§ Order for Second Reading read.
§ DR. LUSH, in moving that the Bill be now read a second time, said, that since he had introduced it circumstances had very much changed, as the Government had brought in a Bill in "another place;" but, notwithstanding that, he did not feel justified in withdrawing this Bill for the reason that there were some points dealt with by it which made it a different measure from that of the Government, which he supposed they would see in that House at no distant date. The introduction of the measure of the Government had had the effect of postponing one of the most important provisions of the Bill which he proposed, and probably it would have the effect of postponing it altogether. He understood from the statement made the other day by the noble Lord the Vice President of the Council, that the only point which the Government would agree to refer to a Select Committee was the constitution of the Medical Council, and the mode in which the Medical Profession were represented upon it. They would, he thought, have shown greater wisdom if they had made a larger concession, and consented to the whole question involved in the Bill being referred to a Select Committee, in order that this important question, which deeply affected the public, might be once for all settled on a satisfactory basis. He would just observe that he had seen in the papers that morning that a Member of the Government in high position had stated that unless the Government Bill were passed substantially as it was it would be dropped, and he regretted that such a statement should have been made public, because it might tend to prevent a settlement of the question this Session. During the past year there had been a growing feeling in favour of alteration in the law. Even the Government Bill of last year, when it was returned from the House of Lords, was not the same 759 Bill as was introduced by the Vice President. The Government had conceded the point that the minimum qualification of medical practitioners should be ascertained by a joint board; but the point in regard to the admission of women to the Profession was still sub judice. The hon. and learned Member for Dewsbury (Mr. Serjeant Simon) had given Notice of a Motion for the rejection of the Bill, having a strong feeling upon the subject. There was one important point included in his (Dr. Lush's) Bill which was not embraced in any other measure—namely, the prevention of the signature of certificates of death by unqualified persons. At present it was a common practice on the part of duly qualified medical men to sign blank forms, which were afterwards filled up by unqualified persons. Some amendment of the law in that respect was absolutely necessary for the protection of the public. Again, by a recent Act, no person was allowed to open a shop for the sale of drugs unless he had a special licence or certificate from the Pharmaceutical Society. He could not see why there should not be a similar law in relation to the Medical Profession. Before a man practised medicine, he should be required to give proof to a competent body that his education in surgery and medicine was such as to justify the confidence of the public in his qualifications. Turning to the constitution and functions of the Medical Council, he maintained that the representation of the Profession in that body was now inadequate and unsatisfactory. It no doubt consisted of very able men; but, as a matter of fact, it had become a lesser Parliament, and practical work was sacrificed for ornate eloquence. The members of the Profession had paid the Council something like £200,000 in the shape of fines, and they had got very little in return for their money. He had no objection personally to the members of the Council; but he submitted that they did not perform their duties satisfactorily. If the whole question embraced in this Bill, together with the Bills of the hon. Member for Exeter and other hon. Members, was referred to a Select Committee, carefully chosen so as to be capable of examining the subject without partizanship or bias, a just and proper solution might be arrived at. He begged to move the second reading of the Bill.
§ Motion made, and Question proposed, "That the Bill be now read a second time."—(Dr. Lush.)
§ MR. SURJEANT SIMON, in moving an Amendment that the Bill be read a second time that day six months, said, he did so purely upon public grounds, and if his hon. Friend had accepted certain Amendments which he had suggested he would not have opposed the Bill. Indeed, if it were the general wish of the House to refer the Bill, along with others, to a Select Committee, he should not be disposed to press his opposition. His hon. Friend (Dr. Lush) had said that the Bill was designed to meet a growing wish and a growing feeling on the part of the public; but he (Mr. Serjeant Simon) would be glad to know how his hon. Friend was justified in saying that, for he was at a loss to see that there was any growing wish or feeling in the country for the measure. If there had been a growing wish or desire for it, as had been alleged, the fact would have been indicated to the House by the presentation of Petitions; whereas the only Petition on the subject was the Petition just presented by the Attorney General for Ireland, and that was against the Bill. His hon. Friend complained that the Council had received £200,000 in the way of fines from the members of the Medical Profession, and he seemed to think that there ought to be some return for these fines in the way of protection to the Profession. He protested against the idea that there ought to be special protection for any Profession. It was too late in the day to attempt to re-enact such a principle. It had been long repudiated both in commerce and in other avocations of life. He did not deny the right of Parliament to prescribe a standard of qualification for the Medical, as well as for other Professions, but they ought not to protect any special interest—their duty being to protect the public, and the public only. This Bill was clearly not introduced in the interest of the public, but in the interest of a