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those by whom they are appointed, can exercise any effective control or jurisdiction in the case. Of this fact, there can be no doubt. The federal government possesses no power under the constitution to regulate the business pursuits of the citizens of the States. Every thing of that kind is left with the States respectively. This is the practice as well as the theory of our government. Every state in the union, then, possesses excluşive power over this subject within its limits. But most of the states have refused, absolutely, to restrict the practice of medicine, or to prescribe any qualifications whatever for those practising it, leaving to the common law the task of guarding their citizens by suits for malpractice.
The states respectively have the power, and many of them have exercised it, of establishing colleges for giving instruction and granting degrees. Will these colleges surrender the business of teaching to other and irresponsible associations ? That would be to neglect and refuse to perform the duties of a public trust, for which the law has instituted them; and if the existing faculties were to take that course, there is little doubt but that the trustees who govern these institutions would soon find other occupants for their chairs, even among those most eager for reform.
Will the faculties and trustees of the colleges decline to grant diplomas or testimonials of competency to their pupils, whose deportment and acquirements have justly earned them? That is not likely. It would be surrendering the common privilege possessed by all men, of rewarding merit. It would be denying to themselves the right possessed and exercised by every school master and master mechanic, of testifying to the good conduct and proficiency of their pupils and apprentices. Until some legal enactments can be had, prescribing who may practice, and by whom they shall be examined, which is not likely to occur in many of the states in any short period, we apprehend that the present system of examination will continue, and that the character of those who shall be recognised as members of the medical profession will depend on the more or less general diffusion of education and the character of the professors in the different medical schools; whilst the character and fitness of the latter will depend upon whether the honors and emoluments of their stations shall afford adequate inducements to properly qualified individuals to accept the appointments. That such will continue long to be the case may be doubted, when we see the facility with which charters are obtained, and the genera rage for engaging in the business. If the system of medical education is to be improved, and the respectability of the profession maintained, the number of medical colleges must be limited to the actual wants of the community. How this is to be attained it is difficult to say. Most likely the college fever will be allowed to run its course, until a crisis ensties from the complete exhaustion of all means of support. In some instances, like too many plants in one parterre, some will wither and die, whilst others, deriving additional strength and support from their decay, will bring forth better and more abundant fruit.
Notwithstanding the unfavourable picture of us painted by Dr. Suillé, we very much doubt whether we are really so much worse off, or the physicians of the United States are in practical tact and usefulness so much in arrear of their European brethren. Take, for example, the following sketch of matters in England, quoted by him from a work by Mr. Surgeon Wilde, of Dublin: “In England, with few exceptions, (and even in those exceptions the kind of instruction is very meager) there is little or no preparatory education required by the different colleges and licensing bodies. The student is at perfect liberty to choose what lectures, or how many, he will first attend; the object being not how he can best prepare his mind by initiatory degrees, for the more mature branches of study, but how he can soonest, easiest, and cheapest, become possessed of the certificates of attendance on the lectures he has never heard. There are no tests required as to his knowledge of any of the subjects he is supposed to study till the hour of his examination—and when this examination does arrive, the chances that he is never asked a question, except upon anatomy and surgery, and a little physiology, are, in the chief licensing institutions of Great Britain, so slight as almost to amount to a certainty."
If there is any institution for granting degrees in the United States where the business is conducted as badly as this picture represents, we are wholly ignorant of it. But the author of the lecture says they manage things better
in France, in Prussia, and in Austria. The two last of these governments are units,-absolute monarchies; and can there. fore enact what eclicts they please, and enforce them throughout their entire kingdoms; which makes a wide difference between their condition and ours. But are the medical men of these countries so much superior to those of Great Britain ? Who among all their physicians has done more for our science than Sydenham, Harvey and Jenner; of their surgeons, who more than Pott, Hunter, Cooper, and Brodie ; among their chemists, who more than Cavendish, Davy and Dalton? We are aware that a few bright examples are not fair representatives of the whole; but how is it with the mass? Are the practitioners of Great Britain inferior iu skill and capacity, as a general rule, to those of France and Germany? We think Dr. Stillé, with all his predilections on this subject, will not assert it. Great learning and the capacity for great usefulness do not mean one and the same thing, nor are they always associated in the same indi. vidual. A certain amount of learning is unquestionably essential for a physician;-as to how much, and on what subjects, apart from that of the science itself, much contrariety of opinion exists. Dr. Suillé would undoubtedly require, as a part of his preparatory education, that a student of medicine should be well versed in the Greek and Latin languages; and yet Dr. Rush, in an introductory lecture delivered several years after that quoted by Dr. Stillé, argued that the time employed in their acquisition is mis-spent, and ought to be devoted to other objects. A gentle. man, who is himself a bright example of what learning can conser upon its possessor, is content to say that “the education of the youth who is intended for the medical profession should be essentially that adapted for the well educated gentleman," which is probably as near an approximation to the point as we are likely to arrive at.
