SKETCHES OF THE MEDICAL PROFESSION IN IRELAND. No. XXIII.

746

SKETCHES OF

THE

MEDICAL PROFESSION IN IRELAND. No. XXIII. COLLEGE OF PHYSICIANS IN IRELAND.

Science, independent of Corporations. 1BIANY of those controversies which have lately agitated the medical profession may be traced to the fallacy of confounding the advancement of science with the interests of corporations. While one party

747 in its favour. If, on the other remembered for their mercenary vices, were in the habit, until very lately, of trans- hand, we were aware that it had originated mitting, for a certain sum, diplomas by the in a barbarous era, that it was the mere Post Office. In Ireland, we have an uni- offspring of chance, fostered by ignorance,

probability

its

versity which places medical degrees be- and that along with these disadvantages, natutal defects had been deteriorated by yond the reach of the great mass of Irish students ; a college of physicians, which design, to answer other ends than those for offered a bounty on ignorance, by exacting which it was originally created, we should

promise from its licentiates never

to prac- have little hesitation indeed in deciding on useful branches of the the value and titness of a system to the art; and a college of surgeons, which, in present age, which had originated under circumstances. Let us just apply this addition to its former imperfections, is now threatening us with the worst effects of test to the corporate system, and read its the English regime, in a second edition of pedigree by the lamp of history. their charter. It is very remarkable, that Literary corporations were totally unwhile all these institutions act upon one known to the ancient world, and, as they system of policy, each of them condemns exist at present, are comparatively a mothe other with sectarian acerbity, so that dern invention; even their prototypes, the they perpetually keep up a sort of civil war municipal corporations, had no existence themselves, about lectures, privi- then, being the growth of much later ages. leges, and pre-eminence ; and if the influence Some writers, indeed, who affect to see of their folly were confined to the focus of all things prefigured in the page of history, production, it might be suffered to expend as some lynx-eyed physiologists would peritself within its own sphere without much suade they can see the germs of future concern, but-" Quicquid delirant reges, kings and empires in the seminal fluid, plectuntur Achivi, "-the public and the would have us believe that the Greeks and profession are the only sufferers in the end. Romans were blessed with these instituIs this, then, a state of things which the tions, and confidently appeal to the union most violent opponent of innovation can of the Sabines with the latter people, by pretend to justify upon principle ; or how Numa, as a proof of the truth of their asseris it that such a difference of opinion should tions ; but the amalgamation of two conexist as to the extent of the evil and the tending tribes, by mingling them together, nature of a remedy? Simply, in our opi- according to their respective pursuits, or mon, by confounding science with corpora- the voluntary associations of the artizans of tions, which are as independent of each Athens for social and benevolent purposes, other as the Christian religion is distinct present no analogy to the privileges and from church establishments and decimation. immunities enjoyed by modern cotporations. It is the object of the subsequent remarks, No such institutions existed among these suggested by the contemplated considera- nations, who, however, contrived to manage tion of a body which owes so many of its all their affairs without any such assisterrors to this fertile source of evil in the ance ; vve must, therefore, descend from medical world, to disembarrass the question these bright eras of civilization to search of one of these falJacies by which it has for their origin amidst the barbarism of the been hitherto encumbered, through an ex- middle ages. It was at this period of amination of the origin, constitution, and human degradation and ignorance, when the influence of corporate systems of education. light of learning faintly glimmered through If this proposition can be satisfactorily the monastic cowl, and the spirit of free. established, the consolatory conclusion must dom was borne down by feudal and ecclefollow, that a system which has been pro- siastical power ; when man was as much ductive of mischief and discord maybe the property of his lord as the soil on which safely dispensed with ; and that the ground he trod, and the alphabet was known to being thus once cleared of this nuisance, exist but by report to many kings, and the only contention will be, in future, about almost the whole of their subjects ;.-that a substitute more worthy to occupy its the models of those literary corporations, which the sages of the nineteenth century place. In the consideration of any system, it would persuade us are the best ’° possible would tend much to settle our opinions of instructors," woe first established; it is, its merit, if we were accurately acquainted therefore, little to be wondered at, that in with the times when, and the men bv their formation we can discover so few whom, it was instituted. If it were formed traces of wisdom and of enlightened design. in an enlightened age by enlightened indi- The manner, indeed, in which they were mduals, and if along with this we knew founded, almost excludes the 1-ossibility of that these individuals had no other object their being adapted to the dif’usion of knowin view than that which they ostensibly and the political government of the professed, there would be, at least, a profession. We can scarcely disa

