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The Americana: a universal reference library, comprising the arts ..., Volume 10 online

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monly reckoned of a higher standard than
Scotch or Irish. Besides the initials al-
ready given are those for midwifery, viz.,
at the Irish universities, B.A.Oh.. M.A.Oh.,
and Irish Royal Colleges, L.M., and those for
public health (Hygiene or State Medicine), and
tropical medicine, viz., D.P.H. (Diplomate),



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GREAT BRITAIN— MEDICINE



D.S.Sc. (Sanitary Science), D.Hy., and B.Hy.
(Hygiene), M.D. Stat. Med. (State Medicine;,
and D.T.M. (Diplomate). Dental degrees are
independent of the medical profession. There
are no degrees in other special subjects, although
special subjects are allowed to be taken in the
thesis or examination for certain M.D. degrees.
Councils. — The General Medical Council (ad-
dress 299 Oxford St., London, W.) is constituted
undef Act of Parliament. It consists of 34
medical men of eminence, holding office each
for five years, five nominated by the Crown
with the advice of the Privy Council, 12 by
the Universities, Royal Colleges and Apothe-
caries' Hall in England, 7 by those of Scotland,
5 by those of Ireland, and 5 by direct vote of
all registered medical practitioners in the United
Kingdom. There are Branch Councils for Eng-
land, Scotland, and Ireland.. The duties of the
council are to establish and preserve the roll
of registered practitioners. They have to regu-
late by deputed inspectors the standard of ex-
amination and other tests required for the
qualifying diplomas ; but direct pressure can
only be exerted on examining bodies through
the Privy Council. It is theirs to publish the
register every year; and to hear penal cases,
with a view to removing from the register the
name of any man judged (( guilty of infamous
conduct in any professional respect* Such
cases are first investigated by the Branch and
then by the General Council, which is for this
purpose practically a court of law, its decisions
not being open, however, to revision in any
other court. Infamous conduct includes ^cov-
cring® or the employment of unqualified assist-
ants; it does not include the adoption of any
theory of medicine or surgery.

Professional Training. — Education for ad-
mission to the register is largely in the hands
of the Universities and other examining bodies
already mentioned. But in London medical
education is carried out entirely in connection
with the large general hospitals supported by
endowment or voluntary subscriptions, included
only recently and as yet only formally as
constituent colleges in the remodelled London
University, which, until 1900, was but an ex-
amining body. The colleges of medicine in
London, 12 in number, are the schools of the
following hospitals: Guy's, Saint Bartholo-
mew's, London, Saint Thomas's, Saint Mary's,
Saint George's, Middlesex, Charing Cross,
Westminster — with University College and
King's College, both having hospitals attached,
and the London School of Medicine for Women,
attached in 1877 to the Royal Free Hospital in
Gray's Inn Road. These hospitals contain from
165 beds (Royal Free), to 927 beds (the Lon-
don), with large out-patient departments. Most
of the medical, surgical, and pathological work
is carried out by students under the supervision
of a visiting staff; the resident appointments are
held for short periods only, by recently qualified
students, who are the best men of their year and
are given much responsibility and actual major
surgical practice. It is this practical experience
under supervision, this training by responsi-
bility, that gives a special value to the
English training, as compared for instance
with that in Scotland or on the Continent.
Each medical school is a separate organization,



