Science & Education: Essays

by Thomas Henry Huxley

But, as the majority report proposes that the existing bodies should be compensated for any loss they might suffer out of the fees of the examiners for the State licence, the curious result would be brought about that the profession of the future would be taxed, for all time, for the purpose of handing over to wholly irresponsible bodies a sum, the amount of which would be large for those who had failed in their duty and small for those who had done it.

The scheme in fact involved a perpetual endowment of the "black sheep," calculated on the maximum of their ill-gained profits. [[1]] I confess that I found myself unable to assent to a plan which, in addition to the rewarding the evil doers, proposed to take away the privileges of a number of examining bodies which confessedly were doing their duty well, for the sake of getting rid of a few who had failed. It was too much like the Chinaman's device of burning down his house to obtain a poor dish of roast pig--uncertain whether in the end he might not find a mere mass of cinders. What we do know is that the great majority of the existing licensing bodies have marvellously improved in the course of the last twenty years, and are improving. What we do not know is that the complicated scheme of the divisional boards will ever be got to work at all.

My own belief is that every necessary reform may be effected, without any interference with vested interests, without any unjust interference with the prestige of institutions which have been, and still are, extremely valuable, without any question of compensation arising, and by an extremely simple operation. It is only necessary in fact to add a couple of clauses to the Medical Act to this effect: (1) That from and after such a date no person shall be placed upon the Medical Register unless he possesses the threefold qualification. (2) That from and after this date no examination shall be accepted as satisfactory from any licensing body except such as has been carried on in part by examiners appointed by the licensing body, and in part by coadjutor-examiners of equal authority appointed by the Medical Council or other central authority, and acting under their instructions.

In laying down a rule of this kind the State confiscates nothing, and meddles with nobody, but simply acts within its undoubted right of laying down the conditions under which it will confer certain privileges upon medical practitioners. No one can say that the State has not the right to do this; no one can say that the State interferes with any private enterprise or corporate interest unjustly, in laying down its own conditions for its own service. The plan would have the further advantage that all those corporate bodies which have obtained (as many of them have) a great and just prestige by the admirable way in which they have done their work, would reap their just reward in the thronging of students, thenceforward as formerly, to obtain their qualifications; while those who have neglected their duties, who have in some one or two cases, I am sorry to say, absolutely disgraced themselves, would sink into oblivion, and come to a happy and natural euthanasia, in which their misdeeds and themselves would be entirely forgotten.

Two of my colleagues, Professor Turner and Mr. Bryce, M.P., whose practical familiarity with examinations gave their opinions a high value, expressed their substantial approval of this scheme, and I am unable to see the weight of the objections urged against it. It is urged that the difficulty and expense of adequately inspecting so many examinations and of guaranteeing their efficiency would be great, and the difficulty in the way of a fair adjustment of the representation of existing interests and of the representation of new interests upon the general Medical Council would be almost insuperable.

The latter objection is unintelligible to me. I am not aware that any attempt at such adjustment has been fairly discussed, and until that has been done it may be well not to talk about insuperable difficulties. As to the notion that there is any difficulty in getting the coadjutor-examiners, or that the expense will be overwhelming, we have the experience of Scotland, in which every University does, at the present time, appoint its coadjutor-examiners, who do their work just in the way proposed.

Whether in the way I have proposed, or by the Conjoint Scheme, however, this is perfectly certain: the two things I refer to have to be done: you must have the threefold qualification; you must have the limitation of the minimum qualification also; and any scheme for the improvement of the relations of the State to medicine which does not profess to do these two things thoroughly and well, has no chance of finality.

But when these reforms are witnessed, when there is a Medical Council armed with a more real authority than it at present possesses; when a license to practice cannot be obtained without the threefold qualification; and when an even minimum of qualification is exacted for every licence, is there anything else that remains that any one seriously interested in the welfare of the medical profession, as I may most conscientiously declare myself to be, would like to see done? I think there are three things.

In the first place, even now, when a four years' curriculum is required, the time allotted for medical education is too brief. A young man of eighteen beginning to study medicine is probably absolutely ignorant of the existence of such a thing as anatomy, or physiology, or indeed of any branch of physical science. He comes into an entirely new world; he addresses himself to a kind of work of which he has not the smallest experience. Up to that time his work has been with books; he rushes suddenly into work with things, which is as different from work with books as anything can well be. I am quite sure that a very considerable number of young men spend a very large portion of their first session in simply learning how to learn subjects which are entirely new to them. And yet recollect that in this period of four years they have to acquire a knowledge of all the branches of a great and responsible practical calling of medicine, surgery, obstetrics, general pathology, medical jurisprudence, and so forth. Anybody who knows what these things are, and who knows what is the kind of work which is necessary to give a man the confidence which will enable him to stand at the bedside and say to the satisfaction of his own conscience what shall be done, and what shall not be done, must be aware that if a man has only four years to do all that in he will not have much time to spare. But that is not all. As I have said, the young man comes up, probably ignorant of the existence of science; he has never heard a word of chemistry, he has never heard a word of physics, he has not the smallest conception of the outlines of biological science; and all these things have to be learned as well and crammed into the time which in itself is barely sufficient to acquire a fair amount of that knowledge which is requisite for the satisfactory discharge of his professional duties.

Therefore it is quite clear to me that, somehow or other, the curriculum must be lightened. It is not that any of the subjects which I have mentioned need not to be studied, and may be eliminated. The only alternative therefore is to lengthen the time given to study. Everybody will agree with me that the practical necessities of life in this country are such that, for the average medical practitioner at any rate, it is hopeless to think of extending the period of professional study beyond the age of twenty-two. So that as the period of study cannot be extended forwards, the only thing to be done is to extend it backwards.