,-^^^f 
 
 
 V"^^. 
 
 ^--5?^
 
 \JVzth Dr. Robert Fowlers Co7nplwients.~\ 
 
 THE 
 
 ATTEIBUTES, PROFESSIONAL AND SOCIAL, 
 
 OP THE SO-CAIiLED 
 
 "FAMILY DOCTOR." 
 
 Being the Annual Oration delivered Wednesday , February S, 188i 
 
 before the Hunterian Society, at the London Institution, 
 
 Finsbury Circus. 
 
 BT 
 
 EGBERT FOWLER, M.D., 
 
 MEMBER OF THE COURT OP EXAMINERS OF THE SOCIETY OF APOTHECARIES. 
 
 {Reprinted from Mkdical Times and Gazette, February 18 and 25, 
 and March 11, 1882.) 
 
 LONDON: 
 PAHDON & SONS, PEINTER8, PATERNOSTER BOW. 
 
 1882.
 
 THE 
 ATTRIBUTES, PEOFESSIOXAL AND SOCIAL, 
 
 OP THE SO-CALLED 
 
 "FAMILY DOCTOR." 
 
 Mr. President and Gentlemen, — On Thursday, Feb- 
 ruary 9, 1826, your first Orator, who had been your first 
 President, and also was your first honorary member — Sir 
 William Blizard — prefaced his Oration in these words : — 
 
 "Had he duly considered that in his preparative labour on 
 the occasion, the most formidable interruptions from impera- 
 tive calls of public duty would happen, he must have declinod 
 the assigned task, but his obligation to the performance of 
 it appeared irrevocable." 
 
 Such sentiments have, probably, passed through the minds 
 of each and all of your Orators during the last fifty-six 
 years. 
 
 The knowledge that the members of a Society such as 
 this are men who can appreciate the significance of the 
 words, "imperative calls of public duty,'" emboldens your 
 present Orator to anticipate a sympathetic indulgence to 
 these efforts of a busy co-worker. 
 
 This Society, Sir William told his hearers, " sprang from 
 the purest motives of honourable men.'" 
 
 They who, as members of this Society, remember the pro- 
 fessional and social bearing, the character of Dr. William 
 Cooke — the type of what should be the family doctor — can 
 readily recognise this truism. They can easily understand 
 that "with Dr. Cooke's firm intention" and "unremitting 
 zeal " he would never have proposed the establishment of 
 this Society on any other basis. 
 • The influence which all scientific associations have had on
 
 the great progress of our art and science during the present 
 century, has been ably commented on by most of my pre- 
 decessors in office — some elucidating it by reference to the 
 advancement of medicine in general, whilst others have con- 
 tented themselves in demonstrating the improvement in 
 that specialty to which they were particularly devoted. 
 
 The high importance, moreover, of the social characteristic 
 of this Society in particular has also, on more than one 
 occasion, been truthfully and elo€j[uent]y eulogised. 
 
 Acknowledging, therefore, as we safely may, th.e benefits 
 this Society, with other like associations, has conferred on 
 all within its circle during more than a decade beyond half 
 a century, it would seem more profitable now to ask. Have 
 we, tbe agents in the application of this improvement to 
 suffering humanity, ourselves also advanced aequo pede in all 
 those attributes essential to the honest and honourable 
 cultivation of our noble profession ? 
 
 Can every one of us conscientiously affirm that we to-day 
 are actuated with the seK-same ''honourable motives" 
 alleged by our first Orator to have been the ruling spirit 
 of the foundersj our predecessors in membership ? 
 
 It wouldj however, be absurdly invidious and unseemly, 
 trenching, indeed, upon the personal, to confine an inquiry 
 of this character solely to the members of the Hunterian 
 Society. I extend my investigation far beyond our own 
 numerical sphere. I will endeavour in the time at my dis- 
 posal to broadly^ but pertinently, portray what should, in 
 my opinion^ be the attributes, professional and social, of tbe 
 trusted medical attendant in the family domestic circle. 
 
 More than two-thirds of the present members of this 
 Society belong to that great class (numerically considered) 
 of general practitioners. 
 
 Of the one-third of consultants who are ordinary members, 
 more than half the number have migrated westwards. The 
 residential population of this immediate neighbourhood is 
 annually decreasing. The attractions elsewhere of societies 
 appointed solely for the consideration of the so-called speci- 
 alities of medicine entice certain devotees. It may therefore 
 be considered as almost a tolerable certainty that the very 
 vitality of this Society will more and more have to rely in 
 the future upon that largely preponderating class of medical 
 men of whom we have, fortvmately for my illustration, so 
 excellent and worthy a representative this day in our 
 Presidential chair.* 
 
 Our present art and science, calling to their elucidation 
 the aid of each and all of the accessory sciences, doubtless 
 necessitate more than ever the continuance of that primary 
 
 Dr. Peter Lodwick Burchell. 
 
 <i^$^ 
 
 u,uc'
 
 threefold separation in our ranks which has for so many 
 years obtained. The very perfectness and minuteness of 
 detail now thought essential in the study of every disease 
 furthermore also obviously augment the still increasing 
 subdi\dsion in the practice of those we desire to look upon 
 as the leaders in our px'ofession. 
 
 Nevertheless, the exigencies of our English domestic circle 
 •will, in all probability, always demand the care and super- 
 vision of the so-called family doctor. 
 
 In discussing what should be the attributes, professional 
 and social, of the trusted medical attendant of at least nine- 
 tenths of the whole population, I am, I believe, but por- 
 traying the type of what should be the character of every 
 "practiser in the Faculty of Physick" — be he general, 
 consultant, or special. 
 
 Prior to 1511 the science and cunning of physic and 
 surgery were " daily within this realm exercised by a great 
 multitude of ignorant persons," who are otherwise very 
 quaintly described, in the preamble of the first Act* of 
 Parliament relating to our profession. 
 
 To those who read aright the history of our Faculty — at 
 all events, in tliis country — there can be little doubt but that 
 long after the reign of Henry VIII. the so-called physicians 
 were really the analogues of those who for some years have 
 been, and are now still, styled the " general practitioners," 
 or " family doctors," who would therefore appear to have 
 been the very first body of medical men who received legal 
 recognition from our English Parliament. 
 
 These early physicians — as did their predecessors the 
 monks and clergy, who wei'e necessarily the first practi- 
 tioners in this country — practised medicine, surgery, and 
 pharmacy ; and in this body of practitioners this " Act for 
 appointing physicians and surgeons " appears to have 
 vested the Faculty of Medicine. 
 
 The word "physician" would seem to signify, one who 
 practises physic. Dr. Goodall, in his "Epistle Dedicatory," 
 appended to his " History of the Eoyal College of Physi- 
 cians" (1684), more than once styles his "most Honoured 
 Colleagues "" practisers in the Faculty of Physick" — the 
 name given in their charterf to all practisers, whether 
 "illiterate" and "unexperienced," or "learned, grave, and 
 profound." 
 
 By the wisdom of the Parliament of the great Henry, 
 the following comprehensive definition was given to the 
 
 * 3 Henry Vni., c. ix., "An Act for the appomting of Physicians 
 and Sui-peons." 
 t 8th October, 15 Jac. I., preamble.
 
 word "physick": — ''And forasmucli as the science of 
 ' physick ' doth comprehend, include, and contain the know- 
 ledge of snrgery, as a special member and part of the same ; 
 therefore be it enacted, that any of the said company or 
 fellowship of physicians being able, chosen, and admitted by 
 the said presidents and fellowship of physicians, may from 
 time to time, as well within the city of London, as elsewhere 
 within this realm, practise and exercise the said science of 
 physick in all and every his members and parts; any 
 Act, statTite, or provision made to the contrary notwith- 
 standing.*'* 
 
 Thus legalising the axiom of Celsus, which was thought 
 and practised by Hippocrates : — " Illud ante omnia scire 
 convenit, quod omnes medicinse partes innexte sunt, ut ex 
 toto separari non possint." 
 
 The celebrated authoi' — your quondam no less celebrated 
 Orator— who, in 1879, gained the first Carmichael Prize, 
 awarded by the Council of the Eoyal College of Surgeons of 
 Ireland, is, therefore, I think, somewhat too narrow in his 
 implication, that the definition given in 1703 by Queen 
 Anne's Lord Chief Justice Holt of the word "physic" 
 applies only to that branch of our profession which is now 
 recognised as the province of our modern physicians. 
 
 The signification, then, unanimously agreed upon by the 
 Court of Queen's Bench in the action of the case of the 
 College of Physicians v. Eose is as applicable to every part 
 as to the whole of the science of physic ; and in no way in- 
 validates the comprehensiveness of the definition laid down 
 by Henry's Parliament. 
 
