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ABSENCE OF RELIGIOUS EXCLUSIVENESS.
exceptionable, if stringent declarations are enforced to prevent favour or affection. And, fourth, by the choice of religious orders, under the suggestion of the medical officers and direction of the Church. In two of such hospitals, different from most others, the appointment does not procure money for the predecessor or the charity.
It has been lately alleged that sectarian considerations influence hospital elections in this city. Of 12 recognised hospitals (10 general and 2 midwifery), 2 are exclusively officered by the members of one religion, and 5 by those of another. Of all these hospital officers, over three-fourths belong to one persuasion, which holds a still higher proportion among the fellows of the Colleges of Physicians and Surgeons, a position usually required to qualify for hospital appointments. Now, these fellowships are granted without any religious distinction whatever, and it is the fault of the members of the other persuasion if they do not take them. Doubtless, the restrictions which have been heretofore placed in the way of Roman Catholics for obtaining university education have limited the number who could qualify for the highest professional rank; but, in spite of them, the number of gentlemen of this faith who hold hospital offices is every day increasing. Some other circumstances beyond religious exclusion have probably contributed to this unequal sharing of first places among the two persuasions; for instance, ascendancy alone could not account for the fact, that no Roman Catholic surgeon
in this city has qualified himself for the speciality of an oculist, while seven Protestants have done so. If there be religious exclusion, however, it is the directors, not the medical officers, who are to blame for it, as there is no body of men so free from bigotry as our profession. When vacancies occur in those hospitals supported by public grants, the electors would act most unfairly if they allowed a candidate's religion to bias them. But it must
EXTRA PROFESSIONAL ELECTORS.
be remembered that in at least four of the hospitals, appointments are got by purchase, the price current now ranging from £400 to £1,200 ; and Catholics may not be able to afford these sums, or they can obtain greater bargains at hospitals where those of their creed are readily accepted. In one hospital, the medical officers obtained the right of nominating colleagues by the relinquishment of £100 a-year, the sum voted for their payment. This undoubtedly encourages nepotism, a system under which men like Dupuytren, Velpeau, and Jobert, who rose to the first places from the very humblest positions, would never have had opportunities. In the hospital alluded to, it cannot be denied that worthy officers have been universally appointed; but those who are not thus born to surgeoncies have little chance. This was disapproved of by the parliamentary committee (1854) on the Dublin hospitals; and a subsequent royal commissioner hinted that the privilege was turned to very profitable account. It is however stated that the surgeoncy to this hospital was never sold. In another hospital, in which by Act of Parliament the medical offi cers elect, a sum was lately given for a place which only ten years of pupils' fees could repay.
The election to medical officerships of important public institutions should certainly not be left in the hands of clerics, lawyers, or town-councillors, for professional merit will seldom weigh much, such electors not having discrimination regarding the relative merits of candidates. Hence it is much to be wondered at that the practice of leaving the selection of Edinburgh University professors to the town council has not been abolished. It was made notorious so long ago as 1751, by the election of one Mr. Clow to the chair of logic, David Hume and Edmund Burke having been the other candidates; and in regard to medicine, many analogous instances might be cited. A system of nomination by such authorities as the President of the Colleges of
THE COMPETITIVE SYSTEM.
Physicians and Surgeons would be most desirable and feasible. The election to the Linacre professorship of physiology is made in a very commendable way, the electors being the visitor and warden of Merton College (the last-named position Harvey filled in 1646) and the Presidents of the Colleges of Physicians and Sur. geons, and of the Royal Society.
The governments in France and Austria direct the hospitals, which are admirably managed. The great Vienna hospital, for instance, has several grades of medical officers—first extern ; after a year intern at £24 a year; then secundär physician for four years, when he leaves if not selected as primär or clinical physician. The latter offices are well salaried. Its income by patients (for most of them pay) and donations is £54,000 yearly. The number of resident medical officers is seventy-six. This great institution, as well as all the educational establishments of Austria, are most fully described in Sir W. Wilde's work on the subject.
The most senior physicians and surgeons retain their offices usually in Dublin ; but in London, at sixty-five retirement is compulsory, the office of consultant being offered to the retiring gentleman. This is a better plan than the system of serving for ten years only, as at Edinburgh, and for seven, as at Sir P. Dun's until last year, when the offices were made permanent by an Act.
The conviction has gradually forced itself on my mind that the competitive principle—which is growing every day, and substituting manly self-reliance for cringing place-hunting-might be applied in determining the relative fitness for junior appointments-assistant physiciancies and assistant surgeoncies. The importance of selecting the best qualified for such posts cannot be over estimated. It has been said that the vital interests of electors in self-supporting institutions will urge them to select the man in their judgment best qualified
to serve the establishment, irrespective of all other considerations. But it is not easy, even for the best intentioned, to form a just opinion of the relative qualifi'cations of candidates by mere recommendatory testimonials or even antecedents; and as it is human to err, how can it be insured that favour or other interested motives will not influence electors, to the exclusion of actual merit? It may likewise place in the hands of the unworthy the power of refusing more competent rivals. The method by concours, adopted in France and Germany, might be applied in a modified form to many institutions in this country. In France, when a vacancy amongst the adjunct officers occurs, graduates are freely invited by a six months' notice by the special government board, which in every point directs the hospitals, to compete, and a jury is formed out of the professorial staff, with the addition of members of the Academy of Medicine, independent members of the profession. The professional public is admitted to the theatre, and each candidate having submitted his claims, writings, and evidence of having lectured (which is indispensable), writes an essay, and then delivers a lecture on a subject chosen by lot and for preparing which three hours in a closed room are allowed. Each member of the jury has given in a subject. They are also called on to defend theses previously written by them, and each aspirant has to make dissections, perform surgical operations, examine and prescribe for patients, or undergo some other practical test depending on the nature of the chair which is vacant. There can be no doubt that this method may not exclude those who are deficient in moral attributes, though sufficiently informed, and possessing that facility of expression and impressiveness of address, which a lecturer must have. But how much - more likely are such to creep in under the testimonial, interest, or purchase system. To render, then, this method more unexceptionable I would advise that the
139 electors for hospital appointments should each nominate a candidate having regard to his mental and physical endowments and moral character, and thus there would be no difficulty in refusing any undesirable person; still the man of retiring modesty who, under the canvassing system has no chance, might succeed by force of brains. A competitive trial somewhat like the “
concours,” but well-devised and practical, would then decide the appointment. The precedents of the public services and some high places in the universities being thus decided, can be adduced. It is stated in a biography of Prof. A. S. Taylor, that he obtained his chair of medical jurisprudence at Guy's hospital in 1830 by the giving of six probationary lectures, and thus the electors selected the greatest master of the subject who has ever lived. The system of promotion by merit is one of the greatest triumphs progress has to boast of during the present century, as the opening of 40,000 offices to the truly deserving has had the most salutary effect in encouraging education. Many evils and errors in state departments, due to the ill-suited officers obtained by former means, have been corrected since appointment by merit has been in force.
The competitive examinations for the army and navy services have benefited medical education, for those who have students under observation must have remarked an increase in their zeal and industry from the beginning, which is found to be absolutely necessary to obtain places. These services will soon become filled with thoroughly efficient and well-informed officers, the more so if good literary education is insisted on.
LECTURES. Lectures have often been decried, but most unjustly it has been their abuse and not use which has been injurious. The relative value of professorial and tutorial instruction have been often controverted, but