525

DARWIN. On the other hand, the authors of the dissertt-

tions that compose the present volume would of themselves

have given éclat to any society of the kind. They are DANIEL

RUTHERFORD, JAMES GREGORY, GILBERT BLANE, ROBERT

JAMESON, HENRY HOLLAND, RiCHARD BRIGHT, MARSHALL

HALL, ROBERT LISTON, JAMES SYME, ROBERT CHRISTISON,’WILLIAM SHARPEY, ALLEN THOMSON, JAMES YOUNG SIMP-

SON, JOHN REID, MARTIN BARRY, WILLIAM BENJAMIN

CARPENTER, JOHN BROWN, JOHN GOODSIR, CHARLES MUR-

CHISOX and JAMES MATTHEWS DUNCAN. The first essays

of these men, as now given to the world, " form," n.s Sir

DOUGLAS MACLAGAN says, "important additions to the

history of medicine-a study too mllch neglected." " More

than this, they give conclusive evidence of the disciplinaryand educative value of medical debating societies at that

stage of the student’s career when his mental faculties are in astate most favourable for the reception of impressions which

may modify his whole future character and individuality.

BRITISH QUALIFICATIONS ABROAD.

As a very considerable number of medical men for one

reason or another decide to leave these islands and to settle

in practice in some other country, and as the conditions

under which men holding British qualifications are per-mitted to practise differ widely in different countries, it willbe useful to give in the present issue of THE LANCET an

epitome of such information as we have been able to obtainconcerning the regulations in force in various countries. It

will be remarked that in British colonies generally little diffi-

culty need be anticipated beyond having to furnish proof ofthe possession of a bonâ-fide diploma entitling the holder to

registration in Great Britain and perhaps the payment of afee. To this rule there are, however, as will be seen, excep-tions-viz., British Columbia and Ontario, where an examina-tion is necessary. It must be remembered, however, that

these regulations are constantly changing, and generally inthe direction of increased stringency, so that any prac-

titioner thinking of settling abroad would be well advisedto write direct to the authorities of the country or State towhich he proposes to go for the latest information. It is

well, too, to get diplomas and certificates of registrationendorsed by the consul in England before sailing. This will

sometimes obviate difficulties as to identification.

BRITISH COLONIES.

Antigua.—No formality is required.Australia.—In all the Australian colonies the Medical

Board must be first communicated with and the diplomasproduced. It is generally necessary also to produce someevidence that the applicant for registration is really the

person referred to in the diplomas, and the Board may takemeans of satisfying itself on this point. There is in some of

the colonies a fee of £1 1s. to pay. In Western Australia the

Board may examine and register an unqualified man.

Barbadoes.—Application has to be made to the MedicalAssessors. Fee 5s.

Bermuda.—The Governor in Council gives permission topractise on the production of diplomas. There is no fee.

British Columbia.—Diplomas have to be produced to theMedical Council, Victoria, with satisfactory proof of iclenti-fication, and an examination must then be passed in :

(1) Anatomy, (2) Chemistry, (3) Physiology, (4) Patho-

logy, (5) Materia Medica, (6) Medical Jurisprudence,(7) Theory and Practice of Medicine, (8) Clinical Medicine,

(9) Surgery, (10) Clinical Surgery, (11) Obstetrics and

Diseases of Women and Children. Candidates must obtain

75 per cent. of the marks in each of the last three subjects.A fee of$100 is required before the examination, half ofwhich is returned in case of failure. Examinations are held

in January, May and September.British Guiana.—Application has to be made to the Secre-

tary of the Medical Board. Qualifications which have notbeen registered-ill Great Britain may be recognised.

British Honduras.—No formality is required.Cape of Good Hope.—The Colonial Medical Committee

examines the diplomas of applicants. The Colonial Secre-

tary will then grant a licence to practise. There is no fee.

Ceylon.—Practice is free.Dominica.—No formality is required.Gibraltar.—Diplomas must be produced to the Governor.

There is no fee.

Grenada.—Application has to be made to the Clerk of theColonial Secretary. There is then a delay of a fortnight.The fee is .El.

Hong-Kong.—The Medical Board examines the qualifica-tions of applicants. A declaration has to be made before a

magistrate. The fee is$5.India.—Practice is free.

Jamaica.—The Registrar-General acts as Medical Registrar.A declaration has to be made before a Justice of the Peace,and the diplomas are initialled by him. The fee is £1. Un-

qualified persons can be examined by the Medical Council.Fee Ell lls.

Malta.—A fee is necessary.

Manitoba.—Application should be made to the Registrarof the College of Physicians and Surgeons. The fee is

about$5.

