§ COLONEL FRENCH
said, that the noble Lord (Lord Elcho) was bound to rise and give his reasons why the House ought to refuse to read the Bill a second time, in order to enable him to bring the measure 715 which he thought necessary before the House. Now, so far as he (Colonel French) could gather, there was every reason to believe that the object the noble Lord had in view might be effected in Committee; and certainly no ground whatever had been laid by the hon. and learned Member for Ayrshire (Mr. Craufurd) for postponing the Bill of the hon. and learned Member for Newcastle. The noble Lord's name appeared on the notice paper as the mover of an Amendment against the Bill, but he had chosen to delegate this duty to another. It might be that he wished to have the last word; but it was only due to the House, after the notice he had given, that the noble Lord should put himself into the front rank. He, therefore, begged to call upon the noble Lord, to rise and state his reasons for asking the House to reject that measure.
§ MR. W. EWART
said, that he did not see that the noble Lord was obliged to comply with the appeal which had been made to him by the hon. and gallant Member for Roscommon—[Lord ELCHO: Hear!] With reference to the general principle of the two Bills, he (Mr. Ewart) would grant that there was something fascinating in the principle of representation contained in the Bill of the hon. and learned Member for Newcastle, but when he looked at the workable character of the two Bills, he must confess that he was inclined to give the preference to that of his noble Friend (Lord Elcho), winch was certainly the more workable of the two. True, there might be an objection to the council being nominated by the Crown; but then it should be remembered that the Crown would be responsible; that there would be a person sitting in this House as the representative, more or less, of the medical body, and that he would be responsible to the House. It had been objected by the noble Lord the Member for Norwich (Viscount Bury) that the medical council would assume a political character; but he (Mr. Ewart) did not see that that would necessarily be the case more than with any other public department, the constituent Members of which were nominated by the Ministers of the Crown. For instance, there were constituent parts of the Board of Trade, the Board of Customs, the Board of Inland Revenue, and other boards, which were made responsible to Parliament; but they did not change their places with a change in the political character of the Government 716 or of Parliament. Those persons continued to hold their offices notwithstanding such changes, so long as they gave satisfaction in the performance of their duties. He saw no objection to this principle, then, provided the Board so nominated was a national Board, responsible to Parliament, and both of these he believed it would be under the Bill of his noble Friend. On the whole, he certainly preferred the Bill of his noble Friend, which was more rational in its character, which respected but did not obey the medical corporations, and which, he believed, was more consonant with the wishes and interests of the medical practitioners generally. Much, therefore, as he admired the representative theory contained in the Bill of the hon. and learned Member for Newcastle; yet, seeing that the Bill of his noble Friend contained the principle of representation, so far as to make the council responsible to Parliament, and that it was a more operative Bill, and more likely to be practicable than that of the hon. and learned Member, he should certainly give his support to the Bill of his noble Friend.
said, the objection made out of doors to the first Bill seemed to be based chiefly on the ground that it had emanated from the medical profession itself; but that appeared to him to be a strong argument in its favour; for if there were, one profession or calling in the community concerning which it was almost impossible for non-professional persons to be judges of the manner in which that profession ought to be conducted or controlled, it was this very profession of medicine. He supported this Bill because it contained the principle of representation; for he believed that it would be found impossible to form any governing bodies for the medical corporations and societies of the country, so as to enable them to act to the satisfaction of the profession without having recourse to the principle of representation. That was not his opinion only: it was the opinion of all the most competent persons who had considered the subject. He was himself unconnected with the medical profession; but he believed it was the opinion of all writers on the subject of medical reform, that three provisions should be introduced into any measure that should be propounded; firstly, that all persons who intended to practise medicine should undergo a preliminary examination in science and art; secondly, that they should 717 pass a strictly professional examination; and, lastly, that there should be some system of registration, whereby it could be known who had, and who had not qualified themselves to practise. The Bill of the hon. Member for Newcastle contained these provisions, therefore he would support it. It was objected that the distinction between surgeons and physicians was invidious, and ought to be abolished, but he could not conceive any distinction less invidious than that which was acquired by greater abilities or superior attainments; and he believed that such distinctions were calculated to secure to the public a higher standard of competency in the profession than there would exist were all to be brought down to one dead level, as was proposed by the Bill of the noble Lord (Lord Elcho). He thought it would be unwise, moreover, to subvert those ancient institutions under which the medical profession had attained a position most creditable to the practitioners themselves and to the country.
§ MR. BLACK
said, he was placed in an awkward position, for whichever of the Bills he might support, he should offend a portion of his constituents. He believed, however, that the best test of a medical man's competency was the opinion of the public, and that, however rigid might be the system of medical examination, men incompetent to practise would succeed in obtaining certificates of competency from the examiners. He admitted that before a man was allowed to practise as a surgeon or physician he ought to be examined as to his skill by competent persons; but why should he, after having obtained a certificate of his competency, be called upon to enter into a corporation, to submit himself to its regulations, and to pay certain fees? There ought not to be any class distinctions in the medical profession. Those who had attained the highest eminence in this country as consulting physicians, probably started in their public career by attending to infantile diseases. From mere surgeons they rose by their perseverance, and the increased confidence of the public in their ability, to the position of distinguished physicians. For his own part he should have preferred a more liberal measure than either of those before the House, but he would suggest that whatever was beneficial in Bill No. 1, should be engrafted on the No. 3 Bill, which he regarded as a better "stock." That part of the Bill of the hon. and 718 learned Member for Newcastle-on-Tyne which provided that there should be a council of representation was unanimously opposed by a deputation of Scotch medical practitioners; and so strong was the feeling of the medical profession against that provision that the Secretary of State for the Home Department assured the deputations that waited upon him that, although the Government, generally speaking, were in favour of the Bill, they would oppose that part of it. He (Mr. Black) objected to the Bill, because it gave such immense power to the corporations of the profession, and placed such restrictions upon its practice. One of its clauses provided that in the case of a practitioner removing from one part of the kingdom to another, he should not be allowed to practise in the place to which he had removed until the expiration of two years, so that he must remain perfectly idle for those two years. He (Mr. Black) had no desire to injure the ancient medical institutions, they had been of great service to the community; but he thought it should be optional with physicians or surgeons to enter them, and not compulsory. The majority of the profession would, no doubt, have the ambition to seek admission into them. No person was compelled to enrol himself a member of the Geographical or the Geological Society, and entrance into the medical corporations should be equally voluntary. It was not on the privileges which they might confer, but on his skill and good conduct that a practitioner ought to rely for his success.
§ MR. GROGAN
said, that what the hon. Member who had just spoken wanted, was evidently free trade in medicine; but he contended, in opposition to that doctrine, that it was imperative upon the legislature to take care that the health and safety of the people were not entrusted to incompetent hands. It was a singular peculiarity of this debate, that Bill No. 3 was supported by all the hon. Gentlemen who came from the North of the Tweed, and Bill No. 1 by those who came from the southern part of the island. It was, however, universally agreed that it was desirable to improve the education of medical men, and that, for this purpose, mere voluntary study was not enough. It was a matter which must be put under regulations and restrictions, if they would have a well-educated body of medical men, and at this both Bills aimed, but they went about the accomplishment of the object in 719 different ways. Under one Bill the Council was to consist of thirteen members, who were to be all selected by Government. Under the other, they were to be chosen by the different Colleges or Corporations. But, was it necessary, he would ask, that a science which had attained the highest rank should be placed under the control of a Council to be appointed by the Government? He (Mr. Grogan) preferring the representative system to the system of a nominated Council, preferred, therefore, Bill No. 1 to Bill No. 3, and though he did not, by any means, consider that measure as perfect, he believed that all Amendments could be better engrafted on it. But there were other points to be considered. Almost all the medical societies, the colleges, the schools of medicine, the universities, were all but unanimous in favour of Bill No. 1, with the exception of the universities north of the Tweed. Was the House prepared to run counter to the opinions of those medical men of the highest rank, and the greatest experience in this country, or in the world, as to the mode of teaching medical men in future? Dr. Hamilton Rowe, who recently pronounced the Harveian oration at the College of Physicians, declared that, if the Bill before Parliament (No. 3) passed into law, it would be subversive of the high tone of the profession, and cause the extinction of the college. It was impossible to avoid the worst results, if free trade in medicine were adopted. There was also another opinion to the same effect from an M. D. of Edinburgh. A paper had been laid before the House respecting the valuable museum of anatomical preparations maintained at such cost, and attended with such care, by the College of Surgeons; what was to become of that important museum if the funds of the college were placed under the control of the rival body proposed by the Bill of the noble Lord? Could it be expected, for a moment, that the same care, or attention, or cost would be expended on its maintenance? He (Mr. Grogan) thought, however, that other parts of both Bills were valuable—registration, for instance; and he candidly admitted that many points of No. 1 Bill might be changed with advantage; but he looked upon that Bill as a better stock on which to engraft such alterations as were necessary, and he should, therefore, support it in preference to the Bill of the noble Lord.
