Thomas Beddoes to Sir Joseph Banks, [between April and 8 August] 1808
SIR,
In January, 1806, it was publicly announced that ‘a medical society in Lincolnshire had deputed Dr. Harrison their chairman, to confer with the right honourable Sir Joseph Banks their patron, concerning the means proper to be pursued for securing the co-operation of the faculty and the legislature towards suppressing, or at least restricting, empirical practice and rendering the medical profession more respectable; that at Sir Joseph’s suggestion Dr. Harrison had visited the metropolis, and that several well-attended meetings of the faculty were held at Sir Joseph’s house, where only one sentiment prevailed concerning the existence and magnitude of the evil.’
From this, and from a great variety of subsequent notices, you appear to have warmly espoused a scheme for reforming medicine; that is, in effect, for diminishing some of the severest evils which flesh is heir to. This, sir, even had there been no private intimation of the design, would have justified an address to you from any one who might desire to excite a stronger extraprofessional interest in the enquiry. It has now been going on nearly for two years; but the documents have been almost entirely confined to publications, circulating exclusively among medical men. – I know not whether the pamphlet by Dr. Harrison on the ineffective practice of medicine in Great Britain, ought to be rated as an exception. – Whereas not a moment, I think, should have been lost in attempting to influence the whole public: a purpose which, according to all modern experience, requires much above two years. And, if not to the ehtment, yet to the efficacy of any law on such a subject, is not public opinion altogether indispensable? By repeated admonition who knows but our ‘merchant princes,’ our peers and country gentlemen, would be generally led to suspect that their accommodation on the journey of life depends as much upon the state of medicine as upon that of the inns and roads, in which they wisely take so deep an interest? On computation they would probably find that the inevitable law of necessity places them for a greater portion of their days at the mercy of physicians, than of publicans and postilions. Why, therefore, should they not consider whether the one be not as capable of amendment as the other? We do not perhaps abound in public men of Lord Bacon’s discernment, but we may have those amongst us, who are capable of judging, probably much better than numbers belonging to the profession, of the due relation of medicine to society.
It must, therefore, have gratified all those who have carefully considered this relation to find other persons of distinction, and some of them high in office, fixing their attention at the same time upon the same object. The permission of a post-free correspondence, by the late ministry, deserves honourable mention: nor is it easy to believe, that any ministry will hesitate to indulge their humane feelings, and to do themselves credit by exerting their whole influence in correcting abuses in medicine, if a case and a remedy can be made out. After the general defence, nothing surely can have a claim upon the powerful superior to the security of individuals. If the country be really infested by deceivers going about to assassinate his majesty’s sick liege subjects, under pretence of making them well, would not indifference to the extermination of these wolves in sheep’s clothing be also
––communi deesse saluti?
Early in the discussion indeed, (Clutterbuck’s Med. Review, March, 1806, p. clii.) a certain northern professor of medicine took occasion to argue, that ‘our statesmen care nothing for the welfare of the people in point of health, morals, and industry,’ because they do not prohibit the distillation of spirits; and he speaks of the revenue from quack medicines, ‘as more valuable in their judgment, than the health of the people, the prosperity of physicians, and the improvement of physic.’ Your perseverance, however, shews, that you do not believe them to be quite so hardened as this modern medical Cato the censor represents. After an arduous struggle in a cause not to be reputed greater than that of the general health, and certainly more remote, we have lately seen greater interests overcome. Were a Clarkson to open this cause before the public, and a Wilberforce to espouse it in parliament, we might, I think, rely upon self-love re-inforced by sympathy, for final success. But it behoves us not to deceive ourselves, either as to the nature of the evil, or the remedy. You and your illustrious associates in the patronage of this undertaking, and those who may hereafter join you, would, I feel assured, have nothing rashly attempted, or weakly enacted; nothing plausible in the way of proposal or objection dismissed unheard. For yourself, your life affords the fullest assurance of impartiality; when a person, besides other proofs of philosophical courage, has been led by curiosity to the remotest corners of the earth, he has given pledge enough of a mind open to information. But it is upon the extent of your intellectual-range that I should still more securely rely. From office and from inclination, you, sir, of all men living, are, I should suppose, the very one most accustomed to enter into the views of others. To whatever subject, therefore, you turn, it is natural that you should wish to have it fully expanded before you; and seek not merely for truth, but for the whole truth. Nor will private favour interfere with your judgment on a public question, like that which is agitated by Dr. Harrison and his associates.
When I look at the standard erected by these gentlemen, I behold, inscribed in terrific characters, ‘destruction and disgrace from unauthorised intruders into medical practice.’ At the sight, numerous voices cry out from all quarters, with one accord – ‘Physicians almost every where without degrees; surgeons and apothecaries without sufficient education; brayers in the mortar and sweepers of the shop putting themselves on a level with the most instructed; a herd of quacks and itinerants dealing out their poison with an unsparing hand; the profession degraded in all its branches; necessity for a law to compel practitioners to undergo a suitable education.’
The correspondence must have borne several hundred names. For though these were in some cases communicated only to the editor of the publication in which the letters appear, we find, sometimes, from four to five-and twenty signatures to one letter. And the whole returns from the faculty were too numerous to be read to the committee. But Dr. Harrison, after laying them upon the table, produced a digest of those from the most respectable practitioners in every part of the kingdom and the public bodies. This digest (l.c. September 1806) bears first, ‘that the profession is greatly injured by diplomas granted to the illiterate; hence, secondly, that practitioners are too numerous; thirdly, that the emoluments of respectable practitioners are unjustly reduced by the admission of low, uneducated persons; fourthly, that unqualified army and navy surgeons settle, after quitting the service, in various districts, to the great annoyance of established practitioners; fifthly, that dangerous impostors ingross a considerable share of practice; sixthly, that pernicious empirical medicines greatly injure the public health; and seventhly, that chemists ignorant of the animal economy take upon them to prescribe, to the great detriment of the profession and the community.’
Bodies corporate we find adding their grave authority to the substance of this representation. The royal college of physicians in London notified through their register to Dr. Harrison, that the evils and a plan of redress had already occupied their attention. In the journal quoted above for February 1806, there is given the outline of a bill said to have been adopted by the college, by which they propose to erect themselves into a medical magistracy, invested with the full authority of a committee of private safety, having deputies over the face of the whole country, with great discretionary powers, and salaries of ‘not more than five hundred pounds each.’ A refusal on the part of the Scotch college to join in the project seems to have checked it for the moment; but the strength of the measure shews us what opinion its learned authors entertain of the emergency. The academical senate of Edinburgh, whose opinions I shall make it a principal business to examine, frankly acknowledge, that ‘many great abuses prevail in the practice of medicine, from the removal of which many great advantages would be derived.’ By the king and queen’s college of physicians in Ireland it is declared, that ‘complete irregularity prevails in profession and practice; for not only is the necessary separation of the profession little observed, but also persons who have not received any education to qualify them for the exercise of the subordinate branches of medicine, act as physicians, to the injury of the public and well-instructed practitioners; and that though means have been devised for protecting from encroachment the professions of law and divinity; that of physic is still open to every intruder.’ – (Report Clutterbuck Medical Review, Feb. 1807, xxix.)
Resolutions from various medical assemblages perfectly coincide with the three royal colleges. On this one subject at least, which touches them so nearly, the faculty are unanimous. It would be in vain for an individual to oppose his voice to this phalanx of testimony; and, for myself, were I obliged to move, I could not but join it with what strength I may have. Without going a hundred miles from Clifton, Bristol, and Bath, you may meet with practitioners, whose genius has transported them at a single bound from the side of the mortar to the bedside; and who go about distributing their poudres de succession through town and country, with as much professional gravity, as if they had gone through the longest course of study, and stood the severest trials of skill. As to consumption-doctresses, cancer curers, mechanics professing to treat divers disorders, and particularly those of the female sex, there have arisen within my short memory, several, in whose behalf to speak with the cricket players, one might safely challenge all England; nay, in this favoured district, do we not behold the splendid seats of solemn, regular, respected quackery, methodized, as you shall hear, if you do not know it, according to the most approved forms of a foreign merchant’s counting house.
One exception, indeed, it may be politic to make before I proceed a step further. For when complainants start with palpable exaggeration, the only redress they are likely to obtain from the public is a smile. The Irish college and some correspondents represent the hardships of our faculty as peculiar. Now, this is taking a very partial view of society, and shewing insensibility to evils by which we are not pinched ourselves. Let us, therefore, candidly acknowledge, that the grievance, as far as it regards medicine, is not confined to our times, and that we hear from twenty other quarters complaints to the self same tune. Hippocrates, I am sure, manifests jealousy enough of intruders, which he would hardly have done, had he not been galled by their competition. The same feeling has tormented all the generations of medicine down to us. There may not heretofore have existed so brisk an effervescence, and so strong a combination; but Dr. Charleton, who, a century and a half ago, was king’s physician in ordinary and all the rest of it, cloathes the common sentiment in imagery certainly still stronger, or, if you will, more gross than any of Dr. Harrison’s 500 discontented correspondents.1 And is there really no complaint among politicians against those, who set up without going through their studies, and receiving regular admission into the fraternity? Are not the clergy themselves, according to members of their own body, reduced by irregular rivals to a state of utter insignificancy?’ (see Mr. Acklom Ingram’s recent sermon. ) Is it necessary to live here close beside the nursery and hotbed of English fanaticism, to perceive that this profession is overrun with quacks? From what point cannot the vast cauldron of religious opinion be seen steaming in the midst of society, while uncouth forms, just escaped from the awl, the anvil, and the loom, stalk furiously round it, heaping new fuel upon the fires beneath, and throwing in foul and venomous ingredients, that it may bubble and heave, and pour its consuming deluges once more over the land. ‘Whereas,’ say Mr. James McDonald and Mr. William Whitehead by authority, ‘whereas the trade of frame-work-knitters has been long subject to deceits and abuses, by the intrusion of strangers and others, who, unskilled in our art by time and servitude, have long brought the trade into bad credit: in order to establish the business on a more permanent foundation, and restore it to its original purity, for the general advantages of ourselves, our employers, the merchant and consumer’ (Gloucester Journal of Nov. 30, 1807.) And what have the orators of medicine been able to say more pathetic? Although, therefore, it be the season to cry, Physic, heal thyself, we ought not to deny to other callings the comfort of representing how much they also stand in need of a helping hand.
It was in the month of August 1806, that a remedy for the evils, under which we particularly groan, was circulated by the ‘associated faculty’ in Soho Square. After a year’s deliberations, they confirmed their first proceedings by a set of resolutions dated August 18th, 1807; and in a letter of the 5th of last November Dr. Harrison, who scarcely speaks on his own account, says, that ‘they are authorised to endeavour to obtain a redress of their own grievances; and can never consent wholly to abandon into other hands a measure of such infinite importance to themselves’—(l. c. Dec. 1807, p. 113.) Let me, for greater precision, place once more under your eye, the leading article of the remedial project. I shall afterwards produce objections from a body of formidable authority, and so much concerned in the event as to have appointed a committee to watch the proceedings of the associated faculty. The juxtaposition will enable you to judge, with more convenience, of the reflections which I have to offer.
It is proposed, then, that ‘no person shall practice as physician, unless he be a graduate of some university in the united kingdom, and has attained the age of twenty-four years; that he shall have studied the different branches of physic in an university, or respectable school or schools of physic, during the space of five years at least, two of which he shall have passed in the university where he takes his degree.’
The objectors to this fundamental measure are nothing less than the Edinburgh college, in a paper transmitted through you by the rev. Dr. Baird, the principal and successor to the historian Robertson. The college first observe, that it is inconsistent with their ancient rights and privileges, in virtue of which they have conferred degrees in physic upon those who have studied all the branches of physic in some university for three years; generously professing, however, a readiness to abandon these privileges, were they but once persuaded that the intended plan would have the effect of removing the abuses which at present prevail.
I think it necessary in fairness to transcribe the sequel of their objections to the important restrictions proposed. The paper, you will recollect, is in the form of a report by a committee of the senatus academicus. 2. ‘The committee need not mention the origin and the reason of conferring degrees in physic; a practice which has been long followed in Europe; and of which the expediency, and even necessity, are now universally acknowledged. They beg leave, however, to observe, that it has never been intended to declare to the public, that the person upon whom a university confers the degree of a doctor in physic has acquired a complete knowledge of medicine; but to announce to the world, in the most public manner, that he has been regularly educated; that he has studied, during a university period, all the branches of medicine; and that he has acquired such a stock of knowledge as, in the opinion of competent judges, qualifies him for entering upon the practice of physic. A period of three years, employed in the study of all the branches of medicine, has been considered by our predecessors as sufficient, according to the average of human abilities, for the above purposes. The propriety of fixing upon this period has been proved from ample experience. For the graduates of this university have acquired as high a degree of respectability, have shewn themselves as deserving of the confidence of the public, and have contributed as much to the advancement of the science of medicine, as the graduates of other universities, in which the duration of study is much longer.
3. It may, however, be alleged, by the proposers of this plan, that a part of the long period of five years’ study might be employed with advantage in attending to many of those branches of science, which are nearly connected with medicine, and must essentially contribute to improve it. But for the attainment of this very desirable object, this plan of medical reform makes no provision whatever.
4. The proposed plan of prolonging the period of study would increase very much the expence of a medical education, at present very considerable. The consequences of this may prove very injurious to the future state of medicine in this country, It would deter many from applying to a profession, in which at present they must wait long before they receive an adequate return. It would effectually exclude many whose talents fit them for adding to the dignity and to the improvement of medicine, from taking degrees in physic; and it would therefore tend to diminish the number of well-educated young men of the medical profession.
5. If by the proposed plan, it is intended that no university in the United Kingdom shall, in any case, be allowed to confer degrees in physic until after a study of five years, it will necessarily prevent the subjects of other states, and even those of the foreign dominions of Great Britain, from studying medicine in these 4 kingdoms, unless other states, which is in the highest degree improbable, should adopt the same plan.
6. The proposed plan will prevent those persons from practising medicine in Britain who have taken degrees in foreign universities: a measure which appears extremely illiberal, as well as unreasonable, and which probably would be retaliated by other nations and their universities.
7. It has been the practice of most universities to admit those certificates of study, which are given by universities only. Because these universities having been established and acknowledged by the government of the country in which they are, will in general be filled with proper and well qualified teachers, and possess faithful registers. But the proposed plan, by admitting certificates of education from schools of physic, may prevent the possibility of ascertaining a regular education; and it may lead to many other abuses, because these schools may be self-created, and conducted by teachers over whom there may be no controul.
8. All the above objections, which have been made against the intended plan of reform in the practice of physic, may be urged with still greater force against that which regards surgery.’
The point on which the parties are at issue will doubtless, on all sides, be allowed to involve the merits and the fate of the whole project for reform. For to an individual, or a body, which has once lost the public confidence in a matter dependant upon skill, rehabilitation by dry statute is impossible. The power of a former French king, or present French emperor, would be unavailing. Whereas, to use, by way of example, the words of the association, ‘abundant proofs have been produced of the deplorable state of society, in being exposed to the injuries resulting from a numerous race of unqualified practitioners, and the consequent discouragement of well-educated members of the faculty, ’ what would it avail if, to this litany, our legislators were, nemine contradicente, to respond – ‘be it therefore enacted, by and with &ndash&ndash&ndash, that doctors of medicine, of the universities A. B. C., are from the present date respectable; and let them henceforth be respected, and feed in preference to all pretenders whatsoever.’ – One of two conditions seems indispensable to the redress of the alleged grievances. Either some error, by which the public has been led to confound their destroyers with their preservers, must be detected; and not only detected, but exposed in such a way as to render the respective distinguishing marks apparent: or else some change must take place in the regular practitioners themselves, which shall command the whole public esteem, and in consequence of which they shall be recognized as alone qualified for exercising the functions of their high vocation.
Now the former expedient for restoring us to that rank in esteem of which we deplore the loss or the want, you, if I mistake not, will allow to be altogether hopeless, or at least inadequate to the occasion. The progress of empirical practice would almost seem to have been in proportion to the efforts to expose it; and our curses to have turned into a blessing upon our adversaries. All further explanation will be in great measure lost upon the country. If there exist a chance from remonstrance, it must arise from engaging, in our interest, the ministers in Wesley’s and similar connections. Such is their influence, that possibly they could speak to the people effectually. But one need not be over-sagacious to snuff danger in the measure. For what is to hinder these good people from taking the body also into their care – John Wesley set them a tempting example in his primitive physic – and then how should we rue the consequence of calling in a too powerful host of auxiliaries?
It remains that some change, which shall strike mankind, take place in those who, on the plea of superior qualification, claim the rewards allotted to the care of human health. Improvement in education is not, in truth, the only imaginable means of effecting such a change; nor does it seem exactly to suit a case, in which urgency is so loudly proclaimed. But it is gentle, gradual, and perhaps the sole practicable. Nay, sir, does not such improvement come so much home to every one’s feelings and affections, that if he pause but a while on the question, can the answer turn out other than this? The whole wisdom and power of society ought to be exerted in seconding such a design, even though there existed not the smallest shadow of the reasons assigned; no one abuse; but only the rational prospect of amendment in the education of physicians. That a difference in the state of our medical seminaries may eventually make the difference between life and death, suffering and enjoyment, to the first individual you meet, or to his child; and that it must daily make such a difference to thousands, is a reflection which no one can require to have forced into his heart.
Let the public therefore not too ‘lightly give’ credit to the doctors of Edinburgh, when they insinuate or more than insinuate, that their plan of education requires no radical change. Whoever takes but the small pains necessary to a clear conception of the stake which the country has in its medical schools, must recoil with horror at any attempt to persuade us, that we ought to acquiesce in their present condition, if it be not altogether the most perfect practicable. These doctors ought surely to be heard. But in what capacity? as judges or as parties? – they who have their honour and their purse so materially involved in the decision?
If those who like you can be actuated by no other motive than honourable zeal for the public welfare, are merely to weigh opinion against opinion; (and while I regret that it should be so, I beg you to be aware that we have hardly any thing more substantial to put into the scale;) I must here take leave to ask, whether the proceedings themselves do not already furnish a contrary authority equal, if not superior, to that of the academical senate? This is the authority of those physicians, who having been educated at Edinburgh, still approve the extension of the term of study. The complaint of a pupil may, in many cases no doubt, be justly interpreted into an encomium upon the master; as, for instance, if the pupil be young, and represent the discipline of the school as too strict. If, however, he be not only his own master, but have had time to feel himself, and to compare the mode of his education with the object, and if he have no obvious motive for undervaluing the school, we should at least not take the word of the master implicitly, when he is contradicted by pupils so circumstanced. The attachment to schools of celebrity rises too often to bigotry, and it is almost always one of the strongest features in the character of persons who have been educated together. No wonder, since in demonstrating an amiable feeling, they gratify their self importance. Of the faculty who assemble at your house, many are, I believe, pupils of the Edinburgh school.2 Among the approving correspondents, since the plan was issued, are also many such. I wish Dr. Harrison would give the numbers as nearly as he can. The objections seem to call for it. The proceedings no where indeed state, in so many words, that the Edinburgh education in particular is insufficient. But does not the declaration of all those who prefer five years to three, imply a persuasion that this period is too short to ‘qualify a man for entering upon the practice of physic:’ and the Edinburgh senate, you perceive, feels the inference. ‘Entering upon the practice of physic! ’ Any lad will enter on the practice of physic as soon as he can but scrawl the cabalistical signs for ounce, dram, and scruple, and knows about how much jalap is to be given to purge, how much chalk to bind, or laudanum to compose; and whatever it may cost the sick, he will take his chance for the benefit of the proverb – practice makes perfect.
