MEDICAL EDUCATION IN 1858

 

The 12th London and Provincial Medical Directory of 1858 includes advertisements from regulatory bodies for physicians, surgeons and apothecaries, which give us a brief insight into the times. These three rival professions had been induced to unite by the government, at least in part because of they shared a fear of unqualified men.

The Physicians were founded by Henry VIII in 1518 to regulate teaching in London. By the end of the 18th century they had restricted membership to those with a degree from Oxford or Cambridge, the only two English universities, partly as a protection against the Scottish trained men. This in effect restricted access to the profession to Anglicans as Nonconformists could not graduate from Oxbridge. The Scottish universities admitted all religions. There were relatively few physicians and they practised almost exclusively in London, where they could make a good living by attending the rich. They were largely life-style advisers. If they thought it necessary to bleed the patient the physician sent for a surgeon, if an emetic or purge was called for they sent for an apothecary.

The Surgeons had formerly been part of the Guild of Barbers Surgeons set up Henry VIII in 1540. They split from the barbers in 1745. The Royal College of Surgeons (England) formerly the Corporation of Surgeons, received its charter in 1800. Qualification was by apprenticeship. There were no universities other than Oxford and Cambridge in England until University College London in the 1826 was set up, initially with the name of the University of London. It admitted Nonconformists and gave medical degrees.

Apothecaries provided most of the medical service outside London especially for the middle and lower classes.  They formed an Apothecaries Company.  Qualification was originally by apprenticeship.  The Apothecaries' Act of 1815 empowered the Society to examine and to grant licences to successful candidates to practise as an Apothecary in England and Wales.  It also gave the Society the duty of regulating such practice.  The title of the original qualification was Licentiate of the Society of Apothecaries (LSA).  Following the establishment of the General Medical Council in 1858 the LSA became a registerable qualification.  There was also the higher qualification of FSA (Fellow of the Society of Apothecaries). The apothecary was, in effect, the forerunner of the modern general practitioner and indeed many had the double qualification of apothecary and surgeon.  It was the chemists and druggists who were the forerunners of the modern profession of pharmacy.

In 1858 there were universities or colleges at Cambridge, Oxford, Durham and London as well as Trinity Dublin, Queen's University in Ireland, Edinburgh, Glasgow, Aberdeen, and St Andrews.

By 1858 there were provincial medical schools at Queen's College and Sydenham College in Birmingham; Bristol; Hull and East Riding; Leeds; Liverpool; Manchester Royal; Newcastle-on-Tyne (one under Durham and one under London University); Sheffield and York.

The Metropolitan Hospitals and Schools of Medicine in 1858 were St. Bartholomew's, Charing-Cross, St. George's, Grosvenor Place School of Anatomy, Guy's, King's College, King's College Hospital, London, Marylebone Infirmary, St. Mary's, Middlesex, St. Thomas's, University College, Westminster. There was also the Royal College of Chemistry and the School of Pharmacy.

THE ROYAL COLLEGE OF PHYSICIANS IN 1858

The physicians start their advertisement by emphasising their powers to prohibit others from practising.

The College of Physicians is entitled by Charter to prevent any one from practising as a Physician in London, and within seven miles thereof, who has not submitted to its examination. The Licentiates enjoy the same privileges as the Fellows as far as practice is concerned, but they have no share in the direction of the affairs of the College. The Fellows are now chosen from the body of Licentiates, a certain number being generally elected on the 25th of June of each year.

Details follow on the fees to be paid for each level of entry. It was £56 17 shillings in 1858, a huge sum of money at the time. Following these details, the Royal College of Physicians emphasises its antiquity (founded by Henry VIII) and its conservative nature by giving the rest of its article, amounting to three pages, in Latin. If you could not read this there was no chance that you were ready to join! Among the subject areas that would have to learn over a period of five years were anatomy, the theory and practice of medicine, chemistry, materia medica, natural history, botany, obstetrics and the principles of surgery. Hospital practice was required (in Nosocomio)

Nemo in Permissorum numerum admittatur, qui non prius Praesidentem et Censores certiores fecerit, per literas testimoniales a Comitiis Minoribus approbandas, sese Disciplinae Mediae studiis per quinquennium integrum incubuisse. Disciplinam autem Medicam haec precipue studia complecti volumus: scilicet, Anatomicen; Medicinam, theoreticam, practicam, et forensem; Chemiam; Materiam Medicam; Historiam Naturalem; praecipue Botanicen; Artem Obstetrician; Chirurgiae Principia. Statuimus insuper et ordinamus, immo hoc summi esse censemus, ut nemo in Permissorum numerum admittatur, qui non pries sera Medicorum praxi in Nosocomio aliquo idoneo triennium integrum consuevisse, per literas testimoniales Comitiis Minoribus prolatas, comprobaverit.

