657

THE LANCET.

LONDON: SATURDAY, JUNE 17, 1865.

THE SYSTEM OF EXAMINATIONS AT THE COLLEGE OF SURGEONS.

’ EXAMINATIONS differ widely : in the work and qualifica-tons of the examiners; in the views and motives of aspirantsor the office; in the main end and aim of the test itself. In

regard to the latter, the difference is such that it may be ex-

pressed by saying that some examinations are conducted tofind out how much, and others how little, a man knows." "

Such are the opinions of one of the acutest thinkers of the

present day-Professor OWEN,-as reported in our journal oflast week; and taking them as our text, we would supplementhis important remarks upon the examinations at the Collegeof Surgeons with a few details with which the majority ofour readers are probably unacquainted, and which are of espe-cial interest at the present moment, when the election of newCouncillors is rapidly approaching.To the older universities, to whom Professor OwErr awarded

a just meed of praise, we would add the University of Londonand the College of Physicians as meriting high positions fromthe manner in which their examinations are conducted. Let

us inquire, however, a little more particularly how the exami-nations of the College of Surgeons are managed.In the "good old days," which we believe the College

authorities look back upon with fond regret, the whole exami-nation for the diploma lasted but one hour ; and as there werefour "tables" going at once, twelve or even sixteen memberswere turned out of hand in an evening, to the great advantageof the funds of the College generally, and the pockets of theexaminers in particular. In process of years, however, thescandal of this mode of proceeding became too great; andowing to the movement of members of the Council, ratherthan the Board of Examiners, which more suo was obstruc-tive to the last, a newregimewas introduced: the examinationwas divided into two parts, and became partly written andpartly by vivtt-voce demonstration and examination.The division of the examination into two parts- one in Ana-

tomy and Physiology, to be passed at the end of the secondwinter, and the final one in Pathology, Surgical Anatomy, andSurgery, at the end of the third winter, -although beneficial insome respects to the student, has been to some extent disad-

vantageous to the young practitioner for the following reasons.After satisfactorily passing the first examination, the studentmay, and does, dismiss from his mind all the anatomical and

physiological facts which he had accumulated, and which helearns from his friends will be of no service to him at the final

examination; which, though said to include Surgical Anatomy,does nothing of the kind in reality, since very rarely is a ques-tion upon that part of the subject asked, and never is there

any opportunity afforded him of proving his knowledge byoperating on the dead body. Hence it follows that newly-fledged members of the College are more ignorant of SurgicalAnatomy than in former days, when Anatomy formed one ofthe subjects of the final examination ; and this is proved by

the experience of the Army and Navy Examining Boards,which are constantly obliged to reject for the public servicesmen who have but recently received their diplomas.The examiners in Surgery to the University of London and

the College of Physicians think it advisable to test the know-

ledge of candidates by taking them to the bedside, by requiringthem to apply surgical apparatus, and to explain specimensand casts, in addition to paper and viz«-voce examination; but

nothing of the kind is done at the College of Surgeons, if weexcept the occasional production of a few stock specimens., With regard to the paper examination there is this unsatis-

factory point, that the same questions are so constantly re-peated that it is possible to predicate with tolerable certaintywhat will be asked. This, it may be said, is almost unavoid-able with such frequently recurring examinations. But a moreserious matter is, that there is no definite standard of excel-lence maintained; the papers at one time being absurdly easy,and at another containing questions which require considerableinformation for their solution. Again, with so large a Courtof Examiners as exists at this College, it is not considered

necessary that the papers of each candidate should be sub-

mitted to the whole Court, but two examiners only reportupon each paper. With such an arrangement, where neces-

sarily the estimation of the value of the answers by the dif-ferent examiners must vary considerably, it would have been

expected that a system of "marks," such as obtains at everyother pass or prize examination with which we are acquainted,would have been enforced as a matter of necessity; but so farfrom this being the case, the absurd system of classifying thepapers arbitrarily as "good," "middling, "or "bad," is fol-

lowed. Now anyone who has had any experience in lookingover examination papers must know how difficult it is to esti-

mate a paper except by carefully allotting marks to each ques-tion, and that under any other system one’s mind is unavoid-

ably biased by the last answer. Under these circumstances it

is obvious that the -,t-,2-itte?b part of the examination at the

College affords no proper test of a candidate’s information;and we shall be able to show, on another occasion, that thevivcl-voce portion is not more satisfactory.The whole system of examination for both the membership

and the fellowship of the College is a subject which we com-mend to the attention of the elective Councillors, since to themwe must look for any measures of reform.

