SECOND READING. (Hansard, 1 July 1857)

§ MR. CRAUFURD
said, that in moving that the Bill be read a second time on that day six months, he would glance at the history of former attempts at legislation on the subject of medical reform. In the 708 course of last year, his hon. and learned Friend (Mr. Headlam) introduced a measure, on which considerable labour had been bestowed, and which to a great extent elicited the united support of the medical profession, more especially of the large body of practitioners constituting the Provincial Medical Association. To secure the unanimity necessary to give a measure of that kind a fair chance of success, it was framed on the principle of a compromise. With the view to carry out that spirit in the fullest sense, and to do justice to certain Universities and other bodies concerned in the question, his noble Friend (Lord Elcho) also thought proper to bring forward a second Bill, when the House, having regard to the magnitude of the interests involved, and anxious to avoid hasty legislation, decided on reading both of the measures a second time, and then referring them to a Select Committee. The task entrusted to the Committee was that of investigating the merits of the various compromises suggested by the Bills, in order, if possible, to gather from them some means of settling a long dispute. Most of the hon. Gentlemen who composed the Committee were Members of the present Parliament; and though they entered upon their inquiry with the greatest discordance of opinion, yet, by dint of the most careful attention to the subject, together with an earnest determination to arrive at a practical result, their differences were gradually eliminated, and rarely has a Committee come to a more unanimous conclusion than that they ultimately came to. The consequence was the framing of a measure considerably modifying the one proposed by the hon. and learned Member for Newcastle (Mr. Headlam), and assuming the form now presented to the House by the Medical Profession (No. 3) Bill, introduced by the noble Lord the Member for Haddingtonshire (Lord Elcho). In the shape in which that Bill came down from the Committee it almost entirely coincided with the measure which had been originally drafted by the Provincial Medical Association, but which had been modified in some of its details in the Bill introduced in 1856 by the hon. and learned Member for Newcastle (Mr. Headlam), in order to conciliate the corporations, who threatened to offer to it a strong opposition. Everything was in a fair train for the solution, in a manner satisfactory to all parties, of a very difficult and tangled question, when unfortunately 709 the late period at which the Committee concluded their labours rendered it necessary that the matter should stand over till another Session. Since then his hon. and learned Friend (Mr. Headlam) introduced a Bill last Session, which he presumed was the same as the Bill now under discussion, but which, owing to the dissolution early in the spring, was [not printed. Now, it was certainly not a little extraordinary, after there had been a complete investigation of this subject by a Committee, that his hon. and learned Friend should almost wholly disregard the decision of that Committee, and should again introduce a Bill nearly identical with; that brought in by him in the Session of 1856. He regretted this exceedingly, because, when they had got so far on the road to a reform of the medical profession, it was hardly wise to take what appeared to him a retrograde course, and by raising a new element of discord, create a fresh impediment to the settlement of that important question. What were the provisions of the Bill? It betrayed a greater anxiety to consult the interests of the corporations than he thought the House would sanction, by compelling every person who had passed an examination and who was to be entitled to practise, to become a member of some one of these corporations, and, what was more, it confirmed in perpetuum to these bodies the large fees which most people thought it highly desirable to abolish. Now, he (Mr. Craufurd) did not want to upset vested interests, but he was certainly indisposed to perpetuate an expensive system like that now existing, and to continue these corporations in the possession of privileges which were no longer suited to the spirit of our times. His noble Friend (Lord Elcho) made no such proposal. Bill No.3 dealt tenderly with vested interests; it did not sweep away the medical corporations, which had undoubtedly done much good in their time, and which might continue to be beneficial to the profession if put on a sound basis; but, on the other hand, while preserving their dignity and prestige, it did not compel students before they could he admitted to practise to pay heavy fees to these bodies. It required that students should pass a preliminary and a professional examination, that there should be a minimum of qualification; it constituted a board of examiners from the corporations and the universities which now exercised the privileges of admitting to practise; it enacted 710 that the title to practise should no longer be absolutely given by them, but after the student had been admitted to practise, he might still, if he chose, stand the examination, and obtain the higher degrees of any of the colleges of physicians or of surgeons, and affix to his name the additional title he would thus acquire. His noble Friend would, in fact, preserve the existing rights of these corporations, but would not compel a practitioner to pay to them the large fees which they at present obtained. That was one important change which the Bill of his noble Friend would effect. Another distinction between the Bill of the noble Lord and the hon. and learned Gentleman referred to the medical council. Last Session he (Mr. Craufurd) confessed that he was much wedded to the principle of a representative body. He thought it very fair that the profession should regulate itself, and that if it were possible to concoct a workable council on the representative principle, that would be the proper course to pursue. He must say, however, that the discussion which had taken place in the Committee upstairs, and the fuller consideration of the subject brought before them, had induced him to change his opinion. Though in theory a representative council might be thought the best, he was now convinced that it would be impossible for such a body to work in a manner satisfactory to the profession; that from its size it would be unwieldy and unmanageable, and that though nominally based on a system of representation, it would not have within itself that element which was essential to its proper working, namely, the element of responsibility. On the other hand, however objectionable in principle a Council nominated by the Government might be, a body so constituted would certainly be responsible to the country through Government; the head of the Council would have a seat in that House; and thus you really carried out the principle of responsibility to the public; whereas by the Bill of the hon. and learned Gentleman, though you got the shadow of responsibility, the substance would in reality evade you. These were the main features of difference between the two measures proposed on this subject. For his own part, he owned that he thought the Bill now more immediately under discussion was in no way calculated to advance the interests of the medical profession, though it would increase the privileges of certain corporations at the cost of the public. The Bill of his noble 711 Friend would reduce the expenses of students by requiring them simply to pay a small fee on the first preliminary general examination, and a somewhat larger fee on admission to the profession upon the second examination. These two comparatively small fees would replace the enormous ones now levied, and thus a great boon would be bestowed on the profession. It was most desirable that a uniformity of authority should be obtained in this matter. At present it was necessary, in order to enable a medical man legally to practise in every part of the kingdom, that he should have received not less than twenty-two diplomas, and that he should have paid fees to as many colleges or other corporate bodies. It would have been more for the honour and dignity of the medical corporations to have rested on their long and deserved reputation, and the feeling of the country in their favour, and have come forward and said, "We will not seek to obtain by Act of Parliament that which the country would refuse to give us without an Act of Parliament." Let them throw themselves upon the country then, and they would find that when placed upon a broad and popular basis they would receive the public support. He would not detain the House further, but conclude with moving as an Amendment that the Bill be read a second time that day six months.

