HC Deb 24 June 1884 vol 289 cc1259-79

Order for Second READING read.

MR. MUNDELLA

, in moving that the Bill be now read a second time, said, it was a great measure of reform, earnestly desired by the Medical Profession, and one of great public interest. The Bill had been so long before the House and the country, however, that it was not necessary he should dwell at great length upon it. The proposed reform came from the Medical Profession, and was not forced upon them by Parliament or the public from without. It was a case of the Medical Profession demanding, in the interests of the public, better government and a higher status as regarded education. This demand on the part of the Profession was not a new one, inasmuch as an agitation in favour of such a reform had been going on for many years. In 1853 a deputation, headed by Lord Maucaulay, Mr. Milner Gibson, Mr. Bright, and others, waited upon Lord Palmerston, and urged upon him the necessity for legislation to secure— first, uniformity of custom; secondly, reciprocity in regard to practice; thirdly, direct representation on the Medical Council; fourthly, a National Pharma-copcoia; and, fifthly, the registration of legally-qualified medical practitioners. The Act of 1858 had dealt only partially with certain portions of the subject, leaving others altogether untouched. The consequence of this failure to satisfy the legitimate aspirations of the Profession had been that the agitation, which had been commenced in 1831, had been continued to the present day, and had increased in force and in intensity as time went on, with the result that during the 16 years in which he (Mr. Mundella) had had the honour to occupy a seat in that House scarcely a Session had passed without a Bill at- tempting to legislate for the Profession being introduced into Parliament. In 1870 Lord Ripon, and in 1878, 1879, and 1880, the Duke of Richmond and Gordon had brought in Medical Bills, the last of which was referred to a Select Committee, but was ultimately dropped. In view of these facts, the present Government had felt it to be their duty to make an effort to secure a satisfactory settlement of this vexed question, and they were supported in that attempt by the almost unanimous opinion of medical men, and by the Medical Press of the country. In 1881 the question was referred to a Royal Commission, presided over by the Earl of Camperdown, the Members of which had in their Report unanimously approved certain leading principles which had been embodied in the present Bill. The measure, which had received the assent of 19–20ths of the Profession, was a consolidating, as well as an amending, Bill to a largo extent, for it absolutely repealed eight Acts of Parliament, and portions of nine other Acts, so that the whole of the rules for the government of the Medical Profession would be found in the Bill. There were at present in existence in this country 20 Medical Licensing Bodies, who had the power of conferring 60 registerable medical diplomas. The evidence showed that one of the great evils of the present system was the inequality of the examinations for the licence. This inequality in the test of efficiency was the more unfortunate, as every licence equally conferred the right to practise everywhere. Men of the highest eminence in the Profession had shown that an easy examination by one Examining Body had a general tendency to lower the standard of education. Sir James Paget said that candidates who failed to pass the examination of the Royal College of Surgeons had no difficulty in getting their diplomas elsewhere. It was obviously desirable, therefore, that there should be something like uniformity of examination providing for the minimum of qualification. The importance of this object had been recognized, for on the 26th of February, 1870, the Medical Council passed, with only one dissentient, a resolution to the effect that a Joint Examination Board ought to be formed in each of the three divisions of the United Kingdom, and that every person who was desirous to be registered on any of the qualifications set forth in Schedule A of the Medical Act should be required to appear before one of those Boards, and be examined in all the subjects specified. There was much more evidence of the same kind as this to be adduced in favour of the Bill. The main principles of the present Bill were contained in a very few clauses. The first had reference to the reform of the Medical Council; and, in saying that, he did not mean to imply that the present Medical