CLUBS: THEIR ABUSES AND DOCTORS.

not dependent THE AMENDED MEDICAL PROFESSION BILL. salary licence or diploma.

on

the number of those who obtain the

To the Editor of THE LANCET.

That the candidate having passed this examination be allowed to practise under the title of licentiate in medicine, session of Parliament. surgery, and midwifery, and be immediately eligible to present The Amended Bill presents a few points for consideration, himself for examination for the College of Surgeons, who would which, with your permission, I will briefly review. The test his proficiency in surgery; and that at twenty-six years of Council is cut down to thirteen in number, the elective privi- age, he be further eligible for the fellowship. That licentiates of lege is given up, and the Crown appoints instead. The regis- the faculty be eligible to present themselves for examination tration clauses are retained, and we are to have six new boards before the College of Physicians at the age of twenty-six years, for the United Kingdom, two for each country-preliminary producing testimonials of additional attendance on hospitals medical practice. and professional. ! That none of the universities or colleges be allowed to grant With regard to England, I would, Sir, submit it for opinion, whether it would not be as well for the professional board to licences to practise, which should be obtainable only by passrelieve themselves entirely of surgical examination, and, in ing the examinations at the central boards in London, Edinplace of it, demand the diploma of the London College of Sur- burgh, and Dublin; but that certain privileges (as dispensing geons. As the matter at present stands, Lincoln’s-inn-fields is with the preliminary examination) be awarded to graduates of altogether thrown into the shade. The Council would cer- universities. That licentiates of either of the three metropolitan boards be tainly appoint some of their body examiners, but that is all. It appears to me, if this new professional board for England authorized to practise in any part of the kingdom, the examiperforms the duties of the Society of Apothecaries satisfactorily, nation fees being the same in all.most I am, Sir, your obedient servant, that is all that is wanted. The claims of the above-named London, June, 1856. MEDICUS. Society are recognised in this Act, by appointing some of the examiners from amongst them until 1865. The cry of "wolf" has been so often raised in medical reform of late years, that CLUBS: THEIR ABUSES AND DOCTORS. the profession will be surprised if any measure is really enacted To the Editor of THE LANCET. this session. during Sir, it cannot have escaped your notice to see how many are THE LANCET of Saturday, June 28th, appears a. SIR,—In entering the profession with only one qualincation, the diploma letter under the above heading, certainly not one which some of the London College of Surgeons. Where ten pass the ’, future compiler of a reading exercise shall transfer to his College, (if we may trust the published lists,) only four or five ’, book, for the beneiit of the rising generation, as a specimen obtain the Hall licence; and be assured, Sir, that this is en- of elegant composition, but one which nevertheless takes a tirely because no examination in Classics is demanded at very one-sided view of what he styles " the system of farmand a more Lincoln’s-inn-fields, while the contrary, searching ing clubs." That these institutions do contain evils is unordeal, is required at Blackfriars. If this Act passes, the deniable ; and let me ask " Fiat Justitia," what human Council will do well to decree that no one shall after a certain institution is free from them ?-but at the same time they time practise medicine with a surgical diploma only; and again do exercise a vast amount of influence in unquestionably with regard to the pure surgeon, why should not the law elevating the morals, improving the social status, and developcompel him to obtain the licence of the professional board be- ing the principles of self-reliance and independence amongst fore he presents himself for the fellowship examination? It those who come within the sphere of their benevolent operawould make him all the better practitioner. and possessing such advantages, they merit the countions ; From beginning to end, this Bill ignores the apprenticeship tenance and support of every generous and well-constituted system. It has been the fashion of late years to decry it; but mind. I maintain that unless a student previously passes a certain If man were to live solely for his own unsocial ends, if his time with a practitioner of medicine and surgery, and witnesses of acquisitiveness were to be exercised to the prejudice Organ the daily routine of actual practice, he will nowhere else attain of other more ennobling craniological developments, "Fiat a most essential part of his education. He will blunder at the Justitia’s" line of reasoning might pass for the current coin of very threshold, and before he commences practice will have to the realm; but I am happy to say that such is not the case, learn the alphabet of his profession. and there are gentlemen, whose " status and respectability" As in the original Bill, so also in this, there is no direct penal are not inferior to his, who undertake the medical management clause. If the irregulars are to be met by indirect means only, of clubs, and make them, by diligent attention to their interests why not require an inquest on every person who dies under a and requirements, the stepping-stones to fame and honour. treatment ? quack’s Most of our best surgeons here have, in early life, held such. I am, Sir, your obedient servant, appointments, and they have been the means of acquiring for W. N. SPONG. Faversham, June, 1856. them an opportunitv of getting into notice; otherwise they might have been " born to blush unseen" during the term of their natural lives; they have been the means of enlarging MEDICAL ORGANIZATION. their views, and giving to their professional knowTo the Editor of THE LANCET. ledge. I happen to be acquainted, Sir, with one medical gentleman SIR,-On looking over a work on " Foreign and English Medical Organization," published in 1847, by Mr. Edwin Lee, in this town who has the management of 900 club members so well and so favourably known to the profession by the in- regularly under his s2crveillance, and he declares that at the formation he has communicated on various points connected present time he has not one single individual requiring his with continental medicine, I was gratified to find the following attendance. This, I am aware, is a very rare, perhaps an occurrence; he is nevertheless paid for them after the propositions for improving the state of the medical profession, unusual which it will be seen are almost identical with those of the rate of 3s. per head-i. e., £135 per annum; but he does his Amended Medical Reform Bill, the chief difference being, that work to our satisfaction, and we consequently pay him with Mr. Lee advocates the elective principle of nominating the much pleasure. But it is indirectly that he derives henefit from his devotion to our interests. There are few indeed members of the Council. A supreme council of health, composed partly of medical amongst us in whose families he is not the regular attendant" members elected by the profession, and partly (one-third) of "their guide, philosopher, and friend. Does " Fiat Justitia" non-medical members, to take cognizance of and decide upon see no advantage to the young surgeon "just let loose from matters relating to the regulation of the profession, and of school," in the sprinkling of prosperous, respectable tradesmen medical education, as well as those appertaining to hygiene amongst his constituents in these farmed clubs ? Is it not and medical police. through such individuals that many a man "Climbs the steeps Students, whether intending to practise as physicians, surWhere Fame’s proud temple shines afar" ? geons, or general practitioners, to go through the same course of study in the first instance. Do we not hear of many a man of talent and ability being shut That there be two examinations before the licence to prac- out for ever from respectable practice through a false pride in tise be granted: the first (preliminary), upon the accessory neglecting to avail himself of the means of introducing himself to sciences; the second (practical and clinical), at the age of public confidence and public notice which such institutions, well twenty-two years, before a joint board, composed of professors managed and properly attended to, must inevitably have proand examiners from the colleges, who should receive a fixed for him? Have not the assistant-surgeons in our navy