§ MR. NEATE
said, he rose to warn the 720 House against the growing custom of undervaluing those ancient institutions which had done good service to the State, and of turning them to purposes for which they were never intended. Free trade and unrestricted competition were very good in, but very bad out, of their place. Free trade was a very good servant, but a very bad master. It was to monopoly that much of our progress in arts and sciences was due. That remark applied to the medical more than to any other learned profession. Did the House wish to see free trade, extended to the legal profession or to the Church? The noble Lord (Lord Elcho) asked them to enter upon a new course entirely at variance with that which had been pursued for many generations, and which had raised the medical and other learned professions to a degree of eminence, dignity, and usefulness, which they had not attained in any other country. He was speaking, however, as if the Bill of his hon. and learned Friend would sanction a monopoly; but it would do nothing of the kind. It would admit everybody without distinction to qualify himself for the medical profession, but it would also require, as it ought to do, that those who had been long connected with that profession should ascertain whether he had, in fact, so qualified himself before he was permitted to practise. The College of Physicians was, no doubt, for a time actuated by a spirit of selfishness and exclusiveness, but it had renounced that spirit, and was determined to meet, as far as possible, the requirements of the present state of society. The House of late had heard a great deal about the extension of Scotch writs and judgments, but he, for one, was not disposed to give increased currency to Scotch prescriptions with regard to the scientific societies of this country. It was for the interest of the State at large to maintain, in some shape or other, professional aristocracies, for if they were destroyed, the only other aristocracy which remained—that of wealth and position—would be placed in a more isolated and insecure position than before; and, therefore, from considerations of general and political expediency, as well as in respect to the health of the community, he should support the Bill of the hon. and learned Gentleman.
§ MR. VANCE
said, he should support the Bill of the hon. and learned Member for Newcastle, on the ground that it was a measure for the reform of the medical 721 profession, while the Bill of the noble Lord was one of entire reconstruction, and in some cases of entire destruction, of existing rights and privileges. He thought that the different degrees of the profession recognized by the Bill were of great importance. No doubt it might do very well in a remote colony to do without professional distinctions, but in this country it would be a practice attended with the greatest possible inconvenience. It had been urged as a grievance that parties could not change their medical qualification for two years; but he (Mr. Vance) did not look upon that as a hardship, as the parties could give notice, and satisfy the heads of the profession that they were entitled to change. The hon. and learned Member for Ayr (Mr. Craufurd) said, that the institutions appointed to make examinations were obsolete, and behind the spirit of the age; but when it came to be considered that these bodies consisted of the Colleges of Physicians and Surgeons, and of the Universities, he could not allow the censure of the hon. and learned Member to pass without comment. With respect to the Bill of the hon. and learned Member for Newcastle (No. 1), he considered that there were many points omitted; for instance, he considered that the Apothecaries Company of Ireland were not fairly treated in it; they did not wish to interfere in matters not pertaining to them, but he held that they were as well entitled as their brethren in England to form part of the examining body, with regard to pharmacy, poisonous ingredients, and matters of that kind. The Bill of the noble Lord violated existing rights, and took away pecuniary privileges which had been granted by Royal charter, while it did not provide for a preliminary education in medical science. The Bill of the hon. and learned Member did not do this, and he (Mr. Vance) thought, therefore, that the House should support it, as in so doing they would follow the principle enunciated by a great statesman, namely, to reform existing institutions, and change them in accordance with the wants of the age, but not to destroy them.
§ MR. T. DUNCOMBE
said, the hon. Member for Oxford spoke of the House consulting the dignity of the medical profession by passing Bill No. 1. He (Mr. Duncombe) was not prepared to define what the dignity of the profession meant. He thought they were sent there for the welfare of the people, and not to promote 722 any dignity; but at all events he could not fancy the dignity of the profession more insulted on any occasion than by the paper before the House, which contained no fewer than five medical Bills, or Bills relating to the medical and surgical profession. First, they had the Medical Profession Bill, No. 1, and Medical Profession Bill, No. 3. What had become of No. 2 did not know, but he supposed it had taken the wrong medicine. Then there was the Vaccination Bill, for which he was responsible, and which was a Bill to repeal the Vaccination Act, smuggled through Parliament, and to take the parliamentary lancet out of the national arm. Then there was the Medical and Surgical Sciences Bill. There was only wanting the Poisons Bill, which was blundering through the other House, to wind up with the second reading of the Burials Bill, which also stood on the paper. In all these Bills, however, there was no provision made for the interest of the public. This country had already got a State religion and a State education; and it was now about to get State physic. He (Mr. T. Duncombe) objected to Bill No. 1 and to Bill No. 3; but he should vote for Bill No. 3 as against Bill No. 1, and then when Bill No. 3 came to a division he should vote against that also, to return the compliment. These medical reform bills were not what the country required. The people of this country wanted a Bill which should place all medical practitioners on an equal footing, after having undergone the same examination. That, however, would be impossible under the Bill of the hon. and learned Gentleman. The medical reform required was to do away with exclusive privileges of all kinds in the practice of medicine. The country had no confidence in chartered societies, as regarded real medical science, and he thought that a worse quackery even than medical quackery was legislative quackery. The Colleges of Physicians and Surgeons in London and Dublin had exclusive privileges no doubt, but they were not at all adapted to the present day. In short, they wanted a medical reform bill with something like a schedule A with Gallons and Old Sarums in the medical world. Look back to former days, and see the injury these colleges had done to the public in attempting to impede the march of medical science. The individual who first invented tourniquets to supersede hot pitch upon amputated limbs was persecuted; 723 while the individual who applied cantharides as a cure for dropsy—a German doctor in this country—was incarcerated in Newgate at the instance of the head of the College of Physicians. Could any confidence, then, be justly placed in the action of these bodies for the interest of the public? It was Sir A. Carlisle who said of medicine that it was an art founded on conjecture and improved by murder; and instead of appointing a council composed of the chartered bodies he would say, "Leave the Colleges of Physicians and of Surgeons, the one to prescribe for and the other to operate upon the public, and let the Apothecaries' Company drench them both." He (Mr. Duncombe) advised the House to reject the Bill on these grounds. He also advised the House to reject it because of the registration which it proposed. He wondered, for his own part, how the medical men of the United Kingdom could desire to be reduced to the condition of cabmen, and wear a badge round their necks. If, however, they wished to be badged and numbered, then, in Heaven's name, he would say, let them be so; but as he considered that the public interest was not only not promoted, but was, on the contrary, injured by the kind of legislation proposed in those Bills, he should oppose the second reading of the Bill under discussion.
§ MR. BLAKE
said, that he, as an Irish Member, should give his most strenuous opposition to Bill No. 1, and if the second Bill came to a division, he would vote with the Scotch Members in preference, because it would not destroy a numerous and valuable class of men, the apothecaries of Ireland, who were the poor man's doctors, as the Bill of the hon. and learned Member for Newcastle in effect proposed to do. He (Mr. Blake) was for placing the Irish apothecary on the same footing as the English apothecary in every respect.
§ MR. BRISCOE
said, he should support the second reading of Bill No. 1 on account of the composition of the council. Under this measure the council would consist of seventeen representative members and of six nominated by the Crown. As six were to be nominated members there would be no difficulty in having one of them a Member of that House, while the seventeen representative members would ensure the confidence of the profession and of the public. So far from agreeing, therefore, with his hon. Friend the Member for Finsbury (Mr. T. Duncombe), he believed 724 that in voting for the second reading of this Bill, he was honestly and conscientiously consulting the best interests of the public. As regards the fees paid to the College of Physicians for a fellowship, which amounted to £55, it was found that £25 went to the Government for the stamp, while £10 was applied to the support of the library. The remainder alone went to defray the expenses of the College.
