The Sun.
London, England, 1841-01-08 00:00:00

MEDICAL REFORM.

The interest taken in this subject generally, as
well as by the medical profession, induces us to make
an abstract of the article on " Medical Reform," in
the Quarterlg Review, to which we have already
referred. The author begins lir noticing the Com-
mittee of 1834, the evidence 'collected by which
was so voluminous as to defy analysis, and prevent
a report. Four hundred out of the eight hundred
pages of evidence, were taken up with the disputes
between the Fellows and Licentiates of the College
of Physicians, in which the public feel no interest.
The first question discussed by the Reviewer is—
But here a preliminary question presents itself. Are
we to admit it as a general principle, that it is wise and
expedient for the State to interfere in any way with the
regulation of the medical profession ? There is no such
interference with the majority of other professions. No
course of study is prescribed as a necessary qualification
for civil engineers, architects, surveyors, sculptors, or
painters ; nor are there any colleges whose business it
is to examine those who have completed their studies,
as to their knowledge and attainments, and give them
licenses to practise :—Yet there is no want of talent,
information, and skill among these who are engaged in
these pursuits. Even in the Inns of Court, the being
called to the bar proves little as to the qualification of
the candidate, except that there is nothing disreputable
in his general character. It may be further observed—
mei it will not be denied by those who are acquainted
with these matters—that no degree of discipline, nor
any kind of examination, can ensure the public against
having a certain number of persons who arc very indif-
ferently qualified included in the list of well-qualified
practitioners. Young men may be compelled to have
opportunities of study, but they cannot be compelled to
learn ; and it is notorious that of those who have
wasted their time for two years and nine months there
are many who contrive, by means of labour and a good
memory, to learn their lessons so well by rote in the re-
maining three months, that the most careful and expe-
rienced examiner will find it no easy matter to detect
their insufficiency. It is, indeed, impossible, under the
very best system of examination, to prevent a certain
quantity of base metal receiving the stamp which ought
to be impressed only on the good ; and it to this we add
the following coesideration, that such an examination
as all ore required to pass neither can, nor ought, to
prove more than that the individual examined has the
tn:nimum of knowledge which a practitioner should
possess, we cannot well be astonished that there should
be reasonable persons who doubt the advantage of ex-
aminations altogether ; and who regard the various me-
dical corporations as being nearly in the same situation
with the City Compar.ies, which, however useful they
may have been in nursing the infancy of British com-
merce, contribute little or nothing to its advancement
at the present period.
Admitting, as we do, the force of these arguments,
still they are not convincing to us. Would out naval
officers be such as they now are, if midshipmen were ad-
mitted as lieutenants without examination ? or would
our artillery and engineer officers have the high cha-
racter which they now possess, if, as cadets, they had
not been made to go through a certain course of study,
and prove their fitness afterwards ? As to the attain-
ments of those engaged in most other professions, the
public have the means of forming a tolerably correct
estimate. Every one can see what goes on in the con-
struction of a church or a railroad, and those who do
not understand the subject themselves may be assisted
by the opinion of those who do ; but in what regards
the medical profession the case is wholly different.
There is no subject. of which the public; on the whole,
knew so little as they do of the medical sciences. Al-
though in the end they seldom fail to distinguish know-
ledge from ignorance, and real talent from mere preten-
sion, they are always liable to be deceived in the first
instance. It is true that the physicians and surgeons
of a large hospital, having a school attached to it, prac-
tice their art openly enough, and are sufficiently amen-
able to criticism ; but it is also true that, in private
practice, the practitioner is not before the same tribunal.
What he prescribes is often known only to himself'.
Those who employ him have no direct means of judging
of his qualifications ; and it is not until after the.lapse
of a considerable time that even those belonging to the
same profession are enabled to form an exact opinion as
to what he is really worth. Then, although, when a
certain course of study has been prescribed, it may not
be always diligently pursued—it will be so in a great
number of instances ; and it is of no small importance
to the student himself that his friends should be com-
pelled to afford him the proper opportunities for ac-
quiring a knowledge of the profession which it is de-
signed that he should practice. Lastly, although no
examination can be regarded as furnishing an exact mea-
sure of the fitness of a candidate to enter on the du.
ties of a practitioner,! yet it is a measure of it to a cer-
tain extent ; and there is no doubt that the prospect
of the examination which is to close his career as a
student is, in a great many instances, the principal sti-
mulus by which it young man is urged to be diligent.
And here another question arises. Should those who
have passed their examination, and received their li-
cense. have a monopoly of practice ? Should there be
penal laws to prevent their being interfered with by the
colupetition of the ignorant, the uneducated, and unli-
censed? or is it sufficient that the public are supplied
with a list of those who are supposed to be qualified
practitioners, it. being then left to individuals to procure
medical assistance where they please ? To us it seems
not in the least doubtful that the latter is the proper
course to be pursued. It is right that no individual
should be allowed to be inoculated for the small-pox,
because he may communicate the disease to others ;
but in what concerns himself alone, we see no justice in
the interference of the State. It may be foolish to be
rubbed with St. John Long's balsam, or to trust to the
prayers of Prince Hohenlohe, hut mankind do many
things more foolish than these, and nothing can prevent
them. There can be no greater mistake than to sup-
pose that, if there be no pens' laws to prevent the ex-
istence of unlicensed practitioners, there will net be su!-
ficient inducement to those who enter the medical pro-
fession to go through a long course of study, and then
to subject themselves to an examination. The empire
of opiniol here, as in most other instances, will do more
than legislative enactments ; and this is no speculative
doctrine, but the result of actual experience.
The College of Physicians possess, under their char-