Council had not done its work as well as it was possible to do, but it had hitherto only been able to recommend, but not to enforce, its views. This reform was sought to be obtained by diminishing the number of the members of the Council, strengthening its powers, and giving to the Medical Profession what they had so long demanded and what they had been so long denied— direct representation. He believed it was the absence of direct representation which had wrecked most of the measures hitherto introduced. The next point was an approximation, as he had said, to uniformity of examination; and this was accomplished by the establishment, in each division of the United Kingdom, of Medical Boards, which should regulate the examination under the control of the Medical Council. The third point—and he thought that in the interest of the public this was, perhaps, the most important—was that, in future, a three-fold qualification should be required from everyone who required to be admitted to practise, before he could be placed on the Register. Clause 3 contained what was really the pith of the question, as far as this three-fold qualification was concerned. It provided that no person should be entitled to be placed on the Medical Register unless he or she had proved, at the final examination, his or her competency in medicine, surgery, and midwifery. Nothing could be more important to the public generally than this clause; and it redounded to the honour of the Medical Profession that, for 50 years, they had been advocating the change. This was a most important and long-desired reform; and it was due to the Medical Profession that he should state that it was not that Profession that had retarded it, but rather certain interested bodies, and he hoped they were now within measurable distance of a reform which everybody desired. The multiplicity of the Examining Bodies had been long tolerated by the State, but its effect on the Profession was unfavourable. Its effect had resulted in what had been aptly called the "downward competition," and he hoped they were now about to get rid of that sort of competition. He believed this country was almost the only State in Europe that had tolerated this downward competition. The Government had no desire to imitate the strict State examinations of Germany and other countries; but they desired that the Medical Profession in Great Britain and Ireland should rank, as it would rank immediately this Bill was passed, among the very first in Europe. They did not, however, aim by this Bill at an ideal uniformity, or an unnecessarily high standard; but what they asked for in the public interest was a minimum qualification. They were now agreed that there should be one Board for this purpose, and that no person should be entitled to registration unless he had the threefold qualification he had described. They wished, however, to deal justly by the Examining Bodies; and they would continue to have the power of conferring the present diplomas and degrees. He had stated the main principles of the Bill; and he might add that while adhering to them, they were not pledged pedantically to all the details of the measure by which they should arrive at that result. He asked hon. Members to consider the Bill fairly, and to allow it to go into Committee as soon as possible, in order that the details might be discussed. There were a number of minor questions —questions of Colonial and Foreign titles, penalties for misuser of titles, medical education, and other questions of interest and importance to the Profession, upon which, doubtless, there might be some difference of opinion; but all of them could be dealt with in Committee. The title of registration was the one question, after passing the final examination, about which they were most anxious. They had in this country about 23,000 licensed medical practitioners, of whom about 12,000 were members of the British Medical Association, which Association was almost unanimously in favour of this measure; while of the many deputations from the Profession which had come before him not one had expressed a desire to escape from the legislation proposed by it. He approached the question with feelings of the deepest respect and gratitude to the Profession, and he hoped that the Bill would settle all those questions in a manner which would give satisfaction to the medical authorities, and would set at rest a vexed question respecting the dignity and honour of a noble Profession. He begged to move the second reading of the Bill.

