543

THE LANCET.

LONDON, SATURDAY, MAY 19, 1849.

THE FORTHCOMING MEDICAL BILL.—THE COLLEGE OF SURGEONS.

WE have no doubt that within a week after the Lord Advocate’sBill has been laid on the table of the House of Commons, the

profession will be in a state of intense excitement. We haveno wish to be the harbingers of evil tidings, but we cannotdisguise our fears that the coming Bill if it be anything morethan a simple Registration Bill, will be framed rather accordingto the wishes of the corporators than the wants and rights ofthe profession at large. In such a case, the opposition wouldspeedily reduce the Lord Advocate to the position of Sir IJAMES GRAHAM as a medical reformer, for in the present tem-

per of the profession no unfair Bill could pass through Par-liament. We shall be delighted if our apprehensions shouldprove unfounded. If, in consequence of the machinations ofthe corporations, a Bill, such as would be rejected by the pro-fessional masses, should be proposed, the next thing after ob-taining its expulsion will be to procure a Parliamentary Inquiryinto the past doings of the College of Physicians, the Collegeof Surgeons, and the Apothecaries’ Society; to show how

these bodies have performed their several duties -towards

the profession and the public, under the charters and

Acts of Parliament, by which they are constituted the

governing powers of the profession. If they have the rightto exert a great influence with the government on thescore of past good deeds, let those deeds be blazoned

forth to the world. If, on the other hand, it can be shownthat they have played false to every professional duty, let itbe seen that they have no right whatever to dictate the futurelegislation of the profession. If the medical-reform agitationis to continue, the real cause of its continuance-the selfish-ness of the corporators-must be directly attacked. Theymust be treated in the same way as the old municipal corpo-rations, as recommended in the Manchester and other memo-rials. When it has been shown that they have neglectedevery duty, and brought the profession of medicine to thelowest ebb; their right to a legislation entrusting them withall the vital interests of the professional body, will disappear.We can confidently say that no selfish or unfair Bill will be ac-cepted by the profession, and we need only point to the past toshow that after every year of deferred legislation, the demandsof the great bulk of the profession against the would-be privi-leged and governing few, increase. As we have already said, wehave grave fears respecting the embryo measure. We shallbe delighted to find that our anticipations are falsified by theevent; but we point out the results if they should be wellfounded. We implore the profession to hold itself ready toscan with careful eye, and with a determination to withstand

injustice to the utmost, the proposed measure, immediately onits promulgation.

AT the present moment, the College of Surgeons of Englandis an examining body, empowered to give certificates of

qualificative surgery, and to claim certain exemptions for itsmembers. Various Acts of Parliament also render it neces-

sary that candidates for certain offices shall be examined bythe College. But beyond this, the College of Surgeons hasno legal power whatever. It cannot force any individual to

join it if unwilling to do so ; it cannot prosecute any personfor practising surgery without its diploma. In this respect, itis very different from the College of Physicians, which isoverladen with ridiculous powers that have long disappeared.except from the parchments upon which they are written.The Yorkshire bone-setter has as much legal right to exercisehis calling as Sir BENJAMIN BRODIE or Mr. GUTHRIE. In the

eye of the law, the one is as good a surgeon as the others.We are not now approving of such a state of things, but merelynoting the fact. The College of Surgeons, for all purposesbut that of injuring its own members, is as helpless, in a legalpoint of view, as can well be conceived.Let us briefly examine what powers this body modestly

proposed to assume, according to the precious project foundedon those " Principles" which we have so often had occasionto reprobate with such severity.What the College will claim now that it has refused the

power of independent surgical examination to the inferior

College, remains to be seen; but it is not likely that its

demands will be more modest than they were last year. Ac-

cording to the " Principles" scheme, the College would acquirea governing power over the whole of the surgeons and thegeneral practitioners of the kingdom. The powers and num-

bers of the College of Physicians would be inconsiderable incomparison, and the elder College must inevitably take asecond-rate position. At the present time a man can pass theHall, and enter upon general practice, without having hadanything to do with the College of Surgeons. If his means or

his inclinations lead him to do so, he can become a generalmedical practitioner without a strictly surgical education.But under the proposed measure no such plan is possible.Every man, whether he engage in general or strictly surgicalpractice, must have passed an examination at the College ofSurgeons, and have paid toll to the College funds. He mustdo this in order to become the general practitioner in medi-cine, surgery, and midwifery. The College of Physicianshas nothing to do with the physic of the general practitioner1but the College of Surgeons will not allow his surgery so toslip through its fingers. In addition to this power over the

general practitioner, the College has its separate examinationsfor its fellows, who are, it is presumed, to be devoted to thepure surgery of the profession. Thus the College of Surgeonsbecomes the controller of the great mass of surgical andmedical practice throughout the country ! It will, if allowed,become the autocrat of the profession. But we have not

yet reached its limit. The fellows of the College of Sur-geons will receive a strictly surgical education, and be exa-mined in surgery alone; but under the proposed measure, theywill be allowed to practise as physicians, to consult in medicalcases, to take physicians’ fees, and in every respect but in

