REPORT OF A COMMITTEE OF THE MEDICAL SOCIETY OF THE STATE OF NEW YORK, ON THE SUBJECT OF MEDICAL EDUCATION, ALBANY: PRINTED BY J. MUNSELL, 58 STATE STREET. 1840. [By order of the Society, 1000 extra copies of this re- port have been published, for distribution among the Coun- ty Medical Societies.] REPORT. [On the 7th of February, 1839, the following resolution, on the motion of Dr. Goodrich, delegate to the Society from the Medical Society of the county of Rensselaer, was adopted. Resolved, That the subject matter of the resolutions of the majority of the Committee of which Dr. Manley was Chairman, together with the resolutions reported by the Committee of which Dr. Rogers was Chairman, be referred to a Select Committee, and that they be required to give the whole subject of medical education in this state a thorough investigation, and report to this society at its next an- nual meeting. Drs. Manley, Beck, and McCall were appointed the Com- mittee.] The Committee appointed in February last to report at the present meeting of the Society, on the subject of Medical Education, with directions to give the same " a thorough investigation," beg leave to present the following &EBORT : The first colonial assembly of the province of New-York met in the year 1683, and probably regularly thereafter continued their annual sessions. It was not, however, un- til 1760, that the subject of the due regulation of the medi- cal profession attracted their attention. In June of that year, an act was passed, entitled " an act to regulate the practice of Physic and Surgery in the city of New- York." Its preamble gives the following exposition of the condition of the profession. " Whereas many ignoran t and " unskilful persons in Physic and Surgery in order to gain " subsistence, do take upon themselves to administer phy- "sick, and practice surgery in the city of New-York, to the " endangering of the lives and limbs of their patients ; and « many poor and ignorant persons who have been persuaded tf to become their patients, haye been great sufferers there- 4 by"-----. It was therefore enacted, that after the publica- tion of this act, no person whatsoever should practise as a physician or surgeon in the city of New-York, before he had been first examined in physic and surgery, and approved of and admitted by one of his majesty's council, the judges of the supreme court, the attorney general, and the mayor, for the time being, or by any three of them, taking to their assistance, for such examination, such person or persons as they in their discretion shall think Jit. If the candidate be approved, the examiners were directed to give him a cer- tificate to that effect; and this certificate gave him the pri- vilege to practise physic, or surgery, or both, throughout the province of New-York. A penalty of five pounds, with costs, was provided against any person practising without the above testimonials. Useful as the above law undoubtedly proved in its gene- ral operation, the Committee cannot proceed without first calling the attention of the Society to the precedent estab- lished by it, that persons not belonging to the profession were constituted judges of the qualifications of those solicit- ing a license. The high officers named in the law were indeed authorised to take other persons to assist them in the examination, but it was left to their discretion. It will be presently seen that the influence of this provision con- tinued through a series of years. After the revolution, the first act to regulate the medical profession was passed as late as March, 1792. In its ope- ration it was confined, like the one of 1760, to the city and county of New-York. Its preamble also gives a similar melancholy picture of the state of medical practice, « Ma- "ny ignorant and unskilful persons presume to practise » Physic and Surgery within the city and county of New- " York, to the detriment and hazard of the lives and limb* "of the citizens thereof." The requisitions of this law are of a higher cast than those of its predecessor. They re- quire, 1. Studying with a reputable physician for the term 5 of two years, if the individual has graduated at some col- lege in the United States; or, three years if he has not. 2. An examination before the governor, chancellor, the judges of the supreme court, the attorney general, the may- or and recorder of the city of New-York, or any two of them, who are to take to their assistance, any three respect- able practitioners, with whom the examined person has not lived. The certificate of this board constituted the li- cense to practise; and no individual without these testimo- nials, was allowed to have a legal demand for his services. The law, however, declares that its provisions are not to affect those already in practice, nor to prevent physicians from neighboring states or counties being called in consult- ation ; nor, finally, to affect those who have regularly re- ceived the degree of Doctor of Medicine. We come next to a law whose provisions were binding throughout the state. This was doubtless rendered neces- sary by the increase