§ Sir J. GrahamI am, Sir, about to ask the House to recommit this Bill, with the view of introducing into it some important alterations; and I may perhaps be excused when I say, that if I could have anticipated the extensive difficulties of this subject, I should not probably have presumed to interfere with it; but having bestowed much labour and attendon 250 upon it, and having at the present moment reason to believe and to entertain the confident hope that I may be able to effect a practical settlement of this difficult question, I should at this, the eleventh hour, abandon that hope with great reluctance; and I own that I have more hope when I ask you to commit this Bill pro formâ, for the purpose of introducing those alterations which I am about to state, than I have ventured to entertain at any former period. I have on more than one occasion, in addressing you on this subject, expressed my very earnest desire, if possible, to adjust the differences which unfortunately exist between the general practitioners of England and Wales, and the College of Surgeons; and I have stated that, in my opinion, a connexion with a body of such eminent superiority for science and ability was a connexion which reflected honour on the entire profession, and was most conducive to its dignity and usefulness, I have expressed that opinion openly and frankly. At the same time, I am bound to state, that differences do exist between the two bodies, which I fear, after much reflection, and after the best attention I can give to the subject, are irreconcilable. The College of Surgeons is in possession of a charter giving the members of that body exclusive privileges, under which they enjoy property of great value, and power and influence commensurate with that property. The general practitioners also are a numerous, and a very strong and powerful body; and if the opinions of a body so numerous and so powerful were to have the complete constituent power in returning the representative body, I believe that in a short time the elected body would reflect only the constituent body, and that the governing body of the surgeons of London would, ere long, be nothing but a reflex image of the general practitioners. Upon former occasions also, I have spoken of the general practitioners in those terms of confidence and of praise which I feel to be their due. In the rural districts, where the subdivision of labour is impossible, they practise as surgeons; and in those cases which need the administering of medicines, they are the dispensers of drugs: their exertions are most useful, and the health and life of a great portion of the community depend on their exertions. At the same time, in this metropolis, where the subdivision of labour is not only possible, but most conducive to the interests of the community, to the practising 251 surgeons—to the pure surgeons, if I may use the term without its being taken in a contemptuous sense, is assigned the great duty of being the teachers of the highest branch of this noble profession; and it is by the College of Surgeons that the bounds of science are extended. I attach, therefore, great importance to the maintenance of the College of Surgeons in London for surgeons, as contradistinguished from the general practitioners; and though I may incur censure for the terms in which I now address the House, I conceive that no greater misfortune could befal the medical world, and no greater evil could befal the community at large, than to degrade the surgeons of this metropolis, which we should do if the College of Surgeons were transferred to Apothecaries' Hall; and if we insist on maintaining the connexion between the general practitioners and the College of Surgeons on an equal footing. If the 12,000 or 14,000 general practitioners have each a voice in the nomination of the governing body, this evil will be produced; for the inevitable effect will be, that the general practitioners will supplant the surgeons, and eventually control the College of Surgeons. Having arrived at the conclusion, not hastily, but after deep reflection, I repeat my fear that the differences between the College of Surgeons and the general practitioners are of an irreconcilable nature. On the other hand, I will confess, although I do not admit that all the objections taken by the general practitioners against the ruling powers in the College of Surgeons and the College of Physicians are well founded, and although I think that their jealousies are in some respects exaggerated, yet there are certain precautions which they desire, and which they may rightly require to be taken. The general practitioners state, with respect to the examination of persons in their own branch of the profession being placed in the power of the surgeons, that it is the interest of the surgeons to degrade the standard of the qualification of general practitioners; and that as the level of the general practitioners is lowered, so the comparative heads of the profession in the College of Surgeons would be exalted. Some precautions ought to be taken against such an abuse of power and authority on the part of the College of Surgeons. Having admitted, then, that some precaution on this point is necessary, and fearing, after the attempts which had been made, that it was in vain to attempt to reconcile the differences 252 between the two bodies, I have come to the conclusion that it is indispensably necessary to maintain the interests of the general practitioners, and to secure the dignity of that portion of the profession by the maintenance of a high level and standard of qualification for the general practititioners; and that it is, upon the whole, expedient to incorporate the general practitioners in a College of their own. This decision will give great facilities for attempting to introduce some alterations, and for securing what I think are objects of great public importance. First, I think that, together with the incorporation of the general practitioners, the connexion between the great body of the medical students and the incorporated colleges need not be dissolved; and next, with respect to all the students who shall hereafter enter the profession, a point to which I have always attached great importance may be secured, namely, that the entrance to the profession shall be by one portal only, whatever may be the future destination of the student. I propose that every person who shall enter the profession, whether it is his intention to become a general practitioner, a surgeon, or a physician, shall undergo an examination by one board, and that the standard of competence shall be, in the first instance, the same to all. I contemplate, then, by this Bill, three colleges—the College of Physicians, the College of Surgeons, and the College of General Practitioners; and my proposition will be, in the first place, that no person shall be examined as a general practitioner till he has attained the age of 22; he may now be admitted at 21; and it is with the view of prospectively elevating still higher the general practitioner, that I now propose that the age for examination in the first instance shall be 22, instead of 21. Then with respect to the College of Physicians and the College of Surgeons, I propose to form a joint board of examiners of those two colleges only This board of examiners, to which every candidate for admission into the profession must first present himself for examination, may be composed, I should say, though I will not now enter into the details, of six members of the College of Surgeons, and six members of the College of Physicians. Before examiners appointed by these two colleges, the candidate for admission to the profession must present himself at an age of not less than 22. The control of the curriculum of education would be exercised by this 253 junction of the board of examiners. Then, I propose that the general practitioners shall appoint another board of examiners, composed exclusively of general practitioners; and if a student of the age of 22 seeks to become