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AMALGAMATION-CONCLUSION. and surgery, and urge that they should be always taught in the same hospital and the same school, and the distinctions between them obliterated as much as possible by a compulsory examination embracing both, and forming the sole portal to the profession. The re-union of these long-estranged sisters seems to have been regarded approvingly in a forcible address delivered by Professor Stokes during the present month : “It is anticipated by some thinking men that the time is coming when the artificial or the corporate divisions in medicine will cease to be, and then the classifications into physicians, surgeons, and general practitioners, and obstetricians will be a thing of the past. But there will be a distinction marked by no feeble or uncertain line between those members of the profession who have received the higher or general education, and those who have only had the lower or merely special training, and this distinction will be recognised by the public and by the State, and by all who are zealous for the advance of human knowledge.”
The feeling on the Continent on this subject may be judged of by the following circumstance. A prize was offered for an essay on the question, “ Is it advisable that surgery
and medicine should be united ?” There were thirteen essays for the affirmative-one for the negative.
However, it is useless to hope that such weighty changes will be brought about without the interference of the State by way of a Royal Commission or Parliamentary Committee. Nearly all the reforms which we enjoy to-day were due to exposure of abuses before the Committee of the House of Commons which sat on the subject of medical education in 1834. To make this evident let me adduce a few instances.
Dr. Clendinning of Dublin was examined as to his having obtained the Oxford degree in 1827, before the parliamentary committee, 1834, as follows: “ Did you keep an Act in physic? Yes. Was that a mere
form ? I think it may be considered a mere form. Did you read a Latin thesis ? Yes. Were you examined by the professor on the subject of the thesis ? The professor was not present. Who was present? The gentleman-bedel. Was it not considered a mere ceremony? Yes. Was the thesis written specially for that occasion ? I suppose I ought to state that I did not write the thesis it was written for me and produced, and I read it, and the counterpart was read by the bedel.” These abuses became gradually reformed and especially by the exertions of the present professor of medicine, one of the most erudite and noble gentlemen who have ever graced the profession of medicine. The ballot has been often abused—for instance, Sydenham, and in later years Wells, who discovered the connexion between rheumatism and cardiac disease, and between renal disease and albuminuria, were thus excluded from the London College of Physicians. When the rule of the same body excluding Scotch graduates was relaxed, the most famous physicians sought examination, and, it is said, Dr. Pearson in his 80th year set about making up his Greek, and died reading Aretæus. Nobility seems to have gained the fellowship, for on the roll of 1771 there occur the names of the Dukes of Richmond and Montague.
Up to 1834 the examination for the licence of the College of Physicians was in Latin, and for only thirty minutes ; so that a man well versed in medical knowledge, but a little "sticky" in the classical tongue, might run great risk of rejection. Mr. Grainger stated that in 1834 two of the examiners of the London College of Surgeons were respectively eighty-three and ninetyfive years old—that they alone occasionally examined a candidate, although they complained much of having to sit from 5 P.M. to 1 A.M.-sleep often having proved irresistible. Their faculty of hearing was also publicly impeached. Lastly, it was brought out by the same com222 MR. CARMICHAEL'S DOCTRINES. mittee that the London Hall had received for the nineteen years after its charter (1815) £43,037 from candidates, yet had only expended £19,797 on officers, and as no museum or library was supported, the great residue had enriched shareholders in the trading firm.
Sir D. Corrigan has urged the appointment of a Royal Commission to investigate the medical profession, and especially the educational and licensing bodies through which it is recruited. Probably in no other way will the deficiencies which it has been our duty to expose in almost every page be corrected. However, these shortcomings and the remedies which they require are by no means novel, for, twenty years ago, in creating the fund for these essays Mr. Carmichael pointed them out when detailing the instructions to the essayists :
1st. “ The state of the medical profession in its different departments of physic, surgery, and pharmacy, in Great Britain and Ireland, at the time of the writing of these prize essays."
2nd. “ The state of the hospitals and schools of medicine, surgery and pharmacy.”
3rd. “ The state and mode of examination, or of testing the qualifications of candidates of the different licensing colleges or corporations in medicine, surgery, and pharmacy.”
“ Under these three heads, the authors will please to make such suggestions as may occur to them respecting the improvement of the profession, with the view of rendering it more useful to the public, and a more respectable body than it is at present. In these suggestions the authors will please to consider the preliminary and moral education of medical and surgical students, as well as the best mode of conducting their professional studies."
“ In considering the third head, or mode of testing the qualifications of candidates by the licensing bodies, the authors will please to consider the most practicable
mode of rendering the examinations as demonstrative as possible—i.e., in anatomy, by having the dead subject placed before the candidate; in chemistry, botany, and pharmacy, specimens of minerals, plants, and pharmaceutical preparations placed before him; and in the practice of physic and surgery, the candidate to be placed before the patients in the wards of an hospital, as the testator is certain that this will afford the most certain and only true mode of ascertaining the qualifications of candidates."
Impressed with the wisdom of the sentiments above indicated and publicly expressed, the writer of this essay has earnestly, but he feels imperfectly, endeavoured to illustrate them. Whatever may be the result of the competition, he fervently trusts that the wise and benevolent intentions of the founder may be realised by the diffusion and enforcement of these guiding principles. The world will then not only have profited by the deeds of Carmichael while living, but will be enlightened by the doctrines he promulgated by means of posthumous generosity. Nobly born, grand in person, rich in intellect, and favoured by fortune, the position he attained few can hope to reach ; but his example and principles will excite in generations of physicians yet to come & resolve to follow in a becoming spirit their calling, which rejoices in having had even a Divine Exemplar.