’ name to be physicians ! The encroachments of physicians and. general practitioners are carefully barred, but the pure sur-I geon may make what inroad he pleases upon the College of

Physicians, and the general practitioners, pharmacy only ex-cepted. We point out this fact, in contradistinction to the

l mode in which the rest of the profession will be bound, and bythis fact we stand-namely, that the fellow of the College of! Surgeons without education as a physician, without education-

as a general practitioner, may practise unrestrictedly in ollr branches of the profession. He is the only One-Faculty man.3 He alone may have family practice as a general practitioner,) attend medical cases in consultation as a physician, and per-

544 THE COLLEGE OF SURGEONS.-THE COLLEGE OF PHYSICIANS.form a purely surgical, or a strictly obstetric operation. In

fact, under the new Bill, the College of Surgeons would makeits Fellow the only omnivorous creature in the profession. Healone would be the true "general practitioner in Medicine,Surgery, and Midwifery." Not that we have any objection toOne-Faculty practice; but we have a very pressing objectionto the admission of a set of high castes into the profession,without any superior desert or qualification.Such were the ambitious views of the College of Surgeons,

so far as they can be gathered from the plain and obviousmeanings of those " Principles" which have been to a certainextent patronized by the College. The College will, if allowed,leave a finger-and a very considerable finger, too-in each ofthe three great branches of the profession. It will over-

Tide both the College of Physicians, and the ApothecariesSociety, or the Jalapian College, should the latter ever seethe light.We need not ask the ten thousand members of the College,

insulted and degraded by the new charter,-Mr. LAWRENCE’Sgeese, the poor-law people of Dr. GEORGE BupRows, in otherwords,—whether the past history of the College of Surgeonshas been such as to justify so large a measure of professional’con6dence as that which is now modestly sought? We aresure that there is no one of the London Corporations, whichthe general practitioner would not rather trust with his in-terests. It was disgust towards the College which producedthe National Association in 1841, and the same men are

actuated by the same feelings now. The country surgeons, thesurgeons in our great cities and towns, remember that theypassed precisely the same examination in surgery as thatpassed by those who now lord it over them as honorary fellows,:under the iniquitous charter, so iniquitously obtained. Theyremember that they were once as surgeons, the equals, by ex-amination and corporate rank, with ASTLEY COOPER, LISTON, andBRODIE, and that without any imputed fault they have beenput in an outer court, degraded into an inferior order, so far ascharter and honorary fellowship could degrade them. The

same spirit as that manifested in the charter is now, and hasbeen, constantly at work. Every succeeding regulation ofthe College relating to the fellowship has for its object towiden the distance between members and fellows. The ex-

.amination for the fellowship is made more and more orna-mental. Latin, Greek, and the Belles Lettres, are added to’the catlin and the trephine; while the examinations for the

membership are relaxed as far as possible.These facts have an unmistakable meaning. The aim and

the interests of the College is to degrade the surgeon ingeneral practice. The only thing belonging to him for which:the College cares is the fee, which it will still force him to

pay, and which contributes to the decoration of the fellows.It remains for a short time, and for a short time only, for the,general practitioners to show, by their acts, whether the un-reformed College in Lincoln’s-inn-fields shall rule over themas it is proposed. Already, both in Scotland and Ireland, the

general practitioners have refused the joint rule of the Collegesof Surgeons and an inferior College. It remains for the

thousands of surgeons in England and Wales to do the samething; but they must do it promptly, or a net, from whichthey and their children will not escape for the next half-eentury, will be thrown over them, and secured. If we maybe allowed to express the profound convictions of our heart,

there never was a time when all the odium of au inferiorcaste was so likely to be fixed indelibly upon the great bulkof the profession. Better they had never emergedfrom theirold rank as apothecaries—mere hangers-on of the physicians-than have now to sink back as dependents upon the Collegeof Surgeons. The lion were better than the wolf. Better

reject all medical reform than accept a reform, the chiefelement in which is, degradation to the general practitioner.The members of the Conference have made arrangements fora very pretty summit of fellows and old men for the medical

pyramid; but they have quite forgotten the base. It is for

the latter to protest against being thus ignobly made use of.The base must be cared for first, and then the summit; andthe present inversion of the proper order of things must be

destroyed. The Colleges were made for medical men, andnot medical men for the Colleges.