It is a misfortune that in all attempts at reform the errors proposed to be corrected and the advantages to be gained by the change, are equally exaggerated in the minds of those engaged in the enterprise. They too often see only what seems desirable: the practicable is overlooked, and they forget that alteration is not always improvement.
Whatever may be said of the system pursued in France, -iu point of learning the members of the medical profession cannot be compared with those of Britain. Even in professional qualifications, with a few bright exceptions, they are behind our own countrymen. Too often, their views and attainments are limited to some specialty, which, in the estimation of the individual, comprises the whole circle of knowledge.
The lecture before us derives importance at the present moment, beyond what is ordinarily due to a well written essay by an estimable individual, from the spirit of reform which has gone abroad among the profession in this country, the prompt. ings of which are to be manifested in the proceedings of the National Medical Convention to assemble in this city in May next. From the diverse objects contemplated by those who are to take a part in the proceedings of the Convention, and the discordant views entertained and already expressed on many points, it is difficult to form any idea of what will be the results of its deliberations. If all utopian schemes be discarded, and none but such as are practical adopted, good may result. For ourselves, we neither anticipate so much good, nor apprehend so much confusion and evil from its proceedings, as many of those who are arranged on opposite sides. None have laboured more earnestly than ourselves, in times past, to elevate the standard of medical education in the United States, nor does any one more sincerely desire it now. On this point our feelings have undergone no modification in the lapse of time and the change of circumstances; but our knowledge of the difficulties that lie in the way is increased, and with it our hopes and anticipations of great results are diminished.
The burden of complaint in the lecture before us, as well as in the mouths of all who are most earnest in the movements on this subject is, that the courses of instruction given in the colleges are not sufficiently numerous and complete, and that the standard of graduation is too low,-forgetting altogether that a very large number of the practitioners throughout the country attend no lectures at all, and a still larger number never graduate or submit to any examination whatever. Now if all could be induced to attend lectures and demonstrations, and undergo an examination, no que can doubt that it would be the greatest of all reforms, as regards the interests of humanity, and the honour of our profession. The great and lamentable error of the existing state of things is, not that they who graduate are insuffi. ciently instructed, but that so many engage in practice who have received little or no instruction at all. It is a serions question, whether any measures that would subject the student to a greater expenditure of time and money to obtain a degree, would not increase the number of uneducated practitioners, and in this way reduce rather than elevate the general standard of medical education in the country. If some means can be devised to require every man to submit to examination before entering into practice, it will do more to improve the respectability and usefulness of the profession, than any and all other means we have heard suggested for that purpose.
The practical scheme of improvement in medical education proposed by Dr. Stillé, at least as a beginning, notwithstanding his somewhat enthusiastic reasoning on the subject, is far from being so unfeasible as many we hear proposed. It is as follows "I will venture to state what reforms appear to me inost desirable, and, at the present time, most feasible. And first, the prolongation of the lecture term from four to six months, without greatly increasing the number of lectures beyond that already delivered, in order to give the student time to think, read and attend the hospitals. Subsequently the entire term of study might be prolonged from two to three winters; an attendance, is now required on two courses only of subjects named in the existing curriculum, and the student restricted during the first year to the lectures on anatomy, chemistry, physiology, and materia medica. In the second or third year, the instruction might include several departments not now studied, such as general pathology, morbid anatomy, medical jurisprudence and hygiene, of which one course might for thie present suffice.”
We have no doubt whatever that this is quite as much as, and probably more than, can be effected; but will the advocates of reform be content to stop here? Will not many of those who have recently engaged in the cause with hot haste, be like the boy with the filberts,-grasp more than is compatible with success? We greatly fear so.