TEACHING IN MEDIGINE 
and 
LI0ENSING TO Pf(A@TI0E. 
Report on the Desirability and Practicability of 
Separating the Work. 
By M. A. MCCLELLAND, M.D., Knoxville, III. 
[Reprinted from the Transactions of the Illinois State Medical Society, for IS 
CHICAGO: 
Brown, Pettibone & Kelly, Printers 
1883. TEACHING IN MEDICINE AND LICENSING 
TO PRACTICE: 
Report on tlie Desirability and Practicability of Separating the Work. 
M. A. McClelland, M. D., Knoxville, III. 
In his “Advancement of Learning,” Bacon remarks that 
“Medicine is a science which hath been more professed than 
laboured, and yet more laboured than advanced.” The same 
remark is applicable to-day. The question upon which 
your committee is called to report is not a new one. 
In the United States, as early as 1835, the Faculty of 
the Medical College of Georgia recognizing that “through 
the rapid multiplication of medical schools, and the active 
rivalry for students to support them,” many persons were 
sent forth but imperfectly prepared for their duties as phy- 
sicians, issued a call for a convention, to be made up of 
delegates from the several colleges, to formulate a course 
of study, and to exact a higher degree of attainment, prior 
to graduation. What followed, is a matter of history,—the 
movement was suppressed through the neglect of the Uni- 
versity of Pennsylvania, to set the time, and designate the 
place at which such convention should be held. 
Four years later, the attention of the New York State 
Medical Society was called to the question of raising the 
standard of medical education by Dr. John McCall, of Utica, 
and by resolution a second convention was called, which, like 
the former one, failed mainly through the apathy, if not open 
hostility, of the schools of Philadelphia. 
Some five years after the question was again discussed in 
the New York society, and referred to a committee, of which 2 
Professor N. S. Davis, now an honored citizen of Illinois and 
a member of this society, was made chairman. Out of this 
grew the formation of the American Medical Association, 
through which it was hoped a higher standard of qualification 
would be enforced, and medicine, in the United States, raised 
from its downward course. To a considerable extent, the 
hopes of the profession have been realized, but much is yet 
left to be done. 
What was true in 1635, in regard to the excess of medical 
schools, in respect to population, is more than true to-day, 
and it behooves the profession to examine the admission of 
members to the faculty, and if possible, suggest some remedy, 
which if not sufficient to cure the disease, may at least serve 
to mitigate its more serious sequelae. 
The part assigned me in this report of your committee, 
will be best shown, in my judgment, by a brief review of the 
status of medical practitioners, in the past few hundred years, 
and of the laws enacted to insure a higher standard of qualifi- 
cation, and the results flowing from such enactments, and 
attempts to insure a greater proficiency on the part of those 
holding themselves out as medical practitioners. To older 
members of this society, and to those who have given the sub- 
ject some attention, this manner of treating the subject may 
be trite and common-place ; to others I hope it may not be 
without interest. 
The condition of medicine, prior to 1511, was so vague 
and uncertain, that when princes were sick, their privy 
council made choice of some one to attend them, “out of the 
many pretenders to the science of physick.” In the third 
year of the reign of Henry VIII, the King and Parliament 
restrained the practice of both pretenders and council, by the 
following act, which, as it shows the standing of medicine at 
that time, and the means thought best calculated to raise the 
standard of proficiency. I beg permission to present it in full. 
“ Forasmuch as the science and cunning of physic and surgery 
(to the perfect knowledge whereof, be requisite, both great learning 3 
and ripe experience), is daily within this realm exercised by a great 
multitude of ignorant persons, of whom the greater part have no 
manner of insight in the same, nor in any other kind of learning. 
