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circumstance that may have a tendency to impair the confidence. Hence the physician is naturally jealous of everything like interference in his professional duties. Everything tends to produce a sensitiveness on this subject, which can only be prevented by an habitual reliance upon his own consciousness of scientific worth.
The disputes and quarrels which thus arise, are sufficiently disgraceful and injurious to the profession itself, but to the community at large the injury is still greater. The sick man is fairly entitled to the best means of relief within his reach. And if the jealousy and animosities of his physicians, deprive him of them, whether it be by cutting him off from the benefit of consultations, or, as oftener happens, by taking away from him the comfort of feeling an assurance that all is well done for him, he suffers a positive, and sometimes a serious injustice. The perplexity and distress inflicted upon the patient and his friends, by disturbing his confidence in his physician, occasion a degree of suffering scarcely less severe than that caused by the disease itself. The question so often asked in ridicule of the profession, is here asked with the most anxious solicitude; and an answer is sought for in vain.
We shall not now stop to inquire how far these evils have been corrected in our own community, by the operations of our Medical Society. This inquiry will best be met when we have shown what those operations have been. We will only remark at present, that their tendency has been to correct them, not only, as we have seen, by raising the minds of physicians, as they have improved the standard of medical education and character, to the contemplation of more worthy methods of professional advancement; but also by fixing the principles of a correct professional conduct, and providing tribunals to which an appeal may be made in case of the infringement of them. It is true the principles already established are not always very closely adhered to, nor the tribunals often called upon to enforce them. Nor is this necessary, in order to give efficacy to the system. While the principles themselves are maintained, and the few simple rules which are founded on them, it is of little moment that they are occasionally violated. He who voluntarily and wilfully breaks through them, does so at the expense of his own self-respect, and of much of his reputation; yet he does not thereby destroy that mutual confidence which the better portion of the members of the profession feel in each other.
It thus appears that the interests of the medical profession are so blended with the public good, that the one cannot be promoted without advancing the other. We do not mean to claim any peculiar disinterestedness for those physicians who have labored (and some there are who have labored much) to advance the character of their profession. But we do claim for them an exemption from the charge of a selfishness, unworthy of a learned and liberal profession, which would seek their own good or that of their associates, at the expense, or in utter disregard, of the welfare of the rest of mankind. In those particulars, by which a selfish man may be supposed to be most readily affected, these are the men to be, less than any others, benefited by improving the condition of the whole profession. They surely have nothing to fear, either for their gains or their ambitious projects, from the encroachments of unworthy pretenders to the profession, whose characters and standing are established, so as to give them opportunity to look around them and busy themselves in elevating the character of their associates and successors. In a more extended sense, they do indeed share largely in the benefit of adding to the general respectability of the whole body of physicians. It is not the least of these benefits, that the profession is no longer held responsible for the acts of those who do not truly belong to it. Quackery and quacks there will be in every community. But the line of distinction between them and educated physicians is now so strongly drawn among us, that the odium of their misconduct no more attaches itself to the medical profession than to any other. In like manner too, the irregular conduct of individual members of the profession itself (for we will not pretend that all are spotless even here) brings not its reproach upon the profession as a whole; for the very rules which they violate furnish the proof that their irregularities are discountenanced by their brethren.
The view we have taken of the interest which the whole community has in the wellbeing and respectability of the medical profession, is still farther sustained and confirmed by the nature of the privileges which have been bestowed upon it. These privileges have been granted from time to time, not as a bounty conferred upon a favored class of men, but either as facilities indispensable to a regular performance of their professional duties, or as an equivalent for the benefits which the community derive from their services. The exemption from the obli
gation to serve as jurors, which has so often been the subject of reproachful jesting, by regarding it as imposed on the profession, and associating it with a less pacific occupation, was granted by the act of 5 Henry VIII. to the Company of Surgeons in common with exemption from 'constableship, watch, and all manner of office bearing any armour,'' for the continual service and attendance that they daily and nightly, at all hours and times, give to the king's liege people, for the relief of the same, according to their science;' and the number to whom the grant was made was limited to twelve.
A few years later in the same reign the charter of the College of Physicians was granted, which at the same time that it exempts the president and fellows from liability to be summoned to assizes, juries, inquests, &c. requires them to elect censors, who should have the superintendence of all persons exercising the faculty of medicine, and scrutiny of all medicines and their administration within the city of London. Again, when a few years later these privileges and exemptions are somewhat enlarged and more accurately defined, the same thing is done with the obligations laid upon the censors, and they are made subject to a penalty, if they refuse or neglect to perform their duty. Thus it is everywhere; the grant of privileges is everywhere connected with the imposition of obligations to perform some office, by which the public, rather than the profession, are supposed to be benefited.
