Rhine to France. In 1806 the formation of the Confederation of the Rhine involved an extension of this mediatizing process, though the abolition of the empire itself deprived the word “mediatization” of its essential meaning. After the downfall of Napoleon the powers were besieged with petitions from the mediatized princes for the restoration of their “liberties”; but the congress of Vienna (1815) further extended the process of mediatization by deciding that certain houses hitherto immediate (i.e. Salm, Isenburg, Leyen) should only be represented mediately in the diet of the new Confederation. On the other hand, at Aix-la-Chapelle (1818) the powers, in response to the representations of the aggrieved parties, admonished the German sovereigns to respect the rights of the mediatized princes subject to them. Of these rights, which included the hereditary right to a seat in the estates, the most valued is that of Ebenbürtigkeit (equality of birth), which, for purposes of matrimonial alliance, ranks the mediatized princes with the royal houses of Europe.
See August Wilhelm Heffter, Die Sonderrechte der Souveränen und der Mediatisirten, vormals reichsständischen Häuser Deutschlands (Berlin, 1871). The mediatized families are included in the Almanach de Gotha.
MEDICAL EDUCATION. Up to 1858 each University, Royal College of Physicians or of Surgeons, and Apothecaries’ Hall in Great Britain and Ireland laid down its own regulations for study and examination, and granted its degree or licence without any State supervision. In that year, pursuant to the Medical Act,Great Britain and Ireland. 21 & 22 Vict. c. 90, the General Medical Council of Medical Education and Registration was established, consisting of twenty-three members, of whom seventeen were appointed by the various licensing bodies and six by the Crown. This number was increased by the amended act of 1886 to twenty-nine, three of the six additional members being elected by the profession as “direct” representatives. The object of the act was “to enable persons requiring medical aid to distinguish qualified from unqualified practitioners.” To this end the “Medical Register” was established, on which no person's name could be inscribed who did not hold a diploma or licence from one or more of the licensing bodies after examination. By the 1886 act a qualifying examination was defined as “an examination in medicine, surgery, and midwifery,” conducted by universities or by medical corporations, of which one must be capable of granting a diploma in medicine, and one in surgery. The Council is authorized to require from the licensing bodies information as to courses of study and examinations, and generally as to the requisites for obtaining qualifications; and to visit and inspect examinations either personally or by deputy. If the visitors think the course of study and examination of any licensing body is not sufficient to ensure that candidates obtaining its qualification possess the requisite knowledge and skill for the efficient practice of their profession the Council, on a report being made, may represent the same to the Privy Council. The Privy Council may, if it sees fit, deprive the accused body of its power to grant registrable qualifications. From this statement it will be seen that the powers of the Council are limited; nevertheless, by their cautious application, and by the loyal manner in which the licensing bodies have acted on the recommendations and suggestions which have from time to time been made, the condition of medical education has been improved; and although there is not a uniform standard of examination throughout the United Kingdom, the Council has ensured that the minimum requirements of any licensing body shall be sufficient for the production of trustworthy practitioners.
One of the first subjects to which the Council applied itself was the establishment of a system of examinations in general knowledge. Such examinations have to be passed before beginning medical study. On presentation of a certificate to the registrars of the Council, and on evidence being produced that the candidate is sixteen years of age, his name is inscribed on the “Students' Register.” The subjects of examinations are: (a) English language, including grammar and composition (marks not exceeding 5% of the total obtainable in this section may be assigned to candidates who show a competent knowledge of shorthand); (b) Latin, including grammar, translation from specified authors, and translation of easy passages not taken from such authors; (c) mathematics, comprising arithmetic; algebra, as far as simple equations inclusive; geometry, the subject-matter of Euclid, Books I., II. and III., with easy deductions; (d) one of the following optional subjects—Greek, French, German, Italian or any other modern language. Certificates are accepted from all the universities of Great Britain and Ireland, from the leading Indian and colonial universities, from government examination boards, and from certain chartered bodies. The German Abiturienten Examen of the gymnasia and real-gymnasia, the French diplomas of Bachelier ès Lettres and Bachelier ès Sciences, and corresponding entrance examinations to other continental universities are also accepted.
As regards professional education, the Council divided its resolutions into “requirements” and “recommendations”; the former consisting of demands on the licensing bodies, non-compliance with which renders them liable to be reported to the Privy Council; the latter are regarded merely as suggestions for the general conduct of education and examination. The requirements may be summarized as follows: (a) Registration as a medical student. (b) Five years of bona-fide study between the date of registration and the date of the final examination for any diploma entitling the holder to be registered under the Medical Acts. (c) In every course of professional study and examination the following subjects must be contained, the Council offering no opinion as to the manner in which they should be distributed or combined for the purposes of teaching or examination, this being left to the discretion of the bodies or of the student—(i.) physics, including the elementary mechanics of solids and fluids, and the rudiments of heat, light and electricity; (ii.) chemistry, including the principles of the science, and the details which bear on the study of medicine; (iii.) elementary biology; (iv.) anatomy; (v.) physiology; (vi.) materia medica and pharmacy; (vii.) pathology; (viii.) therapeutics; (ix.) medicine, including medical anatomy and clinical medicine; (x.) surgery, including surgical anatomy and clinical surgery; (xi.) midwifery, including diseases peculiar to women and to new-born children; (xii.) theory and practice of vaccination; (xiii.) forensic medicine; (xiv.) hygiene; (xv.) mental disease. (d) The first of the four years must be passed at a school or schools of medicine recognized by any of the licensing bodies; provided that the first year may be passed at a university or teaching institution where the subjects of physics, chemistry and biology are taught; and that graduates in arts or science of any university recognized by the Council, who shall have spent a year in the study of these subjects, and have passed in them, shall be held to have completed the first of the five years of medical study. (e) The study of midwifery practice must consist of three months attendance on the indoor practice of a lying-in hospital, or the student must have been present at not less than twenty labours, five of which shall have been conducted throughout under the direct supervision of a registered practitioner.
The fifth year of study is intended to be devoted to clinical work and may be passed at any one or more public hospitals or dispensaries, British or foreign, recognized by the licensing authorities; six months of this year may be passed as a pupil to a practitioner possessing such opportunities of imparting practical knowledge as shall be satisfactory to the medical authorities. This latter method is rarely employed.
The “recommendations” of the Council contain suggestions which may or may not be acted on by the bodies. For the most part they are complied with in connexion with the system of practical and clinical teaching.
The Council satisfies itself that its requirements are acted on, and that the examinations are “sufficient,” by cycles of inspection about every five years. The examination of each licensing body is visited by an inspector, who forwards his report to the Council, which sends each report to the body for its information and remarks. As yet it has never been the duty of the Council to report to the Privy Council that any examination has not been found sufficient.
Most universities exact attendance at more classes than the colleges and halls; for instance, botany and natural history are taught to their students, who are also examined in them. But with these exceptions the system of professional education is fairly uniform. Since 1875 attendance on “practical” classes has been called for in all subjects. Under this system the larger classes in which the subjects are taught systematically are broken up, and the students are taught the use of apparatus and the employment of methods of investigation and observation. Tutorial instruction is superimposed on teaching by lecture. Much the same plan is adopted in respect of clinical instruction: not only is the student taught at the bedside by the lecturer, but he receives, either from the house-surgeon or
house-physician or from a specially appointed clinical