Profession, and at the instance of a narrow section. He did not see why only qualified persons should be allowed to give certificates of death. But by this Bill, if a man did not believe in the present principles of medical practice, he would be acting 761 illegally in being attended by anyone not a member of the Profession, and if the patient should die the certificate of such a person would not be valid, and without a certificate the man could not be buried until an inquest had been held. A few years ago a dead set was made against the homœopathists; but notwithstanding the persecution to which it had been subjected, and the opposition and prejudice which it had to encounter, homoeopathy had made great way, and had effected a remarkable change in the practice of medicine. It had been proved that those strong doses of purgatives which used to be given under the old system were positively injurious, and the most eminent medical men were content to use drugs sparingly, and to leave nature mostly to effect the cure. If he objected to be dosed with mineral poisons and preferred to go to a herbalist, he wanted to know what right Parliament had to stand in the way? Suppose he broke a leg, or dislocated a limb, and he went to a bone-setter who had done wonderful things, what right had Parliament to interfere and say that he should not? This was what this Bill asked Parliament to do. He contended that if he preferred to call in a blacksmith to attend him, Parliament had no right whatever to interfere. Under this Bill it would be made penal for any man to assume a title that would imply that he was a legally qualified practitioner. If that were all, he should not object; but it was proposed that anyone not being a legally qualified medical practitioner should, if he practised any branch of medicine or surgery for gain, be subject to a fine of £20. By that section the public would be deeply injured. The herbalists had a standard of qualification among themselves in order to prevent incompetent persons from being employed by the public, and he urged that they had earned a title to be allowed to practise for profit, and to grant certificates in cases of death. A large number of the working classes and friendly societies did not believe in medical men; but they did believe in herbalists. [A laugh.] The way to meet an argument was not by a laugh. In these matters experience was the only test. Friends of his own had gone to a herbalist after having tried members of the Medical Profession in vain, and to a bone-setter after trying a surgeon. 762 With that knowledge, he did not feel that he ought to allow the Bill to pass without protest. There was another point. The prevention of anyone but a duly qualified practitioner giving a certificate of death amounted to saying that a man should not be attended by a herbalist in illness, as he might die, and no certificate would be given of his death. The measure was a mischievous one. It asked Parliament to take steps in a direction against which Parliament had for a long series of years protested; it was not asked for by the public, and it was not for the interests of the public that it should be passed. For these reasons, he felt compelled to oppose the Bill.
§ MR. BURT, in seconding the Motion for the rejection of the Bill, said, he opposed it entirely on public grounds. No doubt, a great deal of mischief was done by incompetent persons; and if a Bill were to be passed to exclude those, and those only, such a Bill would do great public service by checking those birds of prey that flitted about from place to place living on the gullibility of the public. But this Bill would go a great deal further than that. He was acquainted with many herbalists who had done much to benefit the community. Within a few hundred yards of his own residence in Newcastle was one who had practised for 25 years, and to whom numbers of people came because they found themselves benefited. That man was typical of thousands of others. There was no pretence for saying that there was the slightest imposition on the part of such men, or that they practised under false pretences. These men did not profess to have received a thorough medical education—in fact, many of them had never seen either the inside or the outside of a College; but they had a special aptitude for treating diseases, and having devoted a great number of years to the study of the subject were successful in doing so. People who were ill wanted to be cured, and did not care whether it was by an educated or an illiterate person. If the class of men to whom he referred were prevented from giving certificates of death, they would be prevented from practising medical treatment. He could bear his testimony to the popularity of these men with friendly societies. For these reasons, he should give his utmost opposition to the Bill.
§ Amendment proposed, to leave out the word "now," and at the end of the Question to add the words "upon this day six months."—(Mr. Serjeant Simon.)
§ Question proposed, "That the word 'now' stand part of the Question."
§ SIR JOSEPH M'KENNA, in supporting the second reading of the Bill, said, he could not join in the feeling of confidence in herbalists, as expressed by the Mover and Seconder of the Amendment, considering that they were not required to produce any test of competency or knowledge in medical science, or that they had been shown to have seen either the inside or the outside of a Medical College. He did not think that an ignorant man, almost in articulo mortis, should, on the ground that it was his own choice, be exposed to the danger of being attended by a person who had not received any medical education. The pleas put forward on behalf of the herbalist were equally applicable to the defence of those who practised charms and witchcraft, for those who were practised upon were consenting parties. This was what he would suggest. There were several Medical Bills before Parliament, and all his hon. Friend desired was that all of them should be referred to the same Select Committee, so that whatever was best in each might come again before the House on the Report of the Committee.