§ LORD ELCHO
said, that the hon. and gallant Member for Roscommon (Colonel French) had described the course which he (Lord Elcho) had pursued in this matter as an extraordinary one. Feeling that to a certain extent it was so, and admitting the justice of that remark, he must ask the kind indulgence of the House while he endeavoured to show that it was by a sense of public duty alone that he had been actuated in the course which he had taken. It was the more necessary that he should do so, because his motives had been subjected to misconstruction both by the profession and by the public out of doors, and it had been stated freely that his only object was either to obstruct medical reform or to rival his hon. and learned Friend the Member for Newcastle (Mr. Headlam) as a medical reformer. Now, with respect to obstructing medical reform, he assured the House that he was much too sensible of the necessity of some measure of reform with reference to the medical profession to throw any impediment in the way of it. The anomalies at present were so great and so injurious that he had long felt it to be desirable that some measure of reform should be carried into operation. He would just mention to the House three of the anomalies of the present system. In the City of Edinburgh there was a distinguished professional man, Professor Simpson, who was, perhaps, as eminent a man in his branch of the profession as any one in the kingdom. He was physician to Her Majesty in Scotland; but, under the present state of the law, if he were to be called to London in consultation with any of Her Majesty's physicians on the subject of Her Majesty's health, he would be liable to be prosecuted for practising within seven miles of London. Such of the population as resided within seven miles of the metropolis were the property of the Royal College of Physicians of London; that was their hunting ground; and if any medical man from Dublin or Edinburgh came to attend a gentleman in London with whose constitution he was acquainted, he would be liable to be prosecuted. Again, 725 the degree of the London University was deservedly considered one of the highest medical diplomas in the world; and a London University graduate might practise in any part of Great Britain except within seven miles of the very place where was situated the University from which he obtained his degree. The third anomaly was that the Archbishop of Canterbury possessed the power of granting medical degrees without examination. The hon. Member for Finsbury (Mr. T. Duncombe) had quoted the analogy of the hackney cabmen with respect to registration. He (Lord Elcho) would follow up the figure, and he said that the present state of the law with regard to the medical profession was as absurd as if the cabmen in Palace Yard, with certain badges round their necks, could only convey hon. Gentlemen to Belgrave Square, and that those who asked to go to Hanover Square must procure a cab from some other quarter. So far from wishing to rival his hon. and learned Friend as a medical reformer, it would be sufficient to state that when his hon. and learned Friend gave notice of his Bill, he (Lord Elcho) asked him if it were the same as that which had been amended by the Select Committee on which they had both sat last Session, stating that, if it were so, any sort of assistance which he could give him was at his service; and it was only upon finding that his hon. and learned Friend's Bill was not the amended Bill of the Committee, but the very same Bill, with the exception of some alteration in the constitution of the council, which his hon. and learned Friend had brought in at the commencement of 1856, that he determined to oppose it. He did not pretend to be a more practical man than others, but he ventured to think that if they wished to pass a good measure of medical reform, the practical course would be to take up the Bill in the amended state in which it had been left by the Committee at the end of 1856, and not to take it up as it had been introduced at the beginning of 1856. He (Lord Elcho) stood by the Bill of the Committee, and he asked the House to reject the Bill of his hon. and learned Friend, with the view of substituting in its place the Bill of the Select Committee; because, whatever the fate of the Committee's Bill might be, he ventured to predict that the Bill of his hon. and learned Friend could not pass into a law. No less than three pages of the Parliamentary notice paper last year were filled with notices of Amendments upon the Bill of his 726 hon. and learned Friend as originally introduced. Altogether there were fifty-one Amendments on the paper, and inasmuch, as every principle of that Bill, which was objected to at that time, was to be found, if possible in a more aggravated form, in the present Bill, he left the House to judge what chance it would ever have of passing into a law. He wished to discuss this question upon some broad and intelligible principle, because it appeared to him that such was the rule which they ought to lay down for themselves upon the second reading of a measure, in preference to dealing too much with matters of detail. But first let him read to the House the names of the hon. Members who composed the Select Committee of last Session. The Members were Mr. Cowper (in the chair), Mr. Headlam, Mr. Brady, Mr. Craufurd, Sir W. Heathcote, Mr. Napier, Lord R. Grosvenor, Mr. Black, Colonel Dunne, Mr. Bell, Mr. Strutt (the present Lord Belper), Mr. A. Hastie, Mr. Percy, Mr. Howard, and Lord Elcho. He considered that Committee to have been fairly constituted. Upon it were the three hon. Members whose names were on the back of the Bill of his hon. and learned Friend, and altogether he believed that there was no improper element in it. He had never sat upon a more unanimous Committee. Indeed, so unanimous had they been "upstairs," that he had ventured to express a hope that their proceedings in the House upon the subject of medical reform would be characterized by equal unanimity; and, with the exception of Colonel Dunne, who was no longer a Member of the House, they all agreed to support one another upon the question, sinking all minor differences in the hope of getting the Bill through. To return now to the question of principle. The principle of the Bill of his hon. and learned Friend was that of giving a monopoly on the subject of medical education to the medical corporations. Upon that ground he (Lord Elcho) was opposed to the Bill now; upon that ground he had been opposed to it last year; and upon that ground he should continue to be opposed to it so long as it contained the principle in question. At the present moment there were twenty-one licensing bodies in the United Kingdom, Of those, eleven were universities, and nine were corporations, the twenty-first being the Archbishop of Canterbury. His hon. and learned Friend in his Bill gave the whole licensing power to the corporations, and to the corporations 727 alone. It was true that in the council he gave a certain amount of power to the Universities, but even in the council the proportion given to the Universities was not fair in comparison with the number given to the corporations. By the Bill of his hon. and learned Friend also every member of an University was compelled, before he could be recognized, to be examined by one of those corporations. Moreover, he was compelled to join one of those corporations, and there was an extraordinary clause in the Bill which obliged every gentleman who had passed the necessary examination to reside two years in one country before he could he registered in another. The only reason for that, so far as he had been able to ascertain it, was this. There had always existed a certain degree of jealousy of Scotchmen and Scotch doctors, and even the cheers of that House when expressions of a depreciatory character with respect to Scotchmen were made use of, evidenced that the feeling still existed. It had been shown by Smollet in Roderick Random, for Roderick Random when he went up for examination before the College of Surgeons in London was asked where he came from. "From Scotland," was the reply. "Of course—none but Scotchmen come here—you Scotchmen overspread us as the locusts did Egypt." Scotchmen, however, in this respect followed a natural law, for he (Lord Elcho) well remembered that the late Dr. Buckland in his lectures at Oxford related as a curious fact that the footprints of the palæontological tortoise invariably tended southwards, and that there was no instance of their footprints tending northwards—a remarkable illustration of the tendency of Scotchmen to go south and never to return! Scotch doctors, however, went through as strict an examination and stood as high in the world of science as gentle men who had received diplomas from English Colleges. To justify the principle of his hon. and learned Friend, that the whole power should be given to the corporations and taken from the Universities, his hon. and learned Friend should show, ns the hon. Member for Oxford (Mr. Neate) had endeavoured to do, that monopoly would; work well for the public. The hon. Member for Oxford stated that he did not see why the medical profession should not regulate itself in the same way as the clerical and legal professions did. He (Lord Elcho) was not aware that the medical profession held the doctrine of apostolical succession from Galen and Hippocrates, unless, 728 perhaps, those members did so who had received their degree from the Archbishop of Canterbury; and as regarded the legal analogy, he made hold to say, even in the presence of so many luminaries of the law, that the opinion had long prevailed, among laymen at all events, that distinguished as that profession was, still it might have been improved if admission to its ranks had been obtained, not by the payment of fees only, and by the aptitude of the stomach to digest a certain number of dinners, but by some system of practical examination upon the practice and theory of the law in its different branches. The right hon. Gentleman the Member for Dublin University (Mr. Napier), was so sensible of the objection to the manner hi which the legal societies admitted members to the legal profession, in consequence of having eaten so many dinners in hall, that he moved for the appointment of a Royal Commission on the subject. They had not to do with theory, but with what has been, and is, the practice. They found the practice of licensing universally exercised by the Universities. It existed in the case of the Oxford and Cambridge Universities, and it practically existed in the case of the Scotch and Dublin Universities, and in the case of the Queen's Colleges. This right on the part of the former Universities dated from ancient times, and they had a recent instance of the recognition of that right in a Bill which in 1854 passed through that House, for the purpose of extending to London graduates in the unfortunate position he had referred to the same rights and privileges which were extended to those of the Universities of Oxford and Cambridge. It was an extraordinary fact, too, that among the warmest supporters of that Bill sanctioning the principle that University degrees should give a licence for practice was the hon. and learned Member for Newcastle himself, who supported an Amendment to the effect that the University of Durham should be put on the same footing. Therefore, he repeated that, as regards this country, the principle was founded on old charters, and was sanctioned so recently as 1854 that Universities might grant licences for practice. What was the state of things on the Continent? In France the sole licensing power was the University of Paris; in Germany it was not the profession, but a Government Board which licensed; and in Italy the same rule held good. The right of the Scotch Universities to grant medical degrees originated in bulls of 729 the Popes, subsequently confirmed by; Statute, in which it was stated that the same rights, privileges, and immunities were conceded as were held by the Universities of Paris and Bologna. If, then, this had been the practice both at home and abroad, he thought sonic strong ground should be shown why, when it was attempted to remedy the defects of the