of the population and the wants of the community. On the 23d of March, 1797, the first general act was passed to regulate the practice of Physic and Sur- gery in the state of New-York. The first section is retrospective, and examines into the right of individuals to assume the title of physicians. It ordains, that from and after the 1st of October, 1797, no person tioia practising physic or surgery, or both, shall be allowed to continue to do so, unless he shall have produced satisfactory evidence to one or others of the officers men- tioned in the previous act, that he has practised physic and surgery for the terms of two years next preceding the day aforesaid^ or shall in a similar manner exhibit evidence of having studied medicine for the term of two years. Either of the magistrates mentioned above, was authorised to grant him a certificate ; and this was to constitute his license, as he is directed to file it in the office of the clerk of the coun- ty where he resides ; and the penalty for practising with- out such a filed certificate wns declared to be twenty-five dollars. 6 The second section relates to the student: After the same date as above, he was not allowed to practise, unless he exhibited to either of the above magistrates, a certificate from one or more respectable physicians or surgeons, with whom he had served his apprenticeship, stating that he had studied the profession for the term of four years, and that he was well qualified. The persons signing the certificate were to make oath to the same, and the magistrate was then to endorse on it, a permit allowing the individual to practise. This was also to be filed in the clerk's office. Graduates of literary colleges were, however, allowed to complete their term of study within three years; and again all those who had received the degree of Bachelor of Me- dicine, or Doctor of Medicine, from a medical institution, (there were then only three medical institutions, Philadel- phia, Columbia College, and Harvard,) were allowed to practise, on filing their diplomas. One or two clauses were also added, directing the mode of proceeding, in case the physician signing the certificate was dead, or non resident. Proof was in such instances to be taken, and if it satisfied the magistrate, he was authorised to give the necessary permit. As the operation of this law was co-extensive with the state, the act of 1792, was repealed. Certainly these provisions reflect much honor on their framers. The Committee are not aware whether the law in question met with opposition in its passage, but judging from the course of subsequent legislation, it is highly pro- bable that it did. And this circumstance ought to be taken into account in scrutinizing any enactments of this descrip- tion. There are always individuals in every legislature, who seem to desire to lower, or at least keep down all ef- forts at, improvement, and profess themselves satisfied that things shall remain as they are. Such persons readily be- come violent opponents of a law like the present, which aimed at gradually elevating the medical character. 7 There were, however, serious defects in the acts now no- ticed. Although it dealt leniently with those already in practice, and enabled them to continue in the profession on merely shewing that they had been in practice for two years preceding, yet as it concerned the student, there was a seri- ous omission. He was enabled to commence practice on the certificate of his preceptor, and no examination was re- quired. In this respect then, the law in question was not so useful as the previous one. We are now, however, approaching the period when the profession were to become the sole judges of the qualifica- tions of those who desired to become its members. There was to be an end to the supervision of the legal profession, who in the form of examiners, or judges of certificates, had for nearly half a century held a decided superiority over their less distinguished brethren. In 1806, a law was passed to incorporate medical socie- ties, for the purpose of regidating the practice of Physic and ISnrgery. As this act, although somewhat altered or amended subsequently, is the basis of our present medical code, its provisions require a brief consideration. It directs that the physicians and surgeons in the several counties of this state, now authorised to practise, shall meet on the first Tuesday of the ensuing July, and then if their number be not less than five, form themselves into a medical society. These societies were again, by dele- gates, to constitute a state medical society, which was to meet annually at the capitol of the state. Each of these corporate bodies was authorised to ap- point censors, whose duty it was to examine all students presenting themselves. These censors were thus constitut- ed the sole power from which licences to practise could -be obtained; and the law declared, that all who attempted to practise without such license or a proper diploma, should be disqualified from collecting debts on that account. The student was to exhibit testimonials of having studied