MEDICAL PROFESSION. (Hansard, 25 February 1845)

§ Sir J. Graham
Sir, I should not have considered it consistent with that duty which I am called upon to perform, to have troubled the House at any length upon the subject of the Motion which I am about to make had I not thought that a very great impression has been created on the public mind by misapprehension, and that a very great degree of anxiety exists amongst the medical practitioners, with respect to the alterations which it is the intention of the bills which I am about to ask leave to bring in, to introduce into that profession. I should not but for this have trespassed at so late an hour upon the attention of the House. But the House will no doubt remember, when I introduced, at the latter end of last Session, a Bill for the regulation of the medical profession, I then stated, that considering the various important interests which that measure would affect, as well with respect to the public at large, as to the medical practitioners themselves, hasty legislation upon such a subject would not only be inexpedient, but also unjust to the profession; and that I thought I should best consult the public interest, and accord that general justice which was due to all parties, if I laid the projected measure in its then state upon the Table of the House, in order that its merits, and the various enactments which were proposed in its clauses, might be canvassed and thoroughly sifted during the ensuing recess. It is not denied that this proceeding on my part was characterized by fairness and by a willingness to afford an opportunity for thoroughly examining the proposed Bill; and I am now prepared to admit also its usefulness, for the discussions which have since taken place with respect to that measure, have enabled me to state the changes which I am now prepared to submit 1212 to the consideration of the House. And, first, it will be necessary for me to recapitulate the leading objects of the Bill to which I refer, and then I shall state the change which I have introduced in the measure I am now about to propose. The first provision of that Bill to which I propose to adhere is the establishment of a Council of Health, which shall have the superintendence and control over medical and surgical education, and which shall constitute a Board, the seat of which shall be in the metropolis, so as to be easy of access to the Executive Government, in order to assist the authorities with its advice upon all questions affecting the health of the people at large, such as on occasions when the cholera rages, or when fevers or epidemics are abroad. The Sanatory Board will advise the measures to be taken by the Government with reference to the general health of the people in large and populous cities, and it will constitute a council easily accessible at all times to the Executive Government, for its seat will be in the metropolis. This is the first object of the Bill. The second object which the measure is intended to effect, is to abolish all monopolies of the medical profession, and to secure to all medical practitioners equal facilities of practice, as well as to afford the security to the public of an equality of attainments on the part of the medical practitioners, so that whilst on the one hand equality of practice is given to the profession, equality of attainments is secured to the public on the other hand; these attainments being certified and made notorious to the public by the registration of all the medical practitioners after they shall have undergone an examination before the constituted authorities, and thereby afforded a proof that they have come up to that standard which shall be deemed requisite to qualify them to practise in medicine and surgery; and by the law, as it will in future stand, no title to practise in the three kingdoms will be given in any one of the branches of medicine and surgery to those who shall not have undergone such an examination, and shall not have been found competent. These were the leading objects of the Bill which I introduced last year; to those objects I still adhere in the Bill which I contemplate; and if the House gives me permission to bring it in, it shall be my care that the provisions which I have pointed out shall be fully secured to the public. Having thus shortly stated the leading objects of the proposed measure, I will now proceed to lay before 1213 the House the alterations in the Bill of last Session which it is my intention to make. In that Bill I proposed to repeal the Statute of Henry VIII. (14 and 15, c. 5), which gives to the members of the College of Physicians the exclusive right of practising as physicians in the metropolis, and within seven miles of it. I do not now propose to repeal that Act entirely; but I do so only so far as to exempt from its penalties all physicians who shall be registered according to the provisions of the proposed measure; and I have also framed a clause whereby the Universities of Oxford and Cambridge will be exempted from the operation of the new Bill, and their graduates will consequently be secured in all their present privileges. There exists, I am sorry to say, both at Cambridge and Oxford, a great jealousy respecting their exclusive and peculiar privileges, which they have not as yet consented to forego, and to come within the operation of the proposed measure; I have, therefore, thought it expedient to introduce a clause into this Bill exempting their graduates entirely from its operation, and consequently conferring on them the right to practise according to their respective degrees throughout all England and Wales, save and except in the metropolis, and within seven miles of it. This provision securing the existing rights of the two Universities will be inserted in the proposed Bill, unless they shall, subsequently to its introduction, agree on certain terms to come under its operation. The particular arrangement which it is desirable to accomplish between the College of Physicians and the Universities, is, that assessors from the College of Physicians shall go down to Cambridge and Oxford, and have the power of granting medical degrees in conjunction with the academical authorities, which degrees shall confer on the graduate the same right of practising in the