Mauritius.—No fees are required.Natal.—There is a Medical Board, to which body applica-

tion must be made and a copy of a declaration before a

magistrate produced. The fee is .El 15s.

New Brunswick.—The Council of Physicians and Surgeonsare applied to and the diplomas and certificate of registra-tion in Great Britain submitted to them. A fee of$10 is

charged.Newfounland.—No restrictions.New Zealand.—There is no Vledical Buard here. The

official to whom application must be made is the Registrarof Births, Marriages and Deaths of any of the chief towns.The diplomas must be produced, and a copy certified to by aJustice of the Peace must be left with him. An advertise-

ment must also be inserted in the Nen- Zealand Gazette. The

fees amount to ;E1 5s.

Nova Scotia. -Application has to be made to the ProvincialMedical Board, Halifax, and proof of registration in GreatBritain presented. The fee is$25.

North-West 2erritoy-,y.-Tlie Lord Lieutenant is Registrar.Fee$5.

Ontario.—Diplomas have to be presented to the RoyalCollege of Physicians and Surgeons, Toronto, and an examina-tion passed. The fee appears to be$50. There is also a,

small annual subscription.

526

Prince Edward’s Island.—The Board of Examiners examine

the diplomas and charge a fee of 30s.

Quebec.—Practitioners must become members of the Col-lege of Surgeons and Physicians. No examination is requiredfrom holders of a British qualification. There appears to be

a. fee of$20 and an annual payment of$2.Sierra Leone.-Practice is free.

Straits Settlements.—Practice is free.

St. Lucia.—Application has to be made to the Chief Clerkin the Government Office. There is no fee.

,5t. Vincent.—Application has to be made to the Registrarof the Medical Board. Fee £5.

Tasmania.—Here there is a Court of Medical Examiners,whose duty it is to examine the diplomas of applicants. The

fee is not mentioned in the statute.

Tlte Bahamas.—No formality is required.Tobago.—No formality is required.Trinidad.—The Secretary and Treasurer of the Medical

Board act as Registrar. Applicants have to prove their

qualifications, and also to show that they bear a goodcharacter. All registered persons are members of the

Medical Board. There is no fee.

FOREIGN COUNTRIES.

, Turning now to the question of practice in foreign countries,it must of course be evident that in them more difficulties

are likely to be thrown in the way of a British practitionerthan in the colonies. Indeed, in the majority of the more

important countries an examination of a tolerably strict

character has to be passed before applicants, however well

qualified, can obtain leave to practise.Argentina.—A severe examination, conducted in the

Spanish language, must be passed at one of the two medical

schools, Buenos Ayres and Cordova. It is said that at the

latter school the scientific requirements are lighter, but thefees heavier, than at the former, where they amount to$350

paper currency. Before passing the examination a foreignmedical man may, if he pleases, obtain without difficulty atemporary licence to practise in some locality where there isno fully licensed practitioner.

In Austria it is necessary not merely to pass the examina-tions for the degree of Doctor of Medicine of an Austrian

University, but to become an Austrian subject. Practicallyspeaking, Austrian territory, which of course includes the

Tyrol, seems to be shut off from foreign practitioners. One

case has occurred where an Englishman who was engaged as

surgeon to some works where a number of English were

employed was allowed to pass an examination by means of

papers which were translated.

In Belgium the Government is authorised, on the advice ofa jury, which has the power of granting the diploma oiDoctor or Pharmacist, to give permission to applicants whchave obtained a diploma abroad entitling them to practisein their own country, but no permission can be given tc

practise medicine unless the original diploma authorises thEholder to practise medicine, surgery and midwifery.

Bolivia.—There appears to be no examination. There is ! a

medical faculty in the University of Sucre.Brazil.—An examination has to be passed, but it may be

conducted in Portuguese or French. It is said to be les

severe than some of the other South American examinations

There are faculties of medicine in Rio de Janeiro and Bahia,

rhe recent political trouhlcs may possibly have producedsome change in the medical requirements.

Chile.—A severe examination must be passed, conductedin the Spanish language, in the University of Santiago. The

examiners are mostly Germans and the requirements are as

nearly as possible the same as those of the German

st(itits-ex6t,ineiz.

Colombia.—There appears to be no examination. There is.

a medical school in the University of Bogóta.Costa Rica.—No formalities required.Dutch Gitia7i((.-A State Examination, as in Holland, is,

required.Ecuador.—No requirements.In France a Bill has passed through the French Legis-

lature that entails considerable changes in the regula.tions regarding the granting of licences to foreigners to

practise. The diploma of Officier de Sante, which is thatwhich has been most commonly taken by English practi-tioners, is abolished, and all foreigners, whatever may betheir diplomas, are obliged to pass the examinations and togo through part of the course of study required for the

111. D. degree, which is said to be as difficult as the M.D. of

London.