 It is no part of my purpose to give you a complete history 
 of the College of Physicians, nor to comment unnecessarily 
 on the exclusiveness and pedantry which lost this powerful 
 " commonaltie " the opportunity of assimilating to them- 
 selves the whole body politic of the practisers of physic. 
 
 Sufiice it to say, in reference to this important section of 
 one of the early medical Acts of Parliament, that "the 
 joyning together the two companies of barbers and surgeons," 
 m 1542,t clearly constituted a body of men who were simply 
 and solely emplo3'ed to perform operative or mechanical duties. 
 
 The College of Physicians fifty years afterwards, namely, 
 in 1595, proved that by this section of their early Act they 
 could successfully prosecute, fine, and commit to prison a 
 surgeon who (not being admitted to their College, neverthe- 
 less) pleaded that in his art the use of inward remedies is 
 often necessary. 
 
 In this important prosecution by the College of Physicians, 
 
 • 82 Henry VIII., c. xl., sect. 3. + 32 Henry Vni., c. xlii., sect. 1.
 
 of the two surgeons, Roger Jenkins and Simon Read, the 
 then Chief Justice gave this opinion {inter alia), " No sur- 
 geon, as a surgeon, may practise physick, no, not for any 
 disease." As late even as 1633, the College of Physicians 
 succeeded in enforcing a judgment of fine against "one 
 George Butler, who, under colour of being sworne an extra- 
 ordinary chirurgeon to His Majestie (James I.), did take 
 upon him to give physic and practise chirurgery without 
 either skill or licence." 
 
 They in power were in fact determined to confine the con- 
 trol of all that pertains to the Faculty of Physic to " the 
 President and Censors for the time being of our College of 
 Physicians in London." 
 
 Dr. Goodall's work conclusively illustrates the power and 
 patronage bestowed upon the CoUege in Charles 1.'^ reign. 
 
 No empiric could practise operative surgery, and no 
 chirurgeon could administer internal remedies, even in 
 surgical cases, without being proceeded against by the 
 College of Physicians. 
 
 It was not indeed till fifty years ago that this latter 
 power was successfully resisted by the practising siirgeons. 
 
 In the seventeenth century the Crown applied direct to 
 the collective wisdom of the College itself, to solve any 
 doubt in cases of medical jurisprudence — not as in more 
 recent times by a reference through the Home Secretary to 
 some titled leader in our profession, who may or who may 
 not be specially skilled in all the bearings of the case referred 
 to him. 
 
 In 1632 the College of Physicians in London were law- 
 fully assembled, by the command of their sovereign lord 
 the King, to determine whether a certain Joseph Lane did 
 or did not die by poisoning ; and, if so, by what poison his 
 death was procured. 
 
 The outcome of the determination of the College in this 
 matter eventuated in the expression of a very valuable 
 opinion respecting the sale of poisons. This opinion, how- 
 ever, did not bear any legislative fruit for over 200 years. 
 The " decree to His Sacred Majestie," concerning the death 
 of Joseph Lane, concluded with these recommendatory 
 words: — "That no person presume to sell drugs, either 
 poisonous or dangerous, to poor sorry women or poor people 
 (which hath been too common), but only to those who are 
 willing to give their names; that if there should be occa- 
 sion they may give an account of the reason of their buy- 
 ing these dangerous medicines." 
 
 The Bill to regulate the sale of poisons, and alter and 
 amend the Pharmacy Act, became law on July 31, 1868. 
 Clause 17 enacted, inter alia, that the poison sold should be 
 labelled " with the name and address of the seller " thereof.
 
 8 
 
 In Charles I.'s time, the College of Physicians did 
 certainly not prohibit its members and fellows from prac- 
 tifiingj at all events, operative midwifery. 
 
 Divers ancient mid wives petitioned the College of Physi- 
 cians to protect them from the molestation of a certain 
 doctor of physicj who threatened not to assist in any diffi- 
 cult case unless the attendant midwife had been previously 
 licensed or approved of by him. 
 
 In their answer to the petition the physicians admit that 
 the said " doctour is not otherwise able to instruct them [the 
 midwives] than any other the meanest fellow of our College, 
 unless he understand it by the use of iron instruments, 
 which physicians and chirurgeons may practise if they 
 please ; and some do, and have done, with as good success 
 and dexterity as himself, and therefore there is no necessity 
 for a sole dependence upon him." 
 
 It is painful to recall the fact of the systematic ignoring 
 by the College of Physicians, in after years, of the claims of 
 the practisers in this important branch of our art. I would 
 now simply remind you of the sequence, that on March 18, 
 1852, the Eoyal College of Surgeons of England obtained 
 power by Charter not only to appoint a special board of 
 examiners " for the purpose of testing the fitness of persons 
 to practise in midwifery," but also " to grant certificates of 
 such fitness." 
 
 Until the passing of the Medical Acts of 1815, and sub- 
 sequently 1858, it does not indeed appear that the great 
 power conferred on the Eoyal College of Physicians of London 
 was in the least abrogated, abridged, or altered by any legis- 
 lation subsequent to the time of the Stuarts. In his elaborate 
 judgment, given in 1861, on the case of the Attorney- 
 General (on the part of the Society of Apothecaries) v. The 
 Eoyal College of Physicians, his Honour Vice-Chancellor 
 Page Wood (the late Lord Hatherley) admitted that no Act 
 of Parliament had been cited to or was known by him which 
 conferred on the College of Surgeons the " particular privi- 
 lege of selling drugs when they are dealing with a case 
 surgically," although "he believed from authorities"* 
 (which he did not, however, quote) *' that a surgeon could 
 recover in respect of drugs which he furnishes in pursuance 
 of his attendance in a surgical case." 
 
 * King James, in the last paragraph of his Eoyal Charter to the 
 " Apothecaryes of London,' confines the surgeons to the use of only 
 external drugs in the exercise of their art. "Et denique volumus et 
 intentionem nostiam esse declaramus quod Chimi-gi expei-ti et approbati 
 eorum artem et facultatem exercere possint omnesque et singuli eorum 
 practica sibi propria uti et frui valeant quantum ad compositionem et 
 applicationem medicumentorum extemoriun solummodo pertinet et 
 spectat."— Goodall, op, cit. p. 145.
 
 In the Royal Charter orranted by James T. to the College 
 certain words certainly imply and point out that up to that 
 period the physicians or practisers in the said " Facultie of 
 Physick " did " administer or prescribe " " medycine " unto 
 their patients. *' It is uncertain at what period the physi- 
 cians gave up — ' what was growing too servile and laborious 
 a business ' — the practice of preparing their own medicines." 
 
 In all probability, the universal practice continued till 
 1617, when James I. by Eoyal Charter separated the grocers 
 from the apothecaries, and prohibited the former ever after- 
 wards from keeping an apothecai-y's shop. Up to this 
 period we are told that the physicians' assistants had been 
 styled apothecaries ; and it is at all events a singular circum- 
 stance that the persons first incorporated in one body politic 
 by this Charter of James were 114, coinciding with the 
 number of physicians who were then actually in practice in 
 London. 
 
 There is evidence, however, that as late as 1703 certain 
 physicians continued the practice of preparing their own 
 medicines. In the writ of eri-or, brought that year up to 
 the House of Lords by William E-ose, apothecary, " praying 
 their lordships to reverse the judgment given against him 
 in the Queen's Bench at the suit of the College of Physi- 
 cians," occur these words : — " That several physicians .... 
 lately admitted into the Colledge .... have fallen into 
 divers methods for uionopolising the whole business of 
 physick, both as to the compounding, selling, and prescribing 
 thereof.'^ 
 
 Considering the power, the patronage, the privileges, and 
 the protection accorded by monarchs and Parliaments for 
 about one hundred years from the first Act of Henry VIII. 
 to the Charter of James I. to the Apothecaries' Company, 
 it does appear to have been very short-sighted policy indeed, 
 that the College of Physicians of London did not seize the 
 occasion and opportunity of arrogating to themselves the 
 authoritative and unlimited control of the whole domain of the 
 " Facultie of Physick." James's royal charter had empowered 
 
 them to " make such wholesome and reasonable 
 
 ordinances," etc., as seemed " good, profitable, and necessary, 
 
 for their good rule, order, and government." They 
 
 elected not to devote energies, fo forcibly bestowed upon 
 them, in fostering and developing the art and science of 
 medicine as a compact and indivisible whole ; but in an evil 
 hour they thought their interests were furthered by passing 
 by-laws to prohibit any of their licensees from the exercise 
 of what they then considered the inferior branches of 
 medical practice. 
 
