Medical Education in Ireland

From Modern Ireland: Its Vital Questions, Secret Societies, and Government, 1868

By 'An Ulsterman'

The act of the Queen's University in conferring the degree of the Doctor of Medicine on a simple Bachelor of Arts, unversed in the science, is well fitted to direct attention to the subject of medical education. The history of the grant is a curious illustration of the interior workings of two Universities which claim to control the education of Ireland. The Bachelor of Arts in question was a graduate of the University of Dublin; and, by a natural transition, he passed into the Queen's University as a Professor. It happened, however, that the chair of Botany in the former institution became vacant, and he wished to become a candidate for it. Now, to teach Botany in what has been called the "National University," there are two qualifications indispensably necessary. In the first place, the professor must be a Protestant; in the second place, he must be a Doctor of Medicine. Neither of these conditions, one would imagine, could go far to make a man a perfect botanist. It seems otherwise, however, to the Dublin University, whose liberality is so frequently a theme of declamation on the part of its advocates. Fortunately the aspirant, in this instance, only lacked the second qualification, the degree in medicine; for none of the professors of Natural Science in the Queen's University is other than a Protestant. To obtain a degree causa honoris, it would be natural that the person desirous of it should apply to the University in which he was educated, where he graduated, and on which his celebrity (if any) reflected honor. More especially would this be the case when it was known that he only sought the degree in order to overcome a technical obstacle, and bring his distinction with him to the University as a member of its teaching body. Nothing of the kind, however, appears to have been thought of in the present instance; but rather the reverse of it has taken place.

Another University, which had secured the services of the gentleman concerned, gives him a degree causa honoris, in order to enable him to leave it, and to betake himself and his distinction to the institution in which he was educated, and which has not thought proper to move in the matter. The whole proceeding reminds one of the loyalty which, wishing to commemorate the visit of George IV. to Ireland, erected a monument on the spot from which he left the country. The result has been to place the Queen's University Senate in an awkward position. For the Chair in the University of Dublin was obtained by a Scottish botanist, and the Senate has now on its hands its professor, its degree, and its indignant medical graduates.

In the Senate which conferred the degree in question were three members of the medical profession; Sir Robert Kane, President of the Queen's College, from which the candidate wished to pass; Dr. Robert Adams, University Professor of Surgery in connection with the institution to which he wished to go; and Sir Dominic Corrigan, representative of the Queen's University in the general medical council of the United Kingdoms. We do not know how these gentlemen acted on the occasion; it may be that they did not yield without a struggle—that their desire to maintain a high professional standard, only gave way before the superior number of those whose zeal for keeping up a high standard of University degrees has been better expressed than understood. Sir D. Corrigan, consistently or not, took an early opportunity of expressing his dissatisfaction with existing arrangements so far as they affect medical education. In delivering the address on medicine before the British Medical Association, at its annual meeting held in Dublin last August, he drew to light some grave evils which tend to depress the standard of professional acquirement. Nine years have elapsed since the Medical Act came into existence, and he appears to have had the conviction forced upon him that the standard has been lowered rather than raised since then. For a century or two previous the Dublin University, the King and Queen's College of Physicians in Ireland, the Royal College of Surgeons in Ireland, and the Apothecaries' Hall in Ireland had all required from the candidate for their degree, diploma, or license, a preliminary knowledge of Greek. One of the first deeds of the Medical Council established by the Medical Act was to declare a knowledge of Greek unnecessary. Sir Dominic Corrigan states that as a compromise, after a long contest, he obtained that after 1869 it should be once more required. The same Council in the present year struck off the Science of Botany from the list of subjects for examination; and it is to be presumed they take no cognizance of Zoology. Moreover, the preliminary education of intending students is little cared for.