medical profession in these liberal and anti-monopoly days, a monopoly should not only be perpetuated, but that the holders of that monopoly should have privileges given them which they had not heretofore possessed. Had this practice worked badly, and were the University medical degrees so inferior to those given by the medical corporations? On this point he would read a letter sent by Dr. Reid, the Examiner of the University of St. Andrew's, to the Committee which sat in 1847. Mr. Lawrence, a distinguished member of the College of Surgeons, had stated that the St. Andrew's degrees were valueless, and that he would not trust the smallest union to the charge of a medical officer who only held a St. Andrew's degree. Dr. Reid thereupon wrote to the Committee a letter in which he stated, speaking of St. Andrew's medical degrees—No degree is granted without a regular and stringent examination, in accordance with regulations in force since 1826. In 1840 there were thirty candidates, of whom six were rejected; of the six rejected one possessed no diploma, four were members of the Royal College of Surgeons of London, and one was a licentiate of the Royal College of Surgeons of Edinburgh. In three years previous to 1845 there were seventy-one candidates, of whom twelve were rejected; of the twelve rejected, six, or one-half were members of the Royal College of Surgeons of London; Borne of them also held the diploma of the Apothecaries' Company. In 1846, out of five licentiates of the Royal College of Surgeons of Edinburgh who presented themselves, three were remitted to their studies. In 1847 there were forty-nine candidates, of whom eleven were rejected; of the rejected, seven were members of the Royal College of Surgeons of London, one licentiate of the Royal College of Surgeons of Edinburgh, one licentiate of the Dublin Apothecaries' Company; some of them likewise were licentiates of the London Apothecaries' Company.The fact was that no practical examination in surgery was required at the College of Surgeons, although cases of hernia, fractures, and cases of that kind which required experience, were the class of cases which generally came before surgeons. What, he asked, were these medical corporations? They were merely mediæval guilds, like those of the grocers, shoemakers, and other municipal institutions dating from 730 the same time; but the existence of old charters giving the Universities the right of licensing showed clearly that they possessed the right long before these medical corporations. At that time all learning, whether legal or medical, was centred in the Universities, the Members being ecclesiastics. In 1163 a law was passed which forbade the shedding of blood by ecclesiastics, and in consequence of that law the ecclesiastics selected the barbers, who shaved their heads to bleed for them, and that was the origin of the Barber-Surgeons' Corporation. Hon. Gentlemen in their walks, not at the west end but in out-of-the-way parts of London, had perhaps seen over a barber's shop a pole painted in various colours, but might not be aware what it was intended to represent. The pole represented the wand formerly held by a patient when undergoing the operation of bleeding, and the stripes round the pole represented the ribands by which the patient's arm was bound up. The connection between the barbers and the surgeons was particularly exemplified by the shield of the Edinburgh Royal College of Surgeons, which up to last year bore on it the emblems of shaving—razors, and so forth. On turning to The Encyclopœdia he found that in the time of Henry VIII. the physicians, and also the barber-surgeons of London, were incorporated, and those two bodies over stepped their jurisdiction by prosecuting those who did not belong to either, so that it became necessary to pass an Act in 1543 for the protection of the irregular practitioners. In 1606, James I. incorporated the apothecaries, uniting with them the grocers, and they also began to prosecute as soon as they had obtained their privileges. He had now shown the House the origin of these medical corporations, and their true character was to be found in the Act of Henry VIII., which enacted—Whereas it was enacted that no person within the city of London, nor within seven miles of the same, should take upon him to exercise and occupy as a physician or surgeon, except he be first examined, approved, and admitted by the Bishop of London and others; sithence the making of which said Act the Company and Fellowship of Surgeons of London, minding only their own lucres and nothing the profit or ease of the diseased or patient, have sued, troubled, and vexed divers honest persons (as well men as women) whom God hath endued with the knowledge of the nature, kind, and operation of certain herbs, roots, and waters, and yet the same persons have not taken anything for their pains or cunning, but have ministered the same for God's sake and charity; and it is now well known that surgeons admitted will do no cure to any person, but where 731 they shall know to be rewarded with a greater sum than the cure extendeth unto, for, in case they would minister their cunning to sore people unrewarded, there should not so many rot and perish to death as daily do for lack of surgeons.The same character was to be found in the preamble of the hon. and learned Gentleman's Bill. Now, he asked hon. Members whether, in 1857, they found old corporations, such as the city of London for instance, managing the affairs with which; they were intrusted so well that they would grant to those medical corporations, the relics of ancient guilds, powers which they had not heretofore possessed? It was asked, not that they should have a fair share of power—to which he should not object—but that they should have a complete monopoly. It was on these grounds that he asked the House to reject the Bill of his hon. and learned Friend, As it might be for the convenience of the House to have but one discussion on both the medical Bills standing on the Orders of the Day, he should now say something in support of that Bill which he asked the House to substitute for the Bill of the hon. and learned Gentleman. The reasons which induced him to bring that Bill forward he had already stated to the House, Both Bills had the same object, that of medical reform.
§ MR. T. DUNCOMBE rose to order, He thought it irregular to discuss during the consideration of one Bill the merits of another standing in the business of the day.
§ MR. SPEAKER
said, that as in the course of the discussion that day there had been a constant reference to both of the Bills, it was rather too late now to interpose to prevent the noble Lord entering upon the statement he was about to make.
§ LORD ELCHO
said that, fortified by the decision of the Speaker, and also by the example of the hon. Member for Finsbury, who had himself referred to both Bills, he should proceed to point out to which Bill the preference ought to be given; and he here would observe that he felt the full force of what had fallen from the hon. Member for Finsbury, to the effect that they should be as liberal as possible, and not restrain the profession by needless restrictions. Both Bills had the same object in view—namely, the establishment of as efficient registration of practitioners, but the Bill of the Committee of 1856, which he proposed should be adopted, proceeded to effect its object in a totally different way from the Bill of the 732 hon. and learned Gentleman. The main objection raised against the Bill of the Committee by those who were opposed to it rested on the constitution of the council. They urged that the council ought to be representative, and not nominated by the Crown. He did not, however, consider that provision in the Bill to form the principle of the measure, the important question being whether the House would give a monopoly to the existing corporations or not. That was the principle involved in the Bill, and the constitution of the council was a matter for consideration in Committee. This form of council was adopted by the Committee of 1856, not to give irresponsible power to the Crown, but because they considered it offered the best guarantee for the constitution of a good council. It was thought that if the council were nominated by the corporations the members would go to it as mere delegates of those corporations, while a good council would be nominated by the Crown. Nevertheless, as objections were still raised to the nomination of the council by the Crown, the Committee of 1856 made, as a check on any irresponsible exercise of power, a responsible Minister in that House the head of the council. At that time the President of the Board of Health, who was now in a moribund state, was in full vigour, and that officer was accordingly taken as the natural head of the medical council, which would to a certain extent act as a Board of Health. Now that that office was nearly abolished the Home Secretary or some other public official in that House might be substituted. However, this point, as he had said before, was matter for consideration in Committee, but the question whether a monopoly should be given to the medical corporations was not matter for consideration in Committee. No doubt the Bill of his hon. and learned Friend had been taken by the Select Committee for a basis, but it was so altered, root and branch, that scarcely any part of the original was left. It was therefore impossible so to alter it as to make it resemble the Bill adopted by the Committee. The Bill of the Committee proceeded on the principle of forming a new examining board, to be composed of an equal number of members of the existing corporations and universities. Every candidate, after having passed an examination as to general learning, would have to appear before this board, and, after passing examination, would receive a certificate entitling him to practise as a licentiate in medicine or surgery. 733 It would afterwards be open to him to qualify himself for the higher branches of the profession. There would, however, be no invidious distinction between the surgeon and the physician, and there would be no restriction limiting his practice to one part of the kingdom. Nor was there any clause in his Bill which required that university graduates should be examined. His Bill looked to the public interests, and the public interests alone. It therefore provided that the fees should be paid into a common fund, which was to be distributed in payment of examiners and in aid of museums. A great deal had been said about preserving old institutions and collections, such, as the Museum of the College of Surgeons and the Hunterian Museum. Well, his Bill left the council the power of distributing the fees amongst these institutions as they thought right and proper. This system, however, did not suit the corporations. They are remnants of the old guilds, and "guild" is derived from an old Saxon word, "guildan," to pay; and from their fees the College of Surgeons derive an income of £12,000 a year. His Bill did not touch those fees. Any person who obtained the degree of licentiate might go to the College of Surgeons for a diploma, and they could charge such fees as they considered right. He had stated generally the difference between the two Bills, but he did not wish the House to take the character of the Bill he advocated from any description of his, for it might be said that he was a Scotch jobber. Let the House take the testimony, not of any interested party but of the medical corporations themselves. He held in his hand a petition from the Dublin Corporation of Apothecaries, and it stated that the amended Bill of last Session "is characterized by an equitable adjustment of the vested rights of all parties, and at the same time contains adequate security for a suitable education preliminary and professional;" and the petitioners prayed that the amended Bill might be passed into law. That was the opinion of one corporation in Ireland, and he would now also state what was the opinion of the Edinburgh College of Physicians—itself a medical corporation. When the Bill came out of Committee last year that body drew up a paper, in which they stated:—The amended Medical Bill has appeared to the College