ENORMITIES OF THE PROJECTED CHARTER TO THE COLLEGE OF PHYSICIANS.

403 press a hope, that, if necessary, the whole medical profession in the laws, which the wisest in the land approved, and had will interfere so far as they may, in order to secure justice to sighed for in vain. The acknowledgment of human progress the profession and to the public, and see that collegiate faith is is the order of the day, excepting in those countries where not broken, and that honour remains unsullied and intact. despotism is still strong enough to maintain the power of I particularly allude, on the present occasion, to sections might over that of right; or where, while deeming themselves

4 and 5 of the contemplated new charter. free, the disciples of progress are obliged to shield themselves The tendency of these clauses appears to me highly dis- from the effects of their written instruction by anonymous creditable to the College of Physicians, because, by the con- signatures. This is in the political world. In the world of science and struction of language, they have (perhaps unintentionally) attached a deprecating signification to one class of their of art, now, as heretofore, those in authority give the law. It has long been-chiefly through your instruction-an licentiates. You know well, Sir, that the licentiates of the College are divided into two classes; one which is licensed admitted fact, that the medical profession in this country to practise in the city of London, and within ten miles thereof; is governed by laws inconsistent with the requirements ef the other licensed to practise anywhere in England or Wales, our time and the enlightenment of our body. The " heads without these limits; the one, to use the words of the College, of the profession" have at length acknowledged this truth, the other, "permissi extra urbem"—i. e., " per- for they have come forward with proposals to alter these missi intra urbem," et "permissi extra urbem." This, surely, laws; but the meagreness of their scheme of reform-if it Sir, has a very different meaning to "extra licentiate;" the can be dignified by that title-must be evident to all. What do they propose? To convert a hall into a college, one, reading conventionally, means something on the outside of the " licentiate," whereas the application of the adverb is very and to associate on the more elevated name less real power different, as it clearly means the licentiates authorized to and dignity; to prevent doctors using their titles, and edupractise outside the city, " extra urbem permissi," not " extra cated surgeons calling themselves by the only name they are permissos," in plain English, outside the licentiates. But they now known. And is this the reformation we have all been so anxiously have, nevertheless, so called them, and so constructed the meaning in section 4, and if intentionally, most ungenerously, expecting ?&ic rc; Is the profession to be content with such changes I should think not. as well as improperly and untruly, and they seem disposed to as these? The voice of the intellectual world has declared the science take the same discreditable view of the subject in their I of medicine to be a whole, divisible into parts in practice, retrospective legislation. Who are these permissi extra urbem physicians constituted solely for utility and convenience; but it has not declared for the proper application of this science, a new college according to law ?-licentiates (not extra licentiates) legally that, entitled to practise, because, after scrutiny into character, is needed; or that three colleges at least are necessary to and an examination into competent ability, experience, and give laws to one profession. Circumstances necessitate the acquirement, on the part of the College authorities, licensed establishment of numerous colleges for teaching the art of to practise in any part of England and Wales, excepting in healing, but one institution only is necessary for directing those who are taught, or for ascertaining the amount of knowthe city of London and ten miles thereof? Now, in point of fact, as the law at present stands, no one ledge thatought to be possessed by those who are to be is legally qualified to practise in England or Wales unless allowed to practise. The republic of medicine should be governed by laws authorized by the College of Physicians so to do, and possessed of this qualification. applicable alike to all who are allowed to enter its hallowed Let us see who have sought this privilege-this only legal precincts. If advancement to its inner Temple of Fame cannot be insured without the stimulus of other rewards than qualification to practise as physicians ? After premising that many graduates of British universities those invariably accompanying merit, let them be offered, but let no attempt be made to cripple merit by the false glare of are actually practising without this qualification, at which I do not and never did cavil, considering their diplomas as un- inferior colleges, or by promulgating to the world false doubted tests of competency, I must observe, the physicians notions of real worth. It is proposed that there shall be three medical colleges who have sought the licentiateship of the College, the only the medical profession. " The physician of the legal authority to practise in England and Wales, were the for governing classes" middle is to be compelled to belong to two, while graduates of these universities; or else those who, not being the so situated, were nevertheless, in accordance with the laws of physician of the rich is to give his allegiance to but one. the College, and in consequence of their qualifications, after Why is this ?&ic rc; Is the former, in consequence of this double due scrutiny and examination, found competent to occupy control, to rank above the latter ?&ic rc; Or, if not, are the two this standing in the medical profession, and to practise as colleges combined to be considered inferior to the one ?&ic rc; Or, if it is to be said, " There is to be no inferiority, each alike is physicians accordingly. The College has now, it would seem, concocted a scheme honourable ;" why, then, I would ask, have we these diswhich bears retrospectively, in a most injurious manner, on tinctions? I contend that sufficient proof does not exist to those gentlemen who had sought the legal privilege to prac- answer that it is for the advantage of the profession or the public. The great majority of medical practitioners are tise, and which the College only could confer. Some years ago the graduates of Oxford or Cambridge were obliged to apply their knowledge of medical science to all admitted to the College honours on producing their doctorate kinds of cases occurring in practice; and it is now universally at the College of Physicians, without any examination. This, admitted, that all practitioners should have a competent however, has of late years been abolished. Was it that at knowledge of all branches of medical science. Undoubtedly that time the College of Physicians was jealous of the infant it is useful, as well as convenient, that some members of the universities of London ? profession, should devote their entire energy to the advanceHowever, be the cause what it may, this was done away ment of particular branches of medicine; but this is no arguwith. " Now a change has come over the spirit of their ment in favour of separate colleges, or if it be, instead of dream," and they have made an essay, it would appear, which three, we must have at"least a dozen. I think the medical scheme" now proposed may be fairly carries injustice on the face of it. I am here, Sir, reminded that I must not trespass too far denounced as " class legislation :’ It is not legislation on a broad basis for the profession as a whole; it is a mere on your pages on this occasion, but reserve what further I have to say for another occasion, lest I occupy too much authoritative sanction of grades, where grades should only space in your journal, and tire my brethren by the length of exist in consequence of the necessary existence of difference in capacity. this communication. Not caring to use the shield of anonymous signature I am, Sir, your obedient, humble servant, ONE OF THE "PERMISSI EXTRA URBEM." myself, I beg to remain, Sir, yours respectfully, March 21st, 1848. WILLIAM ROBINS. Upper Southwick-street, Hyde-park, 1848.