, French Guiana.—The medical laws are analogous to those

in France.

In Germany the State Examination, which is severe, mustas a rule be passed. Occasionally exemption may be obtained.

In Greece there is an examination, but it may be passed inEnglish or French.

Guatemala.—No requirements. There is a University andMedical School in the capital.

In Holland, Denmark, Sweden and Norway a severe StateExamination must be passed at a University. Under very

special circumstances exemption might perhaps be obtained-at least in Norway.

In Italy qualified men who confine their practice to theirown countrymen are not interfered with, though, in order to

practise generally, the M. D. of an Italian University must beobtained.

Mexico.—No examination is required. It is, however,considered that a medical degree from the University ofMexico would be very advantageous to anyone wishing to

practise in Central or South America. There are four Govern-ment and five State Medical Schools.

Nicaragua.—No restrictions.

Paraguay.—An examination, said to be of a very simple! character, has to be passed. The chairman of the Board of

Examiners is an Englishman, Dr. HOSKINS. The British

! Consul, too, is an English medical man.

Peru.—Application should be made to the dean of the

) Medical Faculty, Lima, who, after verifying the diplomasobtained in Europe, will’arrange for the candidate’s examina-tion. Five examinations are required and they correspondin general to those of the Paris Faculty ; the pharmaceuticalpreparations which have to be known are those of the

1 French Codex, and the medical jurisprudence is also

French. There is a very thorough clinical examination>3 but plenty of time is allowed, and books, and even the

s patient’s case-register, may be referred to, so that there

.is no attempt to "catch" or to unnecessarily puzzle a

527

,candidate. The examination is of course in the Spanishlanguage, but no very profound knowledge of it is required.A candidate must understand what is said and be able to

make his meaning intelligible in that language, but the

examiners will permit him to explain himself in French or

English. It is not absolutely necessary to take the degreeof Doctor, but it is best to do so in the case of desiring to

join any of the medical societies. The fees amount to

.about £40. There is at present no English medical man in

practice in Lima; and as there are a good many Englishand American residents there would seem to be an opening,though of course the country is not so wealthy as beforethe war.

In Portngczl a State Examination must be passed at one ofthe medical schools. This requires a good knowledge of thevernacular, but it is incumbent on those who wish to practisein Portugal or Madeira.In Roumania there is a vivâ-voce examination.

In Russia the State Examination for 1rach (medical practi-tioner) has to be passed. When the applicant holds a

foreign M.D. of high value, the Minister of Education maypermit the examination to be confined to reading and defend-ing a somewhat elaborate dissertation or thesis. ,

Salvador.-No restrictions.

Spanish Honduras.—No restrictions.In Spain recognition can usually be obtained for British

- diplomas, but there is frequently considerable delay. Appli-cation should be made through the British Minister.

In Srvitzerland British practitioners are now obliged to passthe State Examination, which is conducted in French or

German, at one of the Swiss universities.In Turkey, including Syria, there is an examination at Con-

stantinople which may be passed in English, with a fee of

£4 1Os., and there is frequently a good deal of delay.In The Orange Free State, although there is said to be a

very conservative feeling towards foreigners, it is believed thatBritish practitioners would, if properly accredited, obtain

permission to practise.Lrtycccy.-An examination (or rather a complete series of

examinations) conducted in Spanish at the University of

Monte Video, is required, and a fee of$300 paper currency,which is double the sum required from a native.

Venezuela.—Nominally an examination at one of the twomedical schools, Caracas and Maracaibo, is required, but

practically there is nothing to hinder an English medical manfrom practising.

UNITED STATES.

Alabama.—An examination by the State Medical Board or-one of the County Boards is required. This lasts about a

week, and 75 per cent. of the marks in each subject are re-

-quired to be obtained.

Arizona.—Diploma to be registered by County Recorder.Arkansas.—Diploma to be registered by the State Board of

Examiners or one of the County Boards.

California.—Diploma to be registered by one of the Boardsof Medical Examiners. Fee$5.

Colorado. —Registration of diploma by State Board of

Medical Examiners.Connecticut.—No requirements.Delaware.—Registration of diploma by a County Clerk.

Florida.—Examination required before one of the eightdistrict Boards of Medical Examiners.

Georgia.—Diploma to be registered in the office of the

Clerk of the Superior Court.

Idaho.—Diploma to be recorded at the County Seat.