 Without needlessly alienating from the College walls the
 
 10 
 
 hi TToWol — the busy toilers in the application of physic's relief 
 to suffering humanity — it was quite within legal competence 
 to create a grade accessible but to the few greater intellects 
 of the profession. 
 
 The immortal Harvey doubtless contemplated and ardently 
 desired such an enlarged generalisation of the powers and 
 privileges of the College. In the very last Harveian Oration 
 delivered at the Eoyal College of Physicians, June 18, 1881, 
 the Orator, Dr. Barclay, referring to Harvey's deed of gift, 
 said of him — " He regarded the College of Physicians as a 
 grand foundation. He looked to its future as the great 
 centre from which the light of medical science and skill was 
 to shed its lustre over England; was to be the teacher of 
 her people, the adviser of her rulers, and the training-school 
 of her medical men." 
 
 After an erroneous and unpardonable inference respecting 
 the Act of 1815, and heedless of the maxim, Qui s'excuse 
 s'accuse, Dr. Barclay, in continuation, endeavoured to shift 
 the prime blame of the anti-Harveian " narrow and exclusive 
 jealousy " of his College on to the shoulders of the older 
 universities. 
 
 Long prior, however, to 1815 a Nemesis had arisen in the 
 Frankenstein of the College's own creation. The Apothe- 
 caries, incorporated by the influence and intercession prac- 
 tically of the College itself, increased in number, knowledge, 
 and power. Driven from the College walls by short-sighted 
 and exclusive by-laws, men utilised their brain-energy in 
 developing a medical and surgical practice under the re- 
 munerative guise of the membership of a trading guild. 
 
 The Eoyal College, from its self- asserted lofty pinnacle, 
 still ignoring the comprehensiveness of its own capabili- 
 ties, now sought to recall some of its lost prestige by a 
 demonstrative jealousy and pettiness. 
 
 Inclusive of the President and Censors, fifty-three Fellows 
 and Members, by their signatures and subscriptions, sanc- 
 tioned in 1697, one of the elect of their own college opening 
 dispensaries, whence to supply medicines on reasonable 
 terms to their poor, and even to their wealthy patients. In 
 Garth's satirical poem* the shade of Harvey thus addresses 
 Hygeia, who has conducted Celsus {alias Dr. Bateman) to 
 the Elysian Fields after the battle between the physicians 
 and apothecaries — 
 
 " With just resentment and contempt you see 
 The foul dissensions of the faculty ; 
 How your sad sickening art now hangs her head, 
 And, once a science, has become a trade. 
 Her sons ne'fr rifle her mysterious store. 
 But stinly Nature less, nnd lucre more."
 
 11 
 
 The battle, as described, had indeed waxed fierce and 
 
 sharp — 
 
 •' And now the stagg'ering braves, led by despair, 
 Advance, and to return the churyre prepare. 
 Each seizes for his shield a spacious scale, 
 And the brass weights fly thick as showers of hail. 
 Whole heaps of warriors welter on the ground. 
 With gallypots and broken phials crowned ; 
 Whilst empty jars the dire defeat resound." 
 
 It -would be a waste of time to relate all the recriminative 
 satire and invective which resnlted from this derogatory 
 conduct. Garth, himself a Fellow of the Royal College, thus 
 sums up the offended feelings of the Apothecaries — 
 
 " Our manufactures now the doctors sell, 
 And their intrinsic value meanly tell ; 
 Nay, they discover too (their t^pite is such) 
 That health, than crowns more valued, costs not much ; 
 Whilst we must shape our conduct by these rules— 
 To cheat as tradesmen, or to starve as fools." 
 
 The puerility of the Royal College, of course, fell short of 
 its intent and aim. The leverage of the Corporation of 
 Apothecaries, day by day, raised to the position of general 
 practitioners men who would, had they been permitted, 
 have gladly associated themselves with the more weighty 
 and more ancient edifice in Warwick-lane. 
 
 The apothecaries became, year by year, more and more 
 general practitioners, in consequence of the increased atten- 
 tion which they devoted to medical and surgical practice. 
 
 About 1812, public attention was drawn to the fact that 
 whilst the physician and surgeon were both subjected to a 
 certain course of professional study to be tested by examina- 
 tion, the education of the medical attendant upon the great 
 mass of the population was entirely unprovided for ; and no 
 proof whatever was required as to his competency to 
 discharge his very important duties. 
 
 To effect this desideratum, an agitation — originated by 
 the father of a recently-past President of the College of 
 Physicians* — was joined with great spirit by other well- 
 known medical practitioners of the day. 
 
 Vain efforts were made to induce the corporate medical 
 bodies to co-operate in raising the general practitioner to 
 legal status. The Society of Apothecaries, composed though 
 it was of three-fourths of the very class of practitioners whose 
 improvement it was sought to effect, actually declined, as a 
 body, to concur in the intended application to Parliament. 
 The dogged perseverance, however, of such men as Dr. 
 Gaorge Mann Burrows, Dr. Anthony Todd Thomson, Dr. 
 Kerrison, Dr. Good, and Mr. Upton, ultimately eventuated 
 
 * Sir George Burrows, Bart.
 
 12 
 
 iu the passino^ of the Act of 1815, and the Society of Apothe- 
 caries was "appointed to carry this Act into execution." 
 
 By the accident of association was thus perpetuated the 
 application of the term " apothecary " to the licensees, who, 
 being, in the words of the Act,* " examined as to their 
 fcikill and ability in the science and practice of medicine/' 
 clearly represent that great class of general practitioners, or 
 surgeon-apothecaries, required before 1815, as now, to prac- 
 tise every member and part of the science of physic. 
 
 It is no very great stretch of the imagination to assert, as 
 I do, that the very nomenclatui'e of the several grades of 
 our profession has been affected by the short-sighted 
 exclusiveness of the College of Physicians. 
 
 Fortified with the legal definition of the word " physick " 
 given them by the 32 Henry YIII., the College of Physicians 
 in granting a licence to pi'actise an art and science which 
 comprised and comprehended amongst their " members and 
 parts the knowledge of surgery " as well as the knowledge 
 of medicine (in its most restricted sense), morally, legally, 
 and etymologically created their licensees physicians or 
 practisers of physic. 
 
 The single word, '*^ physician," should and would have 
 •'orrectly characterised the great class of general practitioners 
 .}V surgeon-apothecaries. 
 
 He who aspired to the dignity of a consultant would 
 doubtless have preceded his connexion with the College by 
 the possession of a University degree. 
 
 The term "doctor," i.e., learned, would naturally have 
 been the designation of such a man, even when additionally 
 invested by the College with the o^rade and title of "Fellow." 
 
 The distinctive word "chirurgeon " or " surgeon" would 
 have effectually embraced those — comparatively few — who 
 confined themselves exclusively to the practice of that 
 member or part of our science dependent more or less u^Don 
 manipulative and operative interference and skill. 
 
 This historical sketch brings, I hope graphically, although 
 I fear imperfectly, before you the professional status which 
 the laws of the country have given the so-called surgeon- 
 apothecaries, the general practitioners, or as I prefer now to 
 .style them, the practisers of physic. 
 
 I have shown you what the " practiser of physic " ought, 
 in my opinion, to have been, were it not for the exclusive 
 pedantry of a self-immolating, short-sighted, although 
 powerful. Corporation. 
 
 I proceed to ask. Is this status professionally perfect ? 
 
 The professional status of every practiser of physic neces- 
 
 • Sect. 14.
 
 13 
 
 sarily comprises the consideration of two epochs— the period 
 of preparation, and the period of qualification. 
 
 Eecent Orators of this Society, notably Mr, Rivington and 
 Dr. Pye-Smith, have so admirably descanted on the subject 
 of medical education in general, that it would ill become me 
 to weary you with views in a great measure concordant with 
 the opinions of teachers such as they. An experience of 
 more than a quarter of a century, with all the practical 
 details of the life of a busy practiser of physic, obviously, 
 however, induces a disinclination in my mind to accept, even 
 from so renowned a metropolitan teacher as Dr. Pye-Smith, 
 the dogma that time spent in medical pupilage prior to the 
 medical school is worse than wasted. To assert, as some of 
 the teachers do, that young men who have served an appren- 
 ticeship have turned out " indifferent " hospital students, is 
 no argument adverse to the capabilities of the system. 
 
 What, maybe asked, is the relative proportion of "in- 
 difference " displayed by students unpreparedly entering the 
 hospital direct from grammar-school and college, and of 
 those who have previously educated their eye and their hand 
 under the supervision of a capable and discreet practiser of 
 physic ? 
 
