The President's Address At the Second Annual Meeting New Zealand medical Association,

By Alexander Johnston, M.D. (St. Andrew's),

On the 12th May, 1887.

Gentlemen,—I have the honour this afternoon to address you upon opening the second annual session of the New Zealand Medical Association. This society was conceived and brought forth only last year by the Medical Society of Dunedin. I have now to congratulate its parent upon the vitality and vigour it already displays. The attendance of members from a distance shows that in its early infancy our Association has a power of locomotion that promises a vigorous and important career. Those members who have honoured us with their presence will, I hope, accept the thanks of the members of the Wellington Branch of the Association, on whose behalf I now welcome them, and hope to show that the compliment paid is duly appreciated.

Gentlemen, when I was told that it would be my duty to address you upon the opening of our proceedings at this meeting my thoughts naturally turned back to my experience of the practice of Medicine and Surgery in the colony during the past thirty-five years, but, alas, I found no field for my subject there When the early colonists arrived in New Zealand, they were page 2 obliged, by the heavily-bushed nature of the country and the warlike character of the Natives, to settle down at various convenient places upon the coast. These small centres of population in a few years became provinces, under local government, with separate, and, I might say, different interests. Under these circumstances the medical practitioners of New Zealand were as much separated as the medical men in the different colonies of Australia—indeed, the practitioners of Auckland could more quickly and more easily communicate with their brethren of New South Wales and Victoria than with those of Dunedin. This curious position accounts for the absence of co-operation among the medical men in the past, and consequent loss of medical history in this colony. Now, if I attempted to make one, it could only relate to the struggles of single practitioners in isolated districts, who, without assistance or support from colleagues, heroically accepted heavy responsibilities with but small pecuniary reward, performing their duty with credit to themselves, and generally gaining the respect arid affection of their fellow pioneers, and assisting the introduction and advancing the progress of civilization in this modern land of promise. Most of you here to-day know something of, or can readily understand, the trials and difficulties to be encountered during the first quarter of a century of life in a wild country, already inhabited by an intelligent and warlike, but uncivilized, people, whose place on earth it was our mission to occupy. Let us hope that our present promising prospects may steadily improve, and the aspirations of the founders of this Association may be realized, and result in the acquisition by the medical profession of a more influential position in the good government of the country than it has hitherto possessed.

