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career by exhibiting more or less of talent, though comparatively little of practical knowledge, in monographs containing minute analyses of disease, or specious and fine-drawn theories, too often more wonderful and beautiful than true. * Should this preparation for practice, this theorising, this ploughing and sowing, and, not infrequently, this modern mode of advertising, prosper; the reaping time is but an advanced life of incessant toil and anxiety,t whereby the practical results of these theories or analyses, the ripe fruits of a life well spent, are comparatively but seldom given to the profession. Such a mode of remuneration, leading to such results, is
pure ” in its origin than in its effects. Willcocks$ says, that at an early period, when monks and priests were physicians, “ they could not recover their fees or any remuneration, as they were unable to bring any action, or possess any property, for they were, in the language of the law, civiliter mortui ; and the canon, prohibiting their practice, precluded their superior from instituting any suit in their behalf, or on behalf of the house to which they may have belonged; therefore, having no right to recover a remuneration, they often sought a present in hand.”
“Pure” physicians—fellows of the College of * See · Br. and For. Medico-Chir. Review,' January, 1857, p. 1.
f The one uniform fee is as unjust towards the Physician at this period as it was towards the public at his commencement.
I 'Laws of the Medical Profession,' p. 112.
Physicians of England-are so far in precisely the same position as were the monks and priests in the twelfth century, their fee is an “ honorarium,” they are, in the eyes of the law, "civiliter mortui,” their means of cure are limited, as are the class of cases submitted to their treatment, and thus the mode of remuneration, as well as the mode of practice, first adopted in the twelfth and thirteenth centuries, is perpetuated by the College of Physicians* of England at the present day. “ Pure"
likewise fettered by similar proscribed limits,t are subject also to the same evil effects, and consequently precluded from filling the office of ordinary family physician to all ranks and classes.
The general practitioner stands in the same equivocal position as regards his mode of remuneration as his mode of practice. He has of necessity diverged from the simple and pure practice of the
* Thename “physician,”as well as his modeof practiceand remuneration, is inherited from the same source:- -“Atque ita temporis successu curandi ratio tam miserè divulsa est, ut medici quidem, se physicorum nomine venditantes, medicamentorum et victus ad reconditos affectus præscriptionem sibi duntaxat arrogaverint; reliquam autem medicinam, iis quos Chirurgos dominant, vixque famulorum locum habent, relegârint; turpiter à se, quod præcipuum et antiquissimum est medicinæ membrum, quodque naturæ speculationi (si modo aliud) præcipuèinnititurdepellentes," &c.—Vesalius (Andreas)“ Opera omnia," Dedication to Charles V.
+ The examination at either Royal College ignores the subjects specially enjoined by the other, and the more a physician or surgeon ignores these in practice, the more nearly does he attain to this standard of purity, and becomes eligible for Hospital appointments.
apothecary in the one as in the other, and resorted to a variety of expedients, so as to make the practice of medicine and the trading in drugs either or both available for his purpose. Hence it is, this the only division of the medical profession, qualified to practise medicine in “all and every its members and parts,” is viewed by our continental brethren in no enviable light.
Professor Heinrich Rose, in a paper on the state of pharmacy in England in 1855, describes this portion of the profession as one third, or nearly one half, keeping chemists' and druggists' shops, and preparing medicines prescribed by other medical men.* So, likewise, a recent number of the Archives Gén. de Médecine' gives the following description of another frequent expedient, which, although perhaps the least objectionable mode of evading the difficulties of his neutral position, is not undeserving the satire bestowed on it. After reviewing the divided state of the profession in England, the writer thus continues :—“Il n'y a dans ce désordre rien de ces conditions que nous regardons comme nécessaires : ni garanties sérieuses exigées de ceux qui veulent suivre le carrière médicale, ni égalité entre les hommes qui l'exercent; confusion déplorable qui met l'ignorant sur le même pied que
* See · Pharmaceutical Journal,' vol. vii, p. 149. Also · Evidence of Dr. Taylor before the Committee of the House of Lords on Sale of Poisons Bill,' q. 879.
l'homme instruit et le charlatan ehonté à côté de médecin sérieux. La confusion est d'autant plus inévitable que, dans chacune de ces classes, sans droits et sans attributions définies, sans garanties fixes et égales, il se rencontre à la fois des
habiles et des incapacités des gens honnêtes et des indignes. Aussi a-t-on compris qu'il fallait faire un tout homogène de ces éléments divers, et constituer une unité avec toutes ces fractions isolées. Ce besoin d'unité du corps médical se traduit quelquefois par des projets assez excentriques.
“ Ainsi un praticien pharmacien, jouissant d'ailleurs d'une réputation honorable et méritée, a trouvé un ingénieux moyen de réunir la médecine et la pharmacie, et le propose avec
une candeur admirable. Je ne vend plus de médicaments, dit-il ; je fais payer mes visites un certain prix fixe, et, moyennant ce prix, je fournis à mes malades les drogues dont ils peuvent avoir besoin. J'ai, ajoutet-il (et ceci fait honneur à sa probité), la délicatesse de leur en fournir à peu près à chaque visite, et, de cette façon, me voici sur le même pied que mes confrères. Cet ingénieux moyen semblerait inspiré par les enseignes de nos restaurateurs à prix fixe : Visites à tel prix, deux drogues au choix; calomel et tisane à discrétion."*
Besides these, and a host of other minor divisions, we have the “ Eminent Physician " and the
" and the “ Expe* Cinquième série, tom. 3, p. 250.
rienced Surgeon” publicly co-operating with the druggist in our great thoroughfares; or more privately with the apothecary, by prescribing
gratis” for the sale of a multiplicity of medicines, whereby, alone, an ample mode of remuneration is established for both parties.
"Oh, wad some power the giftie gie us
The evil effects of these corruptions and divisions of medicine may be traced also in Ireland and Scotland, but proportioned only to their number and extent.
Those of the Physician and Surgeon we have seen to have shared the same origin, history and issue in each division of the Kingdom-originating in the same PAPAL decrees-struggling through a like period with their several usurpers—and at length terminating in the establishment of Royal Colleges of Physicians and Surgeons, "pure" it may
be from the corruption with which they had for so many ages been associated, but " pure” also from each other, in accordance with the restrictions laid on their predecessors by Romish Synods and Councils in the twelfth and thirteenth centuries.
With the third corruption, however, that of the Apothecary—as we have traced a very distinctive character in its origin, and in its history, so also may we do in its effects. * Inasmuch as the efforts of both Ireland and
* See antè, pp. 103 et seq.