tise

one

of the

most

such

among

ledge,

strong medical

748 movement in their formation which framing by-laws for any or all purposes, the result of some accidental cause, that the London College domineers over the or motive for the attainment of some tem- surgeons of England ; the Dublin College porary purpose. Thus, Richard the First excluded all but their own apprentices from patronised Oxford, because he had been an examination ; and the College of Phycover a

was not

born there ; Edward the Third was actuat- sicians swore their licentiates never to ed by nearly a similar object, on account of practise surgery. The simple fact of each having been educated there ; and Queen of our medical corporations having thus Elizabeth, for the high and useful ends of really forfeited its charter by its contravenforcing Protestantism on the people, by tion through the enactment of by-laws, and compelling the students to submit to the yet remaining free from the operation of the degradation of taking test oaths on their intended check, is evidence quite sutiicient admission. The masters of this university to establish, that a system which enables were not exceeded in good sense and libe- men with impunity to do,in short, whatever rality by their royal patrons; for such was they please, can neither be adapted to the their hostility to the Greek language at this purposes of instruction, nor the government time, that they absolutely formed them- of a liberal profession. There are persons, however, so ignoselves into what they classically denominated a Trojan association for the exter- rant of the history of literature and scimination of that language, and violently ence, and so insensible to the facts which opposed the learned Erasmus, who came are every day presented before them, that over to England to open the treasures of they endeavour to persuade the public Grecian literature to the people, in a series that were corporations to be extinguished, of lectures, which, for the honour of the the world would be left in instantanecomposers, and the amusement they would ous darkness. At the head of this class no doubt afford, it is a pity that they have stands, " in bad pre-eminence," that "mere been lost. It is not from such royal patch- white curd of asses’ milk," Sir Anthony Carwork, or literary vandalism, that we could lisle, who has lately taken the trouble of expect a prudent and liberal system of edu- embodying the opinions of his disciples cation and policy would have arisen. We into a sort of negative creed, which is worth are not, however, beholden to historical the transcription, as the political faith of testimony for proofs of the inaptitude of this party. 11 I do not believe," gapes the corporations for the cultivation of science oyster, " that any subversive change in our and the government of its professors. English colleges, would amend the proThe constitution of these bodies presents fession, or benefit the public." We shall a primafacie evidence of their unfitness for immediately show the sceptical Knight, that such purposes. The consequences which not only would a " subversive change" be have resulted from them are precisely those useful, but that such a change is essentially which might, a priori, be expected from necessary to the amendment of the protheir organization. The distinguishing fea- fession, and the benefit of the public ; but ture of a corporation, and that which gives may be as well to prove to him in the tone to all the others, is the possession of an first place, that those institutions, on which irresponsible power conferred in the legal he places so high a value, can be safely disof making by-laws. Now, it is pensed with. The ancients, he will admit, axiom proved by the experience of almost were as thoroughly masters of the arts, all bodies politic, as well as of individuals, ’, sciences, and literature of their time, as that the abuse of such power is as certain as the moderns are of those which prevail at its possession, without some competent present. Let the population of Athens be check. It is true such a check is contem- taken as an illustration. Every citizen, in plated in all charters, by providing that the higher ranks of life, was expected to be these by-laws are not to contravene the ends a proficient in philosophy, in the art of for which the charters were granted ; that war, and the polite accomplishments of they are not to be contrary to the common civilized life, so as to be able to serve his and statute law of the country ; and that the country, if called on, in a civil or military holders of such charters can be sued in capacity. Among the lower orders, a suitCourt for a violation of their privileges, by able education was general;and for reasons a quo warranto prosecution. But to what which it would be pedantry to quote, we purpose are these restraints imposed, which know that each class excelled those of every are but as gossamer to the hand which sets other nation in their respective accomplishthem at defiance? What individual will ments. By what means was learning, of risk the trouble of litigation, and the expense every kind, so generally diffused, and so attending it, in the application of this check successfully cultivated in this city of the to a body supported by an ambiguous sta- soul?" Not by colleges, corporations, nor by tute, and a joint-stock purse, accumulated any other species of chartered institutions, by public exaction ? It is by this power of for there were none such in Athens; but

