MR. HEADLAM, in moving for leave to introduce a Bill to alter, and amend the Laws regulating the Medical Profession, said it would be in the recollection of all present who were Members of the last Parliament that the first general object of the Bill was to ensure uniformity of medical education throughout the United Kingdom; so that a gentleman educated for the medical profession in Scotland would have to go through the same curriculum of studies as his brethren in England and Ireland. That was the first and most important feature of the Bill. It then went on to provide that a person who had passed his examination in one part of the kingdom obtained thereby a right to practise in any other. There was to be complete reciprocity of practice between England, Scotland, and Ireland. The third and last object of the Bill was to provide that a complete registry of the medical practitioners of the country should be kept, so that the public might be able to know who were duly qualified to practise. He had only to add that the objects of the Bill were carried out by a machinery which had been most carefully considered, and which had been approved of by the members of the medical profession generally.
MR. COWPERadmitted that the subject of the Bill was one of great importance, and was glad to hear that it had met with the approbation of that profession the interests of which it to so great an extent affected, because, during upwards of fifteen years that medical reform had been 244 mooted, the impediment to satisfactory legislation had mainly arisen from differences of opinion among those who represented the views of the medical profession. The subject was one of very great importance, and pressing urgency. The State had taken upon itself to prescribe what should be the qualification of medical practitioners; but the laws by which the nature of that qualification was regulated were chiefly to be found in old charters and old statutes, and the whole subject was in a most confused and anomalous condition. The qualifications required were as various as was the area over which those qualifications could be exercised. The College of Physicians and the Universities of Oxford and Cambridge adopted a high standard of qualification. There were other bodies who tools quite a different view of the subject. For instance, the College of St. Andrew's, in former times, had taken a mercantile view of the matter, and not having facilities for personal examination, used to forward their degree by return of post, on receipt of a fee of £25, or whatever sum might be agreed upon. This practice had been long discontinued, but it showed the latitude that existed. The College of Physicians was only enabled to give a licence to practise medicine within the metropolis and for seven miles around it; while those who obtained licences at the Universities might practise throughout the whole kingdom. The College at Glasgow could give licences to practise over only four counties, while the College at Edinburgh gave them for the whole of Scotland, exclusive of those four counties. In the whole there were sixteen bodies in the United Kingdom, the diplomas of which entitled holders by law or usage to practise, and many incompetent persons received licences. For the practise of surgery, no qualification is required by law, and a man could call himself surgeon without knowing any graver operation than carving a fowl. What was generally speaking meant by the word "surgeon" was a member of the Royal College of Surgeons; but that was not the legal definition of the term; it was in his opinion extremely desirable that the State, having assumed the power to settle the qualifications for medical licences, should do it effectually, and should not allow anybody to practise that profession without having given proof of competent skill in his art as well as that he had received a fair general education. As things at present stood, 245 there were to be found among licensed practitioners, men who were incompetent in technical still, and deficient in intelligence and in an ordinary English education. The reason alleged by the College of Surgeons, by way of excusing that fact was, that the demand for general practitioners was so great that, if a high standard of competency were fixed as necessary before they could obtain a licence, the supply would not be equal to the demand, and the rural districts would be in want of the services of medical men. Experience, however, in his opinion, tended to show that such would not be the case, inasmuch as it was quite clear that what he might term over-competition now prevailed in the profession, as was clearly shown by the circumstance that medical men were in many instances found to be ready to take under the Poor Law Board, salaries which they themselves regarded as being an insufficient remuneration for their services. With reference to the Bill before the House, he could only say that he was disposed to look upon it with favour, introduced as it had been under such favourable auspices, and as emanating from an hon. Member who had taken great pains with the subject. The views of the Committee which had sat some time ago, and of which he (Mr. Cowper) was a member, embraced the necessity of uniformity of qualification, and of fixing a minimum standard, without having attained to which no one could obtain a licence to practise. In order to come up to that standard it was necessary that a surgeon should know something of medicine, and that a physician should be in some degree acquainted with surgery, while it was left to the medical colleges to fix the qualifications they might consider necessary for consulting-physicians or pure surgeons. These were the objects which he thought it was desirable to carry into effect in any legislation upon the subject, and in so far as the Bill of his hon. Friend tended to that end he should give it his cordial support.
§ LORD ELCHOsaid, it had been remarked by the late Sir Robert Peel that there was scarcely a Session without a Salmon Bill, and in his (Lord Elcho's) opinion the same observation might very well be applied to the Bill before the House. He must, however, admit that in the laws relating to the practice of medicine there existed the most glaring injustice and anomalies, which, for the sake of the profession, as well as of the public, ought 246 to be removed. He did not, therefore, rise to offer any opposition to the introduction of the Bill, but simply to put a question to his hon. Friend, by the answer to which his course with respect to the subsequent progress of the measure would be guided. Before he put the question he should say a few words in explanation of its nature. His hon. Friend had introduced a Bill in the penultimate Session of the last Parliament which passed a second reading, but to which so many objections were taken on going into Committee, that it was thought advisable to refer it to a Select Committee. Whatever may have been the intention of the framer of the measure, it was certainly one which greatly favoured the medical corporations. It entirely ignored the position of University graduates, and it had been characterized by the hon. Member for West Surrey as a Bill to provide for certain bodies corporate at the expense of our corporations. Well, the Bill was thus referred to a Select Committee, which sat several weeks, and which effected so great an alteration in the provisions of the measure that scarcely a line of the original remained. The Bill thus changed had come down from the Committee, and was, he might say, unanimously reported to the House. Now, he thought the most practical step which the House could adopt would be to take up that Bill again and to pass it into a law, instead of embarking on a fresh measure. The question, therefore, he had to ask was, whether this Bill was bonâ fide the Bill of the Committee? It was possible enough that there might be a unanimous feeling among the medical corporations in favour of this Bill, without a corresponding unanimity among the great body of the profession; and he was very much afraid that the tendency of the hon. and learned Member's Bill would be, as the former one was, to benefit the corporations at the expense of the Universities. Now, the medical education given in the Universities of Scotland and in the University of London was about the best in the United Kingdom, and their degrees were a better test of a medical man's qualification than the examination before any of the corporations. The degree of Doctor of Medicine of the University of London carried more weight with it than the diploma of the College of Physicians, yet an M.D. of the University of London was prohibited from practising within seven miles of the metropolis. If the Bill were bonâ fide the Bill of the Committee he was 247 ready to give the hon. and learned Member his humble support, but if it differed in any essential respect he should ask leave of the House to lay upon the table to-morrow the Bill recommended by the Committee.
