180 PRACTICAL MODE OF EXAMINING. suffice for twenty candidates. He should be required to discover and explain anomalous distributions of arteries, &c., of practical import on preparations, which almost every museum contains-or if not, they should be prepared. In the London College, owing to the great number of candidates, the dissections must be already prepared for the candidates, and this is done by students of various schools. Care should be taken that they would not peach to others about the parts they had prepared. The army and navy examiners now demand from candidates a knowledge of operative surgery, and call on them to operate on the dead body. The subject will, therefore, have to be more generally taught in schools than it has been, and the question will have to be settled whether a separate fee will be charged for the instruction. By dissection, by practising operations on the dead body, and by the experience of human suffering, which will deeply impress a well-regulated mind, can alone those characters of the operative surgeon be acquired which Lord Robertson aptly defined in describing the hand of Liston, “If as hard as iron and true as steel in the theatre of operation, it was as soft as thistledown when applied to the throbbing pulse or aching brow." In physiology, he should be called on to describe such preparations as the foetal circulation, the descent of the testis, the impregnated uterus, the stages of development of the frog, and also to recognise sections of bone, cartilage, muscle, capillary injections, and epithelium, under the microscope, arranging the instrument for such. He should also prove the presence of albumen, mucus, pus, or sugar, in different fluids. In chemistry, he should be required to name some ordinary chemical bodies and to explain their properties, and to test for some easily discovered metal, constituent of food, or water, or poison. In pharmacy, he should recognise PRACTICAL MODE OF EXAMINING. 181 by the aids of sight, taste, and smell, some ordinary articles of the materia medica, and should be called ou to prepare some pharmaceutical combinations in ordinary use. In botany, he should name and give brief specific descriptions of the more common and important plants in the British Flora. A given number of questions should be set to be answered in the allotted time, at the expiration of which he should be required to read his answers aloud, and then submit them for further perusal by the examiners at their leisure. It would be convenient to have the second day for viva voce interrogation and demonstrations, in order to allow the examiners to announce their decisions to the candidates at once, their written answers of the previous day having been adjudged. The second examination would take place at the completion of the curriculum, and might, for some two years or in special cases, be passed at the same time as the first, as it might be necessary for a candidate to obtain his licence at once, having studied with that intent. On the first day he should be given printed papers in anatomy and physiology, in medicine, surgery, midwifery, and forensic medicine, the number of questions in each subject being commensurate with its importancesay six in anatomy and physiology, six each in medicine and surgery, and three each in midwifery and forensic medicine-twenty-four in all. After a proper time, probably six hours, having been granted for answering as many of these as possible, the answers should be delivered to the examiners. On the second day he should be brought into the wards of an hospital, and required to elicit by the usual channels of information the history, diagnosis, and prognosis of six medical aud six surgical cases, and to prescribe accordingly for them, and exhibit his surgical handiness. This should be done in the presence of the examiners, as instances have occurred of candidates learning, by means of a bribe, 182 PRACTICAL MODE OF EXAMINING. all this information from patients more than usually intelligent submitted for this mode of examination. At first sight in the method there may appear a difficultynamely, how to select without apparent partiality the hospital wherein the clinical test was to be applied. Let, however, each recognised hospital be selected by lot or in rotation (the order being kept secret lest students should merely prepare the cases in it); or let three be selected at once, and the students, divided into three batches, would undergo this real trial in the presence of at least two examiners. To this plan, then, no objections suggest themselves to my mind. At the last College of Surgeons and Hall examinations, living patients and microscopical objects were submitted to the candidates. It might be well if candidates were obliged to draw up reports of these cases against the following days, so as to encourage this invaluable practice. This system of examining for a diploma by the bedside is carried on at the university of Prague, the oldest in Germany, Latin being the language used. Students are examined ten times during their five years course. Instruction is free, the professors being paid by the State. In Berlin, each candidate has the noting and treating of two cases for a fortnight previous to his being licensed. On the third day he should prepare dissections, and explain them, of some important cavity or surgical region, demonstrating and perhaps performing any surgical operation of which it may be the seat; and finally should be called on to perform some surgical operation and should be also interrogated upon some ordinary morbid preparations, after which a short viva voce examination in all the subjects should be given. The votes of the examiners should then be taken by numbers, and if the candidate had gained a determined minimum, he should have passed. The details of this plan may be more readily seen by the following tables: PRACTICAL MODE OF EXAMINING. FIRST EXAMINATION. 188 First day, 9 to 12, and 2 to 5 o'clock.-Printed papers on anatomy and physiology (human and comparative), chemistry and physics, materia medica and botany. Second day, 2 to 5 o'clock.-Dissection of subject and demonstration and interrogation on same, chemical examination of articles in Pharmacopoeia, &c., specimens of materia medica and plants, and further oral questions. Do., 5 o'clock.-Decision of examiners to be announced to candidates. SECOND EXAMINATION. First day, 9 to 12, and 2 to 5 o'clock.-Printed papers on anatomy and physiology, medicine, surgery, midwifery, and forensic medicine, delivered to the candidates. Second day, 2 o'clock.-In the wards of hospital, six medical and six surgical cases submitted to each candidate for diagnosis, prognosis, and treatment, and to be reported upon, examiners to be present. Third day, 2 o'clock.-Operations on dead body, recognition of morbid specimens, viva voce examinations on medicine, surgery, midwifery, and medical jurisprudence. Do., 5 o'clock.-Decision of examiners to be announced to candidates. The examination should be marked by numbers, a certain minimum passing. Although the system of appeal from examiners' decisions is dangerous, it would be only just to make some distinction between him who closely approached the required standard and him who wholly failed. It might be done by a more early period for re-admission to examination. The medical examinations at Cambridge approach 184 PRACTICAL MODE OF EXAMINING. closely to what has been detailed, and students are allowed to be present at them, by which they may gain many facts, and much about the right modes of study, and they form, as in most continental universities, an appreciative public. Such a real, substituted for a verbal examination, would have the most who'esome effect in stimulating medical education, which has been already considerably done as regards those who seek appointments in the public services, for there the examination is demonstrative. No test, however, is required, after whatever licence he may have taken, from that officer whose duties may be thought by most more important to the State, viz., the poor-law surgeon. But indeed it may be doubted, under the present insufficient pay they receive, whether candidates could be induced to look for these offices if they required additional trouble and study. The marks of candidates should be certified if they required it, and they would prove a far more reliable testimonial than the recommendatory letters so much in vogue. Such a practical method of examining would compel students to be industrious during their entire pupilage, for indeed, under the present theoretical mode, they not unfairly say, "Oh, I'll learn my business after I have passed my examination by grinding.' As an additional stimulus to prolonged and patient diligence, the establishment of first and second honour and unclassed divisions would indubitably do good service. It has already worked well in some institutions. A brief historical and descriptive account of each licensing body will now be given. ENGLISH LICENSING BODIES. England.-Royal College of Surgeons, chartered 1800, and supplementally 1822, 1843, 1852, and 1859. It is governed by a council of twenty-four, who elect from amongst themselves ten examiners and a professor |