it

right

3n j

749 the whole

was

simply and effectually accom,

I

But it is unnecessary to go

so

far back for

private instruction. There was proofs of the independence ofscience or corplished by an we need but look to the in invested of

proud porations ; by compel pupils to prospect which talent, triemphing over all attend the lectures of particular persons, at the disadvantages of the law, exhibits in the fixed periods of the year. By one of Solon’s private medical schools of Great Britain laws, which exonerated the son from the and Ireland. In London, Edinburgh, and natural obligation of supporting his father, ifDublin, the really important part of medihe had not been brought up in some pro- cal education is, for the most part, confession or other, the republic, indeed, re- ducted by private teachers. Sir Anthony quired that every individual should be edu- may gape at this assertion, but he will cated ; but beyond this expectation, and find it correct on examination. We will the granting of such places as the Gymnasianot assert that the aggregate number for conducting education, the state did notof students, attending private schools, is interfere. Neither did it allow a salary to greater than at the public schools; but any professor for teaching particular sci- we assert that there are private teachers, ences ; nor was this practice known until whose classes equal those of any single prothe reign of Antoninus at Rome, whose fessor of our colleges, though assisted by example, we believe, was not followed by compulsory laws. Yet, most of the pupils his successors. It is certain the Academy, of private teachers are obliged to fee the at Athens, allowed Plato no annual stipend; public professors; a sacrifice which they Aristotle received no salary from the obviously would never make, unless they Lyceum; Zeno was not indebted to thefound it their interest. Indeed, we scarcely Portico for his support ; each of these ever knew a pupil intent on the acquisition professors being exclusively feed by theirof knowledge, and who had the means of pupils. In the cities of Ionia, in Asiaticmaking a choice, that did not select a priGreece, which reflected back the lustre off vate, in preference to a public teacher. It Athens on herself, there were no cor-its always on the benches of the snug little porations, or pensioned professors. Gre- theatre of the private teacher, that you are cia Magna, comprehending the celebratedI sure of finding the hard-working men" schools of Italy and Sicily, where medicinepreparing for Mr. Jacob’s " stone wall," bewas first systematically taught, was equally cause they there expect to find ability and destitute of chartered tutors ; while theassiduity in the teacher. It is quite unpractice was as little known to the schoolsI necessary to strengthen this position, by an of Egypt : and, in Sparta, it is remarkable,, appeal to the facts furnished by unpro-

no

body

act of the

men,

Athens,

Prytamia,

to

"

where the little literature which was tole- fessional schools, where the whole educarated was under the management of thetion of the people is conducted without a police, learning never flourished ; and wesingle act of parliament. Yet, with all this are indebted for all we know of the singularbefore his eyes, poor Sir Anthony shudders system of Lycurgus, to the writers of theat the idea of any " subversive change in other states of Greece. In the formerour English Colleges," though it is certain cities, therefore, the whole business off that these bodies could not only be diseducation was conducted by private schoolss pensed with, but that they are decidedly and private teachers, many of whom rea-- injurious to the interests of science. With lized fortunes by their pursuits. Aristotle,the excellent opinion of Mr. Lawrence, enriched by the bounty of his imperial pupill I shall conclude this part of the subAlexander, was induced, by the profits off ject, which cannot be too often repeated, private tuition, to re-open his school int because it condenses into an axiom all that Athens ; and the sums received, in theis required of the statute book in medical same manner, by Gorgias and his brotheraffairs :-" Were I," says he, " to propose rhetoricians, Lysias and Isocrates, by re-.a legislative enactment on the subject of duction into British money, according to) the medical profession, it should be short, the tables of Arbuthnot, far exceed theand confined to the single point of preventaverage incomes of any private teacher ofF ing uneducated and unqualified persons modern times. The success and profits off from practising. I would appoint an examthe private system of education, were ob- ining body, to be composed of the most viously the results of free competition, andI eminent professional characters, without the talent which it elicited. While atten-any regard to the present artificial distion and ability were called forth by thiss tinetions, and empower them to make an system, private teachers were not impove-. efficient examination of all candidates; the rished by being undersold in the market off testimonial granted after such an examinaeducation by pensioned professors, who aretion, should authorise the individual to enabled, by their salaries, to retail their in-practise any, or all the parts of medicine, dolence and stupidity at a low price, to the; and none should be allowed to practise manifest injury of genius and industry. without it." This single sentence contains -