medi- 8 cine for the term of three years before the censors were permitted to commence the examination; but always pro- ceeding on the principle of improving the profession in fu- ture, and not pressing too hard on the peculiar situation of those now in practice or preparing, the law also allow- ed such as had commenced their studies prior to the 1st of January 1805, to study four years, and then to be licensed according to the law of 1797, that is, without examination. The last law was declared to be repealed on the 1st of September, 1806, at which time the present act was to go into operation. The history of the origin and successful passage of this law has been given by Dr. John Stearns in the New York Medical and Physical Journal, (Vol. 7, p. 380). The first movements in its favor originated in the county of Sarato- ga, of which that gentleman was then a resident; and there is no doubt but that he was its principal and most ef- ficient friend. The medical gentlemen of Saratoga inter- ested their professional brethren in the adjoining counties of Washington and Montgomery, to unite in the undertak- ing, and the proposed plan of improvement was thus brought before the Legislature. Fortunately Dr. Alexan- der Sheldon of Montgomery, one of the committee appoint- ed to prosecute the application, was this year (1806) chos- en speaker of the Assembly. The bill in its progress met with the most powerful opposition. Dr. Stearns observes that « the danger to which the tranquility of the state " would be exposed by the incorporation of forty distinct " associations of physicians, was so magnified by the oppo- " sition, and the impression thereby made on the house was « so great, that but feeble hopes were entertained of its suc- "cess. At this critical juncture, when a decisive vote "against the bill was every moment expected to be taken "the late honorable William W. Van Ness rose its most el- oquent and powerful advocate. And perhaps (adds Dr. « Stearns) the pre-eminent powers of his parliamentary elo- 9 " quence were never exerted with better effect. He refuted " the arguments of the opposition, portrayed the benefits to " the profession and to the public in such glowing colors, " and with so much energy and zeal, that the opposition be- " came feeble, the friends of the bill increased, and from "that moment the successful issue was rendered certain. " To his memory do the profession owe a monument of " marble, with their gratitude deeply engraven upon its " tablet." "On the first Tuesday of July. 1S06, three months after " the passage of the law, about twenty societies were organ- " ized, pursuant to its provisions ; and within two years, "scarcely a county in the state, of any considerable popula- tion, was without a duly organized medical society." The great and striking feature of this law as it respects medical education, was its requisition of an examination by practitioners, before the student was allowed to become a member of the profession. Various amendments to this law were from time to time found necessary. In April, 1807, an act was passed which contains several clauses, regulating the internal organiza- tion of the medical society of the state. It then ordains that the penalty for practising without being authorised ac- cording to the act of 1806, should be jive dollars per month. This, however, was not to prevent a person from using or ap- plying for the benefit of the sick, any roots or herbs, the growth of the United States. In March 1809, it was enacted that the degree of Doctor of Medicine granted by the re- gents of the university should allow the person obtaining it, to practise physic and surgery, any law to the contrary not- withstanding. Again in May 1812, the penalty for practis- ing without license was increased to twenty-jive doldars for each offence ; and licenses are also directed to be deposit- ed in future in the county clerk's office. On the revision of the laws in 1813, the above acts of 1S06, 1S07, 1809 and 1812, were consolidated with the ex- 2 10 ception of those provisions which had become obsolete or nugatory. Accordingly, the revised law of April 10, 1813, is the authority to which physicians were to refer in all disputed cases connected with this subject. This law will be found in the appendix (p. 21) to the 1st vol. of the Trans- actions of the Medical Society of the State of New-York. In 1818 the legislature superadded to the requisites alrea- dy in force, some additional ones. By the act of 1813 the student was required to study medicine three years, and at the end of that time submit to an examination. By the present act it was declared that from and after the 1st of May, 1821, he should study four years, with however, the following exceptions : One year might be deducted from the above, provided he had attended to classical studies for that period after the age of sixteen ; and again, " atlend- "ance on a complete course of lectures delivered by each " of the professors, on all the branches of medical science " in either of the medical colleges or institutions of this " state or elsewhere," might be accepted in lieu of one year's study. The examinations were to be continued, but no person was to be licensed, unless he had arrived at the age of twenty-one years.