ESSAY II.

§ 1. IT seemed desirable in the preceding normal project to assume a theoretical standard, by which to test various measures which have been proposed or carried into effect in this country for the attainment of one or other of the objects of State medicine.

Some of these objects must now be viewed in a more practical light, with special reference to our own necessities, our own institutions, and our own modes of legislation and administration. Medical Police must be anglicized.

§ 2. The aspects of State medicine in the educational department have determined me to consider in the first place, the vexed question of "Medical Reform," which has now been before Parliament in one shape or another for twenty years.

For there seems no reasonable ground to expect that any administrative machinery for the protection of the public health can be constituted satisfactorily to the legislature, to the medical profession, and to the better informed portion of the community, until the ground-work be laid in an improved system of medical education and organization.

§ 3. The courses of study and preparation deemed necessary for entering upon the profession of medicine in its various departments, and the nature and amount of the qualifications (so far as these can be ascertained by examination) of those legally admitted to practise in England, Ireland, and Scotland, are still determined by various licensing bodies in each part of the kingdom.

62

COLLEGES AND PRACTITIONERS.

These bodies appear to treat medical education on different principles, and to hold different views as to the minimum degree of preparation and acquirement necessary for each class of practitioners.

Thus, as might have been expected, the main obstacle to the adoption of any general scheme for the uniform training and examination of medical candidates throughout the British Empire, has consisted in the difficulty, hitherto insuperable, of reconciling the contending claims, the conflicting educational theories, and the rival pecuniary interests of the several universities, medical or surgical colleges, and quasi-medical corporations, to which the legislature has unhappily committed the power of authorizing persons to treat the sick.

§ 4. Another weighty, though more passive hindrance to legislation has consisted in the indifference of the majority of the profession to any measure which would not guarantee to them a monopoly of curative practice. Their cry is "Protection." So that even if the educational bodies could arrange their differences, we must not expect the general hearty acquiescence of the profession in any measure, unless it contain stringent penal clauses against irregular practitioners.

Now, if the Government should decide on waiting until the various medical bodies and the majority of practitioners shall have concurred in one bold and publicly useful measure, all legislation on the subject must be indefinitely postponed.

Nor is it likely that such concurrence would be obtained, unless by delegating to a representative medical council an amount of power, the surrender of which by the Crown and Parliament would be scarcely consistent with a due regard to the public interests.

For instance, the medical corporations and the body of practitioners might require that none should be admitted into the ranks of the profession, except those adhering to "orthodox' medical theories, and authorized modes of practice.

§ 5. Now, it cannot be denied that improvements in medical

PROTECTION AND PROHIBITION.

63

science of great benefit to mankind, have now and then originated externally to the pale of the "regular" faculty, whilst many of those still more important reforms and discoveries, made within that pale, have been vehemently opposed, and the progress of truth for a time checked, by the heads and governing councils of the profession.

Any medical doctrine, not sanctioned by those authorities, has accordingly been accounted heterodox; and no discreet aspirant for medical honours has ventured to consider it even an open question.

Supposing, then, that the Legislature, beside conferring exclusive privileges upon persons duly accredited on this exclusive system, could be persuaded further to prohibit, under penalty of fine and imprisonment, all others from practising the medical arts; it must be clear to any one who does not shut his eyes to notorious facts, that numbers of the educated and intelligent portion of her Majesty's subjects would be deprived of those sources of advice and aid on which, however unwisely, they choose to depend for the relief of their disorders.

§ 6. Prohibition, under such a law, would not be confined to those grossly "ignorant persons, of whom," says the old statute of 1511, "the greater part have no manner of insight in the same [science], nor in any other kind of learning; some also can (sic) no letters in the book, so far forth that common artificers, as smiths, weavers, and women, boldly and accustomably take upon them great cures and things of great difficulty, to 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."

"*

The prohibition sought for, would not apply specially to uneducated medicine-vendors,† who, notwithstanding their entire

* Willock-Laws relating to the Medical Profession, part ii. p. vi.