§ MR. ERRINGTONsaid, he defended the Bill as the only one which included in a complete form the various reforms which were necessary. It was a peg to hang inquiry upon, and therefore the House ought to give it a second reading. There was the greatest possible demand for medical reform. Some years ago a Bill was introduced by Lord Ripon which proposed to deal only with the subject of medical education; but that was only a portion of the question which this Bill raised. Lord Ripon's Bill was defeated, and Her Majesty's Government introduced what was precisely the same measure, but it also failed. As soon as the question was raised of reforming that particular portion of the medical system which those Bills dealt with, it became evident that there were many other matters which also required reform. Last year, he and others brought forward a series of Bills, hoping to get the whole question referred to a Select Com- 764 mittee, which would take evidence in time to obtain the views of the medical institutions, and proceed to legislation in the present Session. But the Government seemed to have come to the conclusion—first, that there was virtually only one large question requiring to be dealt with—namely, the educational portion of the system, ignoring altogether the re-organisation of the Medical Council, which was at least so much desired; and second, that the particular plan which they had adopted was not only the most satisfactory plan that could be produced, but was, in fact, the only plan. But in reality it was only one among many plans that had been suggested. It dealt in a summary way with vested interests; and the Corporations and individuals affected, when they became conscious of the immediate approach of legislation, were anxious to be heard. It would, therefore, be a great advantage to refer to the Select Committee, not the limited question suggested by the noble Lord (Lord George Hamilton), but the whole question, so as to have a complete and satisfactory settlement. It might be said that there would be great delay if such an inquiry as was asked for should be assented to. But, as there had already been so much delay, a further delay of a few months, or even a year or two, would be as nothing compared with the advantages which would result from effectually dealing with the whole matter. The question was divided into two branches, with one of which only the Government proposed to deal; and if the Government Bill were allowed to pass, while the other portion of the question were referred to a Select Committee, probably no more would be heard of it. There were many points in the Government Bill which were suited for consideration by a Select Committee, and if those points had to be considered in a Committee of the Whole House, the noble Lord opposite scarcely knew how great the delay might be. He earnestly appealed to the noble Lord to re-consider the decision which it was understood had been come to by the Government, and to allow the Reference of which he had given Notice to be enlarged so as to include the whole of the questions which had been raised. He had a Bill of his own, which represented a totally different principle from that of the Bill of 765 Her Majesty's Government and the Bill of his hon. Friend, and the advantage of referring all the Bills to a Select Committee would be that the various principles which they embodied would have an opportunity of being fully considered.
§ MR. COWPER-TEMPLEsaid, that the hon. Gentleman proposed by his Bill to amend the Medical Council. The Medical Council had very well and wisely fulfilled the task imposed upon them 20 years ago; they had succeeded in greatly improving both the teaching and the examination of the licensing bodies. He did not deny, however, that the constitution of the Medical Council might be improved by including representatives of all the licensing bodies. With reference to the pains and penalties inflicted on persons who might do injury to the public by their practice, he did not think the House would be prepared to prosecute herbalists, however much hon. Members objected to homoeopathy. He hoped they would not agree to pass any Bill that would impede the freedom every man had of trying to get cured in the way which best suited his own notions, and that the public would not be brought by compulsion under the despotic rule of even so important a body as the Medical Profession. What was right to be done was, as indeed the law now stood, that no person who might be designated a quack was entitled to adopt any name or title which did not belong to an unauthorized and unexamined person, so that the public should clearly distinguish between those having qualifications and those who had not. He was glad to hear that it was the intention of the noble Lord to appoint a Committee which might inquire into those points of principle on which there was a difference of opinion; but he did not think it necessary to examine points of detail. A Bill had been introduced by the Government in the other House, and when it came down it would furnish them with an ample opportunity of discussing details. The result of the Committee would be a guide to the House.
