recommendations. However, the new requirements were a great improvement on the older regulations, and they were issued in mimeograph form, on an interim basis, in December 1948. When the various reports had been consolidated in book form, it became evident that there were great variations in the amount of detail in the sections dealing with the different specialties; some were extremely full, while others appeared to be quite scanty. Re-editing was required, and in the following year Dr. Farquharson was appointed chairman of a small committee to review the requirements and to give them a greater degree of uniformity. This was completed in 1950, and the Essential Requirements were issued in printed form in May of the following year. The new requirements included regulations for the examinations as modified for the Fellowship in the specialty of anaesthesia and for separate modified examinations in neurology and psychiatry, as it was felt that the combined specialty of neuro-psychiatry was now obsolescent. While the new version of these regulations was a great improvement on its predecessors, difficulties arose in certain of the specialties, and following the introduction of the modified examinations for pathology in 1955 it became obvious that the whole code of regulations and requirements of training must be revised and consolidated. For this purpose, Dr. Janes appointed the following committee: Dr. E. S. Mills, Dr. R. F. Farquharson, Dr. N. W. Philpott, Dr. Richard Lessard and himself. In his presidential report to the Annual Meeting in 1957 Dr. Janes referred to the completion of this revision as a "monumental task well done." As time has passed, more and more detail has made its appearance in succeeding revisions of the requirements, along with an attempt to maintain a basis of uniformity for the training in the specialties. This doctrine of "uniformity" has met with considerable opposition in many of the specialties. 91

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ASSESSMENT OF CREDENTIALS At its second meeting, on May 26, 1930, Council appointed a small sub-group of the Committee on Fellowships, Applications and Credentials to assess the qualifications of those who might apply for Charter Fellowship, either on the basis of holding diplomas in the British and Irish Royal Colleges or because of their special qualifications in the field of medicine or surgery in Canada. This first Committee on Credentials consisted of Dr. Austin, Chairman, Drs. Starr, Duncan Graham, Connell, and Pope. Even before commencing its work of assessing credentials, Council directed the committee to prepare a letter to be sent to Canadian holders of equivalent qualifications granted by the British and Irish Royal Colleges, drawing their attention to the incorporation of the new College; and also to draft a public announcement inviting applications for Charter Fellowship from those who considered themselves suitable for admission on the basis of their established position in Canadian medicine. The committee was able to carry on the work of assessment until the flood of applications for Charter Fellowship occurred in the early summer of 1931; then, almost every member of Council was called upon to assist the committee in the task of selecting the Charter Fellows. The problems before the committee did not await the completion of the Charter Fellowship, and enquiries began to arrive regarding the training and examinations of the College. For example, a number of missionaries in China were expecting to return to Canada on furlough in the near future. They asked whether they might take the written examinations in China and the orals after their return to Canada. Council ruled that the whole examination must be taken in Canada. Another person wished to take the written examinations in French and the orals in English. Could this be arranged? The answer was in the negative, the whole examination must be taken as a unit. Enquiries came from Canadian graduates practising in the United States, but they were informed that a Canadian licence was essential. The first formal request for assessment of training and the approval of a hospital for training purposes, came from Dr. Morley A. R. Young of Lamont, Alberta. His plans were approved, and two years later he successfully passed the examinations and became one of the 92

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first three Fellows by examination of The Royal College of Surgeons of Canada. By 1933 Council had built up a small body of decisions, which might be used as precedents; most of the routine work of assessment was delegated to the Honorary Secretary, Dr. Lyman, and Council ruled only on the unusual cases. The work did not make any great calls upon his time, as only fifteen candidates had taken the final examinations by the end of 1935. However, the system broke down in 1936. At that time, Dr. George S. Young was the chairman of the Committee on Examinations, Applications and Credentials. He lived in Toronto, but the College office was in Ottawa. When he attended the June Meeting of Council in Victoria, he heard for the first time that the Honorary Secretary had been seriously ill for some weeks. Only ten of the twenty-six members of Council were present, both the VicePresidents and the two Executive Officers were absent. There was a short report from the College office, but no mention was made of any prospective candidates for the examinations. Interest in the College seemed to be at a low ebb. As is usual in such circumstances, the faithful few who were present received the full benefit of the President's indignation. Dr. Bazin was the President, and the minutes record the following remarks: "The passing years are crucial years for the College. During the next years it must go ahead with a strong push or I fear it will dismally fail and finally die. The members of Council must take their duties more seriously." Immediately on his return to the east, Dr. Young went to Ottawa and found that conditions, while confused, were much better than had been expected. There were over 40 applications for permission to take the examinations which had not been dealt with. Owing to the illness of Dr. Lyman, the announcements for the examinations did not appear in the medical press until the months of July, August and September, although the advertisement stated that July 1 was the closing date for the receipt of applications. Dr. Young was a most patient man, but he gave vent to his feelings in his report at the next meeting of Council. In the first place, many of the applicants had changed their addresses at the end of the hospital intern year and could not be found. Applications for permission to take the examinations kept on arriving during the summer, and indeed up to within ten days of the examinations; and, 93

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finally, the examiners had not been asked to prepare the examination papers and many of them were away on their holidays. Dr. Young reported that he had written over two hundred letters to disentangle this frightful state of affairs. He recommended that a permanent superintendent of examinations should be appointed, a resident of Ottawa, who would be responsible for the assessment of the applications and the conduct of the examinations; and that the examiners should be appointed at least twelve months in advance, so that they would be available for the preparation of their papers. Dr. Young retired from the chairmanship of the committee on his election to the presidency of the College in 1937. Dr. Bazin acted as superintendent of examinations during the following year, but in 1938 Dr. Plunkett was appointed as permanent superintendent, and this began a period of fifteen years of most devoted service to the College, which was terminated only by his sudden death in 1953. With the increasing number of candidates a new difficulty made its appearance. On the original form of application the candidate was required to give the names of two Fellows or others who might supply references as to his moral and ethical standing. The responsibility for obtaining these references rested with the College. This was no great problem when the number of candidates was small and most of them were known at least by sight or reputation to the examiners, and many of the candidates had been allowed to take the examinations while their character records were still incomplete. In October 1937, Council received a letter from the examiners drawing attention to this most unsatisfactory state of affairs. The examiners were examining candidates without knowing anything about their moral or ethical status, and yet they were directed to inform the candidates each evening as to their success or failure in the tests. It would be most embarrassing if, after they had informed the candidate of his success in the examinations, they were compelled to tell him that he was unacceptable morally or ethically. Council never did things hurriedly, and the discussion of this problem covers some nine pages of the minutes, but finally it was decided that the application blank should be changed and that the applicant himself must produce satisfactory references before his admission to the examination. 94

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Dr. Young returned to the chairmanship of the Joint Committee on Examinations, Applications and Credentials in 1939 at the conclusion of his presidency. At this time the committee consisted of Drs. Duncan Graham, Albert LeSage, John A. Oille, D. E. Robertson, and R. F. Farquharson. Dr. Farquharson acted as chairman of the committee from 1941 until 1945, and in 1943 Dr. Perron replaced Dr. LeSage, and Dr. Gallie succeeded Dr. Robertson. With the outbreak of World War II in 1939 there was a rapid decrease in the number of candidates for the examinations, which reached a low point in 1943 when only seven presented themselves for the final examinations. The routine work was done efficiently by Dr. Plunkett, the Honorary Assistant Secretary, and there were few calls upon the committee. On the other hand, the years 1941 to 1945 had been extremely busy ones for the Committee on Specialists under the direction of Dr. Patch, especially in the last two years when the committee had been engaged in the selection of those specialists who were entitled to receive the Certificate without examination. It had been an exhausting task but it was almost completed and the first examinations for the Certificate were to be held in the autumn of 1946. As hostilities drew to a close in 1945, there had been a sharp rise in the number of enquiries about the examinations of the College and Council decided that the work of these two committees should be rearranged and that the Fellowship and the Certificate should be brought under unified control. With this in mind, Council appointed a Committee on Credentials and a Committee on Examinations, the former to assess the training of applicants for the Fellowship and the Certificate and the latter to be responsible for the examinations. Dr. Patch was named chairman of the Committee on Credentials, and Dr. Roscoe R. Graham was given charge of the examinations. Both Dr. Patch and Dr. Graham had had considerable experience on committees of the College and were eminently qualified for their respective tasks. The end of the war brought many problems before the Committee on Credentials. There was a marked increase in the number of applications for assessment of training and for permission to take the examinations. These came from men returning from overseas service. 95

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Many of these applicants listed as years of training all the time which had been spent in the armed services. These claims were difficult to assess and required individual attention by the committee. They could no longer be dealt with by the office. It is true that the regulations for training had been improved, but they lacked detail and were in terms of peacetime service. How were they to be applied to the overseas service of applicants whose work during the war might have been in hospitals, in the forward area, at sea, or even in administration? It was finally decided that all those who had been overseas for more than twelve months should receive credit for one year of training, no matter in what capacity they had served, but that all further credits should be based on the amount of clinical experience which the type of service might have afforded. For example, a year in hospital would count as a full year of training, but an applicant would receive less credit for time spent in the forward area, and little if any for work in the administration branches. Each request entailed an assessment of the training of the applicant and in many cases the preparation of an outline of what further training would be necessary to meet the requirements of the College. The first reference to the number of applications for the assessment of training occurs in the minutes of Council for November 12, 1947, and the following table shows the rapid increase in the work of the Committee on Credentials: TABLE I Applications for Approval of Training FELLOWSHIP

CERTIFICATE

RECEIVED

APPROVED

RECEIVED

APPROVED

282 299 400 502

135 245 390 398

217 515 571 793

169 445 545 662

1947 1950 1955 1959

In the assessment of training, Dr. Patch and his committee faced many difficulties besides sheer weight of numbers. The first detailed statement of the new requirements for graduate training did not appear until December 1948, and the first official list of approved hospitals 96

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was not published until two years later. It was a transition period, and allowance had to be made for imperfections in training programmes which might have been commenced by the candidates before the new regulations had come into effect. Dr. Farquharson resumed the chairmanship of this committee at the end of his presidential term of office in 1947, and was faced with similar difficulties. He pursued the same policy of a broad interpretation of the regulations. There was some criticism of this policy on the grounds that many imperfectly trained candidates were accepted, but reference to the Tables shows that a higher percentage of applicants were refused permission to take the examinations at the time than in later years when approval was based on the detailed requirements of the 1950's. Also, it may be noted that there was a lower percentage of failures in the Fellowship examinations. The Committee on Credentials rapidly increased in size after the Amended Charter authorized the College to grant certificates of specialism. As each specialty was approved, a new sub-committee was appointed to represent the specialty, and its chairman became a member of the Committee on Credentials. It was the duty of these specialty sub-committees to assess the training of applicants in their particular fields and to report their findings without delay. Many members of the early committees were nominees of nationally organized specialist societies and had no other connection with the College. It had been the custom to send the complete file of the applicant to the chairman of the appropriate sub-committee for circulation amongst the members of his committee for study and report. The files became increasingly bulky, difficult to handle, and they were frequently mislaid. In 1948 the chairman of the main committee, complained of these delays and ruled that the complete file would not be sent to the sub-committee but that a summary would be prepared in the College office and copies sent to all members of the committee at one time. A note at the foot of the summary sheet stated that if no reply was received within two weeks, it would be assumed that the training of the candidate was satisfactory. This plan allowed a ruling to be given to the candidate within a reasonably short time, and it was only when there was a wide divergence of opinion that the complete record was submitted to each member of the Specialty Committee. 97

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In 1949 there were 973 enquiries regarding the examinations, and it was obvious that something must be done to relieve the chairman of part of the burden in the work of this committee. The first step was taken at the meeting of the Executive Committee on November 25, 1949. Dr. Janes was appointed General Chairman of the Committee on Credentials with Dr. Detweiler, Dr. Dube and Dr. Lessard as co-Chairmen. The work would be divided into four parts. Dr. Janes would be responsible for the English surgical applications, Dr. Detweiler for the English medical applications, and Dr. Dube and Dr. Lessard would take charge of the French surgical and medical candidates. There were six other members who represented different areas of the country. It was agreed that summaries of the applications would be prepared by the Honorary Secretary and sent out to the members of the interested sub-committees. When their replies had been received at the office, they would be added to the file of the applicant and, when complete, the whole file would be sent to the chairman of the appropriate committee who would study the documents, give his opinion of the suitability of the candidate and send the file to the General Chairman, Dr. Janes, for final confirmation and signature. The application would then be returned to the College office. While the new plan relieved the General Chairman of much of the detail work, he still had to countersign each application. The requests for assessment of training continued to increase, and a further change in policy was made in 1951 when the committee was divided into two completely independent sections. Dr. Detweiler, Dr. Romeo Pepin and Dr. Lessard were to be Chairman and Vice-Chairmen of the medical section, and Dr. Janes, Dr. Gavin G. Miller and Dr. Dube would be responsible for the applications for general surgery and its specialties. The sub-committees for the specialties were retained, and Dr. Hepburn and Dr. McLachlin were appointed members of the main committee. Drs. V. 0. Mader and C. W. Holland, of Halifax, Dr. J. W. Scott of Edmonton, and Dr. H. Rocke Robertson of Vancouver were appointed corresponding members. This new arrangement gave satisfactory results and was continued for some years. In 1953 Dr. Mills was appointed chairman of the medical division of the Committee on Credentials, with Dr. Lessard as co-Chairman. 98

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The other members of the medical division were Dr. K. J. R. Wightman and Dr. Jacques Genest. Dr. Holland and Dr. Scott continued as corresponding members of the division. Dr. Philpott was appointed chairman of the surgical division, with Dr. Dube as the French coChairman. The members of the main committee were Dr. C. E. Hebert and Dr. W. K. Welsh, with Dr. Mader and Dr. Robertson as corresponding members. In 1955 Dr. D. R. Webster became the senior chairman and also chairman of the surgical division of the Committee, with Dr. Hebert as co-Chairman, and Dr. Georges A. Bergeron replaced Dr. Lessard as co-Chairman of the medical division. On the main committee Dr. F. G. Kergin replaced Dr. Welsh who had been appointed chairman of the Committee on Examinations, and Dr. L. Philippe Roy of Quebec succeeded Dr. Dube in surgery. At this stage the main Committee on Credentials consisted of eight regular and four corresponding members, and there were more than 160 members on the various committees representing the twenty-two approved specialties. This was a great change from 1947, when the original Committee on Credentials had consisted of twelve members, Dr. Patch, Chairman, four representatives for internal medicine and general surgery, and seven others representing the specialties. In his presidential report in 1956, Dr. Janes drew attention to the enormous amount of work carried out by the Committee on Credentials and the College office. During 1955 there had been 559 applications for the assessment of training of prospective candidates, all of which had to be processed and referred by mail to several members of the Specialty Committee. In addition, 500 applications for the Certificate and 400 for the Fellowship examinations required similar scrutiny and treatment. By this time, the essential requirements for graduate training and the list of approved hospitals had been in printed form for several years, and prospective candidates realised the necessity of meeting the requirements of the College. Assessment of applications became more and more a clerical matter of checking the applications against these two documents. Had the applicant taken, or was he proposing to take a course of training which would meet the essential requirements, and was the work being done in institutions approved by the College? During the next two or three years much of this detail was gradually 99

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taken over by the office of the Honorary Secretary, and only the problem cases came before the main Committee on Credentials or were brought to the attention of Council. Dr. Francis Brien of London became chairman of the medical division of the Committee on Credentials in 1957, and Dr. D. G. Cameron of Montreal was appointed to replace Dr. Mills. Dr. Dickson of Halifax and Dr. R. B. Kerr of Vancouver succeeded Dr. Holland and Dr. Scott as corresponding members. Two years later Dr. Brien relinquished the medical chairmanship and Dr. Malcolm Brown of Kingston was elected in his place. EXAMINATIONS FOR THE FELLOWSHIP Frequent reference has been made to the examinations of the College, and it is obvious that the founders were convinced that the reputation of the organization would depend on the quality of its tests. One of the original members of the Nucleus Committee (Dr. C. F. Martin) had remarked that the College could have low standards of admission, a large membership and a valueless diploma, or it could set high standards, have a slower rate of growth, and a diploma of established reputation. In the following section it is proposed to follow the development of the examination policy of the College. During the first year, the members of Council had been fully occupied with the task of organizing the College and selecting the Charter Fellows, and it was not until its fourth meeting, on November 26, 1930, that any mention was made in the minutes about the details of an examination programme. At this meeting Dr. Austin and Dr. Connell were asked to prepare a draft of the rules and regulations to govern the examinations, and their report was presented to the Council on March 2, 1931. The President, Dr. Starr, appointed Dr. Connell of Kingston, Drs. Munroe and Pope of Edmonton, Dr. Graham of Toronto, Dr. Meakins of Montreal, and Dr. Dagneau of Quebec, to study the report and to prepare the official regulations. Their report was adopted on the following day. The regulations called for an examination in two stages, a primary and a final. The primary might be taken at any time after the completion of the academic courses in anatomy and physiology, and the examination would include, in addition to anatomy and physiology, 100

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questions in the broad field of histology, embryology, and biochemistry. It would be a written and oral examination, and it would be the same for candidates for the medical and surgical Fellowships. Graduates prior to 1925 (later amended to 1930) would be excused this primary examination, but would be required to write an extra paper on the clinical application of the basic sciences when taking their finals. The subjects of the final examination were set down as follows: For the Fellowship in Medicine (a) The principles and practice of medicine including therapeutics, preventive and forensic medicine. (b) Pathology, including bacteriology. (c) Also, one or more special branches of medicine, if elected by the candidate and approved by Council. For the Fellowship in Surgery (a) The principles and practice of surgery, including operative surgery and surgical anatomy. (b) Pathology, including bacteriology. (c) Also one or more special branches of surgery, if elected by the candidate and approved by Council.

For admission to the final examinations, candidates of recent date must have passed the primary examination of the College, in lieu of which the primary examination of the Royal College of Surgeons of England would be accepted. There were a number of reasons why these regulations so strongly resembled those of the Royal College of Surgeons of England. It will be recalled that Drs. Low, Moore and Johnstone of Regina had presented a report to the Canadian Medical Association in 1927 which had resulted in the incorporation of the Canadian College. In a letter written in 1959, Dr. Johnstone stated that much of this report had been based on information received from the British Royal Colleges. The report had called for an examination in two stages — a primary and a final. The primary examinations were almost identical in content with those of the new regulations, and the final examinations in medicine and surgery of the Low report even foreshadowed the provision of examinations in the special branches of the profession: paediatrics in medicine, and otolaryngology, ophthalmology, gynaecology and obstetrics in surgery. A more immediate reason was the fact that Dr. Primrose and Dr. Starr had persuaded the English College to hold primary examinations in Canada and these examinations were actually going forward at the time. 101

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At a later date, Dr. Bazin noted that the scheme of examinations had followed the pattern of the Royal College of Surgeons of England, with the idea that it might lead to a closer affiliation of the two Colleges. According to Section IV of the Regulations, the examination might be taken in French or in English, and, according to Section V, the following schedule of fees was set forth: Primary examination Final examination Special examination for graduates prior to 1925 (later 1930) Admission to Fellowship

$ 50 $100 $125 $100

In 1933, the fees for the examinations were reduced but the admission fee was increased to $150. While the regulations for the final examinations contained a clause offering examinations in the special branches of medicine and surgery approved by Council, it was decided that, for the present, the examinations would be limited to internal medicine and general surgery, but announcements of these special examinations continued to appear in the official leaflet until 1936. THE EXAMINATIONS 1931-1944 Members of Council were now faced with the problem of actually arranging for the conduct of these examinations. While the original regulations for graduate training had been extremely vague, the report of the Nucleus Committee in 1928 had called for examinations which would be a "severe test of the knowledge, ability and judgment of the candidate." Only three members of the first Council had actually taken the examinations of the older colleges, and their experiences dated back some twenty or thirty years. Their opinions could therefore be of little assistance in setting the standard. Dr. Duncan Graham referred to these difficulties in his valedictory address as President in 1935. He spoke of the necessity of maintaining a uniformly high standard of examinations throughout Canada, not only for the Fellowship but also for the primary examinations, and then he paid the following tribute to the early examiners: "With no background of experience in determining satisfactory standards for the Primary Examinations, the College was fortunate in securing for the 102

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first examinations, men experienced in conducting similar examinations for the Royal College of Surgeons of England. Each year the same Board of Examiners, consisting of Professor Whitnall of McGill and Professor Grant of Toronto in anatomy, and Professor John Tait of McGill and Professor Best of Toronto in physiology have agreed to act for the Primary Examinations." These men had all been assessors at the primary examinations of the English Royal College which were held in Canada in the years 1929, 1930 and 1931, and were familiar with the standards of that College. Acceptable standards were particularly important in these early days, when the possibility of some closer affiliation with the British College was being discussed. This original group, with local replacements and with the addition of representatives from the pre-clinical departments of the maritime and western universities, continued to act as the Board for the primary examinations until these examinations were discontinued, in 1944. The dates of the first examinations were announced in May 1931, and the transactions of the 62nd Annual Meeting of the Canadian Medical Association in the following month had this rather guarded note in the report of its Executive Committee to the General Council: Royal College of Physicians and Surgeons of Canada Members of Council will be interested in knowing that the dates of examinations have been definitely set, and, perhaps, will desire to take part in stimulating interest in their respective districts.

This understatement did not agree at all with the feelings of members of the Royal College Council. For some weeks they had been refusing admission to applicants for Charter Fellowship, and informing them that it would be necessary to take the examinations of the College. It would appear that they had expected a generous response to this invitation. In any case, complete Boards of Examiners were appointed for both the primary and the final examinations, and in both languages. The examinations were to be held in Montreal and Edmonton and, if necessary, the whole Board would examine in each centre. Fortunately, all the applicants were English-speaking and only wished to take the primary examinations, but the directions to the examiners were impressive, and reminiscent of the dramatic report on the first Toronto examinations of the Royal College of Surgeons of England in 1929. (25) The written examinations were to be held in Montreal and Edmonton, on September 27 and 28. Due notice was 103

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THE FIRST BOARDS OF EXAMINERS

English Divison PRIMARY EXAMINATIONS Professor S. E. Whitnall, McGill Professor J. C. B. Grant, Toronto PHYsIoLOCY: Professor C. H. Best, Toronto Professor John Tait, McGill

ANATOMY:

nED ICINE: SURGERY: PATHOLOGY:

FINAL EXAMINATIONS Dr. Duncan Graham, Toronto Dr. J. C. Meakins, McGill Dr. E. W. Archibald, McGill Dr. W. E. Gallie, Toronto Professor Oskar Klotz, Toronto Professor L. J. Rhea, McGill French Division

ANATOMY: PHYSIOLOGY:

MEDICINE: SURGERY: PATHOLOGY:

PRIMARY EXAMINATIONS Professor L. N. Delorme, Montreal Professor Paul Garneau, Laval Professor Romeo Blanchet, Laval Professor E. G. Asselin, Montreal FINAL EXAMINATIONS Dr. J. E. Dube or Dr. Albert LeSage, Montreal Dr. R. Desmeules, Laval Dr. Charles Vezina, Laval Dr. Leo Blagdon, Montreal Professor L. C. Simard, Montreal Professor M. P. A. Vallee, Laval

taken of the two-hour difference between Eastern Standard and Mountain time when the hour of the examination was stated. Oral examinations for the Montreal candidates would be held in Montreal on the following day, and at the end of these examinations the candidates were to be called together and informed of their results. That evening, the examiners were to entrain for Edmonton, to conduct the western orals. It was before the days of air travel — a journey of two and a half to three days by train. In the meantime, the papers which had been written in Edmonton were to be sent by registered post to an agent in Winnipeg who would board the train on its arrival and hand the sealed package to the chief examiner. These papers would 104

CHARLES VEZINA

F. S. PATCH

R. F. FARQUHARSON

W. F. GILLESPIE

GERIN-LA JOIE

I). S.

1.1.:Nv IS

EDNIOND DUBE

.1011N HEPBURN

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be corrected en route, and on the completion of the oral examinations in Edmonton, the local candidates would be informed of the results, and the members of the Board would return home. There were twelve candidates in all, and four of these were successful. The examiners reported that there had been no difficulty in assessing the candidates: they were either very good or very poor, but the financial results were disastrous. The College had received $625 in examination fees, but had spent $2,175 in travelling expenses and examiners' fees, a net loss of $1,550, and as a result the College decided to adopt a more conservative policy and to hold the written examinations at a number of centres, but to call those who had been successful in the writtens to Toronto for the oral tests. The first final examinations were held in 1932. There were three candidates, all for the Fellowship in surgery. All were rejected. One of the candidates still remembers his experiences. The examiners were very formal and fair, but the questions were surprising. At the end of the examinations, the candidates were ushered into a room where gowned officials were grouped around a table. The announcement of the results was brief: "Gentlemen, you were not good enough. Good afternoon." There were three candidates in 1933; all were successful, and Drs. G. W. Carrow, L. G. McCabe and Morley A. R. Young became the first Fellows of the Royal College of Surgeons of Canada by examination. In 1936, Dr. J. A. Dauphinee and Dr. J. E. Plunkett passed the examinations in the Division of Medicine and became the first Fellows by examination of the Royal College of Physicians of Canada. The first Fellow (Associ6) by examination of the College Royal des Medecins du Canada was Dr. Richard Lessard, who took the examinations in 1937, and Dr. Paul Bourgeois and Dr. Jean Tremblay who became the first Fellows (Associ6s) of the College Royal des Chirurgiens du Canada in 1938. During all this time members of Council were becoming more and more disturbed by the scarcity of candidates for the examinations. It was small comfort to hear quite frequently from one of their colleagues that things were done much better in England. Council seemed to have forgotten that the College was still a young and untried organization with rather stiff entrance requirements, and spent much time 105

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reviewing the situation. One group felt that the standards of the examinations were too high, and that prospective candidates were discouraged by the number of failures. The opponents of this opinion thought the mortality rate of the English colleges had always been substantial, although there had been some improvement since 1918 when it had become so excessive that Sir William Osler had written an open letter (Lancet 1918-1-715) to the President of the Royal College of Surgeons of England, suggesting that something must be wrong with a system of examinations in which 82 per cent of the better class of students were rejected. In sarcastic vein, the letter continued that perhaps with a slightly greater effort the examiners might attain their apparent objective and succeed in rejecting all the candidates. In the primary examinations held by the Royal College of Surgeons of England at Toronto in 1929, 40 per cent of the candidates had been successful, and in a similar series of examinations held in Australasia, at about the same time, 50 per cent of the candidates had satisfied the examiners. The results of the Canadian College examinations between 1931 and 1944 showed that 334 candidates had taken the primary examinations, of whom 189 or 57 per cent had been successful; and that 86 of the 157 candidates for the final examination, or 51 per cent, had been accepted. In retrospect, these figures suggest that the failure rates in Canada were not excessive. TABLE II Examination Results 1931-1944 PRIMARY EXAMINATION YEAR TOTAL PASSED 12 1931 4 1932 8 4 1933 4 0 1934 21 12 22 1935 10 1936 28 17 1937 47 25 1938 52 28 1939 45 23 1940 32 18 1941 12 6 1942 21 12 1943 12 12 1944 18 18

106

FINAL EXAMINATION TOTAL PASSED 3 0 3 3 1 0 7 2 14 5 18 9 24 11 34 18 16 6 18 9 11 5 7 7 11 11

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Other members of Council from the Maritime Provinces and the West emphasised the expense of obtaining the Canadian diploma, and criticized the examination policy of the College. While the written examinations were held in various parts of the country, those who had been successful in these tests were required to go to a distant centre for the oral and clinical examinations. They stated that many of their good men were going directly to England for postgraduate work and, while there, would write the examinations of the London and Edinburgh Colleges. There were well organized courses of postgraduate instruction in anatomy and physiology which were not available in Canada. Finally, a candidate who was unsuccessful for the Canadian Fellowship had very little in return for his efforts, whereas the other man, even if unsuccessful, would have had the advantage of organized postgraduate instruction, and also, on his return home, the kudos of having "walked the hospitals in Europe." A survey of the records of those who later applied for ad eundem gradtom Fellowship in the College suggests that there was some truth in this statement. It was also claimed that there would be few candidates from the East and the West as long as Montreal and Toronto continued to dominate the Board of Examiners. Council made every effort to deal with these criticisms. The demand for the refresher courses came chiefly from those who had graduated before 1925 or 1930, and who had to write the special examination in clinically applied anatomy and physiology as part of the final examination. These courses were organized in Montreal and Toronto in 1935, but did not attract a large following. Council also attempted to solve the question of the long trips that were required for the oral and clinical examinations. From 1938 until 1940 it was agreed that the written examinations would be held in the usual nine centres, but, in addition to the clinical and oral examinations in Montreal or Toronto, similar examinations would be held at Winnipeg in 1938, Halifax in 1939 and at Edmonton in 1940, and that one examiner in each subject would be appointed from the medical school of the year. To maintain uniformity, and perhaps to keep an eye on the new examiners, the other examiner in each subject would be drawn from the main Board of Examiners in the East. In this connection the following new names appeared on the Examining Boards: 107

