Medicine – Provincialism in Medicine

While we may congratulate ourselves that the worst aspects of nationalism in medicine are disappearing before the broader culture and the more intimate knowledge brought by ever-increasing intercourse, yet in English-speaking countries conditions have favored the growth of a very unpleasant sub variety, which may be called provincialism or sectionalism. In one sense the profession of this continent is singularly homogeneous. A young man may be prepared for his medical course in Louisiana and enter McGill College, or he may enter Dalhousie College, Halifax, from the State of Oregon, and in either case he will not feel strange or among strangers so soon as he has got accustomed to his environment. In collegiate life there is a frequent interchange of teachers and professors between all parts of the country. To better his brains the scholar goes freely where he wishes—to Harvard, McGill, Yale, or Johns Hopkins; there are no restrictions. The various medical societies of the two countries are, without exception, open to the members of the profession at large. The President of the Association of American Physicians this year (Dr. James Stewart), is a resident of this city, which gave also last year I believe, presidents to two of the special societies. The chief journals are supported by men of all sections. The text-books and manuals are everywhere in common; there is, in fact, a remarkable homogeneity in the English-speaking profession, not only on this continent but throughout the world. Naturally, in widely scattered communities sectionalism—a feeling or conviction that the part is greater than the whole does exist, but it is diminishing, and one great function of the national associations is to foster a spirit of harmony and brotherhood among the scattered units of these broad lands. But we suffer sadly from a provincialism which has gradually enthralled us, and which sprang originally from an attempt to relieve conditions insupportable in themselves. I have praised the unity of the profession of this continent, in so many respects remarkable, and yet in another respect it is the most heterogeneous ever known. Democracy in full circle touches tyranny, and as Milton remarks, the greatest proclaimers of liberty may become its greatest engrossers (or enslavers). The tyranny of labour unions, of trusts, and of an irresponsible press may bear as heavily on the people as autocracy in its worst form. And, strange irony of fate! the democracy of Provincial and State Boards has imposed in a few years a yoke more grievous than that which afflicts our brethren in Great Britain, which took generations to forge.

The delightful freedom of intercourse of which I spoke, while wide and generous, is limited to intellectual and social life, and on the practical side, not only are genial and courteous facilities lacking, but the bars of a rigid provincialism are put up, fencing each State as with a Chinese wall. In the Dominion of Canada there are eight portals of entry to the profession, in the United States almost as many as there are States, in the United Kingdom nineteen, I believe, but in the latter the license of any one of these bodies entitled a man to registration anywhere in the kingdom. Democracy in full circle has reached on this hemisphere a much worse condition than that in which the conservatism of many generations has entangled the profession of Great Britain. Upon the origin and growth of the Provincial and State Boards I do not propose to touch. The ideal has been reached so far as organization is concerned, when the profession elects its own Parliament, to which is committed the control of all matters relating to the license. The recognition, in some form, of this democratic principle, has been one great means of elevating the standard of medical education, and in a majority of the States of the Union it has secured a minimum period of four years of study, and a State Examination for License to Practise. All this is as it should be. But it is high time that the profession realized the anomaly of eight boards in the Dominion and some scores in the United States. One can condone the iniquity in the latter country more readily than in Canada, in which the boards have existed for a longer period, and where there has been a greater uniformity in the medical curriculum. After all these years that a young man, a graduate of Toronto and a registered practitioner in Ontario, cannot practise in the Province of Quebec, his own country, without submitting to vexatious penalties of mind and pocket, or that a graduate from Montreal and a registered practitioner of this province cannot go to Manitoba, his own country again, and take up his life’s work without additional payments and penalties; is, I maintain, an outrage; it is provincialism run riot. That this pestiferous condition should exist throughout the various provinces of this Dominion and so many States of the Union, illustrates what I have said of the tyranny of democracy and how great enslavers of liberty its chief proclaimers may be.

That the cure of this vicious state has to be sought in Dominion bills and National examining boards, indicates into what debasing depths of narrow provincialism we have sunk. The solution seems to be so simple, particularly in this country, with its uniformity of methods of teaching and length of curriculum. A generous spirit that will give to local laws a liberal interpretation, that limits its hostility to ignorance and viciousness, that has regard as much or more for the good of the guild as a whole as for the profession of any province—could such a spirit brood over the waters, the raging waves of discord would soon be stilled. With the attitude of mind of the general practitioner in each province rests the solution of the problem. Approach it in a friendly and gracious spirit and the difficulties which seem so hard will melt away. Approach it in a Chauvinistic mood, fully convinced that the superior and unparalleled conditions of your province will be jeopardized by reciprocity or by Federal legislation, and the present antiquated and disgraceful system must await for its removal the awakening of a younger and more intelligent generation.

It would ill become me to pass from this subject—familiar to me from my student days from the interest taken in it by that far-sighted and noble-minded man, Dr. Palmer Howard—it would ill become me, I say, not to pay a tribute of words to Dr. Roddick for the zeal and persistence with which he has laboured to promote union in the compound, comminuted fracture of the profession of this Dominion. My feeling on the subject of international, intercolonial, and interprovincial registration is this—a man who presents evidence of proper training, who is a registered practitioner in his own country and who brings credentials of good standing at the time of departure, should be welcomed as a brother, treated as such in any country, and registered upon payment of the usual fee. The ungenerous treatment of English physicians in Switzerland, France, and Italy, and the chaotic state of internecine warfare existing on this continent, indicate how far a miserable Chauvinism can corrupt the great and gracious ways which should characterize a liberal profession.

Though not germane to the subject, may I be allowed to refer to one other point in connexion with the State Boards—a misunderstanding, I believe, of their functions. The profession asks that the man applying for admission to its ranks shall be of good character and fit to practise the science and art of medicine. The latter is easily ascertained if practical men have the place and the equipment for practical examinations. Many of the boards have not kept pace with the times, and the questions set too often show a lack of appreciation of modern methods. This has, perhaps, been unavoidable since, in the appointment of examiners, it has not always been possible to select experts. The truth is, that however well organized and equipped, the State Boards cannot examine properly in the scientific branches, nor is there need to burden the students with additional examinations in anatomy, physiology and chemistry. The Provincial and State Boards have done a great work for medical education on this continent, which they would crown and extend by doing away at once with all theoretical examinations and limiting the tests for the license to a rigid practical examination in medicine, surgery, and midwifery, in which all minor subjects could be included.