a general practitioner, the examiners of the Colleges of Surgeons and of Physicians would grant the permission, after an examination by them, to go before the examiners of the College of General Practitioners. With regard to the Colleges of Surgeons and of Physicians, I propose that at the age of 26, the student may also go before another board of examiners; if he seeks to become a surgeon, that he shall go before the examiners of the College of Surgeons at the age of 26; and if he seeks to be a physician, he shall at that age go before the examiners of the College of Physicians. The only difference will be, that for the general practitioners the age will be 22, and for the surgeons and physicians the age will be 26; and the candidate seeking to be a general practitioner will go before the board of examiners of the general practitioners, and in the other cases they Would go before the College of Surgeons and the College of Physicians respectively, according to the branch of the profession they may propose to follow. Sir, I could not have come to the decision of recommending the Crown to grant a charter of incorporation to the general practitioners, without the full concurrence of the Apothecaries' Company. I should not have thought it consistent with my duty so to advise the Crown to set aside the charter to that body. That body, however, acting in the most handsome manner, have concurred with the general practitioners, and have consented to surrender, on terms, the powers of the Apothecaries' Company under the Act of 1815. In the Bill, as now amended, I propose to repeal the Apothecaries' Act. This repeal will obliterate every vestige of that system of five years' apprenticeship which has been thought so very objectionable, so injurious to the character of the general pratitioner. I should state, in frankness to the House, that although on former occasions I said that I did not attach much importance to the powers of prosecution given to the Apothecaries' Company under the Act of 1815, still I am prepared, instead of abolishing these powers, to transfer them entire and intact—neither adding to them, nor taking anything from them—to the new College of General Practitioners. I should now mention, 254 as consequent upon the change to which I have already referred, that I propose some alteration also in the composition of the Council of Health. It has been urged by persons whose opinions are entitled to the greatest respect, that the elective principle should be abandoned, and the power of nomination vested absolutely in the Crown, under certain restrictions. I have stated, and I repeat, that, occupying the place which I now hold, and having introduced this Bill, in concert with many parties, upon another principle, I am reluctant to take that course. It is for the House deliberately to consider that question; but I adhere, as at present advised, to the principle of the constitution of the Council as it now stands. But maintaining it in that form, having erected the general practitioners by charter into a college, I think it absolutely necessary that they should be represented in the Council of Health; and I propose, therefore, that two of the College of General Practitioners, chosen by the Council, shall be members of the Council of Health. I must also say, that I think upon the whole, I ought to supply an omission which I have hitherto made, and that the University of London ought to be represented in the Council of Health. I propose, that either the Chancellor or Vice Chancellor of that University shall be a member of that Council. When I last addressed the House upon this subject, I stated that no arrangement had been come to between the Universities of Oxford and Cambridge, and the College of Physicians, and that it would therefore be necessary to introduce into the Bill a clause exempting Oxford and Cambridge from its operation; the effect of that exempting clause being, to leave to those Universities such power of granting degrees as they now enjoy, so that their graduates would be entitled to practise throughout England and Wales, but they would remain still excluded from practice in the metropolis, and within seven miles around it, by the privilege of the College of Physicians. I am happy to say that an arrangement has now been made between those bodies. It will still be necessary to retain in the Bill a clause exempting the Universities from the operation of the measure; but practically, the agreement, while it lasts (and I hope it will be permanent), will render that clause inoperative. The agreement between the Universities of Oxford and Cambridge, and the College of 255 Physicians is this—that after a party shall have graduated in medicine, and obtained the degree of Doctor in either of those Universities, he shall, if he think fit (and the temptation is great to induce him to think fit), come up to the College of Physicians for examination; and his diploma of the College will open metropolitan practice to him; but at his previous examination assessors from the Universities are to be present and to take part in it. An objection has been taken to the concluding part of Section 28, which gives to the Council of Health the power from time to time to make regulations, specifying what institutions are to be considered "public institutions" within the meaning of this Act, and what form of testimonial shall be necessary to qualify the officebearers in them, whether they shall be physicians, surgeons, or general practitioners. I think that upon the whole that is an invidious power to vest in the Council of Health. I am disposed, therefore, to omit that provision, and to leave it to the operation of public opinion, and to the various hospitals and institutions, to decide which of the three classes or of the particular candidates is best entitled to their confidence. Some misconception also has arisen with respect to the import of Clause 23, with regard to what is there termed an "inceptor" of medicine; I think that is perhaps a term better avoided, and I propose to introduce the word "licentiate." At the same time it is an important clause, especially as relates to the Scotch Universities. [Mr. Warburton; Hear.] My hon. Friend cheers; I am afraid the cheer indicates jealousy; but the right hon. Gentleman below him, the Member for Edinburgh (Mr. Macaulay), would be disposed to defend the just rights and interests of that eminent school of medicine which he more especially represents; for Edinburgh has produced some of the greatest physicians, and to whom the science is greatly indebted; and I think, while we are bound to take every precaution against undue preference of the Scotch Universities, we ought to take care that their just claims shall not be prejudiced. I think also that the licentiates in the Scotch Colleges at 22, on passing not only their examination before their University, but undergoing a stict examination before a board composed from the College of Physicians and College of Surgeons in Scotland, are fairly entitled to all the benefits of general practitioners throughout the United Kingdom. I admit at once that the justice 256 of this measure depends entirely upon the standard of acquirement and knowledge being fairly maintained; and from all my communications, both with the Scotch Universities, and Colleges of Physicians and Surgeons in Scotland, I am quite satisfied that there is no indisposition on their part that the standard shall be fixed high, and being fixed, shall be carefully observed. Observe, the Council of Health will have a general controlling power over all the examinations, by all bodies in the Kingdom. I think the hon. Member for Kendal (Mr. Warburton) appears to demur. There is a power (which I am quite prepared to maintain rigidly) of sending down assessors to be present at these examinations; but if you fix your standard as high as the learned bodies in Scotland by their curriculum are prepared to elevate it, and the College of Physicians and Surgeons in Scotland also, and if over the whole you