Look, sir, I beseech you, at the paragraph numbered 3 by the objectors. Can you trust your eyes, when you read such language as this? Such language, too, from men at all acquainted with the average proficiency in medicine, to men at all capable of feeling what instruction has effected? – ‘The long period of five years’ study!’ – ‘no provision for employing the excess of time upon sciences nearly connected with medicine!’ Let any one then number upon his fingers the sciences auxiliary to medicine; let him consider the extent of simple anatomy; the immensity and difficulty of morbid anatomy; let him compute the time requisite, after these and other preliminary studies, to observe over and over again in nature the species and subspecies of disease (leaving the more uncommon out of the question), and to acquire sufficient readiness in distinguishing their nature and degree, in familiarizing himself with contingencies, and in selecting, among many remedies that may offer as almost equally promising, the one best suited to the case. Let him take it into the account, too, that the physician cannot safely be without precise information concerning the principles of certain arts which he is not to practice; I need not name pharmacy, midwifery, surgery. He who shall give these considerations fair play, may possibly come to think three years barely sufficient for rough hewing the physician, and preventing him from disgracing himself, and those who have formed him in the eye of the first apothecary, nurse, or patient, with whom he falls in. He may suspect that all the finishing and master-strokes are yet to come. If he suspect this on contemplating the map of medical science merely, I do not doubt but close examination of its provinces will uniformly tend to confirm the suspicion.
The difficulty attending the treatment of diseases is fully evidenced in the innumerable deaths which, in spite of the best medical aid, happen from every other cause rather than that necessary disease, extreme old age. The cultivation of the mind must be proportionably difficult and slow. Work that is vamped up too quickly always turns out slight. Upon the front of every medical library, of every set of medical regulations, and every medical college, might be justly inscribed; (and, from what we have read, the inscription would seem particularly wanting over the medical halls of the new college of Edinburgh)
––Pater ipse colendi
Haud facilem esse viam voluit.
Mirabeau, if I do not mistake, in his Monarchie Prussienne, represents Frederic II as conceiving clear ideas on the instant; but if he made efforts to fathom a subject, he became all at once confused. The Edinburgh senate seem to apprehend that medical students should contract some such unlucky habit, by dwelling too long upon the objects of their profession, before they ‘enter upon practice.’ If they had not actually met with some instances of blindness, from excess of light poured by the luminaries of that school upon the mental eye, would they have insinuated that the new regulations ought to have provided some occupation accessory to medicine, for the two last years of the five proposed? I am sure I should never have apprehended any such danger; and I hope, Sir, that a reflection which has apparently escaped the objectors, will make it appear that it is the very opposite danger which really exists. If the industry of three years qualifies to profit by attendance on the sick, then I say that by such attendance, more will be gained towards a safe and efficient practitioner in each of the two additional years, than in all the preceding. By dropping the character of student to assume that of practitioner, the scene of extensive observation must generally be abandoned. The mind is cut off from the very nourishment which it requires, and may be considered as a tree torn from its soil just as the fruit was about to set. For one young person in an hundred, connections may have secured a field of practice as soon as he can obtain a decent diploma. I have known such an occurrence, and can only add, that if we lived in a catholic country, no time should be lost in founding masses for the souls of his patients, both on his first starting and ever afterwards.
It will, perhaps, be remarked, that many do persevere in their studies full two or three years after graduation. I should myself have reminded you of this fact. Nothing can be more to my purpose; and I have only to ask, whether the force of regulation ought not to prevent any one from neglecting a practice which the sense of propriety impels some to observe? I find it still more easy to chalk out a course of study for the two last than the three first years. We have no sure data for calculating the space which the human mind can upon the average traverse in a given time; but I shall, by and bye, offer you my computation, and request that you will take the trouble of comparing it with that of others, and with the best observations we have.
Meanwhile, it must be allowed, that the question of time is but accessory. The effect produced in the time is the great point. If we were bound to think as highly of Edinburgh as Edinburgh talks of herself, we still ought not to be quite satisfied, because full medical attendance at other universities entitles to an Edinburgh diploma – after examination, it is true. Neglecting, however any alien students, who may particularly relish Scotch diplomas, let us attend to the allegations of the senate respecting the pupils of their own seminary. The appeal to ‘the confidence’, which the public reposes in their graduates. It is sometimes not impertinent to ask if there be any sense in the vox populi? and this, I apprehend, is, of all occasions, the one on which the question is least out of place. Has the public ever thoroughly considered medical education? Has the subject ever fairly been brought before the public? Does not the evidence produced by the association from all quarters, Edinburgh included, go to prove that a great part of this very public is incapable of distinguishing square from round, black from white, in the forms and colours of medical character? It might sound extravagant and harsh to say that the natives of our British Isles are as credulous as those savages, who believe themselves so wonderfully benefited by the wooden swords, which their conjurors pretend to thrust down their own throats. But certainly they are less advanced than on most other subjects of human consideration, and differ from the rudest savages, more by their capacity of attaining to think rightly, than by any justness of prevailing opinions, even among those, otherwise the most instructed. Have we not lately seen a French doctor of the old school succeed for a time in his attempt to introduce the helpless habit of ptisan-drinking; and that by a pamphlet full of the most portentous and obsolete jargon in recommendation of the Iceland liverwort, of which the inefficacy in consumption, the disease for which it was recommended, had been long since proved over and over again. If we are to judge by the usual signs of public confidence in medicine, has not a fellow who orders British gin from Bristol to Liverpool, colours and christens it balm, as much of this confidence as almost all the fellows of the three royal colleges put together.
However the pupils of Edinburgh may succeed in the world, and fair as it may be for an advocate to avail himself of the fact, I doubt exceedingly whether the public would, if called upon to act with deliberation, yield its confidence to one of their three years’ graduates. In case, for instance, of an election to an hospital, would not the shortness of his standing, and the necessary immaturity of his experience, operate as a fatal objection? Well then if he is not fit to have pauper-patients committed to him, why should others be allowed to commit themselves? It may be said, that a five or six years’ graduate would be thought equally incapable of the charge. I believe quite the contrary; provided the electors should have both information and integrity enough to vote according to the merits.
It always seems invidious, and in many cases is arrogant in an individual to adduce his opinion of a public body in argument; but as the merits of the Edinburgh school are opposed in this manner to the projected improvement of medical education, those who take a part in the question, seem called upon to declare themselves, if they have any probable cause of knowledge.
Let me, therefore, briefly state that I went to Edinburgh as an Oxford bachelor of arts, passed there three winters and one summer, was perpetually at the lectures of the professors, and in the societies of the students. You may think it probable that I have no humiliating associations connected with Edinburgh, if I add that I can never hope to be of so much consequence among my equals any where else, since the students heaped upon me all those distinctions which you know it is in their power to confer. Few individuals, certainly, have ever had a better opportunity of knowing any school. I have seen other schools of medicine, conversed and corresponded much, from that time to the present, with pupils and professors, studied their methods, and the productions as well of the youth as of the seniors. So that I cannot accuse myself of having omitted any thing by which I might be enabled to form an opinion concerning this grand question of medical instruction.
After comparing, on the spot, the means with the end, I certainly did conceive that a more deliberate process would be preferable, and that a method of instruction, in some other respects, materially different, would form physicians far more trustworthy. This opinion, various members of the medical societies could, I dare say, testify that I expressed; and every thing that I have since seen of practice and of literature has tended to confirm After a lapse of years, and without the smallest communication, it is satisfactory to find the associated faculty and their correspondents concurring to make it the basis of a legislative measure, and certainly without being actuated by the least ill-will towards any medical school in the universe. I know not whether any impartial person, after seriously reflecting upon the surest way of advancing in so difficult a study, ever surveyed the medical classes at Edinburgh. He would see that perpetual bodily hurry which is generally attended with a good deal of confusion of mind. No sooner does the college hour-bell toll, than the audience rush out in full stream, leaving the last word half finished in the mouth of one professor, not a few fearing lest they should miss the first words of another. Will you call this mere juvenile ardour. The young men there were generally, and doubtless still are, earnest in their pursuits; but it was a common feeling, that each attempted too much at once; and if it be true, that figures and hues which are to last, must be laid again and again on the mind, with pauses between to allow them to fix, somewhat as in fresco painting, this feeling would appear to be right. A calculation had been made, and the required attendance distributed as well as possible through the three years. Considering the number of professors, and the necessity for those, who were to trust to this school solely, to attend certain courses, (as the anatomical, practical, and clinical,) two or three times; considering, besides, that the merit of out-lecturers will have claims upon the inquisitive, and that many had no other chance for acquiring a smattering of natural philosophy and natural history, how could any student, and especially the most ardent, avoid attempting too much at once? The consequence was too apparent. Our academical architects, in their hurry to finish the structure, failed to lay a solid foundation.
But the contrary is, in effect, affirmed. The senate appeal to the advancement of medical science, by the graduates of their school. Here again, unless we had a measure for the quantity, and a test for the quality of improvement, which may be fairly expected in a given time, to what can we have recourse but the inconclusive expression of opinion? While some acquiesce or admire, others viewing the immense number of labourers sent from Edinburgh into the field of medicine, may feel astonished at the insignificance and small value of the produce.
When persons, however rude or undertaught, have certain objects constantly under superintendance, they inevitably acquire some insight into their properties, and skill in their management. Were the Hindoos indebted to instruction in mathematics for their proficiency in astronomy? Of all knowledge the beginnings, and of some the great part, are owing to the lessons of opportunity, which has forced improvements upon the faculties. The improvements in the steam-engine are in part contrivances by children, eager to go on uninterruptedly with their play. In estimating the merits of any school, are we not, therefore, to subtract, as well as we can, the portion due to necessary natural proficiency from the whole mass of improvement made by the disciples. And will not this be greater as they are more numerous? Let us glance, however, at particulars.
Fever and febrile disorders form incontestably the largest and most important department within the sphere of the physician. No school, perhaps, has enjoyed greater celebrity for its doctrines concerning fever: and our age has certainly afforded too many opportunities of putting the proficiency of the pupils to the test. Yet when certain fevers, of which the character is to be traced in the records of medicine, from Hippocrates downwards, became, as is too well known, epidemic in various regions of the earth, during the last twenty years. I do not know that any men were more confounded or more helpless than the pupils of Edinburgh; they had the fairest possible field for a display of skill, yet their practice was either more unsuccessful than that of the despised French schools, for example, or at least not more successful. And if any one should succeed in persuading you that the sick did not perish in greater multitudes under their hands, (which yet I hardly think they will accomplish, if you have the whole of the evidence before you,) what argument would this afford against an attempt to improve the study of medicine, by providing that the students shall carry to the infected city or camp a larger stock of knowledge? There stood, as I have said, on record, a great deal of that information which the occasion demanded. At college, however, for what was there time but attending to the oral instruction of the masters? From the constitution of the place, I shall afterwards give my reasons for thinking why it was not likely that they should supply for themselves what the discipline they had undergone left deficient.
We have a long series of publications from army, navy, colonial, and home, practitioners, on epidemic diseases. These appear to me to demonstrate how much a contracted period of study tends to keep the ideas of successive generations, within the same barren circle, and what good reason Edinburgh graduates have to complain of being ill provided against the difficulties of their career. That such of these works as appeared before the great modern invasions of pestilence were of as small avail as the lessons of the schools, the mortality which they occasioned demonstrates. No one of the authors since has, I think, equalled the absolute merit of Pringle, and certainly none has approached his relative merit. Now of him we know that he was not hastily squeezed and moulded into the form of a doctor. His faculties were allowed room to spread and time to ripen, otherwise he would probably have been as little of a classic in his kind as the generality of his successors.
There exists no set of men more meritorious than the body of our military practitioners of medicine. Their ardour seems to have as much exceeded that of their brethren in civil life, as their situation has been more uncomfortable, and their rewards more scanty. It has been common among those both in the army and navy, after fatigues of which we who go on so much at our ease have scarcely a conception, to employ the hours due to repose, in noting down their observations. What pity that such men are not more solidly grounded, and more highly finished by those who undertake to form their minds!
Allow me here to remark, that I am far from seeking shelter against refutation in general charges. I cannot indeed inclose a minute practical discussion in this letter, but I have been particular enough in a late tract entitled, ‘Researches concerning Fever, ’ from which, for further illustration, I shall introduce a passage in the postscript to this letter. My facts may be easily shewn to be irrelevant, if they are really so. Otherwise it must be concluded that the Edinburgh school has not, more than others, avoided the great and inveterate defect, noted by Lord Bacon. ‘They have not, partly out of their own practice, partly out of the constant probations reported in books, and partly out of the traditions of empirics set down and delivered over certain experimental medicines, for the cure of particular diseases, besides their own conjectural and magistral descriptions.’ No school, indeed, without allowing itself time, can ever avoid this reproach. But the devoted admirers of Edinburgh, as ‘the first medical school in the world,’ and probably the impartial, will produce against me the merits of your late public correspondent, Dr. James Currie, who, though a Glasgow graduate, was an Edinburgh student. I hope that I need not go about to prove myself fully sensible of those merits; but the lustre which they reflect upon the Edinburgh school is too dim to strike my (perhaps it will be said jaundiced) eyes. When a pupil stumbles upon a gold mine and works it, is that a merit of the school where he was bred, if it gave him no hint of its situation or its value? Or are medical teachers to be allowed, like keepers of lottery offices, to found a claim to superior custom, upon the chance sale of a prize ticket? It seems to me full as fortunate that Dr. Currie was originally destined to a different calling, and that he visited a distant part of the world with other views than those of a medical student, as that he studied at Edinburgh. Thus his faculties must have been enlarged and quickened; but even thus has he escaped altogether the effects of a cramped medical education? That his notions concerning fever are much too limited, and so far dangerous, must, I think, appear to every, one acquainted with the history, and especially the anatomical history, of the disease. Hence the rashness with which he has scattered the seeds of discredit over the results of a fellow experimenter on fever; results confirmed, to say the least, as amply as his own, by prior, by contemporary, and subsequent experience. I should also be glad to learn from intelligent and impartial readers of Dr. Currie, if his mind do not seem frequently labouring, as under night-mare oppression, from a mass of indigestible hypothesis laid upon it in the school of medical practice, which he frequented. The defect, if it exist, I should, in great measure, impute to a most amiable motive, pietas erga preceptorem; but if the preceptor, or the genius of place had initiated him more extensively in the results of faithful experience, might he not have had the piety equally without the defect?
Our documents relative to improvements in the treatment of disorders, not so general or alarming as fever, are necessarily less copious; but here, whether I advert to the still remaining imperfections of medicine, to the achievements of the pupils of other schools, or to what may be reasonably hoped from seminaries better constituted, I can find little answering to the assumptions of the senate. I suspect that a good judge of medical stock would find many physicians educated during the greatest splendour of the Edinburgh school, whatever local admiration several may enjoy, among the sorriest sheep in the whole flock of Esculapius. Edinburgh graduates, in short, no less than others, have ‘professed more than laboured, and yet laboured more than advanced,’ our art.
You would not fail to observe the senate advancing it as a fact decisive against the extension of the term of study, that their graduates turn out as good physicians as the graduates of ‘other universities, when the duration of study is much longer.’ Here two things will probably occur to you; the first, that the remark is nothing to the direct purpose, unless the excess of time be employed in serious and well-ordered study; the second, that this clinching insinuation must be levelled at Oxford and Cambridge, for one may swear that Salamanca was not in contemplation. In other papers, which this occasion has brought out, we poor Oxonians and the Cantabs are either dispatched by a sneer, as by a stroke of the stilletto, or attacked by a formal criticism on our exercises and residence, as by a charge of the bayonet; but I do not see any great courage in assailing the unresisting, for, I believe, that the English universities are never recommended as schools of medicine by any even of their own members. Some of us may, perhaps, lament that our scholastic founders should have carried that study, (along with others more suited to the scene) which delights to have its seat amid the filth, distress, din, and debauchery of great cities, to the sequestered banks of the Cam and the Isis; but this inconvenience, and the antediluvian motions which they entertained concerning the progress of the human mind, seem to be more than redeemed by one important, though accidental benefit. They afford the country some slender provisional security against that baneful system, which your association is desirous to correct; and it is solely owing to them that half drilled medical recruits have not absolutely every where usurped the function of commander in chief.
There is, I acknowledge, in our preliminary forms no bar against those, on whom all instruction is thrown away. Hence a few of the superlatively regular maybe as bad as any intruder, if not worse by the difference of their pretensions; and I long for another Moliere to render these episcopal Diafoiruses of our day as contemptible as, by their pompous incapacity, they deserve. But do not blockheads enough bolt through the Edinburgh sieve? I have seen scores of them before they were put in as well as after they had passed; and were I addressing the senate, I might surely, after their implied compliment to Oxford and Cambridge students, take the liberty of requesting them to point out when the generality of us proved so stupid as not to discover where the best sources of medical information lay, or so indolent as not to resort to them when discovered. Anciently, when knowledge revived in Italy, our predecessors repaired to Italy; we have since gone elsewhere in search of knowledge; to Holland, for example, or to Scotland. If any peculiar lights were to spring up in America, I do not believe that our successors would be deterred from approaching them by the distance. And now, Sir, I will venture, in opposition to the senate, to deliver it as my idea, that the effect is in medical education also as the cause; that is, the minds of the medical members of Oxford and Cambridge being more maturely cultivated, because they have so long to wait for a degree, do bring forth valuable fruits in proportion. Among our physicians we may find these three besides other classes: first, pure three years’ Edinburgh graduates; secondly, those who having been members of Oxford or Cambridge, passed to Edinburgh or elsewhere, and obtained a diploma there; thirdly, graduates of one of the English universities. Now I hold that the first class, taken collectively, though it exceed the last so much in number, has exceeded it in no other respect. From Heberden downwards, (for we must not look beyond the period of the celebrity of Edinburgh) whether we judge by the value of publications, or by any other criterion, the last and smallest body may be safely opposed to the first; and till the legislature shall interfere, I hope that the London college of physicians, disregarding the cry of illiberality, will maintain their post, as the vestige and memento of a much stronger and more extensive bulwark that requires to be raised against men, of whom all may have drawn from their alma mater some mouthfuls, but few indeed, the admirable Crichtons excepted, a bellyful, of the knowledge proper to their vocation. Should not those gentlemen, who call for a law nearly to double the period of preparatory study, wish, if they be consistent, that there may, in the mean time, exist some distinction, visible to the public, between graduates of three years or less, and others? But they will, I dare say, Sir, remark, that though there should, caeteris paribus, be no conspicuous general inferiority caused by the short space of Edinburgh education, the propriety of the first fundamental clause in the plan of reform, stands unimpeached. Though nothing certainly could be more conclusive in its favour than that mere delay in graduation, without any advantage specially attached to it, does tend to secure to the student collateral advantages.
