The letter was occasioned by an agitation which had been long gathering strength in Scotch medical circles against the laxity with which certain of the Scotch universities—­St. Andrews and Aberdeen in particular—­were in the habit of conferring their medical degrees.  The candidate was not required either to attend classes or to pass an examination, but got the degree by merely paying the fees and producing a certificate of proficiency from two medical practitioners, into whose qualifications no inquiry was instituted.  In London a special class of agent—­the broker in Scotch degrees—­sprang up to transact the business, and England was being overrun with a horde of Scotch doctors of medicine who hardly knew a vein from an artery, and had created south of the Border a deep prejudice against all Scotch graduates, even those from the unoffending Universities of Edinburgh and Glasgow.  A case seemed to be brought home even to Edinburgh in the year 1771.  The offender—­one Leeds—­had not, indeed, got his degree from Edinburgh without examination, but he showed his competency to be so doubtful in his duties at the London Hospital that the governors made it a condition of the continuance of his services that he should obtain the diploma of the London College of Physicians, and he failed to pass this London examination and was deprived of his post.  This case created much sensation both in London and Edinburgh, and when the Duke of Buccleugh was elected an honorary Fellow of the College of Physicians of Edinburgh in 1774, he made that body something like an offer to take up the question of examination for medical degrees in Parliament and try what could be done to remove this reproach from his country.  The College of Physicians thereupon drew up a memorial to Government for the Duke of Buccleugh to present, praying for the prohibition of the universities from granting medical degrees, except honorary ones, to any person in absence, or to any person without first undergoing a personal examination into his proficiency, and bringing a certificate of having attended for two years at a university where physic was regularly taught, and of having applied himself to all branches of medical study.  They add that they fix on two years not because they think two years enough, but because that was the term adopted by the London College of Physicians, and they suggest the appointment of a royal commission of inquiry if Government is not prepared for immediate action.

The Duke of Buccleugh sent the memorial for the consideration of Adam Smith, and asked him to write to Cullen his views on the subject.  Smith thought that it was not very practicable in any event for the public to obtain a satisfactory test of medical efficiency, that it was certainly not practicable if the competition by the private teachers were suppressed, that otherwise the medical examination might become as great a quackery as the medical degree, and that the whole question was a mere squabble between the big quack and the little one.  He unfolds his views in the following letter:—­