maintain the control of the central ruling authority of the Council of Health, you certainly have taken every reasonable precaution against an inequality of standard and of acquirement. Some doubt having arisen with regard to that clause, I think the phraseology of it may be altered. The purport and intention of it are as I have stated; but for the sake of perspicuity, and to remove all doubt, I alter the language of it to give more strict effect to the object of the Bill. There is some little difficulty, because while prospectively there will be only the three classes—physicians, surgeons, and general practitioners—retrospectively there are certain distinctions in different parts of the United Kingdom; for instance, physicians entitled to a license to practise intra urbem, or a license to practise ultra urbem. When we go into Committee on the other Bill (the Collegiate Bill), it will be my duty to lay upon the Table a copy of the new charter proposed to be granted to the College of Physicians in England, and to certain bodies holding charters under the sanction of Acts of Parliament in Scotland and Ireland. The general practitioners will receive a charter by prerogative, which it is in the power of the Crown to grant, and on my responsibility I shall advise the Crown to grant it. But I was about to say, that due facilities will be given to parties now exercising limited rights to practise under restrictions, which it will be possible for them easily to remove under the new charter; but in case of their not choosing to avail themselves of those facilities, 257 I propose to introduce into the register a particular mode, by which they will register their existing right, and retain it intact, nothing being taken from it, nothing added to it; but during thir lives they will be entitled to the full enjoyment of the exact privilege they now possess. For instance, a physician licentiate practising beyond the seven miles may register as a licentiate extra urbem; a Scotch physician now practising in England will retain his existing legal right, but acquire no additional one by the new Act. I propose to prevent all ambiguity with reference to the assumption of titles. I stated when I addressed the House before, that I thought it most consistent with the principle of this measure, not to introduce provisions for the suppression of quackery by Act of Parliament, but still that the simulation of titles not really enjoyed in conformity with the Statute shall be a misdemeanor. To that principle I shall still adhere. Some doubt has arisen with regard to the assumption of the title of "Doctor" by a general practitioner, not a member of the College of Physicians; I think, upon the whole, it is not unreasonable to insert that title as one which shall not be assumed except by a member of the College of Physicians; but with that single exception, I am not prepared to carry the provisions of the Bill further than they stand in that respect. I am not aware that I have now omitted any point; it is most important that it should be known throughout the United Kingdom what is intended to be proposed, and at the risk of wearying the House I have thought it right to make this statement. I propose now to go into Committee pro formâ, and then to reprint the Bill, and postpone the Committee to some day towards the middle of June, leaving till the same day the second Bill with reference to the charters of the incorporated bodies. Immediately after the recess, or, if possible, before it, I will lay upon the Table the new charter of incorporation, which I shall advise Her Majesty to grant. The matter then will be fully and fairly before the public, and time will be given to the country to consider it. I have done my best towards a settlement of this question. If I fail in what I now tender to the House and to the public, I confess I shall absolutely despair; but I cannot at present despond after my communications with the College of Physicians and the College of Surgeons, and the general practitioners, all of whom have 258 consented to this measure, though of course in such large bodies there must be several dissentients. It is an arrangement which I cannot but hope will be conducive to the promotion of the health of the people of this country, and to the honour and harmony of a most meritorious and useful profession.
§ Sir W. Claywished to know whether the draft of the new charter was now to be laid upon the Table?
§ Sir J. Grahamsaid it was not; but he had no objection to state the outlines of it. He proposed that the council should consist of forty-eight members; that the qualification should be fifteen years of general practice; that the constituent body, voting for the election of the council, should be general practitioners of ten years' standing; and with regard to the council, that there must be the double qualification for the last fifteen years of membership of the College of Surgeons, and also of the Apothecaries' Company.
Colonel T. Woodinquired whether this new incorporation was to give a second degree in medicine after a certain number of years?
§ Sir J. Grahamanswered, that it was not. The general practitioner must, before he could become such, pass a double examination; before the mixed Board of Surgeons and Physicians in the first instance, without whose initiat he could not go before the Board of General Practitioners. The general practitioner would have nothing to do with the College of Physicians or of Surgeons. A party desirous to become a surgeon, would in the first instance go before the mixed Board of Physicians and Surgeons; and then for the fellowship he must undergo an examination of a higher character in surgery, before examiners appointed by the College of Surgeons.
§ Captain Rousasked, whether the examinations would be public or private?
§ Sir J. Grahamsaid, the details of these regulations were to be the subject of bylaws, which must receive the sanction of the Secretary of State.
§ Mr. Hawesthought the right hon. Baronet had taken a satisfactory view of the question; and there was no reason why he should despair of effecting a final settlement. Equality of qualification, combined with equality of privilege, seemed to be the main principle of the Bill. At present, however, he (Mr. Hawes) did 259 not see that there was sufficient security for the observance of that principle, if the 26th Clause (constituting the examining bodies) remained as it was, coupled with the 22nd Clause. The right hon. Member for Edinburgh (Mr. Macaulay) would see that the Council of Health had full power over the regulation of the examination. It might be extremely difficult at present, without their active interference, to constitute a board in Edinburgh; but it was not quite clear that their interference would secure the great principle just mentioned, to the satisfaction at once of the schools in Scotland and other parts. The best security would be, the teacher's being in no case the examiner; that the board should be perfectly independent of schools and pupils. The principle of separating the teacher from the examiner had worked well in the University of London, and had given satisfaction to the public. But these were matters of detail that might be reserved for the Committee, where, he thought, the 22nd, the 23rd, and 26th Clauses would require some consideration. He did not share the apprehensions expressed by the right hon. Gentleman as to the consequences of making the general practitioners the constituent body of the council of the College of Surgeons; but he believed there were now insuperable difficulties in the way of such an arrangement, and, therefore, he thought the right hon. Gentleman had done wisely in making the general practitioners an independent body. He had had extensive communication with the profession both in London and its neighbourhood and the country, and he believed it would receive the declaration of the right hon. Gentleman with great satisfaction, and feel most grateful to him for the pains and care he had bestowed on the measure.
