843

THE LANCET.

London, Saturday, September 2, 1837.

THE CERTIFICATE SYSTEM.

THE senate of the new metropolitan uni-versity—the University of London-is now,in all prohability, employed in preparingthe curriculum of studies to be pursued bysuch students as may desire to present them-selves for examination before the members

of that institution. The publication of thisordinance, and particularly of that portionof it which must relate to medical educa-

tion, cannot be delayed for any lengthenedperiod. Indeed, the plan of the gentlemenwho compose the senate must now be nearlymatured, and its appearance is anxiouslyawaited by all the members of our pro-fession. This curriculum ought to form the

: commencement of a new era in the history ofeducation in this country. We have suffered

severely under the monstrous abuses whichhave prevailed in our old and aristocratic

institutions, and we earnestly hope that

the new university, the ofrspring of Reform,true to the principles which gave it birth,will, at once, adopt a large and liberal planof medical education, rejecting the sordidand absurd restrictions which abound in the

system so pertinaciously adhered to by its

predecessors. The rejection of this essen-tial principle of its existence, the very firstattempt to countenance any one of the abuseswhich have hitherto encumbered science

and repressed the genius of our youth inthis country, will prove an act of self-de-struction to the new institution.

Without intending, on, the present occa-sion, to pass in review the entire system ofmedical education, or to expose to view thewhole of those errors in legislation whichthe senate of the London University is called

upon to avoid, we shall enter, at some

length, on the most prominent points of

consideration in discussing this subject,dividing them under three heads, namely,lhe complete abolitiou of the certificate-sys-

tem ; the expediency of conducting all exa- minations for medical degrees in public,and the necessity of making all such exa-minations strictly practical in their nature.

The gross dishonesty and hideousness of thecertificate-system do not supply us withnew topics of debate, but the individuals towhom it is a source of profit, cling withsuch tenacity to this fountain of emolu-

ment, this means of aggrandizement for

themselves, and of mental and pecuniarydespoliation of their pupils, that we returnto the charge with freshness and vigour, forthe recovery of such an instrument of avarice

and mischief from the hands of the monopo-lists. Time, in such a contest, increasesin utility the warfare which it despoils of

novelty.We have said that the certificate-system

is a fraud, unblushingly imposed upon the

acquisition of knowledge. It is rendered

a double fraud by its inventors and sup-porters. Not content with throwing everyobstacle in the path of the student whichcan be there heaped-that path being Z3 al-ready of itself sufficiently difficult and pain-ful--these robbers presume to dictate to

the student the precise spot on which heshall expend his time in obtaining instruc-

tion, and then, in that convenient place for

plunder, sell to him an adulterated articleat a most exorbitant price! The absurdi-

ties with which the system abounds are

thus fully equalled by the injuries which itinflicts. Nothing can be plainer than this tothe senses of disinterested observers. Know-’

ledge, being a mental acquirement, indepen.dent of all fashion, and, like the mind itself,’incorruptible, may be obtained with equaladvantage, at all times, and in all places,provided a fair opportunity of acquiring itexist. Knowledge is not a coat with which

any fool may invest himself, provided thegarment be made by the court tailor.

Knowledge will not spoil during its con-

veyance from one part of the kingdom toanother. Some of the brightest ornamentsof science have ever laboured in seclusion,and produced their discoveries far from the

844 PUBLIC EXAMINATIONS FOR

ravenous haunts of those plundering certifi

catc-mongers who would persuade us thalight can only emanate from their own fou

lamps and dull windows. It is an intolera

ble presumption in any set of men (andwhat a set!) to announce that all truths

are valueless that do not proceed from

certain oracles which, with a mock so.

lemnity that inflates whatever is empty and

flimsy, are labelled and inscribed "Recog-" nised Lecturers." To those Gamaliels,saythey, you must " pay all that is demanded ;‘° be not anxious about the doctrines which

they teach, and the facts they may dis-close; simply behave with decorum in" their presence for four years, and then

" obtain from them, in exchange for your" money and time, certificates of the ex-

" penditure of both, and we will admit you" to examination before our Court,-a con-" cession which will be granted on no otherterms. It is useless to urge the fact that

one of you may obtain a competent know-

’’ ledge of medicine in half the time that

" another, a less gifted individual, will oc-" cupy in acquiring some vague notions

" of the science. A may make himself mas-

" ter of mathematics in a few months, while" B cannot get beyond the yons asinorum in" as many years ; still, it is a principle of" the old and venerated institutions of this

