university the two occupations were dissevered, and the separation thus remained as licensing bodies grew up, through a reverence for the antiquated. In Italy these branches were kept distinct up to 1451, even those physicians who were not clergymen being forbidden to marry. In the law there is no such distinction made, at the educational stage at least; but as tastes or circumstances direct, the barrister may become afterwards distinguished as a criminal, nisi prius, or chancery lawyer. I would, then, urge that no one-sided or special examinations should be allowed. The late most wise regulation of demanding a knowledge of internal as well as external pathology and therapeutics from candidates for the diploma of the Royal College of Surgeons, London, and other surgical bodies, will do much to accomplish their re-union. The Royal College of Surgeons in Ireland, from the day of the incorporation to the present hour, has never recognised the absurd distinction. The London College of Physicians until lately rigidly enforced the separation, and it is said that its president (Sir H. Halford) refused to bleed a friend who while travelling with him had an apoplectic fit, although that surgical operation would have saved his life.

In the third part of this essay the union of the profession will be fully discussed; but as to the title of the members of the united body, that of "physician" seems preferable and more comprehensive, as implying the student of nature, whereas "surgeon" refers to a mere handicraft. However, the best etymologists assert that the word in the Old Testament, which occurs therein four times and is usually translated "physician," really means one who stitches a wound.

The only branch of the profession which it is very desirable should in cities be practised separately is obstetrics, for attendance on surgical cases, and in a greater degree anatomical pursuits, on the part of a practitioner, render his visits to lying-in women very hazar

16

MEDICAL LEGISLATION.

dous. The isolation of the pharmaceutical art will be advocated presently.

At the commencement of the present century, practitioners in England were chiefly licensed by the College of Physicians, and the College of Surgeons, established in 1800; and the Apothecaries' Company exercised their legitimate office of licensing persons to practice pharmacy. But this latter body being ambitious, despising the calling they were trained for, and seeing the College of Surgeons neglecting to examine candidates in medicine and collateral subjects, and altogether apathetic, succeeded in 1815 in gaining the power of examining and licensing general practitioners in conjunction with the College of Surgeons. There were besides numerous foreign graduates and very many unlicensed practitioners.

In recording the efforts of the profession to alter many undesirable conditions into which it had lapsed, I shall endeavour to avoid repetition as much as possible, lest the subject should become as tiresome as an article with the oft-repeated heading "Medical Reform” was to some a few years ago. The first agitator in this cause was Dr. Harrison of Horncastle, who, in 1807, vigorously exposed the disorganised state of the medical profession. In 1826 Mr. Courtenay endeavoured to introduce a medical bill, but no efficient steps in the matter were taken, as the profession itself was divided, and the institution of the British Medical Association became a necessity. Founded in 1832 by Sir Charles Hastings, this association has been a powerful means of raising the medical profession in a moral, a social, and a scientific point of view. Its declared objects are to promote and diffuse medical science, and to maintain the honour and interests of the profession. Its annual addresses are marked by extraordinary learning, and in them all the members may hear a resume of what has been done in each branch at home and abroad. For the yearly

MEDICAL ASSOCIATIONS.

17

subscription (one guinea) every member receives the weekly journal, which is edited with extreme ability.

A great congress of the profession assembled in the theatre of the Royal College of Surgeons, 29th May, 1838, and adopted, among others, the following important resolution: "That it is therefore our opinion that a legislative measure should be sought for by us to unite the medical profession of Ireland into a corporation, upon such principles as shall constitute them one national faculty, and thereby identify, in feeling and interests, the great mass of provincial practitioners with their metropolitan brethren." Previous to this congress the College of Surgeons unanimously expressed itself in favour of such a union, while the proposition to entertain the question at the College of Physicians was negatived by 22 to 3. Thirty years have made surprising changes, and the latter body will not scout so readily propositions which will be made in the third part of this essay. The profession was then, and indeed is still, governed by so many corporations, that no union was to be found when its interests were at stakę. How different is the case of other professions, employments, or even trades?

There was established then, as a result of the congress, two great instruments of reform-the Medical Association of Ireland and the faithful chronicle of its proceedings, the Medical Press-to which, as space will not allow me to record its proceedings very fully, I will refer. Mr. Carmichael was chosen president, Dr. H. Maunsell, whose medico-political services have been immense, secretary. It has since met annually, and at all times when the interests of the profession were at stake, and has thus conferred great benefit. The American Medical Association, founded in 1847 after the models of the British and Irish, has done incalculable service in elevating the profession in that country.

Mr. Warburton, in 1839, nearly succeeded in obtaining legislation. His bill provided for the registration of

licensed practitioners, and for the equalizing of qualifications. He did not provide against quackery by legal measures, believing that such remedies were impracticable, and that the diffusion of physiological knowledge constituted the chief weapon against this fearful evil. It was at this juncture a forcible letter to Sir R. Peel, then premier, appeared from Mr. Carmichael, in which he allowed that the subject was most difficult and uninviting for a statesman, as so many conflicting interests existed. He urged uniformity of examination, the union of physic and surgery, and the separation from both of the practice of pharmacy-as thus would be created a valuable practitioner for all classes of society, while the usefulness and status of the pharmacien would be augmented by incorporation into a college. He allowed that the middle classes of society, and all persons in remote districts, would be best suited by an attendant who should supply as well as prescribe medicines, not charging for them, but for the advice-in fact, the reverse of the existing system. In order to equalize qualifications, he proposed the formation of three facultiesone for England and Wales, one for Ireland, and one for Scotland, which were to govern each country's medical men. Mr. Carmichael lamented the depreciation of the medical calling in public estimation; while the choice of the law or the church raised a man's social position, devotion to medical science lowered it. So disorganised was the profession just now, that Professor Macartney exclaimed, “I am quite satisfied that it would be better for society that the profession was altogether abolished, than that it should be suffered to continue as at present constituted."

In 1840 a bill was introduced by Messrs. Warburton, Wakley, and Hawes, to register practitioners on payment of an annual tax (a most objectionable clause), and to constitute one body or faculty for each division of the empire, the members to have votes (collected by post)

for the council. It was to remain in force till 1860. Some time after, Mr. Hawes proposed to compel every one who had taken a degree or diploma, or who should hereafter take one, to undergo a second examination. As a re-examination would be only dreaded by those who had entered the profession with too great facility, this proposal was approved of by a committee of the College of Surgeons on 6th February, 1841, but elsewhere it met with great opposition.

To show that increased education (and perhaps, therefore, increased expense) will not diminish injuriously the number of medical men, let me quote Mr. Carmichael: "I know that some political economists contend that if the education of medical men be expensive, the cost of employing them must be proportionally high. To this I answer, that it would be wiser to give a fair price for any article we want, or even to remain without it, than to purchase one ill-manufactured and of bad materials. But in my opinion the objection that one grade of welleducated medical men will be either too few or too high in price to meet the wants of the people, is altogether fanciful and founded on prejudice and error; and while there is an abundant supply, the res augustæ domi of the young, and too often of the old, will furnish a host of practitioners to meet the means of remuneration of all those who seek their assistance."

In 1844, Sir James Graham and Mr. Sutton brought in a bill which proposed the formation of a Council of Health and of Medical Education and Registration, to be elected by the crown. It provided for two grades in the profession-viz., physician and surgeon, and licentiate in medicine and surgery, the latter to be examined by the Colleges of Physicians and Surgeons, and in England by the Society of Apothecaries, who were also to license a class of pure pharmaciens. This bill aborted owing to the conflicting interests of the various medical bodies. Had they but attended to the great principles