DR. CAMERONstrongly supported the second reading of the Bill, and maintained that the objections which had been offered to it were utterly misleading. It had been urged that it was a protective measure, intended to hedge round the privileges of the Medical Pro- 766 fession and curtail the liberties of other persons in the practice of herbalism, bone-setting, &c. But that was a great misapprehension. A single clause of the Bill might possibly be open to such a construction; but that clause was susceptible of different meanings, and legal Members disagreed among themselves as to what it really did mean. Certainly it was not the intention of the promoters of the Bill to curtail the freedom of trade in the practice of bone-setting or herbalism, but only to do in the Medical Profession what was done in the case of manufacturers—to institute, as it were, a system of trade marks which could be registered, and which would give the owners of the trade marks a property in them. The promoters of the Bill were not even responsible for the wording of the clause, for they had taken it from the Bill of the Government, and under any circumstances it was only a matter of detail, which could easily be modified in Committee, if necessary. Objection had also been raised to the proposal that unqualified persons should be precluded from giving certificates in case of death; but he thought that a very valuable provision. A certificate of death was not indispensable, and in Glasgow, for example, at the present moment, a large percentage of the population died and were registered without certificates, being registered as "non-certified;" and he asked what use there was in keeping up a large and expensive machinery for throwing light on the conditions of mortality, if certificates of death were to be taken from persons who might know nothing whatever about the disease that had caused the death. And there was surely no hardship involved to the relations of the deceased, if the cause of death was registered as uncertain. The great advantage which he found in the present Bill was that it was an eclectic measure. It was the best of all the Medical Bills now before the House for the purpose of reference to a Committee, because it had selected whatever was good from every other of those Bills, and consisted of a collection of all that was valuable in the Bill of the Government, in the Bill of the hon. Member for Exeter (Mr. Mills), or in the former Bills of the hon. Member for Salisbury (Dr. Lush) himself. There had been three leading proposals in regard to medical reform, 767 and they consisted—First, of a proposed reform of the Medical Council, that great body which had the control of medical matters, and which at present consisted of the representatives of various licensing and educational medical corporations, with a few representatives nominated by the Crown. The second proposal was that instead of degrees and licences to practise medicine and surgery being granted by 19 different licensing bodies, those bodies should be grouped together and Conjoint Boards formed for examination, so as to insure greater uniformity in the qualifications demanded for the securement of degrees and licences, and to do away with the prevailing competitive under-selling of medical degrees and titles. The third proposal was for the repression of the assumption by unqualified persons of medical titles. In his opinion, the first proposition—the proposal for the reform of the Medical Council—was by far the most important. Unless they began by attempting to reform the Medical Council, everything else would be in vain. The anomalies, to remedy which medical legislation was at present demanded, need not have existed if the Medical Council had done what it had power to do. The power of conferring civil right to practise medicine and surgery had been given by the State to 19 more or less responsible bodies. Some of them granted licences in medicine, and some in surgery. Now, the separation between medicine and surgery was entirely artificial. It originated in an Edict of the Council of Tours. Previously to the 12th century, medicine and surgery were practised almost exclusively by clerics; but at the Council of Tours it was declared that the Church abhorred the shedding of blood, and the consequence was that the practice of surgery was relegated to the barbers. He did not mean to say that a man might not practise medicine or surgery as a speciality, or the medicine and surgery of some paticular organ as a speciality; but what he said was absurd was that a licence to practise medicine and surgery, such as was conferred by any registrable diploma or licence under the present law, should be granted on an examination solely, or almost solely, in one of these branches. This Bill proposed to remedy that; and the Government Bill had also a remedy for it. There would have been no ne- 768 cessity at all for a legislative remedy if the Medical Council had done their duty, as they should have done, and had insisted that the examinations for every registrable diploma should include both medicine and surgery. Another great evil lay in the fact that there were 19 licensing bodies, which competed with one another. It was notorious that, when a man was doubtful about passing one examination, he at once found an easier one; and in that way competition among licensing bodies was calculated to do great harm, and to lower the status of medical knowledge. But not only did they undersell each other in the case with which they granted licences, but they also entered into competition with themselves. It might be that when an University, whose degrees held a high reputation, saw itself being undersold by another Corporation, if it had the power under its charter of inventing a new licence, it did so, and gave the new licence under easier terms. In that way, no fewer than 50 or 60 different documents were registrable. These licences and diplomas were granted after examinations conducted altogether differently, after different periods of residence, different degrees of study, and different requirements of preliminary education. Men in very high positions had again and again protested against this. If the Medical Council had done its duty under the existing law, all these discrepancies might have been done away with long ago. They had the power to call the attention of the Privy Council to the fact that this or that body was granting degrees on lower terms than was desirable, and that the Privy Council ought to interfere. To turn to the measure before the House, the Government, in their proposal, accepted the principle of a conjoint scheme. The logical basis upon which one would like to urge the proposal for a conjoint scheme would be that there should be but one Examining Board for the whole of the United Kingdom; but for convenience—and, no doubt, for the purpose of conciliating jealousies—that proposal had been departed from, and a separate Conjoint Board was proposed for each part of the United Kingdom. These Conjoint Boards were undoubtedly a step in the right direction. Why had they not had these conjoint schemes long ago? The reason was that the various licensing bodies had 769 been unable, through jealousy, to enter into them. They had gone on competing with each other for candidates for their degrees and diplomas, and yet the Government now proposed to intrust to the representatives of these very bodies the carrying out of what constituted really the whole substance of the Government Bill. The reform should have been carried out long ago, and it was useless to pass a Bill now which would merely enable the Medical Council to do what they or their constituents should have done already. How were they to improve the Medical Council? He believed the whole voice of the Medical Profession demanded that the general body of practitioners should be represented. He believed that if they were to allow the Profession at large to send representatives to the Council, the result would be that they would introduce into it an element the object and sole interest of