LEAVE.—FIRST READING. (Hansard, 23 March 1858)

MR. COWPER
said, he rose to move for leave to introduce a Bill to regulate the Qualifications of Practitioners in Medicine and Surgery. The question was one that was so beset with difficulties, and gave rise to so much jealousy, that he should have been very unwilling to bring it forward had he not been solicited to do so when he held office at the Board of Health; and he must state, that iu framing the Bill he had availed himself of the aid of the medical officers, in order that he might be able to devise a measure which should no t revive obsolete monopolies, or unduly weigh upon the rights and privileges of the medical corporations. The proper objects of all legislation upon the subject appeared to him to be, in the first place, that the qualification required by law to entitle a person to become a medical practitioner should be maintained up to the standard of modern science and practice, and should be valid in all parts of the United Kingdom; and, secondly, that a register should be established, which would enable the public generally, and the less educated portion of the community in particular, to ascertain what practitioners were really qualified, and in what the nature and extent of their qualification consisted. Constant reference was made in our statutes to the due qualification of medical men, and public appointments could, generally speaking, be held only by persons who were legally qualified. That was a principle which he thought it was desirable to uphold, notwithstanding that he was disposed jealously to guard the right of private individuals to consult whomsoever they pleased, whether they happened to be learned or unlearned. For appointments connected with the army, navy, friendly societies, or other institutions, it seemed right that the re- 649 striction should exist, in order that from caprice or other motives, unqualified persons might not be chosen. That practice had been justified by usage from the earliest times. There were a dozen Acts of Parliament concerning the medical profession always referring to qualified persons, but none settling what the qualification should be. Some of these Acts dated from a time as far back as that of Henry VII. and Henry VIII. Although it was to be expected that many incongruities would creep into those statutes from the course of time and the necessity of allowing the tests to meet the changes that had taken place, still he believed that former efforts in that direction, although foiled by the rival pretensions of class interests, had not been without some use, and there was an extending opinion of the necessity for the organization of the profession, for some established qualification, and for some arrangement whereby that qualification might be made known. One of the greatest defects of the legal qualification at present existing was, that it was partial in application and jurisdiction. Many assumed the position of a general practitioner on the strength of only a medical or only a surgical diploma. Then, again, an English practitioner had no standing in Scotland or Ireland, and vice versâ; while, even the London University, which conferred degrees for practice in the country, could not authorize any one to practise in the city wherein it was situate, and whence it derived its name. It was agreed, amongst those who had considered this subject, that the first step must be to establish a better minimum qualification, without which no one should be permitted to practise. The proposal in the Bill of last year was, that a new board of examiners should be created, consisting of persons delegated by the College of Physicians, the College of Surgeons, and the Society of Apothecaries; but the Bill altogether deprived the Universities of the share they now possessed in the examinations for licenses. The Bill which was prepared by the Select Committee of 1856, and which was laid upon the table by the noble Lord the Member for Haddingtonshire (Lord Elcho), provided a now board of examiners, consisting of persons nominated by the medical corporations and the Universities, the intention being that the Universities should examine as to the sciences collateral to the study of medicine, while the professional colleges should examine as to medi- 650 cal practice itself. There were, however, objections that that plan would compel graduates to undergo a second examination after obtaining their degrees, and there would be also a difficulty as to the apportionment of the fees among the various bodies entitled to receive them. He thought it would be wise to make the least amount of change that was necessary, and the best course would be to leave the examination to be conducted by the present licensing bodies, under the general control and supervision of a general council, to whom power should he given to decide upon what examination should be required, or what certificates should be produced before any person could be placed upon the register. If the Council had the right to be present at the examinations of the College of Surgeons and the Society of Apothecaries, they would be enabled to prescribe the standard which should be required, that at present existing being admitted to be too low. If the low standard were raised benefit would be obtained by more skilful treatment, and to the profession by reducing the competition of those who underbid one another from the want of remunerative practice. The principle of registry was an important part of any scheme in connection with this subject, but it was one with respect to which great difficulties had been raised. The Bill which was introduced last year by the hon. and learned Member for Newcastle (Mr. Head-lam) proposed a new division of the medical profession—the higher class to be called physicians and the lower class surgeons. That created a difficulty, as many who were always considered surgeons, would then be called physicians, while the ordinary understanding was, that a physician attended to the interior of the human body, while a surgeon attended to the exterior. The College of Physicians, moreover, had had always been anxious that they should he distinguished by being placed upon a separate register. An alphabetical register might have physicians and surgeons appended, but this detail might well be left to the consideration of the Medical Council. He now came to the mode of constituting the Council. Since 1834 the proposals had oscillated between a Council nominated by the Crown and a representative Council. In 1848 the medical profession were unanimous in favour of a nominated Council. As they subsequently declared in favour of a representative Council, however, be recommended the House to adopt that plan, which would be open probably to less objection 651 than a Council nominated by the Crown. He proposed that it should consist of six members to be nominated by each of the present licensing bodies, and six to be nominated by the Crown. The great objection hitherto made against a representative Council was its great size, but this difficulty might be got over by giving the Council the power of forming committees. In order to connect the Council in some way with the Executive, it had been suggested that the President should be either the Secretary of State for the Home Department or the President of the Board of Health; but he thought that a better course would be to follow the precedent of many other commissions, and to provide that the rules of the Medical Council should only be adopted when they had been confirmed by an Order in Council. By these means the medical profession would derive the benefit of an organization which it never had before. While the legal, the military, and the naval professions were amply represented in that and the other House of Parliament, it was rarely that one of the medical profession ever found his way there; and yet there were sanitary and other social questions with which no men could be more competent to deal. Moreover, the medical profession required the exercise of as great skill, and was actuated by as noble an aim as any other profession, for it was not less noble to seek to save, than to destroy life, or to preserve life than to preserve property. In conclusion, he moved for leave to bring in a Bill to regulate the qualification of practitioners in medicine and surgery.

§ MR. WALPOLE
said, that the Bill which the right hon. Member bad suggested appeared to be by far the best proposition which he had yet heard on the subject, and he should not object, therefore, to its introduction.

§ LORD ELCHO
said, that the Bill which had just been proposed by his right hon. Friend was an old friend with a new face, for it was precisely the same measure which he had himself ventured to introduce in 1856; and wonderful as were the changes which daily took place around them, there was no change more wonderful, perhaps, than that which had occurred in the mind of his right hon. Friend upon this subject. His own Bill of 1846 and the Bill of the hon. and learned Gentleman the Member for Newcastle (Mr. Headlam), were referred to a Select Committee, and the former was preferred and sent down to the House, but too late to pass into law. The hon. and learned Gentleman had then 652 turned his back upon his own Bill, and supported another which was totally different in principle. With regard to the constitution of the council a most unfounded prejudice had been created against his Bill in that respect, but it was shown before the Committee that a council appointed by the Crown would be the most acceptable to the profession and the public. The question of the council was not the principal point of the Bill, but he would observe that he should be very happy to modify that part which related to the institution of the council in the direction of the Bill of the right hon. Gentleman.

MR. HATCHELL
said, he had voted against the Bill of the noble Lord at the time, thinking the question of the council the main point of the Bill. He rejoiced that the right hon. Gentleman (Mr. Cowper) was prepared to grant representation to the medical profession. This would produce greater confidence in the public mind, as well as cause satisfaction to medical men.