* •In the law of 1818, also appears the first enactment as to filing certifi- cates of the commencement of the term of study. As this however with all the provisions concerning it, and some concerning examinations were incorporated into the " General Regulations," we postpone the mention of them. So also in strict chronological order, it would be proper to state, that the following constitutes the second section of "an act further to amend "the act to incorporate medical societies for the purpose of regulating "the practice of physic and surgery in this state," passed April 13° 1819. " That no'college of physicians and surgeons in this state shall confer'a "diploma for the degree of Doctor of Medicine upon any student until such "stu*denfshall have fully complied with the requisitions contained in the "first section of the act entitled an act to amend an act to incorporate me- "dical societies, &c. passed April 20, 1818; and shall also in addition " thereto, have attended one complete course of lectures delivered by each » of the professors of such college."-Session Laws, 1819, p. 308. This also in* less ambiguous form is incorporated into the "General Regulations.' 11 It was made a question by some, after the passage of this act, whether cases might not arise in which students could justly claim according to the above, a deduction of two years' study; having, for example, attended to classical studies for one year after' the age of sixteen, and also at- tended a full course of medical lectures. The Committee, however, are not aware that any such claim was ever set up. It was provided for by the enactments of 1827. These are to be found in our present Revised Statutes, under the title of " General Regulations concerning the practice of Physic and Surgery in this state." (Appendix, p. 17 of 1st vol. Transactions State Medical Society) As the ordinances contained in them are with some few alterations (which we shall specify) now in force, and in conjunction with the act to incorporate medical societies, constitute the Statute Law on the subject of medical education, we shall briefly ana- lyze their contents. 1. As to a license to practice Physic and Surgery, it is ordained, (Sections 8, 9, 10, 11, 13,14,15,19,) that no stu- dent shall be admitted to an examination by any medical society, until he shall have completed with some physician and surgeon, duly authorised by law to practise his profes- sion, the term of medical study. And this term is defined as follows : It shall be four years, but a deduction in no case to exceed one year, may be made from it in either of the following cases—(a) if the student after the age of six- teen shall have pursued any of the studies usual in the col- leges of this state, the period during which he shall have pursued such studies shall be deducted, (b) If the student after the age of sixteen shall have attended a complete course of all the lectures delivered in an incorporated me- dical college in this state or elsewhere, one year shall be deducted. In order to fix a time from which the com- mencement of a student's term of study should be dated, his preceptor is directed to file a certificate with the Presi- dent of the county medical society, statingthe date in ques- 12 tion, and from that period it shall be deemed to commence; and if there are any deductions to be made agreeably to the above provisions, they are also to be stated ; and the Presi- dent is then directed to annex an order to the certificate, setting forth how long the term of study is to be. The stu- dent is always to be examined before the county medical society of the county in which he has pursued medical studies for four months immediately preceding his exami- nation. But if the student had attended a course of lectures in either of the medical colleges of the state, (then New- York and Fairfield) he might be examined and licensed either by the medical society of the county in which such college is situated, or by that of the county in which he shall have resided previous to such attendance. This last clause was repealed by an act passed May 26th, 1836, and it was then ordained that no student who has attended one or more courses of medical lectures, shall be admitted to an examination by any medical society, except of the coun- ty in which he shall have pursued his medical studies for four months immediately preceding his attendance upon his last course of lectures, or by the censors of the state medical society. The right of appeal to the state medical society, in case a student is rejected by a county society, is given—but he cannot apply to the censors of any other county medical society ; and if a student is rejected either on an original examination or an appeal, by the censors of the State. Medical Society, he cannot be admitted to an ex- amination by any county society. Lastly, a copy of the li- cense granted to the student by either of the above socie- ties, as the case may be, is to be deposited in the office of the clerk of the county in which he resides, and who is re- quired to file the same ; and until such license is so depo- sited, the individual attempting to practise shall be liable to the same penalties as if he had no license. 