HUMANITIES | PROFILE Serving two masters: the medical and political careers of Sir Charles Tupper n Cite as: CMAJ 2017 June 26;189:E866-8. doi: 10.1503/cmaj.170224 ir William Osler acknowledged the that this would be his life. He served a on a call; they would find a different horse challenge of serving two masters, large rural area with calls as far as 40 miles in their barn, because Tupper exchanged in his obituary for Sir Charles away. Farmers knew when Tupper was out horses on his long routes. STupper but said that Tupper had applied himself fully as a physician and a politician. Tupper was a physician who championed public health, better hospital care and improved medical education. He became a founder and the first president of the Canadian Medical Association (CMA). At the same time, he was a formidable pro- vincial and then federal politician, a Father of Confederation and prime minister of Canada. Osler recognized the unique con- tribution of this combination in his com- ment, “His life is an illustration of the bril- liant success of the doctor in politics.”1 Sir Charles Tupper was born in Amherst, Nova Scotia, on July 2, 1821. Early in life, he saw himself as a physician, not a politician. His education was initially at home and directed by his father, a Baptist minister who wrote scholarly religious tracts. His parents were both descendants of New England Planters who arrived in the Mari- times after the expulsion of the Acadians. In 1835, at age 15, Tupper apprenticed in Amherst with Dr. Benjamin Page and then with Dr. Ebenezer Harding in Windsor, Nova Scotia, before applying to study medicine at Edinburgh University. The university accepted his years as an apprentice, and he was able to complete his medical training in three years. His 1843 thesis on obstetrics was put forward for a university medal by his mentor, James Young Simpson (who introduced chloroform as an anesthetic).2 He had some extraordinary teachers at Edinburgh who believed that medicine was a social good, and this had a profound influence on the young Dr. Tupper. He began practice in Amherst, where he also opened a pharmacy with his brother Peter B. Waite fonds (MS-2-718, PB Box 13, File 93). Dalhousie University Archives, Halifax that is still in operation. Tupper expected Photograph of Sir Charles Tupper circa 1880. E866 CMAJ | JUNE 26, 2017 | VOLUME 189 | ISSUE 25 © 2017 Joule Inc. or its licensors His career changed in March 1852 when Since 1860, Tupper had been working a professional code of ethics. At the end HUMANITIES he agreed to introduce a local Conservative toward a larger end. He envisioned a con- of the meeting he was elected for another politician who was debating the prominent federation of the Canadian colonies but term; this was repeated the next year, editor and Liberal politician Joseph Howe. wanted to begin with Maritime Union. In making him the only CMA president to The introduction gave Tupper the opportu- 1864, he called the Charlottetown Confer- serve three terms. nity to speak his mind. The force of his rea- ence of the Maritime Provinces and His presidency was admired, and soned arguments impressed his neigh- invited representatives from Upper and although the medical politics of the day bours and the politicians. It would also be Lower Canada, who came with a desire were often very heated, Tupper was the beginning of a life-long feud between for that wider confederation. At home in always cool.4 He came prepared for what- the two men; within a few years Tupper Nova Scotia, he had to contend with a ever issue was raised. His long political would defeat Howe and become premier of strong anticonfederation movement that experience showed in his leadership of Nova Scotia in 1864. Both men had strong was led by Howe, bankers and wealthy the CMA and gave his decisions “weight feelings for Nova Scotia but differing merchants. The colonies were prosperous and character.” The association members visions. Howe looked inward to Nova Sco- and saw no reason to change the status “invariably submitted” to his will, show- tia’s virtues. Tupper looked outward and quo, but Tupper saw confederation as a ing their complete confidence in him.5 saw Nova Scotia as part of a larger British way for Nova Scotia to become part of a Tupper continued to practise medicine presence in North America and the world. larger presence. wherever he was living during his political As premier, Tupper pursued an active In the 1867 elections in Nova Scotia, 36 life: Halifax, Ottawa, Toronto, and at his political agenda but continued his busy of the 38 seats were won by anticonfeder- summer home in St. Andrew’s, New Bruns- medical practice and also became the ationists; federally, 18 of 19 Nova Scotia wick. He always