§ Mr. Wakleydiffered entirely in opinion from the hon. Member for Lambeth. He was inclined to believe that the alterations in the Bill which the right hon. Gentleman had announced would be productive throughout the profession of the greatest possible dissatisfaction. The hon. Member for Lambeth might be better acquainted than he was with the feeling of the profession; but he had had an intimate intercourse with them for the past twenty years, and was in the habit of hearing from them daily from most parts of the kingdom; and his conviction was that they would 260 feel the greatest possible disappointment on hearing the alterations the right hon. Gentleman proposed to make. He was sorry to be compelled to make this statement, because he had hoped the changes intended to be introduced would have improved the Bill, and removed the feeling of discontent that prevailed so generally in the ranks of the profession throughout the country. He had understood that one object of this legislation was to simplify the state of medical law; did this Bill effect this? By no means; for the purpose of carrying his object into effect, the right hon. Gentleman first proposed to repeal the 55th of George III.—the law which prevented a gentleman educated in Ireland or Scotland practising in this country. What did the right hon. Gentleman say now? He meant to transfer the powers and provisions of that Act to the new incorporation; and stated that no person should be permitted to practise in England as a general practitioner, unless he had undergone an examination before this new board.
§ Sir J. Grahamsaid, the hon. Member for Finsbury had misunderstood him. The Bill provided that any person passing the necessary examination in Ireland or Scotland before the Joint Board of the College of Physicians and the College of Surgeons of the two countries respectively, should be entitled to be registered as a general practitioner throughout the United Kingdom; and no power was transferred from the Apothecaries' Act of prosecuting parties so registered for practising.
§ Mr. WakleyThen, in that case, of what value would the new incorporation be to the general practitioners? It would be the mockery of a benefit, and nothing more. Under the Bill, as it formerly stood, the general practitioner was to derive his right from one examination instituted by the College of Physicians, assisted by a Board of Examiners of the Apothecaries' Society, and the College of Surgeons. That was a more simple arrangement than the present; now, every man before he could practise in England must go before the College of Physicians, or the College of Surgeons, or both, in the first instance. [Sir J Graham: Before a joint board.] He must go before a joint board! But did that elevate the general practitioner in public estimation? It degraded him, and placed him in a lower position. In point of fact, by this very board, instituted 261 stituted between the two Colleges, they repudiated the general practitioner, and declared him unworthy of forming a portion of that board; if the general practitioners were entitled to that respect which the right hon. Gentleman had expressed for them, why not at once admit them to form a portion of that board? But the fact was, the ruling powers of these Colleges had induced the right hon. Gentleman to make their insulting conduct towards the general practitioners the rule for the legislation of that House; he trusted that this disgraceful conduct would not receive the sanction of Parliament. What provision was there in the Bill that removed the hostility felt by the council of the College of Surgeons to the great body of the profession? Did any provision refer in the slightest degree to these parties? None whatever. What was the history of this transaction? He was labouring under so severe a cold that he could not go into it — and perhaps the right hon. Baronet was glad he could not—but the House and the country ought to know it. 12,000 gentlemen had been subjected to the greatest indignity from parties whom he could not then name; a conspiracy against them had been entered into and carried out by the same parties; and the right hon. Gentleman was prepared to ratify what they had done. For many years the profession had been petitioning the House for a reform in the state of medical law; for fifteen or twenty years they had been making every effort to improve their condition. In 1826, one of the largest medical meetings ever held took place in London; a member of the council of the College of Surgeons, Mr. Lawrence, was in the chair; at that meeting resolutions condemnatory of the conduct of the council were adopted, and a petition agreed to which was afterwards presented to that House, praying that the members of the College of Surgeons might be admitted to the elective government of that institution. From that time the subject had been discussed, medical associations had been formed, and Parliament had been entreated to do justice to the great body of the medical men of the country. But, to the astonishment of the Members of the College of Surgeons, a charter was granted to the council of the College, containing provisions of an odious and obnoxious nature. The Members of the College were 12,000 or 14,000 in number; the council 262 consisted of 21 only; yet the council, whose conduct was condemned—the council, who were the individuals who had so misbehaved themselves in reference to the mass of the members, and to whose conduct the most opprobrious terms were applied, and most justly—how were they treated? Were they punished for their conduct? On the contrary, they seemed to be rewarded for their misbehaviour by the new charter, which they received in a secret, private, and, he would say, in a clandestine manner. Did the present Bill propose to alter the powers of that charter, and to place the Members of the College in a better position? In the Bill, as it stood, the powers of the charter were confirmed. In the proposal of the right hon. Gentleman, no reference whatever was made to them with a view to their being altered. Only that day the right hon. Gentleman had had a memorial addressed to him at the Home Office from thousands of the medical men of the country; and he had also that day received a communication from Shropshire, forwarding to him the resolutions of a meeting of the medical men of Shropshire and North Wales, held on the 3rd of April last, one of which claimed the right of admission to the advantages enjoyed under this charter, on the ground of having passed through the same course of study, the same examination, and having paid the same fees. Language of a much stronger kind than this had been used, for the feeling of discontent was general and deeply rooted. Yet the right hon. Gentleman made no proposition for preventing these 12,000 or 14,000 gentlemen from being subjected to the same indignities of which they had before complained. But the right hon. Gentleman had got some kind of remedy; he proposed to transfer them to an institution of their own, which would be a kind of new Apothecaries' Hall. Did the right hon. Gentleman believe that the surgeons of this country would be contented with such an arrangement? The proposition was an insult to them, and if they were contented with it, they deserved to get no redress. Did the right hon. Gentleman propose to place the College of General Practitioners on the same footing as the College of Surgeons? No, it was on an inferior footing, both as to privileges and laws. If it was an equal institution, enjoying equal rights and equal laws, it 263 would be another thing; but the right hon. Gentleman had yielded to the suggestions of the other governing bodies. The right hon. Gentleman stated, that his arrangements were in unison with the wishes of all parties, including the Committee of General Practitioners; but before the middle of June the right hon. Gentleman would know what was the feeling of the profession on this subject. They were denied the privileges to which the right hon. Gentleman allowed they had a right. Were they to be denied the enjoyment of the privileges of their own College? Could not the right hon. Gentleman alter the charter, notwithstanding the council was hostile to the alteration? He had full power to do it, and might dissolve the whole body if he chose. Under such circumstances, was it prudent to multiply corporations? To gratify the ignorant and stupid prejudice of the council, the Parliament was called on to degrade the members of the profession, although