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Primary Examinations Winnipeg J. MacLaren Thompson D. K. Moorhouse Halifax

Donald Mainland C. B. Weld

Edmonton Ardrey Downs Ralph M. Shaner

Final Examinations C. R. Gilmour John Gunn Daniel Nicholson K. A. MacKenzie H. K. MacDonald Ralph Smith E. L. Pope W. Fulton Gillespie J. J. Ower

While this arrangement did away with the criticism of the long journeys, and the dominance of Toronto and Montreal in the examinations, it did little to help the financial situation of the College. The examiners from the maritime provinces and the west had to be brought either to Montreal or Toronto for their tour of duty at the oral and clinical examinations, and the members of the main Board had to travel to the second examination centre. Dr. Bazin, an old Honorary Treasurer of the Canadian Medical Association, made a doleful reference to this new system in his report on the 1938 examinations. Very few candidates made their appearance at the secondary centres and on more than one occasion, at Dr. Duncan Graham's suggestion, the College paid the travelling expenses of a candidate to Montreal or Toronto to avoid sending the full Board of Examiners on a long and expensive journey. Having had some experience with the uncertainties of expense accounts, the College informed the candidate that the grant would cover return railway fare but that he would eat and sleep at his own charges. Letters in the files suggest that the Honorary Secretary did not apply this regulation very strictly in his scrutiny of these accounts. The Council was adamant on one point, the standards of the examinations must be maintained. During the war years the number of candidates dropped to such low levels that the system of multiple centres was discontinued, and in 1941 the examinations were held in Montreal and Toronto, and in Toronto alone in 1942. The question of distance and of strange examiners did not arise for the French-speaking candidates. The examinations were held alternately in Quebec and Montreal. The members of the French Board of Examiners were always representative of both universities, 108

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and any change in the Board was due to illness or retirement from teaching. By the year 1940, Dr. Romeo Pepin had succeeded Drs. J. E. Dube and Albert LeSage as the examiner in medicine, Professor Louis Berger had followed Professor A. Vallee in pathology, and Dr. Jean Lesage had succeeded Professor L. N. DeIorme in anatomy. THE PRIMARY EXAMINATIONS The primary type of examination was always more popular with the surgeons than with the physicians, and as the College began to assume a more definitely Canadian pattern, an undercurrent of dissatisfaction with the examination system began to make its appearance. The first criticisms were directed against the primary examinations partly because of the expense to the candidates, who up to 1937 were almost entirely undergraduates at medical schools, and partly because it was claimed that the examinations were not fulfilling the desired purpose — the content of the examinations was unsatisfactory. Control of the final examinations had been relatively simple. While many of the examiners in pathology were not Fellows of the College, they worked with the examiners in medicine and surgery who were all College Fellows, and they had a common point of view. On the other hand, owing to a defect in the Charter, none of the primary examiners were Fellows of the College. They were pure scientists and had no close contact with the clinical branches. It was claimed that their questions were more what might be expected in an examination for a Doctorate in pure science than in a preliminary examination of candidates who were proceeding to a further three years of study and training as clinicians. The matter came into the open at the October 1938 meeting of Council, and the discussion became quite heated. Finally, Dr. Gilmour of Winnipeg suggested that the primary examinations be abolished, and the system used by the Royal College of Physicians of London be adopted, where there were two written papers one of which dealt in part with the basic sciences. To all intents and purposes, this was the type of examination used by the Canadian College in its examinations for older graduates who were excused the primary but wrote an extra paper on clinically applied anatomy and physiology. Even Dr. Bazin, who had always been a strong supporter of the primary examination, 109

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remarked that no one seemed to like the examinations and perhaps it would be better to discontinue them. At this point, the President, Dr. George S. Young, became alarmed and sounded a note of warning against precipitate action. He poured oil on the troubled waters by complimenting Council on its full and frank discussion of the subject, and passed on hurriedly to the next item on the Agenda. For the next two years, the attention of Council was occupied by the amendment of the Charter and the removal of the College office to the National Research Council building, and nothing further was done about the primary examinations until 1940 when it was suggested that clinical examiners should be added to the Board of Examiners for the primaries. This suggestion did not meet with approval, and the "professional" anatomists and physiologists remained in charge until the examinations were discontinued, four years later. It is interesting to note, that, according to Sir Harry Platt, when the same suggestion was made with regard to the Board of Examiners for the primaries of the Royal College of Surgeons of England in the late 1950's, "some misgivings were expressed about the possible dilution of the examining panel by the addition of clinicians, whether there was a risk of the examinations becoming more superficial by the loss of the dominating influence of the professional Anatomists, Physiologists and Pathologists." (26) It will be recalled that the Committee on Education had been very critical of the regulations and examination structure of the College (see p. 88) in 1939, and that an enlarged Committee on Educational Standards had been appointed to study, among other things, the examinations of the College. The Medical and Surgical Divisions of this committee made many attempts to rehabilitate the primary examinations, but no agreement could be reached between the two divisions of the committee. Criticism of the College examinations now began to appear in the medical press. Some of the letters were quite intemperate, but H. E. Rawlinson, Associate Professor of Anatomy at the University of Alberta, wrote a very sound letter which appeared in the Canadian Medical Journal in June 1944. He suggested that the examination policy of a primary and final examination was unsound. Pre-clinical examiners should not have the power to stop a man in the primary examinations. 110

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The two examinations caused two breaks in a man's practice if the primary were taken after graduation, while if taken as an undergraduate it might very well wreck a year of his medical course. He pointed out that the Royal College of Surgeons of England had stopped the taking of the primary examination before graduation, but now allowed the two examinations to be taken close together. He advised the holding of a single examination. Even if the candidate failed he would have the advantage of the extra study in preparing for it. He also advanced the idea that if there were a single examination, the universities would be much more likely to approve of well integrated refresher courses and would probably set them up. This letter drew a graceful reply from the President informing Dr. Rawlinson that his suggestions had been acted upon and that the primary examinations were on the point of being discontinued. During the war, the Government asked the medical schools to accelerate the graduation of doctors. Each school followed its own system, and for a time there was hardly a month in the year when one or other medical school was not holding graduation exercises for its medical students. In this state of confusion it was almost impossible to arrange suitable dates for the primary examinations, and in 1944 the College decided to follow the suggestion made by Dr. Gilmour in 1938 and to abandon the primary examinations. Under the new system, papers on clinically applied anatomy, physiology and biochemistry were added to the final examinations for the Fellowships in Medicine and Surgery, but candidates who had passed the primary examinations were to be excused this paper. In 1951, members of Council became concerned with the long period of graduate training which preceded the examinations for the Fellowships, and felt that a revised form of the primary examinations might be introduced at some time during the earlier years of training, to screen out candidates who would appear to have little chance of success in the final examinations. Council appointed the following committee to examine the question: R M. Janes, Chairman Francis S. Brien Douglas E. Cannell Edmond Dube G. Lyman Duff

Edouard Gagnon F. G. Kergin Richard Lessard W. J. McNally

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There were many opinions both for and against the suggested plan, but after an exhaustive study the committee reported to Council, on October 29, 1953, that it did not recommend the reintroduction of a primary examination. THE PRESENT EXAMINATIONS 1945-1960 With the end of hostilities in 1945, the College entered a new phase in its development as far as examinations were concerned. The greatest number of candidates until that time had been in the year 1939, when 45 had taken the primary and 34 had written the final examinations, a total of 79. In 1945 there were no primary examinations, and there were 35 candidates for the finals; but with the addition of the Certificate examinations in 1946 and the examinations for the Fellowship as modified for a specialty in 1947, the number of candidates rapidly increased. In 1947 there were 295 candidates, and by 1955 the total number of candidates for the Fellowship and the Certificate was almost 875. In other words, one of the main activities of the College had become the holding of these examinations. With the rapid increase in the number of candidates it became necessary to appoint additional examiners for the Fellowship, and in 1946 an extra examiner in each subject was appointed from Halifax. In 1947 the extra examiners came from the West, and finally, in 1948, the load had become so great that four examiners were appointed for each subject. The introduction of the examinations for the Certificate in 1946 and the new specialty examinations at the Fellowship level in 1947 called for a complete re-arrangement of the College examinations. When the original Committee on Examinations, Applications and Credentials had been divided in 1945, Dr. Farquharson had been appointed chairman of the new Committee on Examinations. In a short time he was succeeded by Dr. Roscoe Graham, and following Dr. Graham's sudden death, Dr. Lion Gerin-Lajoie was appointed chairman of the committee. The examinations were now placed under the control of a general chairman and the examiners were divided into four Boards with French and English sections and each with its own chairman. It was decided that one Board would deal with the examinations for the Fellowship in medicine and its specialties, the second with the 112

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corresponding surgical examinations for the Fellowship, and the third and fourth Boards would be responsible for the Certificate examinations in the medical and surgical groups of specialties. Each Board would be responsible for the preparation and correction of the papers and the conduct of the oral and clinical examinations in its own subjects, and would report to Council through the general chairman. TABLE III Examination Results for the Fellowship of the College 1945-1960 GENERAL TOTAL YEAR CANDIDATES TOTAL PASSED

1945 1946 1947 1948 1949 1950 1951 1952 1953 1954 1955 1956 1957 1958 1959 1960

36 74 129 138 158 176 212 208 223 276 293 347 423 350 398 459

36 74 95 89 104 114 129 132 129 153 186 203 231 197 231 249

23 42 59 47 64 56 71 77 57 63 84 77 68 85 91 91

SPECIALTY TOTAL

34 49 54 63 83 76 94 123

107 144 192 153 167 210

PASSED

21 28 34 32 44 35 38 51 51 53 66 64 70 83

The appointment of these later Boards raised considerable problems in finding suitable examiners for the special branches. Fifteen years had passed since a small number of specialists had been admitted to the College as Charter Fellows. They had been older men and most of them had now retired from teaching. Apart from gynaecology and obstetrics, very few of the younger specialists had taken the general examinations of the College. With the new Boards and with the inclusion of the specialties, the College found itself in the embarrassing position of being forced to invite non-Fellows to conduct these new examinations. This inconsistency has been corrected gradually, as increasing numbers of specialists have passed the modified examinations for the Fellowship, and almost 113

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all the examiners at the Fellowship level are Fellows of the College. Five years is the usual term of service as an examiner. While there have been occasional requests for a reassessment of the marks on the written papers there have been very few serious criticisms of the fairness of the College examinations. The Honorary Secretary occasionally has received critical, and even abusive letters, and the College has been threatened with legal proceedings by candidates who felt that their professional reputations had suffered because of the College having failed them in the examinations. No one has gone to the extremes recorded in Sir Zachary Cope's History of the Royal College of Surgeons of England, where a candidate is stated to have fired a number of revolver shots to express his displeasure at the examination results. The following summary will give an idea of the amount of office work involved in organizing and conducting these examinations. When the first primary examinations were held in 1931 there were only 12 candidates; they wrote two papers, and there were four examiners. Seven years later, in 1938, with the entry of the French-speaking candidates and the inauguration of the final examinations, the number of examiners had risen to 20; there were 16 written papers, and 76 candidates. In 1958 the examiners numbered 180, there were a possible 234 papers, and there were actually 347 candidates for the Fellowship and 663 for the various specialist Certificates. Fortunately, candidates did not present themselves for all these possible examinations, but, in 1959, by actual count, 110 different papers were required for the Fellowship and 98 for the Certificate examinations, a total of 208. In addition, arrangements had to be made for 308 oral and clinical examinations. For the written examinations a huge bulk of material had to be distributed to 12 or 13 centres in Canada. The examination books had to be circulated to the examiners, and those successful in the writtens had to be notified to report at one of two or three centres for their oral and clinical examinations. No charge for the administrative and material cost of these examinations has ever appeared on the annual statements of the College, although in 1950 the auditor estimated that almost 60 per cent of the total disbursements of the College were related to the examinations, quite apart from any direct payments made to the examiners. Had 114

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these costs been taken into account, the net examination revenue of the College would have been small indeed. Ten years later, a further survey showed that the unit of costs for the examinations had more than doubled but there had been no compensating increase in the examination fees since 1952. As a result, the examinations were now the cause of a substantial loss rather than a source of revenue. The College will undoubtedly take action to correct this situation. EXAMINATIONS FOR THE FELLOWSHIP AS MODIFIED FOR A SPECIALTY A certain number of the older specialists had been elected as Charter Fellows in 1930, but until 1946, or even later, the policy of the College seemed to be dominated by the internists and general surgeons, and no particular effort was made to facilitate the entrance of those with special interests. It is true that the first schedule of examinations for the Fellowship had contained a clause offering examinations in special branches of medicine and surgery subject to the approval of Council, but this offer had been nullified by a subsequent decision that the examinations would be limited to internal medicine and general surgery until the College was firmly established. In the regulations for 1936 the special examinations were withdrawn in surgery, but examinations in paediatrics and neurology were still available for the Fellowship in medicine. There is no record of any applications having been received for these special examinations and all mention of them disappeared in the regulations of 1937. However, in the following year the minutes of Council refer to a statement by Dr. Gallie that the restrictive character of the examinations was preventing the entrance of many of the younger specialists because they were unwilling to attempt the examinations in their present form. Council took little notice of this remark, and the first mention of examinations modified for a specialty did not appear until October 1940, when in the closing paragraph of his report for the Committee on Specialists, Dr. Patch suggested that the College should consider some modified form of the Fellowship examination for those in special branches of the profession. He stated that the Certificate had been 115

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introduced to identify the average well trained specialist, and that it would be desirable to have a higher qualification for the outstanding members of each specialty. Little attention was paid to this part of the report, but Council was not allowed to forget the claims of the specialists because at its next meeting a letter was received from Dr. Gordon Chown, Professor of Paediatrics at the University of Manitoba, tendering his resignation from the College because his specialty was being ignored in the examinations. Dr. Chown was well-known, and his letter gave rise to considerable discussion. His resignation was not accepted but the question was referred to the Committee on Educational Standards. There it remained until the committee made its report in 1944. This was an important report and initiated policies which were to affect the College for some years to come. The committee made the following recommendations: The primary examination in its present form should be abolished. Examinations for the Fellowship modified for a specialty should be set up. A Junior Class or Membership of the College is not desirable. The Charter of the College should be amended to allow for the admission as Fellows without examination, of persons of distinction who are graduates of at least twenty years standing. 5. The Certificate should be quite outside the structure of the College.

1. 2. 3. 4.

These recommendations were approved at the Annual Meeting on October 28, 1944. Council immediately authorized the provision of modified examinations for the Fellowship in three specialties in the Division of Medicine and four in the Division of Surgery. The College has added to this list from time to time, and now these modified examinations are available in sixteen specialties of medicine and surgery. These may be set down as shown in Table IV. It will be recalled that the specialists had made very few enquiries about the Fellowship until the adoption of the certification programme in the early 1940's, and Council felt that there would not be any great demand for these new examinations. Considerable surprise was expressed when over 25 per cent of the candidates for the Fellowship at the first examination, in 1947, were found to be in the specialist branches, and this proportion gradually increased until it became stabilized at between 40 and 45 per cent in the later 1950's. (Table III, p. 113). 116

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TABLE IV Modified Examinations for the. Fellowship DATE OF INSTITUTION MEDICINE AS MODIFIED FOR A SPECIALTY

Dermatology and Syphilology (Dermatology 1955) Neurology and/or Psychiatry (discontinued 1949) Paediatrics Radiology, Diagnostic Therapeutic Neurology Psychiatry Anaesthesia Pathology Physical Medicine and Rehabilitation

1944 1944 1944 1946 1946 1949 1949 1950 1955 1956

SURGERY AS MODIFIED FOR A SPECIALTY

Neurosurgery Obstetrics and Gynaecology Orthopaedic Surgery Urology Ophthalmology Otolaryngology Plastic Surgery

1944 1944 1944 1944 1947 1947 1951

The records show a wide variation in the acceptance of these higher diplomas. Some specialties are well represented, while in others the number of candidates for the Fellowship is extremely low. From this point of view the specialties may be divided into two large groups. In the first would be placed neurology, neurosurgery, obstetrics and gynaecology, orthopaedic surgery and urology, where the proportion of Fellows by examination is extremely high. In the second group, which would contain amongst others ophthalmology, otolaryngology, psychiatry, anaesthesia and diagnostic radiology, the proportion varies between one Fellow to ten and one Fellow to thirty-nine Certificated Specialists. A number of reasons have been advanced for this irregular distribution of the Fellowship and the Certificate in the various specialties. The training requirements and the content of the examinations have been the subjects of criticism. The College has made extensive changes to meet these complaints, but it is too early to assess the results of these changes. 117

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In certain specialties there is still a large demand for holders of the Certificate, particularly in anaesthesia and diagnostic radiology. This may explain the large preponderance of the Certificated Specialist in these fields. The chief problem before the College at present is to determine whether the lack of persons of Fellowship standing in these specialties requires correction, and if so, how it can be done without endangering the standards of the Fellowship.

118

CHAPTER XVIII

APPROVAL OF HOSPITALS FOR GRADUATE TRAINING The approval of hospitals for graduate training has become an important feature in the educational programme of the College and has resulted in a great improvement in the quality of hospital service available to the public. When the College was founded in 1929, organized postgraduate training was in its infancy in Canada. Most training was taken in Europe or the United States, usually on the advice of some older friend or teacher. For entrance to its examinations the Royal College of Surgeons of England gave a short list of approved Canadian hospitals. The Council of Medical Education and Hospitals of the American Medical Association also issued a list of hospitals approved for general intern training. This list contained the names of a small number of Canadian hospitals, which were given for the information of American students who were attending medical schools in Canada and who would later be sitting the examinations of American licensing authorities. From time to time, there had been complaints that Canadian medical schools and hospitals were dependent on American agencies for their classification and approval, but the American Medical Association continued the approval of Canadian hospitals until 1931, when it informed the Canadian Medical Association that, on account of expense, it wished to withdraw from the Canadian field. If the Canadian Association wished to assume this responsibility, its list of approved hospitals would receive official recognition in the United States. The Canadian Medical Association had been hearing a good deal about the disagreements which had accompanied the standardization of Canadian hospitals by the American College of Surgeons, and was reluctant to undertake a somewhat similar campaign of its own. Finally, however, after consultation with the Canadian schools of medicine, the Association decided to embark on the plan and a "Basis 119

THE ROYAL COLLEGE OF PHYSICIANS AND SURGEONS OF CANADA

of Approval for Internship of Hospitals in Canada" was adopted at its Annual Meeting in June 1931. On the first Canadian list, 26 hospitals were granted full approval and a further group of 12 were classed as recommended, but on account of their size or special characteristics they were not given the status of full approval. Dr. Harvey Agnew, the Director of the Association's Department of Hospital Service, and his committee seem to have used a good deal of discretion in their choice of approved hospitals, and the new list was well received. From time to time, further hospitals have been added and there are now between 75 and 80 hospitals approved for general internship under the auspices of the Canadian Medical Association. In 1931, the executive groups of the Royal College and the Canadian Medical Association were almost identical and it is not surprising that the question of preparing a similar list soon came up at a meeting of the College Council. However, there were very few candidates for the final examinations and it was decided, on a motion by Dr. Duncan Graham, seconded by Dr. F. G. Fitzgerald, that such a list was unnecessary for the present and that the application of each candidate should be decided on its merits. In 1936 the regulations only required one year of hospital training, and Dr. George S. Young, Superintendent of Examinations, reported that the College was using the approved list of the Canadian Medical Association in assessing the training of prospective candidates. Nothing more was heard about the preparation of a list of approved hospitals until 1945. In the interval, the required period of training had been increased by the College. Dr. Patch was directly concerned with the problem of hospital approval, as the regulations for the specialist certificate required at least four years of hospital training. Where was this training to be obtained? He asked Dr. Agnew if any considerable number of hospitals in Canada had availed themselves of the approval plan for postgraduate training which had been set up recently by the American College of Surgeons. On March 26, 1945, Dr. Agnew replied that Canadian hospitals had apparently made very little use of the service, and only six Canadian hospitals were listed by the American College. They were: 120

APPROVAL OF HOSPITALS FOR GRADUATE TRAINING

Montreal Montreal General Hospital Royal Victoria Hospital Toronto Hospital for Sick Children St. Michael's Hospital Toronto General Hospital Toronto Western Hospital

General Surgery and Otolaryngology General Surgery, Otolaryngology, Urology, Obstetrics and Gynaecology, Neurosurgery General Surgery General Surgery General Surgery and Obstetrics and Gynaecology General Surgery

Dr. Patch and Dr. Farquharson both referred to this difficulty in their reports to Council in November 1945. The new Honorary Secretary, Dr. Plunkett, also brought the matter before the Executive Committee in the following March. He stated that the College was receiving many inquiries from prospective candidates regarding hospitals approved by the College, and that, apart from the list supplied by Dr. Agnew, no approved list was available. As a result, there were long delays in answering these inquiries. After much discussion, the President was authorized to discuss the question of hospital approval with representatives of the Canadian Medical Association and the Canadian Hospital Council. For this purpose he appointed the following committee, consisting of representatives of the Committee on Specialists and the Credentials Committee of the College: R. F. Farquharson, Chairman Duncan Graham F. S. Patch Edmond Dube R. I. Harris Louis Berger

When the Committee met two months later, Dr. Graham presented a tentative plan for the approval of hospitals which had been approved in principle by Dr. A. D. Kelly, Assistant Secretary of the Canadian Medical Association, and Dr. Agnew for the Canadian Hospital Council. The committee could not agree on the exact wording of its report, and it was not until June 1947 that the plan was approved by the College. 121

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It was agreed that hospitals must apply to the College for approval and that on receipt of such a request a special form would be sent to the hospital. On completion, this form would be examined by the Committee on Approval of Hospitals whose report would be considered by the Council, and the final decision would be sent from the College office. The application consisted of two parts: first, a general statement of the standards which would be required for the approval of a hospital, and second, a questionnaire to be completed by the institution. The General Statement contained the following nine sections: 1. The hospital must be suitably planned and have adequate facilities and equipment for the care of patients and the practice of medicine by scientific methods. 2. There must be indoor and outdoor services, with a sufficient variety of clinical material and a sufficient number of patients in attendance to provide the graduate student with adequate opportunities for training and experience in the broad fields of medicine and surgery and/or the special branches of medicine and surgery for which the hospital seeks approval for training. These services shall be in charge of an organized medical staff. 3. Each division of the outdoor and indoor active medical staff shall be in charge of a Chief-of-Service with the necessary number of staff assistants, each certificated as a specialist. It is desirable that the Chiefs-of-Service and their assistants be Fellows of the Royal College. 4. The following special departments and services must be maintained:— (a) Adequate laboratory facilities and personnel under competent medical supervision. (b) A department of radiology, properly equipped, under competent medical supervision. (c) A department of physical therapy, properly equipped, and under competent medical supervision. (d) Efficient dental, nursing and dietary services; occupational therapy and social service departments are highly desirable. 5. Accurate and complete medical records must be kept of all patients treated by the services of the hospital. The record room must be properly equipped and supervised. 6. Complete autopsies must be done under the supervision of a competent pathologist (minimal standard of qualification — Certification) on at least 25 per cent of fatal cases. 7. There must be easy access to an adequate medical library. 8. The medical staff shall hold conferences at least once a month for the review of their clinical work in the hospital, the presentation of cases, and the discussion of subjects of scientific interest. 9. In modification of the above requirements, provision is to be made for approval in part, or on an interim basis, of hospitals which may not fulfil completely all the above requirements.

The questionnaire covered 14 pages and called for information on the ownership and management of the hospital, its bed capacity (public 122

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and private, etc.), the number of admissions, the beds allotted to the various specialties, the number of out-patient clinics and their attendance. It dealt with the organization of the hospital staff, their names, ranks and qualifications, the laboratory, radiological and physical therapy services, anaesthesia, records, library and postmortems. The hospitals were notified of this new activity of the College in September 1947, and were invited to apply for approval if they so wished. During the first six months completed questionnaires were received from 47 hospitals, and in June 1948, Dr. Farquharson reported that the committee, now under the chairmanship of Dr. McLachlin of London, was engaged in the task of assessing the applications for approval. By the autumn of 1948 Council had given decisions on 72 hospitals; of these 37 had received full approval for one or more services, 8 had been given conditional approval, in 8 the decisions had been deferred, and in 19 cases the applications had been definitely refused. Most of the refusals had been based on the small number of public ward patients or on the organization of the attending staffs; a few had not received approval because of the low percentage of autopsies. The post-war years saw an extensive campaign of hospital construction; new ones were built and older ones were enlarged, and many new names appeared on the list of approved hospitals. It is interesting to compare the simple statement of 1948 with the extensive compilation of 1960. In 1948 approval had been granted to 37 hospitals, in 1960 the number had increased to over 140, but there had been very little change in the number of hospitals which had received unrestricted approval for more than two years of training. The hard core was still in the teaching hospital group. The large increase had been in the medium sized hospitals where periods of training were restricted to one or two years for a limited number of trainees. With the increasing number of applicants, suitable facilities for training became a problem. There were a good many smaller hospitals and specialized clinics doing excellent work in a restricted field, but whose facilities could not be approved under the broad regulations. Here, a very real contribution was made by Dr. Aldwyn B. Stokes of the Toronto Psychiatric Hospital. In 1950, he suggested that many of these institutions and hospitals might be arranged in groups under 123

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the aegis of a university department, and that a trainee could be moved from one institution to another in an orderly fashion during the course of the year. The deficiencies of one of these hospitals would be supplied by another, and the result would be a year or more of excellent training and, at the same time, the system would supply the senior intern needs of each institution. This system of group co-operation under university control has been introduced in radiology, obstetrics and gynaecology, and psychiatry, and has given encouraging results. The institutions grouped under the Stokes Plan were either teaching hospitals or located in their immediate vicinity. The question arose as to whether the plan might be extended to non-teaching hospitals situated at a distance from a school of medicine. Could some longterm project be introduced to extend the orbit of university influence? It was felt that, under university supervision, much more efficient use could be made of the training facilities of a substantial number of institutions which had only received College approval for limited periods of training. With this in mind the College discussed the matter with the Association of Canadian Medical Schools in November 1959. However, the problem of extending the sphere of university influence to these more distant non-teaching hospitals was not a simple one, and the whole question is still in the exploratory stage. THE PROBLEMS OF HOSPITAL APPROVAL The approval of hospitals by correspondence was soon found to be open to criticism. Hospitals on the borderline tended to emphasise their advantages and to minimise their defects, and yet the cost of a paid inspection service seemed to be out of the question. Dr. Gillespie of Edmonton went into the matter during the term of his presidency in 1947 to 1949, and it was decided that, even on a part-time basis, the cost would be beyond the resources of the College. The possibility of obtaining government assistance was suggested, but Council felt that this might mean a loss of independence, and the suggestion was put aside. For the time being, the College decided to do its own inspections and a large Inspection Committee was appointed whose members might be asked to visit hospitals in their neighbourhood, when the statements 124

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on the application seemed to be out of line with the local reputation of the institution. While not perfect, the system gave reasonably satisfactory results, and in 1950 the first list of approved hospitals was printed and made available for the guidance of candidates. At this time, approximately 100 hospitals had been approved for longer or shorter periods of training, but only one-fifth of the number had been given unrestricted approval. From 1951 until 1955 the minutes of Council contain frequent references to negotiations between the Royal College and the Canadian Medical Association regarding the formation of a Canadian agency for the inspection of hospitals. This programme had been suggested by Dr. E. Kirk Lyon of Leamington, Ontario (later Deputy to the President of the Association, H.R.H. Prince Philip, Duke of Edinburgh, in 1959-60) who had become greatly concerned about the lack of supervision of the smaller hospitals. The Medical Association appointed a committee to study the question and the College was invited to join in the project. Up to that time all professional inspections of hospitals in Canada had been conducted by surveyors of the American College of Surgeons, and their inspections were limited to hospitals of 50 or more beds. Shortly after the appointment of this committee the American College of Surgeons informed the Canadian Medical Association and the College, that it wished to retire from the field of hospital inspection and standardization and would associate itself with a Joint Commission of Hospital Accreditation being sponsored by itself, the American Medical Association, the American Hospital Association and the American College of Physicians. It was intimated that one seat would be reserved for the Canadian Medical Association if it wished to join this new Commission. It would be an administrative body, and each sponsor would conduct its own inspection service, except in the field of cancer where the American College of Surgeons would still inspect these centres in the United States and Canada. The American College was retiring because of the expense involved in its standardization programme and because the American Specialty Boards wished to expand the hospital inspection to include the educational side of hospital postgraduate training. There was a feeling that 125

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many hospitals were using their senior residents merely as skilled workmen and paying little attention to their education and training. The retirement of the American College meant the end of any professional inspection of Canadian hospitals, and the Canadian Medical Association felt that some inspection service should be organized in Canada to continue the work. Dr. McLachlin, Chairman of the College Committee on the Approval of Hospitals, was instructed to attend the first meeting of the Association Study Committee and to state that the College was interested chiefly in the educational side of hospital training in a few of the larger hospitals, and that the suggested plan did not seem to meet the needs of the College. In the meantime, the Canadian Medical Association had taken a seat on the American Joint Commission and efforts were continued to organize a Canadian hospital inspection service. After a further two years of negotiations, the College finally agreed to take an active part in the proposed Canadian inspection service, provided that it should receive its reports directly from the field surveyor and make its own decisions regarding approval for senior postgraduate training without reference to the American Commission. In his final report as Chairman of the Committee on Approval of Hospitals, Dr. McLachlin stated that, while no great contribution had come from the inspection service of the Joint Commission of Hospital Accreditation, still the cost of membership in the Canadian section could be justified as a donation to a good cause. Dr. McLachlin's term of duty came to an end in 1954. He and his committee had accomplished a great deal, a useful body of precedents had been established and the work of hospital approval was well organized. Dr. D. A. Thompson of Bathurst, a newly elected member of Council, now became chairman of the committee. He had been on the Executive Committee of the Canadian Medical Association for some years, and, for the preceding two years, had been one of the Association representatives on the Canadian Commission of Hospital Accreditation; he was therefore conversant with the activities of that group. While the actual inspection of Canadian hospitals was commenced in 1955, it was not until after the incorporation of the Canadian Council of Hospital Accreditation (Le Conseil Canadien d'Accreditation des 126

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Höpitaux) in 1959, that any considerable amount of information came to the College from this source. The inspection service is gradually becoming organized, and during the past two years it has been most useful in providing quantitative information about hospital activities, i.e. the number of admissions, the organization of the hospital staffs, the number of autopsies, the state of the hospital records, laboratories, etc. It has been more difficult to obtain information about the educational or qualitative side of the training programme, but the College is developing a special questionnaire for the surveyors, which should give a good deal of indirect information about this side of the picture, (organized seminars, general staff rounds, conferences, journal clubs, etc., in which the residents are required to participate). In addition, much greater use is being made of reports from the various specialty groups, and some of these groups have prepared minimum training requirements for their own specialties. Very striking changes have taken place in the postgraduate training of hospital residents during the past twenty years. It has been a change from what might be called the apprenticeship system to an organized programme of considerable value, and the College has played an important role in bringing about these changes.