permissi

’

THE PROJECTED COLLEGE OF GENERAL PRACTITIONERS. To the Editor of THE LANCET. SIR,—In truth we live in stirring times. At present it is not the fashion for those in authority to initiate reforms, these are now dictated by subjects. A few days ago, we were told that a blacksmith arrested the progress of a sovereign, and compelled him, in an official manner, to decree

alterations

ENORMITIES OF THE PROJECTED CHARTER TO THE COLLEGE OF PHYSICIANS. To the Editor of THE LANCET. SIR,—The object of the present communication is to show I shall be treated, if the College of Physicians how succeed in obtaining their projected charter. It cannot be possible but that those laws were in contemplation at the

unjustly

404 time when they were putting me through a stringent examination (both written and vivd voce) for the extra-licence, as it is only a year and a half since I was admitted. I refrain from making further remarks than to state my own case, as it will show, practically, how the intended changes would affect many hundreds of medical men who are similarly circumstanced. I became a M.R.C.S.L. in 1824, and also a licentiate apothecary. I was five years a resident medical officer of an hospital. In 1832 I went abroad, and in the exercise of my profession I was so fortunate as to realize a moderate independence. I returned to this country in 1845, solely with an intention of obtaining the degree of doctor of medicine. Residence and university tickets being necessary, I passed the winter sessions of 1845 and 1846 in attending the universities and infirmaries of Edinburgh and Glasgow:

,the

of each year was passed in London. In 1846, I admitted an extra-licentiate of the College of Physicians, and I obtained my doctor’s degree last year, having incurred an expense of nearly £800, solely to attain those summer

was

distinctions. Now, the proposed charter has for its object the degrading all graduates in medicine in Great Britain and Ireland, who haye taken their degrees subsequently to 1841, and to reduce them again to a state of pupilage ! Nay, more-they are to be punishable if they assume the title of M.D., conferred on them by their respective universities, unless they again submit to an examination such as the newly-to-be-chartered body may think fit to demand; and they must pay a certain sum of money, exclusive of stamps. As well may a charter be granted to the Blue-coat School, to disrate all doctors of laws, M.A. and A.B. of the said universities. Reform, indeed, is wanting; but it is to guard the public and the profession against quacks, and not, as in the present instance, to insure a monopoly of fees. You have my sincere thanks for your long and active exertions in opposing those who would reduce our profession to a mere trade. I send you my card and address;

and I will most willingly come forward with any subscriptiorr, to aid in opposing such injustice. I will also attend any necessary meeting, and act in any useful way that may be pointed out in that behalf.-I am, Sir, yours, A GRADUATE AND ExTRA-LlCENTIATE. March, 1848. P.S.-I forward to you, separately, my name and address.

THE PROPOSED NEW CHARTER TO THE COLLEGE OF PHYSICIANS. To the Editor of THE LANCET, SIR,—Noneof your correspondents have noticed one iniquity of the new Charter of the College of Physicians. There are many graduates of British universities, who, from a variety of motives, have been induced to pass an examination before the elects of the College, and pay their £18 for their permission to practise as extra-licentiates. I am one of these unfortunates. If the College gets its Charter I can claim to be admitted as a member, because I am a graduate of a British university, of above seven years’ standing, but I must pay my .625, just the same as if I did not belong to the College, had never passed an examination, or paid £18. Is this just ? Is it honest ?-I am, Sir, your obedient servant, AN EXTRA-LICENTIATE.

numerous, highly respectable, body as the surgeons, or, as they are now called, general practitioners, of our country. Assuming for the nonce that physicians stand in need of a plea, it is a pity that their advocate was not better instructed could thus slander and belie and acknowledgedly useful

in

the

so a

points and requirements

of their

case.