they had violated no law whatever. A more unjust proposal could not be made to Parliament. The evidence taken before the Committee of 1834, including that of the most eminent men, Sir Astley Cooper, Lawrence, and Sir B. Brodie, recommended the establishment of only one medical corporation, and examination before one board of competent men. What were surgeons if they were not competent as medical practitioners also? Surgery constituted but a small part of medical practice. Not 20 cases out of 100 in succession were purely surgical cases. The most important part of practice was medical treatment; and if a man was not capable of giving such treatment he was incompetent to practise the profession. Why, then, should the boards be multiplied? He was not aware that the surgeons of this country had forfeited, in any particular, the respect to which they were entitled from that House and from society. Their object was to participate in the government of their own College. The College of Surgeons had one of the most splendid museums in the world; one that was an honour to the country, an advantage to science, and of vast use to medical men; more than 100,000l. had been spent upon it; the library of the College contained 16,000 volumes of books. The members of the College wished to have some voice in the government of this institution; and if the 264 right hon. Gentleman knew anything of the feeling of the profession, he would not hesitate to declare that such an arrangement ought to be made forthwith. The council themselves were not satisfied with the charter. During the last year a member of the council (Mr. Guthrie) petitioned the House against it, and had repeated that petition in the present Session. But, notwithstanding the allegations of this petition, and those contained in memorials of the same kind, the right hon. Gentleman insisted on maintaining the integrity of the charter, and the continuance of that injustice so wantonly inflicted on the great body of the surgeons of this country. Did he believe they would be satisfied with being thrust out of their own institution, for the purpose of exercising a miserable privilege elsewhere? What was the title of the new Corporation? [Sir J. Graham: "The College of General Practitioners."] It was not a faculty of medicine; it was not a College of Surgeons. [Sir J. Graham: It is the title they have given themselves.] He contended that it was a name forced on them by the aristocratic and conceited bodies, the Councils of the Colleges of Physicians and Surgeons. Had they possessed the right of governing their own institutions, they would never have heard of any other names than those of surgeon and physician. A judge had declared, in a recent trial, that the same degree of medical skill could not be expected in the country as in London. Why, there was hardly a country town in England that had not a Brodie in it, with the same amount of talent, but with less opportunity. He undertook to say that the surgeons of this country were the first body of medical practitioners in the universe. In London the arrangements of society separated the medical men into different divisions; but in the country, if a surgeon had a difficult case, one which required promptitude of action, decision, knowledge of anatomy and pathology, and operative surgery, had he the means of casting off his responsibility on some distinguished "pure" of London? Could he send for Brodie or Mr. Liston, or any other man, to take the responsibility from himself? No; he was called on to act at the moment, and at the moment he did act, in a skilful and scientific manner. The operations which many of the country surgeons had performed were never 265 surpassed in skill by the first men in the metropolis. Many of those men had been in practice twenty or thirty years; yet under the provisions of the charter of 1843 they found young men, who had their diploma only four or five years, exalted to the position of Fellows, while they, notwithstanding their ability and success in their profession, felt themselves disgraced and degraded by comparison with those Fellows. Those country surgeons were not only capable as surgeons, but they were physicians; they were complete medical practitioners, they knew their business thoroughly. For those men the right hon. Gentleman was going to provide a second Apothecaries' Hall. ["No, no!"] The right hon. Gentleman had stated that if the general practitioners got possession of the College of Surgeons, it would become another Apothecaries' Hall. He hoped the right hon. Gentleman would pause before he took the steps he had intimated to the House. The scientific portion of the community had a right to expect that the members of the College of Surgeons should be enfranchised in their own institution. The principle upon which the right hon. Gentleman acted was this: twenty councillors who had misconducted themselves, and brought upon themselves the slight of the whole profession, because they had acted unjustly towards them, were to retain their power; and yet their convenience and feelings were to be consulted, and 12,000 members of the College, who had committed no offence, who had done no wrong, who had violated no law, were to be spurned with contempt from the portals of their own institution. It was the duty of the right hon. Gentleman to diminish the number of examinations, rather than increase them; and it would be advantageous to have one board only, instead of three or four, provided proper arrangements were made. He would take that opportunity of asking whether the right hon. Gentleman would assent to have a Committee appointed to inquire into the state of the College of Surgeons? [Sir J. Graham: No, no.] The right hon. Gentleman refused. Well, then, he must admit the facts stated? There would be no justice in refusing an inquiry. [Sir J. Graham: There has been one.] That was in 1834. There was quite sufficient then to show that an alteration of the jaw was required; but more proofs had accumulated 266 since. He hoped the letter from the council to the general practitioners would be printed, without further delay, and laid before Parliament. It ought to have been printed before. Would the right hon. Gentleman print it? [Sir J. Graham; The House prints, not I.] He believed that when the House was in full possession of information with regard to that College, the right hon. Gentleman would not carry his Bill; for it would then be apparent that the general practitioners ought not to be left in their present anomalous position, and that they should be removed from the degraded situation in which they had been placed by the charter. With regard to the memorial, that was not sent by the College, but by the council. [Sir J. Graham; It bore the Corporation seal.] Yes, doubtless it had the Corporation seal; but the members were never consulted upon it. Upon no occasion, during the whole forty-five years of their existence, had the council ever called the members together to consult them upon any one subject. Moreover, the council conducted all their proceedings with closed doors, so that when the time of election came they elected in the dark. Look at the manner in which the money was dealt with. The College had received 400,000l. since 1800, and had never established a single medical scholarship until four years ago out of their funds. The whole proceedings of the College were unjust to the members, who, by their own talent and respectability, had most honourably established themselves in society, while from their own institution they received nothing but insult and indignity.
§ Mr. Warburtonsaid, that, considering the happy unanimity which seemed to prevail on the subject of Medical Reform, he had no doubt that the cause could easily be discovered why he had been induced to abandon the lead on this subject, and leave his mantle to be taken up by the right hon. Gentleman opposite. The Bill had for its objects the establishment of a uniformity of education, examination, and privilege in practice throughout the whole kingdom. The question was, whether the right hon. Gentleman had taken ample security for the accomplishment of those objects. Some of the profession thought not. He feared that, with regard to Scotland, the Bill would have the effect of rendering the system of 267 medical education there less efficient than it was at present. The hon. Gentleman was pursuing his observations, when
An hon. Membermoved that the House be counted; but more than forty Members were found to be present.
