MEDICAL PROFESSION BILL. (Hansard, 8 February 1856)

MR. HEADLAM,
in asking leave to bring in a Bill to amend the laws relating to the medical profession, said that the measure was first introduced to the House 498 in the latter part of last Session, but it was not then prosecuted further in concurrence of an understanding to that effect between the gentlemen who represented the medical profession and the Secretary of State for the Home Office, who, on his part, undertook to circulate the measure during the recess among the several medical societies throughout the kingdom, and thereby ascertain what were the opinions of the profession upon the measure. It was accordingly sent to the Colleges of Physicians and Surgeons in London, Edinburgh, Dublin, Glasgow, and all the medical societies and universities of the kingdom; and also to a large number of individuals practising in the medical profession. From the numerous answers returned to the questions asked, he found that so much unanimity now prevailed among the members of the profession with regard to some reform being necessary, and such a general desire to concede the extreme privileges and rights of particular bodies, that he (Mr. Headlam) was placed in a more favourable position than that which any Gentleman had occupied who had yet attempted to legislate upon this very difficult subject. With regard to the Bill itself, he would first state to the House what the measure did not pretend to do. It did not, for instance, seek to interfere with the present right of the British subject, a right which he certainly exercised with very great freedom—namely, the right of obtaining medical advice and assistance from any person whatsoever, although the person from whom he obtained that advice and assistance had not gone through any professional education or passed any examination, or was in any other way qualified to give that medical advice and assistance. But one part of the Bill provided for the registration of legally- qualified practitioners, and he thought it was due both to the public and the profession that there should he a penalty against any person who, not having gone through an examination, and not having had a medical education, pretended to be that which he was not, that was to say, who pretended to be a registered and legally-qualified practitioner. He left it open to persons to go to non-educated and nonqualified individuals if they chose; but he would give the public the opportunity of ascertaining whether a particular individual was or was not a regularly-qualified practitioner. That would be a protection to the public if they chose to use it, and it would be a protection also to the certified 499 practitioner, who, having gained his status at great expense and severe study, was entitled to have his degree and authority known and respected. There were at present altogether in the United Kingdom, about twenty-two different bodies exercising various powers of licensing persons to practise the medical profession. In England there were the Universities of Oxford, Cambridge, and London, all of which had the power of conferring degrees; at the same time, certain doubts existed as to the validity of those degrees in conferring a licence to practise. In London the College of Physicians—perhaps the highest body in the medical profession in the realm—exercised the privilege of licensing to exclusive practice within the district of London and seven miles beyond, and also the power to license in the rest of England, though not to exclusive practice. The College of Surgeons, too, had the power to license for practice throughout England. But coming to Scotland he found various bodies there which had the power of licensing to practise medicine only within particular districts, and at the present moment there was not one body in the kingdom that had the power to license persons to practise medicine generally throughout the kingdom. Again, no one could now say what strictly constituted a legally-qualified practitioner. A gentleman might have obtained a degree of the Royal College of Edinburgh, and be the most eminent physician in his profession, yet he would have no right to practise in London or within seven miles of it. Nay, it was even doubtful whether he had a strict right to practise in England. On the other hand, the most eminent medical man in London had not power to practise either in Scotland or Ireland. These instances, he thought, would serve to show the extreme confusion of the law upon the subject. These inconveniences were rendered still greater by the language of some of the recent Acts of Parliament wherein reference was made to what are called "legally-qualified medical practitioners." No one can say what is the exact meaning of such a title. See how the evil of this uncertainty operated. By the Nuisances' Removal Bill a power was given to magistrates to convict for certain offences upon the certificate of two legally-qualified practitioners. Suppose the magistrates convicted, an objection may be taken to the title of the medical practitioners upon whose certificate the conviction rested. As the law 500 now stands, no magistrate can be cognisant of the fact, whether an individual is or is not, in the language of the Act, "a legally-qualified medical practitioner." If