Illinois.—Diploma to be presented to the State Board ofHealth.

Indiana.—Diploma to be registered by the Clerk of theCircuit Court of the County. Fee $1½.

Iowa.—Diploma to be registered by the State Board ofMedical Examiners.

Kansas. -No requirements.Kentucky.—Diploma to be registered by the State Board of

Health.

Louisiana.—Diploma to be presented to the State Board ofHealth and endorsed and afterwards registered by a CountyClerk or Justice of the Peace.

Maine.—No requirements.Maryland.—Diploma to be presented to the State Board of

Health, Baltimore. The fee is$10.

Massachusetts.—No requirements.Michigan.—Diploma to be registered in the County Clerk’s

Office.

Minnesota.—Examination required before the State Boardof Medical Examiners, St. Paul. Candidates whose diplomasare more than five years old are considered ’’ old practitioners"and are not required to obtain more than 35 per cent. of themarks in anatomy and some other subjects, but their generalaverage must be 65 per cent. There are examinations in

January, April, July and October. The fee is$10.

Mississippi.—Examination required before a County Boardof Medical Censors.

llissotcri.-Diploma to be registered by the State Board of

Health, City of Jefferson. Fee$1.

Montana.—Diploma to be presented to the State Board ofMedical Examiners.

Nebraska. -Diploma to be registered by the County Clerk.

Nevada. —Diploma to be filed by the County Recorder.New Hagnvs7zire.-No requirements except of a formal

character.

New Jersey.—Examination before the State Board of MedicalExaminers, Jersey City. The Examination is in writing andoccupies two days ; 33 per cent. of the marks are requiredin every subject, and a general average of 75 per cent.

Fee$15.New York.—The only body entitled to license applicants is

the University of the State of New York, Albany. An exami-nation, lasting four days, is required. This embraces Ana-

tomy, Physiology, Hygiene, Chemistry, Surgery, Obstetrics,Pathology, Diagnosis, Therapeutics (including Practice)and Materia Medica. Examinations are held in New York

(410, East Twenty-sixth-street), Albany (High School Build-

ing), Syracuse (High School) and Buffalo (High School) fivetimes a year. Seventy-five per cent. of correct answers are

required in all subjects, and all subjects must be passed atthe same examination. The fee, which must be paid in

advance, is$25.North Carolina.—Examination by the State Board of

Medical Examiners ; 80 per cent. of the marks are requiredto be obtained. A temporary licence can be obtained while

waiting for the examination. A fee of$10 is required.

528

North Dakota.—Examination by the State Board of Medical

Examiners, Grancl Forks. Examinations held in January,April, July and October.

Ohio. —No requirements.Oregon.—Diploma must be recorded with Secretary of the

State Medical Board, Portland. Fees$2.

Pennsylvzania.—Diploma to be endorsed by some medicalcollege in the State, and then registered by a county proto-notary. Fee$1.

Dltode Island.—No requirements.South Carolina.—Examination before the State Boarc

required.South Dakota. —Diplonia to be recorded by the State Board

of Health. Fee$5.

Tennessee.—Diploma to be registered by the State Board oMedical Examiners, Trenton. Fee$1.

Texas.—Diploma to be presented for endorsement to a

District Board of Medical Examiners and afterward

registered.Utah.—No requirements.Vermont.—Diploma to be endorsed and registered.Virginia. -Examination by the State Medical Examining

Board.

Washington.—Examination by the State Medical ExamininBoard, Walla Walla. Fee$10.

West Virginia.—Diploma to be registered by the Stat

Board of Health.

Wisconcin.—No requirements, but it is advisable to joisome medical society.

Wyoming.—Diploma to be filed with the County Registryof Deeds.

SESSION 1892-93.

GENERAL COUNCIL OF MEDICAL EDUCATIONAND REGISTRATION OF THE UNITED

KINGDOM.

Registration of Jf(,,tlie6il Students.—The following are theGeneral Medical Council’s Regulations in reference to the

registration of students in medicine :-Every medical student shall be registered in the mannerprescribed by the General Medical Council. No medicalstudent shall be registered until he has passed a preliminaryexamination as required by the General Medical Council,and has produced evidence that he has commenced medicalstudy. The commencement of the course of professionalstudy recognised by any of the qualifying bodies shall notbe reckoned as dating earlier than fifteen days before thedate of registration. The registration of medical studentsshall be placed under the charge of the branch registrars.Every person desirous of being registered as a medical studentshall apply to the branch registrar of the division of theUnited Kingdom in which he is residing; and shall produceor forward to the branch registrar a certificate of his havingpassed a preliminary examination as required by the GeneralMedical Council, and euidenee that he has commenced medicalstudy. The branch registrar shall enter the applicant’s nameand other particulars in theStudente’ Register, acd shall givehim a certificate of such registration. Each of the branchregistrars shall supply to the several qualifying bodies.medical schools, and hospitals, in that part of the UnitedKingdom of which he is registrar, a sufficient number ofblank forms of application for the registration of medicalstudents. The several Branch Councils-and in Englandthe Executive Committee, if its meeting be more convenientand the case be uigent- have power to admit specialexceptions to the foregoing regulations as to registration,