SIR,—Medical legislation occupies

a

prominent part

this

-

efficiency

cured

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much cause to envy the man who has thus an opportunity No. 2. AT DURHAM.—(June 9th, from 2 o’clock till 5 P.M.) afforded him of being contented, in the first years of his proAnatomy and Physiology. fessional career, with learning practice upon the materials of 1. Describe the minute structures of the areola, the osseous, which these clubs are constituted ? The " fiat experimentum and the nervous tissues. 2. Describe the hip-joint, including an enumeration in order in corpore vili" must surely offer sundry advantages to "Fiat Justitia," and men of his calibre. A long letter from "A of the muscles which surround it. Mention the varieties of Deluded Assistant-Surgeon," in THE LANCET of June 28th, movement at that joint, and point out the chief structural and clearly demonstrates that there are grievances to be found in functional differences between the hip-joint and the shoulderthe Indian medical service also; and yet we find in The Times joint. of June 30th an instance of the extraordinary good fortune (so 3. Describe the portal circulation, and the anatomy and far as this world’s goods are concerned) to which medical men uses of the liver. in that service may attain. 4. What is a gland ? Give a classification of glands ? 5. Describe a pulmonary air-cell ? and state clearly the While, then, the leading medical men in our large towns are contented to attend upon the poorer classes in the infirmaries changes undergone, during respiration, by the air and by the and dispensaries and kindred establishments without fee or blood. What are the peculiarities of the functions of the lungs, the reward, and solely, as it appears to me, for the indirect advantages which such a prominent position holds out to them- skin, and the kidneys respectively as purifiers of the blood ? 6. What is an excito-motor or reflex act, and ’what are the viz., of bringing before the world their claims to professional skill--and while several do not despise the far less ostentatious conditions necessary for its performance ? mode of establishing "Medical Aid" Societies, in which a 7. How are the nervous centres developed ? Enumerate the penny per week constitutes their sole remuneration, the club chief differences between the brains of the four classes of versurgeon should be allowed to follow his equally influential tebrata. calling, undeterred from his laudable exertions by the sneers or No. 3. AT DU-RHAM. -(June 10th, from 9 o’clock till 12 A.M.) the cavillings of such one-sided reasoners as "Fiat Justitia." Principles and Practice of Midwifery. Principles and Surely, Sir, your highly instructive pages never contained a Practice of Surgery. more striking instance of the necessity for your hearing both 1. State the signs of pregnancy, and the value of each resides of the question-the " audi alteram partem" motto which you practise with so much disinterestedness-than does your spectively. 2. What are the constituent parts of a Graafian vesicle, and Coleshill correspondent. Never was the maxim of " Fiat of its contained ovum. Justitia" more unreasonably used. 3. Give the diagnosis of placental presentation, its varieties I remain, Sir, your very humble servant, and its treatment. A MEMBER OF AN ODD FELLOW CLUB, AND " 4. State the injuries which may happen to the head-scalp, A LAY READER OF THE LANCET." skull, dura mater, and brain. Enumerate the causes of comNottingham, June, 1856. pression of the brain, and state the difference in symptoms between concussion and compression of the brain. 5. Enumerate the causes of retention of the urine, and UNIVERSITY OF DURHAM - EXAMINATION describe the treatment appropriate to each case. FOR THE LICENCE IN MEDICINE. 6. Mention the injuries to which the shoulder-joint is liable. To the Editor of THE LANCET. State briefly their symptoms, pointing out clearly the diasigns between fractures about the head of the bone and SIR,-If it be within the scope of your journal, the Council gnostic dislocations. of the Newcastle-upon-Tyne College of Medicine in connexion No. 4. AT DURHAM.