« НазадПродовжити »
Certainly it appears to us to be of no small importance that nothing should be done which would lead directly or indirectly to the extinction of the grades of physicians and surgeons, and the inerging them in the other grades of the profession, not only on account of the services which they render as officers of the public institutions, and as teachers of the rising generation, but also because experience has shown that it is to them that we are principally indebted for whatever improvements are made in pathological science and in medical and surgical practice. Still, when we consider how great are the prizes offered to those who are engaged in these lines of the profession, the competition to which they are subjected, to which we may add the circumstance of a large proportion of them being occupied in hospitals and schools before an open, and not always a very lenient, tribunal; and that after all it is but a very small number of such persons that is really wanted; we are compelled to acknowledge that there is no great danger of there being an insufficient supply of well-qualified physicians and surgeons; and that it is not so much practitioners of these descriptions, as it is those who belong to the class of general practitioners, that require the especial attention and protection of the legislature. Thus we arrive at what may be considered as by far the most important part of our subject, namely, the wisdom and propriety of the plans which are 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 practise as apothecaries in England and Wales should be examined by, and receive a licence 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 under the direction of the governing bodies of two separate institutions; the one prescribing a system of education 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 belong : secondly, that it is their duty to require of the candidates for their
diploma or licence the highest qualifications which they may be expected to possess, at the same time taking care that they do not raise the standard so high as to prevent a sufficient number of persons 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 Random became a surgeon's mate in the navy with no other stock of knowledge than that which he had obtained from the surgeonapothecary to whom he had been apprenticed; and we conclude that many private practitioners must have been in the same situation at the time when Smollet wrote; as schools of anatomy and medicine were then only just established in Edinburgh and London, 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 metropolis, 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 Apothecaries have respectively taken advantage of these circumstances, and have gradually increased the amount of studies required of those who come before them.* No one can now receive a licence of any kind to practise who has not been engaged for at least three years in the pursuit of his profession in a regularly organised medical 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 å 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 information, and may qualify himself 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 1815 it is made necessary that every candidate for a licence to practise as an apothecary should have been apprenticed to an apothecary, who also had been li
• Let honour be given where honour is due. The first improvements were made by tbe Society of Apothecaries, and it was not until they had set the example that the Colleges of Physicians and Surgeons awoke from their long slumber, and discovered that the time was come for requiring a more extended medical education in every department of the profession.
censed, censed, during a period of at least five years; and the regulations 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 (for what reason it is difficult to understand) 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 surtlıer 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 have always been informed that those whose minds have been prepared by a good preliminary 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 venture to deny that there are moral as well as intellectual advantages belonging to a well-trained mind which are nowhere more likely to be conspicuous than in the various departments of the medical profession. · As matters now stand we find the subject of general or preliminary education altogether unnoticed in the regulations 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 importance, 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 produce as 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. What is to be considered as a test of a good preliminary education? and in what does it consist? On these points there may be great differences of opinion, for while the mental faculties may be improved by the cultivation of various branches of knowledge, each individual is apt to regard that as most im
portant which has most contributed to the improvement of his own.* To require degrees at colleges and universities for the whole of those who enter the medical profession would be manifestly absurd ; and, after all, the common degree of B.A. at Oxford and Cambridge is not incompatible with very little study and a very low degree of knowledge. Are the candidates to be especially examined as to their general as well as professional attainments? There being not fewer probably than five or six hundred candidates in the year, who would undertake the task? and, if such examinations were instituted, would they not soon degenerate into a mere empty form ? Are the licensing bodies to be satisfied with certificates from schoolmasters and tutors? Those must have very little knowledge of the world, or of the nature of testimonials generally, who think that these would be of the smallest value. Let us look at the question as we will, we perceive insurmountable difficulties in the way of any other system than that of offering a negative encouragement to young men to obtain a good general education, by the removal 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 expense 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 that he should dissipate his time in idleness. Besides, satisfied as we are of the vast advantages which the many are likely to derive from 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 entering the medical profession. The Inns of Court have acted wisely in this respect. The tendency of their regulations 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 of its brightest ornaments.
* If the wrangler believes that no pursuit is so useful to the mind as that of Mathematics, the classical scholar is not less disposed to attribute the same virtue to Greek and latin, and the Metaphysician to Moral and Intellectual Philosophy. The impartial observer, however, cannot doubt that there are many kinds of exercise which equally tend to produce the desired result. It appears to us that those who are intended for the medical profession will generally derive most advantage from a variety of studies; and (without meaning to recommend superficial acquirements) we should say that it is better for them to go a moderate way in each, than a very long way in one to the exclusion of the rest.
But But it may be urged that, if young men are not able to obtain a licence to practise until they are twenty-three years - of age, so many to whom it is important to obtain a livelihood in early life will be deterred from entering the profession, that there will be an inadequate supply of licensed practitioners, and that the result will be to call into existence a number of other practitioners, who are unlicensed and unqualified. It is true that such was the effect of the too stringent regulations of the College of Physicians in former times, and such would be the effect of too stringent regulations at any period. But there must be much greater changes than those which we venture to suggest to make us liable to any such danger at the present moment. The supply of medical practitioners is in fact not only very much beyond the demand, but very much beyond what is necessary to ensure a just and useful degree of competition. For the truth of this assertion we venture to appeal to the experience of all those who will be at the trouble of making their observations on the subject; and to this cause may mainly be attributed the present restless and uneasy state of the profession. In this, as in all other pursuits, a certain degree of competition is required for the security of the public; but in the medical profession it is easy to conceive that the competition may be not only beyond what is really wanted, but so great as to be actually mischievous. We have heard it suggested that a tax in money should be levied on those who are brought up as medical practitioners, in the same manner as on attorneys and solicitors; but such a tax would be of little service to the Chancellor of the Exchequer, and surely one in the shape of a better education would be much preferable.
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 apothecary should have served an apprenticeship. We understand, from the evidence given before the Medical Committee (page 21 of the Report on the Apothecaries), that Mr. Rose, who introduced the bill into the House of Commons, objected to this elause; that it was in consequence struck out; but that it was afterwards inserted in the House of Lords (we believe on the suggestion of one of the bench of Bishops). Dr. Burrows, who gives this piece of secret history, says that the Association of general Practitioners were anxious for the apprenticeship clause, on account of the great difficulty of getting 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