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edge of herbs, roots, and waters, in any of the king's dominions, to minister in and to any outward sore, uncome, wound, apostemation, outward swellings or disease, any herbs, ointments, baths, pultess and emplasters, according to their cunning,' or drinks for the stone, strangury, or agues, without suit, vexation, trouble, penalty, or loss of their goods. It matters little to our purpose whether the surgeons of Henry the Eighth's time really deserved the character here given of them, or whether these reproaches were the result of an unreasonable excitement against them produced by their claiming the privileges which had been previously granted them. In either case it is a powerful illustration of the unsuitableness of penal enactments for such a purpose. Whether abused or not, they are necessarily liable to be in some cases oppressive in their operation, and will always tend to cast an odium both upon the profession and those who practise it.
If the London Colleges of Physicians and Surgeons have failed of accomplishing that part of the design of their institution which relates to the exclusion of the ignorant and unskilful from practice, they have scarcely less signally failed of producing that harmony and concert among the members of the profession, which we have before said, should be one of the great means of usefulness of such institutions. We have not left ourselves room to pursue this branch of our subject as intended ; but must content ourselves with remarking that the whole history of the College of Physicians furnishes a series of legal controversies, sometimes with men of distinguished worth, about the extent of their privileges, and their right to restrict the enjoyment of them to a small and favored number. A by-law was early adopted, declaring that no person shall ever be elected a fellow of the society who has not had a medical degree at the university of Oxford or Cambridge. The absurdity of this by-law is the more conspicuous from the fact, that neither of these universities has ever had a medical school of any distinguished celebrity. So that to enjoy the high honors and privileges of this college, a physician must have obtained his education under circumstances much less favorable to a thorough professional knowledge, than fall to the lot of many
of those who are excluded from it. It necessarily follows, that many physicians of the first talents and character, being shut out from a share of its privileges, are opposed to many of its operations. Thus instead of harmony and con
cert, it produces division and contention. Each of the three great institutions, the College of Physicians, the College of Surgeons, and the Company of Apothecaries, is at this present time, before the public in a state of controversy and high excitement; the first in the courts of law, the second in parliament, and the last, in the public journals, respecting alterations of their rules.
Let it not be supposed that we forget or undervalue the benefits conferred on mankind by the Colleges of Physicians and Surgeons, by what they have done for the promotion of sci
We are aware that in this respect they have accomplished much good ; although when the great extent of their powers and their patronage are considered, not more, perhaps less, than was fairly to be expected from them. But to speak of this, is not to our present purpose. Our inquiry has related only to those other means by which they have exerted so powerful an influence upon the condition of the profession ; and we now return to pursue the same inquiry in relation to the state of things in the commonwealth of Massachusetts.
The powers and duties of the Massachusetts Medical Society are as simple and well defined, as those of the London College of Physicians are complex and uncertain. This Society was first incorporated in 1781. Its only privileges were the right to act and to hold property as a corporate body, and to make by-laws for the government of its members, sanctioned by a penalty not exceeding twenty pounds; and the only duty prescribed was the election of censors who were required to examine and license candidates for the profession under a penalty of one hundred pounds. This license conferred no privilege upon the recipient of it, and was of no other benefit to him, than as it made known the fact that he had been examined and approved. In 1789 some farther directions were given by an additional act respecting the reception of licentiates, and the counsellors of the society were required to point out and publish from time to time a suitable course of instruction and education.
In 1803 the charter of the Society was entirely remodelled by a new additional act of the legislature. The number of fellows, which was before limited to seventy, was extended without limitation, any physician or surgeon in the commonwealth being made eligible ; and authority was given to the counsellors to establish subordinate district societies, with boards of censors for the examination of candidates. Under this provision, and that of a subsequent act, there are now four distinct boards of examiners, elected annually by the counsellors, and of course subject to the same regulations. Every candidate who has been licensed by the censors, or who has received a medical degree from Harvard University, being of good moral character, is, after three years' approved practice, entitled to be admitted a fellow of the Society. The only privilege granted to the fellows of the Society, beyond those enjoyed by other physicians, is an entire exemption from liability to enrolment in the militia ; except such as arise incidentally, from the very existence and the operations of the Society as a corporate body.
