Jacalyn Duffin talks about Queen’s School of Medicine in 1867.
Museum of Health Care
Dr. Jacalyn Duffin talks about Queen’s School of Medicine in 1867
Queen’s, here in Kingston, had a medical school at that time. It was one of the first academic endeavors of Queens University writ large. They would come to get their education here, a lot of it would be book based learning at the time with lectures. The students at Queens, as opposed to those in Toronto and Montreal which were other centers of learning, tended to be local, they tended to come from farms, and they tended to return to that kind of practice when they graduated.
They paid for their learning by paying so much for each course that they took, so rather than having an annual tuition fee they paid a little bit for each course. We are very fortunate that we have all of the calendars laid out, what the students should be learning, so not only do we know what subjects they were taught, we also know what books they had to buy, or read. The medical school had a small library though because the books were expensive and students couldn’t necessarily own their own. So the professors will come in and give a lecture on a certain topic and the students will be required to learn these things.
We also have a few of the examinations they were asked, and in a time-traveler kind of way it is also fun to go and look at the question and then think how the correct answer has changed through time. A typical class would be a lecture but by the time Queen’s Medical School was founded the trend in both Europe and the United States was that medical students should see real-life patients, they should go on the ward.
So in the morning where they would go and attend patients relative to the subject that they were learning at any given time. The expectation was that they would be welcome at Kingston General Hospital, and also at the Hotel Dieu Hospital as well. These things were a matter of pride for the medical school at Queen’s. They did have a General Hospital that had been operating for a long time, and that the professors who taught the students were working there. So mostly they had lectures, but then it will be amplified by being able to drop into the hospital and see a sick patient. Often when they saw a sick patient they didn’t work them up in the way of how we do today where the students are junior interns, or what we call clinical clerks and they go and help in the care of the patients.
Mostly the patient would be demonstrated to the students so the students would have had a lecture on the topic and then the preceptor would introduce them to the patient and point out various signs. The professor might interview the patient a little bit: what does it feel like to have this,or what does it feel like to have that. The students would stand back in a cluster and look and observe.
I have done a study on access to medical education which was published some years ago. My main target was how much it costs, and it was not cheap. It was expensive for families to send their children to medical school.
The getting in part, the academic record that you needed to be admitted, as long as he could afford the fee, was actually easy. We believe we don’t have the records of everyone who was rejected, so we can’t say in absolute numbers what your shot was at getting a seat in the medical school, but we think it was probably one in two were actually admitted, maybe even more than one in two, as long as they could pay the fee. Over the course of time the fees proportionately descended until quite recently in the 1990s when they took an astronomical turn upwards.
As they relatively descended the expectations of what the students needed to have in terms of education prior to medical school increased dramatically, so that now in our time period there are thousands of applicants for just 100 seats in our medical school.
It’s not quite correct to say that we didn’t have professional nurses in that we had people who worked as nurses and who were paid for it from the time of the very first hospitals. The hospital can’t function without people to clean it, people to lift the patients, people to do the laundry, people to dress the wounds, and they would be paid a fee. The profession of Nursing and by that I’m referring to the idea of professionalization where there’s a formal education, and there is a formal examinations, and licensing, and an identity that is established, and becomes autonomous and self-controlling. That didn’t come until the 1870s for lay people.
So there were nurses and it is also wrong and unfair to insist that they were all bad evil people who were drunk, although I’ve seen draconian histories that go around making these claims. I think that most of them were very well-intentioned and tried to comfort the sick the best they could, but they didn’t have the formal training they didn’t have the education.
When you think that Florence Nightingale made her big incursions into nursing education with the Crimean War, that really laid the foundation of Nursing as a formal procession as we know it. And then her school in London England, most of the lays school for nurse training came after her school, and on that model. Canada didn’t get one until the 1870s.
The support of hospitals was almost arbitrary prior to the 20th century when we made it a matter of government. It was more a matter of civic pride because hospitals inevitably were charities: they were not many making profits. The people who occupied the hospitals were largely the poor who couldn’t afford to bring the doctor their bedside in their homes, and so they weren’t likely to be able to pay the bill. Although, records were kept and we know what it costs for a bed and what it cost for a day in the hospital, but this tab had to be picked up by the local community.
Cities took great pride in the hospitals that they had, and we must not neglect the importance of the religious orders that founded hospitals.
At least half of the hospitals were religious in nature, Catholic hospitals, they were an object of philanthropy through the Catholic Church. Staffed by nuns who had taken a vow of poverty, therefore they were not making lots of money while doing their charitable work, very carefully.
Communities tried to have a hospital and there would be pressure, sometimes there
would be a tragic situation that had happened and somebody had died, and then an initiative would come along that we need a hospital and subscriptions would be taken to build that hospital, so that the community would be more attractive.
It wasn’t until the 20th century when hospitals fell under the jurisdiction of provincial governments and, more or less, received income from those jurisdictions so that it was the citizens of the problems that was paying for it collectively, rather than just local municipalities.