§ Mr. Warburtonresumed: According to the evidence obtained by the Royal Commission to inquire into the management at the Scotch Universities, it appeared that the professors were considered rather lax in their examination of candidates for medical degrees in Edinburgh, because, being paid in proportion to the fees paid, they were interested in the number of persons admitted to degrees. Therefore the provision in Clause 26 of the Bill, which proposed to constitute a joint board, composed partly of the professors of the University and partly of the examiners of Colleges, in order to ascertain the qualification of candidates desirous of becoming general practitioners, took away the security which at present existed in Edinburgh, of the second examination. These, however, were matters which admitted of improvement in the Committee on the Bill. There was nothing in the Bill with respect to the privileges that ought to attach to those who attained a proper degree of education. They must offer rewards in the way of privileges to those who attained a certain standard of education. What were to be the privileges of the general practitioners under the new charter which was to be given them? Would those who were to be examined by the joint board of physicians and surgeons, and by the new corporation of general practitioners, be considered admissible to all situations now held by licentiates of the College of Surgeons? [Sir J. Graham observed that they would.] It was also a point worthy of the consideration of the right hon. Baronet, that, as those who were examined in Scotland and Ireland were to be admitted to the practice in England, there should be a reciprocity, and that it should be provided on the other hand that all who reached the standard of" education in England, should be admissible to the privileges existing in Scotland and Ireland. He objected to the ridiculous feeling of monopoly on the part of those who governed the College of Surgeons in London, which induced them not to admit into the College those who, as it was termed, had dirtied their fingers with pharmacy or midwifery. What was the case in Scotland? 268 There Dr. Abercombie, and other eminent men, had begun their career as general practitioners, had risen to the rank of consulting surgeons and physicians, and were admitted into the College of Physicians.
Mr. Aclandthought it would be a great evil if such general and violent statements as those made by the hon. Member for Finsbury against the College of Surgeons were to go forth to the country uncontradicted. It was difficult to collect anything very defined from those statements, beyond the oft-repeated cry against the "pure" surgeons. The simple question, however, was, whether or not the science of surgery, for which the College of Surgeons was founded, was not as a distinct subject, one of national importance. He was quite sure that such was the opinion of the leading men in the profession. He did not see, if the 12,000 or 14,000 general practitioners in the country were to elect and be eligible for the council of the College of Surgeons, how a great evil in the excitement of popular feeling and canvassing which would distract the profession, could be avoided; and it might be doubtful whether, under such circumstances, the leading men in the profession would be the governing body. He (Mr. Acland) had had opportunities of ascertaining the opinions of medical men in the metropolis, and he believed that they had generally much more confidence in the College of Surgeons than the hon. Member for Finsbury was disposed to allow. He denied that the College of Surgeons had shown themselves an exclusive body. During the first four years from 1800, 682 persons were admitted by them to diplomas, which showed an average of 134 per annum. During the last five years, however, they had admitted 2,763 persons, an average of 552 per annum. It must be remembered, too, that the application for the diploma of the College was voluntary, not compulsory; therefore the number who had taken diplomas was a proof of the high value in which they were held. The hon. Member said he felt bound to vindicate the conduct of the College. They had only been influenced by a desire to maintain the dignity of the profession, and, at the same time, to obtain the best security for the future advancement and enlargement of the boards medical science.
Mr. H. Berkeleywished to say one word in explanation of the course which 269 he had taken that evening in moving that the House be counted. He did so in order to express his extreme disgust that the Motion of the hon. Member for Finsbury should have been stopped on the preceding night, as it was a Motion which he thought ought to have been disposed of before the present measure should be proceeded with. He thought Her Majesty's Government were bound to have given the hon. Member an opportunity of bringing his Motion in the first instance, more particularly as the object of it was to bring before the House the conduct of the College of Surgeons, which conduct, he begged leave to say, had excited the disgust of the greater portion of the medical profession throughout all England. The persons selected as Fellows by that College were in many instances marked by an absence of talent. In fact, they had frequently no reputation at all. He entirely disagreed with the hon. Member who had last sat down in his opinion that those who had not been selected by the council of the College of Surgeons as Fellows had not suffered in their professional interests. He would mention cases in point. He would take the case of a man very well known in the medical profession—one who, he believed, was distinguished for his very great scientific abilities. He alluded to Mr. Dermott. He was a gentleman who had had under his care a considerable number of pupils, some of whom had arrived at all the knowledge of the highest branches of their profession through his instrumentality. Now no person could convince him that a gentleman in Mr. Dermott's position, who was a lecturer, and not a medical practitioner, was not injured in being omitted by the council of the College of Surgeons from the fellowship of their body. He would maintain that it was a slur upon that gentleman, and an injury to him in his profession. [Mr. Acland had alluded to patients, and not to pupils.] He said, the gentleman to whom he alluded was a lecturer in the Charlotte-street School of Anatomy, Bloomsbury, where the hon. Gentleman could go and take lessons in anatomy, if he had any mind for doing so. He would take another case in the hon. Member's own neighbourhood. It was the case of a gentleman who had performed operations in surgery as difficult and as celebrated as any ever attempted even by Sir B. Brodie or Mr. Liston. He referred to Mr. Frogley, of 270 Hounslow; and he would ask whether it was no slur on such a man to be passed over by the council of the College of Surgeons? He had had no intention of addressing the House, but he was anxious, after moving that the House be counted out, to assure the hon. Member who had been speaking at the time, that he had adopted that course out of no disregard to the hon. Member, but solely to mark his sense of the position in which the hon. Member for Finsbury had been placed by Her Majesty's Government.