metropolis, and within seven miles of it, which they will possess with respect to all the other parts of England and Wales, under the operation of the clause I have already referred to. If the Universities shall, previous to the passing of this Bill into a law, consent to wave their exclusive privileges, and to place their graduates under its operation, then the exemption clause can be withdrawn in Committee, and the same arrangement can be made with respect to them, which I am happy to say the Universities in Ireland and Scotland have already acceded to. I now come to the 1214 question more particularly referred to in the petition just presented by my hon. Friend the Member for Middlesex; namely, the question of the repeal of the Apothecaries' Act. After having reflected upon this subject with great anxiety, I have come to the conclusion that it is not expedient to propose the total repeal of the Apothecaries' Act. It is my intention to propose the repeal of that Act only so far as parties who shall be registered under the Bill I am about to introduce shall be concerned. A great complaint made against the measure proposed by me last Session was, that I gave no additional security against empiricism, and that I abolished the penalties already in force. In the present Bill, whilst I propose the partial repeal of the Apothecaries' Act, I shall leave the full powers to enforce penalties untouched which the Apothecaries' Company now enjoys. The Apothecaries' Company will still be allowed to prosecute all those practitioners who shall not be registered under this Bill, and who shall practise without being licentiates of their body. I confess, Sir, that I do not attach much value to the enforcement of these penalties, but I am content to leave the power. Nor do I stop here; I do hope that I shall be able to give an additional security to that offered in the Bill of last year; and as I think it is a security which I can offer consistently with the principle I maintain, against the simulation of the right to practise by an individual who shall not be duly enrolled; I cannot regard it as an offence for any person not professing to possess the required standard of an examination, to practise surgery or medicine, subject to the risk which he runs of a criminal prosecution, and, I believe also, of a civil action, if any injury shall result from his practice. He will still be subject to the general operation of the law; and if he does not pretend to be what he is not, I cannot see why we should make any new crime to make him amenable. I propose, however, to go the length of saying that there shall be an additional restraint, by making it penal for any unqualified person to assume the title of physician, of surgeon, or of apothecary or doctor, or any other title recognised by this Bill. My best course, however, will be, as this is a most important clause, that I should read the whole clause, which runs in these words:— And be it enacted, that every unregistered person who shall wilfully and falsely pretend 1215 to be, or take or use the name or title of physician, doctor, bachelor, or inceptor in the faculty of medicine, or surgeon, or licentiate in medicine and surgery, or apothecary, (I retain that, because I do not now propose to repeal the Apothecaries' Act,) or any name, title, or addition implying that he is registered under this Act, or recognized by law as a medical or surgical practitioner, shall be deemed guilty of a misdemeanour in England and Ireland, and in Scotland of a crime and offence, and being convicted thereof, shall be punished by fine or imprisonment, or both, as the Court before which he shall be convicted shall award. I shall meet many objections by this provision; and I feel it consistent with my duty to go this full length against empiricism, and against the pretenders to medical titles who have not the qualifications they claim. I propose, also, to repeal so much of the Apothecaries' Act as requires the examiners, who will hereafter be conjoined with physicians in the examination of licentiates in medicine, of necessity to be members of the civic Guild of Apothecaries of the city of London. The examiners are now part and parcel of a civic guild, the admission to which may be by purchase or by inheritance, without any medical knowledge or examination. In lieu of the present provision, I propose that the qualification for an examiner shall in future be, an apothecary of ten years' standing, who shall be in practice as an apothecary; or a licentiate in medicine of ten years' standing; anticipating that, after the lapse of ten years, the examiners will, in fact, be licentiates in medicine under this Act, and that under the general name of "licentiates" the examiners will be general practitioners. I come now to another alteration, to which I attach great importance. I confess that I could earnestly desire to see one admission to practice by an examination common to all, and that after all shall have passed one common portal, each should choose what branch of medicine he may wish to practise. My desire would have been to see that common examination; but I have found objections raised to that plan which appear to me to be reasonable and to be insuperable. The College of Physicians has always attached—and, as it appears to me, they rightly attached—great importance to a university education; and to enforce upon persons who have received that education another examination, such as would be enforced upon others at an earlier period, would greatly increase the protracted study of the physician, who could not, according 1216 to my proposal, enter into practice as a physician till he is twenty-six years of age, which is certainly not too late a period of life for a physician to commence practice. This objection is made—that academical education, which is his best foundation in arts, literature and science, is not so various, and not so full upon particular points of the curriculum of surgical and medical instruction as may be acquired by attendance on chemical lectures, and by walking hospitals. This objection, does not apply to surgeons; and I have great satisfaction in knowing, as far as my inquiries have gone, that there is not, on the part of the College of Surgeons, or of the surgeons generally, any objection