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as he should think proper. The archbishop of Canterbury has occasionally granted licenses, in consequence of a power to confer degrees, transferred to him from the Pope by an act of 25 Henry VIII., and in 1670 he licensed William Lilly, the astrologer, to practise physic except in London and within seven miles. It is said that the bishop of London has within a few years licensed a practitioner in the city. The validity of such licenses is however now disputed, since, although the act granting the power of licensing to the Bishops has never been repealed, a paramount authority has been granted by charter, and confirmed by acts of Parliament, to the College of Physicians, the College of Surgeons, and the Company of Apothecaries.
The charter of the College of Physicians under which that body still holds its powers, although several subsequent charters have been prepared and offered to it, was also granted by Henry the Eighth, in the tenth year of his reign. It was ratified in the fourteenth and fifteenth years, by an act, declaring that 'forasmuch that the making the said corporation is meritorious, and very good for the common wealth of this your realm, it is therefore expedient and necessary to provide, that no person of the said politick body and commonalty aforesaid, be suffered to practise physick, but only those persons that be profound, sad, and discreet, groundly learned, and deeply studied in physick.' The powers granted for the purpose of carrying into effect this provision are, one would think, abundantly ample, if power alone could do it; especially when taken in connexion with those added a few years later by the act of 32 Henry VIII. The college are authorized to make bylaws for the government, superintendence, and correction, not only of its fellows, but of all persons exercising the faculty in the city, or within seven miles of it. No person is permitted to practise in London or within seven miles without a license from the President and College, under a penalty of five pounds for every month he shall so practise; nor is any person permitted to practise elsewhere in England without submitting to an examination in London before the censors of the college, and being licensed by them, unless he has received a medical degree at the university of Oxford or Cambridge. The four censors elected by the President and College have the superintendence, correction and government of all persons exercising the faculty of medicine, in any manner,
in the city or within seven miles, and the superintendence and scrutiny of all medicines and their administration, with power to punish for malpractice by fines, amercements, imprisonments, and other reasonable modes.' The act of 32 Henry VIII, to which we have just referred, directs how the superintendence, and scrutiny of medicines shall be performed. It requires the four censors, at least once in each year, and as often as they shall think meet and convenient,' to enter the house of every apothecary and to search, view, and see such apothecary's wares, drugs and stuffs' as he may have in possession; and all that they find to be defective, corrupted, and not meet nor convenient to be ministered in any medicines for the health of man's body,' they are to cause to be burned, or otherwise destroyed. It may well be supposed that such an exercise of power cannot be very agreeable to either party, and accordingly, the censors are each laid under a penalty of forty shillings for every neglect of it, and the apothecary under a penalty of five pounds, which was afterwards increased to ten pounds, for every refusal to submit to it. To complete the powers of the College of Physicians, by an act passed in the first year of Queen Mary, the president or the censors in order to correct and punish all offenders in the said faculty, within the same city and precinct,' are authorized to commit them to any prison in the city, except the Tower; and the officers of the prisons are required to keep such offender or disobedient,' at his own expense, until he is discharged by the president or censors.
In a manner somewhat similar all persons are prohibited, by a series of enactments, from practising surgery without examination and license. There is however a remarkable difference between the two colleges of physic and surgery in respect to the power of inflicting penalties upon unqualified practitioners. The College of Surgeons do not appear to possess any such powers. The reason may have been that until 1745, the surgeons were not a separate corporation, but shared their corporate powers with the worshipful company of barbers; and that was too late a period for the acquisition of such enormous powers as are possessed by the College of Physicians. We are not quite satisfied with this reason however, since at a much later period a heavy fine was laid upon apothecaries for practising without license.
It seems to have been a consequence of the rigid exercise of
their powers by the College of Physicians, by which either the qualifications of physicians were raised above, or their number reduced below, what the wants of the community required, that apothecaries came to take a part, and a very extensive part in the practice of medicine. Whatever may have been the cause of the change, the apothecaries having become established in their right to practise, we find them also regulating their admissions to it by licenses and penalties. In 1815 they obtained an act of Parliament, which subjects every one who commences practice as an apothecary in any part of England or Wales without a certificate of qualifications to a penalty of twenty pounds, and every one who thus commences as an assistant to an apothecary to the penalty of ten pounds, besides depriving them, in either case, of the power to recover their charges in a court of law. They were indeed long before, at least as early as 1666, bound by rules which were sanctioned by penalties, to a prescribed course of requirements in respect to compounding and delivering medicines; and these rules were not annulled, nor their penalties remitted, when they were admitted to a higher rank in the arts of healing. For by the act of 1815, if any apothecary shall refuse to compound or administer or deliberately or negligently, falsely or unfaithfully mix, compound, or administer any medicines ordered by any lawful physician, by any prescription signed with his initials,' he shall on conviction before any justice of the peace, unless he can show a satisfactory excuse, forfeit for the first offence, five pounds, for the second, ten pounds, and for the third be deprived of his certificate, and be rendered incapable in future of using the art of an apothecaay, until he shall give satisfactory security that he will not again be guilty of a like offence.