which would be but to raise the status of the Profession, and to carry out any needed reform without being hampered at every turn with the consideration of how it would affect the private interest of this or that Corporation. In fact, he believed that as an almost indispensable preliminary to any real reform they must commence by re-constituting and re-modelling the Medical Council. The Council was composed very often of men of very high eminence, and that was especially the case with the representatives of those bodies who were conveniently near the place where the Council sat; but as regarded bodies situated in remote parts of the country, men in active work as practitioners or professors could not find the time to come up to take part in the debates. Hence several members of the Council were gentlemen who had practically retired from active professional life, and found it almost as much as they could do to undertake the journey. Much energy could not be expected from a body so constituted. If they had, on the other hand, a Medical Council with representatives sent by the Profession at large, they would have it considered a great honour to be elected by the Profession of England, or Scotland, or Ireland, and they would have the very best men, and they would have men who were constantly in contact with the constituencies, and who knew exactly what the constituencies desired and required; and they would find that with 770 such a body it would be possible to do a vast amount under the existing legislation—much more than, he feared, would be effected with the existing Medical Council under any legislation. He had said the proposal of Conjoint Boards was a step in the right direction; but they must be careful it did not effect some mischief. It would reduce to one level minimum the standard of medical education. On that ground, the University of Edinburgh had petitioned against the Bill, and the University of Glasgow had also expressed its hostility to it. The Conjoint Board which was to examine for the whole of the country could hardly take the highest standard; therefore, there was a considerable danger that the high standard at present exacted by some licensing authorities would be reduced. Another important detail was the system on which it was proposed to divide the fees, which under the conjoint scheme were to be paid into a common purse. There seemed to him a danger of all interest being taken away on the part of the licensing authorities, who would find it much simpler to give their degrees and take their share of the proceeds; and unless they proceeded very carefully and knew what they were about a tendency to lower the standard must be apprehended. Again, a large number of men became licentiates of the London College of Surgeons, for example, and then went to Scotland, and took a medical degree at one of the Scotch Universities. The benefit of studying medicine in more than one place was very great, for the reason that instead of a man being sent forth to practise when indoctrinated with the crotchets of one set of teachers, he saw what was common to various sets of teachers, and what was exceptional to each, and, therefore, was better fitted for this work than if his education was limited to the teachings and crotchets of only one school; but no doubt the present Bill would discourage such migrations, and a man would be almost compelled to take his qualifications from the medical authorities of his own particular portion of the country, whether England, Ireland, or Scotland. Then there was the question of the Branch Councils of the three Kingdoms being allowed to make special rules; for what was to prevent these conglomerations of corporations from competing 771 with each other in a degrading sense as to facility of examination? Still, he thought the Bill now before the House was the best of all those before Parliament, so far as its principle was concerned, inasmuch as it embraced everything that was important in all the other Bills; and under these circumstances, he should give his hearty support to the second reading, on the understanding that it was to be referred to a Select Committee. Of this he was convinced, that to intrust the task of medical reform to the Medical Council, as at present constituted—a body which had for 20 years neglected to exercise those powers which it possessed—would be as unsatisfactory as the experiment of putting new wine in old bottles. The first thing to be done, therefore, was to impart some vitality into the Medical Council, as was proposed by this Bill.
§ DR. O'LEARYsaid, the debate was almost as lively as one he remembered hearing in that House on the subject of hypothec. He did not agree with the details of the Bill, but he fully concurred in the principle of it. In England there Were certain bodies giving licences to practise surgery; and in Ireland and Scotland it was the same; but while in Dublin and London the fees were nearly equal, they were very much lower in many Colleges in Scotland, and, besides that, there was a difference in the number of years of study, so that, on the whole, there was a great discrepancy between arriving at the Medical Profession in Scotland and in England and Ireland. The scheme before the House was intended to put all the bodies on an equal footing, so that all medical men should possess the same qualification; but the Bill did not carry that intention out, and failed miserably and lamentably in the attempt. A meeting of the College of Surgeons in Ireland had been held a few days ago; but they had not had time to urge their very strong objections to the scheme, and had authorized him specially to speak in their name on the subject. The Irish College of Surgeons and College of Physicians differed essentially from the same bodies in England. In the latter country they had large endowments, direct and indirect, sufficient to enable them to maintain their museums, but in Ireland they had no such endowments; no private money had been left to them, and the 772 consequence was that one of the most magnificent museums in the world—the surgical museum which existed in Dublin—had to be maintained by the savings out of fees for the examination of the students. By the present scheme that fund was abolished, so that there would not be sufficient to pay the rent and taxes of the College, or the curator, and the library would have to be closed. It was very difficult for Members to appreciate the technical details of a conjoint scheme of examination, and he thought the Bill should be read a second time, in order to refer it to a Select Committee, which was the only possible way in which the subject could be dealt with. Reference had been made to the herbalists, but the Bill said nothing about them, unless they happened to be dealt with in the class of unqualified persons who assumed the title of doctor, physician, apothecary, or surgeon. A great majority of the cures effected by those men was the result of the confidence of the patients, and he would not duly tolerate, but would protect that class. He sympathized with them, and with the poor people who believed in them; and he repudiated, for his own part, any narrow feelings against such men, who did a great deal of good. Of course, a higher state of medical science now prevailed than there did 40 years ago, and greater advances had been made in that time than in the previous 1,500 years. In 1834, when a conflict arose in the House between the real practitioners and herbalists, and others, a Select Committee was appointed, in the face of the difficulty, and there was far greater reason now for a similar course being adopted. He appealed now to those in power not to object to the second reading of the Bill, with the distinct understanding that it be referred to a Select Committee. He would not vote for the Bill as it stood, for it was imperfect; but on the pure ground of referring it to a Select Committee he would support its second reading, and he considered the Government ought to do the same, or make some alternative proposal of their own on the subject.