750 all that is required by medicine from Iegis- tors, he is of opinion, that" Whatever force lation ; for, competency to practise is, after a certain number of students of any college all, the important point ; how, or where or university, independent of the merit orrethis competency is attained, is a matter of putation of the teachers, tends, more or less, the most perfect indifference. Though Mr. to diminish the necessity of that merit or

(

Lawrence has the merit of reducing the reputation. " This certain diminution of the question to, perhaps, the most simple state diligence of teachers by the compulsory to which it could be reduced, he is not the ticket and pension system, is not, according only writer of celebrity, who, convinced of I to our author, the only injury which science the evils resulting from colleges, has suffers from this which extends its the manliness to put his opinions on record, influence beyond its immediate objects, and lessens the profits of those private teachers, against the system of chartered tuition. We shall give some observations on this in- for " Such salaries," he continues, "put the teresting subject, because they are apposite, private teacher, who would pretend to come and not generally known to medical readers, into competition with them, in the same state and from a writer whose name is an autho- with the merchant who would pretend to rity which cannot be slighted or Have trade without a bounty, in competition with endowments," asks this writer, those who traded with a considerable one. public " contributed in general to promote the end If he sells his goods at nearly the same of their institution ? Have they contributed price, he cannot have the same profit, and to improve the abilities, and encourage the poverty and beggary at least, if not bank. di- ruptcy and ruin, be infallibiy his lot. If he diligence of the teacher’! Have rected the course of education to objects attempts to sell them much dearer, he is more useful, both to the individual and the likely to have so few customers, that his public, than those to which it would have circumstances will not be much mended." gone of its own accord? It would not be Though private medical schools were comdifficult to give at least a probable answer paratively unknown when the preceding to each of these questions." So we thinkz sentences were written, the author of them but the proposer of them, instead of giving has predicted, we may say, with extreme a direct answer, by appealing to the facts accuracy, the consequences which the forefurnished by " public endowments,"adopts ing system has produced ; for, it is a nothe more philosophic manner of proceed- torious and disgraceful fact that, where priing, and answers them first by a kind of vate and public schools co-exist, the pro. axiomatic argument, founded on those laws prietors of the former are obliged to teach which are known to govern human action, at a rate considerably lower thau their prithus’6 In every profession," says lie, vileged competitors, in order to secure cus" the exertion of those who exercise it, is tomers. Not only is this excellent authoalways in proportion to the necessity they rity averse to having education regulated are under of making’ it. This necessity is by the statute-book, but he justly considers greatest with those to whom the emolu- it altogether independent of legislative asments of their profession are the only source sistance :-" Those parts of education," he from which they expect their fortune, or says, " it is to be observed, for the teachIn ing of which there are no public instruceven their ordinary revenue to subsist. order to get this fortune, or even to get tors, are generally the best taught. When this subsistence, they must, in the course a young man goes to a fencing or a dancing of a year, execute a certain quantity of school, he does not, indeed, learn always to work of a known value ; and where compe- dance or to fence well; but he seldom fails tition is free, the rivalship of competitors, of learning to fence or to dance." The who are all endeavouring to justle one ano. illustration, borrowed from teaching the ther out of employment, compels every man ’ poetry of motion,’ as dancing has been to execute his work with a certain degree defined, must be admitted to he at once of exactness." These are principles, of the apposite and excellent; for who will assert truth of which Sir Anthony himself cannot that there are not ’te judice Crampton,’ doubt. Now for their application, by the more good dancers than good practitioners, same philosophic mind:—" The endowments even among the doctors themselves. And of schools and colleges have necessarily di- the reason is obvious: they were taught minished, more or less, thisnecessity in the medicine by public, and dancing by private attention of teachers;" and why ? for the professors. Cliange the system of educatsimple reason, as our author remarks, that ing the feet, that is, institute professorships 41 Their subsistence, so far as it arises from of dancing’, with permanent salaries attheir salaries, is evidently derived from a tached to them, and the art and worship of fund, altogether independent of their suc- Terpsichore are no more. Thus, let Mr. and cess and reputation in their respective pro- Mrs. Noble be translated from Drury-lane fessions." In addition to this fertile cause to Oxford, place them on a rich endowment of idleness and ignorance in pensioned tu- there, and in less than one year they will

