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Bearing in mind then the essential distinction between Medicine as a science and Physic as an art, it will be understood, at once, that it was not the former-as based on the demonstrative facts of Anatomy, Physiology, and Pathology-that the eminent Sir Astley Cooper contemplated, when he deliberately said "The science of medicine is founded on conjecture, and improved by murder !" It was clearly physic, or drug medication, that he referred to.
It was also of medicine, as identified with the pernicious art of drugging, that the celebrated Magendie spoke when addressing his students, he said-" Gentlemen, medicine is a great humbug. I know it is called science. Science, indeed! It is nothing like science. Doctors are merely empirics when they
are not charlatans!"
In the same spirit of candour the Dublin Medical Journal said " Assuredly the uncertain and most unsatisfactory art that we call medical science is no science at all, but a jumble of inconsistent opinions; of conclusions hastily and often inaccurately drawn; of facts misunderstood or perverted; of comparisons without analogy; of hypotheses without reason, and theories not only useless, but dangerous."
In even more emphatic terms an esteemed author, Dr. Mason Good, wrote "The science of medicine is a barbarous jargon, and the effects of our medicines on the human system in the highest degree uncertain, except, indeed, that they have destroyed more lives than war, pestilence, and famine combined !"
There can be nothing uncertain in science, and hence the Medical Times admitted that "a scientific, as distinguished from an empirical treatment of disease (by drugs) is an idle dream !" * And the reason of this may be gathered from the clever author of Ourselves, Our Food, and Our Physic, Dr. Ridge, who frankly says "That medicines, administered with the best intentions, and according to all rules of art by the profession itself, as well as by all classes on their own responsibility, aggravate the disease
* When this was published, Feb. 7, 1863, the Medical Times was not incorporated, as it now is, with the Medical Gazette.
and suffering, is too clear to need any illustration." Even the Lancet has had its faith shaken in " Physic as a science." "The progress of true medical science has greatly qualified our estimate of the value of mere drugs in the treatment of disease. It has shown that in medicine, as in politics, the best course is often that of non-intervention."*
The conclusion is, therefore, irresistible-that Anatomy, Physiology, and Pathology, as based on demonstrative facts, can alone be regarded as composing medical science. Hence an eminent authority, Sir Richard Owen, Professor of Anatomy to the Royal College of Surgeons, London, in addressing the students of St. Mary's Hospital, Paddington, at the distribution of prizes in 1865, said "Anatomy, Physiology, and Pathology, all three bodies of doctrine worthy of the name of sciences, must be cultivated-if possible mastered-as the indespensable basis on which a lasting superstructure of a true science of medicine can be raised."
SECTION III.-Popular belief respecting Medical qualificationsFacts concerning present condition of the Medical profession→→→ The Medical Act of 1858-The General Council: its defective administration-Deplorable condition of Medical Education -The Licensing bodies-Their numerous licenses and titles rejected by Army and Navy as no test of qualification— Opinions of Medical authorities on shameful state of the Profession, and destructive character of Medical practice.
BEARING in mind the essential distinction we have established between Medicine as a Science, and the mere practice of Physic, a more correct appreciation and sounder judgment can be formed concerning the condition of the Medical Profession as it now exists. It is a popular belief that any one who ranks as a member of the Medical Profession must necessarily be learned
* Medical Annotations in Lancet, March 21, 1865.
and wise, accomplished and skilful. Popular credulity, indeed, runs so wild, in ignorance of the laws of nature, as to believe that "Doctor" is a name to conjure with-that "M.D.," or half the letters of the alphabet appended to a practitioner's name, has some mysterious signification, and betokens a wizard's power to charm away disease and restore health!
The public willingly assume the existence of learning and ability. They take it for granted that a proper education has been received by all "regular" practitioners. They repose confidence in all diplomas, licenses, and degrees, which are supposed to have been acquired by an enlightened course of study, and after thorough competency has been honestly tested by impartial examination. They do not believe that very ill-informed persons can easily become, and, as a rule, actually do become, "M.D.'s"-obtain diplomas-are licensed to practice, and have their names emblazoned on the Registry as "duly qualified." They do not consider it credible that a scandal so grave could possibly exist, as entrusting to persons of acknowledged and notorious incompetency the serious concerns of life and health. Let us, however, again lift the veil, and look at facts as they glare before us.