Gentlemen, there are already many subjects proposed for your consideration at this meeting; nevertheless, I shall now take the liberty of mentioning one or two others, which, in my opinion, are of vital importance, not only to us as a body, but in a greater degree to the general public. We probably shall not be able during our short session to discuss these questions; but I wish to draw your attention to them, in the hope that the different Branches of our Association may seriously consider them in the course of the ensuing year. One subject which in my opinion requires our earnest attention is the education provided for, and the time and opportunity at present allowed to, students to attain sufficient knowledge to pass the examinations necessary for registration as legally qualified medical and surgical practitioners; and how far these practitioners are fitted by this education, and these examinations, to commence the actual practice of their profession. I am very diffident in addressing page 3 you upon this subject: you are younger men than I, of a new school, and probably will not agree with all I say. But I feel so certain that sufficient time is not, in the present day, allowed to students to enable them to acquire a sufficient knowledge for the practice of their profession, before they receive the legal qualification, that I shall persevere with my subject, and trust that you will receive my remarks with patience. I will go back fifty years, and give you some information upon the training and education then required to enable men to pass the examinations for the double qualification of Medicine and Surgery, and ask you to compare that training and education with the education only which is now provided, and leave you to judge whether the modern system of high-pressure theoretical teaching is producing practitioners as likely to be successful in the general practice of Medicine as if they were trained and educated under the old system. I do not object to—indeed I warmly advocate, the higher education now required: my contention is that sufficient time is not allowed to enable young men to acquire it thoroughly, and so be able to retain it. The great aim of the medical student to-day is to obtain his legal qualification, regardless of the knowledge and experience necessary to practise it. His time of study is curtailed, but the curriculum is extended. However well this looks as a programme, as a fact it can only result in a temporary and superficial acquisition of knowledge, crammed into the student's brain with no permanent benefit, inasmuch as time is not allowed for its reception and assimilation. Under the old system the student was introduced to the profession by articles of apprenticeship. Upon entering the surgery, he was occupied during the first year assisting the dispenser, not only compounding prescriptions, but making all preparations required for them, learning to read and write prescriptions, and obtaining a practical knowledge of drugs and pharmacy. He was then gradually allowed to assist in the attendance upon the club and pauper patients coming to the surgery for minor ailments; his spare time was occupied in preparing for his preliminary or matriculation examination, and in acquiring a knowledge of the bones, thus getting a sound groundwork of the elements of anatomy before beginning his work in the dissecting-room. At the end of his third year he was a valuable assistant, attending midwifery, minor surgery, and visiting patients; so that when he commenced hospital practice, and lectures, he was in a position to understand the instruction there given. After three years of this work he was ready to pass his examinations with credit, and become not only legally, but practically, well qualified to take his place in the ranks of general practice. At the present time, the requirements for the double qualification are only a proof of four years' page 4 study of Medicine and Surgery, one of which may be given as a certificate from any legally qualified practitioner; this, and three years' certificates of attendance upon hospital practice and the necessary lectures, is now deemed sufficient to allow a student to present himself for examination; and if successful he is at once admitted to the register of general practitioners, thus receiving his legal qualification before he has any practical knowledge of his business. The multiplicity of subjects in the extended curriculum, and the abbreviated period of study allowed for its attainment, must result in a competition with time for the earliest arrival at a standard goal of education, which, being gained, is found to be only superficial plate. Under an agreement with the University of Edinburgh, Otago is recognised as a school where two years' study counts towards the four years' University work required before a student can be admitted to examination; therefore, provided he brings certificates of having passed his matriculation, and studied two years at Otago, he can proceed to his M.B. examination at Edinburgh with only two years' residence in that University. I have seen one or two specimens of this arrangement: in my opinion they are not satisfactory as results. One of them told me his experience—it was a really painful one. He said it was one continued struggle to prepare for the examinations, or, as he expressed it, four years' work pressed into two. He tried well, but did not succeed—he was rejected at his final examination; and when ultimately successful he was consoled, and even thankful, for the extra time afforded him for acquiring a better knowledge of his profession than if he had been successful in pulling through the examination at his first attempt. Gentlemen, the University of New Zealand, apparently jealous of the success of her rival at Otago in forcing her students to the goal of legal qualification by means of the University of Edinburgh, has now brought forth a Bachelor of Medicine of her own creation. I do not believe that this degree will carry much weight outside New Zealand; and, as a prophet is scarcely known in his own country, I would not give very much for its chance of success within. In my opinion, the reputation of the University of Otago will be safer with her students stamped as graduates of a Medical University of ancient foundation, and of undoubted modern reputation, than the University of New Zealand will be with her graduates the result of three years and a half's study. I do believe that an intelligent youth, with a natural taste for the trade, may in that time be made an efficient and successful carpenter or bootmaker; but to train and educate a man for the profession of Medicine, with all the acquirements called for by the rapid progress of our age, requires, and must occupy (at least with any hope of future success), a longer period than page 5 forty-two months, as now required by the curriculum of the New Zealand University for the degree of Bachelor in Medicine. Gentlemen, there is no royal road to the study of Medicine. The appointments, appliances, and conveniences necessary for its acquirement will not be established satisfactorily in New Zealand for the next fifteen or twenty years. Population must be the basis to start upon; and until there are large centres of population in the colony it will be impossible to apply the appointments of medical schools successfully, however great may be the amount of money spent in their establishment. Nevertheless, since the University of New Zealand is recognised as an institution for the education of students, and for their qualification legally to practise Medicine and Surgery, making her degrees eligible for registration upon the Medical List of the Colony, it is the duty of this Association to apply its utmost endeavours to make the education required for the attainment of these degrees not only thorough and lasting upon the mind, but of practical utility when required upon the field of active practice. To do this, it is necessary to obtain representation of the profession at the Board of Advice, by the appointment of well-known leading medical practitioners to the Senate of the University, who, by their actual knowledge of the work, will be able to indicate the training and course of study required, and also to judge the merits, acquirements, and practical knowledge of students applying for the legal qualification. Gentlemen, I leave this subject to your future consideration, and I trust that the course of action I have indicated meets with your concurrence, so that the newly-established unity of action produced by the foundation of this society may lead to the scientific cultivation, and at the same time to the practical advancement, of our revered profession.

Another question has exercised my mind for some considerable time, without much hope of relief; but the fact of having a general Medical Society now established leads me to hope that it may prove a means of successfully opening up the subject of Public Health.