I had

they

system,

751 fat and lazy, that neither of them Notwithstanding that this compulto exhibit one out of the ’ five sion is quite unnecessary, if the student It is precisely the same with complains, he is secusfdof contumacy, which charges, however, he is ably dethe cultivators of the head as with those of the feet ; give them a comfortable salary, by this author, as follows : " Such," and, in a short says he, " is the generosity of the greater independent of exertion, time, thatvibratory motion of the parti- part of young men, that so far from being cles of the brain,’ upon which thought is despise or neglect the instrucsaid to depend, will all but cease. Hence tions of their masters, provided they show our author is of opinion, " That the schools some serious intention of being of use to of England are much less corrupted than the them, they are inclined to pardon a great universities. In universities, the youth are deal of incorrectness in the performance of neither taught, nor can always find proper duties, and sometimes even to conceal means of being taught the sciences, which from the public a good deal of gross negliit is the business of these institutions to gence. " It was this compassionate geneteach. In the University of Oxford, the rosity of young men towards their master, greater part of the public professors have which, no doubt, prompted the students of given up even the pretext of teaching." So one of the London hospitals to throw the far, therefore, as the corporate system has shield of their names over the celebrated any effect on science and its diffusion, that lithotomy case of Mr. Bransby Cooper. effect is decidedly injurious. When the student does complain, he has We have thus seen the influence of cor- really no redress; for, as this writer reporate bodies explained on natural princi- marks, " If the authority to which he is ples, and these principles proved by facts : subject resides in the college, body corpoit now only remains for us to see the means rate, or university, of which he himself is a by which they maintain this malignant in- member, and in which the greater number fluence, and the spirit by which they are of the other members are, like himself, in general actuated. " The discipline of persons who either aie, or ought to be, colleges and universities," remarks the pre- teachers, they are likely to make common ceding writer, 11 its in general contrived, cause, to be all very indulgent, and every not for the benefit of the student, (mark man to eonsent to neglect of duty in others, lliat,) but for the interest, or, more properly provided he himself is allowed to neglect speaking, for the use of the masters. Its his own." It is thus that the professors objects, in all cases, are to maintain the of colleges make common cause against the authority of the master, and whether he student, and divide the disgrace of inatneglects or performs his duty, to oblige the tention among themselves, that it may students to behave to him as if he had fall the lighter on each, notwithstanding performed it with the greatest diligence the following case put by our author : " If and ability. It seems to presume perfect in each college," lie observes, " the tutor wisdom and virtue in the one order, and or teacher, who was to instruct each stuthe greatest weakness and folly on the part dent in all the arts and sciences, should not of the other." In these two sentences, we he voluntarily chosen by the student, but have the very essence of corporate legisla- appointed by the head of the college, and if tion ; and as every student must, from his in case of neglect, inability, or maltreatown experience, be aware, a perfect de- ment, the student should not be allowed to scription of the spirit of the licensed pro- change him for another, without leave, first ftssors of colleges and universities. But asked and obtained, such a regulation would we must proceed to the grounds of this im- not only tend very much to extinguish all pertinent dogmatism:-,, Wherever the emulation among the different teachers of masters, " remarks he, " really perform the same college, but to diminish very their duties, there are no examples, I be- much in all ofthem the necessity of dililieve, that the greater part of the students gence and attention to their respective puneglect theirs. No discipline is ever re- pils. " The opinions which we have been tranquisite to force attendance on lectures (just mind this) which are really worth the at- scribing, are so much in accordance with tending ; as is well known, wherever such those which have been advanced in this are given. Force and restraint Journal, and so diametrically opposed to may, no doubt, be requisite, in order to those advanced by the Duncans, Johnstones, oblige children, or very young boys, to at- illocleods, et hoc genus omne of the medical tendto those parts of education which it is press, that we have little doubt but their thought necessary for them to acquire in ignorance of English literature will lead that early part of life ; but after twelve or them to suspect us of " improvising quotathirteen years of age, provided the master tions, " like Master Vivian Grey, to answer force or restraint can never our immediate ends. We have not, howdoes his be necessary to carry on any part of educa- ever, been guilty of this ingenious artifice

will be able

tion. "

positions.’