 The advantages derivable from what I shall call pre- 
 hospital pupilage are entirely dependent on two important 
 factoi's — the receptivity of the student's brain, and the con- 
 scientiousness and capacity for imparting knowledge on the 
 part of the practitioner. It is the non-observance of the 
 mutuality of the bond which has, I fear, done more than 
 anything else to prejudice modern medicine against this 
 bygone mode of entering her precincts. 
 
 I appeal with much confidence to the judgment of that 
 great mass of the practisers of physic who may have passed 
 through a well-spent pre-hospital pupilage, for their verdict 
 on the benefits of the system. 
 
 In almost every manipulative vocation of the present day 
 the want of practical experience is being felt. 
 
 Technical education to adults, to be supplied by the funds 
 of the great guilds of this city, is now forcibly enlisted to 
 act as a supplemental panacea for defects resulting from 
 the non- apprenticeship of our youth. 
 
 Can we positively prove that the present method of medi- 
 cal education has conferred upon suffering humanity practi- 
 tioners so superior that the old mode must of necessity be 
 stigmatised as not only useless, but as actually mischievous ':* 
 
 In his address at the International Congress last year. 
 Dr. Billings, Surgeon to the United States Array, spoke 
 some very characteristically smart words, which are quite 
 dj'pro^pos to my purpose : —
 
 14 
 
 " The lang-uid scientific swell, who thinks it bad style to 
 be practical, who takes no interest in anything but pure 
 science, and makes it a point to retrain from any investiga- 
 tions which might lead to useful results, lest he might be con- 
 founded with mere practical men, exists and has his admirers. 
 "We have such in medicine, and their number will increase. 
 .... While it is true that to the graduate of thirty years 
 ago much of the physiological literature of the present day 
 is an unknown tongue, it is also true that the physiologist 
 of the present, who confines himself to laboratory work, will 
 find himself distanced by the man who keeps his clinical 
 and pathological studies and his experimental work well 
 abreast." 
 
 I am firmly of opinion that there are very many so-called 
 details of practice which are best, and I would say, can only 
 be, acquired during a pre- hospital pupilage. 
 
 I go further. Assuming, of course, the capacity, the 
 capability, and the opportunities of the practitioner, I hold 
 that a knowledge of certain of the preliminary studies could 
 thus be most advantageously acquired prior to entering the 
 bosijital, and when there is really more time at the disposal 
 of the student to master these groundworks of more strictly 
 professional subjects. 
 
 The General Medical Council appears at length, although 
 tardily, to have recognised this latter possibility. 
 
 At its meeting on July 14, 1880, the Council passed an 
 important resolution, insisting that on and after January 1, 
 1882, botany and elementary chemistry be included amongst 
 the optional subjects, in one of which the student must 
 undergo a preliminary examination. 
 
 In advocating the advantages derivable from a pre- 
 hospital pupilage I am not bound to an assertion of the 
 absolute necessity of the old-fashioned lengthy servitude of 
 the past, in which time and opportunities were often both 
 wasted. 
 
 It is but justice to mention that the Society of Apothe- 
 caries, who, by the express requirement of their Act of 1815, 
 had to insist on a five years' servitude, some thirty years 
 ago, recognising this evil of duration, officially and consider- 
 ably modified the spirit of this insistment. 
 
 Despite also the fact that from 1861 to 1865 pre-hospital 
 pupilage was ignored by the General Medical Council as 
 one of the modes of commencing professional studies, that 
 great examining body the Royal College of Surgeons of 
 England had not only the wisdom to perceive that this was 
 a retrograde and unwise step, but the Corporation had 
 also the courage of its own more correct views on the 
 subject.
 
 15 
 
 It politely refused compliance and conformity, and always 
 continued to consider pupilage as one mode of the com- 
 mencement of professional education. 
 
 In January, 1870, the Court of Examiners of this body 
 adopted an important report, a copy of which was, I believe, 
 at the time forwarded to every metropolitan and provincial 
 teacher. In this report the Court " deplores the total aboli- 
 tion of a limited apprenticeship,^' and intimates that since 
 the almost entire cessation of the system, students for the 
 most part enter the medical schools quite unacquainted with 
 any branch of medical knowledge or elementary science. The 
 Examiners tb us further expressed themselves: — ''The pre- 
 vailing defects in candidates for the diploma of member are 
 want of accurate knowledge of objects and facts, and want 
 of skill in using the appliances of surgery." 
 
 Based upon this very valuable report, the Council of the 
 Royal College at once laid down some important modifica- 
 tions of the required curriculum of study. 
 
 Pre-hospital pupilage was still recognised. 
 
 The inference deducible from these facts in favour of a 
 limited pre-hospital pupilage, supported as they are by the 
 conviction of a large proportion of the general practitioners 
 of the country, may be fairly weighed against the recorded 
 opinions of even that large proportion of the past and pre- 
 sent teachers in our provincial and metropolitan medical 
 schools who opine that a return to the system of apprentice- 
 ship, even in a modified form, is not desirable. 
 
 The outcome of these ideas which I have thus endeavoured 
 to portray to you is, that the preparation for the future life 
 of every practiser of physic should be of a thoroughly 
 practical and utilitarian character. 
 
 In 1870, Professor Huxley, speaking at University College, 
 London, on the occasion of the distribution of prizes, con- 
 cluded his remarks on medical education in these words : — 
 *'I entertain a very strong conviction that anyone who adds 
 to medical education one iota or tittle beyond what is abso- 
 lutely necessary is guilty of a very grave offence." 
 
 The tendency of modern medical education, I do not hesi- 
 tate to say, appears to me, as I believe it does to many 
 others interested in the practical performance of their pro- 
 fession, to conduce rather to the formation of purely scientific 
 physicians than to guaranteeing to the public skilful and 
 clinical practitioners. 
 
 Amongst some of our modern teachers, the practice and 
 great aim of our noble calling would appear almost to par- 
 take of the ignoble and derogatory. The extent and progress 
 of science are seemingly deemed paramount to the interests 
 of humanity.
 
 16 
 
 Referring to one of England's great anatomists, the 
 " pupil/' " coad jutoi"," and " attached personal friend " of 
 the "brilliant Thomas Willis," the President of the Physio- 
 logical Section in the International Medical Congress of last 
 year, remarked : — " Had Eichard Lower remained in the 
 academic repose of Oxford, devoted, without distractions, to 
 his researches, it is difficult to say whither hemight not have 
 reached. Unhappily, Willis persuaded him to move with 
 him to London, where, especially after his master's death, 
 his talents soon gained him an extensive practice. He 
 became the most noted physician in London and West- 
 minster. * No man's name was more cried up at Court than 
 his,' and the powers of mind which might have made him a 
 second Harvey, were used for the immediate benefit of his 
 patients and himself." 
 
 In like vein it is deplored that the nineteenth century 
 would not have been ashamed of English physiology, bad 
 but certain of our renowned practitioners given up the 
 practice of their art. 
 
 Paraphrasing Goldsmith's famous verse,* they should 
 to science give up " what was meant for mankind." 
 
 In the name of the great body of the practisers of physic, 
 I demur, with all due respect, to the implications of such 
 sentiments. 
 
 The claim for science as the helpmate of the physician will 
 not in these days be questioned. To arrogate a predominance 
 of science per se over the practical application of knowledge 
 to the urgent needs of our suffering fellow-men is not only 
 to alienate public feeling, which already most ignorantly 
 and most insanely questions the utility of our investigations 
 and discoveries, but it stimulates superficial theory to use- 
 lessly incite the already overloaded energies of would-be 
 practitioners to the acquisition of knowledge " not absolutely 
 needed in their future career." 
 
 " The aim of every student of medicine is," says Professor 
 Owen, " to raise the healing art to the status of a science." 
 Considering, therefore, the attractiveness with which the 
 scientific inquiries of the day must tend to alienate more 
 and more from immediate clinical work, a grave responsi- 
 bility now, more than ever, particularly rests upon the 
 shoulders of those corporate bodies who are empowered to 
 guar<intee to the public the fitness in every respect of their 
 trusted medical advisers. 
 
 Very recently indeed the General Medical Council has 
 returned to a recognition of the importance that candidates 
 
 • "Retaliation: character of Edmund Burke" — 
 
 " And to party gave up what was meant for maDkiad."
 
 17 
 
 for the final professional examination should evince a prac- 
 tical acquaintance with their future duties to humanity. 
 
 The examining bodies have risen to a recognition of this 
 necessity. Anyone comparing, for example, the regulations 
 of the Royal College of Surgeons of England respecting the 
 education and examination of candidates for the diploma of 
 Member in 18C9, with those issued in 1871, and still in force 
 at the present day, will, especially after a visit to the well- 
 arranged theatre in Lincoln' s-inn-fields on examination days, 
 at once recognise the fact that the diploma of the College 
 is now evidence of real fitness for the practice of surgery. 
 
