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54 portant period of his life is frittered away-a time when the character is being formed, and habits of industry and well- directed application are essential to a healthy development of his moral and intellectual powers. I think Sir James Graham laid down a great principle of medical reform when he stated that all medical men ought, in justice to the public, to be educated in every branch of the profession. Would the physician be worse for having a know. ledge of surgery ? Would the pure surgeon be worse for a more intimate acquaintance with internal disease ? Would either be worse for knowing how to act in cases of emergency in the lying-in chamber ?-or for having no refuge in the false etiquette of non-interference. We have it on record, that many a life might have been saved if a physician or a surgeon knowing what to do, had done it. The safety of the public requires that the standard of medical education should be sufficiently high to guarantee efficiency. No man can be considered legally efficient who does not understand the principles of medical practice so far as they are taught; but it is not just or fair to give him pro- fessional rank because he has shown a more minute knowledge of anatomy or of structural botany at the time of his exami- nation, because the chances are, that at the end of twelve months he will be on a par in this kind of theoretical know- ledge with others in the list. True professional rank can result only from the happy adaptation of theory to practice, aided by superior intelligence and observation. How have our great surgeons gained the confidence of the public--their high place as skilful operators ?-what has made them to differ from the hundreds of men who passed the self-same examination ? Did they come forth from the college-library all armed ? Their success is their own, the result of long experience and repeated practice. This is as it should be. Many a man amongst the number has long since forgotten his minute anatomy. I confess I should like to see the particular kind of practice more distinctly defined. That of the physician is clear enough; but the practice of the surgeon-or, as he calls him- self, the pure surgeon-is rather the practice of the general practitioner; for I think it was stated in evidence before the House, that five out of six of his cases were cases of constitu- tional derangement. If compelled to confine their practice, as the name imports, to cases strictly surgical, I fancy the number of pure surgeons would be very much thinned. The general practitioner is considered qualified to undertake the treatment of diseases, whether coming under the province of physic or surgery, and he would be an honour to the profes- sion of medicine in this country if the law did not, as it were, oblige him to receive remuneration for his services through the least of all his services. I think that the examination of all candidates for medical practice ought to be conducted by the men who practise solely as physicians, and solely as operating surgeons. I do so be- cause it is reasonable to suppose that the man who studies a particular disease, or particular diseases, is more fitted to un- dertake the office of examiner of others, than the man whose attention is continually diverted into different channels. On this ground I would make physicians the examiners in medi- cine and the collateral sciences, and operating surgeons the examiners in surgery. One diploma should be granted by both, and no man should be legally qualified to embark in practice, either as physician, surgeon, or general practitioner, until he had received the approval of both examining bodies. Having obtained the diploma, let it be optional with him to register himself for practice in one, or in all the departments of medicine; but do not be guilty of the injustice of debarring a man, when once pronounced qualified, from changing his position. If he be qualified to practise in the double capacity of surgeon and physician, he is assuredly qualified to practise each singly, though the cases would indeed be rare in which such a man would be at all able to compete with the practised operator or the accomplished physician, whose professional superiority over other men would always be, in a great mea- sure, dependent on their connexion with our large hospitals, where the field of observation and practice gives those who have the good fortune to be attached to them a vast advantage. Before I conclude, I must allude to a growing evil conse- quent on the chemist and druggist being allowed to sell medi- cinal substances without any check. This is the enormous consumption of opium, which seems to me to be greatly in- creased since the temperance movement was set on foot. I know one man who, in a thinly-populated district, sells not less than a hundred-weight of crude opium in the year; another, who sells three times that amount. I know one case in which a woman has habituated herself to take six ounces of laudanum daily. If this opium-eating is becoming as general through the country as it is here, we shall not, forty years hence, find, as we now do, in our union districts, men who have reached the age of threescore years and ten, and are yet able to work. I fear, on the other hand, we shall find the English labourer thrown on the parish, and on the country, as a disabled pauper, before the age of sixty, thereby fearfully in- creasing the taxation of the kingdom. If I be not single in this opinion, it behoves our legislature to look forward, and to prevent the possibility of such a state of things ever oc- curring. I am, Sir, your obedient servant, Louth, June, 1848. ST. JOfIN W. LUCAS. ST. JOHN W. LUCAS. GRINDING FOR THE HALL. To the Editor of THE LANCET. SIR,—On perusing your valuable journal of the 3rd of June, I was much struck with the letter of " Mediculus," in defence of the practice of grinding for the examination at Apotheca- ries’ Hall. As I, also, like Mediculus, have passed the above ordeal, without having recourse to means so humiliat- ing and unnecessary, perhaps you will be kind enough to allow me a brief trespass upon your pages, in refutation of his argu- ments, and in deprecation of so degrading, so pernicious, a system. Mediculus says, " It is not a refuge for the destitute; for that many hard-working men, and a credit to any school, grind to secure themselves against a pluck." Now, Sir, this assertion I utterly deny. I have known, and been intimately acquainted with, very many of my late fellow-students, and cannot recollect a single instance of one being plucked (either at the College or Hall) who, possessing ordinary talent and energy, had made a proper use of his time during the three years allotted to him. It is absurd to suppose the examiners expect professors of medicine or surgery in the candidates who come before them, or that they insist on their being intimately conversant with the minutiæ of natural science. If it were absolutely necessary, as Mediculus contends, to learn to answer certain questions in a certain manner, I would ask how it is so many get through their examinations satis- factorily, who have never ground, (himself, for instance,) and who, consequently, according to Mediculus, could not have possessed this essential knowledge ? Mediculus goes on to state, as an additional argument in favour of grinding, that the candidate is expected to entertain certain opinions respecting professional and other topics: and he instances Narcotine, the Newtonian hypothesis of light, &c. I cannot agree with Mediculus in this. It is evident to me, both from the experience of my own examination, and from what I have heard, that on all points upon which authors are at issue, the examiners only wish the candidate to be conversant with the chief theories that have been broached, without caring much to which of these his own opinion in- clines. Mediculus lastly complains, that students are often ques- tioned respecting the construction of a steam-engine, or a pump; hinting that it is necessary to grind in order to acquire such information. In answer to this, I would ask Mediculus, or, indeed, any one possessed of common-sense, if he considers a person competent for the practice of medicine who is not acquainted with, and cannot explain, the simple principles on which depend the phenomena presented to us in our daily life ! The object of the examiners in putting these apparently irrelevant questions is, I think, self-evident, to test the general knowledge and education of the candidate, from which they may draw a just conclusion as to his professional capabilities. Mediculus contends the fault producing this rottenness in the system of medical examinations to be with the examiners, and not with the student. My firm conviction is, that it lies with the latter alone; and I would encourage all such as have yet to pass the Rubicon, to lay aside all foolish fears, to do their duty as students of one of the most ennobling of profes- sions, and they are certain of success. The system of grinding, Sir, is trebly pernicious. It is in- jurious to the student, for, buoyed up with the assurance of his fellows, that with six months’ grinding he can get through at any time, a vast proportion of time that should be devoted to the acquisition of knowledge is otherwise and ruinously employed-opportunities are neglected that may never more present themselves. It is injurious to the examining boards, inasmuch as it tends to lower the estimation in which their licensing diplomas should be held in the eyes of the public. Lastly, though not leastly, it is injurious and destructive to the public, as it admits into the ranks of the profession men wholly unfit for its practice; men who will always be wavering