A hue and cry being once raised against incompetent possessors of diplomas, it was to be expected that some of those, who boast the descent of their dignity from Edinburgh, should exhibit themselves looking down upon the sons of Aberdeen and St. Andrews, with as much pride as was felt by Mars, when he was seated at the right hand of Jupiter. ‘We have no defence,’ says one correspondent of Dr. Harrison, ‘against the pretensions of any half-bred surgeon, or superannuated apothecary, who may have the conceit or effrontery to usurp the name and office of a physician, by virtue of a bit of parchment conveyed by post.’ Another talks in the same strain, adding, that the said bit of parchment, by post, costs 141. A doctor by post or by brevet! surely a most ridiculous creature in speculation! One inevitably thinks of the horse that was created consul, or of an animal by nature still less adapted for bearing the trappings of dignity. But when you come to look closely, and to make comparisons, the aspect of things changes a little. Consider, Sir. The man who sends for the parchment by post, as his formal qualification for practising physician, must generally feel that he has, in some way or other, acquired the esteem of a large portion of his neighbours. He is usually one who has sown the wild oats of his body and mind: he has, at least, no longer his way to make to the routine of practice, through the usual series of murderous blunders. If he be ‘superannuated’ merely in name, he has had so much the more experience; if his faculties have decayed, the defect is so obvious, that he is really a less dangerous pretender than many a raw graduate, who does not get his diploma by post, but manages to persuade some credulous knot of old ladies, that he comes from Scotland full charged with healing virtue. As the patients, who repair to this place for its water and its air, have most of them been in the hands of physicians elsewhere, one has no bad opportunity of comparing the produce of different schools. I have observed watchfully, for above ten years, without discovering any thing like a medical Frith of Forth, dividing Edinburgh from St. Andrews. It would be gross partiality, therefore, in me, to pretend, that those Scotch-stamped doctors, who never were within smell of Auld Reekie, stand a whit behind such as have sucked in their medical nourishment in the very midst of her perfumes.
There is one very material circumstance respecting Edinburgh degrees, to which I doubt if the public have adverted, and which the graduates, together with the professors, seem themselves occasionally to forget, – I suppose because they are so habituated to it. This is the assistance derived from a set of men, so much the more important perhaps to the institution, as they are destitute of official salary or rank. After the ore is raised, stamped and smelted, they may be said to roll and anneal the metal for rendering it apt to receive the impression of the dye. They are, however, from another obvious analogy, called grinders. Were it of the least importance, I could wish them to be re-baptised; for the name they bear ill expresses the important process which they perform. This a good deal in my mind resembles the charging of an air-gun; each candidate being provided with so many Latin responses, which he lets off on a given signal, at two or three different exhibitions, in face of the professors. Most of the young men, as they come from examination with a diploma entitling them to practise and teach physic among all nations, I take to be full as much the workmanship of their grinders, as of their other masters. These, I believe, know much less about them; and often perhaps scarcely any thing but what they have derived from the tuition of the grinders; by whom most are likewise helped to Latin for the inaugural specimen of their talents for exercising and teaching medicine, and now and then to the whole specimen, diction and sentiments. All things considered, it was, therefore, hardly worth the trouble to cast the first stone, on the part of Edinburgh grinding, at Oxford syllogisms.
You would, I think, be seldom edified by modern Edinburgh inaugural dissertations: nothing can less resemble what we would expect from young men full of ardour and information. They seem rather like those dull pacifying explanations from lazy-minded practitioners, who, having been cunning enough to wheedle coterie after coterie into a good opinion of their abilities, grant themselves a dispensation from all contention with the difficulties of their calling, and simply work the routine as a gold mine. I find them very inferior to similar productions from Philadelphia, Halle, Paris, and elsewhere. The fact, on inquiry, has been acknowledged to me as matter of course by various Edinburgh students; who have added, that it is by no means the wish of the seniors, that a young man should labour to distinguish himself by a thesis, full of new and interesting facts, as Drs. Macdonald, Jones, W. Henry, and some others have done. The idea, as I learned, was, that this would abstract more than a just portion of time from other pursuits. If the fact be so, which I do not affirm, it seems a sign of hurry, and another strong indication in favour of the proposal for lengthening the period of study. The consequence must, I think, be mischievous. If the different sciences are connected, much more so are different parts of the same science; and he, who has been incited to cultivate one topic of medicine strenuously, can hardly neglect the rest, if he would. When a circle is drawn round a young man’s ideas, in his days of greatest enterprise, how much more likely is he ever afterwards to loiter within it, than if you make the communication of knowledge an incentive to its promotion?
But in the whole report, nothing startled me more than the fifth and sixth paragraphs, in which the senate speak of it as a thing ‘in the highest degree improbable,’ that other states should think of extending the period required for graduation (to five years, is specified; but the number is not essential to this part of the argument). They go on to point it out as illiberal, unreasonable, and likely to cause retaliation, if we prevent foreign graduates from practising in Great Britain. Really, Sir, either your correspondent must have been dreaming of such and such proceedings had in this matter abroad, or a whole academical senate (which you would with difficulty imagine) must have been ignorant of facts expressly in point, and concerning which it is easy to procure information. I know certainly, by the evidence of my eyes and ears, nor have I better proof that there is paper before me, that, twenty years ago, sensible medical men in France were greatly dissatisfied with their whole method, and particularly with the short term, of medical study. In 1787, I heard this strongly expressed at Dijon, and afterwards at Mr. Lavoisier’s in Paris. I have read, and any one may still read, in the Journal de Physique, the Journal de Medicine, and in separate publications, observations on the necessity of reform, such are the terms used, together with proposals similar to those of the associated faculty. Nay, Dr. Jadelot, whose tract appears to have made a deep impression, even thinks, that the term should be extended from three to eight years, because the pupil would, after this last period, be really fit to ‘enter upon practice;’ and time would be in fact saved by the prolongation, if education were properly conducted.3 Nor were the suggestions wholly thrown away: for, when they had their establishments to form anew, they actually extended the period of study, not to eight, or even to five, but to four, and these full years – an insufficient, yet a very material addition certainly; as would be felt by any man, to whom a quantity of wheat should be given to thresh in three days, were his task-master to allow him another day. To avoid all possibility of error on my part, I applied to Dr. Berger of Geneva, whose philosophical papers, I suppose, must have made his name known to you, and who graduated only in 1805 at Paris. His account is as follows, and he will doubtless be ready to give any further information – ‘D’àpres les reglemens actuels de l’école de medecine à Paris, un étudiant avant de pouvoir être admis à prendre son degré est obligé d’avoir quatre anneés d’inscription à la dite école, qui constatent qu’il a suivi les cours qui s’y donnent. Il paye, pour ces inscriptions et à differens epoques, la somme de 25 louis. Chaque examen se paye séparemment et lorsque l’étudiant se propose de le subir, car rien ne l’engage à le faire à une époque déterminé, il peut mettre, entre le premier et le cinquieme, qui est le dernier, l’espace de dix ans, si bon lui semble, ou quelques mois seulement’ (Extract of a letter, dated Dec. 3, 1807.)
We are thus again saved from all that disgrace and retaliation, which the senate were pleased to apprehend from the demolition of the polite system of triennial reciprocity. In this operation the French, I presume, felt not the slightest compunction, deeming the medical balance of power a very contemptible object, in comparison with any probability of providing for their sick more thoroughly instructed medical attendants.
From the regulation, I must suspect, that if there were peace to-morrow, no doctor would be allowed to practise in France on an Edinburgh diploma. He might be allowed his three years, but possibly required to study one longer, and undergo an examination, which he would find a little different from that at Edinburgh, and through which no grinding would help him. But I speak here from conjecture.
In some other universities, whose institutions have been newly revised, I believe that the period of study is likewise extended: and I hold it impossible, that in any new one the term of study should be confined to three years. But were it otherwise, what objection would this be? The same, I think, was alledged against the abolition of the slave-trade. If states and individuals are to wait, like minuet dancers, each till the other be ready to move, how can improvement ever begin? I should imagine, that nothing illiberal towards foreigners was intended by the ‘associated physicians.’ They would probably have been required to compleat five years of study, and to stand an examination; that is, they would have been put as nearly as possible on the footing of natives: I presume so from the nature of the case merely.
The same passages in the report contain, besides these misapprehensions, doctrines of the most questionable tendency. The increased expence of medical education would, it is objected, exclude ‘many, whose talents fit them for adding to the dignity and to the improvement of medicine;’ it ‘would tend, therefore, to diminish the number of well-educated young men of the medical profession.’ Here, you see, the question is begged; for how are they to be well-educated, unless they can afford themselves due time? Are we to take for our standard the circumstances of every parent, who may be ambitious of having a doctor in the family? This would be an indefeasible plea for two in preference to three years. Indeed if we look to any thing but sufficiency of instruction (for which assuredly time should be meted out with rather a liberal hand) where are we stop in paring down the term of academical residence? Placing a physician’s diploma and his qualifications within the reach of particular people are very different operations; and we must take care not to confound the two – A matter of rather curious speculation comes in upon us here. Some may, for example, suspect that the low purchase of Edinburgh degrees, including the expence of residence, has contributed as little to the dignity, as it has to the perfection of medicine. ‘The physician,’ as the report truly observes, ‘even at present must wait long before he receives an adequate return.’ Unless Edinburgh, therefore, create stoics as well as doctors, neediness can be no very particular cause of dignity. It is certainly not the way of the modern world for neediness and dignity to enter into a profession at the same door. Has not cheap accommodation, in fact, had something to do with the exclusion of such well-born and well-educated young men, as might be a certain source of dignity as well as of use to our profession? Among the students at Edinburgh, I recollect but one solitary sprig of nobility, and this was of Russian growth. From Ireland there may, indeed, have lain concealed in the mob sixscore descendants of her threescore ancient kings. But in all England scarcely will you find on the medical muster-roll, son or nephew of a lord, or of one of the rich old families in the county. Not certainly, because some of these might not find a warmer berth in ours than in other professions. Neither do I by any means affirm that the sole cause of the abandonment of medicine to us plebeians, is the unwillingness of our betters to fraternise with the worshipful society, issuing from this or that cheap seminary. But were medical education necessarily more complete, in which case it must become more costly, high and noble blood might feel one objection the less to diffuse itself freely through our profession also. Would not the profession gain, upon the whole, by attracting a portion of that cultivation, which, alas! it so much needs, and which goes in such profusion to the bar? I leave to you the answer to this question; and go on to remark, that possibly it might gain from this source one attraction and one feature of dignity the more, which I presume to think it ought to have. For that sympathy of the great with their own flesh and blood, which has added so much consideration to the two compact and formidable corporations of law and divinity, would not fail to cry aloud in behalf of medical merit. Statesmen who really serve, and warriors who guard whole communities, are entitled, doubtless, to the first honours from the whole. But what in the order of natural justice follows more closely than the claims of those, who confer upon society, individual by individual, blessings which a great author of antiquity justly represents as approaching near to divine! If life precede property in value, the guardians of life ought surely to stand upon an equality, as to public honours, with the guardians of property. If certain juntos are to share the national dignities and spoils, merely because these lie under their clutches, let us no longer cast reflections on the wreckers of the coast. For what do they do but avail themselves of the jus fortioris, and of opportunity to plunder the helpless? I cannot persuade myself but that the introducer of the cow-pock inoculation, if he deserve any thing at all, deserves a title with a pension to support it, full as well as many a contemporary jurist and diplomatist, with an enquiry into whose merits it was certainly very wise not to puzzle any committee of the house. Consider the case of another physician, to whom every human being, liable to fever, may stand indebted. Was he less entitled to public reward than this or that party-prater, to whom, in point of services, the crier of the nearest town might grudge to give way, or than this or that clerk in office, with whom his namesakes in the compting-house may vie without any violation of modesty? Is it not allowable to conceive that men, well informed concerning the public health, may have their occasional use in either of our legislative assemblies: Is every interest to be represented but this one? You will recollect how much of the ridicule on a late prime minister ran upon his descent? Other associations might have helped in giving currency to the joke against the doctor; but does not its success indicate an established feeling among public men, that every one allied to our liberal profession should be excluded from every good thing of a public nature?4
I do not, therefore, promise myself, that putting a stop to the too rapid manufacture of physicians shall speedily procure grander connections for medicine, supposing them desirable; which would clearly not be the case, if we did not procure them in as large a proportion as the law. For were a patrician doctor a rarity, he would be sure of a preference in virtue of his birth alone. Indeed, I will venture to say, that if the most miserable petit-mâitre that ever owned a diploma, be but lucky enough to get for wife a female allied to the peerage, he shall get for patients as many of the nobility and gentry as his horses can whirl him round to.
But it will, Sir, I hope, he remarked, that the propriety of an education calculated to raise the qualifications of the physician, is properly no further a national question than as it involves the interest of all the three kingdoms. English and Irish graduates from Scotland are far more numerous than Scotch; and we have Scotch practitioners, in whose training Scotland has had no share. I am not quite sure if it be not part of some people’s creed, that the natives of a particular country are particularly gifted for proficiency in the healing art, as was imagined of the Jews some six or seven hundred years ago. But you will hardly give quarter to the notion of a general difference between the natives of the three kingdoms in the power to perceive medical truth. All depends, no doubt, on individual capacity, and on culture. But the refutation of arguments drawn from the supposed advantages of any particular spot, will unfortunately assume the odious air of local reflections; and it will be well if it do not recal the maxim, malignitati falsa species libertatis inest.
The danger of incurring this odium shall not, however, deter me from avowing my suspicion that the singular fortune of the Scotch reputation in England has retarded the agitation of medical reform. Nor am I without my fears, lest it should prevent the requisite measures altogether, even though all our feelings shall not be absorbed in more pressing evils. Sir John Sinclair tells us in his Ossian, that ‘the prejudices in England were once so strong, that every person and every work from Scotland was sure to encounter the keenest possible opposition.’ I do not question the assertion of the worthy Baronet. I remember to have heard from elderly people, that before the first Pitt opened so wide a field for enterprize, the Scotch were regarded here somewhat as the Savoyards in France; and that, in some districts, the Scotchman vulgarly meant an honest pedlar with his pack on his back. Our illiberality could not fail to confirm the natural sympathy among insulted adventurers in a foreign land; nor can we wonder that the Scotch in England should cling together like bees at the mouth of an over-full hive. When so many great historians, metaphysicians, political oeconomists, lawyers, warriors, poets, critics, orators, engineers, and cultivators of the ground, arose to vindicate the Caledonian name; when the beams of court favour were supposed to rest with peculiar complacency on North Britons; when for years after years one Scotchman came to wield so much of the all-ruling influence of the Crown as necessarily attached itself to the pro-consulates of Scotland and of India; and when we became accustomed to see the Scotch oftener in the style of princes than of pedlars, opinion as senselessly swung into the opposite extreme. But the praeter-national clannishness, once established, continued as fervent as ever; and it has proved of more obvious advantage to particular Scotchmen than to Scotland or to England. If, when the name of a countryman was given out, particularly of one who had his fortune to make, we seemed to hear three times three from every Scotch throat between the Tweed and the Land’s end, how could the school of medicine, the boast of the metropolis, whose diploma was a letter of credit, fail to receive a full share of the common plaudits! I do not mean that there was nothing to applaud in that school. From the first MONRO to BLACK, inclusive, medical teachers of undoubted merit appeared. Improvements in the method of instruction were wisely adopted from abroad; and if any were made, let them be acknowledged in every way but as valid objections to greater. Our supine and almost criminal neglect of our own advantages suffered Edinburgh to continue almost the only place in the three kingdoms, where, at once, degrees were conferred, and lectures systematically read. How could Edinburgh then fail to be reputed the best medical school? Nor would any one, except an enthusiast, or a croaker, here and there, have perhaps even now dared to question its perfections, if the present general ferment among medical men, excited by other causes, did not encourage freedom of sentiment.
In resisting the extravagant assumptions of Edinburgh, you would, however, Sir, steer clear of all injustice; and while you endeavour to benefit the whole, be careful not to injure a part. On the late union with a sister kingdom, the boroughs, I think, were bought of individuals; and if Edinburgh, St. Andrews, or any other place, have claims on account of established profits on medical degrees, let them by no means be dismissed in the language of the late ardent apologist for the Irish catholics – away with ‘these Scotch principles of policy which regard only the vulgar interests of men. ’ Let the difference between the average for the last ten years (suppose), and for each year subsequent to the new regulations, be made up to the present professors for life. This will be a trifling fine upon the country for being allowed the chance of better taught physicians. Edinburgh will be saved the sacrifice which the senate offers to make in case there be no other valid objection to the proposed reform. I hope, however, that they will not rest this upon their own persuasion solely, but allow the public and the legislature, after hearing all parties, to judge.
You will hardly have had the patience to read thus far without expecting the positive, and, indeed, sole decisive proof of the hostility of the pretensions of the Edinburgh senate to the public welfare. This consists in the delineation of a course of study, from which it shall appear that a young man can employ five or six years at medical seminaries with advantages of the most essential kind, which he must forfeit on starting sooner as an independent practitioner, and which graduates of three years, as such, can therefore never possess. I beg leave, then, to submit the following scheme, of which I hope that the discerning and experienced will approve the principle. It is too much to expect coincidence in minutiae.
FIRST YEAR. Dissection, anatomical lectures, reading, drawing, and comparison of anatomical engravings with the objects in nature. For relaxation, as much as for instruction, a course of chemistry and elementary reading: – this for winter. In spring and summer, a course of comparative anatomy, dissection of animals, botany and physiological reading, till the winter of the
SECOND YEAR. Anatomy exactly as before, attendance on clinical lectures in surgery; if none are given, close study of surgical cases, particularly of surgical accidents at first; morbid anatomy practically, by every opportunity from this time forward. In spring, summer, and autumn, practical chemistry, pharmacy, botany, materia medica.
THIRD YEAR. In winter – Anatomy and surgery still; but external diseases now more than accidents. Spring, summer, and autumn – Midwifery, medical jurisprudence, comparative anatomy, physiology, and the other before-mentioned pursuits occasionally.
FOURTH YEAR. Anatomy to be kept up, lectures on the practice of medicine, clinical lectures. Observation of medical cases, and practical reading, to be a chief occupation through this year. The student may pass it at Edinburgh, at least from October to July.
FIFTH AND SIXTH YEARS. Close attendance on hospitals, with practical reading and lectures, at Paris and Vienna if accessible; otherwise in London. During the autumn of this or the preceding year, some time, if possible, to be employed in attending military hospitals, especially in the field.
During the summers, oral instruction, as it best offers, in other branches of natural history besides botany, in natural philosophy, and in the speculative sciences, if in these last any lectures should promise more than books. From one or the other, the acquisition of as many facts as possible concerning the mental operations, should be considered as an essential part of the stock of the knowledge necessary to the physician.
You perceive, Sir, that I propose to lay the foundation of medical education in the most exact mechanical and vital acquaintance with the human frame. The anatomie generale of Bichat would have afforded the best example I know of that elementary information at which the beginner should aim, if the author had lived long enough to acquire experience and erudition equal to his signal industry and genius. The knowledge of the human structure should be ultimately rendered so ready and distinct, that as soon as a part of the body is named, there should arise a clear image of its situation, dependencies, and office, as far as the latter is understood. I need not say that for this the student must take the scalpel in hand, and the more the better. There is no royal road to genuine anatomy; nor can it be acquired but by the united help of the senses. May Esculapius protect his votaries from ever again depending on demonstrations in the style of the elder Dr. *****! Preparations alone, could the student command the freest use of them, would be insufficient. What comparison can there be between the conceptions of him who goes through the making of a preparation, and of him who sees it ready made. To this should be superadded the anatomy of disease, in which you see I would begin with the most palpable, namely, the consequences of mechanical injury. You have here the grammar of universal medicine. The pupils of most schools, for want of being thoroughly grounded in it, are turned loose upon the sick, not only with scanty and confused notions, but with very inadequate power of acquiring others. Hence, in many emergencies, they must act at random, and will call a disorder incurable, when, to successful treatment, there was merely wanting a better introduction into the penetralia of animal nature. Had a severe practical study of the ordinary structure been generally followed up for the last fifty years by an investigation of every gradation of change, we should, by this time, have had infinitely less uncertainty in medicine, To proceed in any other order seems to me as absurd, as in beginning the study of geography, it would be to pore oneself blind over the map in quest of every hillock and thread of a rivulet, neglecting the Andes, with the river of the Amazons into the bargain. Do not imagine me, however, insensible to the necessity of taking cognizance of the most subtle objects of medicine in their turn. These I deem the most important and interesting.