Eighteen bodies, scattered over the United Kingdoms, Canada, and Tasmania, are empowered to examine, in Arts and Science, candidates who wish to enter on the study of medicine. The several licensing bodies have no means of knowing how these preliminary examinations are conducted; and they are consequently ignorant of the general attainments of those on whom they confer degrees or licenses They do not always know in what subjects the candidate is examined, in however perfunctory a manner. Some time, for instance, had elapsed before it was discovered that certain bodies whose certificates were recognized did not make even Latin a necessary part of the examination. The consequence of such a system is that when tested by the independent examinations for the army and navy, a per centage of the candidates, "duly licensed practitioners" though they be, fail utterly in the preliminary examination, and are sometimes found unable to write even a prescription. These incapables are discovered only because they have to present themselves for another examination after that which gives them their license or diploma; but there are of course numbers who have no intention of entering the army or navy. Dispersed throughout the country in various capacities, the defects of their general education may not disqualify them from practice, but they are certain to degrade the profession in public estimation.

If the tests for preliminary education are so seriously defective, it can hardly be hoped that the system of professional education is free from grave defects As a matter of fact, it is painfully wanting. According to the same authority, there are in the United Kingdoms nineteen licensing bodies, conferring no fewer than thirty separate licences and fifty-three titles; and, as a consequence, we have a downward tendency of professional education. The opposition which is the soul of trade is sometimes the ruin of traders; here the hurt falls upon the purchasers, who are enticed from shop to shop by the promise of getting the article they require with the least amount of trouble and expense. Good students may present themselves for examination before strict examining bodies; but the indolent or incapable student will seek, and readily find, a licence to practice on easier terms. For this reason certain Scottish examinations used to be frequented by migrants after they had perhaps failed elsewhere. "The sad state of ignorance engendered by the downward competition," says Sir Dominic Corrigan, "has obliged the army and naval authorities to examine for themselves; for they cannot place reliance on the diplomas of our numerous licensing bodies, and could not, on the faith of the diplomas issued by them, entrust to their holders the lives of our soldiers and sailors. It appears to me that if our system be not altered, the civil authorities must ignore all our licensing bodies, and, like the army and naval authorities, institute an examination for themselves. I should deeply regret to see this, but to this I fear it must come, unless we bestir ourselves."

What chance there is of the Council, which assumes to guard the interests of the profession, bestirring itself in the matter may be gathered from its composition and acts. Its members are twenty-four, and these are either representatives of the licensing bodies or closely connected with them. We have seen how they are stated to have lowered the standard of the preliminary examination, and how they have removed Botany from amongst the subjects for examination. Their schemes for preserving the integrity of their own standard have been marked by a kindred want of vigour. First, they issued a set of "recommendations," which were followed or disregarded at will; and, as a consequence, there were criminations and recriminations in the Council, on the part of the representatives. Then they adopted the plan of "visitation of examinations," the preliminary as well as the professional. Considering that the former may be held at varying times and at places very far asunder, an effective visitation is hardly possible; whilst visitation of professional examination by members of the Medical Council would be a mockery. Each member is interested for his own licensing body; and an interchange of visitations would only, as has been remarked, be an interchange of courtesies. In the amended Bill which has been drawn up, an additional step is suggested which may perhaps to some persons appear a sign of progress.

The Medical Council desires to be empowered to register, without any examination, the holders of foreign diplomas, on satisfactory evidence being laid before it that a suitable curriculum has been pursued and an appropriate examination passed. For this it would have, generally speaking, to take the word of the foreign licensing bodies; and it has not succeeded so well with its home corporations as to induce disinterested people to enlarge its powers in this direction. Sir Dominic Corrigan has come into possession of proofs that at least four German Universities grant degrees in absentia, for cash down; but these Universities do not give the holders of such degrees licence to practice in the territories in which they themselves are situated. They, at all events, take care of their own people. Certain German Universities give what would at first sight seem to be an honest degree, since it is to be granted only after the candidate has passed a viva voce examination, but in fact is only a more specious delusion than the other. An applicant, residing in this country, found that in order to obtain it there was no need to present himself at the University. He was referred to one of its graduates living here, and informed that on passing his examination and paying £32 he would obtain the degree. There would be a considerable increase in this sort of traffic if the Bill of the Medical Council were to become law. It is to be noted also that America is not much behind Germany with respect to the grant of venal degrees.