Some, also, can no letters on the book so far forth, that common 
artificers, as smiths, weavers and women bold!}', and accustomably 
take upon them great cures, and things of great difficulty, in the 
which they partly use sorcery and witchcraft, partly apply such med- 
icines unto the disease, as be very noious, and nothing meet therefor, 
to the high displeasure of God, great infamy of the faculty, and 
grievous hurt, damage and destruction of many of the King’s liege 
people, most especially of them that cannot discern the uncunning from 
the cunning. Be it therefore, to the surety and comfort of all manner 
of people, by the authority of this present parliament enacted, that 
no person within the city of London, nor within seven miles of the 
same, take upon him to exercise or occupy as a physician or surgeon, 
except he be first examined, approved, and admitted by the bishop 
of London, or by the dean of St. Paul’s for the time being, calling 
to him or them, four doctors of physic, and for surgery, other expert 
persons in that faculty; and for the first examination, such as they 
shall think convenient, and afterwards alway four of them that have 
been so approved, upon the forfeiture, for every month that the}’ do 
occupy as physicians or surgeons, not admitted or examined after the 
tenour of this act, of five pounds, etc., etc.” 
This, I believe, was the last alliance of medicine with the 
priesthood. Prior to this, by command of Pope Benedict the 
Ninth, and Urban the Second, prelates, archdeacons and the 
superior clergy generally, were forbidden to practice any part 
of medicine, but with the exception of surgical operations, 
especially the use of the cautery or the knife, “the lower 
clergy, whose ignorance and vice were at this time, especially 
notorious,” could practice medicine, or any of the other sciences. 
So the statutes of Henry were an advance upon those of Ben- 
edict and Urban, and there is no doubt that the separating 
of the teaching from the licensing to practice, even if the 
examinations were supervised by a bishop, w’as attended by 
an advance in acquirement on the part of the proposed licen- 
tiate, especially if the bishop called to his assistance in such 4 
examination three or four doctors in physic or other expert 
persons in that faculty. 
Following this, the care and control of medicine, in all its 
branches, passed from the care of the Church to that of the 
Royal College of Physicians, the foundation of which was laid 
in 1518. To it was intrusted the care and obligations to 
enforce the existing statutes, and further by increased powers 
and privileges to not only suppress quackery, but to unite in 
one indissoluble body, all the faculty of medicine, i. e., medi- 
cine, surgery and pharmacy. 
These powers and privileges were confirmed and extended 
by other acts of parliament, particularly those of 14 and 15 
Henry VIII, C. 5, and 32 Henry VIII, C. 40, by which it was 
intrusted the future government of the profession of medicine 
“in all and every his members and parts.” 
By this surgery was made an important part of medicine, 
which was never denied, except by the Church. By it, the 
barber or the most ignorant of the clergy were surgery’s most 
proper practitioners. What course did the College of Physi- 
cians take? The precedents of the Church, and that of 
1 Edward IV, were re-echoed, and surgery was relegated to 
the Company of Barbers. This re-erection of the barrier 
between medicine and surgery, whereby it should be lawful 
to every person— 
“As well women as men, being the King’s subjects, having 
knowledge and experience of the nature of herbs, roots, and waters, 
or the operations of the same by speculation or practice, within any 
part of England, or within any other of the King's dominions, to 
practice, use and minister in and to any outward sore, uncome, 
wound, apostemation, outward swelling or disease, any herb or herbs, 
ointments, baths, pultess and emplaisters, according to their cun- 
ning, experience and knowledge in any of the diseases, or sores and 
maladies, beforesaid, and all others like to the same, or drinks for 
the stone, strangury or agues, without suit, vexation, trouble, pen- 
alty or loss of goods, statutes or ordinances to the contrary hereto- 
fore made in any wise, notwithstanding,” 5 
was a retrograde movement that retarded the advancement 
of medicine in all “his” parts till 1745, in which year it fell 
to the oversight and government of the Corporation of Sur- 
geons, and in 1800 to the Royal College of Surgeons. Had 
the Royal College of Physicians been true to its trust, medi- 
cine would have been advanced, as it doubtless was by the 
statutes of Henry. 
In 1703, apothecaries presuming to visit and prescribe for 
patients, the College of Physicians attempted to restrain such 
practice. C. IS. Rose v. College of Physicians. The case 
being argued three times in the court of Queen’s Bench, the 
judges were unanimously of opinion that the College of Physi- 
cians had such power. A writ of error to Parliament was 
brought to reverse this judgment, and it was reversed. ItMas 
argued, among other things, “that the physicians, by strain- 
ing an act made so long ago, endeavored to monopolize all 
manner of physic solely to themselves, and if they should suc- 
ceed in this attempt, it would be attended with many mis- 
chievous consequences; namely, it would be a heavy tax on 
the nobility and gentry, and would be a great oppression upon 
poor families, who, not being able to bear the charge of a fee, 
would be deprived of all kinds of assistance in their necessities.” 