Immediately after this act was passed, the counsellors took measures to seek out and elect into the Society, as fast as their merits could be ascertained, all the respectable physicians and surgeons in the state, so that in theory (and it is very nearly so in practice) every physician and surgeon of sufficient respectability to be fairly entitled to confidence as a practitioner of medicine, who has been three years in practice, is a fellow of the Society, and is pledged by an express declaration to conform to its regulations and by-laws. This single circumstance is sufficient to preserve a general harmony in the profession; for while these by-laws point out the general course of conduct which ought to be observed by individual physicians towards each other, and contain their pledge to conform to it, they also provide a tribunal to decide the controversy, if any should arise. At the same time a by-law was adopted, that no fellow of the Society should consult with, or otherwise aid or abet, any practitioner of medicine or surgery, who should thereafter commence practice, unless he were either a fellow or licentiate of the Society, or a medical graduate of Harvard University. It is in this by-law, in reference to the exclusion of unfit persons from practice, that the whole strength of the Society lies. By it a broad line of distinction is marked out between those whom the Society believe to be qualified to take charge of the health and lives of others, and whom they are therefore willing to recommend to the confidence of the community, and those whom they do not recommend, either because they do not possess the proper qualifications, or do not exhibit the proper evidence of possessing them. It is no hardship to those who are not included within the rule; it imposes no penalty; and it cuts them off from no privilege which they might have enjoyed if the Society had never existed. On the contrary if it were true, as empirical practitioners often pretend, that they actually possess a skill which education and science do not give, then the line of separation will be an advantage, not an injury. Those whose merits are best acknowledged, suffer by being confounded with others ; and therefore to complain of being distinguished from them is in itself an acknowledgment of inferiority.
At the same time this regulation is in practice perfectly efficient. The reasonableness of it, and the mildness of its operation, successfully claim for it the support not only of the profession, but also of the whole community. It is but twentyfive
years since this by-law was adopted, and it has required a considerable portion of that time for the Society to become acquainted with and elect into it all those whose merits fairly entitled them to a place in it ; so that in the more distant parts of the state, it has not been in operation long enough to put its efficacy fully to the test. But in the more central parts of the state where it has been longer in operation, it is perfectly settled, that no man can obtain any tolerable share of respectability, or property, by the practice of medicine, who is not acknowledged by the Medical Society as an educated physician. The evidence of this fact is abundant and incontrovertible
; but we cannot now go into its details. It is true that we still have among us a few uneducated practitioners. But the number is small, smaller probably than in almost any other place ; and they are regarded by the whole community, and by themselves too, as a distinct and by no means respectable class of men. The hold which they have upon their patients is so frail, that they are often obliged to promise to relinquish it in case of alarm, as the only condition on which they are allowed to prescribe
; and not unfrequently they are subjected to the mortification of being compelled to retire, before even the younger members of the profession.
Such is the system established by the Massachusetts Medical Society. Possessing, as it would seem, few of the insignia of power, in its practical operation it is most efficient. Whether we regard its effects in producing harmony and good fellowship among the members of the profession, in securing to the profession the confidence of the community, or in protecting that community from uneducated and unskilful practitioners, we believe we may safely say that it has fully answered the great purposes
for which it was designed. We mean not to say that the system is perfect, or that it admits of no amendment; but that there has been a constant improvement in the condition of the medical profession, since this system has been in operation, no one who has lived long enough to observe it, and has looked about him, can fail to acknowledge. The standard of medical education and attainment has been constantly rising, and the consciousness of respectability in the profession has given mutual confidence to its members in their intercourse with one another. We do not claim for the Medical Society all the credit of these great and rapid improvements. The Medical School has ably and cordially coöperated, and other circumstances have been favorable to improvement. But we may claim for the Society the praise of having taken the lead in this work, and of having pursued it zealously and steadily.
It is manifest that the system of the Medical Society is built upon the supposition that it should have the control of all admissions to its privileges. But when the Society went into operation there already existed in Harvard University the power to confer medical degrees ; and it was necessary to allow to these degrees, the same authority and the same claim to admission into the Society after three years' approved practice, as are conferred by a license from the censors of the Society. These two institutions therefore still furnish two distinct modes of entering the profession. Although the requirements in each are of nearly equal extent, yet the discrepancy is an evil so far as it goes ; and it is much to be desired that it should be wholly done away. A plan was once digested for effecting a union in this respect, but it was prevented by some unnecessary jealousies from being completed. No such jealousies now exist, and there is every reason to believe that an entire uniformity, if not a union, will soon be accomplished.
Another medical institution has within these few years been incorporated in this state with the power to confer degrees; but its degrees confer no rights in reference to the Medical Society. The legislature has indeed by statute given to its graduates all the privileges granted to similar graduates of Harvard University. But, as they had already vested in the Society the power to regulate the privileges of their own licentiates and fellows (except so far as they had been determined in the acts of incorporation), this provision can only have refer