Science & Education: Essays

by Thomas Henry Huxley

I say comparatively high standard, for the requirements of the University in those days, and even during the twelve years at a later period, when I was one of the examiners of the medical faculty, were such as would not now be thought more than respectable, and indeed were in many respects very imperfect. But, relatively to the means of learning, the standard was high, and none but the more able and ambitious of the students dreamed of passing the University. Nevertheless, the fact that many men of this stamp did succeed in obtaining their degrees, led others to follow in their steps, and slowly but surely reacted upon the standard of teaching in the better medical schools. Then came the Medical Act of 1858. That Act introduced two immense improvements: one of them was the institution of what is called the Medical Register, upon which the names of all persons recognised by the State as medical practitioners are entered: and the other was the establishment of the Medical Council, which is a kind of Medical Parliament, composed of representatives of the licensing bodies and of leading men in the medical profession nominated by the Crown. The powers given by the Legislature to the Medical Council were found practically to be very limited, but I think that no fair observer of the work will doubt that this much attacked body has excited no small influence in bringing about the great change for the better, which has been effected in the training of men for the medical profession within my recollection.

Another source of improvement must be recognised in the Scottish Universities, and especially in the medical faculty of the University of Edinburgh. The medical education and examinations of this body were for many years the best of their kind in these islands, and I doubt if, at the present moment, the three kingdoms can show a better school of medicine than that of Edinburgh. The vast number of medical students at that University is sufficient evidence of the opinion of those most interested in this subject.

Owing to all those influences, and to the revolution which has taken place in the course of the last twenty years in our conceptions of the proper method of teaching physical science, the training of the medical student in a good school, and the examination test applied by the great majority of the present licensing bodies, reduced now to nineteen, in consequence of the retirement of the Archbishop and the fusion of two of the other licensing bodies, are totally different from what they were even twenty years ago.

I was perfectly astonished, upon one of my sons commencing his medical career the other day, when I contrasted the carefully-watched courses of theoretical and practical instruction, which he is expected to follow with regularity and industry, and the number and nature of the examinations which he will have to pass before he can receive his licence, not only with the monstrous laxity of my own student days, but even with the state of things which obtained when my term of office as examiner in the University of London expired some sixteen years ago.

I have no hesitation in expressing the opinion, which is fully borne out by the evidence taken before the late Royal Commission, that a large proportion of the existing licensing bodies grant their licence on conditions which ensure quite as high a standard as it is practicable or advisable to exact under present circumstances, and that they show every desire to keep pace with the improvements of the times. And I think there can be no doubt that the great majority have so much improved their ways, that their standard is far above that of the ordinary qualification thirty years ago, and I cannot see what excuse there would be for meddling with them if it were not for two other defects which have to be remedied.

Unfortunately there remain two or three black sheep--licensing bodies which simply trade upon their privilege, and sell the cheapest wares they can for shame's sake supply to the bidder. Another defect in the existing system, even where the examination has been so greatly improved as to be good of its kind, is that there are certain licensing bodies which give a qualification for an acquaintance with either medicine or surgery alone, and which more or less ignore obstetrics. This is a revival of the archaic condition of the profession when surgical operations were mostly left to the barbers and obstetrics to the mid-wives, and when the physicians thought themselves, and were considered by the world, the "superior persons" of the profession. I remember a story was current in my young days of a great court physician who was travelling with a friend, like himself, bound on a visit to a country house. The friend fell down in an apoplectic fit, and the physician refused to bleed him because it was contrary to professional etiquette for a physician to perform that operation. Whether the friend died or whether he got better because he was not bled I do not remember, but the moral of the story is the same. On the other hand, a famous surgeon was asked whether he meant to bring up his son to his own calling, "No," he said, "he is such a fool, I mean to make a physician of him."

Nowadays, it is happily recognised that medicine is one and indivisible, and that no one can properly practice one branch who is not familiar with at any rate the principles of all. Thus the two great things that are wanted now are, in the first place, some means of enforcing such a degree of uniformity upon all the examining bodies that none should present a disgracefully low minimum or pass examination; and the second point is that some body or other shall have the power of enforcing upon every candidate for the licence to practice the study of the three branches, what is called the tripartite qualification. All the members of the late commission were agreed that these were the main points to be attended to in any proposals for the further improvement of medical training and qualification.

But such being the ends in view, our notions as to the best way of attaining them were singularly divergent; so that it came about that eleven commissioners made seven reports. There was one main majority report and six minor reports, which differed more or less from it, chiefly as to the best method of attaining these two objects.

The majority report recommended the adoption of what is known as the conjoint scheme. According to this plan the power of granting a licence to practise is to be taken away from all the existing bodies, whether they have done well or ill, and to be placed in the hands of a body of delegates (divisional boards), one for each of the three kingdoms. The licence to practise is to be conferred by passing the delegate examination. The licensee may afterwards, if he pleases, go before any of the existing bodies and indulge in the luxury of another examination and the payment of another fee in order to obtain a title, which does not legally place him in any better position than that which he would occupy without it.

Under these circumstances, of course, the only motive for obtaining the degree of a University or the licence of a medical corporation would be the prestige of these bodies. Hence the "black sheep" would certainly be deserted, while those bodies which have acquired a reputation by doing their duty would suffer less.