certificate is made by a person not legally qualified, the conviction would fail. What he sought to do by this Bill was, first to ensure generally throughout Great Britain and Ireland that there should be equality of education; that was to say, that the word "physician," whether applied to a man educated in London, Edinburgh, or Dublin, should mean the same thing; that it should mean a man who had gone through a certain course of liberal education, in the first instance, and a certain curriculum of professional education in addition thereto. That there should be a certainty that he had undergone the same education wherever he came from. A similar provision would apply to surgeons; that was to say, that whether in London, Edinburgh, Dublin, or elsewhere, a surgeon should go through a certain and the same education to qualify him for the profession he sought to practise. Having secured that equality of education with respect to all gentlemen practising in medicine, the next thing the Bill would do was to establish a reciprocity of practice; which meant, that a gentleman who had been educated, say in Edinburgh, should, if he chose, become a Member of the College of Physicians in London, and practise in London, and a member of the College of Physicians in London should, in like manner, if ho choose, become a member of the College of Physicians in Edinburgh, and be at liberty to practise there. Thirdly, he proposed that there should be a general register of legally-qualified practitioners. Every other profession in the country almost had its authorised "list." There were, for example, the Clergy List, the Army List, the Navy List, and the Law List; but at that moment there was no Medical List to which reference could be made for the purpose of ascertaining whether any individual was a legally-qualified practitioner or not; and it appeared by the census returns, that the number of persons who assumed to themselves the title of "surgeons," or other medical appellations, was nearly double the number of persons who were on the books of the learned medical societies of the kingdom. In other words, there were nearly as many unqualified as qualified practitioners in the kingdom. These three principles were the main provisions of the Bill:—First, equality of education; secondly, 501 reciprocity of practice; and, thirdly, a general register. He would now state how he measure had been received by the profession, The numerous answers received during the recess from the several medical colleges showed that great unanimity prevailed amongst those bodies on all these principles. The Royal College of Physicians of London, in their answer, stated that the measure was founded upon a principle which they had always approved of and endeavoured to carry out, and that it would harmonise well with a new charter for that institution. He would here take the opportunity of stating, that it was in consequence of the dissensions amongst the medical men themselves that that Royal College had not obtained the charter which they had a right to expect. He hoped that, contemporaneously with the passing of this Bill, the Government would see fit to grant this charter. The Royal College of Physicians in Edinburgh expressed their general approval of the Bill; and the Royal College of Physicians in Ireland did the same, adding that it was a like comprehensive and liberal, and adapted to elevate the profession and increase its scientific character. The latter body suggested that the several medical societies should have power to remove from their respective lists the name of any medical practitioners who, in their opinion, had been guilty of improper practices, and he (Mr. Headlam), in accordance with the recommendation, had introduced a clause to that effect. The College of Physicians in Glasgow said the Bill embraced almost every object which had hitherto been advocated by the faculty, and dealt fairly with all. The College of Surgeons in London, however, did not quite so cordially approve of the measure. They stated that they approved of the establishment of a register—a most important point certainly; but, with that exception, they thought there was no sufficient reason for any Parliamentary enactment for the infliction of penalties beyond those which the courts of law were already competent to levy. There were differences of opinion upon the details, certainly; but some of the objections he had been able to remove by the Bill in the shape in which he now submitted it to the House, though there might be some arising out of conflicts between the different learned bodies which he had not been able wholly to meet. He (Mr. Headlam) would be happy to receive suggestions, and willing to alter the provisions 502 of the Bill where practicable. He thought he had shown enough to convince the House that the Bill was received favourably by the learned medical bodies, and he could assure the House with great confidence, that it had been most cordially received by the great mass of the individual practitioners throughout the country. The mode in which the different provisions would be carried out he would state generally. He proposed that there should be a medical council, which should be composed of physicians and surgeons; a physician and surgeon to be chosen by each of