With respect

to his estimate of the necessary expense of a professional education, the writer is so very far out that we doubt

whether he could ever have been professionally educated himself. Upon what data the gentleman (?) founds his calculations we are at a loss to determine; for our experience, and, we believe, that of the profession generally, goes to prove that our expenses far exceeded those stated as the maximum of his country gentleman’s son physician. We well recollec.t, in pursuing our hospital studies, numbers of our fellowstudents, whom we met with in Paris and in other countries, who resorted thither for the sole purpose of obtaining an extended knowledge of their profession, who are now general

practitioners.

And we would further ask, whether the fifteen hundred or two thousand students to be found annually in London are to be classed with the scion son of the butcher1 Write, indeed, of forty pound premiums and local schools !—are a tithe of the profession educated in that way ? But it were waste of time to follow him further in his unprincipled slander. Such assertions may, indeed, do well to prop up the tottering fabric that is all but falling to crush these high-blown "ornamentals." All of the "lower grade" will view with infinite pleasure the manner in which you have noticed this subject; and we venture to express a hope, in which we are sure all our brethren will join, that you will not let it speedily drop, as those of the higher grade" will not perhaps understand the silence of contempt. With all due deference to ornamental acquirements, we deprecate the idea of exalting one class of the profession at the expense of another. " Nec sperno, nee timeo." I am, Sir, your obedient servant, A COUNTRY PRACTITIONER. March 13th, 1848. ’

THE WAR AGAINST QUACKERY. To the Editor of TH7-, LANCET. SIR,-It is through the medium of your invaluable journal that I wish to congratulate you on the noble part which you have taken against those most disgusting impostors-quacks. I am of opinion, that if the Apothecaries’ Company would make such exertions as you and Sir James Clark have recently done, it would save the public from being made the dupes of those villains, by whom many are sent to an untimely grave, hastened thither in consequence of their folly in believing the lying advertisements by which the columns of our newspapers .

are so

perpetually disgraced.

Now that Sir James Clark has set so noble an example, will not other gentlemen, placed in similar circumstances, do their utmost in endeavouring to root out these impositions to which the suffering public are exposed, and in so doing, enhance the honour of their profession, as well as that of themselves? Hoping the day will soon come when quackery shall be for ever exterminated; that the toleration hitherto shown to it shall be for ever denied it; and that your exertions may be followed by those of the profession generally, and crowned with success,-I remain, Sir, yours most obediently, AN ADMIRER OF THE LANCET. Newcastle, 18d8.

THE PROJECTED CHARTER TO THE COLLEGE OF PHYSICIANS. To the Editor of THE LANCET. TESTIMONIAL TO DR. BERNCASTLE. CCOPY OF A LETTER FROM DR. JAMES ARTHUR WILSON TO SIR,—Ihave sent a protest to the College of Physicians MR. STEEL, OF LEWISHAM.] against their infamous plan, if true, which I cannot believe, of To the Editor of THE LANCET. unlicensing licensed practitioners, and I hope others will do the same. If it becomes the law of the land, I shall either LET me thank you, without the delay of a post, for the practise in defiance of them, or give up my profession in dis- manly, generous protest which you have entered in THE LANCET in this your valuable journal. gust. I hope you will insert of this morning against the cowardly outrage inflicted on Dr. I am, Sir, yours obediently, Berncastle by the guardians of the Croydon Poor-law Union; E. 1848. Extra-Licentiate. Cardiff,

WILLIAMS,

THE LIBELLER OF SURGEONS IN GENERAL PRACTICE. To the Editor of THE LANCET. SIR,—No man possessing common sense or decency could rise from the perusal of the article in the February number of Fraeer’s Magazine, entitled " A Plea for Physicians;’ without a feeling of the deepest disgust and contemptuous pity for the narrow-minded and miserably ignorant writer who

and will you be so kind as to let me be one of your " neighbours" on this occasion. I send a post-office order for XlIs., as a registration fee, and wish, with all my heart, that, with propriety, I could afford a larger sum, to swell the proposed testimonial. Perhaps, my dear friend, you wilt receive it from your old teacher in his official capacity as " Senior Physician of St. George’s Hospital." I happen, by mere lapse of time, and in conventional phrase, to be among the many so-calledheads of the professionand I should be ashamed, after your appeal, for one day longer to share individually in the discredit that attaches to the chartered bodies

,