to which students look as their professional
home usually from the beginning to end of their
professional lives, the organization in many
instances being completed by a residential col-
lege, clubs' union, athletic ground, and period-
ical gazette or journal. This system involves
a subdivision of the otherwise unique clinical
material of London; but it leads to a healthy
rivalry, closer contact of students with their
responsible work, and greater individual atten-
tion to their needs by the lecturers and visiting
staff. An attempt is at present being made to
concentrate the teaching of elementary medical
studies in London in that part of the Imperial
Institute now given over to the London Uni-
versity; but University College, King's College,
and the larger London Schools are unlikely in
the near future to curtail their own spheres of
educational activity, even for the sake of an
Imperial ideal in medical education. In the
provinces education is conducted by university
schools of medicine in connection with some
lar^e local general hospital, that of Durham
University, for instance, being at Newcastle. But
Oxford and Cambridge Universities, being situ-
ated in small towns, encourage their students to
do their clinical work at the London hospitals.
They are content with having given them as
thorough and liberal an education as possible
in all the medical sciences, including laboratory
pathology, and they trust, by a final examina-
tion in which they can impose their own tests
of efficiency, after two or three years in a Lon-
don hospital, to ensure the proper development
of sound professional ability from the ground-
work of principles which they have laid. This
mixed university and London training, a sys-
tem of only 20 years' growth, is being gradually
developed by Prof. Clifford Allbutt at Cam-
bridge and Prof. Osier in succession to Sir John
Burdon-Sanderson at Oxford, and is already
recognized as providing an exceptionally sound
education. All the other schools give an almost
complete course of medical education. This,
however, may be supplemented by private
schools and special hospitals; and a course of
instruction in infectious diseases at the large
fever hospitals of the Metropolitan Asylums'
Board or elsewhere is obligatory for all diplo-
mas. It is a subject of regret to many in the
present day that the old system of training by
apprenticeship is dead, the law allowing no qual-
ified practitioner to employ unqualified assist-
ants, and the General Medical Council not reck-
oning any period into the requisite time of study
unless spent at a medical school. After pass-
ing the examination in general knowledge, the
minimum length of the course of training is five
years ; the average is over seven. The fees for
the course of teaching, examinations and final
diploma vary in general from $1,000 to $1,500
(£200 to £300).

Medical education in Scotland and Ireland
is on similar lines, the extra-mural school of
the Royal Colleges at Edinburgh and the Ro-
tunda Hospital for Midwifery at Dublin hav-
ing exceptional influence.

Post-graduate study is arranged for sepa-
rately in each hospital; but in London a com-
bined hospital ticket is now obtainable, from the
London Post-graduate Association, Examination
Hall, Victoria Embankment, London, W. C
($42^ for 3 months, $75 for 6), giving ad-



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GREAT BRITAIN— MEDICINE



mission to the clinical practice of the chief
hospitals. Comprehensive courses of post-
graduate study are well organized in London at
the West London Hospital, and at the Poly-
clinic; special courses are arranged for at the
London and Liverpool Schools of Tropical Med-
icine and at most of the special hospitals. Re-
search work and bacteriological and chemical
analysis are carried out at all the above institu-
tions, and virtually at all fever hospitals. Re-
search and supply of vaccines and antitoxins are
the sole aim of the Lister Institute of Preven-
tive Medicine in Chelsea, with Its fine farm at
Elstree, Herts. Bacteriological and chemical
analysis are efficiently organized as a commercial
concern by the Clinical Research Association,
and in certain private laboratories.

Voluntary Organization in Practice. — A con-
siderable fraction of the best students in every
year secure junior positions in their hospitals
or in the medical schools attached to them, and
work their way up by degrees to consulting prac-
tice, mainly with the help of their student-
friends and pupils in general practice. The ma-
jority of those qualified find their way into the
provinces, often after spending a few years in
junior positions at London or provincial hos-
pitals, in trips abroad as ship's surgeon or
otherwise, in assistantships to practitioners ; and
they in most cases buy the good-will of an estab-
lished practice or partnership at one to two
years' purchase. In such positions they are iso-
lated, attached by little more than sentiment
and a dining club to their old hospital, officially
organized only in their occasional vote for a
^ direct representative on the General Medical
* Council. Voluntarily, however, they organize
themselves to a considerable extent for relief
and for protection, as in the British Medical
Benevolent and Lancet Relief Funds, The So-
ciety for the Relief of their Widows and
Orphans, the benevolent and educational work
of Epsom College, and various associations for
medical defence. Still more, a thorough scheme
ol organization has been established by the
British Medical Association, with its 20,000
members, grouped systematically into geographic
divisions throughout the Empire, each with its
divisional council and its delegates to the An-
nual Representative Meeting, which recom-
mends the policy to be carried out by the partly
co-opted, partly nominated Central Council,
during the ensuing year. This council works
largely through committees, of which the chief
are the medico-political, the ethical, and that
which conducts the well-known weekly jour-
nal. Apart from the protection of professional
interests, the association exercises consider-
able influence by memorials and deputations
to government, which otherwise relies for med-
ical advice on the Royal Society, the Royal Col-
leges of Physicians and Surgeons, and the few
medical advisers to government departments.

