advantage of examinations altogether; and who regard the various medical corporations as being nearly in the same situation with the city companies, which, however useful they may have been in nursing the infancy of British commerce, 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 our naval officers be such as they now are, if midshipmen were admitted as lieutenants without examination? or would our artillery and engineer officers have the high character 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 attainments 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 construction 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, know so little as they do of the medical sciences. Although in the end they seldom fail to distinguish knowledge from ignorance, and real talent from mere pretension, they are It is true that always liable to be deceived in the first instance.

the physicians and surgeons of a large hospital, having a school attached to it, practise their art openly enough, and are sufficiently amenable 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 who belong 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 compelled to afford him the proper opportunities for acquiring a knowledge of the profession which it is designed that he should practise. Lastly, although no examination can be regarded as furnishing an exact measure of the fitness of a candidate to enter on the duties of a practitioner, yet it is a measure of it to a certain 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 stimulus by which a young man is urged to be diligent.

And here another question arises. Should those who have passed their examination, and received their licence, have a mo

nopoly

nopoly of practice? Should there be penal laws to prevent their being interfered with by the competition of the ignorant, the uneducated, and unlicensed? 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, but mankind do many things more foolish than these, and nothing can prevent them. There can be no greater mistake than to suppose that, if there be no penal laws to prevent the existence of unlicensed practitioners, there will not be sufficient inducement to those who enter the medical profession to go through a long course of study, and then to subject themselves to an examination. The empire of opinion 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 charter, confirmed by acts of parliament, a monopoly of medical practice in the metropolis, and within the distance of seven miles from it; and they in many instances instituted legal proceedings against the unlicensed physicians by whom those privileges had been invaded; but, 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 Apothecaries possess a similar monopoly, under the act of parliament 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 privileges, but with so little success that it is notorious that many apothecaries are practising without their licence, either in open defiance of the law, or (which is no difficult 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 establish himself as a surgeon, even next door to the college, 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

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 profession. It is natural that the managing bodies of the several corporations should be anxious to maintain and extend their powers and privileges; and it is also natural that licensed practitioners, who have expended considerable 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 medical associations, no subject connected with schemes of medical reform put so prominently forward as the suppression 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 limited; 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 individual who labours under the inflictions 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 gentleman who had known little of the infirmities of age until he approached his eighty-eighth birthday, that no one can discover a cure for my complaints.' Where the resources of skill and science fail, the instinct of self-preservation will lead many sufferers to look for other aid; and the honest and well-educated practitioner will always 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 are in fact no more offensive impostors than those who march under the banners 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 misunderstood, 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 he is to provide medical attendance for his fellow-creatures. The governors

of

of a 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 asylums, 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.

In England, the medical profession may be considered as forming three principal classes-distinguished as physicians, surgeons, and general practitioners. The last, with few exceptions, supply medicines to their patients, and are therefore described also as surgeon-apothecaries. Midwifery, in a few instances, is followed as a separate occupation; but is more frequently in the hands of those who pursue at the same time some other branch of the profession. Whatever may be said to the contrary by some of those whose evidence has been published by the Committee of the Commons, the distinctions which have been just enumerated are pretty well maintained in the metropolis and in the larger towns and cities. There is a considerable field of practice, which forms a sort of neutral ground between physicians and surgeons ;-but the physician rarely deals much with the cases which belong to surgery; and of those who have any degree of reputation in the latter department there are few who much encroach on the province of the physician. Of course the surgeon prescribes the internal remedies necessary for the cure of the diseases which it is his business to attend; and the more extended application of medical treatment to surgical cases constitutes one of the greatest modern improvements in the healing art, and one of the proudest distinctions of English surgery, as compared with that in most parts of the continent. In smaller societies the quantity of surgical practice is too limited for surgery to be followed as a separate vocation; and under these circumstances we find it sometimes in the hands of the physician, but more frequently in those of the apothecary.

On looking into the plans proposed by modern reformers, we find that one of them has for its object to put an end to these distinctions, which are represented as being altogether artificial; to require that all who enter the profession should be admitted at one door, so as to form one society-the individuals of which are supposed to be equally qualified by their education to undertake one or another branch of practice. We do not, however, believe that the advocates of this one-faculty-system form more than a very small proportion of the great mass of medical practitioners; and, for ourselves, we must say that we can discover no wisdom in it. In fact, the division of the profession which has taken place in

this country is anything but artificial. Originally, the only persons legally qualified to undertake the treatment of diseases were the fellows and licentiates of the College of Physicians. The surgeons of that day were not what are called surgeons now, but a class of subordinate persons, who performed certain manual operations under the direction of the physicians; whatever else was required in the management of surgical cases being in the hands of the latter. As society advanced, the extension of knowledge introduced the necessity of a division of labour. It was found that surgical cases were better managed by being left altogether in the hands of a particular order of practitioners, and thus surgery became established as a separate profession. But even this was not sufficient; and the apothecaries, who were originally merely compounders and venders of medicine, gradually became established in the exercise of higher functions, so as to constitute at last the present useful and influential class of general practitioners. All this was accomplished, in the first instance, not only without legislative enactment, but in defiance of the College of Physicians; and the Act of 1815, which first recognised the apothecaries as legitimate practitioners, was not the cause, but the consequence, of the change which had taken place in their condition.

But even if the existing order of things had been artificial, it seems to us to be so exactly what is wanted, that we should be unwilling to disturb it. First-the practitioners employed on ordinary occasions, and to whom the great majority of society look in the first instance for assistance, are those who do not limit themselves to any particular branch of practice; secondly, another class of practitioners, who, having first obtained a knowledge of the profession generally, have afterwards directed their attention chiefly to medical practice, are called into consultation in rare, difficult, and dangerous cases, in all classes of society--at the same time that their opinion is sought in cases of less urgency among those who have the advantages of ease and affluence; and, lastly, a third order of practitioners are, in like manner, consulted in difficult cases, and by the more affluent classes of society, for those diseases which are in the department of surgery. From these two last-mentioned classes are selected the physicians and surgeons of the public hospitals, and the professors of the various sciences, which constitute the foundation of the healing art, in the medical schools; and to them therefore is offered an especial inducement not only to devote ample time to the obtaining a complete professional education, but to qualify themselves for the important situations which they may be required to fill, by a good general education previously.

Certainly