to a provision in this Bill to which I attach great importance—that no one shall be qualified as a surgeon till he is twenty-five years of age, or unless he shall have been previously examined as a licentiate in surgery and medicine, and shall have passed the examination as licentiate in medicine as well as surgery. There was also an objection made to the Bill of last year, which was not so much a real as an apparent objection—that there was no direct provision for an examination in midwifery. I propose, that henceforth it shall be necessary to make provision in all parts of the United Kingdom for an examination in midwifery, and that there shall be in the registration a distinctive mark that the party has undergone an examination in midwifery, and has so passed. Now, my hon. friend the Member for Middlesex has just presented a petition requiring that the general practitioners should be incorporated. I have, Sir, given my most anxious consideration to that subject; and, at all events, I am desirous not to pledge myself to the adoption of any such measure, till the profession at large shall have had an opportunity of considering the very important alterations made in the Bill which I am now opening to the House. I had proposed to repeal the Apothecaries' Act, and thereby, for the purposes of medicine, to leave the Apothecaries' Company to act only as a guild of druggists. I have now departed from that intention, and I do not now propose to repeal the Apothecaries' Act. I should most deeply regret the separation of the general practitioners from the College of Surgeons. That might in some degree have been the consequence of the measure as it was proposed last year; but I think that evil has been met by the proposition that no one shall be able 1217 to qualify as a surgeon without having previously become a licentiate in medicine. I will not now anticipate a discussion on the new charter granted to the College of Surgeons: that there are defects in it I am fully aware; but when I introduced, for the first time, a particular order into that body, which existed in every other college in England, Scotland, and Ireland, namely, the order of Fellows of the College, it was necessary that I should create a constituency for the election of the Council, and it was also necessary that this constituency should in the first instance be nominated. I only state the difficulty in the recent change; but I now hope that the general practitioners and the College of Surgeons will be in a more close and honourable connexion than at any antecedent period. Now, reserving to myself the right of advising the Crown to grant a Charter of Incorporation to the general practitioners, and stating that I shall be ready to give that advice if I shall deem it desirable, I may say, that I am most anxious to sustain the station the honour, and the attainments of the general practitioners. I believe them to be one of the most useful bodies of men in this country. In large cities, where the numbers are great, a division of labour is not only possible, but it is also desirable, for it leads to increased qualifications and greater remuneration; in great cities the division of the profession into physician, surgeon, and general practitioner, arises by the force of circumstances; but we have to consider the interest of the community at large, and we know that the great body of the rural population must look to the general practitioner; and so far it is desirable for the interests of the public that we should use all our power to uphold the character, the station, and the attainments of the general practitioner. These, Sir, are my decided opinions; and, entertaining these opinions, I doubt whether we should be doing good, and should advance the honour and the character of the general practitioners, by dissolving the connexion between them and the College of Surgeons, and by giving them an institution which might be as good in time as the College of Surgeons, but which would be wholly new—a College of General Practitioners. I am anxious that the alterations I propose should tend to promote the spirit of conciliation; and I am ready to consult as far as I can the feelings and wishes of the whole body of general practitioners. They will have an opportunity of consi- 1218 dering the changes I have made, and of reviewing the requisition they have made for a new Charter of Incorporation. I shall be delighted if the result shall be that they will withdraw that requisition, and, as a consequence, form a close alliance with the College of Surgeons—a great and noble institution, which, with all its defects, has produced some of the most eminent and best surgeons in Europe; which possesses, at this moment, the finest museum in Europe, and one of the most renowned collections in physiology. It is impossible that such a connexion can carry with it any other effect than honour and distinction to the general practitioner; and I cannot anticipate any new arrangement which will be more conducive to the fair fame, the character and the station of the general practitioner. I pass on now to another alteration I propose in the Bill of last Session. It was an obvious error to provide that a gentleman seeking to be qualified as a physician should for the two years immediately preceding his examination at the College of Physicians have resided in the University. In many cases this would be found a great hindrance to attendance on Foreign Universities and to his attainment of useful knowledge by various studies in different quarters. I propose to change the necessity to two years' residence at the University after matriculation, instead of two years before examination. So also with respect to attendance on Foreign Universities; I think upon the whole it is expedient to propose that only one year's residence at a Foreign University should be required, if the student has pursued his education abroad. I now come to the general constitution of the Council, and it is a point of great importance. If, Sir, I filled any other situation than that which I have the honour to hold, I should perhaps have ventured to propose some alteration in the Bill in this respect. It is my opinion that it would lead to far greater safety if there were left to the Executive Government, acting on its