Women mostly take the license of the Apothe-
caries' Society in England, the Scotch or Irish
conjoint qualification or the degrees of the
London and the other newer universities. They
are debarred from the English conjoint qualifir
cation, and from the degrees of the universities
of Oxford and Cambridge. They take little
part in the professional organizations, and as
yet they practice but little in the United King-
dom, many being trained for the mission field.



Homoeopathy. — In England Homoeopathy is
a specialty practiced without exception by men
who possess a legal qualification to practice.
They receive their special training, if at
all, by post-graduate lectures and resi-
dent appointments at the homoeopathic hos-
pitals. Of these there are a fine example
of 100 beds in London, and 9 in the
provinces. Most homoeopaths belong to the
British Homoeopathic Society, founded in 1844,
which publishes a quarterly journal. There
are also two monthly journals of the cult and
a new (< British Homoeopathic Association* of
practitioners and laymen.

Medical Societies, Libraries, Journals, and
the Annual Congress form a considerable bond
of union. Apart from branches of the British
Medical Association, there are 100 such so-
cieties in London alone and corresponding
numbers in the other chief towns, many be-
ing associated with a central body in Lon-
don, some for general, many for special pro-
fessional objects. Societies in London mostly
meet at 8 p. m. The best medical libraries in
London are those of the Royal Colleges, of the
Medico-Chirurgical Society, and of the British
Medical Association. The chief periodicals are
the ( Lancet y and ( British Medical Journal *
(weekly) ; the ( Annals of Surgery,' ( Practi-
tioner, > < Journal of the Royal Army Medical
Corps,> and ( Public Health> (monthly);
< Brain * and <The Journal of Hygiene > (quar-
terly) ; annual report-volumes of the various
chief London hospitals; and the annual <Medi-
cal Register > and < Medical Directory. } The
( Pharmacopoeia > is revised from time to time
and published by the General Medical Council.
An opportunity for the interchange of ideas on
all subjects is afforded every year by the
Congress of the British Medical Association,
held usually in the United Kingdom, but in
1906 in Toronto, Canada.

The Government Medical Services are each
separately organized under the corresponding
Government Office. The Naval Medical Serv-
ice includes 520 active and 240 retired medical
officers, with its chief hospital and college at
Haslar, near Portsmouth; the Royal Army
Medical Corps, 1,031 active and 533 retired
medical officers, with the new Army Medical
College opened in 1907 at Millbank, West-
minster; the Indian Medical Service, 747 active
and 546 retired medical officers, sharing in the
Army Medical College; the Colonial Office em-
ploys in Crown colonies several hundred med-
ical officers, who do not hold commissions, but
undergo extra training at the School of Trop-
ical Medicine; and the Foreign Office has also
a staff of medical men in its service abroad.

Under the Local Government Board, for
purposes of the poor law, district and work-
house medical officers and public vaccinators
are appointed in every parish and union for the
most part in conjunction with their general
practice, usually in return for very small sal-
aries, to attend to paupers in need of medical
attention. The workhouse infirmaries in the
large cities are of great size and importance.
Under the Local Government Board, too, is
organized the sanitary medical service. The
head of this service is the political President
advised by his medical officer, and by his legal
adviser, with the assistance of a staff of legal



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GREAT BRITAIN— ENGINEERING



secretaries and engineering and medical in-
spectors of the highest experience and ability.
Local Government throughout the country is in
the hands of borough and district councils,
each of whom has a sanitary inspector and a
medical officer of health, and many of whom
maintain isolation hospitals for cases of in-
fectious disease. Powers of supervision are
given to County Councils, who, with the advice
of County Medical Officers of Health, may
report default of District Councils to the Local
Government Board. The chain of authority is
therefore through the lay authorities, each ad-
vised by its medical officer. Some of these
sanitary appointments are of little pecuniary
value; others of considerable value, demanding
the whole attention of the holders ; and they are
increasing markedly in number, value, and im-
portance. In practice the sanitary service
largely depends on the unofficial Royal Sani-
tary Institute with its annual congress and
monthly journal, its courses of instruction, its
examinations and its diplomas for school teach-
ers and sanitary inspectors, a body of non-
medical men who are the foundation of British
sanitary administration. Among other gov-
ernment appointments are those of police sur-
geon, prison surgeon, factories' surgeon, and
inspector of factories and workshops under the
Home Office, those of Medical Officer to Schools
under County Councils and the Education Office ;
those to lunatic asylums and fever hospitals
under the Metropolitan Asylums' Board and
other local authorities.

