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of Physicians can be, in essential matters, much altered for the better. But we say this on the understanding that it is discreetly and judiciously administered. Although no evidence of a good preliminary education is required by the College, except that of a portion of the examination being conducted in the Latin language, still this most important object is proinoted indirectly, and perhaps more efficiently than it could be by positive enactments. Candidates are not admitted for examination before they are twenty-six years of age; and we apprehend that the effect of this must be, that this part of the profession will be chiefly occupied by those who have had a liberal education; and that a large proportion of the candidates will (as was the case in former times) have pursued their general studies in one of the English universities, and their professional studies in the inedical schools of London.
The London College of Surgeons makes no distinction between those of their body who enter life as surgeon-apothecaries or general practitioners and those who are engaged merely in the practice of surgery, except that the latter class are alone eligible to seats in the governing body or council. There is but one plan of education, and one kind of examination, for all. Yet no one aspires to the situation of surgeon to a London hospital, or to be a teacher of anatomy in one of the metropolitan schools, without having added two or three years of professional study to those which are required by the College; and there are few among them who are not qualified to undergo a much more general and searching examination than that to which they are subjected. To this extent, then, what may be termed the voluntary system, seems to have answered the purpose well enough; and if we look further, as far as London is concerned, there seems to be nothing to contradict that opinion. When a vacancy occurs in the office of surgeon to a London hospital, there is never any want of wellqualified candidates; and if we refer to the history of the profession, from the days of Cheselden downwards, we find no description of practitioners who have done more for the improvement of their art, and of the sciences on which it is founded, than the hospitalsurgeons and anatomical teachers of London. Nevertheless it appears to us very questionable whether the council of the College of Surgeons ought to rest satisfied with leaving matters as they now are. Formerly there were few hospitals, and no medical schools, beyond the confines of the metropolis. There is an hospital now in most of the considerable provincial towns; and in many of the larger towns there are medical schools also. The medical officers of the hospitals, and the lecturers and other teachers in the schools, are the instructors and example of the next generation of practitioners; and it is of the utmost importance that these offices should be filled in the best possible manner. To limit the choice of the governors of hospitals, by whose activity and benevolence these institutions are supported, is out of the question ; but ought not the College of Surgeons, established as it is by a royal charter for the advancement of surgery, to offer to the public a list of those individuals who, by a very extended education, and by the examination which they have gone through afterwards, have proved themselves to be qualified, as far as education can qualify them, to fill those higher situations in which they incur so heavy a responsibility, not only to the existing race of their fellow-creatures, but also to posterity?
Something like this has, indeed, been already attempted by the College. They instituted an examination of those who were desirous of being recognised as teachers of anatomy and surgery. No one was to be admitted as a candidate who had not completed his twenty-fourth year, or who had not already passed the ordinary examination. As this regulation did not affect the established teachers, no one had a right to complain of its injustice; and it certainly appeared to many who might be considered to be competent judges, that it was calculated to be productive of much good ultimately. The council, however, thought it expedient to retrace their steps; and the regulation was rescinded in the course of a year or two after its enactment. It was said that the plan did not answer; that it was difficult to put it into execution, &c. &c. We own that we do not perceive what difficulties could have been met with which might not have been overcome, if a suitable apparatus had been provided for the purpose...
It appears from the evidence before the Committee-we refer especially to that of Sir Charles Clarke (pp. 274-288 of the Report on the Physicians)—that there is at present no examination of those who contemplate being engaged in the practice of midwifery as to their qualifications in that department of the profession. There are indeed few, if any, of this class of practitioners who restrict themselves wholly to this kind of practice, or who have not received a licence of some kind, either from the College of Physicians, or from the College of Surgeons, or from the Society of Apothecaries; so that their qualifications are tested to a certain extent. At the same time, as there is no profession which is more important than midwifery, or which deals in greater responsibilities, there seem to be no good reasons why those who practise it should not undergo a special examination as well as those who practise medicine and surgery. There may be, however, some differences of opinion as to the best mode of accomplishing this object. The eminent practitioner to whom we have just re
ferred states in his evidence that the duty may be undertaken by the College of Physicians, but that it ought to be undertaken by the College of Surgeons. To us it appears that, of the cases which it is usual for the practitioners in midwifery to attend, few only can be considered as being in the province of surgery; and, if we are not misinformed, a high legal authority has given it as his opinion that the College of Surgeons, under their present charter, have not tlie power to institute an examination of this kind. There seems to be no method of getting over the difficulty without some additional power being conferred on the existing institutions, or a separate board being established for the purpose; and we can scarcely venture to say, without more reflection than we have hitherto had leisure to bestow on the subject, which of these methods may be preferable.
In a former part of this article we have offered some remarks as to the difficulty of instituting such examinations as will prove a sufficiently accurate test of the qualifications of medical students. But the subject is one of the greatest practical importance; and we feel it to be our duty to recur to it.