This argument, as it relates at least to the poor, had no 
foundation in fact, as the several orders of the college were 
required to give their advice to the poor gratis ; nevertheless, 
Parliament held that apothecaries had the right to visit and 
prescribe, as well as to compound and sell the medicines 
they had prescribed. Thus a third body was formed, 
empowered to teach, examine and license. This resulting 
badly, an attempt was made to unite the corporations of the 
Colleges of and Surgeons and Society of Apothe- 
caries, by Act of Parliament, but the mutual jealousies of the 
several corporations defeated this. An act, regulating the 
practice of apothecaries, was passed, however, by which this 
corporation was authorized to examine and license one and the 
same individual to practice both medicine and pharmacy. 6 
Under such an arrangement as this there could not help but 
be an invasion of the physician’s office by some ignorant and 
uneducated persons. At present, I believe none of these 
corporations are authorized to examine in all branches of 
medicine, and yet for the most part medical practitioners must 
be general practitioners, and in the United States the teaching 
of medicine, surgery and pharmacy is very generally combined 
in a greater or less degree, and a diploma.to practice one 
confers the right to practice the others, at least; I believe none 
of our state laws forbid physicians manufacturing and com- 
pounding drugs. 
Herein I have tried to show some of the evils arising from 
power delegated to too many examining and licensing bodies, 
not the least among which was the falling of the office of the 
physician in the estimation of the public. What was and is 
true in Great Britain is still more true in the United States 
and Canada, in which there are some one hundred and twenty 
(including Bellevue College, Massachusetts, the sapiency of 
the courts having declared that it has done nothing but what 
the State had authorized it to do) bodies incorporated to teach, 
examine and license often the most illiterate and immoral. 
Who of this society does not know of persons filling the office 
of physician “legally,” whose notoriety is simply that of the 
abortionist. Individual members are powerless to prevent 
this. So long as legislators grant, with facility, charters, just 
so long will we be told, “the state has authorized this corpora- 
tion to issue degrees, and it has been done according to legal 
right. It cannot be argued that the issue is fraudulent, any 
more than an ‘allopath’ can claim that a homoeopathic college 
issues degrees fraudulently. The law makes the faculty of 
the college the sole judges of the eligibility of applicants for 
diplomas. There is no legal restriction, no legal requirement. 
If the faculty choose to issue degrees to incompetent persons, 
the laws of this state authorize it. This is not, therefore, a 
scheme to defraud under the statute.” Possibly it may not be 
“under the statute,” but it is a fraud, nevertheless, and none 7 
know it better than the courts which give such opinions ; yet 
such things are allowed to continue. 
In a town of less than three thousand inhabitants, in Cen- 
tral Illinois, is an establishment, whether chartered or not, I 
do not know, that proposed, after August, 1882, to annex a 
medical department, “which,” in the language of its circular, 
“will sustain every ‘special department’ ordinarily sustained 
in medical colleges, except that of the dissecting of human 
bodies. The whole of the modern science of medicine has 
been brought ‘ onto ’ the ground of a two years’ course of study. 
The special action and uses of the different medicines are most 
practically and carefully studied. Surgery and diseases of 
women are not of so much importance. Special attention is 
given to obstetrics. Any one wishing to make a specialty of 
any branch, will be accommodated.” So the announcement 
informs us. This is rather a large promise for so small a town. 
The State Board of Health has probably not as yet been pre- 
sented any of its “ deplomys,” but why should it not? Penn- 
sylvania and Massachusetts have had such schools, why should 
not Illinois ? Our legislators are quite as capable of judging 
of the country’s needs as were those of Pennsylvania and 
Massachutetts. 
