McGill Medicine, vol. 1: The First Half Century, 1829–1885 by Joseph Hanaway, Richard Cruess (review)

Book Reviews 607 Lemire et qui, au surplus, traduit bien la volonte qui a toujours ete sierme de fouiller aux sources de l'histoire litteraire du Quebec, et de diffuser le fruit de ses recherches. MARIE-ELAINE SAVARD Universite du Que'bec aTrois-Rivieres McGill Medicine, vol. 1: The First Half Century, 1829-1885. rosEPH HANAWAY and RICHARD CRUESS. Montreal and Kingston: McGillQueen 's University Press 1996. Pp. 219, illus. $45.00 In this relatively short account (102 pages, but with an additional 88 of appendices and biographical sketches of McGill Faculty), the authors tell the story ofthe university medical school from its opening in 1829 through to 'the Osler years' (1874-85). Much emphasis is placed on McGill's debt (it is described as a 'clone') to medical education in Edinburgh and on its subsequent slowness' in adapting to changes in nineteenth-century medicine, at least until the impact ofWilliam Osler. The closing section outlines how Osler (with a few others) served as a 'potent ferment' for a new approach in medical education, with 'new facilities for student participation in a hands-on way' (wo). As well as offering a fine collection of illustrations, this book provides a significant account of a leading Canadian medical institution . Although the authors do not reach the period of the celebrated Flexner Report (1910), they prompt questions about the nature of medical education reform not only for the nineteenth-century historian but also for anyone concerned with current efforts to change medical education. 'Reform' (or the need for reform) is constantly raised in the book. This need is couched primarily in 'terms of shifting from the passive student activities (lectures and hurried bedside rounds) that characterized the school's first forty years or so, to an active participation in laboratory science and making students 'think scientifically' (100). In fact, the story offers a sense of triumphal science. However, the sharpness ofthe authors' interpretation raises some discomfort for this reviewer. In tones dismissing the early years as the 'didactic old guard era' (96) of inadequate lectures (xxii), the authors fail to give due weight to the early nineteenth-century emphasis on careful observation in medicine and the need to understand the natural history of diseases. Much of this emphasis was in pursuance of the Hippocratic ideal. Furthermore, any consideration of the importance of trends to 'active' learning needs to consider that apprenticeship remained a central 608 The Canadian Historical Review feature of British and American medical training until well past the middle ofthe century. Although apprenticeship is noted as an informal entrance requirement for McGill students, at least until 1865 (43), we are given no real sense of the background of the students. The emergence oflaboratory studies at McGill in the 1870s is hardly surprising, and _ an appreciation that it was part of a general change in medical education on both sides of the Atlantic could have made the McGill story more meaningful. T.N. Bonner, in his study Becoming a Physician (1995), makes clear that national chara,cteristics in medical education emerged through different responses to medicine's development as an experimental/laboratory discipline..It is certainly a pity that the factors resisting change, especially on the part of the Faculty at McGill, are not detailed. An effort to compare McGill's situation with medical education in Toronto might have helped to clarify McGill's particular characteristics. Did McGill, for instance, develop a research 'ideal,' as apparently happened in Toronto? Some of the evident richness of the story of medical education at McGill is hidden behind 'the authors' discussion ofbuildings, numbers, and courses. As important as these are for the overall story, one begins to wonder about the book's opening sentence: 'All truly great institutions owe their status to those who, having gone before, willingly made sacrifices for the future' (xxi). Unfortunately, although we are given much biographical detail (31 sketches of selected faculty members from 1829 to 1885), a sense of working relationships and the atmosphere of the institution is not easy to grasp. The authors, for instance, do not explore the special relationship between William Osler and Palmer Howard, his teacher and supporter in Montreal, which has been well...