You would probably think me capricious in setting down surgery as the second essential step in the general order of medical study: you will now, I hope, allow me to be consistent. All the world speaks of the necessity of anatomy to the practice of physic. What can render the knowledge acquired by dissection so permanent and so prompt, as the study of fractures and dislocations? Where can we find a set of examples for the young anatomist equally apposite with the analysis of accidents and operations? In other surgical cases, do not alterations in living parts come in succession under the eye, together with the concomitant affections of the constitution? What species of information, soberly applied under the guidance of pathology (including morbid anatomy), can possibly throw so much light upon concealed internal diseases?
Mr. Hunter himself, he who came with the habits of a mechanic to labour in his brother’s dissecting-room, must have proceeded in some such way. I am glad to be able to name Mr. Hunter, because the example shews that the most accurate visual and tactual ideas do not necessarily create that grossness of mind which incapacitates for refined speculation. I believe that the real fact is just the reverse; that contemplation can find no stage so advantageous from which to soar; that those who cannot reason upon a stock of such ideas, would never otherwise be able to reason to any purpose, and that this road is still the best, even for those who are incapable of going so fast and so far.
A single example does not indeed amount even to a probability on the ground of experience, since it may always be suspected that more was due to genius than to opportunity, though the contrary, I think, will appear, upon examination. But facts, unknown to me when the preceding plan was sketched, go far towards demonstrating the propriety of prosecuting practical anatomy to a great extent in the education of physicians. These facts are furnished by the modern school of Paris, where there are from 500 to 600 students. Independently of their application to the question of medical reform, they deserve to be generally understood, both as they concern the professors and pupils. I shall therefore state them explicitly.
In 1578, lectures upon the cases of patients actually under treatment, were established in the great hospital of S. Francesco at Padua. Dr. Albertino Bottoni, and Dr. Marco Oddo, were appointed the first clinical professors, and enjoined to open the bodies of such patients as should die, to discover the seat of disease.5 A century afterwards, this grand improvement in medical instruction was introduced by Sylvius at Leyden, and transferred by the pupils of Boerhaave to Vienna, Edinburgh, and elsewhere. It is susceptible of various forms. The case of a patient being taken down, the professor may report and prescribe from the bedside, as in Scotland, at his daily visits, the students entering what he dictates in a portable journal, and the consideration of the whole case forming the subject of a lecture after its termination. Otherwise, as at Vienna, advanced pupils may take upon themselves the function of practitioner, under correction of the professor: or, after the round of visits, the professor may comment daily in a lecturing-room upon the nature and progress of each case, which is the present method at Paris. In truth, different methods seem to be demanded by different occasions. In acute cases, and wherever sudden variations occur, the attention of the pupil ought, without delay, to be fixed upon cause and effect; whereas it will frequently be more instructive to bring the slow changes in chronic ailments under one view. But to bind themselves to a stupid uniformity is, you know, the old vice of schools. In regard to the Paris method, however, I beg you to remark to what a severe test it brings the discriminating powers of the professor, and how powerfully it must rouse the curiosity of the pupil. How much must the mind be kept alive by the interest always felt in referring a prediction to the event when that is near at hand. For after a patient dies, his case is read at large before the assembled class. The professor explicitly delivers his opinion concerning the cause of death, and the body is opened on the spot to search for it. Late French writers have pretended, that in this clinical institution of theirs, the great object of ascertaining the characters peculiar to the lesions of internal organs has been brought to a degree of perfection unknown before, and such as has nearly precluded error.6 But every one is aware that it is easier still to put upon paper than upon canvas a face too shewy for the object which it professes to exhibit, and that the French are among the greatest adepts in this art. I was therefore far enough from giving credit to so flattering a representation on mere French authority. Yet the allegation appeared of a kind not to be neglected by any medical enquirer, anxious to become acquainted with the advances in his profession. On turning to Dr. Joseph Frank, himself a professor at two great medical schools, and not at all disposed to speak in a partial manner of persons or things appertaining to medicine in France, I found that he had frequently attended the clinical lectures: and he confesses that he could not avoid admiring the sagacity manifested in predicting morbid alterations (Reise I. 44). I had received the same account from him personally, before I saw his book. It is certainly gratifying that this intelligent traveller should have met with so many things in Great Britain deserving his approbation. But by attending to particulars, it is plain that he did not, any where among us, witness the exercise of a talent so difficult, so rare, and so useful, as this nice application of anatomy to the discrimination of internal disease. Opportunities have occurred to me of putting my own questions to such Paris students as could not, at least, be influenced by national vanity, and who were not even originally bred at this school. All concurred in the same testimony. The words of one, not French, and practised in morbid anatomy from his earliest years, were: J’ai été toujours etonné de la justesse du prognostic de M. Corvisart pour les maladies organiques du coeur et des gros vaisseaux. Dans sa clinique sur 30 malades les deux tiers y etoient-ils admis sur les soupçons qu’il avoit de l’ existence de ces maladies; et il est certain que rarement il se trompoit – – – Tous les jeunes gens sortis depuis quelque temps de l’ecole de Paris ont peut-être plus de connoissance d’anatome pathologique que dans tout autre université – – – – – – – – – – – – – . Among physicians, equal in other respects, those who are brought up to distinguish internal affections with accuracy must always be superior; and I am afraid that there is almost as much difference in the cultivation of this fundamental talent between some of our most celebrated schools and that of Paris, as between the chemistry of Glauber and that of Lavoisier. You shall hear further reasons for this opinion. Such a foundation being once laid, the proper structure may indeed not be raised upon it; and, I think, they are but just beginning at Paris to learn how to finish their work. But no other foundation is fit to receive the edifice of medical knowledge: without it, the superstructure must be both irregular unsubstantial.
Other facts may be adduced to shew the prodigious activity of anatomical investigation. Dr. Laennec, a young physician of the same school, speaks, if I remember right, of having opened six thousand bodies. Dr. Dupuytren, his rival, also represents his own experience in pathological anatomy as immense. Suspecting exaggeration here, I applied to a physician perfectly acquainted with the habits and opportunities of both. He felt convinced, that there was nothing at all incredible in the assertion, since each might very well have opened from three to six bodies a day for several years. A foreigner, now in England, assures me, that in two years and a half, during which he was assistant physician to a Paris hospital, he opened about three hundred and fifty bodies. Private families, it may be observed by the bye, seldom refuse this permission, and the magistrate, simply on the plea that the practitioner is desirous to ascertain the cause of death in an obscure case, will authorise an examination. They are not, it seems, quite so unreasonable as to require the full benefit of medical information, and to refuse us the only means of obtaining it.
The arrangement of the lectures at Paris, which seems much more advantageous than at Edinburgh or London, and the examinations, tend to confirm the preceding statements. According to the whole of the plan, little less stress seems to be laid upon anatomy than I propose. I wish that the example was afforded by any other country, though the French have not been remarkably deficient in their methods of teaching science. They had before them the experience of former medical schools, and certainly they would not be such cannibals to themselves as not to provide, in the best manner possible, for the qualification of their medical practitioners.
Most students reside the whole year at Paris. They have two sessions annually; one beginning in October and ending in May; when the summer session commences without any interval, and lasts to the end of August, or middle of September. In winter the lectures are less numerous, that the student may have time to dissect. They consist of courses of anatomy and physiology by different professors; surgery is taught theoretically and practically; a distinct lecture is given once a week on bandages and chirurgical instruments; there is also a course of chemistry. In summer, nosology, botany, materia-medica, pharmaceutical chemistry, medical jurisprudence, hygiene, therapeutics, and medical physics are taught; clinical lectures go on all the year. In the short autumnal vacation, the students may attend courses of comparative anatomy and natural philosophy, and other branches. It seems much better that instruction should thus be distributed through the year, and diversified, than that it should be mostly crammed into the wintry months. The student is much less perplexed by the
–––– mille inde magistri,
Hinc totidem––––.
The following sketch of the examinations I owe also to Dr. Berger. I give it in his own words:
‘Dans le premier examen qui roule sur l’anatomie et physiologie, avant d’être admis à l’examination, vous êtes enfermi pendant deux ou trois heures dans un chambre avec un cadavre et vous devez faire la préparation qui vous est echue par
le sort. Elle est ensuite exposé en public. Cet examen se fait en Français. Le 2d sur la nosologie et la pathologie se fait en Latin. Le 3me. sur la chimie, la pharmacie, et la matiere medicale en Français, anisi que le 4me. qui a pour objet l’hygiene et la medicine legale; sur ce dernier point vous êtes obligé de faire illico devant les professeurs un rapport par écrit sur une question qui vous est offerte. Le 5me. et dernier est un exercise qui roule sur trois questions de pratique. Il est écrit en Latin et l’on y repond verbalement dans la même langue. Comme chaque examen se fait publiquement, les professeurs ne peuvent faire aucune injustice criante ni accorder aucune faveur signalée. Je manque de terme du comparaison pour juger s’ils sont extrêmement rigoreux; mais d’après ce que j’ai entendu dire à des jeunes Americains, qui avoient suivis les cours d’Edinbourg et qui y avoient pris leurs degré, les examens sont beaucoup plus serieuses à Paris. Il n’est pas très extraordinaire de voir des individus ajournées.’
You will judge how far such an examination is calculated to animate industry, ascertain proficiency, and exclude incompetency. The signal merit of numerous productions by the candidates of this school, for several years past, down to the last which I have seen, that of Dr. Delaroche on the effects of a strong heat on the animal œconomy, – a subject which you undertook before to illustrate at your personal risqué – speaks highly in favour of the whole method.
Suffer me however to add, that a rule like that of justice among children – you cut and I’ll choose, might here be applied with increase of advantage. Let one set of men prepare, and another examine. The two royal colleges might examine for England and Ireland: –For Scotland, all not educated at Edinburgh might be examined there; and the Edinburgh candidates at Glasgow. Examination should be of two parts-formal and essential; – the formal to ascertain whether the candidate has had adequate opportunities. Towards the essential, the Paris method presents an excellent model. But more direct proof should be required of that attainment which is the end of all study, and the sole thing to be anxious about on the part of the public – the talent for practice. The pupil, therefore, ought to be made to examine a certain number of patients in some hospital, and to propose a plan of treatment for each.
It may be asked how, under the present discordance of medical opinion, we shall find fit examiners. But the investigation of disease is no longer in general vague. Do not our present nugatory examinations include questions of practice? concerning which, however, it is always comparatively idle to talk in the abstract. If we cannot bring a man to some test of his real ability ‘for entering upon the practice of medicine,’ or if we shun the necessary pains, should we not honestly give up the farce and write, in illuminated letters, on the front of every diploma, CAVEANT ÆGROTI?
Examination should extend also to erudition. The bad effects which I have pointed out as resulting from deficiency in this, induce me to assign to it a large space on the scale of study. The idea that the acquisition may be put off till after graduation, which seems to be generally acted upon at medical seminaries, and admitted by the public, I deem in the highest degree dangerous. Practical reading, combined with extensive observation of the sick, is, in my apprehension, the only possible way of catching that indispensable requisite to the higher order of practitioners, the true spirit of experience. For, as Quesnay well remarks: La Vraie experience est l’experience generale, qui resulte des observations particuliéres de tous les temps et de tous les lieux. The student will, of course, first take into his hands the elementary treatise most in request, or recommended by his practical professor. This, with hospital attendance, will give a rough outline of the more ordinary forms of disease and processes of cure. But his most profitable reading, that which is to form his judgment and furnish him with resources, will be the works of observers; and principally, the collections by societies or individuals in every part of Europe for near a century past, together with Sydenham and a few authors of remoter date. According to some trials against time, I conclude that moderate industry would digest from 500 to 800 of these volumes in the three last of six years of study. Our medical Emilius should not only read, he should sift and lay up in store the pure facts, examine the reasoning, ascend to the source of false analogies, and try to substitute a better practice for that which is related as unsuccessful. He will thus acquire a talent which I do not believe that any triennial manufactory, either directly or remotely ever conferred on its graduates, and which, to say the truth, is often fatally deficient in us all. With equal faculties I should compute, that a student so trained would be actually richer in experience than the generality of three years’ graduates in their twentieth year of practice. Of the routine he would equally possess whatever experience has shewn to be best calculated for the cure and palliation of disease. In the other part of the routine alone, namely, in the medical savoir faire, or the art of passing off words for deeds would he be deficient. Does not medicine consist in the knowledge of facts progressively accumulated; and is not he who sets himself forward as the last hope of the sick, without an extensive study of these facts, guilty of a breach of trust of the most criminal species?
To show the general necessity of erudition to observation and improvement, it may be sufficient to refer to the progress of knowledge, in which we perpetually see one man advancing further because another had advanced so far. Allow me, however, to advert to a single example. I will choose, as the fairest, that of Heberden; in whose works nihil e scriniis aliorum compilatum videmus; and in whom, summa est fides, summa auctoritas, pura, incorrupta, intaminata. But, Sir, was Heberden pure, somewhat after the pattern of those children of nature, the imaginary savages of Rousseau, because he lived a stranger to the corruptions of art? Was he original, because never in the way to be prepossessed? Nothing like it. He was singularly learned – eruditionis omnis amantissimus, ipse omni eruditione ornatus, with that of his own profession among the rest. He did not avoid the snares of hypothesis, because he never approached them, but because he saw where and how they where laid. Ab eo, quicquid vel hilum saperet Theoreticam artem . . . . . . . quam maxime abhorrens. And what instruction, I beseech you, is so effectual as that of bad examples taken right?
Few rules, I apprehend, will be found more free from exceptions than this – those who are perplexed by the observations of others will never combine clear motions out of their own impressions. And I think myself fortunate in having fallen upon a passage of Dr. G. Fordyce, too late indeed for the printer to annex it to what was said above of confusion in the accounts, and failure in the treatment, of certain modern fevers, as depending in part on hurried education. But the passage is still suitable to an argument in favour of copious and well-digested reading as subservient to genuine observation. ‘The opinion about the infectiousness of the semi-tertians of hot climates has been various, and given by young and unlearned practitioners with such positive and contradictory firmness, that it is very difficult to form any true conclusion of it.’ (Diss. 4, on Fever, p. 65).
Anatomy and universal experience being the two intellectual eyes of medical men, when they are sent abroad with both dim, how can their report of objects be either reconcileable or clear. Practical works, so essential towards the completion of the attainments of the student, can be no where found in such abundance as in the seats of education, and certainly no where else can he have the opportunity of comparing the contents with nature. If he take young, he may join a medical book-club in the purchase of new publications, but will hardly ever set about a systematical plan of reading, and go on very contentedly ignorant of a far greater number of useful facts than he has acquired. If he do not take, where is he to have the means, even if he have the spirit of literary enquiry? It is difficult to perceive any good reason why a physician, who is neglected for years, and has, in consequence, small means of improvement, should get into the public confidence at last. Is it believed that we doctors of physic, like apples, grow mellow by mere keeping?
I rejoice at having only one Edinburgh objection more to notice, (though if I knew of any better arguments to the same purport, I should hold their production indispensable). In noticing this, I shall be led to a consideration equally important with the preceding. –The committee of association, as we have seen, propose to put ‘respectable schools of physic’ on the same footing with universities, as to the qualifying effect of residence. The senate, and you cannot be surprised at it, take fire at the proposal. To admit ‘certificates from schools of physic may,’ they object, ‘prevent the possibility of ascertaining a regular education; schools may be self-erected and subject to no controul.’ The omission of a word in this objection does, to be sure, make some little change in the sense. ‘Respectable schools’ are specified. The senate run on arguing as if it had stood ‘any schools whatever.’ The paper, indeed, wanders away too far into minutiae of regulation, which are not yet before the public, and do not belong to the discussion of the principle.
The provisions might have been exposed to just censure. Respectable schools are not easily distinguishable in terms from the reverse, though they will distinguish themselves, and none others be frequented, unless they have the power of conferring degrees. But to oppose conferring equality of right upon schools, which have displayed equal power with any university in qualifying for practice, would not sound quite so liberal as the conditional offer to surrender a lucrative privilege.
You might, I suspect, find among the medical men around you, some who would go so far as to ascribe, to the instructions of the late Mr. Hunter alone, greater effect in forming the practitioner, than to those of all the Edinburgh teachers of his time put together. A majority of the medical world would place him far above the best singly; and does not the whole face of medicine, if we compare the impression left upon it by the one and the other, corroborate the preference? Along with Mr. Hunter the student might have attended his brother, who was the best modern teacher of anatomy, Dr. G. Fordyce, and others, together with the hospitals. Was it just that advantages, so important to the essence, should go no way towards the form, of a doctor in medicine? Had we only to decide, whether the larger share of profit from medical education should go to London or Edinburgh, I would either not waste a dozen drops of ink on the question, or vote for Edinburgh as being in possession. But superior interests are at stake. And now, what is there at Edinburgh in the shape of instruction that London need view with despair? In what respect ought we to deem a London education (equal in time and diligence) with a St. Andrew’s diploma, inferior to an Edinburgh education and diploma? In what but the interposition of the grinders, those dii ex machinâ in the great scene of Edinburgh doctor dubbing7
But, Sir, I trust if it ever come to law-making, that the objection will be radically removed by endowing London at once with the privilege, enjoyed by every great metropolis in Europe besides, and particularly suited to a great metropolis. An attempt at improvement, short of this, though it may not leave British medicine as ineffective as the pamphlet of Dr. Harrison found it, will leave it much more ineffective than the means of instruction allow, and the public good requires. Why, in the name of common sense, should not London be authorised to call candidates in our faculty to the bedside as it does those in another to the bar? Neither English university would, I dare say, view the measure with jealousy. The members and the whole public must perceive, that London is the spot in Great Britain, and probably in the whole world, where medicine may be taught as well as cultivated to most advantage. Nor would it be easy to estimate the number of persons, whom our government has suffered to linger in misery, or to die in the flower of their days, simply from having so long neglected to found a compleat medical seminary there. The claim is on the part of human misery, not of national pride. By the force of its unrivalled opportunities alone, with but few teachers either celebrated or deserving celebrity, though they now seem to have grown as thick as haberdashers, London has, perhaps, more than equalled the most celebrated seminaries; and it would, I think, amount to a sort of treason against the common weal, if they should remain without being seconded by the whole public power, after the state of medicine comes to be a matter of legislative deliberation. In the course of many years, I not only never heard a specious objection, but generally found, when the leading ideas were propounded, that every hearer followed them up to the same conclusion.