" country, to compel both of these men

" previously to pass an equal number of

" years in the study of mathematics," and that principle must be upheld, or the" fountains of knowledge will be dried

" up altogether,-or, at any rate, the

" poor and needy will, by study and exer-

" tion, take honour and profit from the rich" and well-born, whose especial interests it" is the duty of all well-wishers of the

" country and its glorious constitution to

’ protect." Thus the youth of small meansis kept in his "proper station," and theson of the wealthy man is provided witha profession, and a means of emolument

equal to a high condition of life, whilethe leeches who are employed in suckinghim, are odiously entitled and regarded as

. a part and parcel of the " ancient and ve-t " nerable institutions of the country;" andI are enriched by frauds on the pocket, and

. impositions on common sense, while medicalt science, like a cabbage-stalk in a garden, is; fixed to the soil, and rendered one of thei meanest objects in creation.

And this is especially the plan which isenforced against medicine! the first and

worthiest of the sciences. Nothing analo,gous to the monstrous scheme is to be found

in the history of any other of the sciences,or discovered in the proceedings of anyother of our corporate bodies, bad as aretheir arrangements. Take, for example, theUniversities; what might the public be ex-pected to say of either of the Colleges at

Cambridge and Oxford, were they to an-

nounce " that they would admit no student" to pass his entrance examination unless

he brought proof of having been educated" at Eaton or at Harrow, at King’s College" or at Winchester?" Or, if the authoritiesdeferred testing his actual attainments in thedead languages or in mathematics until theyhad become assured that such attainments

could be alleged to have been acquired atcertain favoured institutions in Wales?

What would be the immediate ellect of such

a law, were the authorities of the abovenamed Colleges to enact it? Unquestion-ably to confera monopoly of education uponthe preparatory schools which we have

named. Yet the authors of the certificate

system have the boldness to tell us that theyare actuated in their proceedings solely bya desire to promote the public good, andthat the measures which they adopt haveno tendency whatever to the creation of a

monopoly. No monopoly was there, for-

sooth, in Dublin, when the favours of the

College were conferred solely upon appren-tices ; none in Scotland, where a studentmust inhale the frigid air of " auld Reikie"for twelve months continually, before he can

present himself at the University for the

degree ; or in London, where, not to men-tion old-standing abuses, the Council of theCollege of Surgeons, not content with their

845DEGREES IN MEDICINE.

occupation of examining students, must for discovering the means of satisfying theneeds take to examining the lectures them- hunger after knowledge. Once let the

selves, before 11 recognition," with the osten- streams of knowledge freely flow, and thesible purpose of "recognising" none but sources will be rapidly and correctly found." competent" men, but with a fixed determi- No bad teacher ever sat long in the chair ofnation of keeping the coterie of lecturers a professor, as the freely-elected representa-compact and snug. The fact is, as regards tive of science. Or if so anxious to obtain

the latter proceeding, that lecturers had be- "competent" men, let the monopolists ahan-come too numerous, and pupils too scarce ; don their places, and choose the professorsthe fees were distributed amongst too many of medicine in public institutions by con-instead of being pocketed by the few ; the cours, and then quickly, indeed, will the

gentry at the College became alarmed ; a small fry of lecturers, of whom they standcouncil of war was held, and the remedy to so much in horror, quickly either disappearwhich we have just alluded to was proposed from the field, or merge into " men of emi-and adopted, nence."

We shall not now dwell upon the effect But, say the monopolists, "if the studentof the certificate system in keeping up the be permitted to obtain his information howenormous fees which medical students are and where he likes, without furnishingcompelled to pay for attendance upon lec- " any other proof of his diligence than thetures aad upon hospital practice. The res " correctness or readiness with which he

" angusta domi" argument could have no " may answer all questions that are ad-

effect on the hardened and unprincipled dressed to him, as great an evil will be

abettors of all that is corrupt in the present produced as the one that is proposed to besystem. Little care they for the biting pri- abolished. The pupil would thus be enabledvations which youthful students may have to pass his time in idleness for two or

to undergo in order that their friends, the ’’ three years; for if no certificates be re-

dealers in " tickets," may fare sumptuously quired from him, he will merely have him-every day. Were we to ask one of these self ground for the last few months, andmen " what is a certificate, or why is it en- thus obtain a degree without possessing"joined?" his answer would be, that "a" an iota of practical knowledge." This

certificate is a piece of paper which position leads to our second point. Abolish" proves the diligent attendance of the pupil certificates, says the medical reformer, but,