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CHAPTER XIX

HONORARY FELLOWSHIPS When Dr. Low and his committee were engaged in preparing their report in 1927, they had drawn largely on the Charter of The Royal College of Surgeons of England for the pattern to be followed in organizing the proposed College in Canada. In 1899, the British College had been empowered to elect distinguished persons as Honorary Fellows. It is therefore not surprising that the Act incorporating the Canadian College contained a section granting it similar privileges. The British Letters Patent had laid down the number, the conditions of election and the privileges of these Fellows at some length, but the Canadian Act simply stated that "the Council may, without examination, select and admit as Honorary Fellows, such distinguished physicians, surgeons, or other persons resident within or without Canada, as the Council may deem fit", and there was no limitation to the number which might be elected. The College by-laws simply repeated the relevant section of the Act. The policy governing election to Honorary Fellowship is given in a report of the Executive Committee in 1947, in which it stated that "as a matter of general policy the Hönorary Fellowship should be granted very sparingly and it should be given only to persons of high merit or distinguished service in or on behalf of the medical profession. It should not be given as a matter of custom to the Annual Lecturers of the College." The fact that the Honorary Fellowship has been granted to only 31 persons since the founding of the College suggests a fairly rigid adherence to this policy. The reigning monarch of the day has always honoured the College by acting as its Patron, and each successive Governor-General has graciously accepted the Honorary Fellowship in both divisions of the College. The first Honorary Fellow was His Excellency the Right Honourable the Earl of Bessborough, who was Governor-General of Canada from 1931 until 1935. He was always greatly interested in the College and represented it at a number of official functions in London. He was 129

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followed by the Right Honourable Lord Tweedsmuir (John Buchan) in 1936, and by the Right Honourable the Earl of Athlone, in 1940. Field-Marshal the Right Honourable the Earl Alexander of Tunis was elected in 1946, and His Excellency the Right Honourable Vincent Massey, C.H., in 1953. On Monday, June 1, 1959, Mr. Massey honoured the College by laying the corner-stone of its new building. In January 1961, His Excellency, Major-General Georges P. Vanier, D.S.O., M.C., was elected an Honorary Fellow. In electing these representatives of the Crown, the College had followed the precedent of the Royal College of Surgeons of England whose list of Honorary Fellows is headed by the names of members of the Royal Family. Four other laymen have been elected on the basis of their service to the College or the medical profession. Two were Presidents of the National Research Council of Canada — General the Honourable Andrew George Latta McNaughton, P.C., and Dr. Chalmers Jack Mackenzie. The third was Sir Arthur Sims, of London and New Zealand, the founder of the Sims Commonwealth Travelling Professorships. Grants from this Foundation have enabled distinguished physicians and surgeons to make extended tours of the Commonwealth. Sir Reginald Watson-Jones, Sir Geoffrey Keynes and Professor Melville Arnott, amongst others, have visited Canada as Sims Travelling Professors, while three Canadians, Drs. R. I. Harris, R. M. Janes, and R. B. Kerr, have acted as Sims Travelling Professors in Australasia and many parts of Africa. The fourth was Mr. Robert Samuel McLaughlin of Oshawa. His generous gifts endowed the McLaughlin Foundation whose Fellowships have done so much for medical postgraduate education in Canada. One of the more recent grants of the Foundation has been the endowment of the McLaughlin-Gallie Visiting Professorship of the College which will allow prolonged visits by eminent teachers at one or two Canadian medical schools each year. Professor Charles Illingworth of Glasgow was the first incumbent of this professorship. The names of two Canadian surgeons appear on the list, Mr. I. H. Cameron and Dr. John Stewart. Both were advanced in years at the time of their election in 1933, but they had occupied distinguished positions in Canadian medicine. Reference has been made already to Mr. Irving H. Cameron and his disdain of the title of Doctor. He was a Bachelor of Medicine and a Master of Surgery, and insisted on 130

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being called "Mr. Cameron". He had been one of the outstanding surgical figures of Toronto in his day, but he would have been upset had he known that in the 1934 list of deceased Fellows he would appear as Doctor I. H. Cameron, Toronto. Mr. Cameron and two Montreal surgeons, Sir Thomas G. Roddick and Sir William Hales Hingston, had been the only Canadians elected to the Honorary Fellowship of the Royal College of Surgeons of England when its Honorary Fellowship was established in 1899. John Stewart, of Halifax, was the other Canadian surgeon. He had been one of Lister's favourite house officers, and had been invited to remain as one of his assistants. However, the serious illness of his mother made him decide to return to Canada. He became the Professor of Surgery at Dalhousie University and one of the most respected members of the profession in Canada. He was living in retirement at the time of his election. He died in the following year. Two other Canadian doctors have received the Honorary Fellowship. They were medical parliamentarians of the old school. Senator J. H. King was elected in 1939 as a reward for his service in sponsoring the amendment to the Act of Incorporation which empowered the College to certify specialists, while the election of Major-General Sir Eugene Marie Joseph Fiset, Lieutenant-Governor of the Province of Quebec, was a tribute to his valued help in improving the quality of the medical services of the Canadian army. A graduate of Laval University, he had served as a combatant in the South African war, being decorated with the Distinguished Service Order, and was Deputy Minister of Defence in World War I. In presenting him for the Honorary Fellowship, Dr. Charles Vezina of Quebec ended his citation with the words "the Royal College of Physicians and Surgeons of Canada is pleased to bestow on you this new title in recognition of the services you have rendered to your country." At the same Convocation, in the autumn of 1943, Honorary Fellowships were conferred in absentia on two eminent Russian scientists, and the background of these awards is of interest. Dr. Penfield, a PastPresident of the College, had just returned from Russia where he had been a member of an allied mission made up of British, Canadian and American surgeons. In 1943, the Royal College of Surgeons of England was celebrating the centenary of its Fellowship, which had 131

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been established in 1843. Rear-Admiral Gordon Gordon-Taylor, a Vice-President of the College, was a member of the mission to Russia and he had been authorized to present diplomas of Honorary Fellowship in the British College to Lieutenant-General Bourdenko, Chief Surgeon of the Russian Army, and to Professor Yudin, a brilliant Russian surgeon. The American representatives had also brought similar diplomas from the American College of Surgeons to be presented to two distinguished Russian scientists. The presentation of these diplomas was to be a ceremony of some importance. Dr. Penfield was first informed of these preparations upon his arrival in England to join the mission, and he immediately cabled to the Canadian College for authority to grant similar Fellowships on its behalf. Delays in transmission due to the war prevented this authority reaching him until some days after the ceremony and he could do nothing. At his request, the College awarded an Honorary Fellowship of the Royal College of Surgeons of Canada to Lieutenant-General Yefin Ivanovitch Smirnov, Chief of the Medical Services of the Red Army of the U.S.S.R., and an Honorary Fellowship of the Royal College of Physicians of Canada to Professor A. A. Bagdasarov, Director of the Central Institute of Haematology of Moscow; to the latter because of his outstanding work on blood and blood substitutes, and to the former for his brilliant organization of medical research. During the war many British missions came to Canada, and Honorary Fellowships were awarded to Sir William Wilson Jameson, Principal Medical Officer of the British Ministry of Health, to RearAdmiral Gordon (later Sir Gordon) Gordon-Taylor, and to MajorGeneral William (later Sir William) Heneage Ogilvie, Consulting Surgeon to the Middle East Command, 1942. In 1947 the College elected a distinguished Spanish surgeon, Dr. Josep Trueta, an Honorary Fellow in recognition of his contribution to the wartime treatment of compound fractures. In 1949, the Right Honourable Lord Webb-Johnson, the PastPresident of the Royal College of Surgeons of England, was making an extended good-will tour of North America, and he was invited to delay his return to England in order to attend the Annual Meeting of the Canadian College. He was elected an Honorary Fellow. In presenting him for his degree, Dr. Gallie drew attention to the changes which had 132

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occurred during Sir Alfred (later Lord) Webb-Johnson's term of office as President of the Royal College of Surgeons of England: "During the eight years that he was President of the College he brought about changes that the previous hundred years had failed to do. 'When he took office it was primarily an examining body, dignified, aloof, cold. Now, it has become the very centre of postgraduate education, friendly, stimulating, warm-hearted. He has changed it from a museum to a laboratory, from an examination hall to a great postgraduate school. All this has been brought about by one man .... To him alone must be ascribed the imagination, the drive and the leadership that were necessary to change the customs of a hundred years." Lord WebbJohnson made a suitable reply, during which he referred to Dr. Gallie having been one of the very few recipients of the Honorary Gold Medal of the English Royal College. (27) He then presented a letter of greetings from Sir Cecil Wakeley, the President of the Royal College of Surgeons of England. The College has elected two other eminent representatives of the Royal College of Surgeons of England. In 1955 Sir Harry Platt, the President of the Royal College of Surgeons, attended the Annual Meeting, at Quebec, and was elected to the Honorary Fellowship. In the following year Sir Geoffrey Keynes of London became an Honorary Fellow. He was the Honorary Librarian and the Honorary Curator of Portraits and Works of Art of the Royal College of Surgeons of England, and he brought three engravings of great medical interest as gifts from his College. One of these engravings portrays the granting of the Act of Union to the Barbers and Surgeons by Henry VIII in 1540-41. Holbein had painted the original picture, which is now in the possession of the Worshipful Company of Barbers in London. There is a substantial tablet represented in this picture which contains a lengthy Latin inscription. It is thought that this tablet and the inscription were added by persons who restored the painting after it had been damaged in the Great Fire of London, in 1666. Some foundation is given to this opinion by the fact that the Royal College of Surgeons has a very similar painting, which is thought to be a copy of the Holbein original, prepared in 1618 by order of James I. In this picture the tablet is replaced by an open window which frames a view of the old St. Paul's 133

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Cathedral. This whole matter is dealt with at length in a most interesting way by Cecil Wall in his History of the Surgeons Company, 1745-1800. An Ottawa classicist has very kindly provided the following translation of the inscription: To the Great and Good Henry VIII, King of England, of France and of Ireland, Defender of the Faith, and next to Christ Supreme Head of the Church of England and Ireland, The Company of Surgeons makes this dedication, with protestations of loyalty, on behalf of all its members. Dread Disease once ravaged the land of England, troubling the spirits and fastening itself upon the bodies of the people. Against this calamity God on High has in His mercy bidden you employ the assistance of the Good Physician. The light of the Gospel hovers around on golden wings, and it shall be as medicine to stricken minds. At your behest men turn again to the wisdom of Galen, and by his speedy aid all disease is vanquished. We therefore, the company of your own physicians, in a spirit of reverence humbly dedicate to you this hall. And being mindful of the protection with which you, Henry, have blessed us, we desire all greatness both for your person and for your reign.*

The interest in the inscription had been stimulated by a very amateur translation which was much more poetic and eulogistic of the medical profession than the official version. In 1957 Dr. W. Melville Arnott, William Withering Professor of Medicine of Birmingham University, who was also the Sims Commonwealth Travelling Professor, attended the meeting and was the College Lecturer in Medicine. He was elected an :Honorary Fellow of the Royal College of Physicians of Canada. Sir Walter Mercer, a Past-President of the Royal College of Surgeons of Edinburgh, a distinguished Scottish orthopaedic surgeon, was elected an Honorary Fellow of the Royal College of Surgeons of Canada, in 1961. He had been invited to Canada to deliver the first Alexander Gibson Memorial Lecture at the University of Manitoba. Three important members of the profession in the United States have been admitted to the Honorary Fellowship. Dr. Henry A. Christian, Hersey Professor of the Theory and Practice of Physic, Dean of the Harvard Medical School, and Physician-in-Chief of the Peter Bent Brigham Hospital, Boston, was the first American speaker to appear on the scientific programme of the College. He was elected an Honorary Fellow of the College in 1936, the fourth person to be so honoured. In 1957, Dr. I. S. Ravdin, John Rhea Barton Professor of °A similar translation is to be found in the British Medical Journal, October 6, 1934, p. 651.

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Surgery at the University of Pennsylvania, and Surgeon-in-Chief of the Hospital of the University of Pennsylvania, Philadelphia, Chairman of the Board of Regents of the American College of Surgeons, was elected an Honorary Fellow and gave the College Lecture in Surgery. In 1959, the College honoured Dr. Donald Church Balfour, of Rochester, Minnesota, by granting him an Honorary Fellowship. Dr. Balfour was a Canadian by birth and a graduate of the University of Toronto. He was a Past-President of the American College of Surgeons and had been Chief Surgeon of the Mayo Clinic and Director of the Mayo Foundation until his retirement in 1947. An outstanding academician, he already held the Honorary Fellowships of the Royal College of Surgeons of England, of Edinburgh and of Australasia. Dr. Balfour fulfilled in every way the College requirements that the Honorary Fellowships should be granted only to persons of high merit or distinguished service in or on behalf of the medical profession.

135

R. M. JANES

J. \V. SCOFF

I). A. THOM PSON

F. C. ROL. I 1.1..

W. S. INMAN

J. E. PLUNKETT

CHAPTER XX

THE MEDALS OF THE COLLEGE The original object of the College had been the stimulation of postgraduate training by the award of the Diploma of Fellowship. It was obvious from the regulations that one or more years of this training might be devoted to research, but there was no means by which these researches could be brought to the attention of the College. In 1941, Dr. Mills suggested that when the war security measures were relaxed a medal should be offered by each Division of the College as a prize for reports on investigative work, both laboratory and clinical, which had been done by Canadians, and that the prize essays should be presented at the Annual Meeting. Council acted upon this suggestion at the end of the war, and in 1946 the President announced that two prizes had been established, to be known as the Royal College of Physicians of Canada Medal and the Royal College of Surgeons of Canada Medal. These medals were to be awarded each year for the best investigative work in the basic sciences relating to medicine or surgery or in the field of clinical research, done by Canadian physicians or surgeons. The recipients of these medals were to be invited, as guests of the College, to present their essays at the Annual Meeting. The original terms of reference have been altered from time to time, but the present conditions governing the submission of essays are: 1. Nominations for the award must be made by a Fellow of the College. 2. The author shall not have reached his 41st birthday before December 31st of the year in which his essay is submitted. 3. The awards are open to: (a) Any medical graduate of Canadian nationality. (b) Non-Canadian graduates in medicine where essays are based on work carried out in Canada. (c) Any Fellow of the College, regardless of nationality or the country in which the investigative work was carried out.

The medals have served a very useful purpose and many of the essays have been of an extremely high order. The obverse of the medal 137

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bears the seal of the College and the reverse shows a decorative design of palms with a space for the name of the recipient and the date of the award. A list of the medallists and the date of award, has been placed in Appendix (p. 222).

l38

PART 111 Certification of Specialists 1923-1957

PART Ill INTRODUCTION The Royal College of Physicians and Surgeons of Canada undertook the task of certifying specialists as a service to the profession on the direct invitation of the Canadian Medical Association. It had been found that charter limitations prevented the Medical Council of Canada from taking an active part, and it would have been difficult for the Canadian Medical Association, an organization open to all licensed practitioners in good standing, to place its members in different categories. The situation was pressing — on the one hand, certain specialty groups were urging the adoption of the American system of the time, with the establishment of a number of independent specialty boards in Canada; on the other, there was a strong feeling in the Canadian Medical Association that the specialist question should be dealt with by one central agency. Some effective action was required if a multiplicity of boards was to be avoided. The College accepted the task with mixed feelings, and only after prolonged discussion with the Association. The College felt that this classification of the profession might be ascribed to selfish motives rather than to any desire to protect the public, and that it might arouse new animosities in the profession. Again, a substantial number of Councillors believed that this sudden interest in specialism was a passing phase, and that the demand for the certificate would soon disappear. Finally, no estimate of expenses could be made and the College might be saddled with an unremunerative and expensive venture. Most of these fears proved to be groundless, and in the following chapters it is proposed to trace the development of the plan.

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CHAPTER XXI

HISTORY OF THE MOVEMENT The general use of the term specialist by the medical profession dates from the seventies and eighties of the last century when the expansion of medical knowledge gave some real meaning to the title. In supporting the campaign for the certification of specialists in 1944 Dr. Patch remarked that "a specialist may be defined as one who devotes himself to a particular branch of a profession, science or art, and one who has a special knowledge of some particular subject." (28) At first, he continued, the holders of this title (in medicine) were persons whose knowledge and experience justified its use, but unfortunately the lure of increased rewards from specialist practice had caused the pendulum to swing too far. The role of specialist had not infrequently been assumed without adequate training or demonstrated competence. That these opinions were not new is shown by a very dogmatic resolution which was brought forward by a Dr. Slayter and duly adopted at the 14th Annual Meeting of the Canadian Medical Association in 1881, at Halifax, Nova Scotia. Dr. Slayter did not mince matters.

A RESOLUTION FOR THE DISCOUNTENANCING OF SPECIALISM WHEREAS, The system of specialism and specialists which at present obtains to a certain extent in the Dominion and which has developed to very large proportions in the neighbouring republic, is for the most part the outgrowth of superficial professional education and a want of success as practitioners of medicine and surgery: Therefore be it RESOLVED, That it is the opinion of this Society that specialism should be discountenanced by the members of the Society, and that, except in the rare cases where long experience, extended study and peculiar aptitude have placed a man in a special position toward his brethren, specialists should be treated and looked upon as irregular practitioners. (29)

Nothing came of the resolution, but the period was one of change. Specialists in the clinical subjects were beginning to be recognized in the medical schools. In 1883 gynaecology and the joint specialty of ophthalmology and otology were raised to independent department levels at McGill, and laryngology was recognized in 1893. 143

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In those days, apart from the specialties of the eye and the nose and throat, the line benveen the general practitioner and the specialist was extremely vague. It is true that there were certain internists and surgeons who fulfilled the requirements of Dr. Slayter's resolution defining a specialist, but the majority, while they might be attached to the medical or surgical department of a medical school, forgot this distinction on entering their own offices and became general practitioners. These men gave very little trouble. In the teaching hospitals they were under fairly strict supervision, but in the smaller hospitals which had sprung up in large numbers in the early years of the century conditions were very different. Many members of their staffs had served overseas in the first World War, where they had done minor and traumatic surgery. They considered themselves fully qualified surgeons and there was considerable dissatisfaction regarding the quality of the service being provided by these imperfectly trained and self-styled specialists. This was the key-note of the Joint Report of the Education and the Canadian College Committees presented at the Annual Meeting of the Canadian Medical Association in 1926 (see p. 16). When the formation of the Canadian Royal College was being discussed in 1923, one of the suggested aims of the College was "the setting up of some standard for the qualification of specialists." There was a general interest in the subject in western Canada, and the Manitoba Medical Association passed the following resolution at its Annual Meeting in 1925: Be it RESOLVED that it is the opinion of this meeting of the Manitoba Medical Association that some method should be developed of controlling the requirements considered necessary as to experience in general practice and special training of those who enter the practice of a special department of medicine in this province. (30)

The Manitoba Association went no further with the matter, but in April 1926, the Medical Profession Act of Alberta was amended forbidding any person to advertise or hold himself out to the public as a specialist or as being specially qualified in any branch of medicine without having received from the Registrar of the University of Alberta, a certificate of having complied with the conditions prescribed by the General Faculty Council of the University. (31) To carry out the provisions of the Act, the University appointed a committee consisting of the Dean of Medicine, the heads of the clinical departments, 144

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and a representative of the College of Physicians and Surgeons of Alberta, and five other persons named by the General Faculty Council. The applicant was to have one year of general internship, two and a half years of hospital training in the specialty and be licensed to practise in the province. He was to submit proof of acceptable moral and ethical standing, and to pass such tests or examinations as were prescribed by the University. No other province took up the question of certifying specialists and, for the time being, the profession seemed to have lost interest in the question. Six years later (1932) there was a reawakening of interest when the Ontario Medical Association held a round-table discussion on specialism during which it was stated that the other provinces were considering the matter, but material in the archives of the Medical Council of Canada would suggest that this consideration had not gone very far. Up to this time the discussions had been at the provincial level, but in July 1933, the Canadian Medical Association Journal contained a long editorial comment written by Dr. E. Stanley Ryerson. It was entitled "The Qualification of Specialists in Canada." It was the starting point of a campaign for the certification of specialists which Dr. Ryerson conducted for the next two years. Stanley Ryerson was the secretary of the University of Toronto Faculty of Medicine. He was a descendant of the Reverend Egerton Ryerson, the militant divine, and Superintendent of Education of Canada West, who had not hesitated to cross swords with the redoubtable George Brown of the Toronto Globe, and had not come off second best in the dispute. (32) Stanley Ryerson came of good campaigning stock. After stating that fully thirty-five per cent of the medical profession of Canada restricted their practice to some particular field, he deplored the irregularity of the training of these specialists. Some were well grounded, but many had very scanty training. A means of identifying the well-trained specialists was required. He expressed fears that the provinces would commence setting up independent standards of required training. In his opinion there should be one central body to lay down a minimum standard of qualification for the practice of a specialty. This body should be empowered to conduct examina145

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tions and issue certificates of competence. These certificates could be used by provincial licensing bodies in selecting those who might be approved for specialty practice in each province. The educational requirements of these certificates should lie midway between those of the Medical Council of Canada and the Fellowship of the Royal College of Surgeons of England or the Membership of the Royal College of Physicians of London. He suggested two years of training in the specialty following the year of general internship and proposed that the Medical Council of Canada should be the examining body. Certificates without examination might be granted at first to those who had been in specialty practice for from five to ten years, on the basis of their local reputation as specialists. Dr. Ryerson presented his ideas at the Annual Meeting of the Medical Council of Canada in the following September, but they aroused very Iittle interest. (33) The Registrar, Dr. J. Fenton Argue, was instructed to get opinions on specialist certification from provincial Medical Associations, provincial licensing bodies, the Canadian Medical Association and the universities of Canada. Dr. Argue apparently did not regard the matter as being urgent, and he delayed making these inquiries for three or four months. The replies showed that, with the exception of Alberta, no province had given much thought to the matter; some believed the idea worthy of further consideration; others were quite opposed to it. (34) In his letters to the universities, Dr. Argue inquired about facilities for obtaining higher degrees in medicine. The Universities of Manitoba, Toronto, Montreal, and Laval replied that they had Masterships in Surgery. McGill stated that it had courses leading to Masterships of Science in Medicine and Medical Doctorates of Philosophy. Dr. Alan Rankin, the Dean of the Medical Faculty in Alberta, was the only one who had had personal experience with the registration of specialists. He gave a long and thoughtful reply. He agreed that the protection of the public was important and that the possession of a certificate would be an evidence of superior training and/or skill. He noted, however, that to make the plan a success, it would be necessary to persuade the family doctor to refer his patients to the holders of these certificates. He believed the Medical Council of Canada might 146

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keep the register, but the Royal College of Physicians and Surgeons of Canada should be the examining body. Ryerson pursued his campaign on certification, and raised the question at the meeting of the Executive Committee of the Canadian Medical Association in June 1934. In its report to General Council, the Executive Committee noted: "There is a growing concern and interest in the country with regard to what constitutes a specialist and who should be allowed to call themselves specialists." (35) General Council decided to appoint a committee under the chairmanship of Dr. Ryerson to study the question. There had been no mention of the Canadian Royal College in the Ryerson editorial, and the first official notice received by the College was an enquiry from the College of Physicians and Surgeons of Saskatchewan in the spring of 1934, asking for an expression of opinion regarding the use of the title "specialist" and the restrictions and conditions connected with its use. This letter was obviously prompted by Dr. Argue's inquiries earlier in the year. Dr. Lyman, the Honorary Secretary of the College, replied that the question had never been discussed by the College and no opinion could be given, and he reported this action to Council at the June meeting. As the College President, Dr. Duncan Graham, and two other Councillors (Fitzgerald and Primrose) were members of Dr. Ryerson's committee, it was felt that more notice should be taken of the Saskatchewan inquiry and Drs. Primrose and Gallie, with Dr. Fitzgerald as chairman, were appointed to represent the College in the study of the specialist question. The committees representing the College and the Canadian Medical Association held a joint meeting on October 23, 1934. Dr. Ryerson presented a long memorandum which he had prepared dealing with the certification of specialists, and "after discussion, it was moved by Dr. Fitzgerald and agreed that the outline presented by Dr. Ryerson be sent to the Executive Committee [of the Association] for its consideration." The proposal was a lengthy document and consisted chiefly of an expansion of the views expressed in his editorial comment in the Canadian Medical Association Journal in 1933. The following abstract will bring out the chief points: 147

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1. The Medical Council of Canada was the organized body under which should be placed the supervision of the qualifications and certification of specialists. The Council was an examining body, national in character, but under provincial control insofar that only those possessing a provincial enabling certificate were permitted to take the examinations. 2. For the control of specialists, examinations should be provided by the Medical Council, and admission to these examinations should be limited to those who possessed enabling certificates. Each province would set up its own standards regarding the required training to govern the granting of these enabling certificates. 3. An amendment to the Canada Medical Act would be required to put the plan in operation.

