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MEDICAL DEGREES FOR LONDON STUDENTS.

A SPECIAL general meeting of the Metropolitan CountiesBranch of the British Medical Association was held at thE

Royal School of Mines on the 31st ult., Dr. Walter DicksonPresident of the Branch, in the chair. The attendance was

fairly numerous.The CHAIRMAN, in opening the proceedings, recapitulated

the steps taken by the Branch since its meeting on March 6th1885, to carry out the resolutions then passed. He said thatupon the question of giving facilities to London studentsfor medical degrees depended the future welfare and

prosperity of London as a school of medicine; and he re-minded the meeting that the question was raised in theBranch in 1879, in which year also Dr. Bristowe addressed aletter to the Chancellor of the University of London uponthe need for reducing the stringency of the Matriculationand Preliminary Scientific Examinations. He referred tothe origin of the Medical Faculty of the Edinburgh Uni-versity by the united efforts of the Colleges of Physiciansand Surgeons of that city to furnish the first professors,and spoke of the great impetus given to that faculty whenMonro primus was appointed Professor of Anatomy in 1720.He also pointed out that as long ago as 1827 the proportion- of English students graduating in the Medical Faculty of theUniversity of Edinburgh was greater even than at present.But the unrivalled clinical opportunities of London de-manded that it should take a foremost place in medicaleducation.

Sir ANDREW CLARK, on rising to move the resolution, saidthat the question was a very grave one, that it was aboutto be taken up by the greatest Medical Association in theworld, and that it would not, therefore, in the end fail to becarried. In the statistical report compiled by Dr. GilbartSmith, and in Dr. Hickman’s pamphlet, the subject wasviewed so exhaustively as to leave little to be said. It is afact that the number of medical students in London issteadily decreasing, whereas in other parts of the countrythey are increasing. Why do they leave London for Edin-burgh ? Is it because the teaching is better or livingcheaper ? No, everything leads to this result: that aftertheir education they are examined by their teachers, and inthe end get a degree which is far more profitable than alicence to practise. This is the grievance, and it is a justone. The curriculum is equal, the examination is equal, theage is equal; but the result is an unequal symbol of.efficiency. In some senses it is a sentimental grievance,but not merely so, for it is also a real practical grievance,which affects medical men in England not only socially andmaterially, but even in their practice with their profes-sional brethren, for the holder of a degree is held inhigher estimation than the holder of the diplomas ofthe two Colleges. The grievance is widely and seriouslyfelt, and to such an extent that parents and guardians sendtheir children elsewhere than to London for their education.As there is no reason to believe that education in London isbelow that of Scotland, they had a right to claim that thosewho are trained here should obtain the symbol which shouldtestify as much as if they had been educated in Glasgow orEdinburgh. It must not be forgotten that medicine is an art,and must be learned by observation and work in the hospitalward. There is no medical school in the world where thereis such practical teaching and so much personal influence ofthe teacher upon the pupil as in London. There is no need todisparage Edinburgh; its success has rendered this impos-sible ; there are at least 2000 medical students there, and howis it possible to teach them otherwise than by lectures ? Andhow can any didactic teaching, however good, make a mana doctor? The University of London has done an enormouswork in raising medical education and giving a dignity tomedical degrees which they never had before; hut it has,committed one grave mistake in insisting upon a knowledgeof moral philosophy at the M.D. examination and rejectingin this subject some of those who were best in medicine. Hecharacterised this introduction of so vast a subject at the closeof a medical curriculum as a sham and as offering a premiumupon "cramming." They could not go to the University ofLondon to remedy this grievance, but there was a prospect that 1the two Colleges of Physicians and Surgeons might unite iand form a Teaching University, and thereby do a great service 1to society and the State. If rightly constituted ,with the in- (

troduction of an examination in preliminary science and of a i

third practical examination at the close, a university would beformed which would not only be venerable in age and catholicin its constitution, but which would be able to give strengthto the profession and fulfil better the work which is de-

, manded of the Colleges. He had been struck with the

, paucity of the objections to this scheme. It had been said,,

what is the good of founding a new university when there isalready one in London? But why. he asked in reply, isScotland, with its 3,000,000 or 4,000,000, to have four uni-versities, and London, with its 5,000,000, to have only one?Again, it was objected that students would be deprived ofculture and refinement. But culture is innate; it is that ina man which enables him to see, beneath the common thingswith which he deals, all that is pure, just, true, and good.There is no need for a university to bring this out; and if hefelt that the proposed scheme would deprive men of culturehe would oppose it. Sir Andrew concluded by moving," That negotiations with the University of London not

having led to the desired result, this meeting recommendsthat the Royal College of Physicians of London and theRoyal College of Surgeons of England be requested toendeavour to obtain power to grant degrees in Medicine."Mr. JONATHAN HUTCHINSON seconded the resolution, and