§ LORD GEORGE HAMILTONsaid, the hon. Member for Glasgow (Dr. Cameron) had made out a clear case why pressure should be brought to bear upon the Medical Council to induce them to improve the education of medical stu- 773 dents and raise the standard of examination. He had also stated with ability and clearness the faults of the present system, which promoted competition between the different licensing bodies and lowered the standard of examination. During last year the Lord President of the Council and himself were in consultation with the Medical Council and the various licensing bodies, and also received communications from persons outside these bodies on this subject. The general result was in the direction of the proposals contained in the Bill which the Lord President introduced into the House of Lords some time back. There was also the Bill of the hon. Member for Exeter (Mr. Mills') down for second reading this day, and they had also the fresh Bill—one by the hon. Member for Salisbury (Dr. Lush). These three Bills were almost identical in respect to the proposals for insuring greater uniformity in the examinations, and a more correct registration of the persons who passed them. But there was one subject which the measure of the Government did not take up that the Bills of his hon. Friends proposed to deal with, and that was the reform of the Medical Council. On this matter the Government had always used the same language. That body was composed of most eminent men. In fact, it would be difficult to select gentlemen more widely known, both for their ability and their great practice, than those who held seats on that Board; but there were, no doubt, many who thought that the Medical Council had sometimes been somewhat in error. There were, no doubt, those who thought that some of its members had not always been as active as they might have been; but, if that were so, he believed their inactivity would be found to be due to the difficult circumstances with which they had to contend. The Government had looked over the names of those who composed the Medical Council; and they did not feel justified in proposing in their Bill any alteration in the existing constitution of that body. Still, as there was a strong wish, both in the Profession and outside it, that that question should be considered this year, the Lord President had no objection to the appointment of a Committee to investigate the subject, and to decide as to whether any measures were necessary for the reform of the Council. He had abstained from putting a Notice 774 on the Paper for the appointment of a Committee until Monday last, in order not to prejudice the discussion of that day. There was a strong reason for referring only a part of the subject to the Committee. There was a consensus of opinion about educational reform; but if that were referred to the Committee, it would probably be unable to report in time for legislation this Session, unless it merely went through the clauses of the Bill and suggested changes which would not obviate subsequent discussion in the House. It was a question on which the Government ought to legislate, if possible; and though, under ordinary circumstances, a few months might be a matter of small importance, account must be taken of the length of the existence of the present Parliament; for if they did not succeed in passing a Bill this Session, there was little prospect of one being passed during the life of the present Parliament. If a Select Committee made a full inquiry and Report, the next Parliament would, perhaps, not be satisfied with it, and everything would have to be done over again. He should be very reluctant to oppose the second reading of the Bill now before the House. At the same time, he must point out that it embodied the principle that the Medical Council must be reformed, that members of the Profession outside must be directly represented upon it, and that that object must be achieved by diminishing and curtailing the amount of representation at present enjoyed by the Medical Corporations. Anyone who had been long in the House knew how strong —he did not say, too strong—all vested interests were, and he believed that if the Government were to consent to the second reading of the Bill which was at present under discussion they would arouse such a spirit of opposition as would, in all probability, prevent their legislating this Session. Under these circumstances, the course he would suggest to the hon. Member for Salisbury (Dr. Lush) was that he should, with the leave of the House, consent to the adjournment of the debate. If his suggestion were adopted, he would undertake to-morrow to move the appointment of a Committee to inquire into the constitution of the Medical Council. That Committee would, no doubt, report within a short time, and its recommendations might be embodied in the Govern- 775 ment Bill which was to come down from the other House. He would undertake that the Government Bill should not be received in that House until the Committee had reported. By the adoption of this proposal he believed legislation on the subject would be materially facilitated, and that it would also be rendered more complete and thorough than it would otherwise be. If the hon. Member would not adopt this course, he (Lord George Hamilton) feared that he must vote for the Amendment of the hon. and learned Member for Dewsbury (Mr. Serjeant Simon), which he did not wish to do, as he had no sympathy with the hon. and learned Member's argument. The hon. and learned Member had misapprehended the intentions of the Bill. There was nothing in it to prevent him, if he broke his leg, calling in a blacksmith to set it. It only provided that the blacksmith should not add such a designation to his name as would make people believe him qualified to practise surgery. To refer all three Bills on the Paper to a Select Committee would simply, in his opinion, be a waste of time. On the part of the Government, he had to say that they had endeavoured to give due weight to the interests of the public on the one hand, and to the wishes of the Medical Council on the other, and that their measure would be found to contain, at all events, the groundwork of a reform, the necessity for which had been felt for some time past.