for reasons Which shall appear to unem satisfactory. ’theseveral qualifying bodies are recommended not to admit tothe final examination for a qualification under the MedicalActs any candidate (not exempted from registration) whose ’

name has not been entered in the Medical Students’ Registerat least forty-five months previously. In the case of candi-dates from other than schools of the United Kingdom, theBranch Councils-and in England the Executive Com.mittee, if its meeting be more convenient and the case beurgent—have power to admit exceptions to this recom.mendation.The Preliminary Examination in General Education,

required to be passed previously to registration as a MedicalStudent, shall be as follows :-ins, 1. English language, including grammar and composition. 2. Latin,including grammar, translation from specified authors, and translationof easy passages not taken from such authors. 3. Mathematics, com.prising (a) arithmetic, (b) algebra, as far as simple equations, inclusive;(c) geometry, the subject matter of Euclid, Books I, II., and lit., witheasy deductions. 4. One of the following optional subjects: (a) Greek,(b) French, (c) German, (d) Italian, (c) any other modern language,( f) logic."The Council will not in future accept any certificate of pass in Pre.

liminary Examination in General Education unless the whole of thesubjects included in the Preliminary Examination required by theCouncil for Registration of Students of Medicine have been passed atthe sccrrce time, but this rule shall not apply to those who, previously toJan. 1st, 1892, have passed a part of any Preliminary Examinationrecognised by the Council ; provided that a University Examinationrequired for graduation in Arts, wherein the specified subjects of GeneralEducation are included, may be recognised for the purpose of registrytion.

Professional Education.—1. "The course of professionalstudy after rfgistration should occupy at least five years,conditionally."

2. " The first four of the five years should be passed at aSchool or Schools of Mnlicine recognised by any of theLicensing Bodies mentiomd in Schedule A of the MedicalAct (1858), provided that the first year may be passed at aUniversity or Teaching Institution, recognised by any ofthe Licensing Bodies, where the subjects of Physics,Chemistry, and Biology are taught."

3. " Graduates in Arts or Science of any Universityrecognised by the Medical Council who shall have spent ayear in the study of Physics, Chemistry, and Biology, andhave passed an examination in these subjects for the degreesin question, should be held to have completed the first ofthe five years of medical study."

4. "The fifth year should be devoted to clinical work atone or more of such public hospitals or dispensaries, Britishor foreign, as may be recognised by any of the medicalauthorities mentioned in Schedule A of the Medical Act

. (1858), provided that of this year six months may be passedas a pupil to a Registered Practitioner holding a public ap.poinnment, or possessing such opportunities of impartingpractical knowledge as shall be satisfactory to the medicalauthorities."

5. " The Regulations of the Examining Bodies and ofthe schools should be so framed that attendance on sys-tematic courses may be concluded at the end of the fourth yearof study, so as to permit of the student devoting the fifth

r year to clinical work, as defined in Resolution 4." 6." The regulations requiring attendance on systematicCourses of Lectures ought not to require attendance on, more than three Lectures weekly in any one Course." 7. " Due time should be set aside for Practical Work in the various subjects. Attendance on a Practical Course should be carefully ascertained and certified. By a Prac-atical Course is understood one in which work is done by thes student himself, under the direction of a duly qualified. teacher."b 8. " In order to promote a practical system of Clinicale Teaching, the Regulations should specify Hospital Practicee with Clinical Instruction.’ Ample time should be set

aside for Hospital Work, and means should be taken to1 ascertain regularity of attendance in the Wards and Out. patient Departments. Every candidate for the Final Pro. fessional Examination at the end of the fifth year shoulde be required to give evidence that he has had sufficienth opportunities of practical study."I, This Resolution relates to such offices as the following: Clinical Medical Clerkship and Surgical Dressership—eitherof for in- or out-patients ; Obstetrical Clerkship; post-morteml Clerkship.d 9. " No qualification in Medicine ought to be grantedit without evidence of clinical instruction in infectionsd diseases."

Professional Examination. —10. « With thp. view of