said that he had long ago advocated the union of the Colleges .and the granting of one general title to all general prac-titioners. One of these objects had already been attained,and no one who took a broad view of the interestsof the English profession could fail to support the otherquestion. It was absurd that there should be such a differ-ence in the matter of titles among men who are exactlyequal as to their professional attainments; and the existenceof these differences led to much heartburning and rivalry, aswell as confusion in the public mind. If such common titlewere conferred, it had been said that it would be unjust tothose who possess university degrees; but each degree-conferring body must stand on its own merits. Universitieswere originally local, and it is not consistent that meneducated in London should be sent to graduate at John-o’-Groats because in mediaeval times a university had beenfounded at John-o’-Groats. It was not at all unjust toexisting universities to create a new one. The difficultymight be surmounted by asking, not for a degree but for atitle, something which would not imply a " universityeducation"; indeed, it is absurd that the Colleges shouldask for powers to give a university degree upon a merelymedical curriculum. But the title "Doctor of Medicine"was different from the degree M.D., and the conferring ofsuch a title would work no injustice on the holders ofdegrees. If the title were granted to all who held thedouble qualification, there might be a little temporaryinjustice to those who had but one qualification; but, asa matter of fact, he had found that the senior practi-tioners were those who cared least for a change whichwas almost universally felt by the juniors as essen-

tial and necessary to success. The possession of a degree-granting monopoly by the universities had led to a degrada-tion of the university curriculum; for in many of the mostmeritorious universities a man may at once proceed toprofessional studies with no further evidence of generaleducation than the ability to pass his " little-go." Theonly restriction imposed bv a university was that thestudent must go "into residence"; but this, instead of agood, becomes an evil when it takes a student from hisclinical work in London just at the time when he will mostprofit by it. The examinations of the Colleges of Phy-sicians and Surgeons are equal to those of the universities;many have the same examiners; and, since the number ofexaminers was greater in London, the risks of injustice tocandidates were much lessened. He would not grant theitle to all licentiates, but only to those who, a year afterqualifying, should pass a purely practical examination,which need not be one whit stronger than the previousexamination, whilst it would encourage men to keep at

iospital work for another year.Dr. PYE-SMITH, as a graduate of London University,

;hanked Sir A. Clark for his liberal mention of it, but askedvhether it was correct to say that negotiations had failedvith the University, which was at present engaged in con-sidering questions of reform. It is important to distinguishbetween making an examination easier to pass and makingt easier to take degrees. The examinations of the LondonIniversity need not be diminished in severity, but it isuite possible to facilitate the taking of degrees-e.g., bymaking examinations more frequent, deviating from their

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strict order and in other ways. So that it is not hopeless torender the degrees of the London University more accessible;but if any benefit is to be gained from the University thestandard must not be lowered. He admitted the presentgrievance, but asked if from a certain date all students beadmitted to the title of Doctor or the degree of M.D., wouldnot great injustice be done to those who had taken theirdiplomas in the preceding years. If additions were made tothe present College curriculum for intending graduates, thegrievance would not be thoroughly remedied; and if, on theother hand, all London students were admitted it wouldmake the degree equivalent to a minimum qualification.Again, if the London Colleges gained the power to grantdegrees, the colleges in Edinburgh and elsewhere wouldobtain it also. For his own part, he felt that this universitytitle, which is of no meaning, should be put an end to, andwould be glad if the prefix " Dr." could be dropped bygraduates. After all, the most important question is un-touched by the resolution-he meant the status and educa-tion of London students. We are in want of university life inLondon. The prospect of founding a medical university isdelusive; but it is possible for existing institutions to com-bine and form a real useful university, which should notsimply exist to give degrees, but should widen and deepenthe training of students and raise the tone of the profession.Mr. MACNAMARA pointed out that it was not suggested

that every student should be granted a degree, but that theanomaly should be rectified whereby in Scotland 86 percent. of the medical students graduate, whereas in Englandonly 12 per cent. do so. No one would dream of asking thatpowers should be granted to confer degrees upon minimumterms. The branch had sent two deputations to the Uni-versity of London, but had had no response, and he wouldask how much longer they were to wait for it. The schemefor founding a Teaching University did not touch thisquestion. Our medical students find themselves practicallyshut out from degrees, or else they break off their careerin London in order to go elsewhere to obtain them. He hadnot heard any reasonable objections to the right being givento the Colleges of Physicians and Surgeons; and if theycould be got to unite for this purpose they might draw upa well-devised scheme to carry it into effect.Dr. W. J. COLLINS pointed out that the University of

London had already made reforms in the direction of thememorialists of last year. Two preliminary scientific exami-nations were now held annually; the scheme of Mr. Magnus,based on that of Lord Justice Fry, was in the direction ofincreasing the educational authorities in the Senate, andwas now passing through Convocation ; the subjectof Moral Philosophy at the M.D. had been replaced byMental Physiology. It seemed to him that the idealsketched in the Report of the Branch Council last year wasto reduce the London University to the plan of Edinburgh,in order to enable the majority of students to take medicaldegrees. The whole question was one of insufficient pre-liminary education, and he predicted that the naturaltendency of this movement would be a downward one.