§ Mr. LYON PLAYFAIRsaid, the discussion had ranged into the whole question of medical reform; but the House was not in the position to enter into any such discussion with advantage, and he, therefore, did not intend to weary the House by going over the same ground. Let hon. Members consider the position they were in. They had on the Orders of the Day three Bills on this subject, and they knew there was a Government Bill travelling down to them from "another place," which must give rise to a discussion upon the whole question. To-morrow the question of the constitution of the Medical Council might come before the House on the proposal of the noble Lord. He reserved what he had to say of the general subject of medical reform till the serious battle that would come on when the Government Bill was presented to them. The Rules of the House, indeed, 776 prevented them alluding to any Bill except that of the hon. Member for Salisbury (Dr. Lush). This Bill certainly covered the whole ground—for, first, it profoundly changed the constitution of the Medical Council; then, it provided for Conjoint Boards of Examination; and, finally, for the registration of qualified practitioners. To the construction of the Medical Council his hon. Friend attached the greatest importance. He (Mr. Lyon Playfair) had tried to discover a principle in his plan, but in vain. Did he represent institutions and corporations in proportion to the great medical schools, or to the number of licences or graduates? Certainly neither of these principles was involved. The great medical school of the University of Edinburgh—probably the most important professional school in the world— had 1,200 students, and produced as graduates in medicine a large number of most qualified practitioners. But by the Bill it was only to have one-fourth of a member in the Medical Council, whilst the University of London, producing only 20 or 30 graduates, and teaching no students, was to have one member to itself. Indeed, such medical corporations of secondary rank as the Apothecaries' Company and the College of Surgeons of Glasgow were each to have a member of the Medical Council, while the Universities of Scotland, which last year produced 210 graduates, were only to have one member for the whole four. He did not agree with his hon. Friend about the uselessness of the Medical Council. He (Mr. Lyon Playfair) had been a medical examiner for many years, and he knew that the Medical Council had done admirable work in improving medical education, and raising the standard of examination. At the same time, he admitted that there was a strong desire on the part of the Medical Profession to have direct representation on the Council, and with this view he had considerable sympathy. But his hon. Friend forced every University Member in the House to vote against the second reading of a Bill in which the principle of direct representation was involved. He could not be surprised at this, when he considered what was the main danger of examination by a Conjoint Board. Such examination must always represent a minimum amount of knowledge. Suppose it re- 777 presented a maximum, like the examination of the University of London. The result would be that only 20 or 30 medical practitioners could be licensed in a year to supply the waste by death and wear and tear of the Medical Profession. Unquestionably, a uniform pass must be on a minimum standard of knowledge and skill. The Universities were expected to counteract this tendency, and to keep up the qualifications of medical men by elevating their standards for degrees, so as to induce men of talent to add them to the lower pass examination. But while the Universities of the United Kingdom were expected to serve this important purpose, his hon. Friend proposed to degrade them in public estimation by giving to them only a small fractional representation on the Medical Council. The debate to-day was on a false issue. He was prepared, when the Government Bill came down, to discuss it fully on its own merits, and for this purpose the three Bills now before the House would be very useful to enable them to examine the whole issues involved. He trusted, therefore, that his hon. Friend would consent to the adjournment of the debate. The whole question of medical reform was vastly important to the community at large, and should receive long and full discussion before the House. The proposed Committee on the constitution of the Council was only one part of the subject, and they should not be called upon to consider the Government Bill until the Report of the Committee was in their hands. He understood that the noble Lord promised the House that he would postpone the Bill until the whole question could be discussed on its merits. This would give ample time to the various bodies interested in the changes contemplated to represent their views on the main question, for they did not feel called upon to do so on the side issue of this Bill.
