On March 29, 1867, the British North America Act, the legal basis for confederation of Upper and Lower Canada, New Brunswick, and Nova Scotia into one dominion, received the Royal Assent of Queen Victoria. (The conditions were less hectic than those surrounding the earlier North American union in her grandfather's time.) The act stipulated, among other things, that each member province had exclusive rights to make laws in relation to "the Establishment, Maintenance, and Management of Hospitals, Asylums, Charities and Eleemosynary Institutions in and for the Province, other than Marine Hospitals." Education was also assigned as a provincial prerogative, with the result that development of medicine and surgery and their subspecialties continued to be closely identified with the universities and teaching hospitals in each of the provinces.
In October of this same year, a second event of national significance was a convention of provincial medical representatives at Quebec city during
Feindel W. Highlights of Neurosurgery in Canada. JAMA. 1967;200(10):853–859. doi:10.1001/jama.1967.03120230105015