" on the lectures of his teacher, and, more- at the same time, make the examination

"over, insures the competency of the a searching inquisition, a thorough and =

teacher, because none but men of emi- severe practical inquiry, which no student"nence are authorized to graut it." Yet can pass unless he have really spent theit is an indisputable fact, that the certificates, period of his education in constant atten-

four times out of five, certify to a false- tion to the essential points of the science.

hood. There is not a pupil in London who If " grinding" and private tuition be iden-

is ignorant of their real value,-who does tical in operation, we admit that "grinding"not know that they may be obtained without would thus only change its character in

the ennui of attending the prosy discourses one respect, namely, that the process wouldof the "recognised" lecturers; aye, or be one of years instead of months, continuouswithout ever having set eyes upon the tic- instead of temporary, unbroken instead of

kct-mongers faces. occasional,-instead of a bit for the Hall,The excuse of insuring competent -lec- and a bit for the College, a bit for Latin, and

turers is no less farcical and fallacious. Let a’ bit for botany, a patchwork of education,the pupils elect freely their own teachers. effected by jobs. Who would not recogniseThe want is theirs. Their sense is acutest the extension of " grinding" in this respect

846 PUBLIC EXAMINATIONS.as a most important change for the better? 2Under the new system young men would

really become admirably instructed, eitheras apprentices or as free students, and be

prepared at the qwoyer age to undergo theordeal of a well-conducted, practical exami.nation. This method, as our readers areaware, has been adopted for many years in

France, and experience has proved that itworks well." In that country the student,instead of being asked " How many bones

composer the orbit?" " what are the ori-

gin and insertion of the biceps muscle?"

(answers to which questions may be learnedfrom any elementary work) is desired, forexample, to dissect the femoral artery andits branches, to display the arrangement ofthe fascia of the thigh, to prepare, on thedead body, the superficial branches of thecervical nerves, &c. These proceedingsevidently comprise demands upon the know-ledge of the student which require thathe should have passed many a diligent

_ week in the dissecting-room Again ; the I

candidate should be led to the bedside of

the patient, and there made to undergo astrict examination into his proficiency inmedical and surgical knowledge. Would

not this supersede the necessity of enforcingthe certificate system, and altogether removethe interested objections which have beenraised by those individuals who, with de.clarations respecting the " welfare of the

pupil," pretend that they exact the produc.tion of certificates from him, merely for the

purpose of insuring a constant attention onhis part to the business of instruction ?The examination of a candidate for a me-

dical degree having been made a thoroughly

. practical one, the next step must be that ofinsuring its publicity, against which the

only plausible objection that has ever been

urged, is founded on this supposition, thatthe exposure of the candidate to such a test

might operate unfavourably on his feelings,by exciting the bashfulness and timidity.of youth at an inappropriate time, and pre-vent many students from giving utterance tothe knowledge which they really possess.

But this argument is altogether specious.Were the character of the examination once

made known to be strictly practical, candi-dates would be prepared to an extent, andin a manner, so widely different from the

present one, that they would feel fortified

to meet a becoming inquiry, and confidentin the power of reply,—the natural result ofa consciousness of possessing knowledge,Besides, medical students really are not

timid beings in any situation which eiretim.stances have habituated them to occupy.

Moreover, publicity would inevitably pre.’serve them from the insolent brow-beating,and the brutal and dastardly insolence, towhich they are now successfully subjectedat such places as 11 Apothecaries’ Hall,"and English candidates for diplomas and

degrees would come forward with the samereadiness, and the same degree of confi-

dence as distinguishes the medical studentsin France, when they are placed in similarcircumstances. We have often asked fo.

reign graduates, what effect a public exam-ination has upon their mind and feelings,and the answer has invariably been, " The· amountof fear was very trifling, because" we had already. seen so many others pass