had his black bag by his medical officer for Halifax. While working representatives were anticonfederation. chair in the House of Commons. for Maritime Union and later Confedera- Against these remarkable odds, Tupper Tupper’s remarkable half-century tion, he passed health-related legislation brought Nova Scotians into Confedera- record in public service has seldom been to bury the open sewers running down the tion and kept them there. surpassed. He was premier of Nova Sco- streets of Halifax, dealt with a cholera epi- The odds were more in his favour tia, and after Confederation and election demic, set quarantine laws and estab- when, only a few months later that same to Parliament, he served as president of lished an office of vital statistics. year, Tupper was instrumental in bringing the Queen’s Privy Council, minister of One of Tupper’s first priorities as pre- together the physicians of the new con- internal revenue, minister of customs and mier was to establish free, publicly funded federation. Despite his busy schedule, he minister of railways and canals responsi- education for all children in Nova Scotia, travelled to Quebec for a meeting at Laval ble for building the Canadian Pacific Rail- regardless of income, religion or location. University on Oct. 9, 1867, to discuss the way. He authored the national policy for He was aware that his own party, the organization of a national medical soci- the government of Prime Minister John A. opposition and taxpayers were against the ety. The Quebec hosts felt their society Macdonald. He was appointed high com- idea. Tupper refused to back down: in president should be the first president, missioner to London and, just when he 1864, Nova Scotia established the first free but Dr. W. Marsten declined, saying that was retiring in 1895, was brought back nonsectarian education system in British Dr. Charles Tupper would be “a more from London to help the Conservative North America. Although not voiced as desirable choice.” Tupper was elected party in the election. He was again such at the time, this was a major step for- unanimously and delivered “an eloquent elected and when Sir Mackenzie Bowell ward in improving the determinants of address,” indicating that the new organi- resigned over Manitoba school issues in health for this population. The public and zation would be dedicated to the protec- 1896, Tupper became Prime Minister, the politicians were also getting a taste of tion of the health and lives of the people although his party was defeated just the unbending forceful vision of the “fight- of the nation, and to improving profes- 44 days later by Wilfred Laurier. ing doctor” from Amherst. sional qualification and licensure. The Politicians of the day were puzzled by Not content with reforming primary members then toured the Beauport Luna- Tupper’s forthright, aggressive and force- education, Tupper also looked to estab- tic Asylum. After a fine dinner with many ful manner. They were used to Victorian lish the struggling Dalhousie University as toasts and another speech from the new oratory, negotiation and subtle political a nonsectarian institution, which greatly president, they climbed into 30 carriages expediency. He was blunt and unbending upset his father and the Baptist support- and followed Tupper to the St. Louis in debate. He came to committee rooms ers of his party. He led in getting the uni- Hotel for some final libations and sleep.3 armed with facts and did not leave until versity back on its feet and spent years The first annual CMA meeting was he achieved what he wanted. When it arguing to establish a Dalhousie medical held in Montréal in September 1868. came to unifying the country, he recog- school. The medical society said it was Tupper gave the first presidential address nized that John A. Macdonald, with his not possible without a general hospital or and was interrupted repeatedly by subtle skills as a conciliator, was better at anatomy act. Tupper pushed for both, as applause and cheers as he spoke about bringing disparate groups together. well as a new poor house. Dalhousie Med- the importance of medical education, Tupper was often the driving force, but ical School opened in 1868. regulating the profession and developing Macdonald led the process. Macdonald, CMAJ | JUNE 26, 2017 | VOLUME 189 | ISSUE 25 E867 on the other hand, recognized the value bec. Seldom do we see such selfless acts and politics nothing else but medicine on a of having Tupper by his side, because he in politics.6 large scale.”8 could strong-arm any change. When faced However, Tupper and Macdonald soon with a political impasse, Macdonald had a falling out over the Canadian Pacific T. Jock Murray MD always sent for Tupper. Even Tupper’s Railway.