THE near approach of a general election has a specialinterest for the members of the medical profession. It is

scarcely necessary to retrace the medical history of the presentParliament. A series of abortive attempts at legislation, arepetition of acts of petty injustice, and a general disregard ofthe interests of medical practitioners as a class of professionalmen having substantial claims on State recognition, have beenillustrated by examples too many and too recent to requirefurther comment. That medical debating society, known asthe General Medical Council, has simply proved a failure.

Regarding the Medical Council as occupying a position some-what similar to that of King Log, neither a source of con-

fidence to its friends nor of fear to its enemies, the medicalprofession is bound in self-defence to exercise a discretion inaffording support to candidates at the coming political struggle.Medical practitioners throughout the country are neither few

658 SAFETY FOR THE MILLION.

nor insignificant. We believe that by a proper exercise of theinfluence they possess they will be enabled to elicit from camli-dates such pledges as may not be unreasonably exacted, so thatwhen medical matters are under discussion they may, at least, Imeet with the attention the interests of so large a number ofthe electing community demand. It must ever be borne in

mind, that to the good sense of Parliament in general, ratherthan to the proceedings of any council, must the medical

profession look for the vindication of its position. Let

then this general determination be carried out, of pro-

moting the interests of candidates favourably disposedtowards our profession. We are glad to perceive that ithere are many members of the medical profession themselves Iaspiring to the distinction of a seat in Parliament. A word to !othose who do so. The duties of Parliamentary life, if con-scientiously discharged, involve much physical and mentalwear and tear. Those who are often seen and seldom heard

may be said to constitute by far the most valuable members ofthat deliberative assembly to whom is entrusted both the

public and the private legislation of the country. To be ’’ a

good working member" is to enjoy a reputation for conscientiousdischarge of duty and persistent integrity of purpose. This

involves a close application to routine duties inconsistent withthe active exerciseof other avocations. From these duties

members of the legal profession are generally excused, and sothe practice of their profession proceeds paxi pa88it «vith their

Iparliamentary career, and constitutes a kind of political educa-tion that enables them to exert a certain influence in debate.

In common justice a 1>ractising physician would be entitled toa similar exemption, and no doubt, if claimed, it would be

granted. There are throughout the country many medical menof the largest intelligence and capacity, who would gladly availthemselves of their local influence to get returned did their pro-fessional duties permit. It is not, however, to such that wenow address ourselves. There are medical practitioners whohave realized independence, and retired from the more onerousduties of their calling, who, with vast experience of all things z,affecting the interests of a profession to which they owe much, Imight not unworthily aspire to the representation of those itowns or boroughs in which they have achieved success. We ’’,know of many who, in the full maturity of intellect, and the !,enjoyment of adequate means, are admirably fitted for par-liamentary life. We trust that the coming election will see ’,some such offer themselves. The presence of even a few mem-

bers in the House who could speak from personal experienceon questions of a social or medical character, would not fail tobe productive of much practical good. The House of Com-

mons requires but to be well-informed to act. As it is at

present constituted it must trust to the acquired knowledge ofmembers, not unfrequently most imperfectly acquainted withthe subjects they discuss. We desire to see this state of

things cease, and commend these suggestions to the seriousconsideration, of the medical profession.

4- -

PUBLIC attention is now painfully aroused to the questionai railway accidents and their prevention. The recent occur-

rence of most lamentable misadventures ill rapid succession,clisclosing the circumstances under which railway travelling iscarried on, of necessity fills the minds of men with fear and

apprehension. It is ill vain that coroners juries return

criminatory verdicts, that actions at law result in .hstantial

damages, that dividends are unpaid, and the publie;errified,if such results do not eventuate in that precautu whichprudent men might not unreasonably be expected to xercisewhen human life is the priceless treasure committed) theirkeeping. Railway lines, like all other lines of road, Squirerepair. It is worth while to inquire into the circumstnces

under which such repair is attempted to be completed. Inthe intervals between the hours of transit of the several trins

defective lengths of rail are removed and new ones sb-

stituted. It may be, if caution and sound judgment are ex(:>.