the Colleges of Physicians and Surgeons in England, Scotland, and Ireland; one person by each of the Universities in England, Scotland, and Ireland; and eight persons by the body of medical practitioners throughout the kingdom. The election of these lost would be effected with little difficulty or trouble through the Post Office, and according to a certain form, which would be transmitted to the electors, He attached great value to the representative principle, because there was a general feeling throughout the country that such representation ought to exist in a council that was to have jurisdiction over the entire profession. In the first instance, however, the eight members would be nominated by Government. As soon as the medical council was appointed, they would have to appoint a registrar, whose duty it would be to register every person who was now licensed to practise, without any further examination. All that was requisite was, that every person now licensed to practise as a physician or surgeon should send in his name, and upon payment of a small fee he would be entitled to be registered without further examination. Thus there would be no difficulty whatever in registering persons already in practice; and they would be placed in this improved position—that after such, registration they would be able to practise in every part of the United Kingdom. All others who were registered would have first to pass through a regular examination in medicine, and it would be the duty of the council to see that that examination was the same in all parts of the kingdom. As soon as the Bill came into operation, a physician would have to prove that he was twenty-six years of age, had graduated at one of the Universities, and passed through the necessary examination, before he could be registered. A similar provision applied to surgeons, with this exception, that they 503 must be twenty-two years of age. In conclusion, he would state, that the Bill had been framed on a feeling of the greatest deference and respect to those learned societies in the medical profession, who came down to us honoured by the recollection of the great men that have been enrolled in their lists. It was also framed with the earnest wish to protect the rights and conciliate the feelings of the large body of the eminent practitioners on whom the community at large mostly relies for medical advice and consolation; and many of whom for small pecuniary remuneration were in the habit of doing deeds of almost unrivalled benevolence. He confessed he felt pride and satisfaction in their names, to ask the leave of the House to introduce the Bill.

§ MR. BRADY
said, he willingly seconded the Motion, but he regretted to hear it stated that legislation upon the subject had been hitherto prevented solely by differences amongst the medical bodies themselves. To that assertion he gave a decided contradiction, for they were most fully alive to the necessity for a great and comprehensive measure. Previous attempts had failed because they had not been entered upon with a full determination to succeed, and because the persons making the attempts had submitted to the influence of those interested in keeping things as they were. Even the right hon. Gentleman the Member for Carlisle (Sir J. Graham) on one occasion made this admission—"I may he excused for saying that if I could have anticipated the extensive difficulties of this subject I should not probably have presumed to interfere with them;" in fact, he regarded it as an Augean stable, that he had no hope of cleansing. It was a great error to suppose that the medical profession were alone interested in the Bill, or that, like Sir Lucius O'Trigger, they found it a very pretty quarrel, and wished to keep it so. It was a general measure, calculated to raise the standard of the profession—to make them, as it were, a part of the police of the country, and one that should be supported by the Government. It was much to be regretted that the Bill had not been brought in by a Member of the Government, from the greater facilities it would then have received in its progress through the House.

§ VISCOUNT PALMERSTON
Sir, I have to thank my hon. and learned Friend for introducing this Bill, and I am sure the House has listened with great satisfaction 504 to the able and interesting statement he has made in proposing this measure. I give him great credit for that, and I shall give him more credit still if he succeed in passing it, and thus, as the hon. Gentleman opposite (Mr. Brady) observed, settle the question for ever. My hon. and learned Friend has not exaggerated either the importance of the measure itself, or the difficulties which he has had to contend with, and I speak with some experience on this subject, because, when I had the honour to be at the Home Office, I endeavoured to do that which my hon. and learned Friend has now undertaken. I confess to finding difficulties that I felt I could not surmount, but which I hope my hon. and learned Friend will succeed in overcoming. If he does, he will be entitled to the thanks of the whole country for the great benefits this measure will confer when passed. I wish him every possible success, and with my colleagues will give him all the assistance in our power to carry it through Parliament.