It seems that some thirty-three petitions were presented to Parliament from medical botanists-alias Coffinites-against Mr. Brady's Bill of 1854.

These petitions came chiefly from individual quacks, but one was signed by 4180

64

VARIETIES OF EMPIRICISM.

ignorance of the merest elements of pharmacy and therapeutics, profess, without legal hindrance, to furnish infallible remedies for every ailment of the million hitherto unprovided with proper medical care and sanitary regulation.

Nor would it be simply "a declaratory act withdrawing expressly from the St. John Longs and other quacks, the protection which the law is inclined to throw around the mistakes and miscarriages of the regularly educated practitioner."*

Nor would such prohibition stop, after the enactment of justly severe restrictions upon the sale of pernicious if not poisonous drugs-every one knows how the children of English workingpeople are narcotized into brain-disease and atrophy.

§ 7. But, on the protective hypothesis most in favour with the medical profession, what would become of certain legally qualified practitioners who forsake the beaten path; as, for example, the disciple of Hahnemann, who relies on infinitesimally small doses of certain substances, which even in large quantities. have been, hitherto and generally, believed to be wholly inert; or his ally, who follows another German original in treating all diseases, acute or chronic, by enormous draughts and curiously diversified applications of pure water; or a third, who would revive under a new name the ancient iatroleptic or gymnastic treatment; or a fourth, of the dietetic school; or a fifth, proclaiming his exclusive confidence in the natural forces of galvanism and electro-magnetism; or a sixth, who, by means of mesmerism and its kindred arts, brings more questionable and

inhabitants of the West Riding of Yorkshire; another by 1800 persons at Bradford; another had 368 signatures from a meeting at Freemasons' Hall, London.

The principal drug used by this sect seems to be lobelia. At an inquest held in November, 1853, on a person poisoned by an emetic of lobelia-seeds given by one of the above petitioners, Dr. Letheby (the eminent toxicologist, and now medical officer of health for the City of London,) stated that thirteen cases of poisoning from this drug had occurred within the last three or four years; and that in six the coroner's jury brought in a verdict of manslaughter. Adding two more recent cases, it appears that eight cases of proved manslaughter have resulted from this quackery in four years!-Med. Times and Gaz., May 13, 1854.

* Coleridge's Table Talk, Jan. 2, 1833, p. 189, 2nd edit.

PROTECTION FOR THE PUBLIC.

65

mysterious influences to bear upon the disordered frame and impaired will?

Let any of these more especially if highly educated or keen witted, most certainly if skilful or successful in their empiricism -be found in the nominal ranks of the medical profession, and they would inevitably be expelled, forbidden to exercise their profitable occupation, probably punished severely on the repetition of their offence, and thus be turned into "martyrs for the truth," if our legislators should adopt and enforce the hasty claim of the majority of the regular faculty in this country.

As one who may be supposed to have an interest in the decision, I do not pretend to estimate the amount of real benefit which might accrue to the public from the realization of the protective theory, nor is it necessary to speculate further on this demand. It will not be granted.

§ 8. The practical question now forced upon the consideration of statesmen is, to what extent, and by what safe measures, a principle could be recognised which in the main is correct and reasonable; namely, that the public should be protected from fraudulent and ignorant pretenders to a knowledge of the healing art.

It appears that, on this point, there are two very distinct demands:

:

First, that no one should be legally authorized to practise medicine, who does not avow that he is prepared to treat disease on principles and precedents approved by the most eminent professors and practitioners of the day; in other words, on the therapeutical systems sanctioned by the heads of the medical colleges :

Secondly, that the State should grant its licence to practise medicine to those only (1) whose knowledge of anatomy, physiology, and pathology, and of the various branches of abstract and natural science, on which philosophical medicine rests, has been duly tested; (2) who can produce evidence, by certificates fairly earned and fairly granted, of having carefully observed, by

F