2. As to the degree of Doctor of Medicine. This de- gree, as already stated was, when conferred by the regents 13 of the university, made a license to practise, by the law of March, 1807. The limitations to this power, of the re- gents are given in sect. 12, of the regulations. " No person " shall receive from the regents of the university a diploma " conferring the degree of Doctor of Medicine, unless he " shall have pursued the study of medical science for at least " three years after the age of sixteen, with some physician " and surgeon duly authorised by law to practise his profes- " sion, and shall also have attended two complete courses "of all the lectures delivered in an incorporated medical " college, and have attended the last of such courses, in the " college by which he shall be recommended for his de- " gree." Lastly, sect. 20, is in the following words : No person under the age of twenty-one years shall be entitled to practise physic and surgery in this state. After these enactments there do not appear to have been any laws passed, bearing on medical education, until 1835. The medical faculty of Geneva college were, by an act on the 27th of March, of that year, recognized as a medical school, and the trustees of that institution were empowered on their recommendation, to grant the degree of Doctor of Medicine to students qualified in the same manner as those on whom the regents could confer the degree. This de- gree was declared a license to practise physic and surgery in this state. On the 11th of February, 1837, the university of the ci- ty of New York, was authorised by law to establish a me- dical faculty, and its degrees limited also as above, were al- so declared licenses to practise. Lastly, on the 16th of February, 1839, the Albany Medical College was incorpo- rated, with similar powers and privileges as the two institu- tions just named. Such are the statutory provisions now in force in this state on the subject of medical education. It remains to 14 inquire whether they are susceptible of improvement; and in doing this it will tend much to simplify the subject, if we notice the various requisites separately. 1. Preliminary Education.—The only inducement held out to the student of medicine, in order to acquire a proper preliminary education, is this : If he when above the aa-e of sixteen, has attended to the studies usually pur- sued in our colleges, for the space of a year, that space of time may be deducted from his four years' term of study. But in the same section, the same deduction is allowed if he has attended a full course of lectures ; and it is express- ly ordained that in no case shall the deduction exceed one year. Thus it is no matter whether the student has ful- filled both demands or only a single one, as to his time. The Committee do not complain of this ; the time of study is not by any means too long. It should rather with refer- ence to the above requisitions be lengthened. Let us for a moment ascertain what is the amount of preliminary education required in the other liberal profes- sions. Among the Clergy, we know that there is no sta- tute law, but in each denomination its internal regulations are of binding force. Now it is well understood that in most of these no student is admitted to the study of Theo- logy, unless he has completed a collegiate education, or in lieu thereof undergoes an examination on the studies usu- ally pursued in such institutions. The exceptions to this are not sufficient to invalidate the general rule, and we know that those religious sects which have been the latest in pursuing the study of the higher branches of learning, are now making up for their lost time by the rapid and wide establishment of colleges and academies under their own direction. It cannot then be denied but that the cler- gy are educated men, and that the regulations of their ec- clesiastical bodies act on the students with the force of law —requiring of them four years of preliminary preparation before they enter on the study of theology. 15 How is it with the legal profession? Here the chancellor, and the judges of the supreme court have the power given them by law to prescribe the course of study. The requi- sites are identical in both courts, and as those of the su- preme court are the most minute, we shall give them in de- tail, particularly as we shall need to refer to them on oth- er points. " No person shall be permitted to practise as an attorney or counsellor of this court, without a regular admission and license ; and in order to obtain such admission and license he must be examined under the direction of this court. No person shall be admitted to an examination as an attorney, unless he shall have served a regular clerkship of seven years in the office of a practising attorney of this court; but if he has regularly pursued classical studies for four years, or any shorter period after the age of fourteen, it may be allowed in lieu of an equal time of clerkship. The extent of such allowance, must at the commencement of the clerkship be ascertained and settled by one of the clerks of the court by an order to be signed by him. The evidence of such classical studies shall be, 1. a di- ploma conferring the degree of Bachelor of Arts by some incorporated college, or a certificate of the President of said college. 