from

become

so

fended

disposed to

their

lectures

duty,

I

752 to impose on the ignorance of our sities, want of benevolence, (oh! dear,) and nents ; neither is the author whom we have other little peculiarities to which the Phrebeen quoting, one who. was fascinated by nologist so politely alludes.

oppo-B

the charms of innovation, or smitten with Spurzheim’s talent has nothingto do with the prospect of introducing an Agrarian the question at issue. He, like other men law into the medical profession. His hos- of genius, may have founded his system on tility to the corporate system cannot be at- an imperfect theory; and 1 can only appeal tributed to the agitation of THE LANCET, to the well-known wonders of German for he wrote his book some years before story, to account for the hallucinations (I that Journal was establislied. Of none of use the expression in return, being more these crimes can he be fairly accused ; his apt) of this phrenologist and other learned opinions are the offspring of a disinterested craniologists. Oh ! the noble march of in. attention to the subject, and, consequently tellect, when will its sweeping influence entitled to all the respect which is due cease ? Never. So long as wild speculations to them on this account, along with that entertained, so long will the real truths which they must secure, when it is known of life be forgotten ; and, evident as it is, that they are the sentiments of the learned the more egregious blunders are committed, the more do the infatuated disciples of phreand philosophic ADAM SMITH.

are

ERINENSIS.

Dublin, September J,

1828.

PHRENOLOGY.

To the Editor of THE LANCET.

SIR,—In answer to the " Phrenologist, " who appears to have been excessively galled by my observations, I beg to refer him to Dr. Epps’s letter in THE LANCET, No. 245, May 10, 1828. However, as his opinions seem as obstinate as he insinuates mine are, (and here, I confess, he speaks truly,) perhaps he may not feel inclined to turn to that letter ; I shall, therefore, quote from it :"I leaned over, put my hand under the head, and, after a slight examination, (slight indeed,) stated the organ of sexual love is very large ; that of love of offspring is very large; that of approbation is immense, (l presume this to be peculiarly large in the brain of the phrenologists,) and that of destructiveness MODERATE!! " I now appeal to men of common sense, leaving the phrenologists out of the question, and merely ask, whether this statement can be doubted, and if it does not amply exemplify the absurdity, tom-foolery, and quackery, of the phrenological doctrine? A teacher and lecturer, I believe, on the subject, commits a blunder which could not be overlooked in the merest tyro of the art, and then, with a studied sophistry, endeavours to gloss over his error by means of the sexual organ being

potential, and, consequently, having bumped the one of love of offspring, ’° vi et

more

armis, " out of the phrenological ranks! How can

it

possibly

be

convincing

to a reason-

able mind, that any individual can be capable of murdering her own infant, and have the love of offspring huge ! On this staggering point, I confess my mulish propen-

nology seem

confirmed. Where, may I ask, is the organ of unsoundness of mind placed ? How can the phrenologist account for the slight appearances found on dissection, when, during life, the brain has been the apparent seat of disease? The rupture ofa very slight vessel, a small quantity of fluid in the ventricles, and a patch of coagulated blood, are usually the appearances found by the anatomist, and yet these are the only accountable causes for a train of symptoms of the most alarming character. These slight appearances, I say, are sufficient to unhinge the intellectual faculties of an individual, who, but a few hours before, may have been in

possession of all the lumps and bumps craniology so geographically deli-

There are subjects on which we vainly attempt explanation, and phrenology is one of them. We may pull the neates.

pieces, and the dissection may be cleverly performed, but what do we learn by it more than we did before ?Absolutely nothing ! It is a mass of mystery, and its matter, organization, and uses, can alone be known to that beneficent Being, who has so wonderfully and so wisely created it! brain to

For the latter

part of the learned Phrenolo-

the subject, I have to thank him : let him, however, speak his own sentiments, but not infer mine, for nothing but absolute facts (not such glaung errors as I have taken the liberty of deprecating, and for which I hope I may be excused,) and incontrovertible evidence, can ever make me change the opinion I now hold. Indeed, were I ever to entertain other views, they would be formed from more conclusive reasoning, than this flippant and self-conceited

gist’s epistle

"

on

Phrenologist," dogmatically

adduces.

DER FRIESCHUTZ. L.

Twickenham, August 12,

1828.