The memorandum went on to describe the responsibility of the provincial licensing bodies regarding the educational standards required for the granting of the enabling certificates, and the responsibility of the universities to provide suitable courses of instruction and thorough practical training in the specialties at teaching hospitals. Once more it was emphasized that the certificate would be below the levels required by the Royal Colleges. Finally, Dr. Ryerson expressed the opinion that limitation of practice to a particular specialty was neither practical nor enforceable in Canada. The meetings of the Canadian Medical Association and the Council of the College were held in Atlantic City in June 1935. The Medical Association gave tentative approval to the report, but only six members of the College Council attended its meeting, and Dr. Fitzgerald, the chairman of the College Committee, was absent. The Honorary Secretary (Dr. Lyman) read the memorandum, which aroused little interest as the College seemed to be completely out of the picture. Armed now with the tentative approval of the Canadian Medical Association, Dr. Ryerson once more presented his report to the Medical Council of Canada. It met with a very cool reception. The provincial representatives had not received any instructions from their parent bodies but the majority opinion was against the proposal, especially if it meant any amendment of the Canada Medical Act. One of the strongest opponents was Dr. A. MacGillivray Young of Saskatoon, the Member of Parliament who had sponsored the bill incorporating the Royal College in 1929. He felt that it would be extremely dangerous to open the Canada Medical Act and that the Medical Council should have nothing to do with the plan. To save his proposal from immediate defeat Dr. Ryerson moved, seconded by Dr. Pope, that further discussion be delayed until the 148

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official opinions of the provincial licensing bodies and the medical schools could be obtained. To all intents and purposes, any hope of persuading the Medical Council to undertake the certification of specialists came to an end in October 1935, when the solicitor informed the Registrar that the Canada Medical Act did not confer any such power on the Medical Council. In his presidential report at the Annual Meeting of the College in the following November, Dr. Graham referred at length to the Ryerson memorandum and stated that the College was considering the question of granting diplomas in certain specialties of medicine and surgery along lines similar to those followed by the Royal College of Physicians of London and the Royal College of Surgeons of England. Dr. Bazin now became the President of the College and he appointed a larger Committee on Specialists: Duncan Graham, Past-President, Chairman J. R. Colston, Halifax E. L. Pope, Edmonton J. G. Fitzgerald, Toronto G. A. Ramsay, London W. E. Gallie, Toronto G. E. Seldon, Vancouver George S. Young, Toronto

The new committee could do very little until the official decision of the Medical Council of Canada had been announced. It merely reported progress in June 1936, and recommended that the College continue its studies of measures for the better control of the specialists in Canada. Things however had reached a crisis in one of the specialties. The Canadian Association of Radiologists was exasperated by the delays in dealing with the specialist question. It was reported that the radiologists intended to set up an independent College of Radiology unless the Canadian Medical Association did something about the certification of specialists. The radiologists felt that there was an urgent need for such an organization to protect their interests and those of the public if the government introduced Health Insurance. A resolution to this effect was passed at the Annual Meeting of the Canadian Association of Radiologists, and the President, Dr. W. A. Jones of Kingston, sent copies to the College and the Canadian Medical Association. In September 1936, the Medical Council of Canada finally decided that because of difficulties with its Charter, the Council could do nothing about certification, and Dr. Graham's committee was now of 149

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the opinion that either the College or the Medical Association must undertake the task. In a general way, perhaps, it was felt that the College should do it, as it already conducted examinations and granted diplomas for higher qualification in medicine and surgery, but the committee felt that nothing should be done until a definite invitation had been received from the Canadian Medical Association. Even then, the College would also require the approval of the provincial licensing bodies, the provincial Medical Associations, the Medical Council of Canada and the medical schools, before definitely embarking on the project. In October 1936, Dr. Graham reported that he had been approached by the Executive Committee of the Canadian Medical Association, and had been informed that the committee intended to recommend that the College be urged to take over the certification of specialists in Canada. It appeared that the unrest had spread and that the ophthalmologists, otolaryngologists, and anaesthetists were considering the founding of Boards in their respective specialties. Something must be done at once. Council now agreed that if an official invitation were received from the Medical Association, the College would accept it. However in a decision of such importance the recommendation of its Executive Committee would require confirmation by the Annual Meeting of the Association, and it was not until a year later (October 1937) that the official invitation made its appearance on the agenda of the Royal College Council. The intervening year had not been wasted entirely, as the Committee on Specialists had drawn up tentative plans for certification. It reported that the first step would be the preparation of a general statement for submission to the interested medical bodies, setting forth the reasons why the College wished to certify specialists, what periods of training would be required, and the content of the examinations. The statement should also refer to the proposed amendments to the Charter of the College which would be required to put the plan in operation. Should the replies be favourable, then appropriate steps should be taken to amend the Act of Incorporation. In the same tentative way the committee recommended that the following branches should be regarded as specialties suitable for certification: Internal Medicine, Surgery, Obstetrics and Gynaecology, 150

HISTORY OF THE MOVEMENT

Ophthalmology, Otolaryngology, Dermatology and Syphilology, Psychiatry, Paediatrics, Orthopaedic Surgery, Urology, Neurosurgery, Radiology. The certificate for internal medicine would include the following sub-specialties: Neurology and Psychological Medicine, Gastroenterology, Cardiology, Tuberculosis, Metabolic Diseases, Endocrinology, Industrial Medicine, Physical Medicine. The certificate for surgery would include: Abdominal Surgery, Chest Surgery, Industrial Surgery. In the beginning at least, anaesthesia, pathology and bacteriology, and public health should not be included in the list of approved specialties. The committee went on to suggest the appointment of subcommittees for each specialty and the general principles to be followed in laying down the training requirements. While the majority of Council was in favour of specialist certification, the Montreal and Ottawa members were doubtful about the wisdom of granting a certificate of a lower category than the Fellowship. Dr. Bourgeois of the University of Montreal suggested that possibly university degrees of Mastership in the various specialties might be a better solution of the problem. In any case, nothing could be decided until the official invitation had been received, and the report of the Committee on Specialists was accepted only as a progress report. The next meeting of Council was held in October 1937. Apparently the certification problem had aroused considerable interest because the attendance reached the unprecedented number of twentythree members of the old and the incoming Council, and for the first time Council required two days for the transaction of its business. The officially approved resolution had arrived from the Canadian Medical Association. It had taken twelve months to go through the regular channels. It read as follows: That this Committee heartily approves of the establishment of a central board for the certification of specialists: That this Committee feels that the Royal College of Physicians and Surgeons of Canada is the body which should fulfil this function: That this Committee will co-operate in any way possible with the Royal College in undertaking the work.

RESOLVED:

151

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Council now proceeded to reconsider the June 1937 report in detail and decided that for the present no certificate would be granted in internal medicine or general surgery; the Fellowship was the proper qualification for these specialties. The granting of certificates in radiology, ophthalmology, otolaryngology, paediatrics, and dermatology and syphilology, was agreed to without question, but difficulties arose in connection with urology and orthopaedic surgery. Dr. Patch was a urologist. He was present at the meeting as one of the incoming Council and therefore had the right to enter the discussion but not to vote. He strongly supported the granting of the certificate in urology, but, strangely enough, two of his hospital confreres, Drs. Gordon and Bazin agreed with Dr. Gallie that certification in these sub-specialties of surgery should be at the Fellowship level. Dr. Patch replied that if this was the final decision, the majority of the men would join the American Board of Urology. Dr. Duncan Graham agreed with Dr. Patch that the demand for Fellowship standing was suitable for men attached to teaching hospitals, but he felt that something must be done to certify men who would never qualify for the Fellowship, and it was moved by Dr. Graham, and carried, that urology should be recognized as suitable for certification as a specialty. Apparently, Council had now gone as far as it wished in recognizing the specialties, because when orthopaedic surgery came up for discussion it was moved and carried that no further specialties be considered for the present. Dr. Graham now suggested that each of the specialty subcommittees should consist of (a) three Fellows of the College, and (b) three members of the Canadian Medical Association who were not Fellows of the College; also that, where a nationally organized society of specialists existed, this society should be invited to nominate the personnel of the sub-committee. The wording of his motion suggests that there was still some uncertainty as to whether the certification of specialists was to be the sole responsibility of the College or a joint project of the College and the Association. With the October 1937 meeting of Council the first stage in formulating the plan for specialist certification came to an end. The negotiations had lasted over three and a half years from the time when Dr. Ryerson had presented his reports to the General Council of the 152

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Canadian Medical Association and the Medical Council of Canada in 1934. In many ways the progress of these negotiations had resembled the original campaign to form a Canadian Royal College in the early 1920's. In each case the Medical Association had been unwilling, or unable, to attack a problem which had many possibilities of becoming contentious. In 1920 the question of expense had been important; the Association was in serious financial difficulties. In 1934 it was in the midst of an active campaign under the leadership of its President, Dr. J. S. McEachern of Calgary, and Dr. Routley, to consolidate the provincial Medical Associations into one homogeneous group as divisions of the parent body, the Canadian Medical Association. This was the so-called Federation Movement which reached a successful conclusion in 1938. It was therefore not a time for the Association to embark on a project so full of potential difficulties and animosities. Once again, the Medical Council of Canada had been suggested as the "logical" body to carry out the programme, and for the second time it had been ruled out by the almost insuperable difficulty of amending its Act of Incorporation. It was at this point that the youngest of the offshoots of the Association, the Royal College, was brought into the picture, and the story of the negotiations between these two bodies at certain stages had many of the qualities of a Gilbert and Sullivan opera. The directorates of the College and the Association were almost identical in 1936 and members of the committees would appear gravely on one day as members of the Executive Committee of the Canadian Medical Association, and on the next as members of the Council of the College, and business would be delayed while the secretariats of the College and the Association prepared the official communications between the negotiators. That the final success of the negotiations was due to the patient efforts and organizing ability of Dr. Duncan Graham is clearly shown by the minutes of the College Council. Dr. Graham retired from the Council in 1937 and the incoming Council appointed Dr. Patch as chairman of the Committee on Specialists.

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CERTIFICATION WITHOUT EXAMINATION The results of the 1937 elections gave evidence of the widened interest of the College. Six members of the original Council, having served the statutory two terms of office, were not eligible for reelection, and two other members had refused renomination. Amongst those elected to fill these vacancies were four well-known specialists: Dr. Jones, a radiologist and Past-President of the Canadian Association of Radiologists, Dr. Little, a paediatrician, Dr. Patch, a urologist, and Dr. Penfield, a neurosurgeon. From the point of view of specialist certification, the most dedicated of these four was Dr. Patch who served as chairman of the various committees dealing with the certificate, until his retirement in 1947. The election of Dr. Jones was also fortunate; it proved to the militant group that the College was taking a serious interest in the specialist question, and Council was the better for his first hand knowledge of the attitudes of those who were convinced that certification would play an important role in improving the quality of medical service. The Committee on Specialists under the new regime consisted of Drs. Patch, Jones, and Little, and in its first report to Council in June 1938, Dr. Patch was able to announce that sub-committees had been appointed for the six approved specialties, partly on the nomination of the organized National Societies and partly from nominees of the Canadian Medical Association where no specialist National Society existed. Five of these committees had presented reports. There was still some uncertainty regarding the periods of required training, but progress was being made in developing a uniform schedule of requirements. Dr. Patch also brought up the question of granting certificates without examination to those with an established reputation as specialists and suggested that this privilege should lapse two years after the establishment of the plan. All subsequent certificates should be granted by examination only. 155

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The President (Dr. George S. Young) was now instructed to interview the solicitors of the College and to get information as to the required procedure for obtaining a suitable amendment to the Charter. At the October 1938 meeting, Dr. Young reported on his interview with the solicitors, Messrs. Fennell, Porter and Davis of Toronto. He made special reference to their advice that the amendments dealing with the certificate should be in general rather than specific terms. After considerable discussion of the text of the proposed amendments to Sections 10 and 11 of the Act, Council agreed to the amendments drawn up by the solicitors. It was also agreed that the various interested medical bodies should be informed of the contents of these amendments and that their approval should be obtained. In June 1939, Dr. Young reported that most of the opinions had been favourable, but certain changes had been required to meet the various objections received, and he referred to the useful work done by Dr. Bazin and Dr. Patch in meeting these objections. Finally, he announced that thanks to the efforts of Senator J. H. King and Dr. A. MacGillivray Young, the Act had been passed and had received Royal Assent on June 3, 1939. Dr. Penfield became the President in October 1939, and almost the whole of his two-year term of office was required to arrive at an acceptable schedule of training for the certificate. The original suggestion in 1936 had been a five-year period consisting of one year general internship, two years of hospital training in the specialty, to be followed by two years of study and practice of the specialty. Certain of the specialty sub-committees had suggested periods of training which were even longer than those required for the Fellowship and it was not until 1941 that it was finally agreed that the schedule should call for one year general internship, three years of resident training, and one year of supervised practice of the specialty. The regulations for the granting of certificates without examination were finally approved in 1941. Such certificates would be granted to those who had graduated five or more years ago and who held diplomas or higher degrees, or who had an established local reputation in a particular specialty. The war had made serious inroads on the finances of the College and once again the question of the expense of this venture into certif156

CERTIFICATION WITHOUT EXAMINATION

ication made its appearance in the discussion. A suggested fee of ten dollars for the certificate without examination had become generally known, and the minutes, which were verbatim, record a period of charge and countercharge as to how this information had gotten abroad, in the course of which the President, Dr. Penfield, made the cryptic remark that there had been a leak. The final decision as to the amount of the fee had to await a meeting some six or twelve months later. In the course of this discussion many prophecies were made as to the future of the certificate. Dr. Peters, usually an accurate observer, suggested that the demand for certification would subside after the first rush of applications and that revenue from the certificate would be a mere pittance. Dr. R. J. Collins of Saint John, N.B., felt that one thousand might apply, but most members of Council felt that this was a very optimistic figure. Subsequent experience has shown these opinions to have been very wide of the mark. Dr. Mathers was elected President in October 1941, and a new Committee on Specialties was appointed. Up to this time the organization of the certification programme had been delayed by the long periods between the meetings of Council. The new committee was given power to act for Council and was the predecessor of the Executive Committee of Council. Its members were Dr. Patch (Chairman), Drs. Bazin and Leon Gerin-Lajoie of Montreal, Dr. Little of London, and Dr. Richards of Toronto. The addition of Dr. Bazin and Dr. Gerin-Lajoie brought two excellent organizers to the committee, and much more rapid progress was made. The fee for the certificate and the actual wording of the diploma were settled. Arrangements were made to extend the list of specialties approved for certification by the addition of general surgery, internal medicine, obstetrics and gynaecology, neurology and psychiatry, and orthopaedic surgery; and in 1942 anaesthesia was added to the list. Council decided that in its early stages the granting of certificates without examination should be by invitation. The sub-committee of each specialty was asked to prepare a list of persons who in their opinion, were recognized as specialists in their particular branch of medicine, persons who had been in practice five or more years, and whose moral and ethical standing was satisfactory. After Council had 157

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approved these lists, each of these persons would be invited to fill out an application form, and on receipt of these forms and the payment of the prescribed fee, the College would issue a suitable certificate. On this basis, Dr. Mathers reported to the Annual Meeting in October 1942, that the College was now prepared to issue 43 certificates in anaesthesia, 18 in dermatology and syphilology, 41 in urology, and 50 in paediatrics, a total of 152. By 1943 the number of certificates without examination had risen to 375, and in 1944 the number had reached 1,157. There were now nine fully recognized specialties. Holders of the College Certificate in October 1944 Anaesthesia 139 Dermatology and Syphilology 35 Obstetrics and/or Gynaecology 91 Otolaryngology 88 Paediatrics 114

Radiology Internal Medicine General Surgery Urology

97 226 305 62 Total 1,157

By 1945 most of the well-known specialists in the consultant field had been informed of the new powers of the College, and had been invited to make application for the certificate of specialism. The training requirements had become known and it was decided to send a circular to all practitioners in Canada who had graduated prior to 1939, drawing the certification programme to their attention. The circular gave the details of the required periods of training, and stated that application forms might be obtained from the College office. The circular stated that the privilege of certification without examination would be withdrawn shortly and that prompt action was required if the application was to be considered. Approximately 780 applications were received as a result of this announcement, of which a little over 400 were approved for certification without examination. Many of the refusals were based on insufficient training, and the applicant was informed that he would be permitted to take the examinations when his training conformed with the requirements of the College. The last of the certificates without examination were granted in the autumn of 1947 when Dr. Patch, the Chairman of the Committee, noted that 3,468 certificates without examination had been issued by the College. These numbers give only a slight idea of the amount of work which had been accomplished by the Committee on Specialists and its 158

CERTIFICATION WITHOUT EXAMINATION

various sub-committees. During its most active period the Committee had been headed by Dr. Patch, with Dr. Gerin-Lajoie and Dr. M. H. V. Cameron as Vice-Chairmen. The task was almost completed by 1946 and most of the work was taken over by a new committee — the Committee on Credentials. It was a change of name rather than a change of personnel because, apart from new names in the specialties of internal medicine and general surgery, the chairmen of the specialty sub-committees continued to serve on the new committee. The Committee on Credentials — 1946 F. S. Patch, Chairman R. F. Farquharson R. J. Collins A. D. McLachlan Edmond Dube J. R. Fraser R. I. Harris W. V. Cone J. F. Burgess H. S. Little A. T. Mathers G. E. Richards

Urology Internal Medicine Internal Medicine General Surgery General Surgery Obstetrics and Gynaecology Orthopaedic Surgery Neurosurgery Dermatology and Syphilology Paediatrics Psychiatry and Neurology Radiology

Each of these chairmen was assisted by a sub-committee of at least three members, many of whom were not Fellows of the College. The new committee took over the scrutiny of the credentials of those who wished to take the Fellowship and certificate examinations, and the attention of the Committee on Specialists was directed to matters of general policy.

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CHAPTER XXIII

CERTIFICATION BY EXAMINATION THE REQUIRED TRAINING Wartime restrictions and delays prevented the holding of frequent meetings of the College committees, and during the period when the certificates were being granted without examination (1942-46) there were no changes in the training requirements. Briefly, the regulations called for one year of general internship, two years of hospital training in the specialty and two years of supervised practice. With the institution of the examinations in the autumn of 1946, much more detail was required and the amended regulations were published in March of that year. The new brochure stated that the examinations would be partly written, and partly oral and clinical. They would be conducted by two specialists. The written would consist of two papers — one on the principles and practice of the specialty, and the other on the application of the basic sciences to the proper understanding of the specialty. Admission to the examinations would be governed by the following regulations: (a) Satisfactory moral and ethical standing. (b) Graduation from an approved medical school. (c) Documentary evidence of supervised study and/or practice during an aggregate period of at least five years after graduation. (d) One year in a general internship approved by Council. (e) Two years spent in study and training in the specialty in a hospital or hospitals organized for the training in the specialty. (f) A period of training spent in internal medicine or general surgery and the basic medical sciences necessary to the proper understanding of the specialty. (g) Study and/or practice of the specialty for the remaining portion of the five-year period. (h) Suitability of training on an interrupted or part-time basis to be deter-. mined by Council.

The pamphlet continued that the written examinations would be held at ten centres in Canada, and, if successful, the candidate would be notified to appear at the centre chosen for the oral and clinical examinations. The candidate might elect to be examined in either 161

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English or French, and the fee would be twenty-five dollars for the examination and, if successful, a further fee of twenty-five dollars for the certificate. THE FIRST CERTIFICATE EXAMINATIONS The first written examinations were held in September 1946, and the successful candidates came to Montreal for the orals and clinicals in October. There were candidates in eleven of the fifteen approved specialties. A total of 73 had applied for permission to write the examinations but only 57 had been approved, and of these 36, or 63 per cent, were successful. The following table gives the details: TABLE V The 1946 Examinations for the Specialist Certificate APPLICATIONS APPLICATIONS RECEIVED APPROVED PASSED FAILED

SPECIALTY

Anaesthesia Dermatology and Syphilology General Surgery Internal Medicine Neurology and/or Psychiatry Neurosurgery Obstetrics and/or Gynaecology Ophthalmology Orthopaedic Surgery Otolaryngology Paediatrics Pathology and/or Bacteriology Physical Medicine Radiology Urology Total

14 4

14 3

16 14 3

8 10 3

0 1 0 0 1

0 1 0 0 1

2 0 1 0 0 0

2 1 1 16

0

1 1 1 14 0

0 1 0 9 0

73

57

36

9

2 5 7

5 1 3 3 1 0 0 0 0 1 1 0 1

5 0 21

In 1947 there were 166 candidates, and 80 per cent were successful. The number increased rapidly during the next three years, and 388 wrote the examinations in 1950. Then there was a pause and the number remained stationary until 1953, but by 1955 it had risen to 475 and reached its peak in 1959 when 662 appeared for the certificate 162

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examinations. For the first ten years approximately 80 per cent of the candidates were successful, but since that time there has been a gradual fall in the percentage to more conservative and sounder levels. TABLE VI Certificate Examinations 1946 - 1960 Successful Candidates YEAR

TOTAL

NUMBER

1946 1947 1948 1949 1950 1951 1952 1953 1954 1955 1956 1957 1958 1959 1960

57 166 207 282 383 365 335 364 451 475 534 665 633 662 621

36 135 160 211 313 295 284 297 355 351 368 397 458 414 364

PER CENT

63 82 77 74 82 81 85 82 78 74 69 60 72 62 58

A number of reasons might be suggested for the increasing percentage of unsuccessful candidates: for example, a stiffening of the examination policy, or imperfections in the facilities for postgraduate training, or perhaps a decline in the intellectual calibre of those entering the medical profession due to fears of state medicine and the greater attraction of other professions. These and many others appear in the minutes of Council. It is quite true that the College examinations were reorganized about that time and that the examining boards were placed under stricter control. It had been almost impossible in the early days to find specialty examiners amongst the Fellows of the College. The introduction of the Fellowship examinations as modified for the specialties has solved this problem. The standards of the examinations were definitely raised by these changes. The discussion on imperfections in the training plan centred about the question of hospital approval. A large number of smaller 163

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institutions had been approved for a single year of training. Were the certificants able to get sufficient practical experience and adequate instruction in these smaller hospitals? Reference is made to this problem in the 1959 edition of The Regulations and Requirements of Graduate Training, where it is stated that: "While no precise regulations about it have yet been made, the College disapproves, in principle, of resident training being taken in a succession of hospitals approved for training only for one or two years." (36) The great number of candidates for the Fellowship and certificate made it impossible to apply this rule in assessing the training programmes of the candidates. It is interesting to note that the percentage of failures began to rise shortly after the sudden increase in the number of candidates which occurred in 1954. This has lent some weight to the suggestion that the facilities for training should be re-examined. The third suggestion regarding the popular appeal of medicine as a way of life was made in 1957. Like many general statements, it could be made the subject of endless discussion. The popularity of the different professions tends to go in cycles, and statistics show that there was a definite falling off in the number of admissions to the medical schools in the late 1950's. Certain of the schools might have been tempted to lower their standards, but this could not have played a role in the increasing failures of 1956-60. These candidates had entered medical school nine or ten years earlier. Taking all things into consideration, the most probable cause was the increase in the standards of the examinations.

164

CHAPTER XXIV

THE STATUS OF THE CERTIFICATE THE LOCATION OF THE SPECIALISTS Since the introduction of specialist certification in 1942 approximately 8,500 physicians and surgeons have been granted certificates in one or more special branches of medicine. Of these, almost 7,800 are still in active practice and constitute about 39 per cent of the 20,000 registered practitioners of the country. Slightly over 2,000 of these certificants are Fellows of the College and received the certificate with their Fellowship, 4,074 passed the certificate examinations between 1946 and 1959, and the remainder are persons who were granted the certificate without examination between 1942 and 1946. It will be recalled that Council had felt that the demand for the certificate would be small and would soon cease. As time went by and there was no falling off in the number of candidates, the College became more and more concerned not only about this splitting of the profession into smaller and smaller groups but also about the future prospects of the holders of the certificate. Where would these specialists practise, and what proportion would be able to limit their practice to their specialty? Council would have been even more disturbed had it been brought to its attention that a 1954 survey of the profession by the Department of National Health and Welfare had revealed that there was a substantial number of other doctors who limited their practice to some specialty. (37) A general picture of the location of these certificated specialists may be obtained from this survey and from an independent study of the College records made a year or two later. This showed, for example, that where the group was small or where much equipment was required, as in dermatology, physical medicine and rehabilitation, therapeutic radiology, neurosurgery, thoracic and plastic surgery and urology, most of the specialists were located in the metropolitan areas, teaching centres, and the cities, near the larger hospitals. The same was true to a lesser 165

THE ROYAL COLLEGE OF PHYSICIANS AND SURGEONS OF CANADA

degree of the paediatricians. The separate specialties of ophthalmology and otolaryngology were more usual in the larger cities, while the practitioners of the joint specialty of ophthalmology and otolaryngology were located in the smaller centres as also were the diagnostic radiologists. The internists, and gynaecologists and obstetricians, occupied a middle position — in the larger cities and also in the teaching centres of every size. It is interesting to note that general surgeons formed the largest group of specialists in small town practice. On the other hand, the College survey showed that Fellows of the College were much more heavily represented in the university centres and metropolitan areas. The practice of medicine is in a transition state at the moment. Many feel that the pendulum has swung too far towards specialism and that some correction is inevitable. Members of this group suggest that many of the newly certificated specialists will revert to general practice, but the 1954 government survey indicates that only ten per cent of those holding the College certificate of specialism have given up their specialist status and gone back to general work. RECOGNITION OF THE CERTIFICATE BY THE PROVINCIAL LICENSING AUTHORITIES The specialist certificate of the College confers no legal rights upon its holder. It is merely a proof that the certificant has taken a prescribed course of training and has passed certain examinations. The College is only an examining body. The official recognition of the applicant as a specialist is the prerogative of the provincial authorities. In British Columbia, Ontario and Saskatchewan the College certificate is the only proof of special training that is recognized by the provincial Colleges of Physicians and Surgeons. In Alberta the College certificate is required, except in certain sub-specialties for which the College does not issue a certificate, but the provincial authority reserves the right to refuse admission to the Register of Specialists where it so decides. This right is exercised very rarely. In Manitoba the Royal College certificate is required for registration as a specialist, but the province reserves the right to recognize other degrees or diplomas in exceptional circumstances. 166

THE STATUS OF THE CERTIFICATE

The Province of New Brunswick amended its Medical Act in 1958, and the Board is now empowered to grant certificates of specialism. The Act allowed the admission of an older group of locally recognized specialists, but from 1960 all further entries on the Provincial Register must be holders of the certificate of the Royal College. Newfoundland has no official register of specialists, but, as a matter of convenience, the Registrar of the Newfoundland Medical Board publishes a list of those holding certificates and higher degrees in the form of an appendix to the Annual Register. This appendix has no official status and does not appear in the official Gazette. In Nova Scotia, a licensed practitioner may have additional degrees appended to his name on the Register of the Provincial Medical Board upon payment of a fee, but there is no official list or register of specialists either in Nova Scotia or Prince Edward Island. The College of Physicians and Surgeons of the Province of Quebec conducts its own certificate examinations and has not recognized the certificate of the Royal College since the commencement of its own examinations in 1956. No province has made any demand that a specialist limit his practice strictly to his specialty, although the College of Physicians and Surgeons of Saskatchewan reserves the right to strike off the name of a specialist who fails to limit his practice.

167

150TH ANNIVERSARY, ROYAL COLLEGE OF SURGEONS OF ENGLAND. PRESENTATION OF THE SCROLL OF CONGRATULATIONS BY LORD BESSBOROUGH, THE FIRST HONORARY FELLOW OF THE CANADIAN ROYAL COLLEGE.

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LAYING OF THE CORNERSTONE OF THE NEW BUILDING, JUNE I, 1959. HIS EXCELLENCY THE RT. HON. VINCENT MASSEY, GOVERNOR—GENERAL OF CANADA.

OFFICIAL OPENING OF THE NEW BUILDING, J:\\ _':1RY 19, 1960. THE RT. HON. JOHN G. DIEFENBAKER, PRIME MINISTER OF CANADA; C. E. HCBERT, VICE-PRESIDENT OF SURGERY AND D. A. THOMPSON, PRESIDENT OF THE COLLEGE.

THE COUNCIL ROOM AND COUNCIL IN SESSION.