ter, confirmed by Acts of Parliament, a monopoly of
medical practice in the metropolis, and within the dis-
tance of seven miles from it ; and they in many instances

instituted legal proceedings against the unlicensed phy-
sicians by whom those privileges had been invaded ;
hut, finding that no good arose from these prosecutions,
either to themselves or others, and that they were in
fact altogether ineffectual, they have for many years
abandoned them. The London Society of Apotheca-
ries possess A similar monopoly, under the Act of Par-
liament of 1815, but on a still larger scale, as it extends
to the whole of England. They also have frequently
resorted to courts of justice in defence of their privi
lees, but with so little success that it is notorious that
many apothecaries are practising without their license,
either in open defiance of the law, or (which is no diffi-
cult matter) contriving to evade it. On the other hand
the London College of Surgeons have no monopoly, no
privileges, no power to prosecute. Any one may esta-
blish himself as a surgeon, even next door to the Col-
lege, and no one can molest him. But the College is
of Royal foundation, and the diploma which it grants
has affixed to it the signatures of many of the leading
surgeons of London : and so necessary has it become
to any one who makes the least pretension to practise
surgery, that there are few, either in England or in the
colonies (with the exception of those who have a similar
diploma from the Colleges of Dublin or Edinburgh),
who venture to call themselves surgeons without it.
''We are aware that the foregoing observations will
not be very acceptable to many of the medical profes-
sion. It is natural that the managing bodies of
the several corporations should be anxious to maintain
and extend their powers and privileges; and it 15 a'6o
natural that licensed practitioners, who have expended
cansic:erahle sums of money, and no small portion of
their lives, in their education, should be jealous of the
competition of others. Accordingly we find, among
the resolutions and petitions of the lately formed me-
dical associations, no subject connected with schemes of
medical reform put so prominently forward as the sup-
pression of quackery. Let them, however, be assured
that this is what no legislation can accomplish. It is
no more possible to put down quackery in medicine than
it is to put down quackery in politics or religion. The
medical profession, while human nature continues to be
such as it is now, and always has been, can never
meet the demands which are made upon it. That men
are born to die ; that the power of giving relief is li-
mited ; that many diseases must prove fatal in defiance
of all remedies ; that other diseases, though not of a
fatal tendency, may be incurable—no one will doubt the
truth of these as general. propositions : but the indi-
vidual who labours under the infliction of disease will
always indulge himself in the hope that he is at any
rate safe on the present occasion, and that the time is
not yet come when he can derive no benefit from art.
' It is very extraordinary," said a gentlemen who had
known little of the infirmities of age until he had ap-
proached his eighty-eighth birthday, " that no one can
discover a cure for my complaints." Where the re-
sources of skill nod science fail, the instinct of self-pre-
servation will lead many sufferers to look for other aid;
and the honest and well-educated practitioner will al-
ways have to contend not only with the St. John Longs
of the day, but with those among his own brethren who
do not partake of his anxiety to avoid making promises
which cannot be fulfilled. There arc in fact no more of-
fensive impostors than those who march under the ban-
ners of the true faith, and we suppose that even the
most sanguine of the petitioners against quackery will
not expect that such as these can be extinguished by an
Act of Parliament. Let us not, however, be misunder-
stood as recommending that no distinction should be
made between those who are properly educated and
licensed, and others. Each individual in society has,
with respect to his own complaints, a right to consult
whom he pleases but it is quite different where be is

