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profession, and to exclude from it ignorant and unworthy pretenders, as a scheme to gratify the avarice, or promote the ambition, of those who have engaged in it. This is a question of some importance, and we propose to examine it. For although it has often been examined, and fully settled, to the satisfaction of informed and well disposed men, yet the facts and arguments, upon which a just determination of it rests, are so readily forgotten, while a jealousy is so easily excited of everything that has the least appearance of monopoly or privilege, that we think a slight review of it may not be without its use at the present time. If our medical societies are designed and calculated only to promote the interests of their individual members, or to secure privileges to their own corporations ; and still more if they are associations for the
purpose bling their members to prey with the greater security and effect upon the necessities and distresses of their fellow men, then have they received too much of favor both from the laws, and from public opinion. But if, on the contrary, the best interests of the community are advanced by their prosperity, at least equally with their own, and if the men who have been actively engaged in them, while they have labored for the good of their own profession, have no less promoted the good of the whole community, then they are not unworthy of all the protection and confidence they have received.
That the learning of every scientific man is a benefit to the public as well as to himself, is so obvious as scarcely to need remark. There is no knowledge so abstract that its influence and its advantages are confined to the immediate possession of it; like the garden of the rich man, the beauty and healthful fragrance of which are enjoyed by the poor neighbor, no less than by the opulent proprietor. But the learning of the physician has its influence diffused over the whole community more directly than that of almost any other class of men. His business brings him into immediate contact with every portion of the human race; and under circumstances favorable to the exertion of a powerful influence, whether that influence be for good or for evil. There is a sort of universality to the profession which belongs to no other. Every village has its physician; and he has direct access to every family and every individual in it. Were his knowledge therefore of the most abstract kind, there would be no part of the community to which it would not be a matter of strong interest that the profession should be learned and respectable.
On the contrary, however, medical science is in its very nature peculiarly practical. It embraces an epitome of the more practical parts of all the physical sciences. The physician, if he is properly educated to his profession, must be familiar with many parts of natural philosophy, with natural history, botany, chemistry, &c. as well as with those branches of learning which more immediately connect themselves with the science of life and the knowledge of diseases. Such in point of fact is the real state of things in our country. If we except those whose province it is to teach those branches of knowledge, physicians are almost the only men among us who cultivate them. That even they cultivate them, in any considerable approach to the degree to which they deserve to be cultivated, we would by no means assert. But that they do it much more extensively than any other class of men, cannot, we think, be questioned.
We have thus far spoken of physicians, simply as men, and of their connexion with society as being of the same kind with that of other scientific men. But if we regard them in their professional capacity, engaged in the performance of their peculiar duties, we shall find that the community have a still deeper interest, in their qualifications and character. The physician is not only brought into contact with all classes of men, but every individual in the community is sooner or later directly dependent upon him in matters which concern his most valued interests, his health and his life, and those of the friends most dear to him. It is not a matter in which he has a choice, as in most of the other concerns of life. Man is born to disease; and they that are sick have need of the physician.
There is also a peculiar implicitness in this subjection to medical skill and science, which belongs to no other profession, and which while it involves all classes of men, levels at once all distinctions of rank and intellect. The lawyer advises and argues, and the clergyman hopes to influence only so far as he is able to convince; but the physician prescribes. And the prescription is followed, not because the patient comprehends either the character of his disease or the nature of the remedy, but simply because he relies upon the character and skill of the physician. It is wholly a matter of confidence, and on this confidence the most learned are as entirely dependent, as the most ignorant. The one is no more than the other induced to submit to his physician's directions, by judging for himself of the wisdom of his prescriptions.