Colonel T. Woodobjected to the separate incorporation of the general practitioners, which would create party feelings and jealousy, against which he did think the House were bound to set their faces. The incorporation would be a mere mockery, because they were to have no power. It would only cause them to look with envy and dislike on the College of Surgeons. As to that College, not only did the right hon. Gentleman (Sir J. Graham) obstinately refuse any inquiry into the mode in which the charter of the College had been carried out, but he also refused any remedy. The hon. and gallant Member strongly condemned the manner in which the elections to fellowships had been made. The case of Mr. Frogley was a very strong one. The system operated most injuriously on military and naval surgeons: many of them having been absent discharging their duties in distant climates, from the age of 25, would be excluded from the fellowships when they came to settle in the country, after their period of service expired, until they were become superannuated. The officers of the Public Service had never, since the surgeons were separated from the barbers 100 years ago, been considered as apothecaries, and they had always had the right of succeeding according to seniority and merit, if living in London, to the honours of the college, a right which no members who practised as apothecaries possessed. The officers of the Public Service had been deprived of this right. Why? Would the Secretary of State say in what way they had deserved this punishment? He should detail three cases. In the first two, the surgeons had distinguished themselves at Gwalior and Hyderabad, and had merited the thanks of this House. Educated at Westminster School, they were classical scholars, and house surgeons 271 of hospitals in London, in which they studied five years; they had had a higher course of education than was now required for a fellow or elector. They had been fourteen years in Her Majesty's service. When they had completed their twenty years, and returned to London, they would find themselves excluded from the fellowship, and young men who were infants when they became members placed above them. If they offered to prove their ability by examination, and by the usual fine, they could be restored under any circumstances to the places they held in 1842. The charter that did this was an unjust and oppressive instrument. The third case was not less peculiar. A gentleman of attainments and education, after the usual course of study, was chosen to be teacher of anatomy in an hospital school, and is acknowledged as such by the council of the College of Surgeons. His merit, after a winter probation, was admitted. This gentleman accepted an assistant surgeoncy in the Guards, which took him out of London three months in the year, and was succeeded as a teacher by a junior man, and a junior member of the college. What had been the consequence? This junior had been made a fellow and elector. The man of admitted merit, because he was a surgeon in the Guards, was excluded. The fact was, general dissatisfaction existed in the body of the profession. Still the right hon. Gentleman, upon some principle which he could not comprehend, refused inquiry, which, if it took place, might enable the House to establish the profession on a proper footing.
§ Captain Rousbelieved all parties wished for the introduction of a Bill that would confer the greatest extent of benefit on the profession. By the Bill of the right hon. Baronet, the members of the council of the College of Surgeons were required to be of fifteen years standing, and they were to be elected by practitioners of ten years' standing; he rose for the purpose of suggesting to the right hon. Baronet that it would be an improvement on that plan that would, he thought, become very popular in the profession, if younger members were to be allowed the elective franchise.
§ House resolved itself into Committee.
§ Sir J. Grahamsaid, that now the Speaker had left the Chair, he wished to 272 make a few observations in explanation before he proposed his Amendments on the Bill. In the first place, he must comment on what fell from his hon. and gallant Friend the Member for Middlesex. He could not help feeling that some of the observations of his hon. Friend appeared to be frivolous, when he complained of his (Sir J. Graham's) alterations made in his own Bill. But what was it? He had altered this Bill, and had yielded his own opinion to the feelings and wishes of the profession, and then his hon. Friend brought the charge against him that he had most unnecessarily been the occasion of creating divisions in the profession. He appealed to his hon. Friends the Members for Kendal and Lambeth, as to whether a more unjust accusation could be brought by one Friend against another, than by making him responsible for divisions in the medical profession. The hon. and gallant Officer opposite had asked him what powers would be possessed by the general practitioners. The gallant Officer was quite wrong in supposing that they would have transferred to them the powers of the Apothecaries' Act, so as to prevent any one practising who was not a member of that body; for under this Bill persons registered in Ireland or Scotland would have the same privileges as those in England; but in this country these privileges would be enlarged, as he had already explained. It was said that the Colleges of Surgeons and Physicians wished to arrogate to themselves all the powers of the profession; but by this Bill the body of general practitioners of England and Wales would have transferred to them privileges nearly equal to the membership of the Colleges of Surgeons and Physicians. A great deal had been said about the disgust which had been existed with respect to the new charter of the College of Surgeons. He must express his regret at any cases of hardship and injury, which had been inflicted on surgeons of undoubtedly high character, whose names had not been included in the list of fellows. He had no doubt that cases of hardship had occurred, and that the hon. Member opposite was justified in stating the case of the surgeon at Hounslow as an instance of this. But if they did not admit a large proportion of the 12,000 members of the College of Surgeons as fellows, some cases of hardship would unavoidably occur, and it should be remembered that out of this large number they had only to select 550 names. This, however, was only the retrospective operation 273 of this charter; but in future it would not arise, for when a member of the College of Surgeons was above the age of twenty-six, he was entitled to present himself to the examiners of the College; and if he passed his examination, he was entitled to be placed on the list of fellows. His hon. and learned Friend had alluded to the hardships under which army and navy surgeons laboured, because the period in which they were absent on foreign stations did not count to give them priority in the list. As the charter now stood, the council was to be elected from the list of fellows, beginning with the seniors; and a long absence on foreign service did not count in these cases. He admitted that this was open to objection; and he trusted that he should be able to induce the council of the College of Surgeons to agree to some change. It should be remembered that he could not deprive this large and powerful body of the charter which they possessed, without their consent, and he could therefore only expect to induce them to consent to modify it. He, however, would compare the present with the former charter. Under the former charter, the council was a self-elected body, and no control could be exercised over it by the 12,000 members of the College of Surgeons; but they were bound to submit to the by-laws made by the council, and were sworn to obey them. He had negotiated with the council of the College of Surgeons successfully, and induced them to admit the principle of election as regarded the council. An hon. Gentleman had alluded to the case of the only surgical lecturer in the metropolis whose name had been excluded from the list of fellows. His certainly was a singular case; and no doubt some explanation was necessary, and most probably could be given. With respect to the success of this measure, he had given more time and attention to its consideration than to almost any other measure which he had ever brought forward; and notwithstanding all the predictions of the hon. Member for Finsbury, he believed, on the whole, that the measure would receive the support of the general practitioners. He had been informed that last night the hon. Member had paid a visit to a meeting of general practitioners, and that the hon. Member did not find that his own views were in conformity with theirs; and if he had not been misinformed, the meeting was rather of a stormy character, and that of the 300 persons present, not above ten or twelve 274 agreed with the hon. Gentleman. In the course, however, of a few weeks, when they came to discuss this subject, they would be able to tell what was the feeling of the general practitioners. He believed that the proposed arrangements had satisfied the Colleges of Physicians and Surgeons; and if, as he believed and trusted would be the case, they succeeded in satisfying the great body of general practitioners, the result would be a measure which would prove of great public advantage.
