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ROYAL COLLEGE OF SURGEONS, IRELAND.
Educational. 1. Pupils shall be registered for £5 5s. This sum counts in the licence fee, and confers the privilege of reading in the library and studying in the museum, which can be otherwise obtained, and the regulation might be well erased. 2. Qualifications for licence. 3. Qualifications for fellowship. (Those will be set forth in the table on pages 210-11.) County hospitals may be attended for the summer months. It has been often urged that fellowships should be given by ballot, but such election confers no honour, and in another College of Surgeons is much abused. The admission of fellows on the reception of the new charter has been often regarded as most objectionable, but it was an effort to establish professional uniformity. A somewhat similar co-option of 300 fellows out of the 1,250 members of the London College of Surgeons took place in 1843, on its receiving its new charter, but great clamour having arisen among the disappointed, another batch of 242 was created. 4. Fellows or licentiates shall be examined for diploma in midwifery if they produce certificate of practical midwifery.
As the calling of the dentist is so disorganised in Ireland, and as the public have no means of judging whether a person who assumes the title is really qualified or not, it seems very desirable that the College of Surgeons should grant a diploma in dental surgery, following the example of the London College, and of the authorities in almost every European capital. It may be said that dentists can take the ordinary diploma, as some have done, but the expense and time are too great, and the education is not special enough for their pursuit. The following certificates should be required—1. Of having been three years engaged with a competent practitioner in learning mechanical dentistry. 2. Of having attended the practice of a recognised hospital,
206 BOYAL COLLEGE OF SURGEONS, IRELAND. with which a dental department is connected, for twelve months. 3. Of having attended the following courses of lectures—anatomy and physiology, surgery, medicine (during the first winter session), practical chemistry including metallurgy, materia medica (during the summer session), structure of the teeth of man and lower animals, and dental surgery (during the second winter session). 4. Of having performed a course of dissections during the second winter session--the certificate to give evidence that the anatomy of the head and neck has been, at least, twice carefully dissected.
The examination for the diploma should be conducted by oral and written questions, and by demonstration, by three members (in turn) of the examiners for the surgical diploma, and by two examiners versed in dentistry, and among the fellows of the college many such are to be found ; but after five years they should be chosen by the dental diplomates. The diploma fee should be £10 10s., and if the hospital and schools charged the usual fees the other expenses would be £39 18s. Dentists already in practice should be admitted after attendance on the second year's course, and by a modified examination. A considerable number would annually present themselves for examination, for there are in Dublin alone over 100 practising dentists, and about half as many apprentices. Ten gentlemen obtained the diploma in London last year.
5. (a) Candidates for licence shall be examined by at least five examiners, in anatomy, physiology, medicine, surgery, materia medica, and prescriptions, performing operations or dissections, explaining anatomical or pathological preparations. If they fail, they shall not be readmitted for six months. The examination should include practical pharmacy, especially if the candidate is to engage in general practice. Licentiates have often lost repute by their prescriptions being shown about by compounders or by patients, who are apt to proclaim errors.
ROYAL COLLEGE OF SURGEONS, IRELAND. 207 (6) Candidates for fellowships shall be examined in the same way, the president or vice-president and two councillors being present, operations and comparative anatomy being added, and written papers being obligatory. Re-admission after one year.
Brodie expressed a strong opinion that the licence examiners should not expect that a man will be perfect at the outset of his career ; but for fellowship, evidence of the highest proficiency should be given.
(c) Candidates for the midwifery diploma shall be examined by the examiners in midwifery, and in anatomy and physiology, and shall be re-admissable in three months.
The arrangements for the quarterly examination being novel, it may be well to quote them in full. examinations shall be held quarterly on the second Tuesday in February, May, August, and November, at which candidates shall be divided into two classes junior and senior. 2nd. The junior class shall produce certificates of having attended three courses of lectures on anatomy and physiology, three courses of lectures on practical anatomy, with dissections; two courses of lectures on chemistry, one course of lectures on materia medica, one course of lectures on botany, and one course of lectures on forensic medicine. 3rd. This class shall be examined in anatomy, physiology, and materia medica. 4th. The fee for this examination shall be five guineas; not to be returned in case of rejection, but to be allowed in the fee for the second examination. 5th. The senior class shall produce certificates of having attended three courses of lectures on the theory and practice of surgery, one course of lectures on the practice of medicine, and one course of lectures on midwifery; also certificates of attendance on a recognised hospital for three winter and three summer sessions. 6th. This class shall be examined in surgery, operative surgery, the practice of medicine, and form of
ROYAL COLLEGE OF SURGEONS, IRELAND. prescription. 7th. Both of these examinations shall be partly written and partly oral. 8th. The fee for this examination shall be fifteen guineas.
FEES.—1st. The candidate pays ten shillings for his preliminary examination. And. Five guineas as registered pupil of the college. 3rd. Five guineas for the junior class examination, which is not returned in case of rejection, but is allowed in the fee for his second examination. 4th. Fifteen guineas for the senior class examination-total, £26 15s. 5th. Every candidate rejected at the quarterly examinations shall be required to pay to the College the sum of two guineas on applying for reexamination, so as to recompense the college for the necessary expense.'
Regulation of Schools.
2. Certificates to be received from other schools sanctioned by council—(a) if in return they receive their certificates ; (b) if the teachers lecture on but one subject as usually allotted ; (c) if lectures on anatomy and physiology be delivered five days weekly, or on surgery three days weekly, between October and May; (d) if the lectures on medicine, chemistry, materia medica, midwifery, and medical jurisprudence, number sixty each; (e) if the courses of dissection last six months; and (f) if the lecturers be qualified in opinion of council.
There are some clauses of the charter which many fellows think should be altered—the necessity of personal attendance for voting, the election of officers by a third instead of the whole council, and that incapacitating councillors from being examiners, for instance. But such may be well postponed till the time of a general reorganization of the profession shall arrive.
It will be seen by the table on pp. 210-11 that, exclusive of the Pharmaceutical Society for the licensing of dispensers, there are in the United Kingdom nineteen bodies which grant licences, diplomas, and degrees, en
MULTIPLICITY OF LICENSING BODIES.
titling the holder to enter them in the medical register, and practise medicine and surgery. As many of them grant several kinds of qualifications—the University of Dublin, for instance, 5—there are 54 various documents which may be presented as evidence of right to practise. These licensing bodies are fed by 33 recognised schools and nearly twice as many hospitals. These 54 qualifications do not include midwifery testimoniums, of which there are 6. The United States is often accused of a great multiplicity of medical bodies; but in proportion to area, general population and educated population, they are fewer than in these kingdoms, and, besides, the title universally conferred is that of "M.D." M.B. was conferred by some colleges up to 1812, but a separate surgical diploma has never been issued. All ours differ very materially in their educational regulations, and thus vie with each other most injuriously. Some of them hold out lower terms, which are sure to attract the idle and imperfectly educated. Justly might Mr. "Carmichael apply the term of “ Dutch Auction” to this state of things; and might Professor Grant exclaim, "The existence of so many licensing bodies is an absurdity of legislation unparalleled in the history of any civilized country, the most ruinous to the best interests of society, and the most injurious the human imagination could devise to the respectability and usefulness of the medical profession.” An eloquent lecturer in 1857 said, “ Step by step each college descended below its neighbour in the sliding-scale, till it has come to this, that now a candidate rejected at one college has beforehand prepared for his immediately setting out for the next lowest in the scale that will gladly sell its diploma on easier terms. This is the present state of things. Who is to blame for this ? Neither students or colleges, but a higher power still—the legislature, that permits this discreditable state of professional education and examination to continue.”