" the ordeal with success."But a public examination is a very great

stimulus to exertion, No student would

think of presenting himself as a candidatefor a degree until he was thoroughly prepar-

ed to enter on the practice of his profession;and such persons as had already acquiredsome little fame in the paths of science

would double their exertions to supporttheir reputation. Events have repeatedlyestablished this fact. No one would con-

sent to disgrace himself before a crowd of

proud and anxious friends and relations, byexhibiting proofs of ignorance similar to

those which, from the known laxity of the in-vestigation, are too often displayed before

the Courts of Examiners in the British

capitals. The question there with a studentmay most naturally become, not with howmuch preparatory information he shall

enrich himself, but with how little he shall

847

pass. In making these remarks we are not

ranging in the fields’of mere declamation or

conjecture. We declare only that which is

notoriously true. Never, indeed, were re-

sults which might be anticipated, by theory,to flow from any system, more fully verified

by facts, than have been the consequences ofthe schemes of the medical monopolists ofthis country. No astronomer ever prophe-sied more truly the effects of physical lawsin the celestial world, than might the pre-sent condition of English medical educa-tion and practice have been foretold as a tresult of the ticket and certificate system.Nor ever was prophecy more correctly ful.filled than will this forewarning be veri.fied-that the abolition of the present sys-tem will insure for medicine the higheststation among the useful sciences, and formedical practitioners the first rank amongthe professional members of the community,

UNIVERSITY COLLEGE HOSPITAL.

CITRIC ACID AND OTHER REMEDIES IN CASES

OF PURPURA, OCCURRING IN ADULTS AND

CHILDREN.

DR. ELLIOTSON this week took occasion tomake some remarks on comments attachedto the report of a case of purpura occurring Iat this hospital, and inserted at page 777 ofthe present volume of THE LANCET. Hemerely wished to add to the observationswhich he had made on the case in question,that his experience of lemou-juice as a

remedy in purpura, held good with regardto children as well as to adults. He hadseen a very large number of cases of pur-pura occurring in children. The writer,w ho had commented on his case, spoke ofhaving seen five or six cases in Paris, andthat they were all treated by citric acid withsuccess. Now, lie (Dr. E.) had seen a

large number of cases, very many morethan five or six ; and having an idea at onetime that purpura bore a very great simi-larity to scurvy, he had given citric acid inseveral cases ; his experience was, thatcitric acid was of no more use in this dis-ease when occurring in children, than whenit happened to adults. Now, to reason onthe point. If this medicine was of no be-nefit in adult cases, why should it be of be-nefit in those of children ? If we possess amedicine which has a kind of specific powerin any disease, it is of the same benefit

both to adults and to children. Quininecures agues in both, so syphilis, in both, iscured with mercury; so itch, in both, iseradicated by sulphur. Whatever is goodto the adult is, if given in proper doses;good also to children in the same disease,particularly if the medicine possesses a

kind of specific power in the particularmalady. As he had said before, the onlyrelation scurvy had to purpura, was thepresence of the purple spots, for oppositeplans of treatment were adopted, and foundbeneficial in the two diseases. Who hadever known a case of scurvy cured by ex-tensive bleeding, as instanced in the casewhich had given rise to these observations,and in which the patient was better andstronger after losing 150 ounces of blood,than he was previously. He believed

scurvy was never treated in this way.Again, in the purpura of children, the samekind of treatment was successful, whilstthe disease was increased by those remedieswhich were most successful in scurvy. He,last spring, attended a young gentlemanwith purpura hasmorrhagica, in whom therewas a great number of spots; he had ten-derness of the abdomen, and a discharge ofconsiderable quantities of blood from theintestines ; his pulse was full. He hadnot suffered either from bad living or im.pure air. He was bled in the arm, tookdilients, and was kept on the lowest diet ;he got well, though he was obliged after’wards to have leeches applied to the abdo-men on two or three occasions, and turpen-tine injections once or twice. When hehad got quite well, lie feasted on venison,turtle, and other rich things, and the dis-ease immediately returned. The spots againappearecl, and the abdomen became tender.He (Dr. E.) gave him gruel and water tolive on, had leeches applied to the abdo-men, and the youth again got rapidly quitewell; he is now in good health, but is kepton moderate diet. This case displayed acharacter totally opposed to scurvy. The

gums, too, were not affected in purpura, asthey were in scurvy. Many in purpuramight, indeed, accidentally have spongygums, as many people have when their teethare not kept clean and well brushed ; but notto the extentobserved in scurvy. With regardto lemon-juice in purpura, it might be ob-served that many children, who had thedisease slightly, might, and did get wellwith one or two doses of moderately purgingmedicine ; he had found Epsom salts andcolchicum the best purgatives in thesecases. Now, if lemon-juice happened tobe given at the same time with other medi-cines, it was said to have done good. Many

cases, again, yielded of themselves, and thusmistakes regarding the efticacy of medicines

. were made. So, in haemorrhage, acetate’ of lead, in one-grain doses, mixed with in-tfusion of roses, was administered by some