MR. HEADLAMsaid, that in some respects his noble Friend had rather seriously misrepresented the circumstances under which the former Bill had been brought before the House. So far from that having been a Bill brought in on behalf of the corporations and colleges of the profession, it had been prepared and brought forward by a totally different body, who were not in any way connected, but were rather antagonistic to the colleges. This body, of which Sir Charles Hastings was the President, went to the Secretary of State for the Home Department, and asked him to bring in the Bill. The Government declined to do so. They then applied to him (Mr. Headlam) to bring it in. So far from the Bill being in favour of the corporations, it was through their influence that it had been sent to the Select Committee. A deputation from the corporate bodies went to the Secretary of State for the Home Department, and induced him to offer objections to its going into Committee, and their opposition had been the cause of the final rejection of the Bill. In answer to his noble Friend's question as to whether the present measure was bonâ fide the Bill of the Select Committee, he would at once tell him that it differed in one most important particular. According to the scheme of the Committee, the Government was to appoint every single member of the council of the governing body. Now, in that shape the Bill would not have had the slightest chance of meeting the favour of that House, or of being acceptable to the medical profession and the country. In that very material respect his Bill differed from the Bill of the Committee; but it conformed in all other material respects to the principles which were laid down by the Committee. It provided for education in the shape suggested; and it had regard to the rights and interests of all licencing bodies. The best proof that the rights of the University had been fully and fairly considered was, that the names of the hon. Baronet the Member for the University of Oxford and the right hon. Gentleman the Member for the University of Dublin were upon the back of this Bill. He believed the Bill had regard to the rights and inte- 248 rests of all parties in the medical profession, and to the rights and interests of the public at large. His noble Friend was entirely in error when he suggested that there had been any intention to introduce a clause, inflicting a penalty on any one consulting an unregistered practitioner. There had never been the slightest attempt to put a stop to people "quacking" themselves if they felt so disposed. The framers of the Bill knew that the practice was too general for them to attempt to fetter the subject in the free exercise of his judgment in that particular. After that statement, his noble Friend would of course be at full liberty to take any steps he might think fit; but he hoped, under the circumstances, he should have leave given him to introduce the Bill.
MR. NAPIERsaid, he was a Member of the Select Committee on the previous measure. He hoped every facility would be given for passing the present Bill. They could not all have their particular views carried out; there must be concessions made in order to get a good and practicable measure. He believed that it was the great object of all parties to elevate the whole system of medical education, and to make it uniform, both of which desirable objects would be substantively effected if the measure passed into law. His own constituency and the other Universities in Ireland had agreed to it, various other bodies in England and Scotland had agreed to it, and he thought it would be improper to disappoint their expectations. The great thing was to get a good basis in a sound enlightened general education of the members of the medical profession. This Bill would tend much to carry that out. He hoped, therefore, the House would give it every facility in passing.
§ MR. CRAUFURD, as a Member of the Select Committee of last year, while concurring as to the desirability of making a good sound basis of education for the medical profession, could not but regret that the course taken by the noble Lord below him (Lord Elcho) had not been followed on the present occasion. They had had great difficulty in framing a measure which should satisfy the corporations and colleges, but notwithstanding the difficulty of the task they had come to an almost unanimous result. He thought, after having experienced the labour of that Committee, it was much to be regretted that in pursuing this question the hon. Member for Newcastle (Mr. Headlam) had not adopted the course which 249 appeared the most natural, that of bringing in the Bill as framed by that Committee, and leaving it to the House to decide whether his objections to the measure were really such as ought to be met and attended to. He thought good grounds could be shown for the alterations made in the Bill by that Committee. He did not think the interests of medical reform could be served by their continually chopping and changing measures. As the present Bill differed in the material point of the governing body, he should reserve to himself the adoption of the course he should pursue until he saw it in print.
§ MR. BLACKwas of opinion that it was to be regretted that the Bill of the Select Committee had not been laid on table as the foundation of any Bill to be passed through that House. He would suggest that that course be adopted, in order that the House might be enabled to judge between the two measures, and decide on the best.
§ LORD ELCHObegged to explain that he had not implied that the hon. and learned Gentleman the Member for Newcastle had brought in the former Bill to favour the colleges, he had merely stated that he thought that would have been the effect of the measure. After listening to the reply of the hon. Gentleman, he begged to state that he should to-morrow ask for leave to bring in the Bill to which he had referred.
§ Leave given.
§ Bill ordered to be brought in by Mr. HEADLAM, Sir WILLIAM HEATHCOTE, and Mr. NAPIER.
§ Bill presented, and read 1°.
§ House adjourned at Five o'clock.