With these offices and work for insurance
and friendly societies, sick-clubs and private
nursing homes, the practitioner ekes out his
slender earnings.

The numbers on the British Medical Register
in 1006 were roughly as follows: London,
6,400: Provincial England, 17,000; Wales, 1,200;
Scotland, 3,800; Ireland, 2,700; Foreign and
Colonial, 4t7oo; Naval, Military, and Indian
Services, 3,200. Total, 39,000.

Francis Fremantle,
Herts County Medical Officer of Health.

31 (c). Great Britain— Engineering. Engi-
neering as a profession is only partially organ-
ized in Great Britain. To understand the pres-
ent state of development a brief historical
statement is necessary.

Historical. — On the military side engineer-
ing is and has been thoroughly organized. For-
tification and the art of constructing defences
are probably as old as society. The Babylon-
ians, Greeks, and Romans showed skill and
originality in design and construction which has
nowhere been surpassed. From the introduction
of the catapult, ballista, and other engines of
war amongst the Greeks and Romans mechani-
cal skill likewise received wide and steady de-
velopment.

Into Great Britain engineering was probably
first introduced by the Roman invasion and then
languished until William the Conqueror brought
with him a large body of engineers.

As gunpowder, cannon, and later muskets
replaced catapult, arquebus and crossbow, me-
chanical skill and ingenuity made steady
advance until at the present day the manufac-
ture of war implements and their invention and
design have passed to a considerable extent into



the hands of civilians. Military engineers are
organized as the Corps of Royal Engineers with
their headquarters at Chatham, although it has
recently been proposed to remove them else-
where.

The Artillery is organized in several corps,
according as service in the fortress, field,
mounted, or on foot, is required. Knowledge
and training in a specialized branch of engineer-
ing is needed for these services.

Guns and military equipment are manufac-
tured at the Royal Arsenal at Woolwich and at
the Royal Small Arms Factories at Enfield and
Birmingham, under Army control, and in vari-
ous factories belonging to civilian firms.

In the Navy engineers have steadily in-
creased in importance as the construction of
ships and their working depended more and
more upon machinery until under the recently
modified regulations it has been arranged that all
naval officers whether navigating, gunnery, tor-
pedo, or engineering shall for the first years of
their training be educated together, specializa-
tion being left to the later years of their course.
Engineer officers will therefore rank with other
officers of equal standing and be capable of
executive command.

On the Civil Side. — The foundation of Eng-
lish Civil Engineering may be said to have been
laid by Smeaton (1724-1792). He was the son
of an attorney, became a philosophical instru-
ment maker, and subsequently devoted his at-
tention to a study of windmills, canals (for
which he made a tour of the low countries in
1754). and lighthouses. He reconstructed the
Eddystone Lighthouse in 1756. He was there-
fore "much consulted in regard to engineering
projects, including river navigation, the drain-
age of the Fens, design of harbors, and the
repair and construction of bridges.*

Smeaton founded in 1771 the € Society of
Civil Engineers,® the members of which dined
together once a month during the parliamentary
session and discussed subjects of professional
interest. It still exists under the name of
•The Smeatonian Society of Civil Engineers *
No records of its discussions have been kept nor
published but its foundation shows the earliest
step in the direction of organizing the non-mil-
itary engineers into a profession in Great
Britain.

