MEDICAL OFFICERS OF POOR LAW UNIONS. (Hansard, 11 February 1845)

§ Mr. Wakley
wished to move for a Return Containing a description of the diplomas, licenses, or other letters testimonial, that are admitted and sanctioned by the Poor Law Commissioners as legal qualifications which entitle Medical Practitioners to be appointed Medical Officers of Poor Law Unions in England and Wales. Since the passing of the New Poor Law Act, great confusion had existed as to the qualifications of persons who it was considered were entitled to be appointed medical officers to Poor Law Unions. A great many medical men believed that unqualified persons were admitted to such offices, while, at the same time, highly qualified persons were excluded from being medical officers of Unions. It appeared that the Commissioners had the power of dismissing the medical as well as all other paid officers of Unions; indeed this was obvious from the Interpretation Clause of the Act. By another Clause of that Act, also, the Commissioners had the power to declare what were the qualifications required of persons holding offices under the Unions. The question as to the qualification of medical officers to Poor Law Unions, and the decisions of the Commissioners on the point, had been a constant subject of discussion before medical associations, and the matter had also been considered by a Committee of that House. In March, 1842, the Commissioners having had their attention called to the subject, issued a general order and rule as to medical relief, and in part of which the qualifications of medical officers to Poor Law Unions are stated. The part to which he alluded was as follows:— It shall not be lawful for any of the said 299 Boards of Guardians to appoint any person to be a medical officer, unless such person at the time of his appointment shall possess one of the four following qualifications; that is to say:—

"1. A diploma from the Royal College of Surgeons in London, together with a degree in medicine from an university in England, legally authorized to grant such a degree, or together with a diploma or license of the Royal College of Physicians of London.

"2. A diploma from the Royal College of Surgeons in London, together with a certificate to practise as an apothecary from the Society of Apothecaries of London.

"3. A diploma from the Royal College of Surgeons in London, such person having been in actual practice as an apothecary on the first day of August 1815.

"4. A warrant or commission as surgeon or assistant-surgeon in Her Majesty's Navy, or as surgeon, or assistant-surgeon, or apothecary in Her Majesty's Army, or as surgeon, or assistant-surgeon in the service of the Honourable East India Company, dated previous to the 1st day of August, 1826."

These four rules were accompanied with the following proviso— That if it shall not be practicable for the Board of Guardians to procure a person residing within or near the district in which he is to act, and duly qualified in one of the four modes recited in Art. 3, to attend on the poor in such district, or that the only person resident in or near such district, and so qualified, shall have been dismissed from office under the seal of the Poor Law Commissioners, or shall be judged by the Poor Law Commissioners to be unfit or incompetent to hold the office of medical officer, then and in such case, the Board of Guardians shall cause a special minute to be made and entered on the usual record of their proceedings, stating the reasons which, in their opinion, make it necessary to employ a person not qualified as required by Art. 3, and shall forthwith transmit a copy of such minute to the Poor Law Commissioners for their consideration; and the Poor Law Commissioners may, if they think fit so to do, permit the employment by such Board of Guardians of any person duly licensed to practise as a medical man, although such person shall not be qualified in one of the four modes required by Art 3. Art 5. Provided also, that it shall be lawful for the Board of Guardians, with the consent of the Poor Law Commissioners first had and obtained, to continue in office any medical officer duly licensed to practise as a medical man already employed by any such Board of Guardians, although such medical officer may not be qualified in one of the four modes required by Art. 3. Thus, then, it appeared that those who had obtained medical diplomas in Ireland 300 and Scotland, as well as those who had obtained medical degrees in the Scotch and Irish universities, however great their professional abilities might be, were not qualified to act as medical officers to Poor Law Unions. There did not however, appear to be anything in the Act, namely, the 4th and 5th William IV., to call for such exclusion. The result, however, was, that it was put in force, and it had caused great dissatisfaction amongst members of the medical profession, both in Scotland and Ireland. The discontent on the subject had increased, as this exclusion had been made one of the pretexts for introducing a general Medical Bill, and thus break down that protection to the medical practitioner which was given in 1817, by the measure commonly called the Apothecaries' Act. After this order, dated in March, 1842, which certainly was most loosely drawn up, a communication, dated early in 1843, was made by the Presidents of the Colleges of Physicians and Surgeons in Dublin to the Poor Law Commissioners, which was answered at some length by the Poor Law Commissioners. On this subject the Poor Law Commissioners, in their Report in 1843, observe— With respect to the first of these subjects, we explained in the last annual Report (s. 31) the nature of the difficulty which we had found in the state of the law affecting the validity in England of medical qualifications derived from a Scotch source. We then stated that, according to the best legal advice which we had been able to obtain, it appeared to us that a person having merely a medical qualification derived from an university or other body qualified to grant medical diplomas in Scotland or Ireland, could not be considered as coming within the words 'persons duly licensed to practise as a medical man' in (s. 109) of the Poor Law Amendment Act. Since the date of that Report, we were induced to consult the Attorney General and Mr. Martin on the subject; and they gave it as their opinion that persons having a surgical diploma or degree from a Royal College or University in Scotland or Ireland, are legally as competent to be medical officers under the Poor Law Amendment Act as persons having the diploma of the Royal College of Surgeons in London; but that persons having only Scotch or Irish medical qualifications are not as such competent to practise pharmacy in England and Wales. Accordingly, by a letter dated the 31st of August, 1843, which was sent to all the Unions, we stated that we considered ourselves justified by this opinion in admitting persons having a surgical diploma or degree from a Royal College or University in Scotland, to the same rights under the Poor Law Amendment Act, as Members of the 301 Royal College of Surgeons of London; and we added that we should be prepared to consent to such arrangements, and to make such modifications in our general order of March, 1842, as might be necessary to give effect in any Union to the Attorney General's opinion. The letter of the Commissioners, and the opinion of the learned counsel, were printed as a supplement to the annual Report, and were as follow: —