Thus we see that in every department of the profession in England, the sole dependence for the protection of the community against the intrusion of unworthy and unskilful practitioners is upon the force of prohibitions and penalties. There is nowhere manifested any reliance upon the readiness of the public to prefer the attendance of an educated and skilful physician, however fully his qualifications may be attested, to that of an ignorant pretender. On the contrary everything is founded upon the presumption that they cannot discern the uncunning from the cunning.' We call the attention of our readers particularly to this circumstance, because it is a principal feature in the distinction between the system established in EngVOL. XXVII.-NO. 60.
land and that which has been adopted under the auspices of the Massachusetts Medical Society in this commonwealth. Here are no prohibitions and no penalties; but a simple reliance upon the confidence of the community in the faithfulness of the profession in respect to the qualifications of its own members.
Before we proceed however to a comparison of the two systems, we will return to that of England, and inquire how effectually it has accomplished the objects for which its various provisions were designed. And first, in respect to irregular and ignorant practitioners, England has become proverbial for their number, until it has been called not unaptly, the paradise of quacks. Prohibitions and penalties may answer for the more despotic governments on the continent of Europe; but where public opinion operates so directly, they serve to weaken the confidence of the mass of the people in those who rely upon them for protection, while they awaken a sympathy for those who are proscribed by them. Of what concern is it to the itinerant, whose only property is his wheelbarrow and its beggarly contents, that he incurs the liability to a fine of five pounds for every month of his miserable practice. His poverty and insignificance are a sufficient protection against the severity of the law, while that very severity becomes the principal means of all the influence he obtains.
But it is not in these lower walks of practice alone, that similár effects have been produced. The introduction of apothecaries to the right to visit patients and prescribe for them, affords a signal example of the impracticability, in any but a despotic government, of executing a law which is opposed by the sense and feeling of the community. In 1704 the College of Physicians instituted a suit against an apothecary for a breach of their charter by practising without a license from them. In the Court of King's Bench the case was decided against him; but on an appeal to the House of Lords, the judgment was reversed; and thus was permanently established the right of apothecaries to practise medicine for ever after, subject only to the absurd condition that they shall take no fee for professional advice, but only charge for their medicines. It is quite apparent, that the House of Lords were induced thus to evade the strictness of the law, by the urgency of the demand for a class of practitioners, who should be more accessible to the body of the people than were the licentiates of the college.*
* The case turned upon the question, what is meant by practising
This sudden extension of the privileges of apothecaries, was for a time a great evil to the community; for it drew into practice a great body of men who had been educated for a different line of business. But the evil has gradually corrected itself, and now the apothecaries themselves require an education in the members of their Company, who as we have seen are alone allowed to practise, scarcely less thorough in its practical parts, though less formal and expensive, than the physicians themselves. Thus the wants of a people will provide means for their own supply, and in some degree suited to their own condition, in spite of all the enactments of the laws.
A still more striking example of the inefficacy of severe enactments, in opposition to the general sense of the community, and of the reaction to which they are exposed, is exhibited at an earlier period of the history of medicine in England. We have mentioned a statute of 3 Henry VIII, which prohibited any person from practising medicine or surgery in London or within seven miles, without a license from the bishop. In the thirty-fourth and thirty-fifth years of the same reign a bill was passed which, referring to this act, declared, that since the making of which act, the company and fellowship of surgeons in London, minding only their own lucres, and nothing the profit or ease of the diseased or patient, have sued, troubled, and vexed divers honest persons, as well men as women, whom God hath endued with the knowledge of the nature, kind, and operation of certain herbs, roots, and waters, and the using and ministering of them to such as have been pained with customable diseases, as women's breasts being sore, a pin and the wale in the eye, ́uncomes of hands, burnings, scaldings, sore mouths, the stone, strangury, saucelim and morphew, and such other like diseases.' After various other severe charges against the surgeons, among the rest that it is well known that the surgeons admitted will do no cure to any person, but where they shall know to be rewarded with greater sum than the cure extendeth unto,' and 'the most part of the persons of the said craft of surgeons, have small cunning, yet they will take great sums of money, and do little therefore, the act authorizes every person having knowl
medicine. The Court of King's Bench decided that it consisted in judging of the disease and constitution of the patient, and judging of the proper remedy, and applying it, all which had been done in this case, but without fee. The house of lords on the contrary seem to make the practice of medicine consist essentially in the fee.