But let us not, at least not wilfully, take a station below Paris. Let our regulations aim at still greater maturity in those whom we shall send forth to practice and teach the healing art – ubique gentium. What would it avail to increase the breed of practitioners, akin to those coffeehouse politicians of ours, to whom the leading paragraph of the Morning Post stands in the place of history and political economy; – practitioners all absorbed in the last curious case at Guy’s, or the last curious opinion from St. Bartholomew’s; and not much more deeply skilled in the disorders of the individual than the newsmongers are in those of the body politic.
Every well-wisher to medicine and to mankind would desire to see Edinburgh maintain or recover what she ever had of real excellence. The contest would be generous if fairly carried on, and the competitors be allowed the fullest exercise of their faculties. But let not London have her hands tied behind her that the sons of Edinburgh may have the delight of beholding her superiority, or at least escape being mortified by her manifest inferiority.*8
I should here finish my attempt to procure a larger audience for this obscure, but important, discussion, if I could suppose that you would like a scheme the less, merely for being comprehensive. One may likewise hope that the legislature, having fixed medical education upon a basis less unworthy of the general state of science, and of the peculiar object of the art, would not feel so faint in the labour of well-doing as to refuse all further consideration to the protection of individuals against disease and unskilfulness in its treatment. But, Sir, I must trouble you to remark, that there is no necessary connection between the suggestions which I am about to throw out, and the conclusion to which the preceding arguments lead. The epithets romantic, visionary, extravagant, or the like, will be bestowed upon what follows: but let no one imagine either these, or any reasonings that may happen to accompany them, necessarily fatal to those arguments.
Though there be small likelihood that any of our physicians, even those who may receive the justest tribute of gratitude from the whole world, shall ever be thought personages considerable enough to be ennobled, one may hope, that on proper explanation, we shall be allowed to ennoble our art. This would not interfere with the customary perquisites of any class of men, and every class would feel the benefit. One cannot complain of impediments thrown purposely in the way of physic. But neglect is sometimes more baneful than opposition. And here, Sir, I would ask you why we should not be permitted, and not only permitted, but encouraged, to collect and embody the whole medical experience of the country for the benefit of the country? I need not say to you that such an attempt has been made in favour of agriculture. It certainly is equally desirable in regard to medicine; and would, I believe, be attended with just difficulty enough to give a zest to the undertaking, and no more.
Why should not reports be transmitted at fixed periods from all the hospitals and medical charities in the kingdom to a central board? The regulation would prove beneficial beyond all calculation, both to patients within the house and to those out of doors. To the patients by increasing vigilance, and, of course, by rendering practice more accurate. To all mankind within the influence of recorded medical observation, in a way that does not require to be explained. The art of healing is deeply indebted to such men as Pott and Hey, to several among our predecessors and several among our contemporaries, for what they have recorded of hospital experience. But if a part is so precious, what would the whole be? and how can the facts that have been preserved, be justly considered otherwise than as fragments of a mighty wreck, demonstrating the value of the mass that has perished? To lose a single fact may be to lose many lives. Yet ten thousand, perhaps, are lost for one that is preserved; and all for want of a system among our theatres of disease, combined with the establishment of a national bank of medical wealth, where each individual practitioner may deposit his gains of knowledge, and draw out, in return, the stock accumulated by all his brethren.
It is true, that there may be infinite delicacy required in meddling with establishments principally supported by voluntary contribution. But it is impossible to suppose that any being, endowed with the human form, can fail to be gratified by the chance of contributing by the same act to the relief of the afflicted, not only of his own day and neighbourhood, but of all future times and all countries. The institutions themselves would be also greatly benefited by the notoriety of the transactions of each. In papers not long since printed by Dr. Clark, the Newcastle infirmary was declared to be in a state of disorganization. Nor is it to be supposed that any hospital is so completely organized as not to admit of additional improvement. The most odious feelings seem sometimes to operate against the sufferers within their walls. I could undertake to bring judicial proof of undoubted improvements, made by persons not belonging to the hospital of a given place, and sturdily rejected by those who did belong to it, though received elsewhere. Can you have any difficulty in assigning the motives of such rejection? And would they not be controuled by notoriety? Medical proceedings in charitable institutions must be arbitrary. But it is always some security against the abuse of arbitrary power to subject its operations to public censure. The infusion of new life into these institutions, by a regular change of their medical attendants, would obviate at once many of the bad effects of inactivity, and of professional jealousy. The medical body of an hospital never deserve the preference, which an appointment for life seems to give them over their brethren. The propriety of a rotation is not only sanctioned by all analogy, but by direct experience at Glasgow, and in the clinical wards at Edinburgh; and after a grand public discussion, in which the present professor of the practice of medicine headed the opposition, this was adopted in preference to the system of permanency in the new regulations respecting the surgeons to the Edinburgh hospital. It was wisely preferred for the new cancer institution, and is equally applicable to all medical establishments.
But I think, Sir, that there is another simple expedient which would prevent the waste of facts. The degree in which this misfortune to society subsists is striking to every one who adverts to the subject. Thus it is remarked (as I presume by Dr. Clutterbuck, secretary to your association, and undoubtedly a man of acuteness) of the mercurial lepra, that this ‘is a disease well known in the London hospitals, and probably from its notoriety too little regarded to be thought worthy of writing a book upon.’ ‘This,’ he adds, ‘is a too common error in London, but scarcely avoidable from the vast variety of facts which are constantly obtruding themselves. London furnishes more medical facts than all the united kingdom beside, in proportion as there are more subjects in the hospitals; yet the number of records bears no proportion to the difference,’ (l. c. May, 1805, p. 425.)
Why then not at once multiply the number of labourers since the harvest is so vast and so valuable? If the present labourers be overpowered, add two or three times the number to every field.
The state of medicine might, if I do not mistake, be further essentially improved by a species of dispensary, to which I have ventured to give the name of preventive medical institution. I wish I had it in my power to produce other testimony besides my own, and that of several other medical gentlemen, who have assisted at one which has existed here for several years. I have described it fully in a little tract, entitled Instructions on the subject of Health (Longman, 1807). I hope that an account of the observations, to which it gave occasion, which I mean shortly to submit to the public, will effectually recommend it. The utility of the thing is, I trust, too obvious to require an elaborate exposition. If we medical men do not know how to eradicate the disposition to our common fatal or harassing chronic disorders, and to cure these in their early state, there is nothing which we ought to be more eager to learn. If we do know how, we ought to have more frequent opportunities of exerting this the most beneficial part of our skill. These objects will be best attained by establishing preventive institutions, or by extending subsisting medical charities to the same effect.
No corpse ought to be allowed to be buried without the name of the fatal disorder from a medical attendant. If there have been no attendance, this ought to be specified. We may surely condescend to baptize the complaints which we cannot cure. The lists of mortality, so obtained, ought to be annually transmitted to the central board.
Thus, in spite of inaccurate and discordant nosology, there will be acquired a sufficient general knowledge of the depredations committed by our fatal disorders, and it must become perpetually more accurate. The state of health of the army and navy would of course be combined with the civil reports; and the authority of a board, properly sanctioned, would command the contributions of private practitioners at home and in the colonies, to an extent far beyond that of the editors of our collections of medical facts, so that scarce a corner of the empire should conceal an observation capable of useful application to the national health.
The central board should be, or at least it should contain, an office for proving popular as well as secret remedies. The lesson taught by the history of medicine concerning the Peruvian bark, and other precious articles of the materia medica, we have just seen confirmed by the cowpock inoculation. This was picked up from popular tradition; and it appears oftener than once to have tried to force itself into use, as we learn from the anecdote respecting the practitioner, who lost his popularity by undertaking to propagate it from the trials of Mr. Benjamin Jesty, and from the Devonshire communications, which Sir George Baker suppressed. But, Sir, I should hardly conceive it possible, that there can exist a practitioner so vain as not to be convinced by frequent warnings, how much useful knowledge there may be afloat, of which his philosophy has never dreamed; and for want of which, he has prematurely sent many a patient to his long home. This the public has always felt. Acute observers have laid stress upon the fact; ingenuous practitioners have avowed it. Thus we find Antonio Guaynerio, so justly celebrated 400 years ago, yielding the palm to an old woman in a most serious case, where the issue can hardly be ascribed to the power of imagination.9 Saepe medicastri, balneatores, carnifices, fabri ferrarii drastico aliquo medicamine miro efficere videntur, ubi legitimus medicus de salute aegri desperaverat, says Silzle (sylloge, p. 14,) and tells a remarkable case to this effect. Dr. Frank senior, the physician, perhaps, of greatest repute in the present day, gives us a case, in which the patient was not only snatched from the grave, but restored to perfect health, by means the most opposite conceivable to those which he had judged proper, and of which he would have strenuously opposed the administration.10
We continually hear similar instances from witnesses altogether competent to report a gross effect. Nay, we see such every now and then. A gentleman, as well known in Westminster as any inhabitant of the place, of remarkably fine person, and in the flower of life, went to a watering-place with the loss of power in his lower limbs. An unprofessional dabbler in medicine offered to restore him in a week: ‘You! in a week! why I have been this twelvemonth under the care of all the best physicians in London.’ The dabbler, nothing disheartened, set to work, and he actually fulfilled his promise. The patient has enjoyed full use of his members ever since: that is, for two years. A lady also, long deprived of the use of her lower limbs, whom I had examined, and the physicians of greatest name in the metropolis had vainly tormented, has been enabled to walk by the same means. I should willingly refer you to the parties. The performer of these miracles talks, to be sure, as wrongheadedly of the cause and cure of disorders as any of us, and seems about as rash as we are cowardly; so he will bring himself into disgrace. For if among ten patients, declared incurable by the faculty, he benefit five, nay nine, and the remaining die, this one will be held up by us to the apprehension of the sick, as the fair result of his practice; whereas our failures are only so many misfortunes, as the girls say, who have children before they have husbands, and are to be laid to poor Nature. – Which is more destructive? the ignorant rashness of quacks, or our ignorant cowardice?
That the initiated are to blame for not venturing upon medicines such as those by which aliens sometimes rescue invalids, whom we abandon to their fate, I by no means affirm. But are you acquainted with any thing more contemptible than that contemptuous air with which we are apt to receive these memorable revolutions in the human system? Is any thing less becoming in us under that helpless ignorance of which such facts convict us? It is plain enough that, in many important situations, we know not either what nature can be made to do, or what she can bear. We are, of course, at a loss to direct what she requires, and our endeavours to render her assistance are nugatory or worse. And shall we allow ourselves to indulge an interested scepticism, rejecting the means of enlarging our ideas to the extent of her capability, when it is not even necessary that our character shall be, in any degree, staked against the consequence?
How very possible is it, that a person out of the profession may get hold of a remedy for some disorder, which bids defiance to the pharmacopeia? How much more likely is this to happen as physical science refines and enlarges? Your generous nature will revolt at the idea of secrecy. But those who have never had to struggle for a livelihood, should, perhaps, hesitate before they proclaim a man a monster for not making an unconditional surrender of a medical secret. Least of all, have we practitioners of medicine a right to exact that any one, more ingenious than ourselves, should empty his brains into our pockets? Are we, forsooth, so disinterested with our pittance of skill? Private and public interest might, perhaps, be reconciled by small provisional grants for new medical applications of any promise, till a sufficient time for a definitive judgment elapse. What matter though a few thousand pounds of the public money be thrown away upon losing chances? That the nostrum be new, or not in use, is a necessary condition; and indeed the whole claim of the secret-monger is founded solely upon the possession of something superior to common medicines.
What would be the effect of register offices, not exactly for receiving votive tablets, like certain ancient temples, but in which attestations, both of the good and the evil, that appears to be done by practitioners of medicine, should be deposited? We can never come at the just balance between regular and irregular practice, without having the accounts on both sides. It may be objected, that ignorance, passion, prejudice, and partiality, would falsify the registers. They would so extremely. But the public gets the particulars infinitely more falsified, as it is. They fly from visitor to visitor, from circle to circle, garbled and disfigured. Some are compleatly forged, and generally without possibility of recurring to any authentic source of intelligence. Rumour puts on the form assigned in the Eneid to one of the furies, when she is charged to mislead Turnus to his ruin –
Alecto – in voltus sese transformat anilis
Et frontem obscœnam rugis arat ––.
In this form there is no lie which she will not propagate in favour of one physician, and in disparagement of another.
Now, if by any means private families could be induced to record the prognostications of doctors, and the event, the mode of treatment, and the appearances on dissection where a fatal termination takes place, there would be less deviation from fact in that circulating intelligence, upon which the world, for the most part, acts in the choice of medical men. Vigilance and humility would be maintained throughout the ranks of the profession. And those fortunate individuals, who rise often without any superiority at all, and always without any proportional superiority, would be saved from the deadly sin of medical conceit.
Should you dislike one pattern of a project, let me offer you another. You would not, I trust, concede so much to the most vulgar among the opponents of medical improvement, as to object to a general experimental hospital, not merely for the trial of secret or popular remedies, but for the exercise of humane ingenuity upon cases deemed incurable in other hospitals, or in private hands. The cancer-institution offers a partial example of such an establishment; and no earthly reason, I presume, can be assigned, why the same chance should not be extended to other complaints equally fatal, though not equally cruel. A general hospital, for the chance of relieving desperate cases, has actually been more than contemplated by the founders of the present great medical school at Paris. I find no distinct account of it in the able rapports au conseil general des hospices (4to. An. xi. ) though two hospices des incurables are described at pages 107 and 110. But Dr. Joseph Frank mentions l’hospice de l’ecole (I. p. 46), as the place where Dr. Petit-Radel and M. Dubois have their clinique de perfectionnement, for the reception of rare cases, and for the trial of new operations or remedies. In 1803 he found them making use of the remedy proposed by M. Seguin, for intermitting fever, under the inspection of a committee of the Institute. According to a manuscript, however, lying before me, by a physician who had better opportunities, and later by two years, than Dr. Frank, this admirable institution would seem now to be nearly limited (perhaps from being too small for both branches) to the experimental improvement of surgery. The account runs: ‘C’est un service chirurgical, à la tête duquel se trouve M. Dubois, operateur très-habile. C’est un charmant hopital, qui se compose de deux salles; l’une pour les hommes, l’autre pour les femmes; dans chacune desquelles il n’y a pas plus de 15 à 20 lits. Ce sont des cas rares et choisis. On opere toujours dans un amphitheatre et à une heure, qui permet aux éleves qui suivent les cours de l’Hotel Dieu ou de la Charité d’assister, s’ils le veulent à cette clinique. Il y un jour ou deux daus la semaine pour la consultation des pauvres externes. Les cas sont autant medicaux que chirurgicaux.’
Provisions like these would not only procure observations in greater abundance, but occasion them to be more nicely made than those with which medicine has hitherto been supplied, – a point now strenuously laboured at Paris. You would not be afraid lest the art should be overwhelmed by their number, as from the example of all physical science, you well know that it is the want of facts which has constantly kept their cultivators in perplexity; and that as more have been acquired, knowledge has become so intelligible and inviting, that from being confined to a few obscure adepts it has entered into the mass that circulates through society. Of this chemistry affords a very striking example.
Whatever obstructions may be apprehended, in an attempt to facilitate the improvement of our art by improving education, the associated faculty have felt greater difficulties from the most crying abuses, as appears by the fifth clause of the original project, and some subsequent particulars. This clause provides, ‘that none of these restrictions shall be construed to affect persons at present regularly practising in the different branches of medicine.’ The term regularly might have perhaps created difficulty in its definition. But from the case recently drawn up by Messrs. Greene, Tennant, and Harrison, for the advice of counsel, it would seem that a change of opinion on this point has taken place; for it is there expressly declared, that the views of the acting parties are to ‘prevent irregular persons from entering into the profession in future, without disturbing those who are at present practising (however irregularly)’—(l. c. p. 115.) A critic (l. c. Dec. 1806) also prefers the plan of Dr. Harrison to that attributed to the college of physicians, because the latter is retrospective without limitation, and likely to offend old practitioners, whereas the former is entirely prospective. As far however as any past statute could be brought to act, I should think it but consistent to urge it to the utmost extent of the letter against the unqualified actually practising. That would be no innovation of principle. Personal security, the only argument which can touch, or ought to touch the public is much more conclusive in favour of cleansing the Augean stable of medicine completely and at once; nor is any reason hitherto urged, or likely to be urged, less so. If incompetent practisers are ever to be stopped, why not now? What right can usurping the privilege of lucrative homicide confer? What has the present generation done that it should be poisoned any more than the succeeding? If a man come into possession of an amulet, shall he lock it up for the use of his grandchildren and great grandchildren, taking his own chance for the mischief against which it would afford him protection? and what is the proposed reform to be, if not such an amulet? In any way, then, short of an ex post facto law, is not the college perfectly right in being retrospective; and may not those, who have illegally profited by the medical destruction of their fellow-citizens, think themselves most mercifully dealt with, that the college is not retributive also. Indeed, whatever a person may feel in adverting to his own insufficiency, as soon as he puts himself in the place of the public, and considers this unanimous testimony of the medical profession against itself collectively, he will not well be able to avoid the wish that the whole were to undergo a scrutiny like that which has been repeatedly attempted upon the worthy electors of Westminster: nor would he much regret, though it were as severe as that which Robespierre exercised upon his Jacobins.
On the subject of advertised quack medicines, the project is silent, whether because insurmountable objections were whispered into the ear of the framers, from the treasury; or with their correspondent, Dr. Storer, of Nottingham, they ‘believe, that any attempt to eradicate quackery by legislative authority will be vain; it seems to depend upon a principle in the human mind, which if it exists, will find its object: while bishops, judges, and peers, furnish certificates for the value of nostrums, there always will be quacks to invent and distribute them.’ – (Med. Rev. Aug. 1806, p. 101.) The association must well know, that perjury is constantly kept up by the means taken to recommend quack medicines: that in consequence of money expended on their purchase, families above the poorest class are frequently deprived of the necessaries of life: that there are instances where people have sold the bed from under them (the rage for quack medicines, in some familiar instances, being just the habit of dram-drinking) and that the resort to these preparations is far from being only the natural catching at a straw in him who feels himself drowning. The prostitute is not content to wait at home in readiness to satiate already excited appetites, but roams abroad to practise all the arts of provocation. Neither is the quack content with the spontaneous yearnings of credulity; his lures are spread in all our streets. The office of every country newspaper, is an office for his medicines, and often for nothing else. From the sale the printer procures advertisements, and pays himself. Every country bookseller almost is stimulated by an enormous commission to pass them off. I think, therefore, that a scheme for the reform of medicine without the abolition of quack medicines, is about as hopeful as one for making the rattle-snake harmless, leaving the venom fangs in his jaws; nor should I be surprised, if such a scheme pass, to hear of a grand dinner among the quacks, and each reformer being toasted in a bumper.
A fair provision being once made in the way above proposed, or in any other, for remunerating the real ingenuity or fortune of such discoverers of new remedies as do not belong to the profession, and will not disclose them gratuitously; the advertising and sale of secret medicines ought to be entirely suppressed. One would hope, that no financier would stand up and plead the revenue alone as a reason for their permission. For is there any one who would not, on the least consideration, perceive, that they by no means contribute to lighten the general burdens, in proportion to the sums, which they may cause to be paid for various stamps? How often do they bring families to the parish, when they neither directly or indirectly injure the health of purchasers? But when the diseased head of a family mistakes in prescribing them for himself, they will occasionally destroy him by standing in the way of proper medicines, or by acting as direct poisons.