cised, that the time allowed for such repair will prove sufl.cient, and the coming train find the renovated portion of Innall the safer for the changes perfected ; or it may be, as inthe case of two, at least, of the late accidents, that the

coming train iinds the line in a condition available for transitat a slow and careful rate of progression, but totally unfit forthe purposes of ordinary speed. Either the plates are notthoroughly settled, the rails not tightly pinned home, or thecondition of the work is so generally incomplete, that when theweight of the engine presses on the further extremity of a railits other end becomes tilted up; a sudden obstacle is therebyopposed to the following carriages, the couplings snap, and, asnot unusually happens, the engine goes on in safety, while the

carriages, diverted from their onward course by the shock, atonce overturn or run down the embankment. This seems

to be the mechanical explanation cf the aitar, and points sto a condition of things quite capable of being avoided, if therule be stringently adhered to, that every portion of a lineunder repair be made the object of special supervision by someofneer of the company particularly responsible for its safety.The course adopted seems to have been to let one ofthe plate-layers act, as it were, as foreman; he, through an

imperfect estimate of the difficulties of his position and itsdangers, has not unfrequently trusted to chance. It may be

that chance favours his rashness, and a train passes in safetyover a line altogether unfit for the purposes of traffic, whilstthose travelling remain in ignorance of their narrow escapefrom danger; or, as in the most recent of the calamities now

causing grief to mr.ny, the rails prove unequal to the duty im-posed upon c;hem, and destruction of life and property follows

through "accidents " caused by inexperience, ading with thebest 131tCI1tZGn.

It is very fearful to reflect how entirely dependent thosewho travel on railways are upon the exact performance of

apparently insignificant duties : a signal improperly shown, awire untimely drawn, a point not regularly kept, a break notpromptly applied, may each lead to a calamity the nature andextent of which it is impossible to estimate. Add to these thesources of danger dependent on the condition of the so-calledpermanent way. A slight deviation from the regularity of thegauge invests a. trifling impedimcnt on the surface of the railwith an importance in the ratio of the speed, and thus whatto the casua 1 obscrver would appear altogether inadequate toproduce a fatality, is rendered a source of incalculable mischief.The locomotives also are far from being free from special sourcesof danger : the loosening of the tire of a wheel, an inflexion ofthe axis 01’ a carriage, the breaking of a connecting chain,may be regarded as the more prominent causes to which acci-dents are attributable. A close scrutiny generally, .however,leads to the conclusion that "trifles" have eventuated in the

659

greatest results. Such trifles are generally committed to thecare of the humbler employés of the company. Of these em-

ployes we would speak. We may refer to the Report of THELANCET Commission on Railway Travelling for the proof thatin many instances they are overworked; their hours of re-

curring examinations of the lines and locomotives are too

protracted ; habits of caution are laid aside, as customarysafety seems to preargue an absence of danger; a cessationof the necessary vigilance takes place, and immediately a catas-trophe follows. On such occasions the character of the official

is advanced as an argument against negligence, not the lesscertainly fatal because attributable to one to whom it maybe ascribed as a first offence. The different railway companiesmust take counsel on this matter. So long as the exigenciesof the age require travelling to be accomplished at extraordinaryspeed and unusual risks to be encountered, so long ought ex-traordinary precautions to be observed. We would fain hear

of a more efficient inspection of signal-stations, pointsmen,and plate-layers than that which appears to have been hithertoexercised. Public duty ought to direct that which personalinterest seems inadequate to secure-safety in travelling. Rail-

way companies possess a monopoly greater than that hithertopermitted in the history of our country. It rests with their

directors to say whether that monopoly is to become the occa-sion of public misfortune without individual responsibility.We desire not to treat this matter in a commercial spirit.Surely the mangled remains of confiding travellers requiresome further atonement than a mere money recompense.

Medical Annotations.

COUNCILLORS FOR THE COLLEGE OF SURGEONS.