I believe New Zealand has the reputation of keeping fairly up with the advanced requirements of modern civilization. There is more money spent in this colony in free education, in proportion to population, than in any other. There has been legislation for the prevention of disease among the lower animals, and so strictly are these laws administered that the introduction of horses, cattle, and dogs is absolutely prohibited; even the vegetable world has not escaped, phylloxera and codlin moth each requiring an Act of Parliament to protect the health of our page 6 vegetable kingdom. With all this care it is incomprehensible, and even difficult to realize, that our grim old enemies disease and death are allowed to walk daily in our midst, bringing ruin, desolation, and grief among us, without an effort being made to check their career. We cannot expect to stop the march of death! But, if the Government would carry out the measures taught by the progress of science during the last twenty-five years, we should be able to keep our dreaded foes from our doors until our natural term of life on earth has expired. We cannot, in this age, hold Nature responsible for a high rate of mortality, since science has revealed the means of preventing disease. It is now full ten years since a very elaborate and lengthy Act was passed by the New Zealand Legislature for the protection of the public health. It provides for a Central Board and any amount of Local Boards of Health throughout the colony, but unfortunately, and, I believe, solely in consequence of the expense of administering it, the Act turns out to be a sham. The Central Board of Health, instead of being an independent body of experts, is composed of some six or seven Civil servants, receiving no extra pay for this work, and taking no interest in it; naturally they are under the influence of the President, who is a Minister of the Crown. This Board appears to have no definite time fixed for its meetings, and usually is in a passive condition, only occasionally being jerked into vitality by the report of disease in the distance. When these reports arrive, a meeting is hurriedly called, resulting in a letter to the Health Officer of the port, instructing him to inspect every ship on arrival, and to look out sharply for any cases there may be of the disease expected. But, as far as I know, there is not the least preparation made for the reception and proper treatment of such cases if any were unfortunately to arrive. Our quarantine buildings were built many years ago, when immigrants were carried in sailing ships—before the direct ocean steamers were thought of. Hitherto we have been fortunate in the arrival of our steamers in good health; but we cannot expect our good luck to be always present, and if a large vessel like the German steamer "Preussen," with 600 or 700 people, and small-pox on board, were now to arrive here, we should be found in a pitiable state of unreadiness and confusion, which would result in an outcry of indignation, panic, and heavy expenditure. The same, or even more reckless, condition of affairs is allowed to exist immediately among us—typhoid and scarlet fever are allowed to scatter our people, and to bring desolation and despair to our families, for the want of that organization and administration which is the duty of the Government to carry out. This duty is recklessly neglected, because it would necessitate the creation of a new department and the expenditure of page 7 money. The money spent on education is not thought too much, but one-twentieth of that sum cannot be obtained for the administration of an Act which, in a great measure, would prevent disease, very materially extend the natural term of life in this country, and allow thousands to escape the too frequently recurring times of grief and trouble. If our existing Public Health Act were vigorously carried out by an independent Board of Health, with an efficient staff of properly qualified Health Officers, spending all their time in the performance of their duty throughout the country, such diseases as typhoid fever, and many others now prevalent in this new and thinly-populated country, could be stamped out, and the rate of mortality would be reduced, to the advancement and prosperity of the country, and to the increased happiness of the people. I trust that the members of the New Zealand Medical Association will therefore take every opportunity of giving information to the public, and especially to their representatives in Parliament, upon this nost important subject, and thus by united influence bring pressure upon the general Government of the Colony, and force it to take a new departure towards the protection of the public health, without which protection the very large expenditure upon the education of the people will be thrown away, in consequence of the beneficent influence upon their mind and character being lost for the want of healthy bodies to act upon.

Gentlemen, there is one other matter to which I beg to call your attention: it is the compilation of a Code of Medical Ethics. This I sincerely trust may be agreed upon during our present session. My own experience shows me that each year brings evidence of the necessity for it; and, unless we are satisfied to allow all esprit de corps, all honourable and honest emulation, and the dignity of a learned and distinguished profession to disappear for ever, we shall at once endeavour to establish, and mutually agree to support, a strict and definite Code, to be compiled and issued under the authority of this Association for the guidance of its members. The facilities now afforded for entering the profession necessarily introduce into the practice of Medicine a certain number of undesirable men, who are perfectly unconscious of the respect due to the profession they pretend to practise. These practitioners, not immediately finding occupation, start the system of advertising and touting for patients; and, being naturally endowed with commercial instincts, they gradually degrade the consulting-room to the position of a shop. These unworthy members of the profession, filled with envy, and jealous of the higher social position given to their more honourable rivals, usually resort to misrepresentation and slander to assist them, which course, though page 8 it may appear for a time to be successful, usually redounds to their own discredit. Such men should not be allowed to enter this Association, but should be made to accept the inconvenience and annoyance their own misconduct brings upon themselves; and they have no reason to complain that members of an honourable society will not receive them as friends and associates.

Gentlemen, as we have many subjects coming up for discussion, and our session can only last a very few days, I will not detain you longer; but, thanking you very sincerely for the patience and attention you have so kindly accorded me, I now propose that we at once proceed to the business of the day.