Scotland in the nineteenth century

5. Education

Section 5.3: Medicine

The object of the inquiry was to try and find what facilities for study were available to medical students and members of the medical profession. The inquiry asked for information on medical museums, how they were managed, what was the size and nature of the collection and was it catalogued; if there were medical libraries or botanic gardens attached to the institution; and what lectures were given, and to whom they were available.

Scottish reports (pp. 20-53).

"The Select Committee to whom the Medical Act, 1858 Amendment (no. 3) Bill (Lords), the Medical Act Amendment Bill, the Medical Appointments Qualifications Bill, and the Medical Act, 1858 Amendment (no. 2) Bill were referred have agreed to the following special report":-

There were 19 examining bodies in medicine, and it was agreed that this was far too many. Discussion centred around the desirability or otherwise of one conjoint board to examine all doctors before they were admitted to the Medical Register. The Scottish universities were against this, and they claimed that their standards were higher than those in England and their students should, therefore, not be put to the trouble and expense of undertaking an additional test.

The opposing point of view was expressed by doctors from England and members of the Medical Council who pointed out the dangers to the profession of the existence of many methods of entrance. They believed that a "one portal" system consisting of one conjoint board examination to be taken by all was preferable. Scottish opposition to the "one portal" system was, in fact, rooted in the rivalry which existed between those Scottish universities which taught medicine, and the corporations, e.g. Royal College of Physicians and Surgeons of Glasgow, who also taught medicine and were recognised examining bodies. Both groups believed that they offered the superior qualifications and both feared loss of status as an examining board under new legislation.

Scottish evidence

Professor William Turner, Professor of Anatomy, and Dean of the Faculty of Medicine in the University of Edinburgh (pp. 211-239) confirmed that he represented Edinburgh and Aberdeen Universities on the Medical Council. He described the steady growth in medical student numbers at Edinburgh during the decade, and gave a full account of the process of medical education at the university. The necessity of taking an additional examination might cause financial hardship to some of his students, for he remarked that in Scotland "we draw ... a considerable proportion of our students from a class of the community that one cannot exactly call poor, but still people of limited means."

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Universities could be vetted by external examiners. He confirmed the view that Scotland was against the "one portal" approach and, within the universities, there were misgivings that a conjoint system would persuade students to be content with this qualification and dissuade them from taking the universities' higher examinations. Thus, the level of medical education in Scotland would be lowered.

Sir Trevor Lawrence questioned the Professor concerning the museum, the library and other teaching facilities at the University of Edinburgh. The Professor replied (para. 3371): "From what I know of the London Medical Schools, no medical school in London has a library which can be compared with our library because we have a library of some 150,000 volumes in all departments of learning, not merely medicine and science, but it is a general university library applicable to all the facilities of the university."

"The Select Committee to whom the Medical Act, 1858, Amendment (No. 3) Bill, the Medical Act, 1858 Amendment Bill and the Medical Appointments Qualifications Bills were referred have agreed to the following special report."

Scottish evidence

Professor John Struthers (pp. 1-14), Professor of Anatomy at the University of Aberdeen, was opposed to proposals for a "one portal" system of admission to the profession. However, he recognised the unsatisfactory nature of the current situation where a doctor could practise with only a half qualification granted by one of the corporations as he believed a complete qualification in all areas of medicine should be compulsory. Nevertheless, he was anxious to retain the anatomy of the Scottish universities as regards medical education and claimed that they provided a more thorough training than did the corporations or the English universities. While successful corporation candidates should sit a "one portal" examination it was unnecessary for graduates of Aberdeen. He did not wish to see the authority of the Medical Council extended, and considered Scotland was under-represented upon it. Whereas, there was a demand for the reform of medical education in England and Ireland this was not the case in Scotland, where the existing system worked well. He believed that the system of half qualifications being granted by the Edinburgh College of Physicians and the College of Surgeons separately should cease, as there should he no surgical degree without a medical degree.

The chief difference between the English and Scots universities as regards medical education was that the English universities required their students to take an arts degree prior to their medical degree. The cost of a medical degree was lower in Scotland than in England, but Professor Struthers felt cost uniformity was unimportant. Professor William Tennant Gairdner, Professor of the practice of medicine in the University of Glasgow (pp. 14-27), gave evidence relating to the teaching of medicine in the University of Glasgow. The faculty had grown swiftly in recent years. In 1861 there were 283 matriculated students, whereas by 1880 there were 560. The stringency of the examinations had also increased, and a substantial number of students now failed the examinations.

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"to inquire into the grant of medical degrees, memberships, fellowships, licences, and other diplomas by universities, colleges, and bodies in the United Kingdom, and the courses of education and examination payments, and other conditions required as a preliminary to such grant ... and further to inquire into the result of the Medical Act, 1858, and the Acts amending the same, and into all matters dealt with by those Acts."

By the Medical Act of 1858, 19 bodies in the United Kingdom, including universities and certain medical coprorations, were recognised as licensing authorities. Anyone who obtained a licence, diploma or degree from one of these bodies was entitled to have his name entered on the Medical Register. A General Council of Medical Education and Registration was created by the Act to supervise licensing. This resulted in a general improvement in the examination of various bodies and greater uniformity.

One major defect in the licensing system, however, was the tendency of nearly all the medical corporations to grant diplomas in medicine alone or in surgery alone. The Commissioners thought that the licence should imply the possession of a complete qualification for practice i.e. knowledge of medicine, surgery and midwifery. In Scotland, the medical authorities attempted to overcome this problem by holding joint examinations and granting a double qualification. The Commissioners proposed that every medical student should pass an examination in general education before embarking on his course. The Scottish universities urged that they should be allowed to conduct the final examination and that their licensing power should, therefore, be retained, on condition of their admitting a certain number of additional examiners, but the Commissioners refused. Most of the Scottish candidates were of a higher standard than those in England and should, therefore, not be put to the trouble and expense of undertaking an additional test.

The opposing point of view was expressed by doctors from England and members of the Medical Council who pointed out the dangers to the profession of the existence of many methods of entrance. They believed that a "one portal" system consisting of one conjoint board examination to be taken by all medical qualification as possible. Scottish opposition to the "one portal" system was, in fact, rooted in the rivalry which existed between those Scottish universities which taught medicine, and the corporations, e.g. Royal College of Physicians and Surgeons of Glasgow, who also taught medicine and were recognised examining bodies. Both groups believed that they offered the superior qualifications and both feared loss of status as an examining board under new legislation.

In Scotland, the medical authorities attempted to overcome this problem by holding joint examinations and granting a double qualification. The Commissioners proposed that every medical student should pass an examination in general education before embarking on his course. The Scottish universities urged that they should be allowed to conduct the final examination and that their licensing power should, therefore, be retained, on condition of their admitting a certain number of additional examiners, but the Commissioners refused.

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Most of the Scottish candidates for the medical profession were educated in the universities. James Bryce, one of the Commissioners, stated in an appendix to the report that "the Scottish universities combine professional with general instruction in a manner and with a success which no English university has yet reached or even attempted to reach".