 I do not, however, hesitate to state that many an old pre- 
 hospital pupil would long before 1871 have found himself 
 quite at home when tested with these *' manipulations," the 
 foundation on which the practice of (certainly operative) 
 surgery depends for its safe superstructure. One cannot, 
 indeed, but feel a sort of malicious delight in contemp- 
 tuously remarking that, had even a " limited appi'entice- 
 ship" been always imperative, the necessity would never 
 have arisen for a member of the Council of the College of 
 Surgeons to insert in (and continue even in the later editions 
 of) his well-known " Manual of Minor Surgery " three whole 
 paragraphs on " washing catheters I " * 
 
 It may, I think, be fairly assumed that the labours of the 
 Medical Acts Commission, appointed last year, will eventuate 
 in the adoption, in some form or other, of what has been 
 called the one-portal system of examination, either by means 
 of a resuscitated conjoint scheme, or of a State board inde- 
 pendent of the corporations. Such a State board (either as 
 one or tripartite for the United Kingdom) finally examining 
 in medicine, obstetrics, and surgery, and appointed, say, 
 partly by the Privy Council and partly by a more truly 
 representative General Medical Council, would, we are told, 
 obtain the confidence of the public in the competency of 
 what is called the general practitioner or the family doctor. 
 
 "What the public require is an authoritative guarantee that 
 the practitioner be competent and qualified to attend to their 
 need, when they are prostrated by accident, childbirth, or 
 disease. The public do not care one jot whether So-and-so 
 is a good physiologist, or is abetter botanist than, or is the 
 best chemist of, his immediate neighbours. 
 
 It is the profession itself, through its constituted authori- 
 ties, which demands that its future practitioners shall prove 
 their competency in a knowledge of these and other (what 
 may be called) preliminary studies. 
 
 It argued, however, badly for the prospective discernment 
 
 • ileath, fifth edition, 1875, pages 74, 7
 
 18 
 
 of our English corporations when, in 1880, the conjoint 
 scheme was allowed to collapse. An opportunity was thereby 
 given for that State interference so galling to the boasted 
 pride of every Englishman — his capacity for self-government. 
 
 Is it too late to retriev.e the error ? 
 
 In great contrast with the opinions of those eminent and 
 strong-minded men who gave the first move to the govern- 
 ment of our Royal College of Physicians, their " degenerate 
 descendants," who ruled over the "^commonaltie" two or 
 three hundred years later, elected, as we have shown, to 
 separate into constituent parts, which Celsus had declared 
 " ex toto separari non possint." This exclusion of surgery, 
 obstetrics, and pharmacy, from the totality of the " Facultie 
 of Physick," doubtless acted for some years as a great bar 
 to the general improvement of medical science. 
 
 Having, however, by their own by-laws assumed for their 
 licensees what was thought the higher position of consul- 
 tants, and prescribers only in one single branch of the whole 
 domain of medicine, it would appear to all, jealous of the 
 honour of our profession, more dignified had the College 
 stood firm on their acknowledged lofty pedestal. 
 
 The age and circumstances had gradually acquiesced in 
 the necessity and convenience of the tripartite division of 
 our science and art. The public willingly recognised the 
 diploma from Pall-mall as a guarantee that its possessor 
 was entitled to that higher confidence which superior know- 
 ledge and skill invariably insure in the season of urgent 
 need and diflBculty. 
 
 In an evil moment it was counselled to revoke their by- 
 law, and to resuscitate a power which undoubtedly the 
 non-annulled charters of the Crown and unrepealed Acts 
 of Parliament still authorised them to use. 
 
 In future every licensee was empowered to " go forth 
 entitled, not only to attend the case, but also to supply the 
 medicines which he should prescribe."* 
 
 Three grades of licensees were established. Confusion 
 again reigned in the nomenclature of our designation. 
 
 In 1815 the Royal College declined the proffered duty of 
 superintending general medical education. It has been 
 but a slow and unwilling convert to the pi'inciple of an im- 
 proved and improving standard of qualification for the 
 general practitioners. 
 
 It has, indeed, thrown itself open to this imputation — that, 
 as the distinction of classes would be imperilled in proportion 
 
 * Printed report of judgment (Attorney-General on the part of the 
 Society of Apothecaries v. the Royal College of Physicians; by Vice- 
 Chancellor Page Wood, 1861.
 
 19 
 
 as the qualification of the family doctor became higher, so 
 therefore it cannot be expected that any present royal college 
 would further, or even perform the duty towards, this 
 advancement with zeal, fidelity, and efficiency. 
 
 Why, then, this outburst of love for that, great class of 
 practitioners, against whom this particular Royal College, 
 styling them " medicasters," had for centuries been fulmi- 
 nating its wrath ? 
 
 Well might each practiser of physic, aghast at this 
 sudden transition from exclusiveness and self-complacency, 
 in wonderment exclaim — 
 
 "Perhaps it was right to dissemble your love, 
 But why did you kick me downsta rs ?" • 
 
 In 1S47, being examined by Mr. Warburton's Committee 
 in reference to the Medical Registration Bill, then before 
 the House of Commons, the President of the London College 
 of Physicians, Dr. Paris, pleaded that they ould not enforce 
 their own powers against unprofessional conduct because 
 they had no money. f 
 
 The vague wording of the reciprocity section of the 
 Medical Act of 1858 flashed the irresistible bait of a " golden 
 shower" before all eager impecunious corporations. 
 
 The "jealous warden" of the brazen tower in Argos 
 failed, we know, to resist the importunities of Jove desiring 
 to confer the privilege of paternity on a son of Danae. So, 
 we may imagine, quailed the virtue of tiie guardian Bedell 
 of the Alma Mater in Pall-mall against the importunities 
 of those loving, and willing to pay fop, affiliation and title. 
 
 '* Custodem pavidum Jupiter et Venus 
 Rississent : fore enim tutum iter et patens 
 Converso in pretium Deo. "J 
 
 This new-born zeal in 1860 of the Royal College of Phy- 
 sicians of London was as ill advised as it was ill timed. 
 
 Ill timed, because for nearly fifty years the necessary 
 work had been most efficiently and sufficiently done by a 
 corporate body called into very existence by reason of the 
 omissions and commissions of this Royal College itself. 
 
 Ill advised, because, on the one hand, it wounded the su.=!- 
 ceptibilities of the Royal College of Surgeons of England ; 
 and, on the other, it forced the well-doing Society of Apothe- 
 caries of London as a plaintiff into the Court of Chancery. 
 
 Though, of course, not publicly recognised, effects such as 
 these must have tended not a little to an undercurrent of 
 
 • Comedy of The Panel, altered from Bickerstaff's comedy, 'Tis Well 
 it'.f no Worse. J. P. Kemble. 
 t Answers to Questions 290, 291. J Horace, Lib. iii., Ode. xvi., 1. 6-8.
 
 20 
 
 jealousy, or at least of lukewarmness, amonffst the corj^ora- 
 tions antagonistic to the success of the English conjoint 
 scheme. 
 
 The natural union of corporations, best calculated, per- 
 haps, at the present day to effectuate an all-sufficient one- 
 portal examination in England, would be the combination 
 of the Koyal College of Surgeons with the Society of 
 Apothecaries. 
 
 The College of Surgeons of England has vast opportuni- 
 ties, which I need not here detail, of giving effect to those 
 excellent regulations issued by its Council in 1871. It has 
 since then insisted well and most effectually, both in its 
 primary and in its pass tests, on the candidates giving 
 demonstrable proof of a thoroughly practical acquaintance 
 with the subjects of examination. 
 
 Its membership is, from past influences, thoroughly in- 
 grained in men's minds as an absolutely necessary qualifica- 
 tion. It would, therefore, probably be impolitic, as it would 
 practically be impossible, to exclude this powerful corporation 
 from taking its future and due share in guaranteeing to the 
 public, medical attendants especially conversant with those 
 subjects which its charters and the Acts of Parliament 
 distinctly empower it to examine in. 
 
 According to the authority of the official Calendar, the 
 diplomas of membership granted during the ten years ended 
 July 31, 1880, by the Eoyal College of Surgeons of England 
 averaged in number 365 per annum. 
 
 The present annual average of licences granted by the 
 Society of Apothecaries amounts to 250. 
 
 It has been estimated that quite one-third of the whole 
 number of medical practitioners on the published Medical 
 Eegister are licentiates of this Society. 
 
 Should a combination of these two bodies for a corporate 
 conjoint scheme be unfortunately unattainable, there is but 
 the prejudice of a name to preclude the practicability of the 
 Society of Apothecaries most adequately and most suffi- 
 ciently supplying the necessary tests for the one-portal 
 system, so far as this division of the kingdom, at all events, 
 is concerned. 
 