§ MR. BLACK
seconded the Amendment.

§ VISCOUNT BURY
said, the effect of the Amendment, if carried, would be to substitute the Bill of the noble Lord (Lore Elcho) for that of the hon. and learned Member for Newcastle. The difference between the two measures was, that whilst the Bill of the noble Lord provided that the medical board should be appointee jointly by the Board of Health and the Privy Council, in certain proportions for England, Scotland, and Ireland, the Bill of the hon. and learned Member for New castle provided that each of the licensing bodies now in existence should send one representative to the Board, to sit with a certain number of Gentlemen to be nominated by the Government. Now, as lover of the representative principle, he could not but think that the latter was 712 the better system of the two. The hon. and learned Member for Ayr (Mr. Craufurd) had pointed out the inexpediency of placing power in the hands of corporations which had already proved themselves incompetent to exercise it, but it should be remembered that though these licensing bodies might have failed, when acting singly, to use their power with good effect, that was no reason why, when they were supplied with the means of combination and united action for the advancement of the common object, they should not do all that could be required of them. The noble Lord's Bill called upon the House to believe that the President of the Board of Health would send to the Council better qualified persons than these licensing bodies, composed, as they were, of men who had devoted their whole lives to the study of their profession. He feared, too, lest this system of nomination should be made use of as a political engine; that when one party was in power, the most necessary qualification for Members of the Council would be that they should be good Whigs, and so with the other side of the House. The only objection he had heard to the Bill of his hon. Friend was, that it perpetuated the absurd distinction between physicians and surgeons; but he could not see that there was any foundation for such a charge. On the other hand, he considered that the Bill of the noble Lord would really perpetuate the system of having two classes of medical men. On another point, he certainly looked upon the Bill of His hon. and learned Friend as superior to that of the noble Lord, because it provided no exclusion for what were called medical heresies. If such men as Jenner and Harvey had lived under such a Bill as that of the noble Lord, he had no doubt that, owing to the jealousy which unfortunately always distinguished an exclusive profession, they would have been placed beyond the pale. The measure brought forward by his hon. and learned Friend provided that there should be no such exclusion, and this, among other reasons, would determine him to vote in its favour. He also preferred the Bill of the hon. and learned Member for Newcastle, on the ground of the examination which it prescribed though he hoped the provisions on this subject would be rendered more explicit in Committee.

§ COLONEL SYKES
said, there were parts of both Bills to which he objected. Each 713 of them professed the same desire—namely, that of raising as high as possible the standard of qualification in the medical profession; and each proposed farther, that individuals who passed certain examinations should be then entitled to practise throughout the British dominions without further impediment. The object of the Bills, therefore, being the same, the question turned upon the difference in their machinery. In the first place, he would express his entire concurrence in the principle of representation as opposed to that of nomination by the Crown. He thought, however, that the Bill of the hon. and learned Gentleman was objectionable, on account of the four examinations which it proposed. The noble Lord's Bill proposed only one examination, as a passport to an individual to exercise his profession in all parts of the world; whereas the other Bill would greatly multiply examinations. Again, the hon. and learned Member's Bill would increase the expense in fees. Whilst under the noble Lord's Bill the whole expense would not exceed £25 or £30, the expense under the hon. and learned Member's Bill, independently of the cost of registration and other payments, would be £111 18s. for the diploma of physician alone. Then, again, the University element was ignored in the Bill of the hon. and learned Member. It appeared to him that such a University as Marischal College should have its diplomas accepted with the utmost confidence throughout the British dominions. By Bill No. 1 the Universities of Glasgow, St. Andrew's, and Aberdeen, were to send one representative to the general Council, and if they could not agree in their choice, it was left to the Crown to select any one of the three names so sent up. Now, this was an indignity offered to the Scotch Universities which he thought quite sufficient to condemn the Bill of the hon. and learned Member, which he should, therefore, feel bound to oppose, while he must also vote against the noble Lord's measure, because it was based on the objectionable principle of nomination to the Council, instead of representation.