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Watson-with nought but an increased scale of expenses and his private resources to support them. * How great then is the temptation, and, it may
be said, sometimes the necessity, to resort to some of those devices, the most favorable of which are not unworthy the sneers of our continental brethren ; for, alas ! too often the more degrading the expedient the more profitable the result. Could a return be made of the receipts of all those who take the higher grade of the profession, no doubt would remain that the vast majority of such are aspirants for honour, rather than emolument; whilst, on the other hand, were the receipts of those lowest in the scale of professional reputation also taken, the evidence would be as clear, that here is the most fertile field for emolument.
The well-educated general practitioner sees that the day has come for some revised mode of practice and remuneration. He can no longer submit to weigh his merits by the amount of drugs his patient swallows; yet the difficulty of separating from pharmacy is great indeed, when so large a number of licensed as well as unlicensed practitioners agree to estimate their value ALONE by this standard.
If honour and emolument combined are to be the fair prize presented to the profession; if health and safety are the objects of the public, all will confess
* See “Hospital Physicians and Surgeons," "Lancet, July 18, 1857.
that these cannot be attained by the present system, or, rather, want of system. In large towns the physician may with advantage give especial heed to individual diseases, means of cure, or classes of society, as circumstances may induce him; but such separation from the general duties of his office should be only a voluntary exception, and in no way give him a superior status in his profession; nay, rather the reverse, as in days of old, or as at the present day in foreign states.* The ordinary family physician must come forth in all his fair proportions, neither reft of half his office on the one hand, nor oppressed with a twofold burthen on the other. If the field of medicine be so vast and extensive, that men assumed to have superior opportunities and attainments, can but grasp a very limited portion, or be “ useful in some cures only,” then most assuredly the “inferior grade,” who are the ordinary attendants on nine tenths of the public, cannot undertake the whole of the physician's office with that of the apothecary superadded, with any honour to themselves, or safety to the public.
All divisions of the profession are, at the present day, alike on one or other horn of the dilemma. The comparatively few who assumethename and status of “pure” physician or pure
surgeon, but half perform the duties of their profession; whilst the 13,470 who, for the most part, are performing the many.*
* See antè, p. 18; also Prussia, p. 184.
office of physician to all ranks and classes, in every city and village, going forth by day and by night, at every call of suffering humanity, are impeded in thus serving the public, and honouring their profession, by the superaddition of another man's work, which, at the same time, disqualifies them for hospital or other honorable appointments, and stigmatises them as of a “ lower grade.” There may be "
There may be “physicians extraordinary,” ap xrarpol, for the few; but there must be 66
physicians in ordinary," latpol, for the
From Her Majesty down to the meanest of her subjects, all are worthy the physician's care, and he who fills that office is worthy the physician's
If a uniformity of education and qualification, if a single portal to the profession be insisted on, no less must a uniformity in name, in mode of practice, and remuneration, follow ; or strife and jealousy will ever reign.
The two corruptions from which medicine has been separated in past times—–1518 and 1745—are the best precedents for the course to be pursued in that which now exists. It was not from those who were the depositaries of power—the legally constituted authorities—the corporate bodies that our chief improvements came; it was from individuals awakened to the necessities of the times, and stimulated by a worthy ambition to meet them. The “ Act for better regulating the practice of apothecaries," 1815,* was of this character; it was an allimportant step towards the supply of well-educated practitioners in medicine, equal to the requirements of the public; but, at the same time, it legalised an alliance that should never have existed, and which tended, with the previous Act of 1540+ to associate the functions of the physician, in modern times, with the then uneducated, and for the most part“ wholly ignorant and utterly incompetent,” usurpers of that office.
* “Truly, indeed,” says Ehrenberg, “the microscopic organisms are very inferior in individual energy to lions and elephants; but in their united influences they are far more important than all these animals.” See · Owen on Invertebrata,' second edition, p. 39.
I mean not to disparage the Priest—the Apothecary-or even the Barber!-in their several relations to society. I would not underrate their individual merit in their several and distinct callings; but I cannot overestimate their evil consequences in relation to medicine. All alike degrade the physician's office by encroachments and alliances, such as I
* See Appendix, 29.
# Although a general analogy exists in thc Acts of 1540 and that of 1815, severally legalising the corruption of the barber, and of the apothecary, yet is there one very striking difference. The former Act unites the barber and the surgeon in one company,
expressly forbids the same individual to practise both“ barbery” and “ surgery” (see 32 Hen. VIII; Appendix, 18); whereby a distinction was made, which in after time—1745—-no doubt aided the emancipation of the surgeon from the barber, and their division into separate companies. Had such a clause been inserted in the Act of 1815, which unites the apothecary and the physician, the path to a separation of two offices equally distinct, might have been much more probable, and easy of
have depicted ; and all honorable minds are equally interested in retracing the steps whereby they have been corrupting and corrupted.
An aggressive warfare meets no sanction by the law of nations; neither can it be better prevented or resisted, than by strength and purity within the state assailed. If such principles had existed throughout in the College of Physicians, neither of the two last corruptions and divisions would have been permitted in modern times. If the limits of medicine had been truly fixed, and its several ranks well filled ; if the powers and privileges possessed by the College had been exercised for the cultivation of medicine in “all and every its members and parts for all classes of society—we should never have had the barber-surgeon of 1540, or the apothecary-physician of 1815, established by law in this land. But the interest of the few-not the dignity of the entire profession—was sought. The “non sibi sed toti” was reversed by the College; the “salus populi suprema lex” was forgotten; and thus the objects of their charter annulled. *
We have at the present day every means for high intellectual cultivation, as witness the incomparable fruits of our second emancipation ;t but morally we are a wide waste, a wilderness, where every tempta
* See antè, p. 112, note, “pro salubri gubernatione,” &c.
+ The Hunterian Museum and its Professors (at the time these pages are written)-Owen, Paget, Quekett.