necessity of apprenticeships in other cases, it is difficult to comprehend: nor is it less remarkable that twenty-five years should have been allowed to elapse without any attempt having been made to repeal a clause so unjust and mischievous. appren 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 education; and in a great number of instances to prevent it altogether. The law requires five years' apprenticeship, and the corporate bodies require three years of study in a medical school, making eight years in all. If a young 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 ticeship 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. If the law be evaded, as it sometimes is, by the master giving up two years of the term of apprenticeship, still there are six years left, and the boy is taken from school at fifteen. If the master reside in a large town in which the apprentice has the opportunity of pursuing his studies in the hospital and lecture-room from the beginning of his apprenticeship, still, even under these more favourable circumstances, under which it can fall to the lot of very few to be placed, he is launched in his profession at the age of sixteen, just as he is entering on that important period in which, in the course of two years, a well-disposed young man will make greater progress with respect to his general education than in all the former years of his life put together. But these are not the only objections. Is this a just monopoly? Is there no way of learning pharmacy, but by means of an apprenticeship? A member of the Committee asks with great reason, If young men, in addition to the customary four years of study in the University of Edinburgh, were to pass ten or twelve months exclusively in learning pharmacy, why should they not be permitted to act as general practitioners?' (Report on the Apothecaries, p. 22.) And again, Were a young man to graduate as a bachelor of medicine at Oxford or Cambridge, and afterwards to apply himself to the study of medicine, and from the want of an adequate fortune be at length prevented practising as a physician, why should he be prevented acting as a general practitioner ? Yet both these descriptions of persons are prevented practising in that capacity under the existing law. We have not the smallest doubt that a residence for a limited period in the house of an apothecary is likely to be very useful to the student who proposes to enter on the same line of practice; but we cannot conceive that an apprenticeship for five years, or VOL. LXVII. NO. CXXXIII. F even even for three years, is necessary, nor indeed any apprenticeship at all. At all events there are good reasons why the legislature should not interfere with a matter of this kind. It may very safely be left to the discretion of the parents and guardians, and of the young men themselves; especially if the Society of Apothecaries require, as they have a right, and indeed as they are bound, to do, that the candidates for their licence, before they had begun to learn anatomy, or at any rate in addition to their other studies, should have devoted a certain time to the study of pharmacy. It is far from our intention to occupy the time of our readers by a lengthened discussion as to the details of medical education : but our inquiries would indeed be incomplete if we left the subject altogether unnoticed. The College of Physicians, for their part of the profession, merely require that the candidates should have been engaged in their professional studies for five entire years; that they should have passed three of these years in attendance on the medical practice of an hospital; that they should bring proofs of their having pursued the various sciences on which the art of medicine is founded: and they descend to no further particulars. The Company of Apothecaries, on the other hand, not only specify exactly the courses of lectures, but the precise number of lectures in each course, and the periods during which the student is to attend them, so that he has little choice as to the mode of occupying his time either in the summer or winter. The College of Surgeons in their curriculum pursue an intermediate course, leaving a good deal, but not so much as is left by the College of Physicians, to the discretion of the student. It appears to us, if any of these bodies be in an error (and indeed they cannot be all in the right), that the error of the College of Physicians is much safer than that of the Society of Apothecaries, or even of the College of Surgeons. It has been observed, we believe by Sir Walter Scott, that no one can properly be said to be well educated who has not been, to a certain extent, self-educated:' and all our experience would lead us to regard this maxim as especially applicable to the education of medical students. It is the duty of the governing bodies to prescribe for them a general plan of study; but as to the details, we are much mistaken if they will not manage them better for themselves than they can be managed for them. One result of the present system, as it relates to the students who mean to be general practitioners, is, that they are too much encumbered with lectures. Let it be borne in mind that it is of little use to sit on the benches and listen to a lecture without taking notes in writing, and that such notes are of little value, unless at one period or another a fair copy is made of them so as to be in a fit state for reference hereafter. If the students were rigidly to attend every lecture prescribed by the College of Surgeons and Society of Apothecaries (which in fact they scarcely ever do), they would amount to not fewer than 1500, exclusive of clinical lectures on cases in the hospital, of which the number is uncertain. If we add to the number of hours which the lectures themselves occupy, those which ought to be occupied in making fair copies of the notes which are taken of them, we may form some notion of the labour which a strict attendance on lectures alone imposes on the students. We have no doubt that there are few of these courses of lectures which might not be usefully abridged. The College of Surgeons expect certificates to be produced of attendance on 140 anatomical lectures and 100 demonstrations during each of three winter We conceive that this regulation might advantageously be commuted for another merely requiring proofs of having studied anatomy during two winters. Fifty lectures would teach all that lectures ought to be expected to teach of the Materia Medica, whereas 100 are required at present. In like manner the lectures on botany might very safely be reduced from fifty to twenty; those on the practice of physic from 100 to seventy or eighty; and those on medical jurisprudence from fifty to a dozen. The foregoing observations would indeed be misplaced if lectures were the only road, or the principal road, to knowledge, which is open to the student. They are but the means to an end. The good