2. If neither can be produced, an affidavit of the teacher or teachers with whom the student has pursued his studies, stating the time spent and the studies pursued, with a specification of the books used, or 3. if the teacher be dead or absent from the country, so that his affidavit cannot be obtained, then the affidavit of the student himself stating such death or absence, and also the time spent with his teacher or teachers, and the books studied by him under each teacher. When the person applying for an order to allow classical studies has no diploma or certificate, an affi- davit shall also be produced, stating the qualifications of % the teacher or teachers. Time spent in classical study without the aid of a com- 16 petent teacher, or time spent in those studies which are taught in common schools, and compose an ordinary Eng- lish education, including English grammar, arithmetic and geography, will not be allowed. And in every case it must be shewn by affidavit, that the studies were pursued after the person applying attained the age of fourteen years. The clerk shall file in his office the papers on which the application is founded, unless it be founded on a diploma. In such case he shall state, in his order of allowance, that such diploma was produced to him. It shall be the duty of the attorney with whom the clerk- ship shall be commenced, to file a certificate in the office of one of the clerks of this court, certifying that the person has commenced a clerkship with him; and if an order has been obtained, as above mentioned, allowing a shorter term than seven years for such clerkship, the same shall be filed with such certificate, and the clerkship shall be deemed to to have commenced on the day of the filing of the certi- ficate." Lastly, " It shall also be the duty of the attorney to give to a clerk, when he shall leave his office, a certificate stat- ing his moral character, the term of clerkship which he has passed with him, and the periods which have been allowed him for vacations; it being understood that not more than three months shall be allowed for vacations in any year." (Rules and orders of the Supreme Court of the State of New-York, January term, 1S37.) Can any reason be assigned why the requisites for enter- ing on the study of medicine should be so decidedly less than those of the other professions? A knowledo-e of the learned languages is certainly quite as important. They furnish in a great degree the nomenclature of our medi- cal works. These are filled with words derived from the Latin and Greek—words which when understood become the representatives of ideas that require long and copious definitions in English. Again, would it not be a great ad- 17 vantage to the pupil to acquire early a knowledge of the elements of Chemistry ? This study enters even into our system of academical education ; and the boy at fourteen or fifteen often knows more of it than the student at eighteen, commencing his studies. But above all, provi- sion should be made for the acquisition of the English lan- guage, so that it can be written with accuracy and fluency. Certainly the importance of a well educated profession cannot be too highly appreciated. A late French traveller has styled the Legal profession the aristocracy of this coun- try. It is undoubtedly the direct avenue to office and power. But although the law may have some advantages peculiar to itself, yet the main cause of its exaltation unquestiona- bly is, that its members are obliged to be far better edu- cated than a vast majority of the community. If these views are correct, should we not make an effort at assimilating our profession to the others ? The desired object may be readily attained by requiring the study of medicine to be determined upon at the age, say of sixteen, and allowing two years of this to be devoted to classical studies, or the higher branches of English studies equiva- lent to them. And in order that no complaint of surprise may be made, let it be enacted that the requisition shall not go into effect until the 1st of May, 1842 ; so that all who are about commencing the study may have due notice. 2. Age.