It does not appear, whether the committee submit to tolerate the existing irregular practitioners, and advertising quacks, because their honest pride whispered them, that it is a paltry ambition to aspire to stand high by sinking a competitor? Did they doubt, whether the present race of regulars deserve to have an unrestrained monopoly of the sick trade secured to them by law; or perchance apprehend taunting comparisons?
‘What insolence,’ the man replied;
‘Shall cats with us the game divide?
Were all your interloping band
Extinguished, or expelled the land,
We rat-catchers might raise our fees,
Sole guardians of a nation’s cheese.’
If it be objected, that medicine is no soil, upon which legislative power can raise a mound strong enough to keep dupes apart from impostors, I reply, and hope to prove, that no such impossibility is requisite: neither does it follow, that poor human beings, racked with pain, or labouring under the terror of dissolution, must necessarily be deprived of any one comfort which they may fancy, by the extinction of quacks. Paradoxical as this may sound, I am persuaded, that by a little management, this race would soon cease to be missed. For, if the fund of quackery already in our profession be not an adequate provision for the credulity of the sick and of their friends, I will venture to say that it can be increased on demand to any extent. Of this encouraging truth you will require strict proof; and I challenge you to detect any false paces in my logic.
Have I not, almost within arms-length, an instance strongly in point? For what, I pray you, could invalids lose by the suppression of all quack medicines for consumption, while the regular faculty is in snug possession of the hotwell here by the side of the Avon? What is there in Godbold’s vegetable balsam that this water cannot replace and (faith in the gift of St. Vincent failing) have we not the air of Clifton close at hand, offering itself to us as presumptive heir to the reputation of the water? Should you allow the said water and the said air to be abundantly calculated to satisfy any cravings of credulity; consider a little, I beseech you, the accommodation of that part of the faculty, which is engaged in the great corresponding branch of medical practice. This cannot be said to be carried on by corresponding societies; the term is too large; knots of two or three only are concerned in this correspondence. These brother doctors, sir, though separated as widely as I am from you at this moment, or more so, sympathize as tenderly, and are as ready to relieve one another’s distresses, as those knights of old of whom we hear as brothers in arms. Take, for instance, a common case: the family doctor in London, Dublin, or where you please, cannot bear to think, that the son or daughter of a dear friend of his should die at home, just under his nose. So no sooner does it come to be a hotwell case (a term within a few weeks synonimous to a corpse) than off the invalid is sent with a pass. Invalid and pass are delivered to the receiving doctor, whose feelings, as he is a stranger, cannot be so much overpowered by the tenderness of friendship. And when the patient is dead and disposed of the receiving party, you know, may never be again distressed by the sight of any of the family. He prescribes, therefore, away as his friend had done before him, adding of course so much per day of the said hotwell water, which, I repeat it, may be considered as a worthy substitute, for any quack composition ever put together. So it goes on, till the jaws of the patient are either locked by death or despair.
You have not, however, yet the whole beauty of the corresponding scheme, on which I rely so much as one substitute of quackery. God forbid that one of us hotwell doctors may not have his fit of fine feeling too. This he can indulge, as you may judge, from the eternal advices of the end of hotwell patients. You oftener have it, to be sure, thus:
Died, November 18, 180–, of a consumption, at the hotwells, whither she was sent for the recovery of her health, Miss ––, aged 19, eldest daughter to Sir Thomas ––-, ––Hall, ––shire.
But then it sometimes runs so:
On the 24th, died the Right Honourable Lady Clementia ––, sister to his Grace the Duke of ––, at the Oxford Inn, Exeter, on her way from Clifton, which place she had left five days before, to try the mild air of Devonshire.
As to the rest, you know, sir, there is to be a little vitriolic acid for the night-sweats, chalk mixture for the bowels, poppy syrup, or that favourite nostrum, the black drop, or what you please of the like, for the anodyne. Although the whole hotwell art of physic may be acquired in three days by a person of the most moderate capacity, what the worse is it when practised by a doctor in form, rather than by an old nurse, or unlicensed practitioner?
Indeed, were the doctor to tell you his own story, ten to one but you would hear him sobbing over la triste condizione d’un medico vero ed ingenuo, and make it out that he has head-breaking work of it, and is obliged to earn his subsistence in the very sweat of his soul.
Some shallow people may talk of the barbarity of sending poor creatures away from home to die on the high road, or in comfortless lodgings. We on our part, however, allege, that it is humanity, and often all that humanity can attempt, to gratify a wish, or kindle short-lived hope. But the gainsayers will retort, that it is right to contrive cheaper, and less painful frauds; and should a sinking invalid be seized with an idle longing to be conveyed to Bristol hotwells, or, like Harry the Fourth, into a chamber called Jerusalem, that it is easy to divert him from the whim. – People, in short, by contemplating this subject, may work themselves up into a sort of phrenzy, and call upon our chimneys to break their natural taciturnity, as those of Madrid did once upon a time, and disclose the secrets of the abominable traffick of corresponding medicine. They may even call upon the spirits of the air to fix in traces of flame upon Temple-gate, Bristol, (which is not much out of character for a portal to Dante’s Inferno, or the hotwells themselves:)
Lasciate ogni speranza, voi ch’entrate.
Abandon hope, all ye who enter here.
In the philosophy of natural history, we hear much of the chain of beings. Now, I think, I may defy a naturalist, even so skilful as you are, to point me out two links in the chain more closely connected than various specimens of watering-place literature, and the productions of quacks. It has indeed been a remark of common critics, that such and such a pamphlet, by such an one M. D. in direct or equivocating recommendation of such a water, is merely a diffuse quack bill.
I was going to shew, that Bath has no less capacity for preventing the public from feeling the extermination of quacks than Bristol. But the argument is not local. In all places, there may be found medical Jansenists to fill up the room of the suppressed Jesuits. Do not the prudent friends of almost every young physician endeavour to give his mind the very turn which tends to render my argument demonstrative? Upon what do they incite him to fix his entire hopes but upon the quality which a philosophical lawyer has coarsely, but expressively called, the gullibility of mankind? He is to assume some part which does not belong to him; and where is the mighty difference, I pray, whether a man for gain, set off himself or a mixture of drugs for what neither the one nor the other is. The trick of a pretended summons out of company or church, may be grown stale. It manifests the spirit of the trade, however. You have perhaps seen the proprietor of a quack medicine, during his triumphal progress through the kingdom, drawing the eyes of a whole city upon the splendour of his equipage. ‘How many people must find their account in taking this doctor’s stuff, if he can afford all this,’ thinks the simple spectator to himself, and away he hurries for a half guinea bottle. The physician cannot start without a quack’s varnish over his carriage. Indeed to coquet for custom in an equipage beyond his circumstances, is considered as altogether essential to his success. The equipage is to serve for an advertisement, which shall render the simple spectator as eager for the one doctor’s prescription as for the other doctor’s stuff. Some of your committee could, I have no doubt, let you into still deeper secrets. And the further you dive, the more securely may you defy any mortal to point out a service performed by quacks, to which we regulars are not competent. In fact, if we do fail to address ourselves with equal adroitness to the self-same gullibility, which is the dependence of the quack, whatever else we may do, it is odds but our ‘chief reward will be,’ as Mr. Hume writes to Lord Kames, ‘the pleasure of studying on such important subjects, and the approbation of a few judges.’ I have heard a young physician in earnest advised to give so many dinners of business per annum; and this, I think, is a recommendation, against which the quacks on their side have nothing to set. When the beginner in practice has the sense (and I have known more than one, who has had the sense), to choose for helpmate, a serjeant Kite in petticoats, the scheme of recruiting for patients by such a bounty, is pretty sure to succeed. Invitations fly in all directions; and when the guests are assembled, it is a pleasure to see how cordially the good lady crams them with her dainties, in sure and certain hopes, that the turn of her doctor will come to cram them equally with his drugs.
Now will you allow of a distinction between us and our bastard brethren, where there is no difference? Are our artifices to be all accounted pious; their’s all impious? Will you believe that it is in their nature to go on eternally sinning for lucre; whereas every legitimate child of Hippocrates, after he has once glided into the sick room on the skaits of deceit, is sure to cast them aside, crying out with the boxer of old –
–– hic artem cæstusque repono?
I need not press this argument any further. You, Sir, must, I think, now be satisfied, that the thunders of the law may be hurled at the quacks without delay. But there are two or three other matters still, seemingly not so easy to adjust as this.
Much is said of the necessity of ‘raising the respectability of the profession:’ yet I do not see that any thing is proposed towards the removal of certain practices which have contributed to draw down upon our art the ridicule, censure, or distrust of the choice spirits of every age; among whom we may reckon Petrarch, Bacon, Montaigne, Moliere, Le Sage, Frederic II., Rousseau, down to the late Lord Lansdown and Mr. Fox.
One of these, if its extent and notoriety be considered, is enough to provoke a man, whose composition has nothing of the cynic, to exclaim: ‘How long, thou huge helpless Public! will thou stand gaping like a brute, whose upper lip is wrung in the cord of the farrier, to receive whatever thy merciless drench-dealers may find it their interest to pour into thy capacious jaws? How long wilt thou submit to a pilfering collusion between doctor and apothecary?’ To ordain that the same person should never prescribe and sell drugs, would weaken this abuse; but the measure is impracticable in country districts, where indeed medical labour is severe, and its recompense scanty. Were the invalid only to pay for medicines at prime cost, and the whole profit to be thrown upon attendance, it would much alleviate the evil, if the rule could be inforced; and the object deserves a statute as strict as that against usury. Or, in mercy to the entrails of mankind, might it not be ordered somewhat in this manner? By the French livre des postes, the owner of the post-horses could charge for so many more than he furnished. As in the medicines sent to opulent houses, the efficient ingredients bear about the same proportion as the bread in Fallstaff’s bill of fare to the other articles, I do not see why this expedient of indemnification should not be imitated; and it would lighten one curse which at present lies heavy on the progeny of the opulent, of whom, to whatever else they are born, we may be very sure that they are born to be wash-tubs to the apothecary or the quack. According to this arrangement, a charge would be made out somewhat in the manner following:
Miss Lydia Languish,
To Drenchard and Co.
| 1808. | £. | s. | d. | |
| Jan. 1. | To a phial of drops – | 0 | 0 | 6 |
| To pills – – | 0 | 0 | 9 | |
| To 6 chargeable imaginary draughts – | 0 | 9 | 0 | |
| An emulsion, do. – | 0 | 2 | 6 |
In our largest provincial towns, apothecaries are said to clear fifteen hundred, two thousand, and three thousand pounds a year; – more of course in London. It would be curious to know by the gallon, kilderkin, or hogshead, how much medicated wash, (to say nothing of pills, powders, and so forth,) must be swallowed to produce these profits. On this view of the subject, one may be led to suspect that the best expedient for all parties would be, that dispensed articles should be charged four-fold their present price. The apothecary could not materially increase the sum total of his bills. Without doing so, he would gain full as much, and families would be spared three-fourths of the present drenching.
Physicians are often as needlessly prodigal of their visits, as apothecaries of their potions. If, indeed, a nervous lady of quality choose to pay every day for an idle morning call, all is very well, and there is sure to be no lack of doctors for morning visitors. But the practice can not so well be generalized. I have heard from several prudent people, that there is no getting doctors and workmen out of a house, when once they get in. These prudent people act up to their maxim, and either trust to nature, that is, manage themselves, or send to the medicine warehouse. In either way they can stop when they please; not being embarrassed by any verecundia erga medicum. This is the only case, I think, in which the prohibition of quack medicines could be sensibly felt.
In a Letter to Dr. Clutterbuck (Rev. Sept. 1807, p. lvi), it is remarked, that ‘if the higher professors of the healing art would be as ready to take a sixpence as the pretenders, and as willing to do as much good for it, the former, without any coercive means, would have no cause to complain of the interference of the latter.’ A skilful hand has here, sure enough, touched the foulest part of the inveterate canker of medicine. Our dignity is unfortunately placed in the quantity of our gains, not of the good we do. What are called the first physicians in town, would be disappointed if they did not scrape together as much gold in six months, as a great government contractor in one; and the second and third rank in popularity pride themselves in enabling their wives and daughters to make as good a figure as those of any fashionable taylor. It is to no purpose to say, that physicians in general are ready to give advice to those who cannot afford to buy it. The modest and the independent will never permit themselves to beg time from a man, whose time is money. And the physician, though he might practise this liberality now and then, must soon cease, if the demand upon it become large. The sort of medical advice termed the best, can never extend to one in a hundred among those who may wish for it; and the less affluent patient must drag his misery to inferiors and interlopers; a plan, to be sure, which is far from always answering in point of œconomy.
It is curious enough to observe certain differences of opinion among the correspondents of Dr. Harrison. The project puts it as a query, whether the fees of physicians shall be made recoverable by law? – No, say the doctors of Shrewsbury: Aye, say the brethren of Liverpool. – Why? because each calculate that they shall respectively get most by the opposite plan. It seems more just indeed, that moderate pay should be secured to the one, than the chance of exorbitant remain to the other. These perhaps will call it more dignified, that this article should be undetermined. Truly, I believe it, if that dignity be meant which is measured by fees. – I leave myself to your honour’s generosity, are sounds of which no body is at a loss for the sense.
Every one knows who the beings are that manage the distaff, thread and shears, by which the fortune of many among us is doled out. These beings never, I think, undertake to dry-nurse the reputation of lawyers. Were the very persons, whose advice so often prevails where life is at stake, to hazard an opinion upon any question involving five pounds’ worth of property, they would hardly gain so much notice as a glance of contempt. But the place about the sick assigned by nature to females, the universal propensity in male and female to explore causes, vanity ever on the watch to encroach on the province of a superior, anxiety, infection, the very imperfection of medicine (though this ought to have a quite opposite effect), all contribute to the fatal authority of the sex in medicine. How unfortunate, that the weakest women will form the strongest opinions, and that these opinions should impress minds, enfeebled by sickness, very much in proportion to the confidence with which they are declared! The busy-bodies in petticoats, who are by turns our rivals and our patronesses, though originally actuated by benevolence in part, soon cease to have any other motive than the ambition of palming a physician on all their sick acquaintance, that the world may learn forsooth, what they can do towards a man’s fortune. They feel, however, aye, and they make the protégé feel, in what a strong chain of gold they hold his heart. For this and for other similar reasons, medicine is the most servile of the professions, and still bears so strongly the marks of the ancient condition of its members. One has heard of fawning divines, fawning courtiers, and the like. But these spaniels in the human form have only to caper at the whistle of a single master; whereas the supple carcase of the physician must perform its cringes to a whole circle every day. The followers of other professions, it is true, find themselves too often in the condition of wretches, condemned to the mines. But in no other is there, I believe, such frequent stooping to pick gold out of the dirt. The complaisance of all our prudent brethren towards the sick and the guardian angels whom we see hovering round the sick, you cannot have to learn from me. The ladies of the court and city not only get their notions concerning disorders and remedies, (as who does not?) but their minds are usually made quite up. The best thing which the doctor therefore can do is, to listen with a face of sanctified wonder, protest that he was just thinking of the same thing, put his goose-quill under the guidance of their inspirations, and content himself with translating them into certain magical abbreviations; as pilul.-pulv.haust.: which are the main support of his professional dignity, and that grand mystery of the art, into which these, his female prompters, have not yet penetrated. This obsequiousness has, I believe, gone far towards making some good fortunes, as fortunes go in medicine. That it is not any creature of my imagination, the following anecdote, concerning no less a personage than Dr. Gisborne, late court physician and president of the royal college, may serve to satisfy you.
‘One of the princesses being taken ill, and Dr. Gisborne in attendance, her royal highness enquired of the doctor if she might not indulge in the use of a little ice cream, as she thought it would greatly refresh her.—Dr. G. who never contradicted his royal patients, answered that he “entirely agreed with her royal highness; ” and the ice was accordingly provided. His Majesty, visiting the chamber and observing the glass, with some of the ice still remaining in it, seemed alarmed, on the supposition that it might be improper; but her royal highness assured him that she had the doctor’s permission for what she had done. His Majesty ordered the doctor into his presence, and observing to him that he had never heard of ice being recommended in such cases before, expressed his apprehension that it was on some new system. The doctor seemed at first a little confounded, but quickly recovering himself, replied, “Oh no, please your Majesty, it may be allowed provided it be taken warm”—“Oh well, well, doctor, very well, very warm ice, warm ice. ” His Majesty seemed to be much entertained, and for some time afterwards always took the opportunity of asking those he was accustomed to meet whether they had heard of Dr. G’s new system of prescribing warm ice.’ (Med. Rev. May 1806, p. xxxii.) It is fair to suspect that the poor doctor was taken up too quickly; for if you only put a comma after ice, in his answer, and make him mean, when the patient was warm, the opinion might be, for any thing that appears to the contrary, conformable to our best knowledge. But I have only to do with his never-failing conformity; and if the habit exist among the haute noblesse of medicine, it certainly descends to the lowest ranks in full measure. Nothing is more usual than a speech of this nature from aunt, cousin, or grandmama. “I saw the poor child was ill, Sir, and you must know I directly gave him so and so, and when our doctor came, he told me that I had done perfectly right, and most likely had saved his life. ” Thus are the pretensions of the vulgar and the stupid fostered by flattery. Just so quacks adapt the language of advertisements to their capacity.
You see how difficult it would be for medicine, had it greater native strength of wing, to soar among the sciences. It may be doubtful whether we raise the minds of the gossips with whom we have intercourse. But who can doubt whether gossips draw down our minds? It is not merely time that is wasted in our private exercises in the art of fascination. But the faculties dwindle under the exercise. ‘Minds that are levelled in their desires, become levelled in their powers.’ Dryden, when he wrote with the same views, wrote with the same dulness as Settle, and became a very quack in poetry. The Settles of physic, whether original or transmuted, do not fail of their reward. A number of patronesses are often better than any patron, and much better than any degree of knowledge; even when such patronesses are nothing higher than mistresses of furnished lodging houses at watering places. You can be at no loss to imagine, how this tribe of sympathizers manage the feelings of their man, when once they get at him, towards medical practitioners. Those who are, may find some elucidation in the way, in which we see Othello managed by his tender sympathizing friend Iago.11
By this time, sir, I am sure, that between the associates and your present correspondent, you must have heard enough of abuses. What I have to add, concerning their removal, is neither profound nor prolix. Only, sir, let me ask, if you will take the fairest chance of mending the matter, whether you should trust to law alone? Is not information a more powerful public talisman than an act of parliament? I dare not, however, prosecute this topic at large: it would lengthen out my letter immoderately. Let me, therefore, content myself with advancing a few propositions, like those at the end of an inaugural dissertation, which I hold myself bound to defend, whenever called upon.
It is an established maxim of prudence, to provide every one with information enough to secure his property against common dangers. Is the person then less exposed or less worthy of defence? The defensive species of medical information is just as capable of being laid down in the form of rules as in any other matter of practice. I may be perfectly able to point out to a traveller the dangers of a particular road, though if he fall and break his leg, I should not know how to set it. It is one thing to caution a child against the berries of the deadly nightshade, and another to administer the best antidote, if he have poisoned himself with them. The distinction between avoiding and remedying disorders is frequently as palpable, and may generally be rendered quite clear.
It is ignorance that commits, encourages, and suffers, from abuses. There is wanting a sceptical or cautionary system of popular instruction in medicine, which shall teach meddlers to distrust themselves and every body else to distrust meddlers.
