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212

INTERESTS OF CORPORATIONS.

The only improvement since effected is the practice of some bodies making returns to the others of the candidates they have rejected. The ablest article on medical education which has probably ever appeared may be found in the Westminster Review for July, 1858 (just before the creation of the Medical Council), and it thus concludes : “ The proposed Medical Council will centralize and consolidate the power of the corporations; while the 20,000 constituents of the profession, who by their struggles have extorted whatever improvements have hitherto been effected, are still to be denied a voice in the constitution and administration of their own government, in the education of their own members, and in the appropriation of their own funds ! The alleged advantage of this despotism is, that it will secure an uniform minimum education, a right to practice throughout the United Kingdom, and a registration of qualifications. The first would, as we have shown, be a great evil; the second now virtually exists, and would do so legally if the State would withdraw its present protection; and the third is accomplished by the Medical Directories, which are everywhere obtainable for a few shillings." The Medical Council is indeed but & corporation of corporations.

The great statesman, Sir R. Peel, as early as 1818, said in the House of Commons, “ It was natural to suppose that a competition would soon be entered into between the several bodies who had a power to grant licences for the purpose of procuring the greatest quantity of fees."

COMPULSORY STATE EXAMINATION. So numerous, then, are medical qualifications, that the public have no criterium of competency, except registration as a practitioner-no way of distinguishing between those really worthy and those, from insufficiency of education and examination, comparatively worthless, whom they accept with child-like trust.

COMPULSORY STATE EXAMINATION.

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The choice which will be made between easy and difficult examinations may be judged of by the registries of last year-viz., 345 who had taken the College of Surgeons diploma, 191 that of the Hall, and 12 the degrees of the London University, the only reliable test of proficiency. In addition to our own qualifications, crowds of foreign ones used to be foisted on the public, and some of these were so much a matter of purchase that the pleasantry related of Rabbelais (who, by the way, was a physician) getting a doctor's degree for his nag, under the title of “ Dominus Caballus," may have been no baseless sarcasm. Sir D. Corrigan lately exposed the diploma trade; and even allowing that American and Continental diplomas were only granted after due examination, there is such difficulty in proving that they are presented by the person to whom they were granted, that they should not be registered at all, or only as additional qualifications to those who had registered some British qualification. It is highly desirable that some remedy should be applied for this great evil, a want of uniformity.

The conflicting interests and vested rights of the licensing bodies will, perhaps, prevent any attempt at diminishing their number, and from variety of existing circumstances their examinations can never be made uniform by reference to the Secretary of State or otherwise. The Medical Council decidedly have the power of recommending the disfranchisement of any body not fulfilling their requirements, but as at present composed they will scarcely suggest this self-immolating process. The only way of obtaining anything approaching to equality of examination will be to compel every one before or after obtaining any diploma or degree, to submit to another trial, precisely similar for all, and held in each metropolis of the United Kingdom. This final test would be found to press hard only on those who from the insufficiency of the previous examination

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COMPULSORY STATE EXAMINATION.

were really unfit for practice, for to those well prepared no repetition could be a hardship. This measuro (unlike one proposed some years ago) should not be retrospective, and only applicable to those candidates who should present themselves two years hence for licences. The State examination would be popular with the profession; in 1845, 5,000 practitioners spontaneously organised the “National Institute of General Practitioners," and demanded a uniformity of qualification.

Such a course is pursued with the most decided benefit in Germany since 1685, when the Collegium Medicum was established. There the “ Staats Examen" tests every graduate or licentiate before he is allowed to practise. In Berlin a minister of state and a number of physicians form a kind of medical hierarchy. Medical degrees are there but honorary titles. It would be probably unnecessary for the public services where such stringent examinations already exist, except for Poor Law services. It would be most desirable, for many reasons, that the medical relief of the country should be given by an organised body of officers, somewhat similar to the constabulary system. No candidate could offer himself till after he had obtained some diploma or degree. The details of such an examination, as regards its general and practical character, have been previously developed. Its conduct and the selection of examiners should be vested in the Medical Council. Sir D. Corrigan has already proposed that “the branch councils should appoint a board of examination for each division of the kingdom, and give to each candidate who passed a certificate to that effect." The revenue from the fees for the state examination should be fairly divided among the licensing bodies to support museums and libraries, or endow them as great teaching institutions. Before the passing of the Medical Act, some of the Scotch reformers, Mr. Syme for instance,

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