PART IV Offices and Administration of the College

CHAPTER XXV

OFFICES OF THE COLLEGE AND ITS EARLY EXECUTIVE OFFICERS The business affairs of a scientific body have a relatively unimportant place in the history of the institution, but certain explanatory notes may be of interest in tracing the gradual expansion of the College and its activities. In the course of the thirty years since its incorporation, the College has weathered the storms of the financial depression of the early 1930's and of World War II. Unlike many of the Royal Colleges, the Canadian College has never received any grant from the Government. Its general reserve represents monies which have remained each year after the payment of its operating expenses, and on a good many occasions it was necessary to use part of the admission fees to meet its current needs. Measures of economy were therefore an important feature of College policy in its early days, and lack of funds prevented the establishment of its own office until 1946. This enforced economy was due in part to a decision made at the Inaugural Meeting that there should be no annual dues. It had been hoped that the income from the examinations and the interest on the invested admission fees would cover the operating expenses of the College. These hopes were not fulfilled. The depression ushered in a period of falling interest rates with a corresponding drop in investment income, and it was not until 1939 that the examination fees were sufficient to meet even the expenses of the Boards of Examiners. For the first three years the affairs of the College were conducted in the offices of the Canadian Medical Association, on College Street, Toronto, with Dr. Routley as Registrar-Secretary. The College paid no rent and the only expense was a small charge for secretarial services. In November 1931, Dr. E. W. Archibald drew the attention of Council to the by-law which called for the location of the College headquarters in Ottawa. He suggested that the time had come to implement the by-law and to remove the offices to their permanent location from the temporary quarters in Toronto, so kindly provided 171

THE ROYAL COLLEGE OF PHYSICIANS AND SURGEONS OF CANADA

by the Canadian Medical Association. This motion was seconded by Dr. Bazin. There was some opposition to this motion by those who felt that for reasons of economy the present arrangement should be continued until the College was more firmly established. However, Dr. Routley supported the motion and stated that in his opinion it would be desirable, as soon as feasible, to remove the College from its apparent close relationship with the Canadian Medical Association, and also to appoint an executive officer to replace him. He had found it embarrassing at times to be at the same time the Registrar-Secretary of the College and the General Secretary of the Association. The motion was carried and Dr. Starr was directed to name a committee to study the question of removing the office to Ottawa. He appointed Dr. Meakins as chairman of this committee, and the other members were Dr. Archibald and Dr. Chipman, of Montreal. They were directed to study the question and to report on the costs of suitable accommodation and the required staff. The close connection of the two organizations had been particularly embarrassing during the election of the Charter Fellows. It will be recalled that over a thousand practitioners had accepted the invitation to submit qualification forms for admission to the College in 1931. Most of these were members of the Canadian Medical Association. Only 263 of these applications had been approved, and 786 had been rejected. It would have caused much embarrassment to the Association if these notices of rejection had gone out to its members under the signature of the Registrar-Secretary who was also the General Secretary of the Association. Council decided that the notices of acceptance should go from Toronto, but that the President should send personal letters of regret, from his Montreal office, to those who had been rejected. In his Annual Address the President made reference to the animosity shown by some of these persons, and in one of his later letters he remarked that when he had finished signing these notices he would be one of the most unpopular men in the country. The Housing Committee made a preliminary report to Council at its meeting in June 1932. It stated that, with the selection of the Charter Fellowship and the formulation of the constitution and by-laws, the work of organizing the College had been completed, but no policy had been laid down regarding its future activities. The committee had 172

OFFICES OF THE COLLEGE AND ITS EARLY EXECUTIVE OFFICERS

been guided in its thinking by the very limited financial resources of the College, and had come to the conclusion that the examinations were its first responsibility. They should be examinations worthy of the name, and the chief function of the office should be the arrangement of these examinations, the convening of meetings of Council and preparations for the Annual Meeting. A small office and one stenographer would be quite sufficient for this work. During its visit to Ottawa the committee had interviewed Dr. H. M. Tory, who had recently been appointed President of the National Research Council. As a result of this visit, Dr. Tory had suggested that space for the College office might be available in the new National Research Building. After considerable discussion, the Council accepted the report in principle and Dr. Meakins and his committee were directed to consult the National Research Council about the available accommodation and the expense involved. Everything seemed to be in order at the November 1932 meeting of Council. It was reported that Dr. Tory had agreed to give the College, free of rent, the use of a room for its office, to supply the ordinary office furniture, and to allow the College to use the boardroom for its meetings of Council and the auditorium for its Annual Meetings. The secretarial expenses were estimated as between a thousand and fifteen hundred dollars a year. The offer was accepted, with thanks. Dr. Routley now resigned as Registrar-Secretary, after three busy and useful years, but he remained in charge of the office until its final transfer to Ottawa in April 1933. The duties of the Registrar-Secretary were divided, and Dr. Lyman was appointed as Honorary Secretary and Dr. Valin as Honorary Treasurer. Both were residents of Ottawa. Dr. Lyman was a graduate of McGill University and a prominent consulting physician. Dr. Valin, also a graduate of McGill, was a wellknown surgeon, and very active in the affairs of L'Association des Medecins de Langue Française de l'Amerique du Nord (later du Canada) and, at the time, its Director-General. Ottawa became the headquarters of the College as of April 1933, and the archives contain a list of the contents of some ten boxes of documents which were sent to Ottawa by Dr. Routley. 173

THE ROYAL COLLEGE OF PHYSICIANS AND SURGEONS OF CANADA

The Transactions of the 64th Annual Meeting of the Canadian Medical Association (1933) contain the following note of farewell: The Royal College of Physicians and Surgeons of Canada: At our Vancouver Meeting in 1920 the Association sponsored a resolution looking to the formation of a Royal College of Physicians and Surgeons of Canada. Nine years later, the College became a reality by an Act of Parliament of the Dominion of Canada, and, with the gracious consent of His Majesty, We are glad to The King, the use of the word Royal' was permitted report that the College has established its headquarters in Ottawa, with Dr. W. S. Lyman as Honorary Secretary and Dr. R. E. Valin as Honorary Treasurer. Council will no doubt wish the College every success in such work as it may undertake. (38)

The suggested location of the new office proved most inconvenient for Dr. Lyman and he informed the Council in the following June, "that it had not yet been feasible to establish the headquarters of the College in the National Research Council Building, as had been anticipated." Council expressed its regrets at this delay, and hoped that it would soon be possible to complete the arrangements for opening the office in the Research building; but it was some time before this happened, and the work of the College was carried on in Dr. Lyman's residence on Somerset Street for the next six years. During this time most of the correspondence was typed by Dr. Lyman's secretary, Miss Doris Thompson (later Mrs. King), but the minutes of the meetings of Council and the Annual Meeting were prepared by a public stenographer, and the bookkeeping was in charge of the College auditors. From 1933 to 1935 very few calls were made on the services of the College office, but, with the election of Dr. Bazin as president, the office was inundated with requests for information, for reports of committees, and finally for the preparation of a list of the 1,049 persons who had applied for Charter Fellowship in 1931 with the results of their requests. Under this load, the organization of the office broke down. There was an urgent need for larger space and for more staff, and it was felt that the progress of the College was being hampered very definitely by the absence of a full-time paid secretariat. Dr. Bazin recalled the previous arrangements which had been made with Dr. Tory in 1932, and on April 14, 1936, he interviewed General A. G. L. McNaughton who had succeeded Dr. Tory as President of the National Research Council in 1935. After a rather long discussion on the objects of the College, Dr. Bazin drew attention to the generous proposal which Dr. Tory had made in 1932 regarding the provision of 174

OFFICES OF THE COLLEGE AND ITS EARLY EXECUTIVE OFFICERS

office space in the Research Building. He asked if the College could still avail itself of this offer. The College had now progressed to the stage where the secretarial work was demanding more time and thought than could properly be expected from honorary officers with secretarial assistance. A full time staff was now a necessity. General McNaughton stated that he would welcome the College into the building as soon as space became available. To provide money for this proposed expansion of the secretariat, annual dues were introduced in 1937 which produced an income of between four and five thousand dollars a year. As nothing more had been heard from General McNaughton since the interview of 1936, Dr. Bazin again wrote to him on February 6, 1938, asking when the room for the office might be expected. General McNaughton replied confirming the offer of a suitable room, free of rent, which would be available as soon as certain government agencies had quit the building. Finally, a year later, on February 21, 1939, the College took possession of Room 3018 in the National Research Building, where it remained until 1946. The ten years between 1936 and 1946 were years of great activity in the affairs of the College. During this period the Act of Incorporation was amended to empower the College to grant certificates of specialism, and the whole examination structure was changed. The primary examinations were abolished and arrangements were being made for setting up specialist examinations at both the Fellowship and the Certificate levels. All this extra work fell on the shoulders of Miss Thompson, but there are frequent complaints in the minutes about the crowded conditions at the office which prevented any increase in the staff. Fortunately, Dr. Lyman now had the assistance of an indefatigable worker in the person of Dr. Plunkett, who had gained the Fellowship by examination in 1936. He had been appointed Superintendent of Examinations in 1938, and Dr. George Young made special reference to his organizing ability in his Presidential Report of that year. Dr. Plunkett became the Honorary Assistant Secretary in 1939, and on Dr. Lyman's retirement he was appointed the Honorary Secretary of the College. During the war years he took charge of the entire examination programme and was responsible for much of the routine 175

THE ROYAL COLLEGE OF PHYSICIANS AND SURGEONS OF CANADA

work of the Committee on Credentials. Many of the letters of this period have survived in the papers of Drs. Bazin, Penfield, Mathers, and Patch, who were Presidents of the College during this time, and it is a constant source of wonder how Dr. Lyman, and later Dr. Plunkett and Miss Thompson, could have dealt with the volume of work. Dr. Lyman resigned in 1945. He had acted as Honorary Secretary for almost fourteen years. He was a kindly and diplomatic person who carried out the directions of Council with discretion, although at times without undue haste. The College showed its appreciation of his work by presenting him with an illuminated address at the time of his retirement. Dr. Plunkett now became Honorary Secretary, and he and the Honorary Treasurer, Dr. Valin, were asked to obtain suitable offices and to engage an Executive Secretary. The final approval of their arrangements was to be in the hands of Dr. Farquharson and Dr. Patch, the President and the Immediate Past-President of the College. The task of renting suitable accommodation proved difficult, and various national medical organizations were approached regarding the possibility of erecting a suitable building, but without success. Finally, in November 1946, the College took a suite of offices at 150 Metcalfe Street (the Medical-Dental Building), and after a portion of the space had been sub-let to the Community Nursing Service, the net rental amounted to ninety-five dollars a month. Miss Crocker, who had been with the Saskatchewan Anti-Tuberculosis League, was appointed as the Executive Secretary in February 1946, and with the enlarged offices she was able to engage a clerk-bookkeeper and an assistant stenographer. Miss Thompson (now Mrs. King) who had been Executive Secretary since 1939 resigned, but consented to remain until the following November when the change of office routine would be completed. The increase in staff permitted the arrears of correspondence to be dealt with, and the College was able to take over its own bookkeeping and other secretarial work. With this reorganization of the College office, Dr. Valin's term of service as Honorary Treasurer drew to a close. He wished to retire, but Council persuaded him to remain in office until 1949. An excellent administrator, he had seen the College through its most difficult days. Unlike most members of Council, he had been firmly convinced regard176

OFFICES OF THE COLLEGE AND ITS EARLY EXECUTIVE OFFICERS

ing the value of the Certificate to those in specialist practice and had insisted that a realistic charge should be made for the examinations and the diploma. The period of enforced economy had come to an end in the early 1940's, and Dr. Valin saw the College well on the way to what might be called its period of consolidation. During his treasurership the College surplus had been quadrupled, but up to the end, like all good treasurers, his reports had always preached the doctrine of economy. On his retirement the College showed its appreciation of his long and valuable service by the gift of a suitably engraved piece of silver. For the next eight years Dr. J. Antonio Lecours of Ottawa acted as the Honorary Treasurer, and the period of financial consolidation was continued. The annual fee, which had met with considerable opposition when it was introduced in 1937, had become an accepted fact and was increased in 1951. With this addition to its revenue the College was able to credit the whole of the Fellowship and the certificate registration fees to its general surplus. Dr. Lecours retired in 1957 and was succeeded by Dr. Kenneth T. MacFarlane of Montreal.

177

CHAPTER XX V1

THE NEW BUILDING The end of the war in 1945 marked a turning point in the fortunes of the College. It began to expand rapidly. In 1945 there had been 36 candidates for the Fellowship examinations. Seven years later the number had risen to 208, in addition 335 candidates had written the examinations for the various certificates, and there had been over 800 inquiries about the training requirements of the College. As a result of the excellent scientific programmes, between four and five hundred Fellows were attending the Annual Meetings which were now being held in other places owing to the uncertainties of hotel accommodation in Ottawa. By 1950 the old complaints about overcrowded offices once more made their appearance. The College had gradually taken over the whole of its suite and there was no room for expansion. The question of buying and remodelling an old building was discussed, but local regulations made it difficult to find a suitable location and the idea was set aside. In 1955 matters were brought to a head by a serious fire in the building, during which dramatic pictures were taken of the rescue of the Executive Secretary, Miss Crocker, by the Ottawa Fire Department. Once more the project of erecting a national medical building was discussed with the Canadian Medical Association, the Canadian Medical Protective Association and the Medical Council of Canada. The Medical Association did not wish to move to Ottawa and the others were still unwilling to join in the project. In view of these difficulties, it was decided to proceed independently and the Executive Committee appointed Dr. George Hooper of Ottawa as chairman of a new committee, with Dr. Malcolm. Brown of Kingston, Dr. George Williamson of Ottawa, and the Executive Officers of the College (Dr. James H. Graham, Dr. J. A. Lecours and Dr. W. Gordon Beattie) as the other members. The terms of reference for this committee were: "That the Building Committee be empowered to select a suitable site for the building and that the site be inspected 179

THE ROYAL COLLEGE OF PHYSICIANS AND SURGEONS OF CANADA

by the Executive Committee, or its representatives, prior to or at the time of the next Executive Meeting." No costs were mentioned, but at a later meeting (February 27, 1956) the construction costs were estimated as being in the neighbourhood of from one hundred and seventy-five to two hundred thousand dollars. The first problem was to find a suitable site, and once again this proved a matter of some difficulty. The federal government had quite definite plans for the beautification of Ottawa, and zoning restrictions had been set up, not only by the government, but also by the city itself. In addition, there was a Federal District Commission which owned or controlled the sale of large blocks of land with which it was unwilling to part. Again, there was the question of cost. Where was the money to be obtained? To what extent was the College entitled to encroach upon its general reserves which then amounted to some $350,000? It was found that substantial government grants had been received by the Royal College of Surgeons of England in 1800, and that the Royal College of Physicians of London had been given a grant of Crown lands in London in 1825, for a token rental of one peppercorn a year. Both of the Australasian Royal Colleges had received substantial help from their governments in the construction of their buildings. Encouraged by these precedents, Dr. Hooper waited upon His Excellency the Governor-General and later upon the Prime Minister, the Right Honourable Louis St. Laurent. Each gave him an attentive hearing but no grant was obtained. He reported the results of his efforts at the 1956 mid-year meeting of the Council. Council seemed divided in its opinion regarding the wisdom of going further with the project, and at the Annual Meeting in October 1956, certain legal questions were brought forward which tended to delay the plan. At about this time, a suggestion was made that in view of all these difficulties the College headquarters might be removed from Ottawa. This idea was not new. According to the Hansard Report covering the passage of the original Act of Incorporation in 1929, a Member of Parliament had suggested that the College probably would wish to erect a substantial building in some large city. The comment had aroused little interest at the time, but now the idea met with opposition in Council, and, at the suggestion of Dr. R. M. Janes, it was finally 180

THE NEW BUILDING

decided that the headquarters should remain in Ottawa and that a new building should be provided for the College. The first mention of what the College might need in the way of space is found in the minutes of the Executive Committee for June 1957. It was suggested that the building should be fire-proof, and be of sufficient size to house two Colleges, should it later be decided to separate the Divisions of Medicine and Surgery; that the Board Room or Council Chamber should be the central point of the building, and that a smaller room should be provided for meetings of the committees of the College. Finally, sufficient space should be allowed for future expansion, not only on the original floor plan, but also, if necessary, by the addition of an extra storey, if required. The minutes contain frequent references to the amount of time and thought which Dr. Hooper and the Building Committee devoted to the search for a suitable site for the new building. Early in the summer of 1957, the College was informed that a most desirable plot of land might be obtained overlooking the Rideau River and close to the entrance to Government House. It was located on Stanley Avenue, in the old suburb of Ottawa, known as the village of New Edinburgh. On September 19, 1957, Dr. Janes and the Ottawa members of the committee took steps to procure the land and a month later Council confirmed the purchase of the site and directed that plans of the building should be prepared without delay. A new and enlarged Building Committee was now appointed consisting of: George Hooper, Chairman G. Malcolm Brown George S. Williamson K. T. MacFarlane Louis-Phillipe Roy C. E. Corrigan Desmond Magner

The firm of Messrs. Hazelgrove, Lithwick and Lambert were engaged to prepare the plans and in October 1958 the building contracts were signed with the well known firm of James More and Sons Limited. The final plans called for a completely fire-proof building, two storeys in height, with sufficiently heavy foundations to allow for the addition of an extra storey when required. The Council Chamber (Board Room) was to be located on the upper floor, with an adjoining room for meetings of committees. There was a room for the library 181

THE ROYAL COLLEGE OF PHYSICIANS AND SURGEONS OF CANADA

and archives, offices for the President, a small lounge, and suitable space for the Secretary and the office staff. For the present, there would be a substantial amount of extra space which might be rented to a suitable tenant. The Executive Committee had been doubtful about including a system of air-conditioning, on account of its cost, but had been entirely converted by holding its meeting in the air-conditioned board room of a local publishing house, after having been driven out of the College offices by a midsummer heat wave. Building operations were commenced without delay, and on June 1, 1959, His Excellency, the Right Honourable Vincent Massey, C.H., Governor-General of Canada, an Honorary Fellow of the College, further honoured the College by graciously consenting to lay the corner-stone of the new building. It was an impressive ceremony, carried out in the presence of a distinguished gathering. Dr. J. W. Scott, President of the College, traced its history for the thirty years since its incorporation in June 1929. Dr. George Hooper then deposited the corner-stone box, containing a copy of the President's address, a list of the Members of Council and the Officers of the College, and other documents of interest. The corner-stone was laid by His Excellency. Dr. Janes, the Immediate Past-President, then presented a souvenir trowel to Mr. Massey and thanked him in the name of the College. The building was completed and occupied by the College in the following November. The final cost had been more than twice the estimates of Council in 1956 when the question of a new building had been under discussion. While the general reserves of the College had increased during the interval, they were invested in government and provincial bonds, which were at a substantial discount, if cash were required. The Committee on Finance was under the chairmanship of Dr. P. E. Ireland. He was fortunate in his choice of a financial adviser (Mr. C. H. Gundy), and thanks to a large scale refunding operation of the government, the College was able to make a considerable saving by its change from long to short term securities. With this profit, the annual capital revenue from its admission fees and the gift of the panelling and furnishings of the Council Room by Messrs. Johnson and Johnson, the total cost of the building was met from the general reserves of the College and no outside assistance was required. Messrs. 182

THE NEW BUILDING

Johnson and Johnson had made a similar gift of panelling for its Council Room to the Royal College of Surgeons of England. A generous grant by the Medical Council of Canada will enable the College to complete the equipment and furnishings of the archives and library room. This room will be a memorial to the late Sir Thomas Roddick, the founder and first President of the Medical Council of Canada. One of its features will be a portrait of Dr. Roddick by Robert Harris. The painting has been given to the College, on extended loan, by the Governors of the Montreal General Hospital. The building was opened officially by the Right Honourable John G. Diefenbaker, Prime Minister of Canada, on January 19, 1961, at the thirtieth Annual Meeting of the College. The official ceremony took place in the Council Chamber where the Prime Minister and Mrs. Diefenbaker were received by the President, Dr. D. A. Thompson, and Members of Council. The College was honoured by the presence of Her Worship, the Mayor of Ottawa, representatives of the sister Colleges in Great Britain and the United States; Dr. R. MacGregor Parsons, President of the Canadian Medical Association; Dr. Chalmers Jack MacKenzie, Past President of the National Research Council; and Dr. C. E. Corrigan, President of the Medical Council of Canada. The opening ceremonies and the addresses were televised throughout the building to a large gathering of Fellows and their wives. The headquarters building is an impressive structure, on a beautiful site, and one of which the Fellows may be justly proud.

183

Appendix

Short Biographies OF THE MEMBERS OF THE FIRST COUNCIL OF THE COLLEGE

SHORT BIOGRAPHIES

INTRODUCTION The material for the following biographies has come from private sources, from obituary notices and appreciations in the Canadian Medical Association Journal, and 1'Union Medicale du Canada, and in part from books of reference. There are many names which suggest themselves for special mention, but it seemed desirable at this stage of the development of the College, to restrict the names to a small and well defined group, a group which had to do with the first organization of the College. A survey of the eighteen members of the original Council brings out some interesting points. Two, Austin and Hadley Williams, came from England; three were born in Montreal; one each in Belleville, Brockville, Hamilton and Ottawa; the two men from the Maritime Provinces came from Pictou County, Nova Scotia; the birthplaces of the others were scattered through the Provinces of Ontario and Quebec. None of them had been born west of the Great Lakes. Of the eighteen, one was a graduate of Cambridge, England; one each from the following colleges: Manitoba, Western, Queen's and Dalhousie; two were graduates of Toronto, two of Laval in Quebec and two from the Montreal Branch of Laval University. The remaining seven were graduates of McGill. Dr. Routley, the RegistrarSecretary, was a graduate of the University of Toronto. They varied in age from 41 to 63 years, but they had one common denominator, they were all senior teachers in the medical schools of Canada. The notes on the Mighty Triumvirate and on Dr. Young, the parliamentary sponsor of the original Act of Incorporation, are based on information most kindly supplied by Dr. J. B. Ritchie of Regina. SHORT BIOGRAPHIES LORIMER JOHN AusllN, M.A., M.B. and M.Ch. (Cambridge), F.R.C.S. (England), F.A.C.S., was born in London, England, in 1881. His family moved to Bristol shortly after his birth, and there he grew up. He attended Clifton College (Bristol) and graduated B.A. in 1903. He took his M.A. and M.B. at Cambridge in 1904, and his Mastership 189

THE ROYAL COLLEGE OF PHYSICIANS AND SURGEONS OF CANADA

of Surgery in 1908. Shortly afterwards he passed the examinations for the Fellowship of the Royal College of Surgeons of England. Dr. Austin was attached for a short time to the London Hospital, but immediately upon the outbreak of war in 1914, he joined the British Red Cross, crossed to France with the "Old Contemptibles", and was taken prisoner in the autumn of the same year. He was exchanged some time later and returned to England where he joined the Royal Army Medical Corps and served as a Major until 1919. He was invited to become a member of the surgical staff at Queen's University, and came to Canada in 1920. He was appointed Professor of Clinical Surgery and Surgeon of the Kingston General Hospital in 1923. He retired from active teaching in 1944, and died in March 1945. At the time of his retirement he was awarded the Queen's Alumni Gold Medal as the man who had done most for the University during his lifetime. He was an active member of the Canadian Medical Association, a brilliant speaker and in constant demand as a lecturer on the postgraduate tours which were organized by the Association. He was a great reader, had an almost photographic memory and, according to an appreciation written by his old friend and colleague, Dr. James Miller of Kingston, most of his addresses were entirely extemporaneous. He was a good surgeon, and had a particularly soft spot in his heart for children. He was a member of the Nucleus Committee, and later of the first Council of the Royal College. He attended all nine meetings of the Council during the 1929-31 period of organization, and with Dr. W. T. Connell drew up the first regulations for admission to the Fellowship. BAzIN, D.S.O., M.D., C.M., D.C.L. (Bishop's), was born in Montreal in 1872. He attended the Montreal High School and graduated in medicine at McGill University in 1894. For the next four years he was a member of the House Staff of the Montreal General Hospital, rising to the post of Medical Superintendent. He was fond of recalling in later years, that while he was on loan to the Civic Isolation Hospital, he had given the first dose of diphtheria antitoxin in Montreal. ALFRED TURNER

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He began his association with the teaching staff of the McGill Medical Faculty in the Department of Anatomy and in the outpatient department of the Montreal General Hospital. In 1912 he was appointed Surgeon of the Hospital and became Professor of Surgery in 1924. On his retirement from teaching in 1938 he was appointed Emeritus Professor of Surgery. Dr. Bazin was in the Canadian Expeditionary Force in World War I, first with No. 9 Field Ambulance and later as Officer-in-Charge of Surgery at No. 3 Canadian General Hospital (McGill) in Boulogne. He was awarded the D.S.O. and was twice mentioned in despatches. He took an active part in the reorganization of the Canadian Medical Association at the end of the war, first as a member of Council and the Executive Committee, later as Honorary Treasurer (1923-1928), President (1928), and finally as Chairman of General Council (1930-1934). It was during his term of office that the Royal College was incorporated. Dr. Bazin had always been interested in the British system of postgraduate training, and had been a member of Dr. Primrose's committee which was attempting to set up a Canadian Branch of the Royal College of Surgeons of England. As Honorary Treasurer of the Canadian Medical Association, he probably had viewed with concern the attempt to incorporate a Canadian College with the financial backing of the Association. However, when the Association had once committed itself to the project, he became one of its most loyal supporters and one of the Nucleus Committee which was appointed to incorporate the new College. He was the chairman of the Inaugural Meeting of the Royal College in November 1929, a member of its first Council, and the fourth President of the College (1935-1937). He retired from Council in 1939, having served the College for ten eventful years. A man of immense energy, an excellent teacher and also an able organizer, Alfred Bazin was one of the leading figures in the various committees of the College. The early by-laws have all the marks of his meticulous care and he later drew up the regulations for postgraduate study for the Division of Surgery. He had a phenomenal memory, and even when well on in his eighties, was able to recall details of the early days of the College, 191

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which later study of the records proved to be correct. Organized medicine is one of the many fields where he will be long remembered. In 1951 he was awarded the Frederic Newton Gisborne Starr Gold Medal, the highest honour in the gift of the Canadian Medical Association. He died suddenly in Montreal in 1958. WALTER THOMAS CONNELL, M.D., C.M., LL.D. (Queen's), was born at the Connell Homestead, Spencerville, Ontario in 1873. The family was of Irish descent. He entered the Royal College of Physicians and Surgeons (of Kingston) in 1890, but in his third year Principal Grant persuaded the College to return to Queen's University as its Faculty of Medicine and Dr. Connell was therefore a graduate of Queen's. He was the medallist in medicine when he graduated in 1894. Dr. Connell spent a year at St. Bartholomew's Hospital, London, in the Department of Bacteriology and Pathology, and while there he noted the startling results which followed the first use of diphtheria antitoxin. He returned to Kingston in 1895, and was the first Professor of Pathology and Bacteriology at Queen's. He held this joint professorship until 1920 when he became the Professor of Medicine and Clinical Medicine. Early in 1915 Dr. Connell went to England and then to Egypt with No. 5 Canadian Stationary, later No. 7 Canadian General Hospital (Queen's). He was recalled to Canada to resume teaching and became Officer Commanding the Military Hospital established in Grant and Kingston Halls at Queen's University. He retired from the active staff of the Kingston General Hospital and the medical faculty in 1941, but continued to lecture until 1950 when he completed his 55th year of university teaching. On his retirement he was honoured by the award of an LL.D. by Queen's University, and was appointed Emeritus Professor of Medicine. Unlike most of his associates on the first Council of the Royal College, Dr. Connell had never held high office in the Canadian Medical Association. His chief interest had been with the medical faculty of Queen's University. He took an active part in the organization of the new College, was a regular attendant at meetings of the Council, and was responsible with his fellow-townsman, Dr. L. J. Austin, for the

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drafting of the early regulations governing the admission to the Fellowship and the examinations of the College. He was elected Vice-President of the Division of Medicine in 1931, and served on Council until 1937. He lives in Kingston, Ontario. PIERRE-CALIXTE DAGNEAU, M.D., Chevalier of the Legion of Honour, was born at Point Levis, Quebec, in 1877. He was educated at the Seminary of Quebec where he graduated in 1897. He was a brilliant student and was awarded the M.D. with distinction by Laval University in 1901. After a two-year internship at the Hotel Dieu Hospital, he went to Paris, and remained there until 1905. On his return to Quebec he was appointed Assistant at the Hotel Dieu on the service of Professor Michel Ahearn who was Dean of the Faculty. He joined the Laval teaching staff as lecturer on the History of Medicine, then entered the laboratories, and finally became Professor of Surgery, and in 1934 began six years of service as Dean of the Faculty of Medicine. Shortly after his return from Paris, he began a lifelong friendship with Dr. Arthur Rousseau (see p. 203), another of the junior teachers of the faculty. They made an excellent pair. Rousseau had tremendous energy but tended to be rather visionary at times. Dagneau, on the other hand, was more cautious, a thinker, one who consolidated the ideas of his friend and helped to put them into effect. Dr. Sylvio Leblond, in an appreciation of Dr. Dagneau, said that Dagneau and Rousseau were responsible for the rearrangement of the medical curriculum at Laval, the reorganization of the Faculty of Medicine, and the founding of the Roy-Rousseau Clinic, the Laval Hospital and, their last effort, the building of the St. Sacrement Hospital. To the St. Sacrement Hospital, Dr. Leblond remarks, Dagneau consecrated the last fifteen years of his life. To it he sacrificed his practice, his leisure and indeed his health. He was an excellent teacher and a surgeon of the first rank, conservative in his outlook, and devoted to his patients. He was widely read in both French and English literature, a musician, and a remarkable speaker in both languages. One who spoke simply, no rounded periods, but one whose speeches were well remembered.