THERE are two clauses in the proposed Charter of the Col-lege of Physicians meriting the attention of all graduates ofmedicine in England and Wales, who are not licentiates ofthe College. We have referred to the nefarious plan of levy.ing black mail upon those who do not wish to belong to theCollege. We now proceed to show, that according to theliteral meaning of the Charter, something approaching to thenature of fraud is contemplated against the graduates thusforced into communion with the College. By a pretendedclause of grace, all graduates are admitted who have takentheir degrees before a certain date, and paid the fees de-manded. But it is proposed, as we now read the Charter,that members thus admitted are to form an inferior class, whocannot be admitted to the fellowship either by election orexamination. Previous examination, not mere admission intothe College, is to be made the condition, without which the fel-

lowship cannot be obtained. But we proceed to quote the sus.

picious clauses., Clause eight states-

" That every member who shall be admitted a member ofthe said corporation, as hereinbefore mentioned, who shall bedesirous of becoming a fellow of the said corporation, shall,after the expiration of one year from the time of his havingbeen examined for his licence to practise medicine, be capableof being elected a fellow thereof, provided he shall, in additionto the examination hereinbefore mentioned, at any time afterthe expiration of one year from that examination, have passedsuch further examination before the censors touching hisknowledge of medical and general science and literature, andcomplied with such other regulations as are or shall be re-quired by the by-laws of the said corporation."

It will be observed that great stress is laid upon the word 11 sex.amination ;" and as the graduates in medicine are to be admittedunder fine, without examination, they are clearly disqualifiedfor the examination for the fellowship.

Clause nine relates to the election of fellows, but nothingis said about the election of members admitted without ex.

amination. This election appears to be limited to those

already licentiates, and now eligible to the fellowship. The

following is the clause in question:-" That during the period of five years, to be computed from

the date of these our letters patent, every person who,according to the present regulations of the said corporationmight be elected a fellow thereof, shall be capable of beingelected a fellow thereof on the terms on which he would havebeen entitled to be elected a fellow thereof if this charter hadnot been granted."

This clause clearly refers solely to those who may be mem-

545

bers at the time of the granting of the Charter. Takingthese two clauses into consideration, together with the rest ofthe Charter, it is evident that the College of Physicians con-template putting upwards of one thousand of the provincialphysicians into a lower grade, without any possibility of reach-ing the fellowship either by election or selection, except bybeginning their education de novo, and re-entering the Collegeas licentiates by examination, after their pretended admission.We fancy that this cunning device on the part of the College,for it deserves no other term, will not render the great body ofprovincial physicians more in love than they are at presentwith the proposed charter of the College of Physicians.

THE present state of the Medical Bill is as follows:-It wasunderstood that the Lord Advocate would bring forward noBill which did not meet the approval of the several parties tothe " Principles," and that before bringing in his Bill it shouldbe submitted to all the parties to the Conference. At this

moment the Council of the College of Surgeons is not a partyto the "Principles," and it has not had any Bill laid before it

for approval. Yet the Lord Advocate stated, ten days ago, inthe House, that he hoped his Bill would be ready in eight orten days. So that, these being the facts, the Lord Advocatemust either bring in a Bill without the concurrence of theparties to the Conference,-and certainly without the approvalof the profession,-or he will have to defer his Bill to a lateperiod of the session. A few days will decide the matter.The Institute is, we hear, busy in endeavouring to arrange asham surgical examination, since the College of Surgeons hasrefused them the real one: but this will not impose upon theprofession.

Correspondence."Audi alteram partem."

A CURIOUS ALLIANCE.To the Editor of THE LANCET.

SIR,-Inclosed I send for your perusal a copy of the Ken-nington District Visiting Society’s Report for the year 1848,as distributed in St. Mark’s Church a fortnight since. One

- paragraph in it cannot fail to arrest your attention-viz." The item of medical tickets forms no part of the Visiting

Society’s expenditure of the past year. This arises from thegreat kindness of Wintour Harris, Esq., in presenting eachvisitor, at each monthly meeting, with a ticket, insuring tothe poor medicine and attendance for a month. Similar ticketsmay be purchased by the poor themselves for 2s. 6d., at Mr.Easter’s, 11, Upper Dorset-place, Clapham-road. During thelast year, ninety-five such tickets were purchased of Mr.Easter, by poor persons, who were anxious to avoid the receiptof parish assistance."

Here, apparently, we have the melancholy example of aprofessional man, and consequently a gentleman, stooping tothe ignoble plan of selling tickets for medical attendance,through the agency of an undertaker. These tickets, chargedhalf-a-crown each, entitle the holder to medicines and attend-ance during the space of one month.