Dr. HABERSHON said that one would think, from theremarks of Drs. Pye-Smith and Collins, that it was contem-plated to grant an insignificant degree, but this was not theirobject; on the contrary, it was hoped by this movement toraise the standard of education. The matriculation exami-nation of the University of London embraced so many sub-jects and such difficult questions that it encouraged cram;for no matter how well a student succeeded in one subject,if he failed in one he was rejected in all. The PreliminaryScientific Examination also tended to make the Londondegree an exclusive one, and the changes made by theUniversity did not meet this point. His late colleague, Dr.Mahomed, in order to obtain a degree which carried moreweight with it than the one he already held, was obliged totravel to Cambridge every night in order to "keep terms,"as if that would qualify him any the more for holding adegree for which he had a right. He did not think theexaminations for the M.R.C.S. and L.R.C.P. were insignifi-cant;. they were equal to those of a University; and if apreliminary examination were introduced, not inferior tothose of other Universities, their candidates might thenjustly demand a title not inferior to those obtained from aUniversity. He fully endorsed what had been said of thevalue of clinical work in London, and would not urge any-thing which tended to lower the standard of professionaleducation.

Dr. MOXON said that the arguments of Sir A. Clark had

not been met. The fact was that the degrees of the Universityof London were too stiff to be obtained by the majority ofstudents, and whatever changes might be made, there wouldnever be anything done to lower the degree. He did notthink Drs. Pye-Smith and Collins were in earnest in holdingthat if degrees are to be given on a large scale they must begiven in the very lowest standard. He felt that in this vastmetropolis, where many persons more or less distinguishedpractised and taught, they ought to have, not the smallest andmost dwindling of medical courses, but the largest and mostimportant. That lofty and honourable body, the Universityof London, must not refuse to allow others to do what it was

unwilling or unable to effect.Dr. WALTER SMITH, commenting upon the confusion that

existed whether a title or a degree should be asked for fromthe Colleges, advocated the formation of a Teaching Univer-sity, and moved an amendment to insert after the word" recommends," instead of the remainder of the resolution,.the words, "that steps be taken to found a Teaching Univer-sity for London."Mr. SWINFORD EDWARDS seconded the amendment.Dr. BROADBENT said that although the primary object

was to request the two Colleges to give degrees in medicine-and thus remove a serious grievance, yet beneath that therewas the other object of raising the culture of London medi--cal students. It would be one way of starting a TeachingUniversity; and already the Colleges possessed a site uponwhich they could found a great scientific institution. Fromthis movement all the advantages of a Teaching Universitywould be obtained; but to suppose that the scheme nowbefore the University of London would meet these wantswas trifling with intelligence.

Dr. SANSOM said that at the last meeting of Convocationthere was evidence, both on the part of Mr. Magnus andothers, that no opposition to this movement would comefrom the existing University.

Sir A. CLARK, in reply, said that Dr. Collins had no-

shadow of ground for his assertion that one of the issues ofthis movement would be a competition downwards to aminimum degree. The Colleges had progressed upwards inraising the standard of their examinations, and there was no,reason why they should go back. Drs. Pye-Smith andCollins would admit that the degree of the University ofEdinburgh is an honourable one; and he contended that theexaminations for the double qualification of the Collegeswere precisely equivalent to those of Edinburgh University,one difference being that in Edinburgh students are examinedby their own teachers. He satirised the substitution of’Psychology for Moral Philosophy at the M.D. examinationof the London University, and concluded by affirming that itwas the object of the promoters of this movement to make.

, Doctors of Medicine, and that their contention had not beengainsaid.The amendment was then put and lost, only the mover

, and seconder voting for it.The original resolution was then put and carried, witb

but one or two dissentients.

LUNATIC ASYLUMS, 1885.

No. II.

A VERY interesting report is sent in by the Superin-tendent of the Sussex County Asylum at Hayward’s Heath(Dr. Williams). He finds that the forms of admission accom-panying patients are often very imperfectly filled up, and thatin some cases they have been absolutely invalid, necessitatingthe refusal of admission to the patient until the form was.amended. " The imperfect filling up of these forms is avery serious matter: because, on the one hand, if the asylumauthorities admit and detain an alleged lunatic on an im-perfect order of admission, they may render themselves liableto an action for illegal imprisonment; whilst, on the otherhand, the delay caused in taking a patient back to have theimperfect order amended may be of the greatest harm tohim, besides causing endless worry to all concerned."

Dr. Campbell gives a sad tale of hopelessness for the inmatesof his asylum (Garlands). "At the present time," he says," there are only 16 males and 49 females out of the totalnumber of 850 in the asylum in whom there is the slightest