Partly contemporary with Smeaton was
James Watt (1735 to 1829). He was trained as
a mathematical instrument maker, but was pre-
vented from practicing by the trade as not being
fully qualified, and therefore he was granted
three rooms in the University of Glasgow where
he carried on experiments resulting in the cre-
ation of the modern steam engine out of the
crude pumps of the Marquis of Worcester, New-
comen, Cawley, and Savory. His improvements
demanded for their perfect fulfillment mechan-
ical skill and workmanship far in advance of the
work of the millwrights of his earlier youth.
Out of the millwright he therefore created the
manufacturing engineer, and did for the
mechanical side of the profession what Smeaton
had done for the constructive side, and like
Smeaton on the constructive side Watt on the
mechanical side was consulted as an authority
of the first rank on all important matters.

Watt moreover had, about 1 767-1 770, a large



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practice as a constructive engineer and surveyor,
and prepared plans for a number of canals and
harbors, chiefly in Scotland.

As manufactures increased, partly owing to
th: impetus given to them by Watt's inventions,
partly as a result of the industrial development
at the termination of the Napoleonic wars, the
improvement of means of communication and
greater rapidity of transit became of first class
importance, and as the roads throughout Great
Britain were at the end of the 18th century in
an execrable condition we find attention more
and more concentrated upon the construction
of inland canals and new and improved roads.

The man who more than any other aided in
this improvement was Thomas Telford (i757~
1834), the son of a Dumfriesshire shepherd and
in early life trained as a stone mason. After
the construction of a house for the Commis-
sioner of Portsmouth Dockyard he became Sur-
veyor of Public Works for Shropshire and con-
structed a bridge over the Severn at Montford
in 1792. The construction of the Elsemere
canal in 1793 lead to his being employed in the
construction of most of the chief canals in
Great Britain, from the Caledonian in 1804 to
the Birmingham and Liverpool junction in 1825
as well as the Gotha canal in Sweden in 1810.
He constructed and perfected most of the main
roads in Scotland, the North of England, and
Wales, involving the erection of the Menai and
Conway bridges, besides numerous others of
less magnitude. He also made many continental
roads in Austria, and was also employed in
Jiarbor construction.

He lived a bachelor in London at the Salo-
pian Coffee House, afterward the Ship Restau-
rant, and two years after the establishment of
the Institution of Civil Engineers in 1818 he
was elected president for life. The meetings
were thereafter held in the Ship Restaurant,
whither the institution removed from the Ken-
dal Coffee House in Fleet street, its earliest
home.

Meanwhile, mechanical road traction, steam
barge, and ship propulsion had advanced with
the advance of the steam engine and with
George Stephenson's triumph at Rainhill in
1829, railway construction had commenced and
was fast monopolizing attention as the most
efficient and rapid means of communication.
iThe names of Brunei, Clarke Russell, Whit-
worth and a host of others claim recognition in
the rapid advance of engineering both at sea and
on land which now followed, but enough has
been said to enable a grasp of the rise of the
profession and the lines of its gradual devel-
opment to be realized.

The progress in organization of the profes-
sion which has since taken place has been due
firstly to the commanding position in the pro-
fession attained by the Institution of Civil En-
gineers and secondly to the development and or-
ganization of engineering scientific education
which has taken place in the Technical and Uni-
versity Colleges and Universities throughout
the kingdom.

Institution of Civil Engineers. — This insti-
tution founded, as already said, in 1818, obtained
a Royal Charter of Incorporation in 1828, its
objects being — as described by Tredgold in a
statement prepared for the Council in applying
for a Charter — a For the general advancement



cf mechanical science, and more particularly
for promoting the acquisition of that species of
knowledge which constitutes the profession of
a civil engineer, being the art of directing the
great sources of power in Nature for the use
and convenience of man as the means of pro-
duction and of traffic in states both for internal
and external trade as applied in the construction
of roads, bridges, aqueducts, canals, river navi-
gation, and docks for internal intercourse and
exchange, and in the construction of ports, har-
bors, moles, breakwaters and lighthouses, and
in the art of navigation by artificial power for
the purposes of commerce, and in the construc-
tion and adaptation of machinery and in the
drainage of cities and towns.*

This is the earliest definition of civil en-
gineering and the profession of the civil engineer
therefore embraces all non-military engineers
who are laboring to ft direct the great sources
of power in Nature to the use and convenience
of man w whatever be the special corner of this



Online LibraryWilfrid RichmondThe Americana: a universal reference library, comprising the arts ..., Volume 10 → online text (page 40 of 185)