The ordinary images and topics being long ago exhausted, exaggeration is the order of the day; and the more inflated the language the better, when national vanity is to be pampered and commonplaces are to be attractively dished up. At the same time there is surely no necessity for going into any refined or recondite train of speculation to show why, speaking generally, our Transatlantic friends (if they will allow us to call them so) want taste, which is the sum and substance of the charge.

ART. II.-Report from the Select Committee on Medical Education, with the Minutes of Evidence, and Appendix. Part I. Royal College of Physicians, London. Part II. Royal College of Surgeons, London. Part III. Society of Apothecaries, London. Printed by order of the House of Commons, 1834.

IN

N the year 1834 a Committee of the House of Commons was appointed to inquire into the laws, regulations, and usages regarding the education and practice of the various parts of the medical profession in the United Kingdom.' A gentleman, who had rendered a great service to the public by introducing what is usually called the Anatomy Act into parliament, having been named chairman, the Committee proceeded to their inquiry, which seems to have been of a very extended nature, as the printed evidence, which relates only to the state of the medical profession in England, occupies not fewer than eight hundred folio pages. The evidence as to Scotland and Ireland has never been printed at all; and it is generally understood that it was destroyed by the fire which consumed the Houses of Parliament a year or two afterwards.

The Committee were satisfied with having performed their duties so far, and, notwithstanding the title which is prefixed to the printed papers, never made a report. We are not surprised at this. To analyse and arrange the discordant materials of which this evidence consists would be an almost endless undertaking; and, even if it were accomplished, it would be found to throw but a scanty gleam of light on the only questions in which the public and the great mass of the profession are really interested. The disputes which so long subsisted between the fellows and licentiates of the College of Physicians, and which, in one way or another, occupy between three and four hundred out of the whole eight hundred pages, have never excited much interest, except among the disputants themselves; nor are there many, even within the pale of the profession, and certainly there are none out of it, who take it much to heart whether the councillors of the College of

Surgeons

Surgeons are elected in one way or in another. As to the best mode of conducting medical education, so as to ensure a supply of well-informed and honourable practitioners, who, while they fulfil their duties to society in the best possible manner, maintain for themselves a respectable station in it—but little useful information can be obtained from the most careful perusal of the whole of what the Committee have published. This, however, is the problem which the House of Commons must have intended (if they intended anything) really to have had solved; and believing, as we do, that the subject is one of the highest importance, not only to the public at large, but to every individual among us, we do not hesitate to draw the attention of our readers to it.

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 licences to practise-Yet there is no want of talent, information, and skill among those 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-and 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 are very indifferently qualified included in the list of wellqualified 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 lesson so well by rote in the remaining three months, that the most careful and experienced 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 if to this we add the following consideration, that such an examination as all are required to pass neither can, nor ought, to prove more than that the individual examined has the minimum of knowledge which a practitioner should possess, we cannot well be astonished that there should be reasonable persons who doubt the advantage

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 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, 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 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 n 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

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that

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