A doctor of medicine of one of our own Universities, who acts as an agent for facilitating the purchase of degrees, writes thus in reply to an application: "After having had the pleasure of your note of the 6th inst." (July, 1867), "I write you in direct course. I stated in terms of my said letter that no university but that of the State of Pennsylvania gave degrees of Medical Doctor in absentia, the cost being £32. 12s., in full of all demands, and delivered free. I also stated in terms of my said note, that the University of Giessen, of Hesse Darmstadt, gave degrees of M.D. for £22 paid there, and £15 10s. sterling paid here, and also in full of all demands. In either case I will cheerfully assist you or your friend in attaining the object in view. As I have four new degrees to get at Pennsylvania next week, and other four at Giessen also, please send me £32. 12s. for the Pennsylvania degree, or £15. 10s. in part of the Giessen degree," &c. This letter was read before the Medical Association; and it was further certified that an agent of an American college in London was prepared with a variety of blank diplomas duly signed and sealed, which he was ready to dispose of for £20 each, with a discount off. They had one distinctive advantage, besides their lower price, over those already mentioned; they were antedated! Some were nine, some ten, and some fifteen years old on the face of them; and thus they would give their possessors the benefit of appearing to be experienced practitioners.

Whatever sympathy may have attended Sir Dominic Corrigan when he was denouncing these foreign practices, he did not carry all his hearers with him when he spoke of home imperfections. He was thought too severe. Nevertheless he had not unveiled all, nor the worst of the abuses that exist, even in the city in which he lives. There are proprietorial or joint-stock medical schools, just as there are joint-stock companies of other descriptions; and some of these sell their certificates as unblushingly as the foreign Universities in question sell their degrees. There have been cases in which strict schools and honorable professors have refused to grant a student who did not attend a certificate of having attended regularly; and nevertheless the student has been able to present himself for examination before a licensing body with all his certificates in due order. How has he been able to do this? He has simply stepped over to another school, where he had previously attended no lecture, and has there paid his money and obtained his certificate of regular attendance on lectures, duly signed and antedated.

There have even been cases in which the student never attended a lecture in the city, never perhaps visited it, and yet has been able to obtain what certificates he required on simply remitting his money. Of course, the existence of only one such school in a city would be enough to make the others more lax; for if they were to require exact attendance, their classes might desert. This is a serious state of things to be permitted to exist in connection with an honorable profession, and on the part of teachers of youth. What idea of honour, or even of common honesty, can students be expected to retain when they see such a system flourishing before them, and regarded as a matter of course? Sir Dominic Corrigan hopes to effect the reforms he desires by a change in the Medical Council so as to make it a representative of the profession at large, as well as of the licensing bodies. He would empower it, subject to the approbation of the Secretary of State, to lay down a code of regulations, both as to preliminary and professional examinations, and order that all graduates and holders of licences and degrees from the several corporate bodies should be subject to examination before being permitted to hold any public appointment supported wholly or in part by public grant. He would exempt graduates in arts from the preliminary examination, but would not give the Central Council power to enact any code of education. The several licensing bodies would have full power to suit education to the circumstances of each division of the kingdom.

This is very fair to the licensing bodies; but is it fair to the student? A young man spends three or four of the best years of his life under a vicious system; he has to pay, perhaps, more money than he can well afford; and, as the end of all, he becomes the possessor of a worthless degree. He finds himself excluded from all public appointments; he must lose more time and more money; and, after having been mulcted for one degree, he must submit to be mulcted for another. As there is no curriculum laid down, nor even recommended, the student has nothing to guide him in his studies, and may be discovered perhaps attending lectures on surgery or medicine before he knows anatomy, or attending discourses on Materia Medica before he has the slightest comprehension of Chemistry and Botany. This absence of system makes him regard the sciences as unintelligible, and throws him completely into the hands of tutors by whom he is taught to get by rote what disconnected information he can. Useful additions to a systematic course, these assistants thus become an abuse; but if they are proprietorially connected with the school or licensing body, it is natural to suppose that they will not sacrifice their own interests to those of the student. It is for the State, however, to take care that the standard of medical education is kept up, and to see that its sanction is not given to anything which savours of obtaining money under false pretences. Venal certificates and worthless degrees are of this nature; and the fact of their existence demands an enquiry into the condition of medical education not in Ireland merely, but in the whole of the United Kingdoms.