 To descant on the continuous progress since 1815 made in, 
 and on the present character of, the Apothecaries' Society's 
 examination would savoiu: too much of the favour of a 
 partisan. 
 
 It is a matter of medical history that, in response to the 
 demands of the Court of Examiners, not only did new 
 schools spring up in the metropolis, but this Court was the 
 first examining body to receive certificates from the teachers 
 of the provincial schools.
 
 21 
 
 The records of the Society tell us that since the passing 
 of the Act of 1815 nearly 20,000 candidates have satisfied 
 the Court of their competency to practise as general 
 practitioners. 
 
 In 1834, Sir Henry Holland, then President of the College 
 of Physicians ; Mr. Guthrie, then President of the College 
 of Surgeons ; Sir Astley Cooper, Mr. R. G. Grainger, and 
 Dr. Seymour were examined before a Select Committee of 
 the House of Commons, and they all gave similar testimony 
 to Sir David Barry, who asserted that " the examination 
 established by the Company of Apothecaries was by far the 
 most comprehensive examination in London." 
 
 The comprehensiveness of an examination in 1834 is not, 
 I need scarcely say, any criterion whatever of the standard 
 necessary at the present day. 
 
 Sections 20 and 21 in the Medical Act of 1858 confer great 
 powers on the General Medical Council in respect of the 
 qualifications granted by the examining bodies. 
 
 It must be admitted that the General Medical Council 
 has, through its Visitors, detected one, and but one only, 
 flaw in the completeness of the examination at the Society 
 of Apothecaries. " The Visitors remark that the Society of 
 Apothecaries is not carrying out the resolution of the Council 
 that surgery should be one of the subjects in which every 
 candidate should be exaDiined before receiving a qualification 
 entitling to registration."* 
 
 The Court of Examiners of the Society of Apothecaries are 
 " authorised and required to examine all person and persons 
 applying to them for the purpose of ascertaining the skill 
 and abilities of such person or persons in the science and 
 practice of medicine.^' 
 
 The word " medicine," both in its narrow and in its broad 
 signification, has always been regarded by lexicographers as 
 synonymous with the word " physic." 
 
 An Act of Parliament has given a legal comprehensiveness 
 to the signification of the words " science of physic." 
 
 I have but little doubt that the words in the Apothecaries 
 Act, "science and practice of medicine," would have been 
 similarly interpreted in our courts of law. 
 
 The dogged determination and bold spirit which domi- 
 nated the handful of Surgeon- Apothecaries from 1812 to 1815 
 were sadly needed in 1858. 
 
 The Society of Apothecaries should then have cared for, 
 and completed, the needed qualifications of the candidates. 
 The Government and the public both would, ere now, have 
 been guaranteed the thorough competency of the licentiates 
 
 * Minutes of the Medical Council, vol. xii., 1875, page 101 ; and vol. v. 
 page -'38.
 
 22 
 
 to practise in the threefold branches of the profession as 
 genei-al practitioners. 
 
 The one-portal system question would have been solved. 
 Failing, then, the desired combination of the College of 
 Surgeons and of the Society of Apothecaries in the establish- 
 ment of a conjoint examining board, there is still ready to 
 the hand of any reforming Government an existing legal 
 and adequate machinery upon which to graft the one-portal 
 system of admission to the practical exercise of the calling 
 of physic, as a whole, in England. 
 
 The elective power conferred by the Act of 1815 on the 
 " master, wardens, and assistants " of the Society of Apothe- 
 caries to ''choose and appoint the Court of Examiners " could, 
 of course, be easily extended in any direction, and by such 
 means as the wisdom of the Government and our Parliament 
 should determine. 
 
 In advocating a scheme for utilising existing legal 
 machinery, and making a complete examination by an 
 enlarged Court of Examiners of the Society of Apothecaries 
 the one-portal admission, guaranteeing to the public the 
 capability of every practiser of physic, I am quite aware 
 that something more is needed than to recall and rely upon 
 the past good work of this Corporation. 
 
 The public and the Royal Commissioners will both alike 
 require to be thoroughly satisfied as to the special fitness of 
 such a body to fulfil present and future conditions. 
 
 Taking the numerical test alone, I do not find that confi- 
 dence in the qualification supplied by the Society of Apothe- 
 caries has been materially diminished by the extraordinary 
 resolution in 1860 of the Eoyal College of Physicians. 
 
 The by-laws founded on this resolution were approved of 
 at the Censors' Board on December 22, 1860, and, according 
 to the official list corrected to December, 31, 1880, it appears 
 that 1388 of these new licences have been granted. 
 
 This total gives an annual average of sixty-seven during 
 the last twenty years. 
 
 During the twenty years prior to the granting of these 
 new licences by the Eoyal College of Physicians — namelv, 
 from August 1, 1840, to July 31, 1860—5927 candidates 
 received the licence of the Society of Apothecaries, making 
 an annual average of 296. 
 
 In the twenty years since the granting of these new 
 licences by the Eoyal College of Physicians— namely, from 
 August 1, 1860, till July 31, 1880—4954 candidates have re- 
 ceived the licence of the Society of Apothecaries, making an 
 annual avei-age of 247. 
 
 The practical outcome, therefore, is that the competition 
 of the Royal College of Physicians with the Society of
 
 23 
 
 Apothecaries lias resulted in tlie diminution by one only of 
 the average number of licentiates passed every week by this 
 latter body during the last twenty years. 
 
 In affirming my belief, as I do, that etymologically, 
 morally, and legally the Society of Apothecaries should so 
 construe the words of their Act as to include ''surgery" in 
 their examination of "all person or persons in the science and 
 practice of medicine/' I would simply make one remark to 
 meet any possible legal objections. 
 
 The Royal College of Surgeons of England is empowered 
 by its several charters to examine only in surgery, in mid- 
 wifery, and in dentistry. Despite, however, the absence of 
 any such legal provisions, this Corporation has for some 
 time examined candidates for its diploma (who have not a 
 medical qualification) in that one of the threefold bi'anches 
 of our profession styled the " principles and practice of 
 medicine." No candidate rejected at Lincoln's-inn on this 
 one subject only has ever applied to the Court of Queen's 
 Bench for a mandamus to compel the College to give him 
 the diploma of membership, which is very properly withheld 
 until the qualification is complete. 
 
 Even before 1874 the Society of Apothecaries, although 
 restricted to select from their own guild (a restriction, by- 
 the-bye, they have frequently endeavoured to remove),* had 
 members upon their Court of Examiners who were Fellows 
 by examination of the Royal College of Surgeons. By the 
 Apothecaries Amendment Act of 1874 this restricted provision 
 of the Act of 1815 was repealed. 
 
 The Society of Apothecaries have fully justified the con- 
 fidence of the Legislature. The examination by this body 
 had in the last sixty years greatly raised the scientific at- 
 tainments of the medical students. f It had, moreover, com- 
 pelled an increasingly higher standard of qualification for 
 the family doctor. The public still perseveringiy demand 
 that they have a medical attendant as competent for the dis- 
 charge of his manifold duties as the improved state of medical 
 education can render him. The Society at once responds. 
 It fearlessly and impartially uses its new legal power of 
 electing on to its Coui't of Examiners any legally qualified 
 member of the profession. Of the present Court of Exa- 
 miners, one-half have nothing whatever to do with the cor- 
 porate body, two of them not even being licentiates of the 
 Society. Of the twelve members, eight of them are M.D.'s 
 of the University of London, and two of these were gold 
 
 * An Address by the Society of Apothecaries to the General Practi- 
 tioners, lbl5, pape 9. 
 
 t " The Touchstone of Medical Reform," by Joseph Henry Green, 
 page 68.
 
 24 
 
 medallists in more tlian one subject ; one is an M.D. of tlie 
 University of Cambridge; and two are M.D. 's of the Uni- 
 versity of Edinburgh. Four of the Examiners are either 
 lecturers at medical schools or physicians to large hospitals. 
 Three of the Examiners are Fellows, and two are Members, 
 of the Royal College of Physicians of London. Two others 
 are Fellows of the Koyal College of Surgeons of England, of 
 which body nine of the remaining Court are Members. About 
 one-half of the whole Court may be appropriately styled 
 Surgeon-Apothecaries — men admittedly best able to form an 
 opinion of the amount of qualification necessary for general 
 practice. 
 
 I may even remark that those very specialities in our 
 practice, which so frequently come first under the particular 
 notice of the general practitioner, and of which he is taught 
 so little at the schools — I allude to diseases of the skin and 
 to diseases of the mind — are ably represented on the present 
 Court by weU-known devotees to the study of those respective 
 maladies. 
 