In the 18th century, the curriculum for physicians at Oxbridge had comprised mainly learning the works of the ancient Greek and Roman authorities, Hippocrates, and Galen, who was the physician to the Emperor, Marcus Aurelius. Exams were oral and the questions were known in advance. It was necessary for candidates to recite what Hippocrates or Galen would have said, in the original language. No contact with patients was required and indeed neither Oxford nor Cambridge had hospitals. By 1858 a wider, more modern curriculum was clearly called for but the old habits died hard. Below we see the section of the regulations that requires familiarity with the ancient writers, Hippocrates (460–c.370 B.C.); Galen (c.130–c.200 A.D.); Celsus (living in 14. A.D) and Thomas Sydenham 1624-1689).

Hisce quaestionibus responsa, ut literis illico mandentur, et inter annales nostros conserventur, curet Registrarius. Praeterea examinetur in Graecis literis ad Medicinam spectantibus, scilicet in Hippocrate, vel Galeno, vel Aretaeo. Proponantur unicuique in prima examinatione loci ex Aphorismis Hippocratis, vel e Galeno; in secunda et tertia examinatione loci ex Hippocrate, vel Galeno, vel Aretae qui Latina reddantur, et brevi commentario illustrentur. Si quis autem in Graecis literis parum profecisse videatur, is saltem e Celsi vel Sydenhami operabus, vel quovis alio libro Latino ad Medicinam spectante, locum Anglice reddat. Singulae examinationes praedictae Latine fiant, et Anglice etiam, si quando id visum fuerit Censoribus.

 

THE ROYAL COLLEGE OF SURGEONS IN 1858

The surgeons are much more forthcoming about their requirements and express them in plain English

REGULATIONS RELATING TO CANDIDATES FOR THE DIPLOMA OR MEMBER OF THE COLLEGE.

I. Candidates are required to produce the following certificates, viz.

1. Of being twenty-one years of age.
2. Of having been engaged during four years in the acquirement of professional knowledge.
3. Of having studied practical pharmacy during six months.
4. Of having studied anatomy and physiology, by attendance on lectures and demonstrations and by dissections, during three winter sessions.
5. Of having attended, during two winter sessions, lectures on the principles and practice of surgery.
6. Of having attended, during one summer session, lectures on materia medica and lectures on midwifery; practical midwifery to be attended at any time after the conclusion of the session.
7. Of having attended one course of lectures on the practice of physic and one course on chemistry.
8. Of having attended at a recognised hospital or hospitals in the United Kingdom the practice of physic during one winter* and one summer** session.
9. Of having attended, during three winter and two summer sessions, the practice of surgery at a recognised hospital or hospitals in the United Kingdom.
10. And of having attended clinical lectures on medicine and surgery in conformity with the following regulations of the council.

The certificates of attendance on the medical practice of a hospital, commencing on or after the 1st of October, 1804, must be accompanied by certificates of attendance on clinical lectures on medicine during such attendance:-and the certificates of attendance, by such candidates, on the surgical practice of a hospital, commencing on or after the said 1st of October, 1854, must be accompanied by certificates of attendance on clinical lectures on surgery during such attendance. Such courses of clinical lectures shall, in England and in the colonies, consist of not less than one lecture on medicine and one lecture on surgery in each week during the summer and winter sessions; and in Scotland and Ireland shall consist of such number of lectures as may be, respectively, required by the Royal College of Surgeons of Edinburgh and Ireland. These lectures shall be additional to clinical instruction given in the wards, and shall have especial reference to cases at the time, or previously under observation in the hospital. The course of study hereby prescribed is required to be observed by candidates who shall have pursued their studies in hospitals and schools in England. These candidates who shall have studied in Scotland are required to bring certificates of having attended lectures on the institutes of medicine during one winter session, and on anatomy during two other winter sessions, and on demonstrations and dissections during three winter sessions (the foregoing regulations being in all other respects observed). Candidates who shall have attended lectures on materia medics in the University of Dublin will be allowed to bring certificates of such attendance during the winter session.