—On this point the law is precise. No person can practise physic and surgery until he has arrived at the age of twenty-one; and it thus affects all, whether they receive licenses or diplomas. If the enactment be proper, and none will deny this, then it ought to be strictly en- forced. And the only question is, how the age of the in- dividual is to be ascertained. In cases where an applicant is known personally, as for example, when examined be- fore a county medical society, there is little danger of de- ception in this respect. But when the candidate presents himself before the censors of the State Medical Society, or 3 18 befor* any of the medical colleges, the fact has frequently to be learnt either from the statement of the individual himself, or the certificate of his relatives or preceptor. In either case fraud may be committed, not frequently per- haps, but it is charged to have been done. Apart from the immorality of such conduct, young men can scarcely be aware how little is gained by entering too early on the practice of the profession. No one ever regretted that he waited even years beyond his majority. Many have abun- dant cause of sorrow that they commenced too soon. But if the present mode of proof be too loose—if it is not uniform—if it allows of collusion, certainly regulations can be made to obviate this, and none appears preferable to re- quiring an affidavit either from the individual applying, or from his parents, or his preceptor, stating that he has at- tained the necessary age. This is demanded from the stu- dent himself, when entering on the profession of law, and certainly therefore cannot bo complained of, when extend- ed to our own. 3. Term of Study.—Here also the law is precise, and its directions specific. The physician with whom a stu- dent commences his study shall file a certificate to that ef- fect with the president of the county medical society—the president at the same time making the necessary deduction for time if required—and the term of study commences from the day of filing. Now if the teacher complies with this requisition, no difficulty can occur as to the com- mencement of the period of study. But in 1828, a case came up before the legislature, in which this had been ne- glected, and the student having studied his full term, pray- ed for relief. The committee of the senate, to whom the subject was referred, were of opinion that the omission should not deprive the student of his right to an examina- tion ; and they intimate that an affidavit stating the neglect, and that notwithstanding the other requirements of the law have teen complied with, would be sufficient. (Trans- actions vol. 1, Appendix, p. 37). 19 This construction has been readily adopted, and the consequence, it is believed, is a laxity in filing certificates. There are indeed several objections to the course now pur- sued. The president may reside in a remote part of the county—frequently he does not hold the office for more than a year, and possibly he may not be very careful in transferring1 these certificates to his successor : Would it not be preferable to have these certificates authenticated by the county clerk in each instance, and then filed in his of- fice ? Public and private convenience would thus doubt- less be promoted ; and as the county town is always much frequented, no difficulty or delay can occur in procuring copies. Having arranged as to the commencement of the term of study, the fact of its proper completion can readily be ascertained by a compliance with a resolution of this Society, passed February 3d, 1836, in the following words : Resolved, That no medical student shall be received for examination by the censors of the state or county medical societies, until he shall have furnished certificates of hav- ing studied the full time prescribed by law, authenticated by the affidavit of his preceptor or preceptors, or in its ab- sence, by his own affidavit. 4. Attendance on a course of Lectures.—At the date last named, the State Medical Society also passed the following resolution: Resolved, That when a student has attended lectures he furnish a certificate from the college in which he has at- tended, that he has attended a full course, or if not a full course, the extent of his attendance; and that his attend- ance has been regular, and his conduct and character as a student proper and respectable. (Transactions, vol. 3d, Appendix, p. 12.) The exhibition of this certificate should be required by the censors of both the state and the county medical socie- ties, and it is to be hoped that all our medical colleges in this state will bestow such certificates on their students at 20 the conclusion of each term. They answer a most useful purpose—promoting correctness of conduct and securing a regular attendance on the lectures. Every inducement that we can thus hold out to industry and morality will re- dound to the welfare of the profession. 5. Examination and Admission to Practice.