of Physicians worthy of support, and they earnestly trust that it will be passed in the 734 Present Session of Parliament, because it will put an end to the constant agitation which has prevailed in the profession on the subject of medical reform for many years past. It will secure in he fullest possible manner that equality of privilege which has long been contended for; it will secure a good minimum standard of education; will not interfere with the higher grades of the Profession, but will leave colleges and universities unfettered in elevating the standard of qualification for those honours which they are entitled to bestow; it will, for the first time, render imperative a proper preliminary examination; it will save those practitioners whose position merely requires the lowest qualification the necessity of Passing more than one examination, by combining he representatives of several into one efficient examining board; it will provide an authorized register, which will at once show who are legally qualified practitioners, and what are the qualifications which they possess; it will provide for such of the museums and other adjuncts of the existing incorporations as are of real public benefit, without rendering them dependent, as heretofore, on the fees of those whom that particular body may pass; it will for the first time introduce some sort of government in place of the present anomalous state of the profession by means of a council, which, if judiciously chosen, may succeed in harmonizing the various conflicting medical incorporations and universities which have never yet been nor are ever likely to be, able to adjust their several claims for regulating the profession. While, in our opinion, it will inflict no real injury on the incorporations, it will give great satisfaction to that large section of the profession who are unconnected with these bodies.Now, let him adduce the opinion of the British Medical Association as given last year in reference to the amended Bill. There was first a meeting of the Committee, from which Resolutions were submitted to the whole Association, and passed. Those Resolutions were to the effect that the provisions of the amended Bill carried out the principles which the Association had always contended for, and the Association stated that they were desirous of seeing the Bill at once passed into a law. It was Madame de Staël, he thought, who said that the opinion of foreigners was the same as the judgment of posterity, because it was removed from prejudice; and he might here observe that he had received a letter from a medical man in Jersey stating that the profession there were most anxious that his Bill should be extended to the Channel Islands. He should not trouble the House with any more arguments in favour of the Bill, but would proceed to meet some of the objections urged against it, and first, as to those urged against the constitution of the council. He repeated that he did not hold that part of the Bill to constitute the principle of the measure, but he wished to show that other 735 persons beside the Committee of 1856 considered the constitution of the council not objectionable. A gentleman, whose name could never be mentioned without honour, had drawn up a most able analysis of the two Bills. Mr. Warburton, the Gentleman he referred to, said on the part of the senate of the University of London, that that body greatly preferred the constitution of Lord Elcho's council with its Committees, to the Constitution of Mr. Headlam's general council and branch councils. Even the corporations themselves expressed similar views, for the Royal College of Physicians of Edinburgh last year suggested—Whether there is not a danger that delegates sent directly by the corporations, or by any public bodies, would not be likely to lean too much to the interest of those bodies, and therefore the less to those of the public and the profession in general?and therefore proposed—That the number of the council should not exceed twelve. That the President of the General Board of Health should be the chairman of the medical council.That was the exact constitution as proposed by the Bill, and yet they found the corporations now coming forward and denouncing the Bill as a strong interference with their rights. Such inconsistency was monstrous. The Royal College of Surgeons was active in its opposition to his Bill in the present year, although last year a petition from that body to the House of Commons stated:—That your petitioners are of opinion that a medical council or central authority of some kind might be instituted with advantage to the public, in order to establish and enforce education and examinations of equal value as a foundation for reciprocity of practice in the three kingdoms. They believe that a council nominated by the Crown, not exceeding five or seven in number, including two non-medical members, might usefully regulate the course of education so as to secure the harmonious co-operation and efficiency of the several schools and licensing bodies. The more immediate connection with the State thus established would create an interest on the part of Government in the affairs of the profession, would insure the personal competency and responsibility of the council, and raise the profession in the estimation of the public.He trusted, therefore, that the House would hear no more of the injustice and degradation, endeavoured to be heaped upon these corporations by means of a council nominated by the Crown. He now came to the next objection, and that was that his Bill merely provided what was called the "one portal system," that in fact there was but one entrance and one examination. But, in reply to this he would ask, for 736 whom were they legislating? For the people of England, and not for the rich merely. The rich had it in their power by means of their guineas to summon to their bedsides in time of illness Sir Benjamin This or That, or any Baronet or Knight who was on the rolls of the register; but the House had to take care that the general practitioners, who were charged with the care of the poor, were not incompetent. In his Bill security was taken that the name of no man not qualified to practise in the opinion of a competent authority should be on the register. When a man was on the register, the Corporations and Universities would then compete together to induce him to go to one or the other. They would grant titular distinctions, and the public would of course form their own opinion as to the comparative value of these particular distinctions. He contended, therefore, that his Bill left competition open, but it was a competition upwards, and not a competition downwards, as provided by the Bill of his hon. and learned Friend. The Edinburgh College of Physicians made the following statement with reference to the proposal to abolish all the existing examining boards and to set up in their places one chosen jointly by the Universities and the Incorporations:—Although some of these bodies have undoubtedly faithfully discharged their duties others have been most remiss, and, from the obvious difficulty of preferring one to another, it seems better to establish one common portal through which the profession must be entered. While men continue to be actuated, as they aye at present, by honourable ambition, and while the competition in our profession remains as it is, there is little fear of this engendering a dead level in medical acquirement; all will, indeed, enter by one portal, but most will seek the higher honours which Universities and Colleges will bestow. There has been no want hitherto of a strenuous competition for the mere honorary distinctions in the profession, and this is not likely to be arrested by the Bill.Mr. Fergusson, the eminent surgeon, expressed the following opinion in a letter to a friend with regard to his (Lord Elcho's) Bill:—In so far as I am myself concerned, I have no objection that my preference to Lord Elcho's Bill should be known. I have for nearly thirty years advocated a main feature in that Bill—the one portal system. There is, in my opinion, no single feature in what is called medical reform of greater importance than this. In other respects there seems a simplicity of arrangement in Lord Elcho's Bill which induces me to look far more favourably upon it than that of Mr. Headlam.The views entertained on the subject of the one portal system by the Edinburgh 737 College of Physicians and by Mr. Fergusson were strongly advocated thirty years ago by Dr. Thomson, the celebrated professor of medicine in the University of Edinburgh. Dr. Thomson, in his Life of Dr. Cullen, thus expresses his opinion:—If it be desirable, for the interests of society, that there should exist a separate class of medical practitioners, under the title of physicians, the Legislature would surely confer a greater benefit on the public by fixing a course of preliminary and professional education, and providing for the strict examination of those who desire to be licensed to practise in this capacity, and then leaving them at liberty to exercise their profession when they please, than by indulging particular corporations in the exercise of a narrow and exclusive system of monopoly, the only conceivable operation of which is to engender arrogance and presumption, and consequently ignorance and rashness, in the minds of those who are admitted within its pale, and jealousy and rancour in those who are kept without it.Similar views were maintained by Dr. Carpenter, of the London University, in the British and Foreign Medical Review, but which it is not necessary that I should quote. He (Lord Elcho) now came to the charge that he was endeavouring to carry out what was called "a Scotch job." Unfortunately, everything he touched seemed to be converted into a Scotch job. He had been charged with jobbery because he had advocated the 25-inch scale for the Scotch survey, and now, because he was anxious to destroy monopoly and to benefit the public, he was accused of being engaged in a Scotch job. He believed that his proposal would be advantageous to Scotland, but others would be equal gainers, as, for instance, the London University and University College. He must say, however, that he had had little communication, with the Scotch Universities with reference to his measure, which he had brought forward simply for public interests. It had been further said that the greatest unanimity prevailed among the medical profession on this subject, and that he (Lord Elcho) was merely throwing down an apple of discord. The existence of that unanimity, however, he begged to deny. By some hocus-pocus the names of two hon. Gentlemen opposite, the hon. Member for the University of Oxford (Sir W. Heathcote), and the right hon. Member for Dublin University (Mr. Napier), who had last year fought the battle of the Universities against the monopolists, appeared this year on the back of the Bill introduced by the hon. and learned Member for Newcastle-on-Tyne. He gave that hon. and learned 738 Gentleman full credit for the diplomatic tact which had led him to get the names of those two hon. Members placed upon the back of his Bill. Last year the names of the hon. Member for Ayr (Mr. Craufurd) and the hon. Member for Leitrim (Mr. Brady) appeared upon the hon. Gentleman's Bill, and, it might naturally have been supposed that when the hon. and earned Member for Newcastle-on-Tyne introduced this Session another measure of medical reform, he would have consulted he hon. Gentlemen who previously backed him, and would again have placed their names upon the Bill, His hon. and learned Friend (Mr. Headlam), however, had not said a word on the subject to one of these hon. Gentlemen, but went over to the enemy, and enticed from their ranks—by what bribe he (Lord Elcho) knew not—the two hon. Gentlemen opposite whose names now appeared upon the back of his Bill. This seemed rather sharp practice, and consequently he (Lord Elcho) asked the hon. Members for Ayr and Leitrim (Mr. Craufurd and Mr. Brady) to allow their names to be placed upon the Bill which he introduced. They unhesitatingly consented, and he obtained leave to bring in the Medical Profession No. 2 Bill. The next day he met the hon. Member for Leitrim (Mr. Brady), who requested him, as a personal favour, to take his name off the Bill, stating that, from peculiar circumstances connected with his position in Ireland, he did not wish to meddle any more with, medical reform. He (Lord Elcho) acceded to the hon. Gentleman's request, but the consequence was, that he had to get the order for the Bill discharged, and to obtain leave to introduce the Medical Profession No. 3 Bill, which stood next upon the orders of the day. He wished to say a few words with reference to a document which had been circulated among hon. Members, and which denounced him for disturbing the unanimity of the medical profession on this subject. That paper was written by a member of the College of Physicians of London, and he doubted whether the oldest Member of the House had ever known so extraordinary a production addressed to Members of Parliament. The paper was headed, "Remarks on Mr. Headlam's 'Medical Profession Bill' and Lord Elcho's opposition." The first sentence ran thus:—Surprise not unmixed with indignation is the general feeling of the medical profession of the three kingdoms on finding that Lord, Elcho, as the 739 advocate of the Scotch Universities, should have come forward to oppose the Medical Bill which was read a first time last Wednesday by Mr. Headlam.The Bill was not his (Lord Elcho's) Bill, nor was it the Bill of the Scotch. Universities, but it was the Bill of a Select Committee, whose names afforded a sufficient guarantee that no "job" could be contemplated. He did not know whether the writer of this paper spoke in the name of the College of Physicians, but at all events he holds an official position in their body, and he proceeded to say:—It is scarcely likely that any Select Committee of the House of Commons should be in a position to comprehend the complex bearings of this difficult subject, still less to amend a decision arrived at with so much knowledge and so much care.There was a compliment to the mental and judicial qualifications of Committees of the House of Commons! The cream of this document was, however, contained in its concluding sentence:—The whole profession, therefore, are determined to regulate the laws by which they are to be governed, and they are decided not to allow any Member of the House, however popular he maybe, to come forward, partially instructed, and biassed, as it would seem, by a small and mercenary interest, to interfere with what they believe to be wise, just, and prudent legislation.Such a declaration emanating from the College of Physicians, expressing their de termination not to allow any Member of the House of Commons to interfere with what they in their wisdom conceived to be "wise, just, and prudent legislation," was really so alarming that he felt some hesitation in inviting the House to attempt to deal with this question. If they did so, they might have Dr. Mayo, at the head of the College of Physicians, inarching down to the House of Commons and ordering that "bauble" (pointing to the mace upon the table) to be taken away. He (Lord Elcho) thought that since the memorable declaration of the Grand Monarque, "L'état c'est moi," this production of Dr. Alderson had not been surpassed. Whether he spoke in his own name merely or in that of the College of Physicians, he (Lore Elcho) did not know; he must deny however, that the unanimity which was alleged to prevail among members of the medical profession with respect to this question really existed. The British Medical Association, the Scotch Universities, Cambridge, the Queen's University in Ireland, the University of London, and the Apothecaries Company 740 of Ireland, were dissatisfied with the Bill of the hon. and learned Member for Newcastle-on-Tyne, and he (Lord Elcho) thought, therefore, there was no chance of its becoming law. The hon. and learned Gentleman (Mr. Headlam) would doubtless ay great stress upon the petitions in favour of his measure, but he (Lord Elcho) contended that they ought to have no weight, and he would tell the House why. He found in the British Medical Journal, the organ of the British Medical Association, a report of a meeting, at which it was resolved that petitions should be forwarded to Parliament in favour of Mr. Headlam's Bill, and the following recommendation wag given on the subject:—It is trusted that each member will write out and sign a petition, and at once forward it to a Member of the House of Commons. The number of petitions is greatly more important than the number of signatures to a single petition; therefore no time should be wasted in endeavouring to obtain, numerously signed petitions."Numerously signed petitions" meant, of course, numerous petitions, each signed by an individual. He believed he might state that, although among the deputation who waited upon Lord Palmerston on this subject the delegates of the Medical Association of Great Britain were mentioned, the committee of that association had not authorized any member of their body to attend. Among the deputation were also delegates from the College of Surgeons of London, but the next day a letter appeared in The Times, signed by a member of the College of Surgeons, who said that the gentlemen who professed to represent the College of Surgeons in the deputation had no more right to speak in the name of the 12,000 surgeons of England than would any three Members of that House be entitled to go to the Government as representatives of the House of Commons. He (Lord Elcho) maintained, then, that the unanimity which was alleged to prevail among the profession did not in reality exist. Indeed, the reason why all former Bills had failed was, that instead of legislating on a broad basis and seeking to promote the true interests of the people, they were founded on the narrow basis of a unanimity which the discordant interests of the Universities and of the governing bodies, rendered it impossible to establish. He hoped, therefore, that the House, instead of assenting to the Bill of the hon. and learned Member for Newcastle-on-Tyne would adopt the Bill drawn up by the Committee to whom they had referred 741 the consideration of the subject. It was absurd to endeavour to obtain the consent of all the various bodies whose interests would be affected by such a measure. If Parliament had waited until the consent of the legal profession had been obtained to improvements of the law, what efficient legal reforms could have been effected? If they had waited for the consent of the owners of rotten boroughs, when would the measures of Parliamentary Reform have been carried? If they had waited for the consent of the farmers, and had been influenced by their petitions, when would free trade in corn have been established? He called upon the House, then, to act with justice in this case, regardless of the interested opposition of a portion of the profession. He was aware of the Quixotic nature of the enterprise he bad undertaken in endeavouring to induce the House to oppose an organized agitation which extended throughout the three kingdoms. He knew what influence must necessarily be exercised by men of intelligent and highly cultivated minds, whose profession it was to heal the sick, to relieve the suffering, and to smooth the pillows of the dying. Their mission was indeed high, and no one could wonder at their influence. It must be remembered, however, that physicians were but men, and that the House was now called upon to deal with men not in their individual but in their corporate capacity. If hon. Gentlemen, setting aside all the influence of private feeling and of personal predilection, would view this question dispassionately and upon its merits alone, he had little fear of the result, and he confidently anticipated that they would reject the monopolizing Bill of the corporations and would substitute in its place the Bill of the Select Committee.
said, that the noble Lord who had last addressed the House was at a loss to surmise what were the views of the Members for the great Universities on the question now before the House; but did it not occur to the noble Lord that they supported the Bill of the hon. and learned Member for Newcastle, because they agreed in its principles? He (Mr. Napier) supported it upon that ground, and because it met with the approval of his constituents—a body of men as distinguished as any in the "United Kingdom, and whose views he, on this matter, adopted as his own. In illustrating the position which the proposed Council would bear in relation to the Universities, he would take the case of the 742 Universities and the Inns of Court, as he was only anxious to carry out the same views with regard to the medical profession which he had advocated with regard to his own. What were these Inns for? Solely to prepare men for the bar. They stood as between the Universities and the bar itself, just in the position occupied by the medical corporate bodies, as between the Universities and actual medical practitioners. They stood between education and actual practice. Now, when the Commission on legal education made their Report, did they propose to take from the Inns of Court their legitimate position, their proper functions, or their property? Certainly not. They simply proposed that these Inns should be made more efficient for the imparting of that special instruction which ought to be obtained by men going to the bar after they had received that general education in arts which it was the province of the Universities to impart. And, whilst alluding to the Commission on legal education, be would ask of whom was that Commission composed? Let them see how the bar was treated, and then see what had been done in the case of the medical profession. On the Commission on legal education were Judges and practising lawyers. Was the medical profession equally well treated, when the system of medical education was under inquiry? But what had the Commission on legal education, composed as it was, recommended? Why, the members decided unanimously that the Universities should confine themselves to the preparatory enlightened education necessary for every man destined to become a member of a liberal profession, but that the Inns of Court should apply themselves to the preparing of men in those particular studies which are necessary to make them fit to practise at the bar. In order that this should be done more effectively, the Commissioners recommended that one uniform plan should be adopted for all the Inns; there being some of those Inns which, like some of the Universities, granted degrees on easy terms, while others of them were anxious to raise the standard of education. However, the Commissioners, while recommending one uniform plan for the Inns of Court, did not wish in the "slightest degree to interfere with the education given in Universities, and which they believed to be most important for the purpose of affording a liberal and enlightened education. In that opinion be fully agreed, 743 because he believed it a great mistake to bring up young men from their first education on a narrow and exclusive system. Such a course would not only be a mistake in the case of men destined for the bar or the medical profession, but also in the case of those destined for the war departments of the public service, the military and naval professions. The Report on military education showed the mistake of any such system; and accordingly it was recommended that after young men who intended to adopt the army as a profession had received in a University a sound, enlightened, and liberal education, that then, and not till then, should they enter a military college to receive that exclusive education necessary for their professional pursuits. The same rule would apply to the legal and medical professions. The College of Physicians and the College of Surgeons were intended for that particular education required for members of the medical and surgical professions. He wanted to put the medical profession on the same footing as the profession of the law, and what he was anxious about was, not so much particular details, as that the House should proceed on enlightened educational principles. This subject had been considered by a Select Committee, of which he had been a member; but, at that