II. Members or licentiates of any legally constituted College of Surgeons in the United Kingdom, and graduates in surgery of any university requiring residence to obtain degrees, will be admitted for examination on producing their diploma, licence, or degree, together with proof of being twenty-one years of age, and of having been occupied at least four years in the acquirement of professional knowledge.
III. Graduates in medicine of any legally constituted college or university requiring residence to obtain degrees, will be admitted for examination on adducing, together with their diploma, or degree, proof of having completed the anatomical and surgical education required by the foregoing regulations, either at the school and hospital of the university where they shall have graduated, or at one or more of the recognised schools and hospitals in the United Kingdom.
IV. Candidates who shall have attended at recognised colonial hospitals and schools*** the medical and surgical practice and the several courses of lectures, with the demonstrations and dissections required by the foregoing regulations, will be admitted for examination upon producing certificates of such attendance, together with certificates of having attended in London, during one winter session, the surgical practice of a recognised hospital, and lectures on Anatomy, Physiology, and Surgery, with demonstrations and dissections.
V. Certificates will not be recognised from any hospital unless the surgeons thereto be members of one of the legally constituted colleges of surgeons in the United Kingdom; nor from any school of anatomy and physiology or midwifery, unless the teachers in such school be members of some legally constituted college of physicians or surgeons in the United Kingdom; nor from any school of surgery, unless the teachers in such school be members of one of the legally constituted colleges of surgeons in the United Kingdom.
VI. Certificates will not be received on more than one branch of science from one and the same lecturer: but anatomy and physiology -- demonstrations and dissections -- will be respectively considered as one branch of science, and in those schools in Scotland or Ireland in which such division of those subjects is sanctioned by the College of Surgeons in each kingdom, the institutes of medicine, -- anatomy, demonstrations and dissections, --may be separately certified.
VII. Certificates will not be received from candidates who have studied in London, unless they shall have registered their tickets at the College, as required by the regulations, during the last ten days of January, March, and October in each year; nor from candidates who have studied elsewhere, unless their names shall duly appear in the registers transmitted during such studies from their respective schools.

N.B. In the certificates of attendance on hospital practice and on lectures, it is required that the dates of commencement and termination be clearly expressed; and no interlineation, erasure, or alteration will be allowed. Blank forms of the required certificates may be obtained on application to the Secretary, to whom they must be delivered, properly filled up, ten days before the candidate can be admitted to examination, and all such certificates are retained at the College.

* The winter session comprises a period of six months, and, in England, commences on the 1st of October and terminates on the 31st of March.
**The summer session comprises a period of three months, and, in England, commences on the 1st of May and terminates on the 31st of July. No provincial hospital will be recognised by this College which contains less than 100 patients; and no metropolitan hospital which contains less than 150 patients.
*** The recognition of colonial hospitals and schools is governed by the same regulations, with respect to number of patients, to courses of lectures, and to physicians, surgeons and lecturers, as apply to the recognition of provincial hospitals and schools in England.

The article continues with details of how those who were already of 15 years standing in the profession on 14 September 1843 could be admitted to the Fellowship other than by examination. For the preliminary examination for the Fellowship the following items were included for candidates who had reached the age of 18. This is roughly equivalent to the entrance level and is baffling in that French is seen as more important than a grounding in chemistry or botany. In the next level of examination the topics were Anatomy, Physiology, Pathology, Therapeutics and Surgery.

Classics: Livy, Book XXX; Horace, Odes III and IV; Thucydides, Book VI; Euripides, Medea. Each candidate is required to bring up one of the above Greek and one of the above Latin authors, one prose writer and one poet.

French: Moliere's Misanthrope; La Martine's Voyage en Orient; Voltaire's Histoire du Pierre le Grand.

Mathematics: Arithmetic, Algebra up to docrine of proportions and equations with one or two unknowns, Euclid books 1, 2 and 3. Statics, hydrostatics, Optics, Acoustics.

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