I feel sure, Sir, you must blush for our recreant profession,as the above is but one out of many instances which daily fall1rnder your notice.

Let Wintour Harris, Esq., if he wishes to be charitable, becharitable in the full acceptation of the term; and show theworld, by his gratuitous services to those who are unable toremunerate him, that he possesses the true spirit of philan-thropy, unbiassed by unworthy motives, and uninfluenced bygain.-I am, Sir, yours &c., ME1VIORABILIA.

SUICIDE BY A NAVAL ASSISTANT-SURGEON.To the Editor of THE LANCET.

SIR,-The melancholy death of Mr. John Acton, an assistant-surgeon of the royal navy, as recently recorded in the dail3

press, should arrest the attention of the legislature, the wholemedical profession, and the public generally, to an impartial’inquiry into the present degrading and heartless treatment ofthe junior naval medical officers, and to a determination, onfinding their grievances real, and their claims based in justice,to obtain an alteration of the existing system pursued towardsthese gentlemen by the board of Admiralty.John Acton in appearance was upwards of thirty years of

age; he was a steady, intelligent, and talented officer, and anauthor. He had served twice on the coast of Africa, fromwhence he had recently returned in her Majesty’s brig" Siren." No wonder, that after nine years of humiliation ina midshipman’s berth-after the enervating effects of longservitude on the tropical and fever-stricken coast of Africa-and after, on his return home, instead of finding promotion ashis reward, meeting only disappointment, and the prospect offurther service on "the coast"-no wonder, that with spiritsbroken, with a constitution shattered, and with the paltryhalf-pay of three shillings per day, in a fit of insanity histermination was suicide, and for which the Admiralty isresponsible.On reading this melancholy case, our attention is directed

to the fact of two naval assistant-surgeons falling by theirown hands within the last two years, and under very similarcircumstances. Mr. Thomas Hart was the first; he was up-wards of thirty years of age, had recently returned fromforeign service, and was disappointed of promotion. Fromboth these gentlemen hope had vanished, and the samegloomy path which they had so long pursued was alone opento them. The next circumstance which attracts attention, isthe occurrence of the suicide of two naval assistant-surgeonsabout the periods when, in reply to the representation of thegrievances and claims of these gentlemen, two Admiraltylords, the sapient representatives of Greenwich and Glou-cester, are pleased to say "they are well treated." "Mylords" may assert that assistant-surgeons " are well treated,"but whatever that treatment may appear to the callous andprejudiced optics of Captain Berkeley and Admiral Dundas,it is such; and a something so cruelly degrading and repul-sive, as to drive some of these officers to insanity and self-destruction, others to a more tardy termination by deliriumtremens, and many to habitual intoxication.What would have prevented Thomas Hart and John Acton

terminating as they have, and what have naval assistant-sur-geons been so long and anxiously agitating for by every legiti-mate means 1 The same things-a cabin, a servant, a seat atthe lieutenant’s table, and a suitable uniform, and that bonafide rank with their army brethren which was given them bythe spirit of an order in council nearly fifty years ago. IfHart and Acton had been ward-room officers, they wouldnever have fallen by their own hands, but it was the idea, attheir age, of again returning to a midshipman’s berth, toassist in rearing a third or fourth Exoneration of vounsr navalheroes, their first, and perhaps their second class of pupilsbeing now raised to the ward-room, which led them to theiruntimely end.The case of naval assistant-surgeons is one of real hardship

and urgency, and we trust Mr. Wakley will shortly bring itbefore those impartial judges where it will be equitably triedand settled. I am, Sir, your obedient servant,

April, 1849. AN ASSISTANT-SURGEON, R.N.

ON A SUMMARY PROCESS BY THE SOCIETY OFAPOTHECARIES.To the Editor of THE LANCET.

SI*R,—In a late number of your journal, I perceive there isan article headed " Summary Process by the Society ofApothecaries," consisting of two or three letters addressed tothe Society by a person signing himself John Brown, LowerIslington," as well as one to yourself, expressing his approba-tion of the promptitude with which the Society have acted inthis case, in consequence, as he supposes, of his letters tothem; but whether it were so or otherwise, is a matter withwhich I do not think it necessary to trouble you, and I onlyrefer to it to let Mr. John Brown, of Lower Islington, know,that however gratifying it may be to him to think he has in-creased the difficulties of a member of the same profession ashimself in the educating and bringing up of a large family, Ihave no complaint to make against the managers of thatSociety.Now, Sir, for his letters. In the first, I am accused of bla-

zoning forth my spurious pretensions to professional skill, bythe use of the words Apothecaries’ Hall over my door, andmy ceaseless iteration of being officially connected with the