 That one great need of all present, and more especially of 
 all future, practitioners, scarcely yet recognised or even 
 mentioned at the schools,— the knowledge of sanitary medi- 
 cine, — has also at least one of its foremost professors amongst 
 the Court of Examiners. 
 
 A complete examination given by such a composite body 
 of well and diversely qualified men, representative of all the 
 knowledge needed for a family doctor, should surely satisfy 
 the Government and the public that the holder of the licence 
 was fully competent to practise in all and every the branches 
 of the science and faculty of physic as a general practitioner. 
 
 Well will it indeed be for all who in time to come may 
 need that aid which our profession alone can give, if the 
 examining body constituted by the State, or the conjoint 
 board of the future, be based on the broad principles which 
 have always actuated the Society of Apothecaries ! Dr. 
 Billings has remarked : " To insure the value of a diploma as 
 a proof of education is the difficulty." 
 
 An examining body admitting candidates through the 
 one-portal system must be competent to guarantee the public 
 that their medical adviser, on whose skill so large a propor- 
 tion of them are solely dependent in every visitation of 
 accident, childbirth, or disease, should be possessed of 
 knowledge sufficient for the practical duties of his varied 
 calling. 
 
 Conjoining boards must exercise a complete abnegation, 
 or rather — to borrow a word from Capel-court— a " back- 
 wardation " of their corporate interests. They must reso- 
 lutely oppose the innate desire to so compose the examining
 
 25 
 
 body that their several nominees be class representatives 
 only of one special subject or particular branch of the art 
 and science of physic. 
 
 Legalised by the powers that be^ the family doctor 
 needs still other attributes to fit him for his great calling. 
 
 The clear trumpet-call to duty, boldly depicting the high 
 ideal of what should be the aim and conduct of us all, was 
 uttered, at the opening of last year's great Congress, by one 
 not only the recognised temporary leader of our profession, 
 but by one sprung from the great class of family doctors, 
 and now high in the confidence of his Queen.* 
 
 Not every general practitioner, however, must expect to 
 attain the position of chief medical adviser to the Crown of 
 this country ; yet each of us is expected to be at all times in- 
 tellectually, morally, and physically attuned for the high and 
 important duties of our calling. 
 
 It is only by maintaining and elevating the standard of 
 our professional and general acquirements that we can hope 
 in this age to maintain and elevate our professional and 
 social status. 
 
 Nevertheless, I again unhesitatingly appeal to all respon- 
 sible for the education of our future family physicians. 
 
 Examining bodies, the practitioners of the day, and the 
 pubHc themselves, recognise the increasing failure in the 
 preparedness of our students for the required qualifications 
 of their future life. 
 
 It is indeed obvious to all thoughtful minds that a more 
 clinical and practical training than our modem system 
 obtains is the one great desideratum still of medical teaching. 
 
 As the application and capabilities of our art rise to the 
 exacting requirements of mankind, in so much will medical 
 men retain that unbounded trust with which the world, 
 from time immemorial, has regarded the character of our 
 profession. 
 
 The confidence which admits us to all the sanctities and 
 tendernesses of domestic life not only presupposes in, but 
 demands from, us an innate possession and a strict cultiva- 
 tion of every unswerving moral attribute. 
 
 There is one phase of our social conduct on which I 
 would for a few moments dwell. 
 
 From the general practitioners in medicine, more than 
 from any other class of the community, are required a great 
 tolerance of and a larger leniency towards the foibles, the 
 whims, and caprices of their fellow-men. 
 
 The practice of this needed restraint is demanded from the 
 family doctor, alike in his daily intercourse with private 
 
 * Sir William Jenner, Bart,, K.C.B., President of the Eoyal College of 
 Physicians of London.
 
 26 
 
 patients, as well as in his contact, socially or officially, with 
 the public at large, individually or collectively. 
 
 Ordinary human nature is, as a rule, forbearing towards 
 the many petty susceptibilities of the sick-bed. It tries hard 
 indeed all our better feelings to calmly receive unmerited 
 ingratitude for labours such as ours. Yet this is what we 
 must steel ourselves to do. 
 
 With true moral courage we must not only more firmly 
 support each other in maintaining the dignity of our profes- 
 sion ; but also we must determine, by increased efforts in the 
 alleviation of suffering, to convince humanity of the nobility 
 and unselfishness of our calling. 
 
 I would only but incidentally allude to two great and 
 serious questions of the day, respecting which certain 
 individuals, as well as collective assemblages of the public, 
 would seem to be mentally incapable either of recognising 
 crude facts, or of appreciating the natural deductions from 
 acknowleged premisses. 
 
 It is deplorable, and indeed discreditable to the intellec- 
 tuality of this country, that our foreign brethren, whilst 
 enjoying our hospitality last year, should have felt the 
 urgent necessity of raising, in reprimand, the voice of injured 
 science against the enactments of our English Parliament. 
 
 The warning words of Virchow or of Pasteur will not, how- 
 ever, I fear, avail any more than has the dulcet eloquence of 
 that veteran in science — our own honorary member — E-ichard 
 Owen ; or than has the unanimous verdict of last yearns great 
 International Congress, against this hasty and obstructive 
 legislation of our country. 
 
 How can we indeed gauge the mental calibre of that 
 batch of individuals, who, with a false sense of humani- 
 tarianism, regard with sentimental horror the insertion of a 
 physiologist's taper needle through the ear of a rabbit, whilst 
 they hesitate not to stand complacently by and applaud the 
 intrusion of a jockey's rowelled spur into the flanks of a 
 thoroughbred at Ascot or at Goodwood ? 
 
 Lamentable indeed is it to vsitness even a great judicial 
 mind, well conversant with the logic of facts, associating 
 itself with this fallacy and fanaticism of the day. 
 " Nemo mortalium omnibus horia sapit." 
 
 Let US, however, with a manly tolerance hope of this great 
 luminary in a sister profession, as was said of the " wedding 
 guest " on the departure of the " Ancient Mariner " — 
 
 " He went like one that hath been stunned, 
 And is of sense forlorn : 
 A sadder and a wiser man, 
 He rose the morrow mom."* 
 
 • Coleridge, '* Ancient Mariner," last verse.
 
 27 
 
 For, as thought Sir Leoline of his old friend Lord Roland — 
 
 " To be wroth ■vrith one we love, 
 
 Doth work like madness in the brain."* 
 
 Otir Government has shown inconsistency in the matter 
 of vivisection. It recognises, and by printing as a Par- 
 liamentary paper virtually adopts, the wonderful results 
 emanating from Professor Pasteur's experiments on living 
 animals in France, whilst it legally prohibits Englishmen 
 performing similar experiments in this country under the 
 penalty of a criminal prosecution ! 
 
 The outcry against vaccination and revaccination de- 
 mands, perhaps more than do the anti-vivisectionists, toler- 
 ance and leniency from the general practitioners, whose 
 decision and action in the former vexed question must 
 necessarily be of daily imminence in many a family circle. 
 
 On the commonplace topic of bodily health, I would 
 simply observe on the great advantages which must in- 
 variably acci'ue to our sex in the performance of the duties 
 of general practitioners, by the possession of a superior 
 physical organism. 
 
 Inferiority, in the conventional use of the term, I do not 
 for one moment apply to our would-be fair rivals. 
 
 In a scientific sense not only are all females admittedly 
 lower in the scale of development than males, but the woman 
 is clearly not, as a rule, the equal of man in stature either 
 of mind or of body. It is for obvious reasons absolutely 
 absurd to imagine that medical women can take upon them- 
 selves duties required of family doctors, at any hour of 
 every day or night. 
 
 The limited field of consultants must soon be closed to 
 those few women intellectually capable of acquiring medical 
 knowledge. 
 
 Let Pall-mall and Lincoln's-inn, however, console them- 
 selves with this one significant fact, pointed out by Delaunay, 
 that " although there have been and are wonderful ex- 
 amples of the skill and dexterity of women as practical 
 musicians, at the same time cultivating the sense of hearing 
 and taste to a state of very high perfection, there has 
 never yet been a great female composer." 
 
 Allied, of course, to the question of health is that of 
 longevity. 
 
 The devotees of our arduous and danger-exposed profes- 
 sion may nevertheless be comforted on the authority of Dr. 
 Guy, that medical men occupy a good position in the high 
 
 • Coleridge, " Christabel," part 2.
 
 28 
 
 average duration of life he assigns to the professional 
 classes.* 
 
 A notable instance has, since our last anniversary, been 
 prominently commented on. 
 