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Like Rousseau, his predecessor in the Deanship, Laval was his first interest, and he maintained the importance of the Paris connection. He was a Chevalier of the Legion of Honour, and Rome made him a Commander of the Order of St. Gregory the Great, one of its highest honours open to the laity. He took an active interest in Canadian medicine as a whole. He was a member of the Executive Committee of the Canadian Medical Association, and was a Charter Fellow of the Royal College. He was elected to the first Council of the College as the Laval representative in surgery from 1929 to 1937, and served as 'Vice-President from 1931 to 1933. An excellent committeeman, he was a regular attendant and was responsible for the French translation of the earlier documents of the College. He did much to expand and cement the friendship of the French and English branches of the profession. His English counterpart in this field of endeavour was Dr. Edward Archibald, a contemporary and a man with the same characteristics of friendship, culture and surgical skill. JOSEPH EDMOND DUBS, M.D. (Laval), M.D. (Paris), Officer of the French Academy, Chevalier of the Legion of Honour, was born in Montreal in 1868. He was educated at the College of Joliette, Quebec, and graduated in medicine at the Montreal Branch of Laval University in 1894. He carried on postgraduate work in Paris and in 1896 had the great distinction of being awarded the Doctorate of Medicine of Paris. Immediately on his return to Montreal he was appointed pathologist at the Hotel Dieu Hospital, and in 1921 became Professor of Medicine at the University of Montreal and Chief of Medicine at the Hotel Dieu. He retired in 1938, and died in the following year. Dr. Dube was a remarkable man. In him the missionary spirit was strong. He was one of the founders of the Montreal AntiTuberculosis League and also of its French counterpart, 1'Institut Bruchesi. He played an important role in the foundation of the Ste. Justine Hospital for Children. A prolific writer, he was a director of the French journal 1'Union Medicale du Canada for almost 40 years. Plagued by ill-health, he rose above it and was one of the outstanding figures of French medicine in the Canada of his day.

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Dr. Dube was a member of the first Council (1929-1933) and was able to give valuable advice in the organization of the College. CLIFFORD ROGERS GILMOUR, M.D., C.M., was born in Brockville, Ontario, in 1879. He attended Bishop's College School in Lennoxville, Quebec, and graduated from the Medical Faculty of McGill University in 1903. He went to Winnipeg in 1904 and remained there until his death in 1952. An excellent diagnostician and teacher, he served on the staff of the Winnipeg General Hospital and was Professor of Medicine at the University of Manitoba from 1928 until his retirement in 1949. He was a member of the first Council from 1929 until 1931, and was elected for a second term from 1937 to 1941. He was an excellent examiner in medicine for the Fellowship, and took an active part in the organization of refresher courses for the examinations of the College during his second term of office. Dr. Gilmour was VicePresident of Medicine from 1937 to 1939. DUNCAN ARCHIBALD GRAHAM, C.B.E., M.B., LL.D. (Toronto and Queen's), Hon. D.Sc. (Western), F.R.S.C., F.R.C.P. (London), F.A.C.P., was born at Ivan, Ontario, in 1882. He was educated at the London, Ontario, Collegiate Institute, and graduated M.B. from the University of Toronto in 1905. After a period of postgraduate study and research in the fields of bacteriology, pathology and internal medicine, in Canada, the United States, and finally in Europe, he returned to the University of Toronto in 1911 as lecturer in Bacteriology. He served in World War I from 1915 to 1919, first with the Duchess of Connaught Red Cross Hospital in England, later with No. 2 Canadian General Hospital in France, and finally with No. 4 Canadian General Hospital (University of Toronto) in Salonika and Basingstoke, England. He was demobilized in 1919 with the rank of Lieutenant-Colonel. On his return to the University of Toronto Dr. Graham was appointed Professor of Medicine, the first full time appointment in the Commonwealth. He continued in this position and as Physician195

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in-Chief of the Toronto General Hospital until his retirement from active teaching in 1947, when he was appointed Emeritus Professor of Medicine of the University of Toronto. During the Second World War he was attached to the office of the Director-General of Medical Services as Consultant in Medicine from 1940 to 1942, and served on the National Research Council from 1942 to 1946. Following these appointments he was attached to the Department of Veterans' Affairs as Adviser on Medical Education and Research. In recognition of his public service he was awarded the King's Jubilee Medal in 1935, the Coronation Medal in 1937, and the C.B.E. (Civilian Division) in 1944. Duncan Graham is one of the outstanding figures in medical education in Canada, and attention is often drawn to the fact that the heads of Departments of Medicine in five Canadian Medical Schools have come from the ranks of his old residents in medicine. In 1957 the Canadian Medical Association gave him its highest honour, the Frederic Newton Gisborne Starr Award, for his services to medical education in Canada. In the field of organized medicine he served on the Executive Committee of the Canadian Medical Association for many years, and became its President in 1940. He was elected a member of the first Council of the Royal College and was the first Vice-President of the Division of Medicine. He was President from 1933 to 1935, and finally retired from Council in 1937. He acted as one of the senior examiners in Medicine for many years, and was chairman of the first Committee on Specialists. He was firmly convinced of the future success of the College, but felt that it could only fulfil its function by maintaining high standards, not only in its requirements of postgraduate training but also in the quality of its examinations. His services and advice were of the greatest value when the College undertook the task of specialist certification. A man of wide interests and culture and with a gift for happy expression, his assistance has been sought frequently at the formal meetings of the College. 196

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GEORGE CARLETON HALE, M.D., C.M., LL.D. (Western), F.A.C.P., was born in Ottawa in 1885. He was educated at Trinity College School, Port Hope, Trinity College, University of Toronto, and in 1909 graduated in medicine at McGill University. After a period of two years on the intern staff of the Montreal General Hospital and a year of postgraduate work in Germany, Austria and England, he went to London, Ontario in 1912. Immediately on the outbreak of World War I he enlisted, and until 1916 served with the 18th Battalion of the Canadian Expeditionary Force. He was twice mentioned in despatches. He was then transferred to England and was Officer-in-Charge of Medicine at the Duchess of Connaught Canadian Red Cross Hospital, Taplow, and at the Kitchener Hospital, Brighton. He was discharged from the army in March 1919. Upon his return to London, he was appointed to the teaching staff of the Department of Medicine at the University of Western Ontario, and later became the Professor of Medicine and Chief of the Department of Medicine of the Victoria Hospital. On his retirement in 1944 he was made Emeritus Professor of Medicine. He still acts as Consultant of the Queen Alexandra Sanitarium, London. In 1952 he was honoured by the award of LL.D. by the University of Western Ontario.

Dr. Hale was a member of the Nucleus Committee, charged with the incorporation of the College (1927-29), and was elected to the first Council in 1929. At the first Meeting of Council he was appointed Honorary Secretary of the Division of Medicine, and he remained on the Council until 1937. A brilliant teacher, lecturer, and a man of great personal charm, his influence has often settled what appeared to be insoluble problems. His papers have been of special value in compiling the history of the early days of the College. Lours DE LOTEINIERE HARWOOD, M.D., LL.D. (Queen's), was born

in Montreal in 1866. His family history is of considerable interest, as the name de Lotbiniere goes back to the 15th century and the reign of Louis XIII in France. The founder of the Canadian branch of the family, Louis Theandre Chartier de Lotbiniere, landed at Quebec in 197

THE ROYAL COLLEGE OF PHYSICIANS AND SURGEONS OF CANADA 1651, only forty-three years after the founding of that city by Champlain. Dr. Harwood graduated in medicine at the Montreal Branch of Laval University in 1887 and then proceeded to Europe where he did special work in gynaecology and was a pupil of the famous Professor Pozzi. On his return to Montreal, Dr. Harwood joined the staff of the Notre Dame Hospital and received an appointment at the University. He was Head of the Service of Gynaecology at Notre Dame from 1904 until his death, and was elected Professor of Gynaecology in 1910. Shortly after the death of Dr. E. P. Lachapelle, be became the Dean of Medicine of the new University of Montreal and with the support of the Faculty proceeded to reorganize the course of instruction of the Faculty of Medicine. He was responsible for the introduction of a pre-medical year and also the year of compulsory internship. Dr. Harwood was President of the Board of Trustees of the Notre Dame Hospital from 1918 and was one of the prime movers in the construction of the new building in 1921-1922. He was a corresponding member of the Societe de Chirurgie of Paris, President of the Institut Franco-Canadien, and an LL.D. of Queen's University. Dr. Harwood was elected to the first Council of the College in 1929, re-elected for a second term in 1933, and followed Dr. Calixte Dagneau as the third holder of the Vice-Presidency of the Division of Surgery. He died suddenly on May 15, 1934, during his term of office. Dr. Bazin noted in the resolution spread on the minutes of Council for October 1934: "France accorded him the honour of creating him an Officer of the Legion of Honour. A man of imposing appearance, tall, dark, with an air of authority; a pleasing voice, a stirring orator in the French language, and fluent in English; charming manners, tactful yet forceful, he was gifted to assume leadership, which he did, and responsibility, which he never shirked."

JOHN

GEORGE MCDOUGALL, M.D., C.M., F.A.C.S., was born at Blue Mountain, Pictou County, Nova Scotia, in 1869, and died at Halifax in 1950, aged 81 years. 198

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He was educated at the New Glasgow High School and taught school for some years prior to entering on his medical career. He graduated in medicine at McGill University in 1897, winning the Holmes Gold Medal for the highest aggregate standing in the medical course. After a one-year internship at the Royal Victoria Hospital in Montreal he began his practice at Amherst, Nova Scotia. He later moved to Halifax, and finally became surgeon of the Victoria General Hospital and Professor of Surgery at Dalhousie University. An appreciation appended to his obituary notice in the Canadian Medical Association Journal notes his excellence as a diagnostician, his skill as a surgeon and his outstanding qualities as a teacher. At the time of his death he was spoken of as one of the remarkable figures in Maritime medicine. He served two terms on the Council, the first from 1929 to 1931, and the second from 1937 to 1941. KENNETH ALEXANDER MACKENZIE, M.D., LL.D. (Dalhousie), was born in Pictou, Nova Scotia, in 1880. He received his preliminary education at the Pictou Academy, a celebrated school, and graduated in medicine at Dalhousie University in 1903. He was a member of the staff of No. 7 Canadian Stationary Hospital from 1916 until 1919, and was discharged with the rank of Major. In the interval between his graduation and his departure for overseas service he had been in general practice, but on his return to Canada he was appointed to the staffs of the Dalhousie School of Medicine and the Victoria General Hospital, and in 1926 was appointed Professor of Medicine and Clinical Medicine. An excellent teacher, his mind seemed to move slowly but there was no lost motion. His judgment was sound. He was a loyal and valued member of the Canadian Medical Association, and was its President in 1938-39. Dr. MacKenzie was elected one of the Dalhousie University representatives on the first Council in November, 1929. He was appointed for a second term in 1937-45, and was Vice-President of the Division of Medicine from 1941 to 1943. Although distance prevented a regular attendance at the early meetings of the Council, his knowledge of local conditions was of great value. This was especially the case when the College was under

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criticism regarding its policy in the selection of Charter Fellows. He was tactful but firm in his decisions. He died in Halifax in 1958. M.D., was born at Mariposa, near Lindsay, Ontario, in 1870, and went with his parents to Winnipeg when he was twelve years old. He belonged to the Old West. He was educated at Manitoba College and graduated M.D. from the Manitoba Medical College in 1898. He was a frequent contributor to the Canadian Medical Association Journal in its early days, and was one of those who insisted that the Association must be kept alive when its dissolution was being considered in 1920. After his internship he was appointed to the staff of the Faculty of Medicine at the University of Manitoba and the Winnipeg General Hospital. In 1922 he had been one of the Faculty Committee which had strongly recommended that a Royal College should be organized in Canada. When the College was at last incorporated he was Professor of Surgery at Winnipeg, and later he founded the MacLeanGunn Clinic which in time became the Winnipeg Clinic under Dr. P. H. Thorlakson. He was described as slow in his movements and deliberate in his thinking, but accomplished a great deal in the course of the day. He was not much given to attending meetings of committees, and retired at the end of his term on the first Council. Dr. McLean died in Winnipeg in 1946. NEIL JOHN MACLEAN,

C.B.E., M.D., C.M., Hon. M.D. (Sydney), D.Sc., LL.D., F.R.C.P. (Edinburgh and London), Hon. F.R.C.S. (Edinburgh), was born in Hamilton in 1882. He attended the Hamilton Collegiate Institute, and graduated in Medicine at McGill University in 1904. He spent the next six years in the United States, first on the Medical Service at the Johns Hopkins Hospital, Baltimore, and later as Pathologist at the Presbyterian Hospital in New York. He returned to Montreal in 1910 and was appointed Lecturer in Medicine and Pathology and Director of Experimental Medicine at McGill University. During 1913 and 1914, he studied cardiology with Sir James MacKenzie and Thomas (later Sir Thomas) Lewis in London. JONATHAN CAMPBELL MEASUas,

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From 1915 until 1919 he was with the Canadian Army Medical Corps on overseas service, first with No. 3 Canadian General Hospital (McGill), and later doing research work on soldier's heart and war gas poisoning, and, finally, as Officer-in-Charge of Medicine at the Duchess of Connaught Red Cross Hospital, Taplow, England. On July 14, 1919, Dr. Meakins was appointed full-time Christison Professor of Therapeutics and Clinical Medicine at the University of Edinburgh and Physician to the Royal Infirmary. It was during this period that he and Professor Barcroft, under the auspices of the Royal Society of Great Britain and the Rockefeller Foundation, organized an expedition to the Peruvian Andes for studies on the physiological processes of the body at high altitudes. Their host on this occasion was the manager of a large copper mine, a McGill graduate and the son of an old college employee of Sir William Dawson's time. Their studies formed the basis of his first book, Respiratory Function in Disease, which was published in 1926. Some of the earliest samples of insulin in the British Isles were prepared by Dr. Meakins in his Edinburgh laboratories. He returned to Montreal in 1924 as full-time Professor of Medicine at McGill University, as Physician-in-Chief of the Royal Victoria Hospital and Director of the University Clinic. He served as Dean of the Faculty of Medicine for ten years, and on his retirement from active teaching, in 1947, was appointed Emeritus Professor of Medicine. Dr. Meakins was a pioneer in applying scientific methods to the study of disease. His clinic developed a series of young men and women who later occupied positions of prominence in research and teaching, not only on this continent but also in Great Britain. There have been six editions of his text-book, The Practice of Medicine, since its first publication in 1936. He was elected President of the Royal College of Physicians and Surgeons of Canada at the first meeting of Council in Ottawa on November 20, 1929. A monumental task faced this group, but Dr. Meakins was an excellent organizer and one who believed in attacking problems directly. Much of the success of the College in its early years was due to the solid foundations laid by Council during his term of office. 201

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He remained on the Council until 1935, but continued to act as an examiner for the Fellowship in medicine and Chairman of the Medical Sub-Committee on Educational Standards until he returned to military service in 1942 with the rank of Brigadier. Dr. Meakins was President of the Canadian Medical Association in 1935-36. He was elected President of the American College of Physicians in 1934, and was honoured by the award of its Mastership in 1949. He died in Montreal in October 1959. In the following year members of his family generously presented his portrait by Jongers to the College for its new building. M.D., C.M., F.A.C.S., was born in Embro, near Woodstock, Ontario, in 1879. Dr. Munroe received his primary education at the Woodstock Collegiate Institute, and graduated from the Medical Faculty of McGill University in 1906. Following graduation, Dr. Munroe practised in Langham, Saskatchewan, from 1907 to 1910. At the end of that period he moved to Edmonton, Alberta, where he remained until 1915 when he joined the R.A.M.C., and served with the 101st Field Ambulance, Fourth King's Regiment, and later as one of the senior officers in surgery at the Duchess of Connaught Canadian Red Cross Hospital in Taplow, England. Dr. Munroe returned to Edmonton in 1919, and was appointed Chief Surgeon to the Soldiers' Civil Re-establishment Hospital in Edmonton. Following the establishment of clinical teaching at the University of Alberta, Dr. Munroe was appointed to the teaching staff in 1923, and became Professor of Surgery and Director of Surgical Services at the University Hospital in 1929. He continued in this position until his retirement in 1939. Following retirement from the teaching staff Dr. Munroe was granted the title of Emeritus Professor of Surgery by the University of Alberta. He was elected å member of the first Council, but refused appointment for a second term of office in 1933. Dr. Munroe continues to live in Edmonton. ALEXANDER RUSSELL MUNROE,

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EGERTON LLEWELLYN POPE, B.A. (Queen's), M.D., C.M. (McGill), F.R.C.P. (London), was born at Belleville, Ontario, in 1874. He died in Edmonton, Alberta, in 1949. He took his Arts degree at Queen's University, and received his degree in medicine at McGill University in 1900. Dr. Pope spent some years of postgraduate work in England and was awarded the Membership of the Royal College of Physicians of London and later was elected to its Fellowship. In 1907 he returned to Canada and was appointed to the staff of the Winnipeg General Hospital and the medical faculty of the University of Manitoba where, apart from war service, he remained until 1923 when he was called to the new medical school at Edmonton as the first Professor of Medicine. He retired from active teaching in 1944. Dr. Pope served overseas in the Canadian Army Medical Corps from 1916 to 1919, and was discharged with the rank of LieutenantColonel. Dr. Pope had always been a strong believer in the idea of setting up a Royal College in Canada. In 1922 he was secretary of a committee of the Manitoba Medical Faculty which had been appointed to study this question. The Committee presented a long report which strongly advocated the advisability of some such action. It was a scholarly document which dealt, in an imaginative way, with the many problems to be faced in founding such a College. He was elected a member of the first Council in 1929 and attended nearly all of its meetings. Each meeting meant a journey of at least 4,000 miles, at his own expense, and he undoubtedly is the man mentioned in the early minutes who had spent over $2,000 to attend the meetings of Council. Reappointed to Council in 1933, he was the third incumbent of the Vice-Presidency of the Division of Medicine. A man of distinguished appearance and culture, a painter of note, he was an active supporter of the artistic life of his community. ARTHUR ROUSSEAU, M.D., Officer of the Legion of Honour, was born at the village of St. Casimir de Portneuf, in 1871. After preliminary education at the village schools and by private tuition, he entered the Seminary of Quebec in 1885, and after a brilliant course he

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graduated in 1891. He received an M.D. with Distinction at Laval in 1895. He spent the next two or three years in Paris, and on his return to Quebec was appointed Director of the Department of Bacteriology, and later of Pathology, at Laval University. He was attached to the staff of the Hotel Dieu Hospital and later became its Medical Superintendent, a position which he held until he took part in the foundation of the St. Sacrement Hospital. His promotion at the University was extraordinarily rapid, and his appointment as Dean of the Faculty of Medicine in 1922, at the age of 51, upset all the precedents of the School. Dr. Rousseau was a dynamic personality and proceeded to reorganize the medical curriculum. Both teachers and students were subjected to his scrutiny. To increase the number of teaching beds, he founded or built three large hospitals, one of which, the Roy-Rousseau Clinic for Psychiatry and Nervous Diseases, was named in his honour. The Laval Hospital and the St. Sacrement Hospital completed the list. Social work and public health were amongst his many interests. He was one of the founders of the Anti-Tuberculosis League in Quebec, and a prime mover in the formation of L'Association des Medecins de Langue Francaise de l'Amerique du Nord. Well known in Paris, Dr. Rousseau was the first Canadian member of the Pasteur Institute. He was an Officer of the Legion of Honour, and also a Corresponding Member of the Paris Academy of Medicine. At the time of his death he was President of L'Association des Medecins de Langue Francaise de l'Amerique du Nord, and was making arrangements for its joint meeting in Quebec, with the French Congress of Medicine. Firmly convinced of the excellence of the French system of instruction, he inaugurated the policy of bringing eminent clinicians from France to act as visiting Professors at Laval University. According to Dr. Albert LeSage, the Editor-in-Chief of L'Union Medicale du Canada "Rousseau was not only a great physician and a great Collegian, he was also a great citizen. His personality rested on a sound foundation. The testimony of the whole population of the Province of Quebec ... proved his moral worth." 204

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He was a member of the Nucleus Committee (1927-29), attended the meeting of the Provisional Council of the Royal College at Ottawa in November 1929, and was elected a member of its first Council. A man of boundless energy, he died suddenly in 1934, at the early age of sixty-two years. FREDERIC NEWTON GISBORNE STARR, C.B.E., M.B. (Toronto),

M.D., C.M. (Victoria), F.R.G.S., F.A.C.S., was born in Thorold, Ontario, in 1867. He received his M.B. from Toronto in 1889 and the M.D., C.M. from Victoria University in the same year. After an extended period of postgraduate study in Britain, France and Germany, he returned to Canada and entered general practice in Toronto. During this time he was the assistant of Dr. W. T. Aikens, Professor of Surgery, University of Toronto. In 1906 he gave up general practice to devote himself entirely to surgery. Always a strong believer in a thorough grounding in anatomy, he served for a long period in the Department of Anatomy. He rose to be Professor of Clinical Surgery at his Alma Mater and head of a Division of General Surgery at the Toronto General Hospital. He was Consulting Surgeon for the Hospital for Sick Children, the Toronto Western Hospital, and the Women's College Hospital. On his retirement he was appointed Emeritus Professor of Clinical Surgery by the University of Toronto. In the resolution spread on the minutes of the Royal College at the time of his death Dr. W. E. Gallie noted, "In his prime and in his later years, Dr. Starr was one of the ablest and most distinguished surgeons on this continent." During World War I Dr. Starr served in France with the University of Cambridge Unit in the Royal Army Medical Corps, was twice mentioned in despatches and became a Surgical Consultant to the Imperial Forces in France. In 1919 he was awarded the C.B.E. (Military Division) for his distinguished service. For over forty years he made important contributions to the cause of organised medicine and medical education in Canada. He was Secretary of the Canadian Medical Association from 1893 to 1901, a member of its Council and of the Executive Committee and finally its President from 1927 to 1928. 205

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He gave generously of his time to other medical organisations and was honored by election to the Vice-Presidencies of the American Surgical Association and the American College of Surgeons. He was President of the Toronto Academy of Medicine and a member of the Board of Governors of the University of Toronto. In 1925 he had the unusual distinction of being elected Vice-President of the British Medical Association. It was during his term of office as President of the Canadian Medical Association that the campaign for setting up the Royal College of Physicians and Surgeons of Canada was successful. Dr. Starr was appointed chairman of the Nucleus Committee which was charged with the responsibility of having the College incorporated by the Canadian Parliament. There were many difficulties, but the final acceptance of the plan and the granting of the Charter were tributes to the national reputation and the careful work of Dr. Starr and the members of his committee. He was a valued member of the first Council and Vice-president of the Division of Surgery of the College. Two years later he was elected its President. He died in Toronto in April 1934. A man of great personal charm and tremendous energy, he devoted a large part of his life to the furtherance of postgraduate medical education and the constant improvement of surgical standards in this country. The F. N. G. Starr Memorial Award of the Canadian Medical Association for distinguished service by members of the medical profession in Canada was established in his memory by his wife. HENRY THOMAS HADLEY WILLIAMS, M.D., LL.D. (Western), F.R.C.S. (England), was born in Devon, England, in 1868, and came to Canada as a boy. He graduated from the old Western Medical College at London, Ontario, in 1889, and later took postgraduate work in England where he was awarded the Fellowship of the Royal College of Surgeons of England in 1899. On his return to London, Ontario, he was appointed to the staff of the Medical Faculty of the University of Western Ontario and was attached to the Victoria Hospital. He later became consulting surgeon of St. Joseph's Hospital.

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Dr. Williams saw active service in World War I, when he was Officer-in-Charge of Surgery at Orpington Hospital in England for two years, with the rank of Lieutenant-Colonel. Following his return to Canada he acted as consultant in surgery for the Department of Soldiers' Civil Re-establishment in the western area of Ontario: he rose to become Professor of Surgery at the University and Senior Surgeon of the Victoria Hospital. On his retirement he was awarded the LL.D. by his University. Dr. Williams attended the meeting of the provisional Council in November, 1929, and was elected a member of the first Council. He was not a great committeeman, but apparently was a believer in the future of the College, because the minutes of Council (1933) show that his widow offered his case-books to the College shortly after his death. Dr. Williams would appear to have been an interesting personality, with a busy practice. He died of a heart attack on February 23, 1932, while making his rounds at St. Joseph's Hospital. Apart from his professional activities he is remembered as an ardent and successful golfer, and he is probably one of the few doctors in Canada who had an excellent golf course laid out on his country estate. THOMAS CLARENCE ROUTLEY, C.B.E., M.D. (Toronto), LL.D. (Queen's, Dalhousie and Toronto), Hon. D.Sc. (Laval), the first Registrar-Secretary of the College, was born in Victoria County, Ontario, in 1889. He was educated in the Lindsay Public Schools and the Parkdale Collegiate Institute in Toronto, and graduated in medicine at Toronto University, M.B., in 1915. He received his M.D. (Toronto) in 1930. Immediately after graduation, he enlisted in the Royal Army Medical Corps and served for four years with the British and Canadian Forces overseas during the first Great War. On demobilization in 1918, he was appointed Secretary of the Ontario Medical Association and continued in that office until 1938. In 1921, when the affairs of the Canadian Medical Association were at their lowest ebb, Dr. Routley became the Associate Secretary of the parent association and its General Secretary two years later. Here he remained until retirement in 1954. He was elected President of the Association and also of the British Medical Association in 1955.