Could people be kept from thinking about their health and acting in consequence, there might be a shew of reason in the doctrine, that they ought to leave it entirely to others to think for them. Even so, however, that would happen which perpetually happens, when of two parties to a transaction, one is ignorant of its nature. The other will avail himself of his superiority for his own emolument, whatever becomes of the interest of the first. But causes out of human controul are always spreading false opinions; and shall they not be counteracted by the diffusion of information, which need only be accurate, not extensive? A moderate share of accurate information, will preserve from gross mistakes and impositions. The first rules of arithmetic will save you from being cheated by your butcher and baker, though they will not enable you to follow the scientific track of Newton through the heavens.
Can you believe the ignorant, that is, the obstinately prejudiced, to be more fit for nurses than for physicians? They will not only acquit themselves ill, but like terrified passengers on board a boat in foul weather, baffle the most expert watermen in the exercise of their functions.
As long as medicine shall be practised in its present form, and we continue to be unassisted by well-qualified domestic observers, so long will the art of preventing diseases be in great measure wanting. The first important series of deviations from health must escape us during our fugitive visits. The number of victims to consumption, madness, and all complaints of obscure origin and slow progress, will keep up, if it do not increase: and medicine still stagger along on disjointed ideas, as upon so many ill-placed stepping-stones, ever and anon dropping its charge into the slough.
Dr. Currie in that letter to you which he has prefixed to his reports, says: ‘It were better perhaps that medicine, like other branches of natural philosophy, were brought from its hiding place, and exhibited in the simplicity of science, and nakedness of truth.’ To this, popular lectures on anatomy and physiology are, I think, indispensable. Were these encouraged by persons of influence in society, and at the same preventive medical institutions set on foot, you would soon see some check to our professional and unprofessional frauds in medicine; nor should I be surprized if those who profit most by the former, were to come forward in active opposition, and canvass, from house to house, against the design; no insignificant proof of its utility. That you would succeed with the public, I have a right to assert from the result of actual trials in a place perhaps the most unfavourable possible for the purpose. Dr. Currie, many years before he wrote the letter above quoted, had very strongly expressed his approbation of this attempt, as it was explained in a lecture, introductory to a course of instruction on the structure and management of the human body, published in 1796, by Johnson.
Were all the sorts of knowledge, like articles in a warehouse, fairly exposed before the most liberal and curious among our youth, I have no doubt but their choice would frequently fall upon the study of animal nature. But its claims being concealed so much from view during the years of education, they escape notice at the time when the heart is both free and warm. Should a serious interest be generally taken in the condition of medicine, an event may happen the sooner, which however ridiculous it must appear, I have contemplated as possible, from the present progress of physics alone. I do not, for example, see why at some future period persons of fortune may not like to maintain as many animals for the prosecution of physiology, as they do at present for barking after hares, stags, and foxes, That they would find at least as much amusement in the former pursuit, we may be certain. He who has at all considered the interior of animal nature, must have a barren head indeed, if he cannot point out numberless processes, which will scarce ever be carried on upon a proper scale by medical men, but which the sums expended upon a pack of hounds would conduct to highly curious, and possibly useful results. Of the effect of the unprofessional cultivation of physiology, may we not form some conception from the progress of another science, since it got out of the hands of dealers in prescriptions, dealers in drugs, and other traders? As chemistry, in losing sight of pharmacy, found the means of rendering pharmaceutical processes more perfect, so when physiology shall wander away from medicine, it will be but to return to her with more precious gifts.
Let me finish with one extravagance more. If you can imagine that the independent cultivator of science will ever ascend from inanimate to animated nature, and to man – if gentlemen of fortune are not for ever to grow up with such feelings towards their own interior, as Captain Lemuel Gulliver brought back from his voyages; – if they are not always to keep aloof from the abominable thing, they can never stop at what is called physiology. As well might one expect the astronomer to overlook eclipses and comets.
It is true that the generality of those who are curious among the rich, require that the feast of knowledge should be served up to them in a comfortable room, well dressed, and in dishes from which they can cut and carve just what suits the palate. But what is there in the nature of things, to prevent a few – one individual, endowed with the more than heroic courage and constancy of a De la Condamine;12 as richly gifted by nature and fortune as Lavoisier; as well qualified for penetrating the abstrusest secrets of creation as some who add lustre to the society over which you, sir, preside, from exerting in behalf of the sick, that generous spirit of investigation which seeks only truth and utility? You must acknowledge, that the contemplation of organic and intellectual nature is a flower that blooms aloft in the purest fields of æther, though it drive its root so deep into the sordid soil of pecuniary interest. But who shall say that this root is incapable of being transplanted into the unpolluted fountains of social affection?
There is no career in which benevolent genius would meet with so rich a reward. Without going to Cherson, a man might relieve more human wretchedness than he who fell a martyr there. Have you any idea, sir, of the complicated misery from disease and medication, in which families above charitable institutions, but beneath the better educated practitioners, are involved, left as they now are to downright quacks, and the non-descripts that figure so conspicuously in the lamentations of Dr. Harrison’s correspondents? Are you at all acquainted with the gross and barbarous empiricism perpetrated upon those who languish in the cells of insanity? I acknowledge with satisfaction that an author or two have lately thrown a few rays of light on this dark part of medical practice. But the first and most indispensable qualification is commonly wanting in those who carry it on. Were they summoned for examination, you would, I fear, find the majority scarce greater proficients in the knowledge of the human mind, than in the Chinese. Much less would they prove themselves capable of availing themselves of their precious opportunities for its application and advancement. The unprofessional proficient in psychology is much better qualified for the charge than the physician who has but gone through the routine of instruction? And shall no man above being a slave to wealth in possession or in prospect, ever devote the heart of a Howard together with the head of a Hartley, to the relief of these most unhappy of captives?
That all-enduring and all-renouncing ardour required for exhibiting to the world one single practitioner worthy of the object of medicine, must be every where rare, but no where impossible. Some may imagine that any one whom it should inspire, would still recoil from medicine, as the field for the exercise of his virtues, on account of the offices which this art imposes, and the constant requisition in which he must hold his person.
This is betraying a very slight acquaintance with the devotion proper to genuine active charity. It is to this day usual for delicately bred persons, independent of all vows, to join the quondam nuns as nurses in the Hotel Dieu. Are we not assured, on the best authority, that the filles de la charité, instituted by S. Vincent de Paul, and lately re-established, scarcely ever change their state, though bound by their vows but for one year?13 And who would compare the life of the greatest slave in our profession to that of these females, either in the constancy of service or kind of employment? Should the simple ardour of useful knowledge ever induce any one to qualify himself for acting the part of physician, the superiority of his motives may be expected to render him as superior to mercenary physicians, as the daughters of charity have shewn themselves to mercenary nurses. It would be injurious to pretend that there are not many practitioners of physic, whose heart the love of their profession more than equally shares with the love of gain. None more bitterly lament the obstructions to which the latter motive obliges us to submit. The man whom I contemplate would tolerate no such obstructions, whatever urbanity he may shew in removing them out of his way. He might give the vulgar race of intermeddlers credit for their intention; but he would make them feel sensibly enough his opinion of their capability. The singleness of his object would enable him to profit more by every opportunity of knowledge; and his zeal would be more permanent, as springing from a more permanent source of activity in the human mind. We should see nothing of that lukewarmness towards improvement, which so commonly arises when the physician has got upon the full scent of profit, and still less of the apathy, which overtakes him as soon as he ‘has feathered his nest.’ I have been assured, by a curious observer, that the late Dr. Warren often bestowed but three minutes on a case. I understand that a fashionable physician in town is not to bestow above ten minutes under peril of being deemed not sufficiently hurried. He who had nothing in view but the benefit of the sick, would feel it as a crime to take charge of cases which he could not study. By the restriction he would acquire far more skill. A multitude of cases viewed hastily, instruct less than a few observed well. We every now and then catch sight of influences, of which the source and action are destined to form new orders of facts in the science of organic nature. But these will hardly be traced in common practice, and I expect that discoveries of this exalted kind, whenever made, will be owing to any other persons rather than to the ordinary practitioners of physic. I expect most from sagacity, generated by the intense desire of finding out how to be useful. Quid non sentit amor? What sharpens the perceptive faculty, even in art and science, like true love?
Some wit, if any wit cast his eyes on these pages, may quote against me –
‘The mob of gentlemen who wrote with ease.’
The peer who took to the lancet for a hobbyhorse, and whose vote Lord Chesterfield secured at the hazard of his veins, may be brought in also as a specimen of independent professors of the healing art. But my imperfect delineation is sufficient, unless there be a pre-determination to misunderstand, to distinguish that enlightened charity ‘which vaunteth not itself,’ from the forwardness of those vain drivellers, who so often crowd round the sick bed, and are either principals, or accessories in the destruction of the occupant.
Such a phaenomenon in medicine may, or alas! he may not appear. But it is certain, that your example cannot be otherwise than beneficial. Should it induce other reasonable and respected persons only to look into the state of medicine, good will arise. A general discussion alone would perhaps do more than any enactment of regulations without discussion.
Finally, Sir, how little would it add to the labour, but how much to the utility of instruction, if people were only put in the way to guard the human stomach against the invasion of our Slops and our Purgons. – When a man, who thrives upon the sale of unsavoury beverages, flies from tea-table to tea-table, declaiming upon the abomination of experimenters in medicine, his hearers, one would think, must be sensible, that the outcry against a rival’s fish as stinking is only to get off his own. –Of quack compositions we regulars cannot in honesty but confess that they are excellent, being, in fact, the very same which we use ourselves. But excellence in this article is strictly relative, though if a quack-bill can really teach the application as well as years of study, the regulars ought to be put down. Let this simple consideration decide concerning the existence of one or the other. Only let it be thoroughly considered, whether the adaptation of a powerful medicine do require judgment or not. This is a point too little attended to; for the vulgar spirit of mankind is a gambling spirit. Hence the medicine-warehouse has in a great measure the same allurement with the lottery-office, and adventurers conceit that their good genius will secure them a prize as well in the one as the other. – It may still be a question, whether it would not be as safe to indulge this gambling propensity as attend to certain recommendations in matters touching health. For why not as well put drugs and doctors upon the turn of a die as be guided by those who must have a wrong bias, from which the die is free?
Topics like these, duly illustrated, would confer a little of that prudence with regard to the person, in which, with regard to the purse, the world cannot be accused of such extreme deficiency. Coarser impostors being sufficiently noted and protested, the public would gain so much insight into this common concern, that scarce would apothecary or physician venture to palm upon an invalid draught or visit beyond what the case requires; and physic, long so much the art of cajoling, will sincerely become the art of healing.
That you, Sir, as you have so well deserved, may live and enjoy life, till this great day of medical emancipation dawn upon the endeavours of the associates and the wants of the public, is a wish in which multitudes will join with
Your very respectful servant,
THOMAS BEDDOES.
20th February, 1808.
POSTSCRIPT
THE following extracts from the outline of a bill for the regulation of medicine, circulated, as is affirmed, (ap. Clutterbuck, l.c. Feb. 1806, p. cxxx.) by the college of physicians, though not published by authority of that body, may excite very serious reflections, (which I shall not presume to anticipate), as well on the remedy proposed in the provisions as on the evil described in the preamble.
Whereas many and great inconveniences have arisen from the ignorance of persons styling themselves physicians, surgeons, and apothecaries, and others known under the appellations of chemists, druggists, and venders of medicine, who are settled in divers parts of the united Kingdom, and who practise their several callings without previous authority derived from regular education, or other legitimate and proper sources, to the great detriment of his Majesty’s subjects, and the great scandal of the medical profession, be it enacted,
1. That no physician, who is not a regular graduate, having personally performed his academical exercises, and been admitted to his degree without grace, either in the universities of England, of the university of Ireland, or in those of Scotland (except as is hereinafter provided), shall be permitted to practise in the united kingdom.
5. That physicians, having no authority by their particular degrees to practise in that part of the united kingdom where they have fixed their abode, shall be licensed so to do by the Royal college within the jurisdiction of which such abode is situated.
11. That no physician who hath not attained his thirty-sixth year, and who hath not been a fellow of the royal college of physicians of London seven years, can be appointed by the royal college of London a physician to any district in England.
14. That each and all of the several royal colleges shall nominate to the districts in their respective parts of the united kingdom; that is to say, the college of London to the districts in England, the college of Dublin to those in Ireland, and the college of Edinburgh to those in Scotland; and the senior physician of such respective college (such physician not being in the enjoyment of any district appointment) shall be nominated resident physician in any district then vacant; and, in case of his refusal to accept such nomination, the next of the fellows, in order of seniority as they stand in the catalogue, shall then be nominated, and so on; and, as often as any vacancy shall occur, the same order of nomination shall be strictly observed, beginning always with the first upon the list, or senior fellow: provided, however, that the president for the time being (unless he really be the senior fellow) shall not, according to any construction, be held to be such, and he is hereby not accounted the senior fellow.
16. That each district physician shall reside within the district to which his college hath appointed him; that he shall have authority to call upon all physicians, practising within his district, to exhibit their diplomas and licences to practise; that he shall, either by himself or with his assessors, examine every surgeon, apothecary, chemist, druggist, or vender of medicine (except such as have heretofore, by proper authorities and privileges, been permitted to practise), touching their qualifications and abilities in their several branches and professions; that he shall once in every year, or oftener if he thinks fit, examine in the day time such houses or shops as dispense medicines, and that he shall report to the quarter sessions, or to the judge at the summer assize, the result of his visitation.
17. That the district physician shall visit and examine all places licensed for the reception of lunatic or insane persons; that he shall report upon the number and treatment of the persons confined, and upon the state and condition of the houses wherein they are kept; and that he shall lay the result of his visitation before the justices in quarter sessions, or the judge at the summer assize.
18. That the district physician shall enquire into and examine the state of the parochial work-houses, or poor-houses, and report upon their salubrity and internal economy to the justices in quarter sessions, or to the judge at the summer assize.
19. That the district physician shall be empowered to grant licences to all such surgeons, apothecaries, chemists, druggists, and venders of medicine, as shall have been examined as aforesaid, settled within his limits, and who may not by proper authorities be otherwise privileged to act in their respective professions and occupations; that he shall exhibit to the clerk of the peace, or other proper officer, at the general quarter sessions, a list of such surgeons, apothecaries, chemists, druggists, and venders of medicine, with their respective residences, as appear to him qualified to act in their several branches, in order that the clerk, or other officer, may receive the payment of their annual licence from all such as, by especial authority and privilege, are not exempted therefrom; and that he shall transmit a similar list to the college of physicians.
20. That each person shall pay for his annual licence two pounds two shillings, and one shilling to the clerk of the peace for registering and inserting a notification of the same in a list to be published after the summer assizes in the county news.
21. That two or more persons acting in partnership shall pay for two or more licences.
22. That persons acting in any of the departments of medicine without licence or authority shall forfeit 30l.
25. That England be divided into sixteen districts.
28. That for each district physician each royal college shall draw annually upon the receivers-general of the counties for a salary not exceeding 500l.
29. That the salary shall be paid by the college, and commence from the quarter day next succeeding the appointment of the physician, and be paid up to the day of death or resignation.
Last year there appeared likewise a paper from the royal college of physicians of Edinburgh, on the same subject and to the same purport as that from the academical senate. I did not think it necessary to insert both above; but that I may not be suspected of concealing any thing in favor of the triennial term of study for physicians, I annex these observations also. The remainder of the paper refers to surgeons, apothecaries, midwives, and retail druggists. I have not troubled you with any remarks on this subject, from the persuasion that when the regulations respecting the physician are once settled, other points will create no difficulty.
Edinburgh, 3d February, 1807.
At a quarterly meeting of the royal college of physicians held in their hall this day, the president laid before them a copy of the outline of a plan of medical reform, with the resolutions lately entered into at a meeting of the faculty held at house of Sir J. Banks, K. B, &c.
The college having attentively perused and considered this outline, appoint the following resolutions respecting it to be transmitted to Dr. Edward Harrison for the consideration of the gentlemen in whose names he has sent this plan to the college and to other public bodies.
The college are of opinion that there is room for reform and better regulations respecting the different branches of the practice of medicine, but they have reason to think that the same abuses do not prevail, or at least not in the same degree in Scotland as in England.
Whatever reform takes place, or whatever regulation be enacted, they are of opinion, that these should have chiefly in view the benefit of the community at large, and not merely the emolument or respectability of the medical profession.
It appears to them that several parts of the proposed plan may tend rather to diminish the number of those who might hereafter engage in the medical profession, than to promote the welfare of the public, by increasing the facility and the certainty with which they may obtain proper advice and assistance in sickness or in bodily injuries.
They cannot doubt that good education both in medicine and surgery may be obtained in other universities besides those of the united kingdom, in some of which, they are sorry to say, that none or at best very imperfect medical education is provided. They cannot, therefore, approve of limiting the practice of physic to the graduates of these universities.
They think that, when persons are properly educated, they may be qualified to enter on the practice of medicine at the time of life they are entitled by law to manage their own affairs.
They are persuaded that a period of study for three years, at some university where proper instructions in the different branches of medicine have been attended, is sufficiently long, provided a degree be conferred only after strict and impartial examinations.
Such examinations should be deemed indispensable in every case, and proper certificates of these should be produced by every person entitled to practise.
No physician should be entitled to practise who has not attended lectures on medicine for one year at least at the university from which he receives his degree.
You will not fail to notice the whimsical insinuation of an argument from the age at which the law entrusts a person with his own affairs to that at which he may be made fit to be entrusted with the life of others. It is doubtless a pretty example of the logic which goes upon false or precarious analogies and is so common among us physicians. I do not assert that it is impossible to qualify people for entering upon the practice of physic by the age of majority, but that a very different course of study is necessary; and, perhaps, it would even then be prudent to stay the prescribing hand for a few years.
I hold in little esteem oral instruction in any science, when it is not accompanied by the exhibition of sensible objects. The current doctrines of medicine may be procured from books about as well as from lectures. And therefore it is, in great measure, that those who send for degrees from one Scotch university are so nearly on a par with those who attend for them at another. Pupils have, perhaps, as often been the worse as the better for the peculiar speculative doctrines of any place. Were clinical instruction extended, and a director of studies appointed for those far enough advanced to combine practical observation with practical reading, I should suppose that the professorship of the theory, and the professorship of the practice of medicine, might be abolished without detriment to medical instruction. Particular cases afford the best opportunity for teaching the doctrines of medicine as particular experiments do those of chemistry, though, in some chemical courses, a verbal exposition by one man has absurdly preceded an experimental exhibition by another. I have briefly observed above, that in the new school of Paris, observation of disease is insisted upon equally with proficiency in anatomy. Hence, that school has to boast of a larger and more valuable series of practical essays from the students, in proportion to their number, than any other. If those who are unacquainted with these productions should suspect the following encomium as too high, it may be fairly taken for the description of an object at which all medical seminaries should aim, and which is not nearly enough pursued at the windy and wordy Edinburgh.