§ Mr. Wakleyobserved that the right hon. Gentleman said that he was convinced that this measure would ultimately satisfy the great body of English practitioners; if this was likely to be the case, he would not be the person to do anything to prevent it. It was true that he had attended a meeting last night of general practitioners. The committee of that meeting was 72 in number, and contained the names of many most respectable persons; and that committee was the whole Court of Examiners of Apothecaries' Hall, besides other gentlemen connected with the Society of Apothecaries. He should not say anything disrespectful of them; but he was informed for the first time last night that they intended to go for a separate incorporation, and every step that they had hitherto taken had been with that object. He was not aware of this, and it, therefore, led to some misunderstanding; but there was no violence at the meeting, but merely such a manifestation as arises in a public meeting when a strong difference of opinion occurs. The law declared that at the age of twenty-two a man should be deemed perfectly qualified in every branch of medical science; but when he came to be twenty-six years of age, something curious happened to him. During the progress of four years he would be losing his medical knowledge, and would then only be deemed qualified to act as a surgeon. Was it practicable that such an arrangement could be carried out? He trusted the right hon. Geotleman would not adhere to it.
§ Sir James Grahamsaid, that as to the absurdity—as it was said—of students of twenty-two years of age being deemed qualified upon examination, he thought that was not too early an age to allow persons, having studied the profession, and undergone successfully the ordeal of an examination, being entitled to commence practice. But the chief absurdity, as the hon. Gentleman said, was that, after four year' 275 additional experience, and extending the bounds of their previous skill and knowledge, at twenty-six they should be admitted, on a second and a higher examination of a more practical kind, and conducted with greater-strictness, and by the first surgeons and physicians in the realm, into the two highest branches of the profession. This the hon. Gentleman called absurd patchwork, and indefensible nonsense. There was neither patchwork nor nonsense about such an arrangement. Those admitted, after their first examination at twenty-two, when they had acquired additional experience, would be admitted, on due examination, into colleges of which some of the most eminent men in Europe were members. This part of the Bill, however, he would leave to the House, not caring a rush for the vituperation with which it might be visited.
§ Mr. Hawesobserved, with reference to the deputation which waited upon the right hon. Baronet, that, had he known that any doubt would have been expressed upon the subject, he would have come down to the House prepared with documentary evidence to show that the deputation did represent a large portion of the medical practitioners. With a few exceptions, he believed they would cordially assent to the adoption of this measure. He hoped the council would be constituted by the Crown. Some efficient control should be exercised over the examinations in the College of Physicians and Surgeons. At the Universities of Oxford and Cambridge, it was necessary for the student to undergo a previous examination in arts before procuring his medical degree. The Bill, generally, had his good wishes, and should have his support.
§ Mr. Macaulayconceived that the general principles of the Bill were uniformity of privilege and qualification. These principles he considered to be those on which any Bill seeking to re-establish the medical profession in this country, should rest. He had formerly expressed his approbation of those principles, and he would repeat that approbation now. As to the particular points of the Bill introduced by the right hon. Gentleman, they could discuss them with greater advantage, and with better effect, when an opportunity had been afforded of considering them, and also of ascertaining the public opinion respecting them; for as the principal object of the provision introduced by the 276 right hon. Baronet, with respect to the incorporation of the general practitioners had been, as was represented, the allaying of discord, and the pacifying of existing discontents; of course the very test, by which they were to judge of the wisdom of the measure, was the effect which, during the next month, it would have in allaying those discontents. The hon. Member for Lambeth had made use of an expression in which he could not concur, respecting medical schools. He did not rise to defend these schools to any extent to which he did not think them entitled, nor did he prefer the interests of the University of Edinburgh, or of the College of Surgeons or Physicians there, to the general interests of science. He only wished to say this, that if his hon. Friend looked into the Bill, he would see that it did contain provisions which made it impossible that these bodies could establish any system of bad or defective examination. There was no provision which these bodies themselves would not be ready and willing to adopt, of which the effect would be to keep up the qualifications of the medical schools of Edinburgh to the same point as that attained by the medical schools of this country, and which, indeed, the University of Edinburgh, the College of Surgeons of Edinburgh, and the College of Physicians of Edinburgh, would not be the first to petition that House to adopt. He was satisfied that there was no provision which could be devised, for the purpose of keeping up the medical qualifications there and elsewhere, which would not meet with both the cordial approbation and willing co-operation of the bodies to whom he had referred. He heartily concurred with the hon. Member for Kendal and the hon. Member for Lambeth, in what they said as to the way in which the Council of Health should be constituted. He must say that he thought it a desirable thing that this council should be constituted by the Crown. He did not think that any person could suppose that the right hon. Gentleman leaned to such a provision from any desire to get patronage into his own hands. As the right hon. Gentleman had indicated that he was clearly of opinion that that was the best mode of appointing the council, if, when they went into Committee on the Bill, the right hon. Gentleman did not move for the insertion of a provision securing such mode of appointment, 277 he (Mr. Macaulay) would. The very strongest arguments existed in favour of this board being nominated by the Crown. He was disposed to give a cordial support to the Bill.
§ Sir James Grahamdid not think that the nomination of the Council of Health ought to be in the Crown.
§ The House resumed. Bill reported with amendments. To be re-committed.
§ House adjourned at a quarter to one o'clock.