207

THE ROYAL COLLEGE OF PHYSICIANS AND SURGEONS OF CANADA Two years later he was appointed Consultant General of the Association and Managing Editor of the Canadian Medical Association Journal. An organizer of the first rank and a brilliant inspirational speaker, the present position of the Canadian Medical Association is a lasting tribute to his energy and skill. In 1948 the Association awarded him its greatest honour, the Starr Memorial Medal. For four years during World War II he acted as Executive Director of the Canadian Medical Procurement and Assignment Board, and in 1945 was awarded the C.B.E. for his war service. At the conclusion of the war he was instrumental in the founding of the World Medical Association and was its first Chairman of Council. He served on many of its committees and is now the ConsultantGeneral of that body. When the Royal College of Physicians and Surgeons of Canada was incorporated in 1929, the Act directed the General Secretary of the Canadian Medical Association to call together in Ottawa all those who were entitled to become Charter Fellows of the College. It would be the duty of this group to elect a Council and such officers as it deemed necessary. Dr. Routley acted as convener of the meeting and later as its secretary. It was at this meeting of the provisional Council in November 1929 that he was elected the first Fellow of the College and was appointed Registrar-Secretary. He served during the first crowded years of the College and when the organization was completed, he retired in 1932. JOHNSTONE, MOORE and LOW The Mighty Triumvirate These three men might be called the Fathers of the College. They made an admirable team. It is said that David Scott Johnstone provided the inspiration, Samuel Ernest Moore kept the idea alive, and David Low had the necessary ability and drive to carry the plan to a successful conclusion. DAVID SCOTT JOHNSTONE was a graduate of the University of Toronto and went to Regina in 1905, shortly after his graduation. With a number of his colleagues he opened a cottage hospital which later became the Grey Nuns Hospital of that city. He saw service in 208

SHORT BIOGRAPHIES

World War I from 1914-18, first as a surgeon in England and later, in France, as the radiologist of No. 3 Canadian General Hospital (McGill) at Boulogne. Johnstone was a member of one of the American Surgical Societies, which later was absorbed by the American Surgical Association. He seems to have had contact with a good many well-known American surgeons of the day, and his election to the Charter Fellowship of the Canadian College was a tribute to his merit. A huskiness of voice and a troublesome cough prevented his being an effective speaker, and, according to Dr. J. B. Ritchie of Regina, he was at his best at small informal gatherings. He appears to have been the power behind the scenes in the group. Dr. Johnstone died in 1960, aged 81 years. SAMUEL ERNEST MOORE was also a Toronto graduate. Like Dr. Johnstone, he began his practice in Regina in 1905, after a period of internship in the United States. Always interested in public service, he was a kindly man and was the perennial Santa Claus at the Christmas celebrations of the Regina General Hospital. Dr. Moore was an excellent speaker. He had the gift, so dear to the politician, of creating an atmosphere and leaving very little for his opponents to seize upon and to use against him. Johnstone remarked after one of his speeches: "That was a hell of a fine speech, Sam, but you didn't say anything." Like the other members of the Triumvirate, he was a tenacious fighter for matters of principle.

He was the only person who sent a telegram of congratulation to the College at the time of its Inaugural Meeting. In 1954 Dr. Moore prepared a short history of the founding of the College, but unfortunately it reached the College too late for inclusion in the programme. It is now in the College archives. Dr. Moore died in 1956. DAVID Low was the third man in the "Mighty Triumvirate". The first two had been born in Canada. Low, on the other hand, came to Canada with his parents from Bainsford, an estate near Kirriemuir, Angus, Scotland. Kirriemuir is the town described by J. M. Barrie in his book A Window in Thrums.

209

THE ROYAL COLLEGE OF PHYSICIANS AND SURGEONS OF CANADA

Low graduated from McGill in 1889 when he was twenty years old. He had to wait until 1890 to receive his degree and spent the year as an intern at the Montreal General Hospital. During the summers of his student days he worked on the gangs constructing the Canadian Pacific Railway, and he went west immediately after receiving his degree. After a short stay in Prince Albert, Saskatchewan, he decided to locate in Regina and he described his trip from Prince Albert to Regina in a letter written to Dr. John Valens in 1935. (39) He first went to Saskatoon which was then a small collection of buildings, crossed the river by ferry and went to Regina by the new railroad which was still in the hands of the contractors. He remained in Regina until his death in 1941. On the fiftieth anniversary of his arrival, the city held an enormous picnic in his honour at which the chief speaker was the Lieutenant-Governor of Saskatchewan. Dr. Low began almost as a saddle-bag doctor. Roads were few and far between in those early days; seriously ill patients could not be transported, and Low was often called upon to make long trips in all kinds of weather. He narrowly escaped death on a number of occasions. In later life he was fond of speaking of himself as a small town practitioner; but a photograph taken in Montreal while he was President of the Canadian Medical Association was much more suggestive of the successful city family doctor of the day. He was extremely proud of his Highland descent. He was a "Bonnie fechter", and his driving power had much to do with the final incorporation of the Canadian Royal College. DR. ALEXANDER MACGILLIVRAY YOUNG was the parliamentary sponsor of the College Charter. He was born at Millsville, Pictou County, Nova Scotia, in 1878. He was educated at Pictou Academy and took his degree in Arts at Dalhousie University. He graduated in medicine at McGill University in 1905. After a year's internship at the Montreal General Hospital, he moved to Saskatchewan where he entered general practice. He took an active interest in public life as well as in organized medicine. He was President of the Medical Council of Canada in 1925-26, and a member of the Executive Committee of the Canadian

210

SHORT BIOGRAPHIES

Medical Association in 1927-29. Dr. Young was repeatedly Mayor of Saskatoon in his earlier years, and was elected to the House of Commons in 1925. With the exception of one Parliament, he represented Saskatoon until his death. He was a medical parliamentarian of the old school; a man with many friends, and one whose skill did much to speed the passage of the College Act of Incorporation through the House of Commons in 1929. He was the supporter of the 1939 Amendment to the Charter which empowered the College to grant certificates of specialism. Council was considering his election to the Honorary Fellowship of the College in 1939, when the news arrived of his sudden death.

211

THE ROYAL COLLEGE OF PHYSICIANS AND SURGEONS OF CANADA

OFFICERS AND MEMBERS OF THE COUNCIL 1960-1962 Officers President Immediate Past President Vice-President, Division of Medicine Vice-President, Division of Surgery Secretary Honorary Assistant Secretary Honorary Treasurer

Dr. Donald A. Thompson, Bathurst Dr. John W. Scott, Edmonton Dr. Lennox G. Bell, Winnipeg Dr. Charles E. Hebert, Montreal Dr. James H. Graham, Ottawa Dr. W. Gordon Beattie, Ottawa Dr. Kenneth T. MacFarlane, Montreal

MEMBERS OF THE COUNCIL Division of Medicine Dr. Lennox G. Bell, Winnipeg Dr. J. G. Dewan, Toronto Dr. Georges A. Bergeron, Quebec Dr. Robert C. Dickson, Halifax Dr. G. Malcolm Brown, Kingston Dr. Robert B. Kerr, Vancouver Dr. Douglas G. Cameron, Montreal Dr. J. Wendell Macleod, Saskatoon Dr. Ronald V. Christie, Montreal Dr. Lea C. Steeves, Halifax Dr. A. L. Chute, Toronto Dr. Donald R. Wilson, Edmonton Division of Surgery Dr. C. E. Corrigan, Winnipeg Dr. Clayton H. Crosby, Regina Dr. Charles E. Hebert, Montreal Dr. George Hooper, Ottawa Dr. Percy E. Ireland, Toronto Dr. Walter C. MacKenzie, Edmonton

212

Dr. Frank P. Patterson, Vancouver Dr. Edwin F. Ross, Halifax Dr. Louis-Philippe Roy, Quebec Dr. Donald A. Thompson, Bathurst Dr. Donald R. Webster, Montreal Dr. W. Keith Welsh, Toronto

APPENDIX

PAST OFFICE BEARERS Presidents 1929-1931 1931-1933 1933-1935 1935-1937 1937-1939 1939-1941 1941-1943 1943-1945 1945-1947 1947-1949 1949-1951 1951-1953 1953-1955 1955-1957 1957-1959

*Jonathan Campbell Meakins, *Frederic Newton Gisborne Starr Duncan Graham *Alfred Turner Bazin *George Sills Young Wilder Graves Penfield *Alvin Trotter Mathers *Frank Stewart Patch Ray Fletcher Farquharson *William Fulton Gillespie David Sclater Lewis *Edmond Dube *John Hepburn Robert Meredith Janes John William Scott Vice-Presidents DIVISION OF MEDICINE

Duncan Graham Walter Thomas Connell *Egerton Llewellyn Pope *Alvah Hovey Gordon *Clifford Rogers Gilmour *Albert LeSage *Kenneth Alexander MacKenzie *Edmour Perron Russell Johnson Collins David Sclater Lewis *John Hepburn John William Scott Edward Sadler Mills Joseph Romeo Pepin Francis Staples Brien

1929-1931 1931-1933 1933-1935 1935-1937 1937-1939 1939-1941 1941-1943 1943-1945 1945-1947 1947-1949 1949-1951 1951-1953 1953-1955 1955-1957 1957-1959

'Deceased 213

THE ROYAL COLLEGE OF PHYSICIANS AND SURGEONS OF CANADA

Vice-Presidents DIVISION OF SURGERY

*Frederic Newton Gisborne Starr *P. Calixte Dagneau *Louis de Lotbiniere Harwood *John Sinclair McEachern *Benjamin Georges Bourgeois *William Edward Gallie *John Alexander Gunn *Charles Vezina *David Edwin Robertson *William Fulton Gillespie *Leon Gerin-Lajoie *Edmond Dube Robert Meredith Janes Newell Willard Philpott Harold Rocke Robertson Louis-Philippe Roy

1929-1931 1931-1933 1933-1934 1934-1935 1935-1937 1937-1939 1939-1941 1941-1943 1943-1944 1944-1947 1947-1949 1949-1951 1951-1953 1953-1955 1955-1957 1957-1959

Registrar-Secretary Thomas Clarence Routley

1929-1932

Honorary Secretary *Warren Soper Lyman *John Elmer Plunkett

1932-1945 1945-1953

Honorary Assistant Secretary *John Elmer Plunkett

1939-1945

Honorary Treasurer Romuald Eugene Valin Joseph Antonio Lecours 'Deceased 214

1932-1949 1949-1957

APPENDIX

PAST MEMBERS OF THE COUNCIL DIVISION OF MEDICINE

1949-1953 James Douglas Adamson 1951-1959 Murray McCheyne Baird 1935-1943 *John Albert Bauer 1951-1959 Francis Staples Brien 1947-1949 *John Frederick Burgess 1939-1947 Russell Johnson Collins 1945-1949 Walter Ford Connell 1929-1937 Walter Thomas Connell 1933-1938 James Robert Corston 1937-1938 *Gaston Lefebvre de Bellefeuille Herbert Knudsen Detweiler 1947-1955 1929-1933 *Joseph Edmond Dube 1939-1949 Ray Fletcher Farquharson 1931-1939 *Hugh Allan Farris 1931-1939 *John Gerald Fitzgerald 1929-1931, 1935-1939 *Clifford Rogers Gilmour *Alvah Hovey Gordon 1931-1939 1929-1937 Duncan Graham 1929-1937 George Carleton Hale *John Hepburn 1947-1955 1943-1951 *George Lyall Hodgins *John Howard Holbrook 1939-1943 Clyde Wallace Holland 1947-1955 1931-1935 *Charles Hunter 1937-1945 Heber Carss Jamieson Jean-Baptiste Jobin 1947-1951 William Alfred Jones 1937-1941, 1949-1953 1939-1947 *Albert LeSage Richard Lessard 1947-1955 David Sclater Lewis 1945-1953 Harold Smith Little 1937-1945 *Kenneth Alexander MacKenzie 1929-1933, 1937-1945 *Alvin Trotter Mathers 1939-1949 Ambrose Gerald McGhie 1943-1951 *Jonathan Campbell Meakins 1929-1935 Edward Sadler Mills 1949-1957 Lorne Cuthbert Montgomery 1939-1947 *Deceased 215

THE ROYAL COLLEGE OF PHYSICIANS AND SURGEONS OF CANADA

DIVISION OF MEDICINE - CONTINUED

John Allen Oille J. Romeo Pepin *Edmour Perron Charles Ayre Peters *Egerton Llewellyn Pope *Gordon Earle Richards Stanley Graham Ross *Arthur Rousseau John William Scott Walter de Mouilpied Scriver *Marie Pierre Arthur Vallee *George Sills Young

1939-1947 1951-1959 1939-1947 1941-1944 1929-1937 1945-1949 1951-1953 1929-1934 1949-1953, 1955-1959 1953-1957 1934-1938 1935-1945

DIVISION OF SURGERY

*Edward Bishop Alport *Edward William Archibald *Lorimer John Austin *Alfred Turner Bazin *Benjamin Georges Bourgeois Charles William Burns Leverett De V. Chipman *Walter William Chipman *P. Calixte Dagneau *Edmond Dube *Frederick Etherington *William Edward Gallie *Leon Gerin-Lajoie *William Fulton Gillespie *Roscoe R. Graham *John Alexander Gunn Robert Inkerman Harris *Louis de Lotbiniere Harwood Robert Meredith Janes Theodore H. Lennie *Henry Kirkwood MacDonald *Ronald Hugh Macdonald Kenneth Turville MacFarlane *Neil John Maclean 'Deceased 216

1935-1943 1931-1935 1929-1937 1929-1939 1934-1943 1947-1955 1941-1946 1931-1935 1929-1937 1945-1955 1937-1945 1931-1939 1941-1949 1941-1949 1943-1948 1935-1943 1945-1953 1929-1934 1949-1959 1943-1951 1941-1949 1943-1949 1955-1957 1929-1933

APPENDIX

DIVISION OF SURGERY - CONTINUED

*Victor Owen Mader 1949-1957 *John George McDougall 1929-1931, 1937-1941 *John Sinclair McEachern 1933-1941 Frederick Gallagher McGuinness 1945-1947 *Robert Edward McKechnie 1931-1935 Angus Duncan McLachlin 1945-1953 *John Douglas McQueen 1943-1945 George Gavin Miller 1947-1955 Alexander Russell Munroe 1929-1933 *George Henry Murphy 1933-1937 *Frank Stewart Patch 1937-1947 Wilder Graves Penfield 1937-1945 Joseph Louis Petitclerc 1949-1953 Newell Willard Philpott 1949-1955 *Alexander Primrose 1931-1937 *George Alexander Ramsay 1935-1943 *David Edwin Robertson 1939-1944 Harold Rocke Robertson 1951-1959 *Francis A. C. Scrimger 1935-1937 George Elliott Seldon 1935-1943 George Ferguson Skinner 1946-1953 *William Harvey Smith 1931-1935 *Frederic Newton Gisborne Starr 1929-1935 *Charles Vezina 1937-1945 *Hadley Williams 1929-1931 *Deceased

217

THE ROYAL COLLEGE OF PHYSICIANS AND SURGEONS OF CANADA

HONORARY FELLOWS DIVISION OF MEDICINE

ELECTED Field Marshal the Right Honourable Earl Alexander of Tunis, 1946 K.G., G.C.B., G.C.M.G., C.S.I., D.S.O., M.C., LL.D., A.D.C., Governor-General of Canada, 1946-1951. William Melville Arnott, M.B., Ch.B., B.Sc., M.D. (Edinburgh), 1957 M.D. (Birmingham), F.R.C.P. (Edinburgh and London). *The Right Honourable Alexander Augustus Frederick George, 1940 Earl of Athlone, K.G., P.C., G.C.B., G.C.M.G., G.C.V.O., D.S.O., A.D.C., Governor-General of Canada, 1940-1946. Professor A. A. Bagdasarov, Director of the Central Institute 1943 of Haematology of Moscow. *The Right Honourable Vere Brabazon Ponsonby, Earl of 1933 Bessborough, P.C., G.C.M.G., Governor-General of Canada, 1931-1935. *Henry Asbury Christian, M.A., M.D., D.Sc., LL.D., Boston, 1936 Mass., U.S.A. Sir William Wilson Jameson, K.C.B., C.B.E., M.A., M.B., Ch.B., 1941 M.D. (Aberdeen), F.R.C.P. (London). Chalmers Jack Mackenzie, C.M.G., M.C., M.C.E., B.E. (Dal- 1947 housie), M.C.E. (Harvard), LL.D., D.Sc., D.Eng., F.R.S., F.R.S.C. The Right Honourable Vincent Massey, P.C., C.H., M.A. 1953 (Oxford), LL.D., Governor-General of Canada, 1952-59. 1961 Robert Samuel McLaughlin, LL.D., Oshawa. General the Honourable Andrew George Latta McNaughton, 1939 P.C., C.H., C.B., C.M.G., D.S.O., M.Sc. (McGill). Sir Arthur Sims, B.A. (University College, Canterbury, N.Z.), 1959 Hon. F.R.C.S. (England), Hon. F.R.C.O.G., Hon. F.R.A.C.S., Hon. F.R.A.C.P., LL.D. (University College, Canterbury). *The Right Honourable Lord Tweedsmuir, P.C., C.H., 1936 G.C.M.G., Governor-General of Canada, 1935-40. His Excellency Major General Georges Philias Vanier, D.S.O., 1961 M.C. with Bar, C.D., Chevalier de la Legion d'Honneur, B.A., LL.B. (Laval), Governor-General of Canada , 1959'Deceased 218

APPENDIX

HONORARY FELLOWS DIVISION OF SURGERY

ELECTED

Field Marshal the Right Honourable Earl Alexander of Tunis, 1946 K.G., G.C.B., G.M.G., C.S.I., D.S.O., M.C., LL.D., A.D.C., Governor-General of Canada, 1946-1951. *The Right Honourable Alexander Augustus Frederick George, 1940 Earl of Athlone, K.G., P.C., G.C.B., G.C.M.G., G.C.V.O., D.S.O., A.D.C., Governor-General of Canada, 1940-1946. Donald Church Balfour, M.D. (Toronto), LL.D. (Carleton, St. 1959 Olaf), Hon. D.Sc. (McMaster, Northwestern, Western Ontario), Hon. F.R.A.C.S., Hon. F.R.C.S. (England and Edinburgh), F.A.C.S. *The Right Honourable Vere Brabazon Ponsonby, Earl of 1933 Bessborough, P.C., G.C.M.G., Governor-General of Canada, 1931-1935. *Irving H. Cameron, M.B. (Toronto), LL.D. (Edinburgh), Hon. 1933 F.R.C.S. (England, Edinburgh, Ireland), Hon. F.A.C.S. *Major-General Sir Eugene Marie Fiset, C.M.G., D.S.O., V.D., 1943 M.D., LL.D., D.C.L., F.R.S.C., Lieutenant-Governor of Quebec. *Sir Gordon Gordon-Taylor, K.B.E., C.B., M.A. (Aberdeen), 1941 M.S. (London), F.R.C.S. (England), Hon. F.R.A.C.S., Hon. F.A.C.S., LL.D. (Toronto, Melbourne), Hon. M.D. (Athens) . Sir Geoffrey Keynes, M.A., M.D. (Cambridge), Hon. LL.D. 1956 (Edinburgh), Hon. D. Litt. (Sheffield), F.R.C.S. (England), F.R.C.P. (London), F.R.C.O.G., F.R.S.M. *Honourable James Horace King, P.C., M.D., C.M., LL.D.

1939

Chalmers Jack Mackenzie, C.M.G., M.C., M.C.E., B.E. 1947 (Dalhousie), M.C.E. (Harvard), LL.D., D.Sc., D.Eng., F.R.S., F.R.S.C. The Right Honourable Vincent Massey, P.C., C.H., M.A. 1953 (Oxford), LL.D., Governor-General of Canada, 1952-1959. Robert Samuel McLaughlin, LL.D., Oshawa.

1961

*Deceased 219

THE ROYAL COLLEGE OF PHYSICIANS AND SURGEONS OF CANADA

DIVISION OF SURGERY — Continued

General the Honourable Andrew George Latta McNaughton, 1939 P.C., C.H., C.B., C.M.G., D.S.O., M.Sc. (McGill), D.C.L., LL.D. Sir Walter Mercer, M.B., Ch.B., F.R.C.S. (Edinburgh), Hon. 1961 F.A.C.S., Hon. F.R.C.S. (England), Hon. F.RC.S. (Ireland), Hon. F.C.S. (South Africa), Hon. M.Ch.Orth. (Liverpool), D.L. (Edinburgh). Major-General Sir William Heneage Ogilvie, ]VI.D., M.Ch. 1943 (Oxford), F.R.C.S. (England), Hon. F.A.C.S. Sir Harry Platt, Bart., M.B., B.S., M.S. (London), M.D. 1955 (Manchester), F.R.C.S. (England), Hon. LL.D. (Manchester, Liverpool, Belfast). Isidor Schwaner Ravdin, B.S. (Indiana), M.D. (Pennsylvania), 1957 LL.D. (Pennsylvania and Temple), F.A.C.S., Hon. F.R.C.S. (England) . Sir Arthur Sims, B.A. (University College, Canterbury, New 1959 Zealand), Hon. F.R.C.S. (England), Hon. F.R.C.O.G., Hon. F.R.A.C.S., Hon. F.R.A.C.P., LL.D. (University College, Canterbury). Colonel-General Yefin Ivanovitch Smirnov, Colonel-General 1943 Medical Services of the U.S.S.R. *John Stewart, C.B.E., Ch.M. (Edinburgh), L.L.D. (Edinburgh, 1933 McGill and Dalhousie), F.R.C.S. (Edinburgh). Josep Trueta, M.D. (Barcelona), Hon. D.Sc. (Oxford).

1947

*The Right Honourable Lord Tweedsmuir, P.C., C.H., 1936 G.C.M.G., Governor-General of Canada, 1935-1940. His Excellency Major-General Georges Philias Vanier, D.S.O., 1961 M.C. and Bar, C.D., Chevalier de la Legion d'Honneur, B.A., LL.B. (Laval), Governor-General of Canada, 1959*The Right Honourable Lord Webb-Johnson, G.C.V.O., C.B.E., 1949 D.S.O., T.D., M.B., Ch.B., F.R.C.S. (England), Hon. F.R.A.C.S. Deceased 220

APPENDIX

THE LECTURERS OF THE ROYAL COLLEGE OF PHYSICIANS AND SURGEONS OF CANADA

Lecturers of the Royal College of Physicians of Canada 1940 1941 1942 1943 1944 1945 1946 1947 1948 1949 1950

A. H. Gordon, M.D., C.M. A. T. Mathers, M.D., C.M. J. C. Meakins, M.D., C.M. George Draper, M. D. R. F. Farquharson, M.B. No scientific meeting D. L. Thomson, Ph.D. G. Lyman Duff, M.D. C. J. Watson, M.D. C. E. Van Rooyen, M.D. Hans Selye, M.D.

1951 1952 1953 1954 1955 1956 1957 1958 1960 1961

C. N. H. Long, M.D. Andre Cournand, M.D. Garfield Duncan, M.D.,C.M. A. J. Rhodes, M.D. R. V. Christie, M.D., Ch.B. C. P. Leblond, M.D. W. M. Arnott, M.D. M. L. Barr, M.D. K. J. R. Wightman, M.D. Jacques Genest, M.D.

Lecturers of the Royal College of Surgeons of Canada 1940 1941 1942 1943 1944 1945 1946 1947 1948 1949 1950

W. E. Gallie, M.D. E. W. Archibald, M.D. W. F. Gillespie, M.B. C. B. Huggins, M.D. R. I. Harris, M.B. No scientific meeting L. R. Dragstedt, M.D. Josep Trueta, M.D. Mercier Fauteux, M.D. F. L. Meleney, M.D. E. D. Churchill, M.D.

1951 1952 1953 1954 1955 1956 1957 1958 1960 1961

F. A. Coller, M.D. K. G. McKenzie, M.B. D. C. Elkin, M.D. Alexander Gibson, M.B., Ch.B. H. B. Atlee, M.D. Sir Geoffrey Keynes, M.D. I. S. Ravdin, M.D. E. D. Gagnon, M.D. H. R. Robertson, M.D., C.M. W. C. MacKenzie, M.D., C.M.

Les Con f erenciers du College Royal des Medecins et Chirurgiens du Canada 1940 L. E. Pariseau, M.D. 1941 Emile Gaumond, M.D. 1942 Gaston Gosselin, M.D.

1944 Louis Berger, M.D. 1946 Richard Lessard, M.D. 221

THE ROYAL COLLEGE OF PHYSICIANS AND SURGEONS OF CANADA

THE ANNUAL MEDALLISTS OF THE ROYAL COLLEGE OF PHYSICIANS AND SURGEONS OF CANADA DIVISION OF MEDICINE

1949 1950 1951 1952 1953 1954 1955 1956 1957 1958 1960 1961

W. S. Hartroft, M.D. No award Robert Teasdale, M.D. Miller Fisher, M.D. G. C. Willis, M.D., C.M. J. C. Locke, M.D., C.M. Armand Ortiz-Galvan, M.D . Donald Fraser, Ph.D. R. D. Rowe, M.B. J. F. Mustard, M.D. J. C. Sinott, M.D., C.M. J. O. Parker, M.D., C.M.

DIVISION OF SURGERY

Euchariste Samson, M.D. J. A. McLachlin, M.D.* C. L. Wilson, M.D., C.M. Ian MacNab, M.B., Ch.B. P. B. Samuels, M.D. R. C. Harrison, M.D. I. B. MacDonald, M.D. W. H. Lakey, M.D. S. C. Skoryna, M.D. P. B. R. Allen, M.D. R. B. Salter, M.D. J. S. Speakman, M.D.

•Awarded Moynihan Prize in England for same essay in 1950.

222

APPENDIX

An Act to Incorporate

THE ROYAL COLLEGE OF PHYSICIANS AND SURGEONS OF CANADA* WHEREAS The

Canadian Medical Association, a corporation constituted by chapter sixty-two of the statutes of 1909, has by its petition prayed in effect that it may be enacted as hereinafter set forth; and whereas His Majesty King George V has been graciously pleased to grant permission to the College to use the title "Royal"; and whereas it is expedient to grant the prayer of the said petition; Therefore His Majesty, by and with the advice and consent of the Senate and House of Commons of Canada, enacts as follows: 1. In this Act unless the context otherwise requires — (a) "The College" means the corporation constituted under the provisions of this Act; (b) "The Council" means the Council of the said College; (c) "Fellows" means members of the College; (d) "Charter Fellows" means members of the College who become such upon the coming into force of this Act, together with those persons selected and admitted as Fellows within two years thereafter. 2. Those persons holding at the date of the coming into force of this Act, appointments as professors in medicine, surgery, gynaecology or obstetrics in a Canadian university together with the persons from time to time selected and admitted as, or otherwise being, Fellows of the College pursuant to this Act, upon their consent so to act, are hereby constituted a corporation under the name of "The Royal College of Physicians and Surgeons of Canada", and when the French language is used to designate that corporation the equivalent name shall be "Le College Royal des Medecins et Chirurgiens du Canada." 3. The General Secretary of The Canadian Medical Association shall call together, at Ottawa, within six months of the passing of this Act all those entitled to become Fellows of the College, as set out in section two of this Act. All those present at such meeting shall •19-20 George V. Chapter 97. Assented to 14 June, 1929. 223

THE ROYAL COLLEGE OF PHYSICIANS AND SURGEONS OF CANADA

constitute a provisional Council. It shall be their duty at this meeting to elect a Council with such officers and officials as they may deem necessary. The elected Council, officers and officials shall hold office in accordance with the provisions of this Act and with the by-laws, rules and regulations of the College. 4. The Council shall hold office for a period of four years, and until their successors are elected and hold their first meeting. 5. The Council may, at any time within two years after the coming into force of this Act and without examination, select and admit as Fellows any duly qualified persons domiciled in Canada who have in their opinion given evidence of high ability in one or more departments of medicine. 6. The Council may without examination, select and admit as Fellows, physicians and surgeons practicing in Canada and licensed to practice in at least one of the provinces thereof, and holding a diploma or fellowship issued or granted after examination by a recognized medical or surgical organization constituted by the laws of the United Kingdom of Great Britain and Northern Ireland, the Irish Free State, any of the British Dominions, the Republic of France, or of such other countries as the Council may direct, if in the opinion of the Council such diploma or fellowship is of equal status to the fellowship in the College. 7. The Council may without examination select and admit as Honorary Fellows such distinguished physicians, surgeons or other persons resident within or without Canada as the Council may deem fit. 8. (1) Except as hereinbefore mentioned no person shall become or be admitted as a Fellow of the College until he shall have complied with such by-laws and regulations as the Council shall from time to time consider expedient, and unless he shall have passed such special examinations, in either the English or the French language, by the examiners of the College as the Council shall from time to time prescribe and direct for candidates for fellowship, but every fit and proper person, qualified as hereinafter set forth and having complied with such rules and regulations and passed such special examination, as hereinbefore set out, shall be entitled to be admitted as a Fellow of the College. (2) All candidates wishing to be examined in either the English or the French language for fellowship in the College shall be graduates 224

APPENDLX

of not less than three years standing of a Medical School or University approved by the Council, and shall hold license to practice medicine in at least one of the Provinces of Canada. (3) The Council may by by-law provide for the organization of the College into medical and surgical divisions, and for admission into fellowship in the College in one or other of such divisions, in which event a Fellow of the Surgical Division may be known and designated as a Fellow of the Royal College of Surgeons of Canada, or in the French language as "Associe du College Royal des Chirurgiens du Canada"; and a Fellow of the Medical Division may be known and designated as a Fellow of the Royal College of Physicians of Canada, or in the French language as "Associe du College Royal des Medecins du Canada." 9. (1) The admittance of every Fellow or Honorary Fellow of the said College shall be by diploma under the seal of the said College in such form as the Council shall from time to time think fit, provided that one or more general diplomas may be granted or issued covering the admittance to the College of such Charter Fellows. (2) The Council shall cause the name of every Fellow or Honorary Fellow for the time being of the College to be entered, according to the priority of admittance or otherwise as the Council may direct, in a book or register to be kept for that purpose at the headquarters of the College or such other place as the Council shall direct, and such book or register, subject to such reasonable and proper regulations as the Council for the time being may direct shall be open to the inspection of any Fellow of the College. 10. The business and affairs of the College shall be administered by a Committee of the Fellows to be known as "The Council" of the College. 11. The Council may make such by-laws, rules and regulations not inconsistent with the provisions of this Act as it may deem necessary or advisable for the government and management of its business and affairs and especially with respect to the qualifications, classification, admission and expulsion of Fellows, the fees and dues which it may deem advisable to impose, and the number, constitution, powers, duties and mode of election of the Council or any sub-committees thereof. 225

THE ROYAL COLLEGE OF PHYSICIANS AND SURGEONS OF CANADA

and of the officers of the College, and may from time to time alter or repeal all or any of such by-laws or rules as it may see fit. 12. The College may receive, acquire, accept and hold real and personal property by gift, purchase, legacy, lease or otherwise, for the purpose of the College, and may sell, lease, invest or otherwise dispose thereof in such manner as it may deem advisable for such purposes; provided, however, that the annual value of the real estate held by the College shall not exceed the sum of fifty thousand dollars. 13. No Fellow of the College shall merely by reason of such fellowship be or become personally liable for any of its debts or obligations.