§ MR. MOWBRAYjoined in the remonstrance of the right hon. Gentleman against the way in which it was proposed to deal with the Medical Council by the Bill, and said he trusted the hon. Member would not attempt to force a Division to-day. He altogether objected to the joining together of the Universities of Oxford, Cambridge, and Durham for the purpose of electing a member on the Council. Oxford and Cambridge were 778 only a short distance from London, and, as a matter of fact, the delegates from these were among the most regular and attentive members. Moreover, he thought there was a great advantage in having on the Council men who were not taken from the actual ranks of a busy Profession, but who came from the Universities. If the hon. Member proceeded with the Bill, he should feel obliged to give his most strenuous opposition to those parts of it which dealt with the constitution of the Medical Council.
§ MR. PLUNKETexpressed a hope that the hon. Member for Salisbury would accept the advice which had been given, and consent to the adjournment of the debate, otherwise he should certainly feel bound to oppose the Bill, which he considered was crudely and hastily drawn. He complained that the University of Dublin and the Queen's College, which had been soldered together in the Bill, were not properly treated. It was stated in one of the clauses that they should be represented by one person collectively; but no provision was made for the case of these bodies disagreeing in their choice. The College of Physicians and the Apothecaries' Hall were also joined together to elect a collective representative respectively, and that was scarcely an intelligible way of dealing with such an important question.
§ MR. MITCHELL HENRYsaid, he thought the proposal of the noble Lord was most practical. The two subjects dealt with in the Bill—the examination of candidates and the constitution of the Medical Council—weretotally and entirely distinct, and he advised the hon. Member for Salisbury to accept the suggestion of a Select Committee. The great improvement which had recently taken place in all departments of the Medical Profession had not been owing to the Council, which had done little besides forming a register of practitioners. It seemed to him that when medical reform was taken seriously in hand it would not be at all necessary to continue this great, unwieldy, and expensive Council. It was too much to expect the Medical Profession to continue to pay these large fees for the expenses of the Council. When the Government Bill came down, and if a well-selected Committee were appointed, he 779 imagined that some facts would be produced which would modify the opinion of the House of Commons as to the question of continuing that body in its present condition. There was no doubt that the variety of entrance examinations had been a great advantage to the Profession; but if Corporations which had hitherto opposed each other, and refused under any circumstances to adopt this conjoint scheme, continued their unwillingness, because it would interfere with their emoluments, he did not see why, with any efficient examination, the Council should be kept up. He did not think fees should be altogether diverted into a common fund; for if they were, many valuable collections and museums would be lost, but he had a very strong sympathy with those who objected to the enormous tax put on the Profession by keeping up the Council. When once there was a scheme of examination, properly supervised, there would be no necessity for anything but a small Council, the Members of which should be frequently changed, for it was not at all necessary that the Universities and Corporations should all be represented at the same time on the Council. If the proposal for a Select Committee was not accepted, there would be no legislation on medical reforms this year; and if the House continued next year there was little hope of the subject being taken up by a moribund Parliament.
§ MR. BERESFORD HOPE, as Representative of the University of Cambridge, did not like to appear indifferent on this subject. He thought the hon. Member had failed in his Bill to grasp the raison d'être of the separate representation of the Medical Council of the various Universities. There was an impression in unenlightened places that one University was very much like another; but the hon. Member for Salisbury could not have fallen into that error. Each University had a distinctive teaching of its own, which was a valuable contribuent to what ought to be a union of deliberative strength. Without disrespect, also, to the University of Durham, he could say that it was not so old, large, or influential as those of Oxford and Cambridge, and that afforded another reason why it was a decidedly unsatisfactory arrangement that all three of them should be equally joined together for the 780 purpose of representation on the Medical Council. Such a proposal was about as reasonable as would be a proposal, in a Bill for the re-distribution of seats, to give one Member to the two cities of Salisbury and Durham.
§ DR. LUSHacknowledged the courtesy with which his proposals had been received. He must, however, deny that he had any wish to establish trade unionism in the Medical Profession. He might also be permitted to state that the ridicule of the Bill by the hon. and learned Member for Dublin University (Mr. Plunket) was founded upon a misprint. As advised, he was quite willing to accept the assurance that the Government Bill would not be proceeded with until the House had before it the recommendations of the Select Committee which the noble Lord proposed to have appointed. He, however, trusted that the noble Lord would consent to enlarge the scope of the Committee so as to include the question involved in his Bill.
§ Motion made, and Question proposed, "That the Debate be now adjourned."— (Dr. Brady.)
§ Motion agreed to.
§ Debate adjourned till Wednesday 26th March.