—(June 10th, from 2 o’clock till 5 P.M.) with the University of Durham, would feel obliged by the insertion of the accompanying questions, which constitute the Principles and Practice of Physic. substance of the examination held in Durham and in 1. Under what circumstances does pericarditis frequently Newcastle, on J une 9th and three following days, of candi- arise ? What are the symptoms and the consequences of peridates for the liceu ace- in Medicine of the University of Durham. carditis ? How do you distinguish pericarditis from acute The examiners appointed by the Warden and Senate of the pleurisy of the left side ? 2. State your plan of treatment in sthenic pneumonia occurUniversity of Durham were-Henry Wentworth Acland, M.D., Lee’s Lecturer in Anatomy, Oxford; John Erichsen, ring in a healthy adult. 3. What are the supposed causes of diabetes? Whence is Esq., F.R.C.S.E., Surgeon to University College Hospital, London; DennisEmbleton, M. D., Newcastle-upon-Tyne, Reader the sugar derived that is found in the urine in this disease?9 in Medicine in the University of Durham; Thos. Richardson. What are the best tests for this sugar ? and how is life extinPh.D., Newcastle-upon-Tyne, Lecturer in Chemistry in the guished in diabetes? 4. What are the symptoms of ulceration of the stomach ? University of Durham. This is the first medical examination of students of medicine at Durham and Newcastle. Can it be distinguished from cancer of that organ ? What are Your obedient servant, the forms of ulceration ? and in what parts of the stomach does DENNIS EMBLETON, M.D., it chiefly occur? Newcastle-upon-Tyne, June, 1856. Registrar, Coll. of Medicine. 5. Describe an ordinary attack of scarlatina; which internal organs are most liable to be attacked; and what are the most common sequelæ of scarlatina. No. 1. AT DURHAM.—(June 9th, from 9 o’clock till 12 A.M.) 6. Give instances in which the microscope is valuable as a means of diagnosis. Mate7-ia and Medical Medica, Chemistry, Botany, 7. Can you distinguish between a chlorotic and an organic Jurisprudence. endocardial murmur ? 1. What is meant by the "equivalent" of a chemical sub8. How do you treat acute gout ? Can lithic acid be detected stance ? in the blood ? 2. Into what three great classes are acids divided, and what 9. Write prescriptions in full, for a mineral and for a vege. important purposes does this subdivision subserve in the case table tonic mixture, and for a mineral diuretic draught. Give of phosphoric acid ? a note the reasons for your combinations. in 3. Describe the oxides of iron, and their use in the animal PRACTICAL EXAMINATION AT NE, WCASTLE. -(June 11 th.) economy. 4. Describe the symptoms of poisoning by arsenic, the proA t the Hospital.-Each candidate was required to examine a cess of detecting arsenic in the liver, and the tests by which surgical and a medical case, and give his diagnosis and treatits presence is recognised. ment. is the utricle of and the vegetable cell, 5. What primordial The surgical cases were :-1. Extravasation of urine. how does it differ chemically from cellulose ? 2. Psoas abscess. 3. Amputation of ankle-joint, and fracture 6. Mention the names of the principal groups into which of thigh. Linnaeus divided plants, and give the names and characters of The medical cases :-1. Disease of heart; mitral regurgitathe principal divisions of Decandolle. tion. 2. Pneumonia with albuminuria. 3. Phthisis pulmonalis. 7. What are the medicinal properties, the doses, and the PRACTICAL EXAMTNATION AT NEWCASTLE.-(June 11th.) of uses of principal potassio-tartrate antimony? 8. What are the medicinal properties and characteristic In the Laboratory of the College.-The undernamed clear effects of opium ? solutions were put into the hands of each of the candidates, ,

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