Many of the privileges which are now enjoyed by physicians among us, and some of the duties which devolve upon the profession, have descended to them by custom and usage from these early charter provisions. Others have been the subject of statutory regulation in the several states; and these vary considerably in different states, in the extent both of the obligations and the privileges. In Massachusetts the fellows of the Medical Society are exempted from enrolment in the militia, which is not generally done in the other states. In many of the states there is at least one medical school; and in most of them a medical society incorporated with powers and privileges varying more or less in each particular case. But upon all of them is laid the obligation, and in some cases under the sanction of a severe penalty, of providing for the safety of the community against the introduction of uneducated practitioners of medicine. The methods pursued to effect this object are as various in the different states as are the powers of the
different institutions themselves. But they all have reference, in this country, chiefly if not exclusively to the education and examination of the candidates for the profession. Rarely, if ever, do the profession interfere with the practice of an individual member of it. Nor do they even attempt to control the conduct of those practitioners who belong not to the profession, any farther than to make it manifest that they have no affinity with them, and are not responsible for their misdeeds.
It being then settled that to the medical profession belongs the office of fixing the standard of qualifications of its practitioners, it becomes an inquiry of importance by what means this standard.shall be supported, so that the great body of the profession shall individually have attained to it, before they are suffered to practise. We have already seen that this can only be done through the medium of organized societies; and we are now to inquire what are the means by which such societies can most effectually accomplish the great objects of their institution.
These means are very naturally divided into two general classes; those which derive all their efficacy from the direct exercise of power; and those which accomplish their object by the influence they are made to exert on public opinion. The first would shut out uneducated practitioners from the profession by compulsion and penalties; the second would deter them from entering it, simply by withholding from them the countenance and encouragement of those already in the profession. The regulations of every medical institution partake more or less of one or the other of these characters. In some they are purely of the former class, in a few, as purely of the latter; and in many the two are variously intermingled, but in this country chiefly inclining to the latter. It is not difficult to see which interferes least with the natural right of every man to do. what he will with his own powers and faculties, and consequently which is best fitted to the genius of our free institutions. But it is not so well understood, and will not perhaps be so generally agreed, which most effectually answers the purposes for which they were designed. In order more fully to illustrate this question, we propose to compare the state of things in reference to it, as they present themselves in the commonwealth of Massachusetts, with that presented by the condition of the profession in England. We select these not merely because
we are better acquainted with the history and operations of the institutions which chiefly regulate the condition of the profession in the two countries, but also because they will furnish us the purest specimen of each of the kinds of power, to which we have alluded, and the best examples of their effects in their practical results.
So early as in the ninth year of Henry the Fifth, a petition was presented to the English Parliament, praying that the practice of physic might be restrained by law to such as had been examined and licensed. 'Wherefore pleseth to 'Wherefore pleseth to your excellents wysdomes, that ought after your soule to have no entendance to youre body for the causes abovesaid, to ordaine and make in statute perpetually to be straitly y used and kept. That no man of no manner, estate, degre, or condition, practice in fysyk fro this time forward, bot he have long time y used the scoles of fysyk, having letters testimonialx sufficianty of on of those degrees in the universite in which he took his degree in, under payne of long imprisonement and paying XL lb. to the king, and that no woman use the practice of fysyk under the same payne.' Accordingly an ordinance was passed giving to the Lords of the Council authority to establish such acts as to them should seem proper and necessary for the punishment of those who should practise physic without the approbation of the universities, or surgery without that of the masters of the art.
In the third year of Henry the Eighth an act was passed, which, after stating that the science and cunning of Physick and Surgery is daily within this realm exercised by a great multitude of ignorant persons, of whom the great part have no manner of insight in the same, nor in any other kind of learning; some also can no letters on the book-to the high displeasure of God, great infamy to the Faculty, and the grievous hurt, damage, and destruction of many of the king's liege people, most especially of them that cannot discern the uncunning from the cunning-provided that no person should take upon him to exercise and occupy as a physician and surgeon' in London or within seven miles, until he had been examined and approved by the Bishop of London, or the Dean of St Paul's, with the assistance of four physicians or surgeons, under the penalty of a fine of five pounds for every month. In like manner, and subject to the same penalty, every physician and surgeon out of London was required to be examined by the bishop of his diocess, assisted by 'such expert persons in the said Faculties'