to provide medical attendance for his feilow-crea-
tures. The governors of & parish union, or a bench
of county magistrates, should be bound to make
their selection from those who are properly authorised
to practise. They have no right to confide the care of
the parochial poor, or the inmates of gaols and lunatic
asylumns, to any other persons. The same rule applies
to merchant-ships, to schools, to the army and navy, and
every other department of the public service.
The Reviewer is so well satisfied with the exist-
ing separation of the profession into physicians,
surgeons, and general practitioners, that had it
been artificial, it seems, he says, so exactly what is
wanted, that he should be unwilling to disturb it.
We now come, following him, to consider—
The wisdom and propriety of the plans which arc at
the present time adopted for the regulation of this part
of the medical profession.
The Act of Parliament of 1815 requires that all
those who mean to practice as apothecaries in England
and Wales should be examined by, and receive a license
from, certain persons appointed to be examiners by the
London Society of Apothecaries; and the force of public
opinion brings nearly the whole of these to be examined
also by the examiners of the College of Surgeons. Thus
the great majority of the general practitioners, in this
part of the British Empire, have pursued their studies
ander the direction of the governing bodies of two se-
parate institutions ; the one prescribing a system of
educatio❑ with respect to pharmacy and medicine, and
the other with respect to anatomy and surgery. These
two systems, of course, agree in many points, while they
differ in others.
We conclude that there are no individuals belonging
to either of these governing bodies who will hesitate to
admit the following propositions as the basis on which
all their regulations should be founded : first, that they
are bound to consider the trust reposed in them as held
for the good of the community at large, and not for the
benefit of the particular corporation to which they be-
long ; secondly, that it is their duty to require of the
candidates for their diploma or license the highest qua-
lifications which they may be expected to possess, at the
same time taking care that they do not raise the stan-
dard so high as to prevent a sufficient number of per-
sons entering the profession to meet the wants of the
public and ensure a wholesome competition ; thirdly,
that as to the extent of the qualifications which ought
to be required, no general rule can be laid down ; but
that they must vary from time to time according to the
state of society generally, or as the means of obtaining
a good education are easy or difficult. Roderick Ran-
dom became a surgeon's mate in the navy with no other
stock of knowledge than that which he had obtained
from the surgeon-apothecary to whom he had been ap-
prenticed ; and we conclude that many private practi-
tioners must have been in the same situation when
Smollett wrote ; as schools of anetomv and medicine
were then only just established in Edinburgh and Lon-
don, and these, in London especially, were of a very
imperfect kind. At present, however, the case is widely
different. There are schools, not only in each metro-1
polis, but in many of the great provincial towns, and the
greater wealth diffused throughout society, places the
means of acquiring an education within the reach of a
greater number of persons than possessed them formerly.
The College of Surgeons and the Society of Apothe-
caries have respectively taken advantage of these cir-
cumstances, and have gradually increased the amount
of studies required of those who come before them.'*
No one can now receive a license of any kind to prac-
tise who has not been engaged at least for three years in
the pursuit of his profession in a regularly organised me-
dical school, not more than three months being allowed
for a vacation in each of these years. Many young men,
indeed, remain in the schools for a still longer period ;
but we doubt whether it would be safe to make a more
prolonged education a matter of necessity : and, in fact,
a diligent student may obtain a great deal of informa-
tion, and may qualify hinisslf for becoming an excellent
practitioner on all ordinary occasions, during the term
which is now prescribed.
But although no alteration in the system of education
may be wanted in this respect, it appears to us that
much alteration is wanted otherwise. By the Act of
181.5 it is made necessary that every candidate for a
license to practice as an apothecary should have been
apprenticed to an apothecary, who had also been licensed,
during a period of at least five years ; and the regula-
tions of the Society of Apothecaries have from the
beginning admitted the candidates for examination at
the age of twenty-one years. The College of Surgeons
formerly did not allow candidates to appear before them
until they had completed their twenty-second year, but
of late (fur what reason it is difficult to be understood)
they have taken off one year, and they now admit them
at the same age as the apothecaries.
Now we hold that the minds of very few young men
can be sufficiently matured at the age of twenty-one
years to fit them for such serious and responsible duties
as those of a medical practitioner ; and we further see
another great evil as the result of this regulation, that
it induces parents, in their anxiety to get their children
off their hands as soon as possible, to send them to begin
their professional studies while they are yet boys, and
often without the advantage of even a moderate degree
of education previously. We have conversed with
many persons who have been engaged in the education
of young men, not only for the medical profession, but
for others also, and here always been informed that
these whose minds have been prepared by a good preli-
minary education have on the whole been found to be
much more diligent, and to have gained knowledge much
more easily, than others. Our own experience, which
has been sufficiently extensive, would lead us to the
same conclusion ; and we suppose that no one will ven-
ture to deny that there are moral as well as intellectual
advantages belonging to a well-trained mind which arc
nowhere more likely to be conspicuous than in the va-
rious departments of the medical profession.
As matters new stand we find the subject of general
or preliminary education altogether unnoticed in the re-
gulations both of the College of Surgeons and of the
Society of Apothecaries, except, indeed, that the latter
require that the candidates should construe some scraps
of Latin. If education be a thing of so much import-
ance, ought such an omission to exist ? and ought not
proofs of a good general education to form a part of the
documents which the candidates are expected to pto-
duce us entitling them to examination ?
With all our prepossessions on the subject we doubt
the policy of any regulation of this kind; and we would
willingly avoid the fault of recommending that over-
legislation which so frequently defeats itself.
Let us look at the question as we will, we perceive
insurmountable difficulties in the way of any other sys-
tem than that of offering a negative eocouragement to
young men to obtain a good general education, by the
seines al of every inducement to begin their professional
studies before they are eighteen or nineteen years of age.
But further, we believe that this would be found to be
generally sufficient. A father will not incur the ex-
pense of entering his son at a medical school sooner
than is really necessary ; and, for his own sake, if not
for his son's he will be disposed to keep him employed
in some kind of study, rather than he should dissipate his
time iu idleness. Besides, satisfied as we arc of the vast
advantages which the many are likely to derive front a
good preliminary education, we are aware that intellects
of a higher order may overleap the barrier which the
want of it places in their way, and we should be sorry
to witness the adoption of any measures the effect of
which would be to prevent these master-spirits from en-
tering the medical profession. The Inns of Court have
acted wisely in this respect. The tendency of their re-
gulations is to encourage those who propose to be called
to the bar to be liberally educated. They do not insist
on it, and, if they had done so, the legal profession
would have been deprived of some its brightest orna-
ments.