responsibility in Parliament, the power of nominating the entire Council. I think there are evils arising from the election of Members by the general medical body, which would thus be avoided; but having proposed a mixed scheme of nomination and of election, on the whole I adhere to the proposition as it was introduced in the Bill of last Session. That point may still be open for discussion; but I beg to state distinctly that, in reserving to the Crown the nomination of six Mem- 1219 bers of the Council, I do not introduce that provision, without stating that any advice I may give to the Crown will be with the view of introducing into the Council a portion of general practitioners, and a portion also of country practitioners. Upon that point I am clear, that the general practitioners and the country practitioners have a right to be represented in the Council. There was also in the Bill of last year an omission which I propose to supply. There was no power given to the Council to remove a person from the register in case of any flagrant misconduct. I propose now to invest the Council with power to remove from the register all parties who may be convicted in a Court of Law of any criminal offence, or who have used any false or simulated testimonials to obtain admission. One other alteration I propose in a provision of the Bill, which arose from a misconception on my part last year. I proposed to give the Faculty of Physicians and Surgeons of Glasgow equal power of licensing with the Faculty of Physicians and Surgeons of Edinburgh. I made that proposition in the belief that the Faculty of Physicians and Surgeons in Glasgow had in the four counties adjacent to that city power to license practitioners both in surgery and medicine; but by subsequent information I have discovered that they have no power to grant licenses for practising medicine. The question has been directly raised before a Court of Law, and it has been determined that they have not such power. I made the proposition on a false conception of their power, and on the whole I think it better to withdraw that provision, and to give the sole power of licensing to the Colleges of Physicians and Surgeons in Edinburgh. I am not aware that there is any other change proposed in the Bill, which I have omitted to state to the House. I have recapitulated the various provisions of the original Bill, and I have pointed out those alterations I intend to make, which, so far from being at variance with any of the objects of the original measure, are quite consistent with them, and conducive to their accomplishment. I have endeavoured to meet fairly the objections of the great body of medical men who have canvassed my measure. I do not complain in the least of the severity of criticism to which it was subjected. I was only anxious to avail myself of the knowledge of the subject which that criticism disclosed. I do now commit the Bill to 1220 the candid consideration of the profession and the public. I certainly have taken a calm and dispassionate view of the whole subject, with only one desire—to promote the interests, not of the profession only, but also of the public. No labour I have bestowed on it will be thrown away in the least degree if that object shall be gained; and I certainly lay this Bill in its amended form before the House in the confident hope and expectation that this Session will not close without some measure receiving the sanction of Parliament which shall better regulate medical practice throughout the United Kingdom. The right hon. Baronet concluded by moving for leave to bring in a Bill for regulating the profession of physic and surgery.

§ Mr. Wakley
I have heard with very great satisfaction the statement of the right hon. Baronet, and I earnestly hope and really believe that the difficulties which beset this subject will be amicably arranged and finally settled. The right hon. Gentleman has shown by the alterations he has proposed that he is most anxious to consider every matter mooted by the general practitioners and the profession. I believe the right hon. Gentleman and the Government to which he belongs could be scarcely aware of the difficulties by which this subject is encompassed. There are so many various interests, so many laws affecting the profession, so many rights conferred by those different laws, in some instances opposed apparently to every principle of sense and reason, that more difficulties were in fact connected with this subject than almost any other requiring the legislative interference of the House. Sir, I must say, I felt very strongly opposed to the other Bill. I considered some portions of it most objectionable; but I do not now wish to refer to those topics of difference. I am so satisfied that the right hon. Gentleman, from the alterations he has proposed, is anxious to conciliate all parties in the profession, and to listen attentively and deliberately to the various suggestions that may be made, that I have only now to request that he will not propose the second reading of the Bill at an early period, but give time for the most mature consideration of its provisions by the profession. If the right hon. Gentleman will only pursue the course he has taken, he will receive, I can assure him, the gratitude of one of the most important bodies of men to be found in this country.

§ Sir J. Graham
had heard with satisfaction the speech of the hon. Gentleman, who had met his proposition in a spirit of calmness and temper that was perfectly satisfactory. He certainly would not propose the second reading of the Bill until after Easter.

§ Sir J. Graham
moved for leave to bring in a Bill for enabling Her Majesty to grant new Charters to certain Colleges of Physicians and Surgeons, which, he said, would serve to render more efficient the operation of the measure he had just now obtained leave to introduce. So far from rendering these bodies more close, the intended Charter would render them more open. He would be quite ready to lay on the Table copies of the four Charters proposed to be granted to the Colleges of Physicians in London, Dublin, and Edinburgh, and to the College of Surgeons in Edinburgh, and then, taking them in connexion with the other Bill, the House would have an opportunity of judging of the entire scheme.