11 Ne quid nimis."

WE may congratulate the fellows that they will have a listof candidates for the vacant seats at the Council which willleave them little difficulty in the selection, and will at oncesatisfy men of all schools and of all parties. The two gentle-men to whom we pointed last week as standing prominently onthe list as the proper candidates on this occasion, Mr. Pagetand Mr. Prescott Hewett, have both sent in their papers.With Mr. Turner as representing the country fellows, Mr.Paget and Mr. Prescott Hewett, there will be little difficultyexperienced in voting to fill the three seats. These fellows areat once acceptable by their scientific claims, by their profes-sional eminence, by their position of comparative seniority, andby the accordance of their political views with those which wetake to be the present opinions of the great body of the electors.The three questions which have to be decided at the Councilare—1st. Shall the country fellows have proxies ? 2nd. Shallthe Court of Examiners be reconstituted, so that the appoint-ments be only for a term of years, only a certain small numberbe members of the Council, and the scientific examiners (inanatomy, physiology, and pathology) be chosen at large fromamongst the younger men of science ? 3rd. Shall the proceed-ings of the Council be published to the fellows and members ?To these questions the fellows say heartily "Aye !" and so doMessrs. Turner, Paget, and Hewett.

Other fellows, with equally liberal views, have been nomi-nated-notably Mr. Alexander Ure, Mr. Charles Hawkins, andMr. Barnard Holt. Mr. Holt, being the junior of all the can-didates, and in the belief that those above named will supportthe programme of the liberal party, has withdrawn, and pro-bably others -will do the same.

UNIVERSITY OF CAMBRIDGE.

A STEP in the right direction, and one of especial advantageto the medical student, has just been taken by this University.Hitherto the ordinary Bachelor of Arts degree could only beobtained by study and examinations in general subjects andclassics, mathematics, &c.; and this necessitated more or lessattention to those subjects during the three years’ residencein Cambridge, whatever might be the caste or future inten-tions of the student. It was, moreover, to some extent basedon the assumption that those subjects, and those only, wereappropriate and requisite for the education of a gentleman.That idea, however, is gradually being dispelled from ourschools and universities. The light of other sciences is beam-ing upon them. Though classics and mathematics are still

regarded, and rightly, as essential elements in education, and asforming the basis for early mental training; yet education-we mean primary or general education, the school and uni-versity education ; in short, the education of a gentleman--can-not be regarded as at all complete unless there be superaddedto this basis some knowledge of the laws by which we live andmove and have our being-some idea of natural existence. Atany rate it is felt that such knowledge ought not to be ex-cluded from a university course. Already the avenue to adegree in honours has been opened through Natural Science ;but it requires much reading, and rather a high order of

knowledge, to obtain a place in the Natural Science Tripos, andonly the more diligent and accomplished students take thispath. Henceforth the ordinary degree also will be obtainableby the same route ; that is to say, upon passing two pre-liminary examinations in classics and mathematics, whereby afair acquaintance with them is ensured, the student mayselect for his final subject some branch of Natural Science-chemistry, geology, botany, or zoology, and, having passed anexamination in it, will be admitted to his degree. This, weneed scarcely say, will be a great boon to medical students,who will be able, during the latter part of their time at Cam.bridge, to pursue without let or hindrance some of thosebranches of Natural Science which form the proper pre-liminaries to special medical science. By the pursuit of thesethey will be able to obtain the Bachelor of Arts degree at theend of their third year ; and they can, if they please, sub-sequently go in for the honour examinations in the same

subjects and so obtain a place in the Natural Sciences Tripos.That, however, is not to our present point. All we wish is tonote this wise additional concession on the part of the Uni-versity to Natural Science, and to the growing feeling whichranks it as one of the recognised elements of general edu-cation ; also, further, to point out that this plan of theUniversity is in accordance with the view which would make acourse of Natural Science a preliminary to special medicaleducation.

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MEDICAL INSPECTION OF WORKHOUSE HOSPITALS.

THE appointment of Dr. Edward Smith, F.R.S., as an in-spector of the Poor-law Board has for many reasons provedsatisfactory both to the public and to the profession. It

is sufficiently evident, as a simply theoretical proposition,that in the care of an immense population of infirm and

sick persons, questions must constantly arise requiring me-dical experience and hospital insight for their proper dis-cussion. It is equally evident that the inspection of infir-maries, with their patients’ dietaries, nursing, medicines, andmedical tendance, involves a great many considerations towhich non-professional men are strangers ; and while, on theone hand, it is very easy for a medical man to acquire all theadministrative knowledge and skill necessary for such dutiesif only he possess the desirable temperament and capacity, itis, on the contrary, very difficult, nay impossible, for a laymanto conduct such duties in an equally satisfactory manner with-