time, they were embarrassed by the fact, that nearly all the medical bodies were at variance, and that great difficulty had to be encountered before they could be brought into harmony. Therefore that Committee tried to do the best it could under the circumstances. All the hon. Members of that House who had served on Committees of the kind knew how much might be learned by attention to the facts detailed in evidence. Now, he represented a "University which had a school of medicine and surgery of very high standing, but the medical bodies of Dublin had felt that their interests conflicted. However, after having considered the matter, he told them that it was most important that they should have a general and enlightened system of surgical and medical education. He advised them to meet together, and confer, before the medical bills would again come under discussion in Parliament, in order to agree on some general principles. The result was that, after frequent meetings, these distinguished bodies at last came to an understanding, and the views presented in the Bill of his hon. and learned Friend the Member for Newcastle embodied in the 744 main the results at which these medical corporations had arrived; and thus a Bill came before the House, having on the back of it his own name, as Member for the University of Dublin, in connection with; he names of his hon. Friend the Member for Oxford and his hon. and learned Friend; he Member for Newcastle. He could not but think that the Bills of his hon. and earned Friend the Member for Newcastle and the noble Lord (Lord Elcho) were irreconcilable. They proceeded on totally different principles. The Bill of the noble Lord transferred all over to the Crown, For the council was to be nominated by the Crown, and the President of the Board of Health was to be the chairman of the council. There was no use in using the ad hominem argument—"You did not object to it before the Select Committee." No man had a right to make use of such an argument in a case like the present. He repeated that the whole medical body would be under the influence of the Crown if the Bill of the noble Lord passed; and that, he contended, would not be a healthy state of things, neither would it be a necessary state of things, if it was possible to get the medical bodies themselves to agree to carry out, under a council of their own members, the desired measures of medical reform. The Bill of his hon. and learned Friend the Member for Newcastle, provided that the council should be an independent one, and that in it should be comprised representatives chosen by the Colleges of Physicians and Surgeons, and the Apothecaries Society of England, the Universities of Oxford, Cambridge, London, and Durham; the Colleges of Physicians and Surgeons of Edinburgh, the College of the Faculty of Glasgow, the University of Edinburgh, the Medical Colleges, the University of Dublin, and the Queen's University in Ireland; the Universities of Scotland (Glasgow, Aberdeen, and St. Andrew's) being grouped together. He was himself old enough to have drawn up the renewed charters granted to the medical corporate bodies in Dublin, and which his right hon. Friend the Member for Carlisle (Sir James Graham) would remember to have been granted by a Government of which he was a member, and he thought Ireland had reason to be greatly proud of her medical schools. Therefore, taking Ireland per se, he did not think the standard of medical education in that country could be at all objected to. But with respect to some of the Scotch schools, he was bound to say the 745 case was different. They had diminished the value of their own degree by the readiness with which they granted it. He would beg distinctly to be understood as speaking with the highest respect of Scotland generally. He knew that that country had produced men eminent in all the branches of learning, besides which it was the country of his ancestors—an additional reason for his respecting it. Nevertheless he was compelled to say, that the value of some Scotch degrees had fallen in the market. He knew as a fact that many men, when they could not stand the necessary test to secure them a degree at home, proceeded to Scotland, and obtained a degree in that country from one of those Universities which did not require a degree in arts preliminary to a degree in medicine. He had met one gentleman, the holder of such a degree, who was ignorant of the name of the most commonly known works of Homer. One of the great points in the Bill of his hon. and learned Friend was, that it contemplated that before taking a degree as a physician a person must have taken a degree in art at some University; whereas his noble Friend (Lord Elcho), only required the minimum of education, thereby lowering the status of the profession to the level of the general practitioner. The noble Lord maintained the right of the Universities to grant licences to practise, but he (Mr. Napier) thought the function of the Universities should be to afford a sound preliminary and preparatory training, leaving to other bodies who were better competent to judge of qualifications for practice the duty of licensing. His noble Friend had referred to the University of London, but the opinion of that University on this subject, as expressed in a printed paper, which had been circulated by it, was contained in these words:—"At the same time the Senate have no desire to see conferred on this University any general or uncontrolled authority to grant licences to its graduates to practise; nor do they desire to secure special immunities for the University of London in particular." The University of London agreed, then, that the right principle was, that no monopoly should be given to the Universities; and this was the principle of his hon. and learned Friend's Bill. What the noble Lord wanted was, that the Scotch Universities should be at liberty to grant degrees in medicine without requiring previous degrees in arts. He (Mr. Napier) must say, that he had met graduates in medicine 746 from Scotland whose ignorance was quite astounding. He contended they ought to take the very highest standard of education, and the question was how that was to be provided. They had in the Bill of his hon. and learned Friend (Mr. Headlam) provision made for a general council formed of the representatives of all the medical bodies, and that council had the power of insisting on a good general education, and a special education in medicine and surgery. If they wished to have medical practitioners a more enlightened and better educated class, they must call upon the Universities to provide a better education. They must refer for their standard of general education to the best University, and take their licensing power from the best professional body. Then the Bill of his hon. and learned Friend (Mr. Headlam) made provision for a register which stated the qualifications conferred on practitioners in every instance, and on which the public could always rely for information of that kind. But it was said there wore several corporations opposed to the Bill of his hon. and learned Friend, and among others the apothecaries of Ireland. With regard to the apothecaries of Ireland he (Mr. Napier) thought that body had quite misunderstood the effect which the measure was likely to have upon their interests, and he denied that it took away from them any privilege they already possessed. It was often said that as a body the members of the medical profession were not equally well educated with the Bar and the Church, but he could see no reason why that should be. No doubt, so many advantages in the way of preferment were not open to them, but still he thought the main reason was that the education of the medical practitioner had heretofore been much too exclusive, and did not embrace that preliminary and good general education which it was one of the main objects of the Bill of his hon. and learned Friend to enforce. That Bill, too, would secure what would be a manifest desideratum—namely, a common standard of education for the medical profession of the whole United Kingdom. Where could they have that education so well carried out as in the colleges enumerated in the Bill of his hon. and learned Friend? The efficiency of that education would be indicated and proved by the licence to practise which would be given only after examinations conducted by the most competent men and controlled by the general council. With that strictly 747 professional education the Universities ought not to interfere, as it did not come within their functions. By the Bill of his hon. and learned Friend the student intended for the medical profession, after an education at a University, would be taken, up by the eminent men who attended the various hospitals and prepared by them to practise. The subsequent examinations would secure the requisite amount of competency, and there would also be the advantage of one uniform licence. As he had before observed, the University of Dublin had medical and surgical schools of high reputation; but from its great desire to advance the cause of medical education it had yielded up its special privileges of granting a power of licensing, and consented to take the position of a University imparting an education in arts, and a medical education without the power of licensing. His noble Friend (Lord Elcho) had stated that the Bill of his hon. and learned Friend the Member for Newcastle was in some measure framed as a bribe to him (Mr. Napier), and his hon. Friend the Member for the University of Oxford; but he (Mr. Napier) hoped that there was nothing in the fact of Members for two such learned Universities advocating the cause of a high standard of education to warrant such a conclusion. He wished to see the medical corporations themselves taking into their own hands the work of medical reform. The same desire actuated the Commission on legal education, who had determined to do everything in their power to induce the Inns of Court to carry out the necessary reforms in legal education, and only to apply to the Legislature as a last resort. The principles of this Bill were also the same as those advocated by the Commissioners on military education, who reported in favour of a liberal and enlightened general education in the first instance, and military colleges as the intermediate between that education and practice of the profession. In France, where a contrary opinion formerly prevailed, it was now decided that it was a great mistake to exclude study in arts from the education of a medical man. He trusted, therefore, the House would not give way to the suggestions made by the opponents of the Bill of his hon. and learned Friend, emanating, as those suggestions did, from quarters where at present nothing like an adequate amount of education was given, and where the governing bodies wanted to have the power of giving degrees in medicine with 748 degrees in arts, and, in fact, to dispose of an inferior article in the market. He thought the medical profession had not been fairly treated in this country. He could not doubt that it ought to rank almost as high as the theological profession, for a man could be the priest of his own family, but he could not be the physician of his own family. It had, however, never been held in anything like equal esteem with the profession either of theology or of the law. He could not understand why that should be, seeing how intimately our moral and physical qualities were blended together, and how delicate and important in the last degree were the functions which medical practitioners were constantly called on to discharge. Believing that the Bill of his hon. and learned Friend would have the effect of insuring to them a higher amount of general and professional education, and of elevating their profession generally, and knowing that it had the approval of his constituents, than whom there was no body of men more capable of appreciating its merits or of forming correct opinions on the subjects with which it dealt, he gave it his most cordial support. There were some modifications which probably would be thought-desirable, but they could be made in Committee, and, therefore, afforded no ground for opposition to the second reading.