— There are, we believe, 58 counties in the state. In up- wards of forty, and probably nearly fifty of these, there are medical societies, each having boards of censors. There are four boards of censors attached to the State Medical So- ciety, and four medical colleges with their professors au- thorised to examine. Thus there are at the very least, fif- ty bodies of men in the state authorised to permit an indi- vidual to practise physic and surgery. It will not be denied but that some diversity must exist in the character of the examinations, as tests of the qualifications of applicants, and such an opinion has led to many propositions for a change. The one that has most frequently been broached in this society, is that of taking away the power of licensing from county censors, and giving it exclusively to the state censors. There are several objections to such a proceed- ing. It may justly be apprehended that it would lead to the dissolution of many county medical societies, and thus gradually tend to the destruction of that system which, on the whole, has been of great benefit to the profession. Se- veral of the societies promote the cause of medical knowl- edge, by appropriating the avails from examinations to the purchase of a library ; and others use it for the unavoida- ble contingent expenses. But it is hardly necessary to dis- cuss this point, as the Committee have reason to believe that the plan in question would meet with opposition quite sufficient to insure its rejection. They will, however, sug- gest as a substitute, the formation of district medical socie- ties, corresponding in geographical extent to the existing senatorial districts. If a large board of censors were ap° pointed for each of these, and required to meet, say quar- 21 terly, at different places within the district for the examina- tion of students, and if together with this, provision be made for dividing the examination fees among the county medi- cal societies within the district, probably the mode of exa- mining would be as unexceptionable as we can expect to make it. In order to satisfy any further objections, the elec- tion of censors might be committed to the physicians resid- ing within the district, or to the nomination of the county societies. And should such a plan ever go into effect, it might be well to annex the provision now in force with the board of examiners in Upper Canada, viz : that every censor absent from his post at the appointed time, shall pay a fine. The examination of students for the degree of Doctor of Medicine is a still more vexed point. It is a matter of re- gret that so many young men at the entrance of their pro- fessional life, are pressing for this distinction. The expe- rience of many has shewn the value of practising for a few years with a license, and then returning with a store of self-acquired knowledge for the degree. But regret is all we can offer; it is in a measure caused by the rapid in- crease of our medical schools, but above all is it owing to our national characteristics. The go-ahead system enters into all the occupations of life, and the young man in and out of the professions is not satisfied until he has got as high at least as his neighbor. But in view of the degree becoming depreciated by the rapid establishment of new medical schools, it may well become a question deserving serious consideration, wheth- er at no distant period, the right of teaching and licensing should not be disjoined. In London, this experiment is now in progress; at the University of London, students from the University College, and King's College medical schools, from the London Hospital schools, and from seve- ral of the provincial medical colleges, are examined by per- sons appointed by the university; and this university has 22 the power given to it by government of granting degrees ; and this to the exclusion of the above teaching bodies. Time will show whether the result will be more beneficial than the old plan. An incidental difficulty to the adoption of this sugges- tion is the fact that we are surrounded by institutions in other states, who might or might not follow it, and thus our students might be induced to desert our own colleges. This, however, will be of little importance if the increase of medical schools for the next five years should correspond to those just elapsed. In concluding this review of the subject of medical edu- cation, the Committee are far from expecting that all or most of'their ideas will meet with the general approbation of the society. They submit them for consideration, for reflection, for discussion. And they may at least be par- doned in the conclusion for a single remark; it is this: Before any alteration in the laws be applied for by this so- ciety, let it be well understood, that a majority of the pro- fession acquiesce in its propriety. And when once we are satisfied of this, let us not be deterred by the usual cant of legislative opposition to a regular medical profession, from requiring its passage. This can at any time be effected by proper explanations to the members of both houses be- fore they leave their homes ; and it is in this way alone, that real improvements can be introduced. True there will always be some who are opposed to any thing that looks like improving other professions—some antipodes of a William Van Ness or a De Witt Clinton—some dema- gogue who comes into the house a flaming patriot, and leaves it a bank attorney. Such men have an instinctive dislike to the increase of knowledge and moral power in the medical profession. But if we ask only for what is right, and what can be shown will conduce, to the o-eneral good, we need not fear the event.