If we examine the grounds of this confidence, we find still another peculiarity, in which the medical profession differs from every other, and one which gives to the community at large a deep interest in the general character and intelligence of that profession. Except in cases where a physician has established a reputation by a long course of professional conduct, the confidence that is placed in him is not so much a matter of personal consideration referring to him individually, as it is a confidence in the intelligence and skill of the profession as a class of men. The knowledge of the physician, upon which of course all his skill is founded, is chiefly made up of branches of learning, of which all other men, however learned in other respects, are profoundly ignorant. It necessarily follows that none but a physician can judge of a physician's fitness to practise. This remark is partly true in the other professions. But it is so in this in a peculiar and exclusive sense; since it not only applies to the first examinations in which the candidate is called upon to exhibit the extent and sufficiency of his knowledge, but it extends also to the observation of his readiness and skill in applying that knowledge to actual practice. His standing among the members of his own profession is therefore the measure, and the only true measure of his desert, for the public at large. If it be asked, why these beneficial results may not be
produced by the character and conduct of the individuals of the profession, without the intervention of an organized society, the answer is a ready one, that the efforts of individuals unassociated with each other, can neither secure the establishment of a sufficiently elevated standard of professional acquirement, nor, were it practicable to fix such a standard, could they compel the candidates for the profession to attain to it, or the members of the profession to maintain it. There would still be men of high worth and learning in the profession, and the success which almost uniformly attends a long course of meritorious exertion would induce many to follow their example. But their effect on the whole community would be like the bravery of an individual in an undisciplined army. He may sometimes be able to excite his companions to such an imitation of his courage as shall secure success; but he will often fail, and he will not unfrequently fall a victim to his efforts. But let those whose character and standing fit them to be leaders in the march of improvement, become associated together for this purpose, and without doing violence to the rights or the feelings of any, the whole body of the profession find it for their honor and their interest to be associated with them. Even those to whom it is a restraint to be confined within the rules of propriety and honor, find it better to submit in some measure to such restraint, than to cut themselves off from the benefit of being ranked with their more worthy associates. Thus the character and conduct of the most deserving become not only an example for the imitation of those who are less so, but a sort of law which, however disposed, they dare not disobey.
In the practical operation of this simple principle, its effects are manifold ; and in every point of view its benefits are extended to the public at large, no less than to the profession itself. In the first place it secures, as we have already remarked, an elevated standard of professional attainment. This cannot be effected by the uncombined efforts of individuals, however desirous they might be of accomplishing it. Many young men, having a just idea of the great responsibilities of the profession, and of the varied learning requisite to sustain them properly, would still prefer to acquire a thorough education before they entered upon it. But many more in their eagerness to get forward into life, would rush into the profession but half prepared, and a considerable proportion of those who, under other circumstances, would belong to the former class, would be carried along with them. It is only by the operations of an organized society, that any fixed rules can be established, by which a candidate shall be compelled to go through a prescribed course of study, or to possess a certain amount of knowledge, before he shall be permitted to undertake the care of human life and health.
But then, if we suppose such a standard to be agreed upon, there must be some acknowledged power to compare the attainments of the candidate with it ; and this can not be effectually done by individuals alone. It could only be attempted by each physician, in the case of his own pupils ; and if we could believe a given individual to be sufficiently impartial to judge fairly of the extent of their qualifications, it cannot be supposed that the public would feel such a confidence in his impartiality, as to place much reliance on his testimony. The interests of the candidate himself, therefore, as well as those of the public and of the profession, require that there should be such an impartial, independent body of examiners as can be provided only by a society, which shall concentrate the power and influence of the profession.
It is a natural and almost inevitable consequence of a low or an uncertain standard of professional requirements, that other considerations besides those of science and worth, come to be relied upon, as the means of gaining influence and distinction. While that sound learning, which, from its very nature, elevates the character, is neglected, those arts of winning popularity, which as certainly debase and degrade it, are cultivated in its stead. He need not be an old man, who can remember when it was the general impression throughout a great portion of our country, that the same course of
preparatory education which was even then regarded as a necessary preliminary to entering upon the study of either of the other learned professions, was quite supererogatory in this. For our individual selves, though we can lay no claim to the honors of age, we have heard in our day a worthy member of a New England legislature speak with great contempt of the folly of sending a young man to attend a course of lectures, and declare that his son, who was to be a doctor, should go to a dancing-master to learn the arts of ingratiating himself with his patients. It need not be said that a physician educated upon this principle, although it should not be carried to the same absurd length, is wholly unfit to take charge of the lives and health of his fellow men. Nor is it for this purpose that the subject is here introduced. We have alluded to it rather for the purpose of remarking, that it is mainly to the insufficiency of the education of practitioners of medicine, that the jealousies and quarrels which have so often disgraced the profession, are to be attributed.
Whenever an individual admits and acts upon the idea that any other consideration than that of professional knowledge and worth is to be the chief measure or means of his success, he becomes accessible to motives which will almost inevitably lead him into practices dishonorable to himself and injurious to others. These of course lead to retaliation, and mutual recriminations. The kind of intercourse, which exists between the physician and his patient, favors such a result. It is, as we have before remarked, wholly a matter of confidence ; and at the same time, the delicacy of the subject, or the seclusion of the scene of operations, may render it difficult to explain any VOL. XXVII. NO. 60.