said, he thought it required all the ability of the right hon. and learned Gentleman who had last addressed the House to justify the deprivation, contemplated in certain cases by the Bill of the hon. and learned Member for Newcastle, of the power of licensing medical practitioners now vested in the Universities. He hardly expected that the right hon. and learned Gentleman, who represented a University in that House, would have given his support to this measure. Last year the right hon. and learned Gentleman took a different view in the Select Committee, and it was to be hoped that on further consideration he might revert to his former opinion. The Bill of the hon. and learned Member for Newcastle took from the Universities the power which they possessed by law of giving licences to medical practitioners; and what was the equivalent they were to receive in return? By the Bill No. 3 they would receive what he (Mr. Cowper) thought was a proper equivalent—namely, that they would have the power of nominating the examiners who were to 749 examine in the sciences connected with medicine, while the medical corporations would nominate the examiners who were to examine in the practice of the art. When the hon. and learned Gentleman (Mr. Napier) found fault with the education given at the Universities, he must have alluded to places where the education given was of an inferior description; but he would ask the hon. and learned Gentleman to look not merely to those Universities, but also to the Universities of London, Edinburgh, and Glasgow, which were medical schools, and especially to that of Edinburgh, where not merely the theory of medicine was taught, but also the practice in the most eminent degree. The House had heard a great deal said about unanimity during this debate. The subject of medical reform occupied a singular position with regard to the question of unanimity. While they had, on the one hand, corporation against corporation, reformer against reformer, and the most conflicting views to take into consideration, every one who came forward to legislate on the subject always began by stating that he had succeeded in attaining unanimity. The hon. and learned Member (Mr. Headlam) stated, when he sought to introduce his Bill of last year, that it had received the unanimous assent of the general body of the medical profession; but when the House went into Committee upon it, no less than fifty-one Amendments were suggested to the measure so unanimously recommended; and, indeed, the opposition to the Bill from every quarter of the House was so manifest, that the hon. and learned Member found it out of the question to attempt to carry the measure further, and he took the very wise coarse of agreeing to a suggestion to refer it to a Select Committee. When it was referred to a Select Committee there was really unanimity, because the only division of importance that arose was on a Motion as to the constitution of the council, which was carried by a majority of 8 to 2. As to the constitution of the council, he (Mr. Cowper) had no objection to the representative formation, if the numbers could be limited and the balance of interests adjusted, but he thought the influence of the Crown ought to be felt in that body; and, if the nomination of the Crown was not to be adopted, there ought to be a provision by which the decrees and resolutions of that council should not come into effect unless they had the approval of Her Majesty by the 750 advice of the Privy Council. By that means the advantages of representations would be combined with the authority and responsibility of the executive government. The question, however, now before the House was not the constitution of the council. That was a matter of detail which might be settled in a variety of ways. The principle of the Bill of the hon. and learned Gentleman was the way in which it decided who was to be hereafter a legally qualified practitioner, and how the lowest requisite amount of qualification was to be ascertained. Those were matters of great importance to every individual in this country who might require to have recourse to a legally qualified practitioner. In the other learned professions the law provided that no person should hold himself out to the world as a practitioner unless he had a legal qualification. He should be sorry to be unjust to a class of practitioners who had the special protection of the hon. Member for Finsbury (Mr. Duncombe), or to throw any restriction, which might be uncalled for by the interests of the public in the way of quacks. If a man, having once obtained a qualification, chose to set up as a quack, and the public chose to go to him, the law ought not to interfere; but he contended, that the public ought to have every facility afforded them for ascertaining which of those quacks had had a proper medical education, and which of them had not. One great defect under the present system was the want of proper qualification among a large number of persons who were yet held to be qualified by law. Several hon. Gentlemen had assumed that the present state of the law in respect to qualification was all that could be required; but he, on the contrary, believed it was very imperfect, and that the Bill of the hon. and learned Gentleman (Mr. Headlam), instead of providing an adequate remedy, rather aggravated the evil than otherwise. He should have been ready to support the Bill if he could have done so, but believing that its effect would be to lower instead of raising the standard of qualification, he should be compelled to vote against the second reading. [Cries of "Divide!"] If he were to leave off speaking, some other hon. Member would claim to exercise his right to be heard, and their impatience for a division would not be satisfied by his resuming his seat. First of all there was the qualification given by the College of Surgeons. If that college were restricted to the giving 751 titles to members of the profession, making fellows, and establishing lectures, he should be anxious to increase their power; but the purpose for which especially they were not well qualified was that of licensing surgeons, whereas it was assumed by this Bill that licensing could not be in better hands. It was quite notorious that the manner in which the thing was carried on was not satisfactory. He held in his hand a memorial presented by the medical officers and lecturers of Middlesex Hospital to the Court of Examiners of the College of Surgeons, imploring them to improve the system of examination, and declaring that at present what the Court required was certificates of attendance rather than proof of proficiency. This question had often been under the consideration of the College of Surgeons, and he believed the argument that had prevailed was, that if the examination were stricter a sufficient number of persons would not be admitted into the profession. On that point he differed from them, believing that if the standard were raised the required number of candidates would come up to it. One great fault in this Bill was, that the examinations for surgery and those for the collateral sciences were both to be conducted by the same Court of Examiners. He thought the examinations in the collateral sciences should be carried on by those who taught those sciences, and that the Court of Examiners should be limited to surgery. The Court of Examiners were the senior members of the college, and had had great experience in practical surgery; but as regarded the sciences of chemistry, botany, physiology, and pathology, he must say that they had no particular aptitude for conducting examinations. A great number of years had elapsed since they were compelled to study such sciences, and they could not be expected to keep up with the progress of discovery as professors must who taught these sciences. Another objection to the Bill was, that it exempted the College of Physicians from the necessity of having an examination in the practice of surgery: so that, after this Bill passed, the physician would still be a man who with haughty and fastidious contempt for a necessary branch of the art of healing, might ignore what the humblest surgeon was compelled to know. Again, by this Bill, medical men, instead of remaining divided into the three branches of physicians, surgeons, and general practitioners, would be classed under the two 752 heads of physicians and of surgeons and general practitioners, the two latter being put together. This was a most faulty arrangement, and one that had always been opposed by those who best understood the interest of the profession. The College of Physicians itself, in a memorial which it presented last year, said it was important that the distinction between the three orders of the profession should be maintained. The Bill of the hon. and learned Gentleman was an ill-advised attempt to patch up the defects of the existing system, and was objectionable in that it did not substitute a better examination for the present imperfect one, of which great complaint was made, and that it did not provide for an improvement in the standard of qualification of the general practitioner. If the House rejected the Bill No. 1, it would not be compelled to accept No. 3. The subject had been thoroughly examined by a Select Committee, representing as far as possible all the interests concerned, and the result had been the almost unanimous rejection of the provisions sought to be introduced by the Bill now before the House. The Government were not in any way hound to support the Bill No. 3, but as the public and especially the poor must be dependent for their health, and for the preservation of their lives, upon the proper qualifications of general practitioners, he had felt it his duty to state to the House his views upon the measure which was now under consideration.
replied: With the permission of the House, he would refer to the history of this question a little before last Session, the period to which the noble Lord and those who supported him had confined their observations. In the year 1844, after investigations by Committees of which the most eminent men in that House were Members, the right hon. Baronet the Member for Carlisle (Sir J. Graham), with the full authority of the Government of which he was a member, brought in a Bill which was in all respects identical with that which he (Mr. Head-lam) had submitted to the House; and in the following year another Bill of precisely similar character, and containing the same recognition of the rights and privileges of corporations as he had embodied in his measure, was introduced by the same right hon. Baronet. Unfortunately the medical profession did not give to those Bills the support which they deserved, and they 753 were lost. Since that time the subject had been agitated again and again. At last the profession had attained a degree of unanimity in favour of this Bill, which, considering the conflict of privileges, rights, and interests, was something wonderful; and he thought it was not too much to ask that the House should at least read a second time a measure which was so recommended and so sanctioned. Last year he introduced, on behalf of the medical association, not on behalf of these corporate bodies, a Bill in which regard was paid to their rights and privileges, and with regard to which there had been some misrepresentation. That Bill was read a second time without opposition. When it went into Committee, the right hon. Baronet the Secretary of Stats for the Home Department proposed an Amendment, of which he had very unfairly given notice only on the previous evening, providing that all the members of the council should he nominated by the Crown. On a division that Amendment was carried by the influence of the Government. The matter was referred to a Select Committee, of which, in the natural course of things, he (Mr. Headlam) should have been Chairman. At first, however, he declined to be even a member of the Committee. The right hon. Gentleman who had just addressed the House, then President of the Board of Health, nominated it, presided over it, and introduced into the Bill which emanated from it those clauses of which he now complained, which would entirely destroy all the organization which had grown up within the medical profession, and subject that profession to a council, to be nominated by the Crown, and of which the President of the Board of Health would be the head. If he had nothing to do with the medical profession he should, on constitutional grounds, to the utmost of his ability, oppose the clauses which would thus subject that profession to the control of the Crown. There were many reasons why it was not desirable that this council should be nominated by the Crown, but the strongest of these was, that it was from this council alone that the right to practise could be obtained. Such a constitution would place the profession entirely at the mercy of the Crown. It was the duty of the House in some measure to consider the rights and feelings of the medical profession; and he would undertake to say that the Members of that profession 754 generally objected to the Bill of the noble Lord (Lord Elcho), and that the assents which he had obtained were mainly attributable to some trifling objections which were entertained to parts of his (Mr. Headlam's) measure. In the course of the last autumn a compromise had been come to, and endeavours had been made to settle this question by mutual concessions. It was not right that the noble Lord, or any other hon. Member, should have endeavoured to revive differences which undoubtedly existed last year, and thus, by exciting old jealousies, to throw obstacles in the way of a measure founded upon that compromise. He objected to the noble Lord's Bill, because the council was to be nominated by the Grown, because it would entirely destroy all the organization which had grown up within the profession, and because it made the minimum of education the sole barrier over which a man must pass before he entered the profession. If the House was prepared to subject to such a stigma as this not only the medical, but all other professions, let them pass the Bill of the noble Lord. If they wished for a council chosen from the profession, with a certain number of members nominated by the Crown, to which should he given the general superintendence of the profession, let them assent to the measure which he now asked them to read a second time.
§ MR. CONINGHAM
said, that neither of the Bills met his views, and he should therefore vote against both. He should oppose that now before the House on principles of free trade, because he did not want to establish a great monopoly.
§ Question put, "That the word 'now' stand part of the question."
§ The House divided:—Ayes 225; Noes 78: Majority 147.
§ Main Question put, and agreed to.
§ Bill read 2°, and committed for Wednesday next.