241

physician, surgeon, &c. And let the clause conclude-" or inany wise, or under any other medical or surgical title, to sopractise, and any unregistered person so offending shall beliable, &c. -

Such a clause, if sustained by liberal powers vested in theMedical Council as regards the recognition of degrees or quali-fications not included in Schedule A, with suitable provisionfor existing rights, if efficiently supported by the co-operationof those bodies represented in the Council, would, we appre-hend, not present many difficulties of construction, and mightpossibly meet with the sanction of Parliament.We shall again return to a consideration of this Act.

TEACHING OF PSYCHOLOGICAL MEDICINE.

AT the meeting of the Medical Sub-Committee of the AnnuaJ iCommittee of Convocation of the University of London, Session 1864—65, held on the 3rd ult., Dr. Storrar in the chair,Dr. Anstie, Mr. E. Charles, LL.B., Dr. Maudsley, Dr. Ran-

dall, Mr. J. Robson, B.A., and Dr. Sibson being also present,Dr. Maudsley read the following report upon the subject of

mental diseases : Whilst every department of medical sciencehas of late years received great extension, and whilst medicalstudies have in consequence been made wider and more com-

plete, there is still, strange to say, no instruction whatevergiven at any of our London medical schools on the subject ofmental diseases, and no adequate knowledge of them, if any,exacted by any of our examining bodies. As long ago as 1831Dr. Conolly, who was at that time Professor of Medicine inwhat was then called the London University (now UniversityCollege), attempted to effect arrangements for giving instruc-tion in mental diseases, and for gaining access on the part ofmedical students to the wards of the London asylums; but,as Dr. Conolly observes, "in that busy period of agitationand movement more important matters occupied the attentionof the distinguished founders of the University, and I couldnot obtain attention to this suggestion. And even now," hecontinues, writing in 1862, " when thirty years more havepassed away, and every department of medical study has re-ceived new and great impulses, the only branch of pathologicalinstruction which it is not thought necessary to illustrate byexamples seen in hospital practice, is still the department ofmental pathology, including all the varied symptoms of themutual influence of the body on the mind, and of the mind onthe body, and the means of their alleviation and cure." Thisentire neglect still continues, although since Dr. Conolly madehis unsuccessful attempt a complete revolution in the mannerof treating the insane has been effected by his distinguishedexertions, and although great activity now prevails in thescientific investigation of mental diseases, and great promiseexists of important progress in a knowledge of them.But though this is the case unfortunately in London, it is a

defect in medical education and a reproach which is nowalmost peculiar to London. In Edinburgh, a systematiccourse of lectures on, and clinical instruction in, mental diseasesis given as a special course by the professor of medicine ; andrecently a chair has been specially endowed for that purpose atthe College of Physicians of Edinburgh by Sir A. Morrison.In Paris lectures and clinical instruction are regularly givenby the physicians of the Bicetre and the Salpétrière ; inVienna certain special teachers are regularly appointed by theUniversity; and at Berlin there is systematic instruction at theasylum in connexion with the great hospital of La Charite.When the East India Company was still in existence, themedical officers who entered its service were wisely required topresent certificates of having given due attention to insanity;and at that time there was some attempt made at the Londonasylums to furnish instruction in insanity; but since the EastIndia Company has been defunct, medical officers are not re-quired to know anything about insanity ; and accordingly noattempts are made to enforce a study of the diseases that pro-duce it.

It is impossible not to think that the public and the medicalprofession both suffer from this complete neglect of mentaldiseases, and that it is most desirable to take some steps toremove the existing reproach. The most obvious and advisableplan of doing so would certainly appear to be by giving to

mental diseases that recognition in the examinations of the, University which their importance demands. Then would thedifferent schools at once take steps to provide the necessaryinstruction, and students would recognise the necessity of pro-

fiting by it. Certain of the medical schools appear now to be

! desirous of making some attempts to establish lectures uponthe subject ; but it is much to be feared that their praiseworthy’ efforts will not be attended with the success which they deserve; unless the University of London does its part also, and duly! recognises an examination in mental diseases as a necessarypart of the medical curriculum.

If this desirable change be allowed to be needful, the wayiin which it might best be done would seem to be by makingmental diseases, and the legal conditions and preliminariesnecessary to the confinement of the insane, the subject of adistinct paper at the Second M.B. Pass Examination. It

plainly is not a subject which might properly be relegated tothe Honours Examination, but one which should rightly form apart of the Pass Examination, inasmuch as it concerns the; whole medical profession that there should be a due knowledgeof mental diseases amongst its members. Every medical manhas in his practice to deal with insanity as with any otherdisease; and it usually falls to him to deal with it at thatearly stage of the disease when there is always the best hope(and sometimes the only hope) of effecting a cure. Everymedical man, again, is frequently called upon to sign a certifi-cate under which an insane person is sent to an asylum andconfined there ; and it is most desirable, therefore, that he

should be fully informed, not only of the phenomena ofthe disease, so that his certificate may be just and valid,but of the legal bearings of the certificate, and of thelegal conditions under which he gives it. Nor is it lessdesirable that every medical man should be acquainted withthe legal enactments with regard to the treatment in a privatehouse of an insane patient whom it is not thought necessary tosend to an asylum. Lastly, every medical man may have to giveevidence in a court of justice with regard to soundness or un-soundness of mind when the gravest consequences dependupon the determination of the question at issue. He is sup-posed by virtue of his profession to be capable of givingscientific evidence on such point; and yet, as things are atpresent, a knowledge of insanity forms no part of his profes-sional education. It is quite possible that he may have togive evidence in the matter of the life and death of an insaneprisoner, when it is the first case of insanity which he hasseen in his life.We deem it, therefore, for every reason to be most desirable,

both for the credit of the medical profession, and the welfareof the community, that the University insist upon an adequateknowledge of mental diseases in all those whom it sends outto the world stamped with its degree as highly qualified prac-titioners. Effectually to do this would require not less than adistinct paper at the Second M. B. Pass Examination.

After considerable discussion, it was resolved, on the motionof Dr. Maudsley, seconded by Dr. Sibson,

" That it is desirable that a certificate of having attended acourse of clinical instruction in mental diseases should be re-quired from all the candidates for the Second M.B. Pass Exa-mination, and that the examinations should necessarily embracethe subject of insanity.

" That Dr. Maudsley and Dr. Sibson be requested to reportthis resolution to the Annual Committee."

Correspondence.

FACULTY OF PHYSICIANS AND SURGEONS OFGLASGOW.

"Audi alteram partem."

To the Editor of THE LANCET.

SIR,—The editorial observations in your number for Feb.18th, on the admission of candidates to the ad euiadem licenceof the Faculty, convey the impression that the Faculty have aregulation limiting such licence to gentlemen ’’ practising inScotland," which they have not observed, " but that the regu-lation has been used for the purpose of inducing gentlemen totake the ad eundem licence of the Faculty of Physicians and