anatomist is made what he is not by attending lectures, but by his own labours in the dissecting-room. A knowledge of diseases, and of the mode of treatment, is obtained not from lectures, but from a diligent attendance in the wards of the hospital; from taking notes of cases, and thinking of them afterwards. In attending lectures the mind is merely passive. It receives knowledge, but when received it does little or nothing with it. But what is chiefly wanted to make a good practitioner, either in medicine or surgery, is that he should have acquired the habit of observing, thinking, and acting for himself; and this is to be accomplished, not on the benches of the lecture-room, but in the wards of the hospital; where the student finds, not dull descriptions of disease, but disease itself in all its variety of forms changing from day to day; where every bed tells an impressive history to those who are disposed to read it; and where the intellect is animated and sharpened by collision with the intellects of others. We scarcely know any physicians or surgeons to London hospitals with whom it is not a matter of deep regret that the great majority of the young men should be so much occupied in other ways, that they have but little time left which they can devote to their hospital studies. The number of those who take written notes of the cases is very limited, and there are many who do not visit the wards on an average more than three or four days in the week. We would willingly see the number of lectures curtailed to whatever point may be necessary, so as to enable the students to find time for pursuing in an efficient manner this higher and more essential part of their education. We offer no apology for having entered thus at length into the working of the present system, as it relates to the general practitioners. What we have to offer respecting the other classes of the profession may be comprised in a smaller compass. We have already had occasion to notice how large a portion of the Evidence before us relates to the disputes between the Fellows and Licentiates of the College of Physicians. These disputes have indeed been most unfortunate, and it is easy to show that they have tended in no small degree to impair the usefulness of this ancient institution. In order that we may make ourselves intelligible to those among our readers who are unlearned in these matters, it is necessary to explain that the Fellows of the College, who constitute the corporation, have at different times enacted bye-laws preventing any but the graduates of Oxford and Cambridge being admitted into their body. To other physicians they merely gave licences to practise. A few, indeed, who were not English graduates, were from time to time received as fellows, but so very few that they formed the smallest possible exception to the general rule. This exclusive system was galling to the excluded, which was natural enough. But the licentiates also believed very generally that it interfered with their professional advancement, and in this we have no doubt that they were mistaken. The public knew little, and cared still less, about the difference between them; and if the greater number of those who obtained a very large practice in the metropolis belonged to the order of fellows, this was to be attributed to their having been brought up with the English gentry at the Universities, and to their having received their professional education in London, and not to their being fellows of the college. However, the result was to make a divided house, and to produce a mischievous jealousy between the two orders of physicians. It is reasonable to suppose that the original intention of the fellows was to maintain the general respectability and usefulness of their profession by encouraging persons of good education to enter into it. But in process of time the fellows, in their anxiety about the means, seem to have forgotten the end. Young men, with the smallest possible amount of medical science, were at once admitted as fellows, while some of the most accomplished and experienced physicians remained remained in the ranks of the licentiates. Nor was this all. No regulation was thought to be necessary as to medical education; the degree of Doctor of Medicine, (which in itself means little or nothing, as there are universities at which it may be purchased for a few pounds,) with two years' residence in any university in which degrees are granted, being all that was required. The consequence was, that many were admitted as licentiates, and even as fellows of the College of Physicians, whose medical education was inferior to that which has been for some years required of the apothecary. The list of physicians went on increasing much beyond the demand which had existed for them even in former times, and this at a period when the improved education of the apothecaries, and the elevation of this part of the profession, rendered the demand very much less than it was before. The effect of this may not have been personally felt by those physicians whose talents and attainments, supported by the good opinion of their professional brethren, have raised them to high places; but we are convinced that it has been felt enough by others, and that the body at large have suffered. Of course there can be no absolute rule as to the relative qualifications of physicians and general practitioners. There must always be a certain number of the latter class who stand higher in public estimation than the average of the former; and there must be always some physicians who will be below the average of general practitioners. The difference of talent and activity in different individuals must lead to this. But the question is, not as to individuals, but as to the body at large; and it is plain that, to establish physicians as a higher grade of the profession, without it being made necessary that they should begin the world with a higher kind of professional education, is absurd; and this is what the fellows of the college seem for a long time to have overlooked. The foregoing observations will enable our readers to understand better the existing order of things. They would have been otherwise irrelevant. Several years ago a more liberal spirit began to prevail in the College, which gradually gaining strength and influence among the fellows, at last induced them to put an end to the old exclusive system; and at the same time to require that candidates for a license should have had as complete a medical education as it is possible to obtain; the only exception to this rule being in favour of general practitioners who, having been many years in practice, and being forty years of age, are allowed to show that they have made such acquirements in that situation as to place them on a level with those who have possessed more extensive opportunities of improvement in early life. We own that we do not see how this new system of the College of |