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Thus it follows that he who only embraces and rigidly confines himself to the restricted limits of the individual body he represents, ranks highest in the estimation of that body, and assumes a purity forsooth not from the corruption only to which each and all of these bodies were for so many ages subjected, but in accordance with that Papal definition of purity,* which our Colleges of pure Physicians and pure Surgeons personate—he assumes to be "pure from the branch of medicine exclusively assigned to the other.
This being the standard of perfection and purity set forth by our Royal Colleges, the evil effects extend of necessity throughout our Medical Schools and Hospitals. The exclusive object kept in view by the medical student who commences with such a definite prospect of his future destination in life, certainly leads to a narrow and contracted view of medicine rather than to an aim at general proficiency; yet, in spite of this, it not infrequently happens that the same man obtains the first prize both for medi
* “Il est dit que les candidats, qui auront précédemment exercés la Chirurgie, ne seront point admis qu'ils ne se soient engagés par un acte passé pardevant notaires à n'en plus faire les opérations • Car' ajoute le statut ‘il convient de conserver pure et entière la dignité de l'Ordre des médecins. Assurément les opérations chirugicales n'ont rien de contraire à la dignité de la médecine. Un médicin qui a l'universalité des connaissances médicales joindroit l'habilité et l'exercice des opérations de la chirurgie, seroit dans le cas des anciens médecins et il completeroit la profession.” -- Crevier's Histoire de l'Université de Paris, tom. vii, p. 85.
cine and surgery, and what then is the career set before him under such circumstances? Much if not everything depends on his pecuniary means. Are they such as to allow the attempt, he probably becomes a candidate for honour rather than emolument, and determines to assume the “higher” status in his profession—that of “pure” physician or "pure” surgeon ; and for this purpose he must subscribe to the division and distinction effected in the twelfth and thirteenth centuries. If the former, that of “pure physician," be his choice, he must henceforth close his eyes to all external wounds, injuries, and diseases; he must advance to the enemy with his hands tied, although he has proved himself eminently qualified for the treatment of all such diseases, and the use of all those means of cure, which it would have been, previous to this division, his privilege to adopt as a part of the physician's office : if the latter, that of “ pure surgeon," be the channel through which he aspires to the highest honours and appointments in his profession, then he must nominally ignore all cases excepting those his eye can see, his hand can touch, or his instruments can reach ; and thus of necessity he perpetuates to the present day the first great compulsory and invidious division in the physician's office, as enjoined by the narrow limits of the Royal Colleges of Physicians and Surgeons.
Having, however, taken this more ambitious course, should he lack the means necessary for his independent support, ere he realises his hopes of hospital or other appointments hereby expressed; or should he, after many years of drudgery, anxiety, and contention, fail to obtain these appointments through lack of interest, or a variety of other unforeseen causes, what is the consequence ?
He then, if not before, either leaves the profession in despair (as many of the best and wisest men are too often doing),* or, after this lengthened pursuit of unworthy examples, he sinks into what has been called the “ lower grade,” and henceforth becomes a candidate for emolument rather than honour.
Should this last be his determination, either from the commencement of his career, or after an ineffectual effort to attain the higher” status, what, then, is the course open to him ? He is permitted, not only to undertake the practice of medicine in “ all and every its members and parts ;' but, in addition to this, another man's labours are imposed on him, whereby all hope of fully cultivating, improving, and exhibiting the talent and attainments he had previously evinced is for ever extinguished, and he becomes a “general practitioner.” Thus, unwillingly compelled by his “ mode of practice and remuneration” to personate the third rather than the two previous usurpers of the physician's office, it must be acknowledged that the more he assimilates himself to the apothecary of the last century, and thereby lends his authority to the trading in drugs, so much the more quickly and easily does he realise the hope of emolument, and the more perfectly does he represent the third great usurper of medicine in this kingdom.
* Two striking instances have been recently brought before the public in one family, that of the late Lord Langdale, and his nephew the present Bishop of Ripon, both originally students in medicine.
As in our Licensing bodies and our Schools, so also in our Hospitals, the interested objects of sections and individuals are too often consulted, rather than the general good—the high and ennobling purposes of ministering to the poor especially, and to the public, and the profession generally, the full extent of those benefits they are so eminently calculated to impart. If we take, for instance, some of our oldest and best Hospitals, their boast is, the number of patients seen (but scarcely seen) by their medical officers in each revolving year.
By the excessive number of the patients, however disproportioned to their medical staff,* the merit of each is supposed to be established, instead of by a well-recorded history of the diseases treated, and the results obtained. What, then, is the consequence ? That the sick and wearied, it may be the starving, poor are kept waiting half or all the day;
“Ex his autem intelligi potest ab uno medico multos non posse curari; eumque, si artifex est, idoneum esse, qui non multum ab ægro recedit.”—Celsus, lib. iii, cap. iv.
the Physician or Surgeon, exhausted and unfitted for his private practice (if he has any), is physically unequal to the task he has undertaken, and therefore deputes his pupils to the work. Thus it is, no efficient record of this fearful amount of disease is kept, and the poor, the public, and the profession, are each denied the fair and just amount of good to which they are all legitimately entitled ; whilst, if this staff was increased five, or even tenfold in some instances, the advantages to all parties would be in more than an equal ratio.
Again, how often are dissentions occurring with these interested parties, in this attempt at impossibilities, and what then happens ? We have committees, and governors, it is not too much to say, perverting the funds entrusted to their care in establishing new institutions, opposition hospitals, or dispensaries, not on account of their need in the localities chosen-not to serve the interests of the poor, the public, or the profession—but for the support of their respective protegées in these feuds and divisions.
In this manner we may see the narrow and selfish interests of our corporate bodies, received each alike from their primary representatives, the Priest, the Barber, and the Apothecary,are reflected in our Schools, our Hospitals, and subsequently in the individual members of their respective communities.
Such are the prospects—such the results of these