Whatever the idea of the early medical colleges of this 
country was in regard to supplementing the teachings of the 
private instructor, the colleges now, in a great measure, 
assume to supersede such instruction, and for this purpose 
hold out grand inducements in the way of clinical study, con- 
nection with vast hospitals, etc. That this instruction is 
of no value, I do not desire to assert; but as to its value, the 
testimony of the majority of the profession will bear me out 
in the assertion that it is greatly over-rated, and that the facil- 
ities for it are paraded merely for the purpose of attracting 
students, many of whom imagine, before having experience of 
it, that it is the “Royal road to learning” medical. What 
well defined ideas can nine-tenths of the audience in an amphi- 
theatre, fix in their minds, and bring away with them as a 8 
part of their acquisitions, in respect to the different physical 
characteristics of cutaneous diseases, of the chancre of the 
chancroid, of the minutia of difficult and delicate surgical* 
and obstetrical operations? None whatever, so far as the clin- 
ical case is a factor, and this statement challenges denial. It 
is not one of the requirements of these clinical schools, that 
their students shall carry field glasses, and if they did the 
body of either surgeon, assistant or private student (for an 
additional fee to the advertised one), would form an insuper- 
able obstruction to a view of the nice details of the operation 
or diagnosis. Then the “ tactus eruditus,” the “bruit de 
diable,” and those other “bruits” “de claquement, de craque- 
ment, de frottement, ascending and descending, de pot fele,” 
etc., etc., the names of which sound so sonorously from the 
depths of the operating arena. 
A return to the normal function of the Medical College is 
of prime importance. The single oral examination, which is 
all, as a rule, that is exacted, is not sufficient to test the knowl- 
edge of those aspiring to the honors of the doctorate, but if it 
continues to be accepted as the test, then certainly an exami- 
nation conducted by a board that has no interest in the result, 
except the best interests of the profession, will be attended by 
many good results. With the rapid multiplication of medical 
schools, with the very lax and partial examinations now in 
vogue in many of them, the profession is made a by-word 
throughout the land. The most eminent in the profession, as 
witness a late historical case, are made the sport and object of 
criticism of all the medical ignorance of the world. Because 
a gun-shot wound, the necessary fatal character of which could 
only be told by a post-mortem examination, was not followed 
by a cure, their services were rated at but a trifle more than 
that of a simple nurse, and the entire profession subjected to 
insult. The degradation of the profession in its alliance, in 
former times, with the priest, with the barber and the corner 
grocery-man is more than paralleled to-day in its alliance, 
forced upon it nolens volens, with the patent and proprietary 9 
medicine vendor, whose wares are recommended in advertise- 
ments in our medical journals, through the certificates of men, 
high in some of our better medical schools, whereby it has 
come to be thought by the public, and by many men pretend: 
ing to be physicians, that the chief duty of the doctor is now 
to find the patient for the medicine, rather than by careful and 
conscientious examination into the condition of the patient 
to found a rational treatment in medicines best adapted to 
restore the patient to health. While “Rational medicine, 
based on experience and pathological research, demands abso- 
lute freedom in the selection and method of administration from 
the materia medica, and there is nothing in the Code of Ethics 
of the Amerian Medical Association, prohibiting the use by its 
members of any known and honorable means of combating 
disease, it does not permit the use of maltine, bromo-chlora- 
lum, viburnum compound, bromidia, iodia, hydroleine, lister- 
ine, healing ointments, liver pads, bilious pills and other like 
traps,” so largely used by many of our practicing physicians, 
under, it is to be regretted, the recommendation of some of 
the professors in our medical schools. Our licentiates should 
cease to be examined by such teachers. If it was not depart- 
ing from the text, our medical journals, teachers also, for good 
or for evil, might come in for some richly merited criticism 
for their advertisements and endorsements through editorial 
puffs of these for the most part worthless wares. The extent 
to which self-prescribing is carried on at the present day, can 
only be realized by one much in a large retail drug store. 
How seldom are we called in to see a patient, who has not 
from a few hours to several days been taking some panacea 
warranted in the so-called “Medical” almanacs, the columns 
of the secular and religious paper, to cure. Too often these 
lies have the apparent endorsement of the medical profession, 
through the endorsement of the half educated, or no educated 
“doctors,” whose only title to respect is in the diploma our 
horde of medical colleges are scattering over the land. Let 
the examination then of those seeking the honors of the doc- 10 
torate be removed from the functions of those who teach, and 
who receive the financial benefit of such successful examina- 
tion. Whether this is yet feasible, and how it may be accom- 
plished, I leave to the consideration of the other gentlemen of 
your committee.