The shameful admission first attracts attention, that the standard of Medical Education is so wretchedly low as to admit persons to the ranks of the Profession who do not possess even the ordinary qualification of a respectable English education! -who are incapable of writing a Latin prescription correctly! The evils that arose within the profession from such a scandalous state of affairs led to the passing of the Medical Act, 21 and 22 Vic., c. 90, in the hope that some improvement might be effected. But in every particular this Act is lamentably defec tive. It did not honestly grapple with the evils that lie at the root of the whole medical organization. It did not touch one of the manifold abuses that pervade the whole system ofmedical matriculation, education, examination, and licensing. On the contrary, it sanctioned and fortified them all.
A General Medical Council was established, but its very
composition precluded all hope of effective reform. It consisted of seventeen persons, elected by nineteen medical corporations, possessing licensing privileges, and all having mercenary interests in existing abuses. Six members are nominated by the Crown, so that assuming they are all anxious for improvement, there are seventeen against them. A Register is provided for, and no practitioner not registered is entitled to recover at law any charges whatever for his services, or to hold any appointment in the Army, Navy, or Civil Service. The authority conferred on the Council it has refused to exercise beneficially. Among its first acts was to dispense with a knowledge of Greek as unnecessary to form any part of the education of a learned and accomplished medical practitioner! In short, the conclusion now arrived at by the enlightened among the Profession itself, after an experience of ten years' working, is, that the whole Act, as administered by the General Council, is a pretentious deception-a solemn burlesque, and an expensive sham! Some little zeal has been displayed, it is true, in seeking to extinguish empiricism outside the registered practitioners, but no attempt has been made to effectively strike at the root of the equally gross abuses which exist and flourish within the charmed circle.
For instance, there exists nineteen separate and independent licensing bodies in the United Kingdom, empowered to confer no less than thirty separate licenses to practice, and fifty-four titles, which the Council is compelled to register without having any authority to test the qualifications of those who possess them. There is not, as there ought to be, one uniform standard of education for all students—one examination to which all should submit, and one title to practice which all should possess; but each of the nineteen licensing bodies is left to consult its own mercenary interests in admitting whom they please, and on whatever terms they please.
The consequence is, that unhealthy competition is encouraged, and as most students will go through whatever curriculum is shortest-will patronise that board of examiners whose examination is lowest, easiest, and cheapest, the inevitable
tendency is to degrade professional education to the very lowest level.
Nor is this all. In many instances the Examiners are paid according to the number of students they pass, and hence their self-interest is adverse to upholding a high standard of education, which can alone reflect credit on the Profession, and properly qualify Practitioners for the service of the public. On the contrary, they are prompted to strain points to pass as many candidates as possible, no matter how wretchedly qualified they may be sending them forth licensed to commit manslaughter with impunity. Medical practitioners are just what they are educated to be, as a rule, neither better nor worse than the average of other men who earn their bread by following a vocation. The vices of their practice, therefore, may be considered not so much those of the individuals, as of the pernicious system that fosters incompetency, and legally recognises it as "duly qualified."
It is somewhat remarkable that individual members of the General Medical Council have been among the most emphatic in lamenting the present degraded state of the Profession as regards intellectual capacity, educational attainments, and professional knowledge. The President, in his opening address at the annual meeting of the Council, May 29, 1867, said—“ If our profession, as a whole, is still to bear the name of, and be regarded as, one of the learned professions, then, undoubtedly, those who enter upon it ought to have received that amount of mental culture, and ought to be capable of passing a preliminary examination on subjects of general education, which shall at any rate be equivalent to the examinations which are passed by those who are entering upon the clerical profession, by those who are entering upon the legal profession, the army, and civil service of the country." No one is likely to dispute this, yet it is notorious that the profession swarms with members who are shamefully illiterate-whose opinions on any subject of general literature or of science, are wholly undeserving of respect.