 A late distinguished member of our own Society, Dr. 
 Archibald Billing, the father of the College of Physicians, 
 died on September 2 last, at the patriarchal age of ninety 
 years. Dr. Billing was admitted a member of this Society 
 just sixty years ago, in 1822, when the Society was but in 
 the fourth year of its institution. Dr. Benjamin Robinson, 
 who had succeeded Sir William Blizard's three years of 
 office, was then President, and he was re-elected the follow- 
 ing year. In 1824-25 Dr. William Babington occupied the 
 chair. Mr. Benjamin Travers succeeded him in 1826-27. 
 In 1828 Dr. Billing was elected the fifth President of the 
 Hunterian Society, retaining the chair, as was then the 
 custom, for two years. In 1832 he delivered the Oration, a 
 manuscript copy of which exists in our library, the subject 
 being " An Essay on Auscultation of the Heart." Dr. 
 Billing was one of the first in London to teach this then 
 new mode of investigating cardiac disease. He afterwards 
 frequently contributed to the pages of the medical journals 
 papers on this subject. He was a well-known and original 
 inquirer into the causes of the sounds of the heart. 
 
 At this time Dr. Billing was living in Bedford-place 
 (No. 5). According to the records of our Society he appears 
 to have moved westward about 1843. When I joined the 
 Society, in 1854, I can well remember the old man occa- 
 sionally attending our meetings, and taking part in our dis- 
 cussions. I will not say '' that old man eloquent," for even 
 his old pupils admit that he was not a fluent speaker. 
 
 He, the cultured, artistic, and from the very onset of his 
 career not needy, physician, never looked down, however, 
 upon the general practitioner. 
 
 He was the advocate of the " one-faculty system," and on 
 one occasion publicly declared that " he desf>ised the man 
 who was incapable of practising his profession from the 
 administration of a glyster upwards." 
 
 I need not dwell, as others have, on Dr. Billing's more 
 public and well-known career. This old link with the past 
 excites indeed our wonder, when we consider that he was 
 admitted a Fellow of the Eoyal CoUege of Physicians of 
 London in 1819, just seven years before was similarly 
 honoured the acknowledged Nestor of our profession. Sir 
 Thomas Watson. 
 
 Our chief interest connected with Dr. Archibald Billing 
 
 * Journal of the Statistical Society of London, 1846, vol. ix., page 346.
 
 29 
 
 is that he was one of those yery few still left to us who could 
 carry back his association to an acquaintance with, or a 
 knowledge of, those grand men of old who founded this 
 Society. Sir William Blizard died in 1835 at the age of 
 ninety-two. 
 
 One other colleague of these two men at the same great 
 hospital, and also a member of this Society, died about a 
 month prior to Dr. Billing. Mr. James Luke, on the death 
 of Sir William Blizard, became one of the principal sur- 
 geons of the London Hospital. He appears to have joined 
 our Society in 1827, and to have followed Dr. William Cooke 
 as President in 1843-44, being succeeded by the well-known 
 Dr. Eichard Bright. Mr. Luke during his presidency ap- 
 pears, from our report of 1844, to have discouraged the plan, 
 adopted in later years, of filling up the evening, when the 
 discussion on the formal paper or essay before the Society 
 is completed, by any impromptu case or remarks from 
 attendant members. 
 
 Mr. Luke does not appear to have ever taken the post of 
 Orator of this Society, although he delivered the Hunterian 
 Oration in 1852 before the Royal College of Surgeons of 
 England, of which he was twice President. He was one of 
 the few consultants who continued to reside in the City (in 
 Broad-street or its immediate neighbourhood) until his 
 retirement from practice, about 1866. 
 
 Dr. Archibald Billing was styled by the medical journals, 
 in their usual obituary, the "father of the profession." He 
 was really not so. About the time of his death, died, also 
 at the great age of ninety, a well-known general practitioner. 
 Mr. Eichard Clewin Griffith was in practice before 1815, and 
 hence was among the first batch of this section of the pro- 
 fession. He was admitted a Member of the Eoyal College 
 of Surgeons in 1813, whereas Dr. Billing was not made a 
 Doctor of Medicine of Oxford till 1818. Eichard Clewin 
 Griffith was, of course, the Father of the Society of Apothe- 
 caries, of which Company he was Master about twenty-seven 
 years ago, when he retired from practice, having then 
 realised a good competence. He belonged to the old school 
 of practical medicine, and despised theories. 
 
 Nevertheless, it has been written of this nonogenarian 
 surgeon-apothecary — " He was one of those old worthies 
 who were a credit to our profession at a critical epoch of our 
 histoy."' Again our profession is passing through a very 
 critical period of its history. Will the same epitaph be 
 written of each and all of us — the family doctors of this 
 day? 
 
 Armed physically, morally, intellectually, neither we nor 
 our successors need fear, despite impending changes and so-
 
 so 
 
 called reforms, comparison witli any section of our profession. 
 In certain parts of the armour of tlie profession the general 
 practitioner should, indeed, by the very force of circum- 
 stances, be stronger than his consultant compeer. In the 
 matter of therapeutics as applied to the patient, and of in- 
 dividual prognosis, the family doctor has, from his more or 
 less permanent, or at all events continuous, opportunities, 
 many advantages over the temporary and casual second 
 opinion. This statement must appear a paradox in juxta- 
 position with an admission I must also in all candour make. 
 The weak joints in the harness of still too many general 
 practitioners are, undoubtedly, diagnosis and pathology. 
 
 The gradual subsidence — I will not call it neglect — of 
 pathological knowledge on the part of most men entering 
 general practice is to be regretted. 
 
 Reasons, good, bad, and indiiferent, may- doubtless be 
 advanced in explanation. The fact, I am siure, is a relic of 
 bygone conditions and circumstances. 
 
 So also with the carelessness about exact diagnosis. 
 
 In days gone by it was insisted that the family attendant's 
 chief, if not only, duty was to help suffering humanity. 
 
 It is even so now. 
 
 Symptomatology was ever clear ; diagnosis might be ob- 
 scure. The former indicated the remedy and the patient's 
 relief ; the latter, with pathological inspection, might satisfy 
 scientific investigation. 
 
 In the posthumous address of Mons. Maurice Raynaud, of 
 Paris, read by his friend Dr. Fereol at last year's Congress, 
 this contrast is thus ably delineated: — ''^ Gentlemen, the 
 true cause of scepticism, the most powerful, that which at 
 all times — formerly as at present — created so many sceptics 
 amongst us, is that medicine is at the same time both a 
 science and a profession. We need not complain of this ; it 
 is one of its glories, perhaps the highest, for it thereby 
 satisfies all that there is most generous and most cultivated 
 in the human heart — the need of helping those who suffer." 
 
 Slowly, however, but surely, a dependence on symptoma- 
 tology as alone a guide to therapeutics is becoming less and 
 less the characteristic of the general practitioner of to-day. 
 
 His present culture leads him also, alike with his con- 
 sultant confrere, so to utilise symptoms as first to ask the 
 question " Where ?", thence to deduce, and thereby to base 
 his treatment if possible on, a scientific diagnosis. 
 
 I commenced my Oration by instancing the founder of 
 this Society — the late Dr. Wm. Cooke — as a type of what 
 should be the family doctor. 
 
 I end it by remarking that even sixty years ago this 
 general practitioner disdained not pathological knowledge.
 
 31 
 
 Besides his own original investigations on the preservation 
 of morbid specimens, he devoted himself to the translation* 
 of Morgagni's great work. He was thereby the means of 
 introducing to the practitioners of this country " a book/' 
 which, Virchow tells us, " became the point of issue of a move- 
 ment which in a few decades has changed the whole face of 
 science." 
 
 Thus utilising ever his powers and his responsibilities, 
 every family doctor may reach that high standard of com- 
 parison, which an eloquent preacher in our national temple 
 last year, with an audacious but yet true reverence, intro- 
 duced as between the science and philanthropy of medicine 
 and the manifold works of mercy accomplished by the Great 
 Physician eighteen hundred years ago.f 
 
 So mote it be ! 
 
 May the verdict of the future be of each and all of us : — 
 
 " His life was gentle ; and the elements 
 So mixed in him, that Nature might stand up, 
 And say to all the world, This was a man I " i 
 
 * Morgagni, " On the Seats and Causes of Diseases investigated by 
 Anatomy." Translated, Abridged, and Elucidated, with copious Notes. 
 1822. 
 
 t "Teaching and Healing." A sermen preached before the Interna- 
 tional Medical Congress at St. Paul's Cathedral on the eighth Sunday after 
 Trinity, August 7, 1881, by H. P. Liddon, D.D, 
 
 X Shakespeare, Julius Ccesar, act v. so. 5. 
 
 Fardon <fc Sons^ Printers, Paternoster Rjw, London.
 
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