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COMPULSORY STATE EXAMINATION.
in his “Letter to Lord Palmerston," advocated a minimum qualification for all who sought admission to the profession.
It has been previously shown that the profession offers fair and honourable recompense, and all that it needed to elevate its tone and position is a much increased standard of education, preliminary as well as technical, and a more sound and appropriate system of sessional and final examination.
I would have the controlling power over these state examinations solely vested in the profession. The lawyers are governed by the Benchers, the clergy by the Bishops, and there seems as little reason for extraprofessional interference in ours as in these high callings.
It might be better to enforce the passing of the state examination before those in the present licensing bodies, as some, after having passed the latter, would practise in spite of the laws, and would have a right to the titles at present conferred. It will be always well that there should be a higher grade in medical titles, so as to stimulate the ambition of the junior practitioner-somewhat analogous to the titles of Q.C. or LL.D. in the law, which are additional to licence for practice. They should be of two kinds_1st. The doctorate of medicine in the universities. We would insist with Prof. Stokes, who has convincingly shown the advisability of the measure, that graduation in arts should always precede that in medicine. 2nd. The fellowship of the Colleges of Physicians and Surgeons, these bodies having been united in each metropolis. This distinction should be only obtainable by examination, or else it is valueless ; moral qualification could be estimated by allowing five years to elapse after the state examination, and candidates should submit reliable recommendations from distinguished members of the profession.
The money test has always proved a most imperfect
HIGHER GRADE REQUISITE.
one for the admission of members of colleges. In old time colleges of physicians exacted sums reaching £100 for admission, and when the graduates in medicine of the university of the same city were anxious for admission into one of them, it was announced that “ half the amount in cash, and the remainder in approved bills at twelve months date," would be accepted. The fee for the fellowship of the Edinburgh College of Surgeons up to 1827 was £250 to non-apprentices. This honour is now dispensed very cheaply to practitioners if recommended, although they may have passed no examination in that college. On the other hand, the admission of fellows into another Royal College for a moderate sum upon the taking of a new charter, although it may have replenished the coffers, greatly lowered the institution in respectability.
The higher qualifications should be insisted on for hospital or college appointments, but the distinction would by no means create, as once urged, a doctor for the rich and a doctor for the poor.
Dr. Burrows, in his evidence in 1848, cited the remark of a country fellow about a doctor : “ He is so much of a gentleman that I do not like to go to him.” Commenting on this, an article in the Westminster Review, attributed to Sir B. Brodie, with great severity remarked : “ Judging from the general want of preliminary education, the kind of pleasures, and the prevailing tone of mind which characterize the majority of medical students at the London schools, we imagine that the simplest of the vulgar will long continue to discover points in common between himself and his doctor.”
The examiners from the boards of the three kingdoms should interchange occasionally, as in no other way could a uniform standard be preserved. We have sufficiently dwelt on the appropriate mode of testing practically a candidate's fitness for practice, but we are not
so sanguine as to hope that it will ever be so perfect as to render it unnecessary to oblige the student to pursue any course of study in hospital and dissecting-room, for instance. Mr. Simon, it would seem from the following extract, thinks the examination test all-sufficient : “Judge the question by the analogous case of a recruiting officer for the army. He does not require a long schedule of his man's antecedents of diet—what oatmeal he ate in his childhood, and what eggs afterwards, and whether his beer was from recognised' publics, and what previous notice was given of his several meals, and which were taken sitting and which standing. No; he makes his estimate of the bumpkin, such as he is, goes with thorough care over all his points, strictly judging his thews and sinews, and accepts or rejects him accordingly. The candidate for a medical licence in any country has, I think, a moral right to demand from the State this sort of examination of his merits has a claim, I think, to be let stand or fall according to the essential fact whether he is competent to practise his profession, not according to inessential and trivial circumstances of how or when he has learnt this or that part of his business. He may fairly make appeal to * results ;' and if regulations are thrown into his teeth, he may fairly answer, as Mrs. Glasse did to Scholasticus, the proof of the pudding is in the eating.”
Medical titles are so varied that the public do not understand them. Some of them are excessively long, and if a gentleman qualified as a physician and surgeon in Dublin, for instance, signs L.K. & Q.C.P.I., and L.R.C.S.I. after his name, he is sure to be ridiculed.
If amalgamation of the licensing bodies can be effected some short title should be chosen, and M.D. would be the most suitable and popular. The State would surely legalise the granting of such a title, the more so as it would be only retaliation, the universities having of late years assumed the giving of licences, diplomas, and
PROPOSALS FOR AMALGAMATION.
masterships in surgery, besides medical degrees. If the title of Medicina Doctor could not be legally conferred, the letters M.D. might still be, if they were to imply o medical doctor,” or “medical diplomate.” At present the title of “ Dr.” is conferred on all medical men, whatever their qualifications, and is frequently adopted by practitioners who have no university degree; for instance, in the programme of a Dublin hospital, the two physicians and the four surgeons are each set down as Dr., while only one of them--a surgeon by the way–has a university degree. The only bodies, so far as I am aware, which discountenance the practice are the London University—“The Senate desire it to be understood that Bachelors of Medicine of the University of London have no right, as such, to assume the title of Doctor of Medicine"-and the London College of Physicians, in which there is a by-law prohibiting any member from using the title of “Dr.” unless a graduate in medicine.
If the State examination in each metropolis were established, there would be no need for the Colleges of Physicians or Surgeons to grant primary qualifications, or still less for the universities to issue their inferior licences; the former should confer the fellowship alone, and the latter the doctorate.
AMALGAMATION OF LICENSING BODIES-CONCLUSION.
If, however, vested interests should render the foregoing scheme impracticable, combined examinations, if not complete amalgamation, can be accomplished—and first as regards Ireland. The union of the universities and the conversion of the Apothecaries' Hall into a Pharmaceutical Society having been discussed, it only remains for us to offer some suggestions for the combination of the Colleges of Physicians and Surgeons. Fees, it is thought, will be the main difficulty. The College of Physicians receives fifteen guineas for its licence, the College of Surgeons twenty-five ; let the fee for the
double qualification be fixed at thirty, and let one-third be for the College of Physicians, two-thirds for the College of Surgeons. Although there is a greater proportional reduction for the former body, it will really gain, for having the Universities and Apothecaries' Hall as rivals in medical licensing, it only passes one-third as many as the College of Surgeons. The addition of its four censors to the seven examiners of the College of Surgeons would make an admirable examining board. Considering the larger building, and facilities for the demonstrative methods which museums and dissecting rooms afford, the examinations should be conducted in Stephen's-green.
In Scotland, combined examinations have been es. tablished for some years, but separate medical and surgical licences should not be granted, and the Glasgow Faculty should be absorbed in the Edinburgh College under the title of the Royal College of Surgeons of Scotland, as it is absurd to have two similar bodies within fifty miles of each other.
In England during the present year a similar arrangement between the Colleges of Physicians and Surgeons is to be commenced, and we trust will lead to the relinquishment of separate diplomas. A candidate who passes this examination will be qualified in all branches, whereas there are 3,000 members of the London College registered who only have been examined in anatomy, physiology, and surgery. The London Uni. versity should still continue to grant its most admirable degrees, but those in surgery it might well abandon. There are great difficulties in the way of the earnest student who wishes to take the degree of the London University as well as the necessary diploma of the College of Surgeons, for the curricula are most differently arranged. The former great body might, as regards medical examinations, combine with the others.
Let me again advocate the indivisibility of medicine