An efficient examination, which distinguishes the well-qualifred from the ill-qualified practitioner, and sends the latter back to improve himself by further study, cannot fail to do essential service to the community ; while an inefficient examination, which gives to the idle and the ignorant the same licence which it gives to the industrious and well-informed, is worse than no examination at all, and actually mischievous. This is a truism which no one will dispute. But by what means may a proper system of examination be secured?
To whatever extent the system of learning by rote (or being crammed) may be carried by the oi 90220: of the universities, we may venture to say that it falls far short of what happens among the oi nodao. of the medical students. It is notorious that the majority of those who mean to offer themselves for examination at the College of Surgeons or at Apothecaries' Hall are, for the two or three preceding months, regularly and daily drilled for the occasion ; that there are individuals in London who make considerable incomes by dispensing this spurious species of instruction; and that it is no small proportion of the medical students who, having neglected all the early part of their education, are at last qualified in no better way than this for the examination which is to crown their labours.
Now we are not so Utopian as to believe that these things can be altogether prevented, where the object of the examination must necessarily be to ascertain not whether the candidate has the highest, but whether he has the lowest degree of know
ledge and talent with which he may be tolerated as a practitioner. But the evil is enormous, and ought to be corrected as much as possible.
The first step towards this would be one which we have already suggested, namely, the diminution of the number of lectures which the students are expected to attend, so as to place more time at their disposal for self-education in the dissectingroom and in the wards of the hospital. The rest must be done by the examiners; whose duty it will be to bear in mind that the intention of medical education is to make, not philosophers, but skilful and useful practitioners; and that those who have higher aspirations may very safely be left to accomplish their object in their own way. In the examinations they should especially make it their business to ascertain what is the amount of practical knowledge, drawn from their own observations, which the candidates possess; and with this view they should interrogate them, not so much about what they have been taught in lectures as about what they have themselves witnessed, and which cannot be learned by rote. But for the accomplishment of these objects it is necessary that the boards of examiners should be rendered as efficient as possible ; and it appears to us that they cannot be efficient unless they include a certain number of individuals who, either as medical officers of hospitals, or as teachers of some branch of the science of medicine, have been accustomed to deal with students. We suppose that it rarely or never happens that any are appointed to the office of examiners at Oxford and Cambridge who have not at one period or another officiated as tutors. The cases are parallel, and the rule which is good in the one cannot fail to be so in the other.
At the College of Surgeons, as we are informed, on the authority of Mr. Guthrie (page 13 of the Report on the Surgeons), it is usual to elect the examiners from the members of the Council in the order of seniority. Whether this be or be not a mere matter of custom, the principle is clearly wrong. The Council in this, as in all other matters, have no business to consider anything but the good of the profession and the public; and in the construction of the court of examiners they should follow no other rule than that of choosing the individuals who are the best fitted for the office. At the same time, whatever may have been the case formerly, there seems to be no reason to complain of the court of examiners of the College of Surgeons at present, there being no member of it who has not been either a surgeon to a London hospital or a lecturer on Anatomy or Surgery in one of the principal medical schools. But let us see how it is with respect to other institutions. At the College of Physicians the
examinations are conducted by the President and Censors. The former is generally re-elected annually for a series of years. The latter in former times were chosen from the fellows in rotation, holding the office only for a single year. We can conceive no worse method of appointing a court of examiners than this, for while it led to many being placed in that situation who were not qualified for it by their previous habits, it afforded no one the opportunity of becoming familiar with the duties of his office after he had been elected to it. By the new regulations of the College, however, the election of the Censors is differently conducted. The rotation system is abandoned, the Council proposing annually those whom they believe to be the most proper persons, subject to the approbation of a general assembly of the fellows. It remains to be seen whether the College avail themselves of this alteration so as to make their board of examiners such as it ought to be.
The examiners at Apothecaries' Hall are selected solely from the members of the Apothecaries' Society. This is in accordance with the act of 1815, which leaves the Society no alternative (Report on the Apothecaries, page 17). But the Society is a commercial body, into which admittance is procured only by patrimony or purchase, and it is difficult to conceive why the legislature should have restricted their choice of examiners in this manner. If a licentiate be remarkably well qualified to officiate as an examiner, why should he be ineligible because he is not actually a member of the corporation? But it appears to us that the door should have been opened wider still; and we have no doubt that if the Court of Assistants, by whom the examiners are appointed, had had it in their power to do so, they would have procured the assistance of some physicians to hospitals and lecturers in schools of medicine as assessors to the Court of Examiners, and that in so doing they would have greatly added to the usefulness and respectability of the examination.
We believe that in the foregoing observations we have pointed out the principal defects of the present system, as far as it relates to the education and licensing of medical practitioners. The next point to be considered is, by what means these defects may be remedied.
It may be said that there is nothing which may not be accomplished by the corporations themselves, provided that the Crown and the Legislature afford them some assistance by making the necessary alterations in their charters and acts of parliament. We cannot, however, look with much confidence to this source of amendment. The corporations are all independent of each other. There is no bond of union between them. They have to legislate for a profession the different branches of which