La necessité de suivre la marche rigoureuse de l’observation pour faire faire à la medecine des progrès réels a été senti de tout temps par tous les bons esprits. Mais jamais, peutêtre, cette vérité n’étoit aussi bien developpée, et surtout aussi sévèrement pratiquée qu’elle l’est aujourd’hui dans l’école de Paris. C’est à cette heureuse impulsion qu’on doit plusieurs monographies pleines des faits exactement recueillis, et de raisonnemens aussi sages que solides. Ces ouvrages abrégés, mais riches en connaissances positives, forment sans doute un contraste remarquable avec plusieurs de ces traités immenses dans lesquels une erudition oiseuse, des explications imaginaires ou hazardées occupent tant de place. On s’etonne en voyant des hommes encore jeunes éclairer déjà leurs pas dans la carrière medicale avec le flambeau d’une experience sure, et découvrir les plus importantes verités pratiques à un âge oú trop souvent autrefois on ne s’intruisoit qu’à force d’erreurs. Tant il importe d’être dirigé dès le principe par une methode sage et exacte, et de n’être point engagé dans une route fausse, á une epoque où il est si difficile de discerner par soi-même la veritable. Corvisart Journ. de Medicine, vi. l84.
I submit to your consideration the following extract from a more exclusively professional publication, (Researches on Fever, Longman, l807 ) as well in illustration of what I have asserted concerning the necessity of a larger stock of erudition in the pupils of our medical seminaries, as on account of the object itself. I have since taken the opinion of several experienced publishers, who expressed their good wishes towards the project, but agreed that it could not be hazarded without particular encouragement. Messrs. Longman, Rees, Hurst, and Orme thought a thousand subscribers requisite; Mr. Phillips seven hundred and fifty at least.
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‘At the close, I presume to offer a few ideas tending to the furtherance of our imperfect art. To these, the consideration of the same subject had given rise. Reconsideration has served only to corroborate them. The general history of useful plans shews that they must for some time lie upon the table. They are discussed. Imaginary difficulties vanish. The living force of reason overcomes the vis inertiae of habit. – And the measure is executed, just as if it were the original instinctive dictate of common sense.’
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Pyreticus.
– – – – – – In the title pyreticus I imitate aphrodisiacus. But I am in no pain about a title, only wishing to procure for society a collection of far more consequence than the aphrodisiacus, promoted by Boerhaave – namely, a collection of original observers of fever.That it is well to preserve and disseminate facts, every philosophical parrot will fluently repeat. But it may be imagined that the demand in medicine must have secured a ready supply of all useful facts; and that old works must be so new nearly as ore thrice picked to the refined metal.
Such is the obvious supposition. What is the reality? – Sydenham points out the misfortune of those who are the first to be seized by an epidemic. Their whole chance for escape lies in their constitution; and that must be peculiarly happy, if it save them from the complication of the doctor with the disease.
The remark of Sydenham has literally held to the present day. It is at the expence of life to those who have suffered on the first appearance of modern fevers, that succeeding sufferers have been sometimes preserved, if we may really flatter ourselves that the interposition of medicine has had any preservative effect at all. – When the yellow fever shewed itself in America, the physicians found themselves in the same condition as the inhabitants of a city, which is stormed at midnight by an unexpected enemy. Their personal disputes and furious paper wars, their contradictions in bodies, their conversions and confesssions, singly and collectively, prove that they were not only unacquainted with a remedy, but confounded by the very form of the evil. Dr. Rush, the pupil of the so celebrated Cullen and the most eminent physician of the New World, found himself, in his distress, reduced to beg alms of information from a physician of the West Indies, accidentally present in Philadelphia. The condescension does the highest honour to Dr. Rush. But where he hoped for medicine, there he found poison: and this he came to know, not in virtue of any instruction, which he had received from his preceptors; but from the wholesale destruction of his patients. I have already noticed the accident which led him into what he thought a better path; namely, the communication of a manuscript by Dr. Franklin.
I dare say we shall all be willing to believe as much as any one may choose to say in disparagement of the American faculty; but our own! the first existing! – Well then our own – Some of our own, scandalized at the disgrace of the common art, did begin to give lectures amain across the Atlantic. The lectures indeed were received as the effusions of men, who set themselves to harangue against facts. And American pride was destined ere long to have a fearful revenge. The deadly feud, excited by a mortality from fever on our own shores, between the physician-general to the army and its most celebrated physician particular, came just apropos to be set against the medical squabbles in America. Gibraltar, Gibraltar is held up against Philadelphia. An American writer has the assurance to say, ‘that after all British reproaches against the American physicians for permitting the yellow fever to commit such ravages, this yellow fever made incomparably greater proportional ravages in a British garrison, where the authority of medical police was unlimited.’ – (New York Med. Repos. viii.) In the West Indies, on the Continent of Europe, at home, wherever the British army was posted during the last war, its history of health has offered not only pretexts to a challenged rival to laugh to scorn the arrogated superiority of British modern medical practice, but also reasons for an impartial man to pause upon the claim. ‘In the late war,’ says Dr. Jackson, ‘hospital expence occupies a conspicuous column in the statements of public expenditure. Hospital mortality accounts principally for the diminution of the army. In these two points, the late war is held to be unexampled.’ (Med. Department of the Army, 1803, p. 159) – What is the death-list of the pleurisy of last spring among the military, and in our naval stations from Yarmouth to Plymouth?
How do these facts bear upon the foregoing proposal? In this way. The office of teacher, whether assumed or conferred, can never compensate for the living lessons of experience. A common place professor follows, a professor of any ingenuity, makes a sect. Now, in medicine also, the different sects proscribe one another. Brown alone was frantic enough openly to fly in the face of all past observation. But the tendency is universally the same. That is effected indirectly, which is not directly avowed. To the herd that follows every master, just observations and salutary practices, delivered in a language different from his, are lost. They are obscured to all who have not uncommon opportunities or uncommon spirit of enquiry.
It might be plausibly, perhaps convincingly, argued that the tens of thousands of sufferers from the pestilential fevers of our times were almost all the worse for the lessons, which their medical attendants had received in our schools of medical practice. That they received many mischievous impressions will be thought probable – But perhaps these were compensated. – That is what I dare not affirm, when I perceive how long we must search without finding a single hint in the productions of the professors, which can be shewn, by any consent of good authorities, to have been useful. Of two equal individuals, if I might suppose one, after preparatory studies and hospital visiting, to hear his professor of the practice diligently; the other to be familiar with the series of original observers; I have no hesitation which I should prefer as my own attendant in malignant fever. However bad medical observers may have been, medical reasoners have always been a great deal worse.
Had I to fit up a hall for practical lectures in medicine, opposite to the chair I would place a group of the faithful observers of our nature in conflict with sickness, fresh in their evergreen honors; and Sydenham in the midst – I would in contrast introduce a group of those medical pedagogues, the most vainglorious of mortals, who have abused their professional authority to dazzle the boys around them, and whose vanity has stimulated them to exertions of a bastard ingenuity, till their faculties have become too weak to burst through the hypothetical cobwebs, which themselves had spun. These men should be seen with emblems of a tarnished reputation, and stealing away from observation, but on that account the more conspicuous; as according to Tacitus, in the days of imperial slavery the statues of the Roman patriots were only more present to the spectators for not being borne along in funeral procession.
But I can dispense with all such considerations. Let a professor ever so fairly give a general abstract of facts, instead of occupying the hours with his own partial ideas of their relations, what can he furnish beyond a faint outline? Nor can this be properly filled up but from the source which I point out. The student – the young man going forth to scatter life and death-requires full and free access to the least polluted sources of knowledge. Images and emblems may fail to infuse into the preceptor due reverence of original observers, but may not the original observations themselves guard the pupil against credulity? And is not the oldest practitioner, from the appearance of unseen modes of disease, often in the very situation of the raw student? In this difficulty, no oral instruction, no doctrine yet broached, no compendium, no ingenuity of the individual can supply what is often to be found among the faithful copyists from nature. It is a difficulty, which arises most frequently from fever, and no man can see various cases of fever without feeling it, unless he be one of those that take diseases in the gross. Many and many cases, that pass off as incurable, are incurable only in relation to the practitioners ignorance of recorded facts.
If we consider all schools as on a level in regard to what they have supposed, it will become but the more interesting to inquire into what each has seen. On so impartial a survey, later speculation will miserably sink in value. But older observations will rise in higher proportion: so that the public, on taking its stock of real knowledge, will find itself richer upon the whole.
Such a collection, I have imagined, would be acceptable to all of our profession, who do not find it enough to make a graceful bow, a grave face, or a speech of hollow condolence – who are anxious about the essence as well as about forms. I have supposed too that an administration in earnest about those brave defenders, of whom we talk so tenderly, might make it a library for ships and regiments. I have conceived that many opulent persons, if they understood the object, would find it worthy of support. Among these, country gentlemen in remote situations, who are sometimes dependant upon practitioners, not overburthened with the literature of their calling, might find it no unwise plan to put such a work, in self-defence, into the hands of their medical attendants. It appeared not impossible that if I could express my own persuasion, the idea of opening an ample magazine of original information concerning a family of disorders, so formidable and so common, might strike upon the heart of some one, to whom it would not seem too great a sacrifice to remove the fears, which must operate with persons in trade. For the work, though published with the most rigid economy, must still be costly. No bookseller, I believe, will engage in it, unless satisfied that the sale would form an exception to that of medical books in general. – Among events, affecting the condition of whole communities, history has sometimes noticed the munificence of individuals. Nor does an age, which has witnessed the public spirit of the good duke of Bedford, and some others, need to envy the Romans their Agrippa or Herodes Atticus. Where there are so many examples of undertakings, which exceed single means, carried into execution by joint efforts, it seems a duty not to suppress any scheme, palpably useful in every view, and nothing complicated or unwieldy. Wesley, when his sect was small, could venture upon a collection amounting to fifty volumes. Is rational approbation among multitudes to be for ever more inefficient than the fanaticism of a few?
The undertaking would require many subordinate hands, but these should be subject to one controul. The editor, however, would be unworthy of his office, if he did not invite contributions and counsel from all quarters. For myself, I could most unfeignedly wish to see the undertaking confided to another – having occupation in abundance, and more congenial to my inclinations. I throw out the suggestion for any one who may choose to take it up. Yet if my services were considered as essential, I might yield a reluctant assent – not to the nature of the employment, but to the utility of the object. I may know where the materials are, in great measure, to be found. As facts are not to be had pure, and as it will be often impossible to separate them from supposition, it must be of use to explain what was the philosophy of the time and to what school the observer belonged. This office, if any, I would undertake – with the selection (for we cannot comprehend all) and the general disposition. But indolent approbation would not satisfy me. I should require, and so certainly would the booksellers, a spirit of cordiality in the public. For myself, I can dispense with the collection, as well as many of my brethren.
Meanwhile, it will be a satisfaction to have given the means of stifling, in their birth, some of those epidemic errors, which issue from the schools and become more destructive, more inveterate and extensive in their range than any epidemic diseases, the chance of being considered in other countries and other ages. Wherever the idea is executed, it will furnish a work for the whole earth, which we mortals inhabit and he who shall execute it well, will entitle himself to a civic crown from the growth of all its zones. . . . . . .
ERRATA.
Page 25, line 20, for The read They.
30, line last, for great read greater.
31, line 22, erase the full stop.
41, line 6, insert as.
62, line 25, for Facceil read Facciol.
66, line 9, for anatome read anatomie.
78, line 13, read additions to the school.
89, line 2, for miro read mira.
ib. line 21, for & read 9, (or novem)
103, line 3, for of read for.
ib. line 14, read Clementina.
104, line 12, read it would be right.
112, line 17, read be left.
1. Medicinam omnium eorum inhonestè se alere cupientium agrum esse, nullumque hodie porcum esse qui in ejusdem vineam, rostro suo grassari non audeat – (de caus, catamen, epiphonema
2. Some have been observed to commence reformers for want of other employment. But when the correspondence supplies names of the most occupied physicians in the kingdom, and on your committee we see Sir J. M. Hayes, Sir Walter Farquhar, Doctors Blackburn, Clutterbuck, Harrison, Garthshore, George Pearson, Stanger, and Willan, it is impossible to suspect that they should have taken up the case of physic itself for want of other patients.
3. Il est vrai qu’au lieu de trois ans, il en faudroit huit; trois dans les hôpitaux et cinq dans les facultés de medecine. En reflechissant qu’après ce temps on sera en état de pratiquer la medecine; on verra qu’il y a encore bien du temps à gagner.
4. A. C. 1270. Maestro Baiamondo della Vezza, famiglia nobile à quei tempi, nei quali però la professione di medico non solamente non derogava alla nobiltá (come nei secoli seguenti e tuttavia nella nostro) ma, quello che é più sicuro, vi faceva strada, e i dispensatori della medesima (nobilta) onoravano nel medico virtuoso e dotto uno dei cittadini più necessari ed uno dei conservatori più positivi della patria – De’ medici negli stati di Savoia, 4to. p.14.)
5. Tomas. de gymnas. Patav. pp. 420&ndash ;1. Facceil. Fast. gymnas. Patav. p. 215. Comparetti della sc. Clinica di Padoua, ib. 1793, p. 7, venne decretato che vissittassero gli ammalati e leggessero su loro mali, ed aprissero all’ occasione li cadaveri per dimostrare le sedi delle malattie.
6. Le point aussi difficile qu’ important; le but véritablement utile, c’est d’étudier, sur l’homme vivant et malade, les caractères propres aux lésions des divers organes, d’en bien remarquer les phenomènes, d’en bien constater les symptômes par des observations aussi multipliées pour qu’il ne soit plus permis de les méconnaitre. ... Constamment M. Corvisart a offert aux yeux de ses élèves les cas les plus graves, les maladies les plus cachées; et toujours après un diagnostic et un prognostic rarement frustrées, il a, la main armée du scalpel mis a découvert les désorganizations qu’il avoit annoncées dans la plûpart des viscères &dash ; Horeau apud Corvisart sur les Lésions du Coeur, p. xiv.
7. Though no set of teachers at any place, calling itself a school of medicine, would feel it incumbent on them to veil their bonnet to the present Edinburgh professors, one may believe these equally useful with their celebrated predecessors. Their opinions may be less seductive in proportion as their reputation is less brilliant, and they may more than compensate by labour the apparent inferiority of talent. Lectures on surgical cases, in military surgery, on morbid anatomy, medical jurisprudence and natural history, are real additions. The ominous circumstance is the number of professors sons of professors. This order has every reputed disadvantage of hereditary monarchy, and not one of its advantages. It may happen, indeed, that the son shall be fit to succeed the father in the chair. It will oftener happen, that a much fitter successor may be found out of the family. On this point, and on the reputation of Edinburgh generally, a physician, well acquainted with schools of medicine, expresses himself thus:
Toutes les fois que dans une université, oú les places qui ne dévroient être accordées qu’au merite seront au contraire comme hérèditaires et obtenues par patronage, je crois qu’on doit s’attendre à voir une pareille université decliner. Si je ne me trompe, c’est généralement le jugement qu’on porte sur celle d’Edimbourg, qui ne vit plus aujourdhui que sur son ancienne reputation; et c’est, il faut en convenir, une bien mince existence. – Dr. Joseph Frank (l.c. II. 259) thinks, that on account of the seductions of Paris, his countrymen would profit more at Edinburgh. He also represents the spirit among the Scotch students as better. That it is still good I do not in the least doubt. But at Paris the zeal of young and old is such as to extort from those who have seen other seminaries, the question, whether this can last? Dr. J. Frank was at Edinburgh but three weeks, and in summer. He does not omit to notice how little the school has been the better for the system of hereditary professorships.—I doubt if the office ought to last for life.
8. I allow little or nothing for apprenticeship; during which the mind is too apt to be choaked up with moral and medical rubbish.
9. Non esita punto à confessare che una vecchiarella le vinse in un caso molto scabroso. La vecchia preparó, una bevanda, la quale presa alla presenza del medesimo etc – (l.c. de, Medici di Savoia, p. 69.).
10. Taurini ante & hos annos in concilium accersitus fui ad aegrum, qui ab anno, et ultra, diarrhoea quae nullo sisti hucusque potuerat auxilio laboraverat. Summâ hic jam macie et lenta febricula consumtus jacebat. Quæ vero proposui ex classe roborantium remedia, non majorem haec quam pristina effectum paestiterunt. Hominem tandem accessit empyricus. Pulvere assumto, insigni sub abdominis dolore, alvus tam copiosa, ut in syncopen laberetur aegrotus, prorupit. Rediit tamen non modo in vitam, sed ad perfectam hoc a tempore salute – (Institut Ticinens, p. xcvii)
11. I have no doubt but our watering and airing places (though I do not mean to exclude other places), would furnish facts relative to our profession, worthy to figure beside the feats of the mudlarks in Mr. Colquhoun’s Police of the Metropolis. Here is one, of which chance brought me information, from an unsuspicious quarter. – Last summer, on arriving at – – a family ordered Mr. A., a medical man, to be called. The name and message resounded through the regions below ground, on which the scullion boldly set off for another medical man, Mr. Z. He ran for it, and got the patient; when Mr. A. arrived, and sent up his name: he received for answer, – sorry for the mistake, Mr. Z. had been with the patient, and it could not be helped. Should you not think, that every fair Cinderella, as also her mistress, must have a per centage upon the patients whom she procures. You who countenance reformers, having for their motto the degraded state of the profession, will hardly require to be told, that no medical anecdote is to be rejected merely for its meanness. Here is another, in which the parties are more dignified.
Quid dominae facient audent cum talia fares?
A Mr. R. of Lechlade went last summer to a watering place, to put himself under the care of a particular physician. On his arrival, the sympathizers surrounded him: his landlady talked of danger of experiments from the physician whom he had in view, and named another, who performed such cures! The poor man acquiesced, grew worse, and returned home dissatisfied. The doctor, first in contemplation, being at Lechlade with another patient, was called to Mr. R– –, and informed of the poor man’s vain expedition. I saw Mr. R– – the very same day myself, and learned the particulars. A practitioner, skilful enough to merit the confidence of keepers of furnished lodgings at a watering place, will have a score or two of patients the more annually, and vice versa. Is it not the same in town? If so, how astonishing that a profession, exercised under such sublime auspices, should be in the condition in which the proceedings represent medicine!
12. Au lieu de dire que M. de la Condamine porta dans les sciences le courage militaire, seroit-il peut-être plus vrai de dire qu’il portait dejà dans l’art militaire la curiosité courageuse du philosophe. Sa passion dominante fut cette curiosité insatiable. Ce doit être celle de ce petit nombre des hommes destinés à eclairer la foule; et qui, tandis que les autres s’efforcent d’arracher à la nature ses productions, travaillent à lui arracher ses secrets. Sans ce puissant aiguillon, elle resteroit pour nous invisible et muette, car elle ne parle qu’à ceux qui l’appellent, elle ne se montre qu’à ceux qui cherchent à la penetrer; elle ensevelit ses mystères dans des abymes, les place sur des hauteurs, les plonge dans les tenebres, les montre sous des faux jours. Et comment parviendroient-ils jusqu’à nous, sans la courageuse opiniâtreté d’un petit nombre d’hommes qui, plus imperieusement mâitrisés par les besoins de l’esprit, que par ceux du corps, aimeroient mieux renonçer a ses bienfaits que de ne les pas connoître.
13. Il institua en France les filles de la charité, qui se devouent aux soulagement des malheureux et qui ne changent presque jamais d’etat, quoique leurs voeux ne les lient que pour un an. Le retablissement des Filles de S. Vincent de Paul, de ces anges consolateurs dispersés dans un tems de folie et de crime a été l’un des premiers actes d’un gouvernement consolateur. (Delille l’imagination, I. 130–132.)
Published: A Letter to the Right Honourable Sir Joseph Banks, Bart. P. R. S.: On the Causes and Removal of the Prevailing Discontents, Imperfections, and Abuses in Medicine (London: Richard Phillips, 1808)