Amendments to the Act of Incorporation The Charter of the College has been amended on two occasions. These amendments received Royal Assent on 3 June, 1939, and on 18 December, 1945, respectively. They have been described on pp. 63-64.

226

NOTES CHAPTER I 1. Minutes of the Executive Council of the Canadian Medical Association, June 26, 1913, (kindness of Dr. A. D. Kelly). 2. Handbook, Royal Australasian College of Surgeons, (Melbourne, 1940), p. 1. 3. Tall oaks from little acorns grow." You'd scarce expect one of my age To speak in public on the stage; And if I chance to fall below Demosthenes or Cicero, Don't view me with a critic's eye, But pass my imperfections by. Large streams from little fountains flow, Tall oaks from little acorns grow. David Everett (1760-1813). A school declamation written for Ephraim Farrar, age seven. New Ipswich, New Hampshire, 1791. 4. T. C. Routley. "Founding of the Royal College of Physicians and Surgeons of Canada" in Transactions of the Annual Meeting of the Royal College of Physicians and Surgeons of Canada, 1954, pp. 126-131. 5. Canadian Medical Association Journal, 10 (Sept. 1920), 876-7. CHAPTER II 6. Canad. M.A.J. 23 (Sept. 1930), Supp. pp. xxi-xxiii. CHAPTER III 7. Routley, op. cit. 8. Minutes of the Executive Council of the Canadian Medical Association, June 1922. 9. Minutes of the General Council of the Canadian Medical Association, June 1924. 10. F. W. Marlow, Report of the Conference on Medical Services in Canada, (Ottawa, 1924), p. 36. 11. Minutes of the Annual Meeting of the Medical Council of Canada, Sept. 1924. 12. Report of the Conference on Medical Services in Canada, (Ottawa, 1927), pp. 14-15. CHAPTER IV 13. Transactions, 56th Annual Meeting, Canadian Medical Association, Canad. M.A.J. IS (Sept. 1925), Supp. p. xv. 14. Transactions, 57th Annual Meeting, Canadian Medical Association, Canad. M.A.J. 16 (Sept. 1926), Supp. pp. xvi-xvii. 15. Routley, op. cit. 16. Letter to the author from Dr. D. S. Johnstone, Dec. 1958. CHAPTER V 17. W. G. Morgan, American College of Physicians—Its First Quarter Century (Philadelphia, 1940), pp. 103-111. 18. Transactions, 59th Annual Meeting, Canadian Medical Association, Canad. M.A.J. 19 (Sept. 1928), Supp. pp. xxv-xxvii. 229

NOTES

CHAPTER VI 19. Canada House of Commons Debates, April 19, 1929, pp. 1830-34. 20. Debates of the Senate, Session 1929, May 28, 1929, p. 421. 21. Transactions, 60th Annual Meeting, Canadian Medical Association, Canad. M.A.J. 21 (Sept. 1929), p. 317. CHAPTER XI 22. Minutes of the 2nd Annual Meeting of the College, Nov. 19, 1931. 23. Sir Zachary Cope, History of the Royal College of Surgeons of England (London, Bland & Co., 1959), pp. 70-71. INTRODUCTION PART II 24. F. A. Hardy, "The Library of Parliament", in Dalhousie Review 37 (1957), p. 178. Hardy gives a most interesting account of the search for the author of this couplet, which had been used by Dafoe of the Winnipeg Free Press in a review of the life of Sir Wilfrid Laurier. Dafoe indicated that the couplet had been written by an English statesman who was also a novelist. CHAPTER XVII 25. Canad. M.A.J. 23 (Sept. 1930), Supp. pp. xxi-xxiii. 26. Sir Henry Platt, "Report to the South African College," Transactions, College of Physicians, Surgeons and Gynaecologists of South Africa III (Oct. 1959), 23. CHAPTER XIX 27. Sir Zachary Cope, op. cit. pp. 40-41. The Honorary Gold medal was instituted in 1802, but no award was made until twenty years later. The first recipient was James Parkinson, well remembered on account of his classical description of paralysis agitans (Parkinson's disease). The medal was awarded for his work on palaeontology. CHAPTER XXI 28. F. S. Patch, "Certification of Specialists in Canada," in Canad. M.A.J. 51 (Sept. 1944) 261-4. 29. H. E. MacDermot, History of Canadian Medical Association, I (Toronto, 1935), 67. 30. Letter to author from Dr. M. T. Macfarland, Registrar, College of Physicians and Surgeons of Manitoba. 31. Letter to author from Dr. W. Bramley-Moore, Registrar, College of Physicians and Surgeons of Alberta. 32. J. M. S. Careless, Brown of the Globe (Toronto, Macmillan Co. of Canada, Ltd., 1959), pp. 53 seq. 33. Minutes of the Annual Meeting of the Medical Council of Canada, Sept. 6, 1933. 34. Archives, Medical Council of Canada. 35. Letter to the author from Dr. A. F. W. Peart, Deputy General Secretary, Canadian Medical Association. 230

NOTES

CHAPTER XXIII 36. Regulations and Requirements of Graduate Training: The Royal College of Physicians and Surgeons of Canada (Sept. 1959), p. 10. CHAPTER XXIV 37. Survey of Physicians in Canada, Department of National Health and Welfare, June 1954, Supp. Oct. 1955. Tables 4 and 5. CHAPTER XXV 38. Transactions, 64th Annual Meeting, Canadian Medical Association, Canad. M.A.J. 29 (Sept. 1933), Supp. p. viii. APPENDIX 39. Archives of the College of Physicians and Surgeons of Saskatchewan, (kindness of Dr. J. B. Ritchie).

231

INDEX

INDEX Names of officers of the college, members of council and honorary fellows, are given on pages 212-220. Biographies of the first council are arranged alphabetically beginning on page 189. The lecturers, the conferenciers and the medallists appear on pages 221-2. These names are not repeated in the index unless they occur in the text of the book. Acr OF INCORPORATION, 21-8, 63, 223-6; amendments, 63-4 Adney, E. T., 41 Agnew, Harvey, 120-1 Alberta, College of Physicians and Surgeons of, 11, 145 Alberta, Medical Profession Act, 144 Alberta, University of, 33, 98, 100, 108, 144, 146 Alexander of Tunis, Rt. Hon. Earl, 75, 130 American College of Obstetricians and Gynecologists, 76 American College of Physicians, 9, 76; joint commission hospital accreditation, 125 American College of Surgeons, 4, 9, 26, 76, 132; Canadian hospitals approved specialist training, 120-1; hospital inspection abandoned, 125; hospital standarisation, 15, 119; joint commission hospital accreditation, 125 American Hospital Association, 125 American Medical Association, approved hospitals, Canadian, for intern training, 119; joint commission hospital accreditation, 125 American Specialty Boards, 125 Archibald, E. W., 30, 33, 70, 89, 104, 171 Argue, J. F., 146-7 Armstrong, G. E., 10 Arnott, W. M., 130, 134

Asselin, E. G., 104 Association des Medecins de Langue Francaise de l'Amerique du Nord, 173; du Canada, 173 Association Canadian Medical Schools, 124 Athlone, Rt. Hon. Earl of, 75, 130 Austin, L. J., 17, 20, 33, 37, 40, 45-6, 92, 100 Australasian College Physicians, Royal, 3, 180 Australasian College Surgeons, Royal, 3, 4, 180 BAGDASAROV, Prof. A. A., 132 Balfour, D. C., 134 Banting, Sir Frederick, 70 Bazin, A. T., 9, 13, 20-1, 30, 32-3, 35-7, 40, 44, 59, 64, 67, 81, 83, 88-9, 93, 102, 152, 156, 172, 174 Beattie, Prof. John, 69 Beattie, W. G., 179 Bennett, Rt. Hon. R. B., 75 Berger, Prof. L., 70, 90, 109, 121 Bergeron, G. A., 99 Bessborough, Rt. Hon. Earl, 69, 75, 129; reception by, 69 Best, Prof. C. H., 103 Biographies, 189-208 Blagdon, L., 104 Blanchet, R., 104 Bourdenko, Major-Gen., 132 Bourgeois, B. G., 81-2, 89, 151 Bourgeois, P., 105

235

INDEX

Bourne, Wesley, 90 Boyd, Prof. W., 70, 90 Bramley-Moore, W., 11 Brien, F. S., 100, 111 British Columbia, University of, 98, 100 British Medical Association, branches in Canada, 8; Carson official delegate, 15 British North America Act, provincial control health and education, 7 British Royal Colleges, fellows and members in Canada, 9, 15 Brown, George (Toronto Globe), 145 Brown, Malcolm, 100, 179, 181 Bruce, Herbert, 31-3 Building, headquarters of college, archives and library, 181-2; committees, 179, 181; corner-stone ceremony, 182; cost of, 180-2; council room, 182; Medical Council of Canada grant, 183; official opening, 183; site, 180-1; size, 181 Burgess, J. F., 85, 90, 159 CAMPBELL, Mrs. Mabel, 22 Cameron, D. G., 100 Cameron, G. Stewart, 13 Cameron, I. H., 130-1 Cameron, M. H. V., 159 Canada Medical Act, 14, 23, 148-9 Canadian Association of Radiologists, 149 Canadian Hospital Council, 121 Canadian Medical Association: Historical reference, 7; hospital accreditation study committee, 125; hospital approval intern training, 120; hospital service department, 120; loan to college, 19, 46; nucleus committee, 19-20, 25-9, 32, 100, 102; first office of college, 171, 179; Regina resolution, 5; sponsors of incorporation, 22. 236

Reports dealing with founding of college: education, 16, 144; Low, 18-9; Marlow, 13; nucleus committee, 21. Certification of specialists: Ryerson editorial, 145-6; Slayter resolution, 143; study committees, 147 Cannell, D. E., 111 Carrow, G. W., 105 Carson, H. W., 15 Certification of Specialists, amendment of charter, 150, 156; credentials, assessment of 157-8; examinations and results, 162-3; fees, 156-7; location of specialists, 165; masterships in place of certificate, 151; negotiations with Canadian Medical Association, 147-153; provincial licensing bodies, 149-150, 166-7; specialists, committee on, 155, 158; specialties, choice of, 150-1; training requirements, 156-7, 161; without examination, 155-8 Charter, see Act of Incorporation Chipman, W. W., 31-3, 172 Chown. S. G., 116 Christian, H. A., 134 College of Obstetricians and Gynaecologists, The Royal, 72 College of Physicians and Surgeons (Kingston), Royal, 36 College of Physicians of Edinburgh, The Royal, 77 College of Physicians of London, The Royal, 77, 146, 149, 180 College of Physicians of Ireland, The Royal, 77 College of Physicians, Surgeons and Gynaecologists of South Africa, 3 College of Surgeons of Edinburgh, The Royal, 77 College of Surgeons of England, The Royal, 146, 149, 180; Canadian branch, 9, 14, 15; examinations, primary in Canada, 9, 103; fellows

INDEX

in Canada (1925), 15; gifts to Canadian college, 133; honorary fellowship, 129; first Canadian grantees, 131; honorary gold medal, Gallie award, 133; reciprocal relations, committee on, 58 College of Surgeons in Ireland, The Royal, 77 College Royal des Medecins et Chirurgiens du Canada, Le, 5 Coffins, R. J., 61, 85, 157, 159 Collip, J. B., 70 Cone, W. V., 85, 90, 159 Conference Medical Services in Canada, 13-4 Conferenciers du college, 221 Connell, W. T., 33, 37, 45, 53, 92, 100 Conseil d'Accreditation des Höpitaux, 126 Constitution and by-laws, Committee on, 44, 58, 64-6; elections, 64-5; equal rights for women, 76 Convocation, ceremonial, 67-8, guests, 76 Corrigan, C. E., 181, 183 Corston, J. R., 149 Cosbie, W. G., 72 Council of the college, attendance at meetings, 57; committees, 57-61; geographic distribution, 55; duties of, 18, 65; first meeting, 37-40; members, number of, 32, 55; minutes, verbatim (1933-46), 56; past and present members of, 212; 215-7; tenure of office, 55; office bearers, past, 213-4 Council, provisional, meeting of; colleges, two separate, 31; election first council, 33; members of, 29; obstetricians and gynaecologists classed as surgeons, 32; permanent headquarters, 34, 35; registration fee, 31 Credentials, Committee on, members of first, 85, 90, 92; assessment train-

ing, certificate, 95, 159; fellowship 93-9; war time training, 95-6 Crocker, Miss P., 41, 57, 176, 179 Crosby, C. H., 74 Currelly, C. T., 75 DAGNEAU, P. C., 33, 37, 39, 53, 100 Dalhousie University, 33, 65, 98, 100, 108, 189 Dandurand, Sen. Raoul, 27, 64 Dauphinee, J. A., 105 deKoninck, Prof. C., 75 Delorme, Prof. L. N., 104 Desmeules, R., 104 Detweiler, H. K., 74, 98 Dickson, R. C., 73, 100 Diefenbaker, Rt. Hon. J., 183 Dinner, annual, speakers, 75; ladies admitted, 76 Diplomas, languages of, 43-4 Downs, Prof. Ardrey, 108 Dube, Edmond, 72, 75, 85, 98-9, Ill, 121, 159 Dube, J. E., 33, 37, 104 Dues, annual, 19, 31, 64, 175 Duff, G. L., 111 EDUCATIONAL

and Endowment Fund,

74

Engraving, Barber-Surgeons, 133-4 Education, Committee on, 58, 88, 110, 144 Educational Standards, Committee on, 84, 88-9, 110; policy recommendations, 116 Elections, Committee on, 58; by-laws governing, 65. Ethics, Code of, 47, 68; Committee on, 60 Examinations, Committee on, 93, 95; boards examiners, 112-3; examination costs, 114-5; standards of, 100, 102 Examinations, Fellowship, final, content of, 101; modified for specialty, 237

INDEX

112, 115-7; number of candidates, 112-4, 179; results, 113; special branches, 18, 101 Examinations, Primary, content of, 101; dissatisfaction with, 109-111; discontinued, 65, 111, 116; first examinations, 103-5; Low Report, 18, 101; older graduates excused, 101; results, 106; Royal College of Surgeons of England, 9, 101 Examiners, first boards, 104; nonfellows as, 113 Executive Committee, 60-1, 84, 86 FØ, G. S., 70

Falconer, Sir Robert, 75 Farquharson, R. F., 61, 68, 70, 78, 85, 89, 91, 95, 97, 112, 121, 159, 176 Fellowship, admission under 1945 Amended Act, 84, 116; difficulty of selection, 85-6; Newfoundland, 86; opinion of solicitors, 82-4; admission by examination, 40, 100, 102 Fellowship, admission ad eunden: gradom, as charter fellows, 37, 45, 77-8, 92; Royal Colleges with equal standing, 77; modified examinations for, 78 Fellowship, admission, Charter Fellows, 18, 22-3, 48-9; notice to all practitioners, 47-8; difficulties of selection, 48 Fellowship, Honorary, policy of selection, 129; list of, 218-220 Fees, examination and admission, 102 Fellows, women equal rights, 76 Fellowship, Credentials and Examinations, Committee on, 45, 88, 91, 95 Finance, Committee on, 59, 182 Fiset, Major-Gen. Sir Eugene, 131 Fitzgerald, J. G., 120, 147-9 Fraser, J. R., 85, 90, 159 GAGNON, E., 111

Gallie, W. E., 81, 83, 89, 95, 104, 132, 149, 152, 205 238

Garneau, P., 104 Garrow, A. E., 5 Genest, Jacques, 99 Gerin-Lajoie, Leon, 72, 112, 157, 159 Gibson, Alexander, Memorial Lecture, 134 Gibson, T., 43 Gillespie, W. F., 61, 75, 108, 124 Gilmour, C. R., 33, 37, 81, 108 Gordon, A. H., 71, 81, 152 Gordon-Taylor, Sir Gordon, 132 Graham, Duncan, 33, 37, 39, 41-2, 56, 69, 90, 92, 95, 100, 104, 108, 120, 147-152 Graham, J. H., 179 Graham, Roscoe R., 90, 95, 112 Grant, Prof. J. C. B., 103-4 Gregg, Alan, 75 Gunn, J. A., 108, 200 HALE, G. C., 20, 33, 37, 39, 56 Hamilton, Glen, 17 Handbook, College, 59 Harris, R. I., 70, 85, 90, 121, 130, 159 Harvie, W. A., 18 Harwood, L. de L., 33, 37 Headquarters, Ottawa, provisional Council, 34, 35; temporary, Toronto, 171; permanent, Ottawa, 174-5; National Research Bldg., 174; Metcalfe St., 176; Somerset St., 174; Stanley Ave., 181 Hebert, C. E., 99 Henderson, V. E., 17 Hepburn, John, 61, 72, 75-6, 86, 98 Hill, H. W., 17 Hingston, Sir W. H., 131 Holland, C. W., 98-9 Hooper. George, 179-182 Hospital accreditation, Canadian council of, 126; joint commission on, 125; C.M.A. study committee on, 125 Hospitals, approval of, by Royal College, committee on, 60, 122, 125;

INDEX

application for, 122; inspection, 124-6; list of, 99; under university supervision, 124 Hospital standardization, American College Surgeons, 15, 119 Housing Committee, College, 58, 172 Howard, C. P., 31 Hyland, H. H., 90 Prof. C., 130 Incorporation of College; bill as proposed by Nucleus Committee. 21; as presented in parliament, 22-4; before parliament, 25-8; text of, 222-6; amendments, 63-4; joint college, 31, 33; use of 'Royal' in tide, 26, 28 Ireland, P. E., 60, 182 ILLINGwORTH,

JAMESON, Sir W. W., 75, 132 Janes, R. M., 57, 72, 91, 98-9, 111, 130, 180-82 Johnstone, D. S., 16-8, 74, 101, 208 Jones, W. A., 149, 155

B., 30, 33 Kelly, A. D., 121, Note, 229 Kergin, F. G., 99, 111 Kerr, R. B., 100, 130 Keynes, Sir Geoffrey, 130, 133 Klotz, Prof. 0., 104 King, Hon. J. H., 63, 131, 156 Krupp, Weston, 19 KEENAN, C.

University, see Universite Laval Leblond, S., 193 Lecours, J. A., 177, 179 Lectures, The Annual, 70-1 Lecturers of the College, 221 LeSage, Albert, 83, 95, 104, 109, 204 Lesage, Jean, 109 Lessard, Richard, 91, 98, 105, 111 Lewis, D. S., 89 Little, H S., 85, 90, 155, 157, 159 Low, David, 16-7, 19-20, 46, 74, 101, 129, 209 LAVAL

Lyman, W. S., 43, 59, 93, 147-8, 173-6 Lyon, E. K., 125 MCCABE, L. G., 105 McCallum, H. A., 5, 11 MacDonald, A. E., 90 MacDonald, H. K., 108 McDougall, J. G., 17, 33, 37 McEachern, J. S., 153 Macfarland, M. T., 12 MacFarlane, K. T., 177, 181 McGarry, M. E., M.P., 63 McGibbon, Peter, M.P., 27 McGill University, 13, 33, 100, 103, 107, 120, 143, 146, 189 MacKay, D. S., 12, 24 McKenty, James, 5 Mackenzie, Chalmers J., 75, 130, 183 MacKenzie, K. A., 33, 37, 65, 108 McLachlin, A. D., 74, 85, 98, 123, 126, 159 MacLaren, Murray, 25 McLaughlin Foundation, 74 McLaughlin-Gallie Visiting Professorship, 74, 130 McLaughlin, R. S., 130 McLean, N. J., 33, 37 McMurrich, Prof. Playfair, 42 McNally, W. J., 111 McNaughton, Gen. A. G. L., 130, 174-5 Mader, V. O., 98-9 Magnan, Arthur, 72 Magner, Desmond, 181 Maheux, Abbe A., 75 Mainland, Prof. Donald, 108 Manitoba Medical Association, 144 Manitoba, University of, 12, 16, 24, 30, 33, 108, 134, 146, 189 Marlow, F. W., 5, 11-2, 16 Martin, C. F., 19-21, 30, 35, 100 Massey, C. H., Rt. Hon. Vincent, 75, 130, 182 Mathers, A. T., 57, 61, 72, 75, 85, 157, 159, 176

239

INDEX

Meakins, J. C., 32-3, 37-8, 41-51, 89, 100, 104, 172 Medals of college, annual, 137; medallists, 222; terms reference, 137 Medical Council of Canada, 179; certification of specialists, 145-153; possible sponsors of college, 13-4; Roddick grant, 183 Medical Protective Association, Canadian, 179 Meetings, annual, first, 46; second, 48. Attendance, 67-8, 76, 179; business, 67-9; conferenciers, 70; convocation, 67-8; lectures, 70; prize essays, 137-8; scientific programme, 69, 71-2. Regional scientific, 72-4; Halifax, 73; London, 74; Regina, 74 Mercer, Sir Walter, 134 Miller, G. G., 98 Miller, Prof. James, 17, 190 Mills, E. S., 91, 98, 137 Montgomery, L. C., 68 Moore, S. E., 5, 16-8, 39, 74, 101, 209 Moorhouse, Prof. D. K., 108 Mullin, J. H., 17 Munroe, A. R., 33, 37, 100 NEWFOUNDLAND, 86 Nicholson, Prof. Daniel, 108 Nominations, Committee on, 60 Nucleus Committee, see Canadian Medical Association

82; Somerset Street, 174; Stanley Avenue, 179-83 Ogilvie, Major-Gen. Sir W. H., 132 Oille, J. A., 95 Ontario Medical Association, conference on specialism, 145 Osier, Sir William, 106 Ottawa, Mayor of, 183 Ower, Prof. J. J., 108 PARIS, connection of Canadian medical schools with, 10 Parsons, R. MacGregor, 183 Patch, F. S., 57, 60-1, 81, 85, 89-90, 95, 99, 115, 120, 143, 152-3, 155-9 Penfield, Wilder, 57, 69-70, 75, 81-3, 89, 131, 155-7 Pepin, J. R., 98, 109 Peters, C. A., 69 Perron, Edmour, 89, 95 Philpott, N. W., 72, 91, 99 Platt, Sir Harry, 110, 133 Plunkett, J. E., 56-7, 59, 61, 94-5, 105, 121, 175-6 Pope, E. L., 12, 24, 33, 37, 44, 92, 100, 108, 148-9 Primrose, Alexander, 9, 12, 14-5, 19, 21, 30, 32, 35, 101, 147 Prizes and Awards, see Medals, Annual Prowse, S. W., 16 Publicity and Publications, Committee on, 59; handbook, 59 QUEEN'S

OBSTETRICIANS and Gynaecologists classed as surgeons, 32 Obstetricians and Gynaecologists of Canada, Society of, 71-2 Officers, election of first, 38-9; executive officers, early, 39, 173; past office bearers, list of, 213-4 Offices of college, Toronto, 45-6; Ottawa, transfer to, 34, 171-3; National Research Council building, 175; Medical-Dental building, 176240

University, 33, 36, 75, 100,

189 RADIOLOGISTS, Canadian Association of, Canadian Board of Radiologists, 149 Ramsay, G. A., 149 Rankin, Alan, 146 Ravdin, I. S., 134 Rawlinson, Prof. H. E., 110-1 Refresher Courses, 58, 107 Regina and District Medical Society, 1920 Resolution, 5

ØØ

Register of Fellows, 40 Report, Low, 1927, 18-20 Rhea, L. J., 104 Richards, G. E., 85, 90, 157, 159 Ridewood, H. G., 19 Ritchie, J. B., 18, 189 Robertson, D. E., 59, 95 Roberstson, H. Rocke, 98-9 Robes of College, 44 Roddick, Sir Thomas, 14, 136, 183; Portrait, 183 Rousseau, Arthur, 20-1, 33, 37 Routley, T. C., 8, 11-2, 16, 30, 33, 37-8, 41-5, 53, 153, 171, 173 Roy, Louis-Philippe, 99, 181 Royal College Physicians and Surgeons (Kingston), 36 Russia, allied surgical mission to, 131-2 Ryerson, Stanley, 145-152 Sr. LAvaam, Rt. Hon. Louis, 180 Scane, J. W., 8 Scott, J. W., 73-74, 98-9, 181 Seal of college, designer, 42-3; motto, 42; inscription, 44 Selden, G. E., 149 Shaner, Prof. R. M., 108 Simard, L. C., 104 Sims, Sir Arthur, 130 Sims Travelling Professorships, 130 Slayter, Dr., specialist resolution, 143 Smirnov, Lieut.-Gen. Y. I., 132 Smith, Prof. Ralph, 108 Specialist certificate, recognition of, 166-7 Specialists, Committee on, 59, 95 Specialists, location of, 165 Specialists, Saskatchewan inquiry on, 147 Starr, F. N. G., 4, 9, 19-23, 28, 31, 33, 37-8, 41, 53, 69, 92, 100, 172 Stewart, John, 19, 130 Stokes, A. B., 123-4 TAIT, Prof. John, 103-4, Tees, F. J., 11 Thompson, D. A., 74, 126, 183

Thompson, Miss Doris, 174, 176 Thompson, Prof. J. MacL., 108 Thorlakson, P. H., 200 Toronto, University of, 13, 33, 42, 75, 107, 120, 146, 189 Tory, A. M., 173-4 Training requirements, certificate, 156, 161; fellowship, 87-91 Tremblay, J., 105 Triumvirate, The Mighty, 189, 208 Trueta, Josep, 132 Tweedsmuir, Rt. Hon. Lord, 75,130 Laval, 10, 13, 33, 75, 83, 98, 100, 105, 108-9, 146, 189 Universite de Montreal, 33, 83, 98, 105, 108-9, 146, 151, 189 UNIVERSITE

VALENS, John, 210 Valin, R. E., 61, 74, 173-7 Vallee, M. P. A., 81-2, 104 Vanier, D.S.O., M.C., His Excellency Major-Gen. G. P., 131 Vant, J. Ross, 72 Van Wyck, H. B., 72, 75 Veniot, C. J., 63 Vezina, Charles, 83, 104, 131

Sir Cecil, 133 Wallace, R. C., 75 Watson-Jones, Sir Reginald, 130 Webb-Johnson, Rt. Hon. Lord, 75, 132 Webster, D. R., 99 Weld, Prof. C. B., 108 Welsh, W. K., 99 Western Ontario, University of, 33, 74, 100, 189 Whitnall, Prof. S. E., 103-4 Wightman, K. J. R., 99 Williams, Hadley, 33, 37 Williamson, G. S., 179, 181 WASEI.EY,

YOUNG, A. MacG., 21-5, 28, 63, 148, 156, 210 Young, G. S., 57, 63, 93-5, 110, 149, 156, 175 Young, M. A. R., 92, 105 Yudin, Prof., 132 241