After advocating very judiciously the propriety of
the selecting a later period of life than twenty-one
for admitting young men to practise, the Reviewer
has these correct and careful remarks on
APPRENTICESHIP.
The addition of one or two years to the age at which
a candidate may be admitted for examination would
however be of little avail, unless another change were
made at the same time. We have pointed out that by
the Act of 1815 it is made necessary,that an apothe-
cary should have served an apprenticeship. We under.
stand, from the evidence given before the Medical Co-
mmittee (page 21 of the " Reportion the Apothecaries,")
that Mr. Rose, who introduced the Bill into the House
of Commons, objected to this clause ; and that it was
in consequence struck out ; but that it was afterwards
inserted in the House of Lords (we believe on the sug-
gestion of one of the bench of Bishops). Dr. Bur-
rows, who gives this piece of secret history, says that
the Association of,General Practitioners were anxious
for the apprenticeship clause, on account of the i.reat
diff►culty of gettin6 apprentices ;' but what could have
passed in the mind of the Right Reverend Prelate
which led him to this notable piece of legislation, about
a year after Parliament had passed an Act abolishing
the necessity of apprenticeships in other cases, it is diffi-
cult to comprehend : nor is it less remarkable that
twenty-five years should been allowed to elapse without
any attempt having been made to repeal a clause so un-
just and m►schievous.
We use these expressions not unadvisedly. The tendency
of the apprenticeship system is always to throw a great
impediment in the way of obtaining a good general edu-
cation ; and in a great number of instances to prevent it
altogether. The law requires live years' apprenticeship,
and the corporate bodies require three years of study in
a medical school, making eight years in ail. If a yaung
man is to obtain his licence (as he may now obtain it)
at the age of twenty-one, and serves the full term of
his apprenticeship in a village or town in which there
are no lectures and no hospital, he must be taken from
school and apprenticed at thirteen years of age. It the
i law be evaded, as it sometimes is, by the master giving
up two years of the term of the apprenticeship, still

Let honour be given where honour is due. The first
improvements were made by the Society of Apothecaries,
and it was not until they had set the example that the Col-
lcges of Physicians and Surgeons awoke from their long
slumber, and discovered that the time was come for requir-
ing a more extended medical education in every depart-
ment of the profession.