§ Sir J. Graham
said, the right of persons holding diplomas of Scotch and Irish colleges to practise generally in connexion with the Poor Law Unions in England, was a matter involved in some doubt. The hon. Member for Finsbury would surely admit that the opinions of the present Chief Baron, and of Mr. Martin, Queen's Counsel, were entitled to the greatest respect on a matter of law, and as to the construction of an Act of Parliament. 303 The Poor Law Commissioners were bound to execute their functions in conformity with law. Among other statutes regulating medical practice in this country was the Apothecaries' Act; and in the opinion signed by the Chief Baron and Mr. Martin, which the hon. Gentleman had just read, they distinctly stated, that practitioners holding surgical diplomas or degrees from colleges or universities in Scotland or Ireland might legally practise as surgeons in England; but that, under the provisions of the Apothecaries' Act, which was the law of the land, they could not act as general practitioners. That was to say, they could not both prescribe and make up medicines—they could not practise pharmacy. He understood general practitioners to be those who could prescribe as physicians, who could practise as surgeons, and who, if necessary, could compound and administer the drugs they prescribed; and it was most advisable that in Poor Law Unions they should have the services of practitioners of this description. It was with the view of offering facilities for the general practitioner that he sought to alter the law relating to medical practice, and more especially to repeal the Apothecaries' Act, which was the great impediment to the general practice in England of Scotch and Irish medical men. He (Sir J. Graham) did not feel the least difficulty or hesitation in laying upon the Table all the Papers to which the hon. Member for Finsbury had alluded, and among them the opinion of the Chief Baron and Mr. Martin, which stated directly that the Apothecaries' Act was the impediment to the practice of Irish and Scotch medical men in this country. The Poor Law Commissioners were bound by the law as it stood to say that no Scotch or Irish practitioner, however eminent for his talent—however satisfactorily he might have passed his examinations, could be employed in any Poor Law Union in this country, unless he was prepared to forego all the advantages which his services as a general practitioner offered to the Board of Guardians. The hon. Member for Finsbury had brought out most strongly—he could not have done so more prominently—the great grievance with which, among others, he (Sir J. Graham) proposed to deal in the Bill it was his intention to submit to the House. He must add, that after the opinion given by the Lord Chief Baron and Mr. Martin, the Poor Law Commissioners issued a circular to the Boards of 304 Guardians, stating that, though Scotch and Irish practitioners could not practise pharmacy, yet that, if their services were strictly restricted to surgery, they might be employed. He begged to express his obligation to the hon. Gentleman (Mr. Wakley) for having brought forward so prominently one very great defect of the existing law relating to medical practice.

§ Mr. Wakley
said, the circumstance which had struck the members of the medical profession as most extraordinary was this,—that, after the opinion he had read, no general order had been issued by the Commissioners to alter the general order promulgated in 1842. The opinion of the Attorney General, obtained in 1843, clearly showed that medical men possessing diplomas or degrees from Scotch or Irish Colleges could legally practise as medical officers to Poor Law Unions in England; and yet no steps were taken to alter the general order which had been issued a year and a-half previously on this subject. He hoped that, when the right hon. Baronet brought forward his Bill on the subject of Medical practice, he would recollect that, inasmuch as the present Chief Baron had given it as his opinion that Irish and Scotch surgeons could practise surgery and medicine, though not pharmacy, which was the preparation of medicine, in Poor Law Unions, it was not necessary to repeal the Apothecaries' Act in order to admit those gentlemen to legal practice.

§ Sir J. Graham
said, his impression was, that, after the opinion of Sir F. Pollock and Mr. Martin had been obtained, a general order on the subject was issued by the Commissioners, but he could not positively state that such was the case. He was, however, quite certain that, either in the form of a circular letter or of a general order, the effect of that opinion was intimated to the various Boards of Guardians.