(NO. 44.) SECOND READING. (Hansard, 15 April 1878)

§ THE MARQUESS OF RIPON

said, the Bill dealt with the important question of how in future persons were to obtain a licence to practice Surgery and Medicine in the United Kingdom. At the Present time there were in England, Ireland, and Scotland 19 different Bodies that could give certificates of competence, and whose diplomas entitled the holder to have his name placed on the Medical Register. It was scarcely necessary to point out the inevitable effect of allowing so many distinct Bodies to confer a title to practice—the natural consequence was that some of those Bodies were tempted to underbid the others as to the terms on which they granted their licence. Consequently the public had not the necessary security that the holder of a licence had the minimum qualification which ought to entitle a man to practise as a surgeon or a physician. It was felt very generally that there ought to be but one Examining Board—or that, at most, there ought to be only one for each of the three parts of the United Kingdom—through which admission to the Medical Register could be obtained. Since 1858, when the present Medical Act was passed, there had been almost continuous, but unsuccessful, attempts to establish what was known as "the conjoint scheme." And, as the Bill of his noble Friend the Lord President did not propose to deal peremptorily with this state of things, but was merely permissive, it would leave the matter of the conjoint scheme where it had been for 1268 the last 20 years. His noble Friend ad expressed a hope that before the Bill went through both Houses, such a scheme would have been established for England; but he held out no hope that such a scheme would, by that time, have been established for either Ireland or Scotland. He only went the length of saying that, when conjoint schemes were framed for those countries, they would, under the Bill when it became an Act of Parliament, obtain legal force. His noble Friend must, by this time, be aware that the College of Surgeons of London, the College of Physicians of London, the Syndicate of the University of Cambridge, the representative of the University of Oxford on the Medical Council, and the Representative of the University of London, had all condemned this Bill for its want of compulsory provisions for the establishment of Conjoint Examining Boards. This was not a case of old Corporations wishing to uphold their own privileges, but that of important public Bodies, who were ready to make a sacrifice of their own independence in the matter of licences to practice and to agree to a conjoint scheme, provided they were not exposed to the competition of small bodies remaining outside that scheme, and having power to grant similar licences. His noble Friend had, no doubt, seen in The Times of Saturday, a report of a meeting of the Medical Council, held on the previous day, at which a resolution in favour of the introduction into the Bill of a compulsory provision for the establishment of Conjoint Examining Boards was proposed by Professor Humphry, seconded by Sir James Paget, and carried by a large majority. The resolution declared that nothing short of the compulsory establishment of such Boards in each of the three portions of the United Kingdom could be deemed satisfactory. The British Medical Association—a body numbering, he believed, 7,000 members—strongly objected to the Bill, because it was permissive in respect of Conjoint Boards, and on another ground. As in 1870, the British Medical Council were strong enough to procure the rejection of his Bill, which was compulsory, he thought his noble Friend had every reason to fear that his measure might not meet with a better fate. He thought it self-evident that the public must be in favour 1269 of one Examining Board. The Bill would also form an almost insuperable barrier to the admission of women to the Medical Profession. Foreign practitioners, also, who held high-class diplomas from their own authorities, complained that they had not been sufficiently considered in the Bill. He did not propose to challenge the opinion of the House on the second reading. As probably the resolution arrived at by the Medical Council was not in the hands of his noble Friend till Saturday, he should not ask him for a positive opinion at the present moment; but he did hope that his noble Friend would seriously consider the question between that stage and the Committee on the Bill, and would see his way to make the establishment of Conjoint Examining Boards compulsory. His noble Friend had a great opportunity of settling an important question, and he hoped he would not avail himself of a political majority to pass a Bill which would settle nothing, and which would put off indefinitely a needful reform for which the public had been waiting for the last 20 years.

THE DUKE OF RICHMOND AND GORDON

said, he was glad to hear that his noble Friend was not going to challenge the second reading; because if he did so, and he were successful, as he seemed to think might be the case, he would indefinitely postpone the settlement of a question which they all wished to see settled. The objections of his noble Friend were chiefly directed to the absence of a Conjoint Board to carry out the Examinations in the three kingdoms, and he would confine himself to that point. The history of the Bill was this. In the month of May of last year he received from the General Medical Council, through its President—of whom one could hardly say too much, either from a professional point of view or in reference to the manner in which he discharged his duties as President of that Body—a Memorial, in which he was asked to deal with five points on which they thought legislation desirable. First, the Foreign and Colonial degrees; second, the registration of the medical qualifications of women; third, the appropriation of penalties under the Act; fourth, registration of midwives; fifth, the lunacy laws. It was a remarkable fact that no suggestion of the conjoint scheme was included in that Memorial. 1270 He did not say that Council was not alive to it; but, certainly, the question was not brought under his notice by the Medical Council. He was quite willing to admit that if there were a uniform and satisfactory test—more especially with this Bill—it would be possible to deal with unqualified practitioners in a more stringent manner than they could now be dealt with; and he thought it possible that the best mode of having such a test was by means of a Conjoint Board. His noble Friend, when filling the Office which he had now the honour to occupy, had endeavoured to legislate on the subject, and his experience in 1870 had led him to very candidly acknowledge that the task was no easy one. There were a number of interests which required considerable attention in order that a means of reconciling them might be found, and it was by no means clear that success in that direction was attainable. In England the difficulty in respect of a conjoint scheme was not so great. All the medical authorities, except three, were centred in London, and the Universities of Oxford, Cambridge, and Durham did not object to such a scheme. In Ireland, again, as all the Medical Bodies were more or less centred in Dublin, he did not imagine there would be any great difficulty. In Scotland, however, the case was otherwise. There were the College of Surgeons, the College of Physicians in Edinburgh, and the Faculty of Physicians and Surgeons in Glasgow; the Universities of Edinburgh, Glasgow, Aberdeen, and St. Andrew's, all of which would be very much affected by a conjoint scheme. The fact was, so desirous had he been, if possible, of coming to some conclusion which would enable him to legislate on this difficult subject, that he had adopted the alternative which his noble Friend condemned so severely, and made the provision as to a conjoint scheme permissive for the three parts of the United Kingdom; and, in order to meet the objection to the provision being only permissive, he had raised the qualification of medical practitioners by providing that no person could be placed on the Register of the Medical Council who did not possess two qualifications—one in surgery, and the other in medicine. He was quite ready to admit that this was not the best solution of the difficulty, 1271 but it was a step in the right direction, supposing that it was not possible to insert in the Bill a compulsory clause for the three parts of the United Kingdom. He was aware of the objections taken to the Bill by the Medical Bodies to which his noble Friend had referred; he knew that they were not satisfied with the absence of compulsory powers for the formation of Conjoint Boards from the Bill—and he (the Duke of Richmond and Gordon) was far from saying that there ought not to be a Conjoint Board—he thought it would be dishonest of him to say that it would not be an advantage to the country; but it was not always easy to carry out by Act of Parliament what one thought desirable. The clause in the Act referring to the medical examination of women was inserted to cure a technical defect in Mr Russell Gurney's Act, and would not render it more difficult for women to enter the Medical Profession, except inasmuch as it raised the standard of qualification for registration, by requiring a double qualification from all persons who sought to be put on the Register. He hoped, notwithstanding all the formidable objections that had been raised to the Bill, it would speedily become law.