Motion made, and Question proposed, "That the Bill be now read a second time."—(Mr. Mundella.)

SIR LYON PLAYFAIR

I think it has been a surprise to most of us that this Bill has been reached to-day; and if I do not discuss it fully, it is because I really did not expect that I would be called on to speak on it until a later date. The reason I intervene so early in the debate is that out of 6,500 constituents, 3,000 of them are medical men, and therefore they are deeply interested in a Bill which will add much to the dignity of the Profession and to its importance in the future. My right hon. Friend the Vice President of the Council has clearly explained the leading features of the Bill. Since 1870 more than 20 Bills for medical reform have been before the House, and have been referred to Select Committees, and ultimately to a Royal Commission. This Bill is certainly the best which has been framed; and it is desirable that it should pass, so as to give peace to a long-agitated Profession. The main object of the Bill is to secure efficient medical education, and to ensure the possession of adequate knowledge on the part of all persons who receive licence to practise. The present Authority, which supervises medical education, is a General Council, created in 1858, partly nominated by the Crown, and partly representative of the Universities and Corporations. This Central Authority, strengthened by direct representation from the medical practitioners of the United Kingdom, is continued by this Bill. In addition to it, three Divisional Boards, one for each section of the Kingdom, are now created. They are in future to be the sole licensing authorities recognized by the State. Their examinations are to be made equally sufficient by the General Coun- oil, and they are to require from every candidate a knowledge of the three fundamental subjects of the Medical Profession—medicine, surgery, and midwifery. This is an essential condition of medical reform. At present, the public have no security that the general practitioner possesses such knowledge. A College of Surgeons may pass into the Profession, a man entitled to attend medical cases, such as measles or scarlet fever, although he has not been examined in the practice of physic. A College of Physicians may license a man legally entitled to amputate a leg, although he may not have passed in surgery; while both may send out licentiates without having passed in midwifery. There are now 19 Licensing Boards, furnished among them with 50 to 60 titles of all sizes and shapes, out of which an embarrassed public has to judge of efficiency. It is true that the Licensing Bodies have been lately reforming themselves, and have, in some cases, coalesced, in order to pass licentiates with a knowledge of the three fundamental subjects; but these arrangements are private, and nut statutory. The general purpose of this Bill is therefore unassailable; for it provides that every licentiate shall have adequate knowledge of medicine, surgery, and midwifery. Opinions differ as to whether the General Council and the Divisional Examining Boards are properly constituted. I do not propose to discuss this question till we roach the Committee stage of the Bill. At present, I confine my remarks to the educational effect of the Bill on the public interests of a great and noble Profession. I have said that the General Medical Council is charged with seeing that the three Divisional Examining Boards in England, Scotland, and Ireland shall have a common standard of sufficiency in their examinations. The standard of sufficiency must not be placed higher than average candidates can pass, for the waste of the Medical Profession must be supplied. This waste is about 1,600 men yearly. The three doors of admission to a licence must be wide enough to let 1,600 men at least pass through them. Suppose that the door was made as narrow as that of the University of London, only 40 or 50 licentiates could pass through annually. Suppose it was merely widened to the size of the Scottish University, only 300 men could pass through, it. With such higher examinations, four-fifths of the medical men annually required by the country would be rejected. The new Divisional Boards of Licence cannot, therefore, have too pedantic views of their functions, because already the supply of medical men throughout the Kingdom does not increase in proportion to the population. Between 1851 and 1861, it positively decreased; for the medical men in 1851 were 15,241, and fell to 14,684 in 1861. In the following decade, ending in 1871, the medical men increased 2 per cent, while the population did so by 13 per cent. In the Census of 1881 the medical men of England increased 3 per cent, while that of the population was 14 per cent. Scotland showed a better proportion, for the increase of doctors was 7 per cent, and that of the population was 11 per cent. In Ireland the doctors increased in all to the extent of 50 men, although there was a slight decrease in population. None of these figures are satisfactory. They show that the present conditions of medical men are not attractive enough to induce students to enrol in sufficient numbers to supply the population. This Bill may provide a remedy, or it may increase the evil, according as it is wisely framed and wisely administered. The conditions of licence must aim at providing a minimum examination for sufficiency, but dare not try for a maximum of efficiency. As Sir William Gull puts it, the Licensing Divisional Boards must only try to give "a better lowest examination than is now given." Of course, that in the future will embrace the three fundamental subjects of medicine, surgery, and midwifery, which all the 19 Licensing Authorities do not do, and, certainly, are not bound by statute to do. No doubt, however, a low pass examination has its danger. Candidates will certainly look to the State examination as the main end to be achieved. Its natural tendency will, therefore, be to produce and often to reduce to a low level of uniformity. In careers barred by examinations, the latter become the motive power, while a desire to attain a higher standard of excellence is limited to the ambitious few. The minimum standard of the State examination will, in future, govern the teaching of medical schools as surely as the main motive wheel of a factory engine governs the motion of 1,000 bobbins. This has not escaped the attention of the Royal Commission, which was obliged to adapt its recommendations to the varying circumstances of medical education in the three divisions of the Kingdom. In England, medical education is chiefly conducted by hospital schools, the pupils of which are examined by the London Colleges of Surgeons or Physicians. The Universities of England have hitherto contributed only 8 per cent of the licentiates of England; but I am glad to say that both Cambridge and Oxford are rapidly developing their medical schools. In Ireland, the Universities play a more important part, for they graduate one-third of all the licentiates. The Irish Corporations also have their own teaching schools, and differ in this respect from the Corporations both of England and Scotland. In Scotland, the Universities take a very conspicuous part both in medical education and graduation. If we compare double licences in medicine and surgery, the Scotch Universities now licence 61 per cent of all the licentiates in Scotland. The students prosecuting medicine at the Universities are 2,700 in number; while their annual graduates are 300, or exactly six times more than the medical graduates of the English Universities. A system somewhat less organized than the hospital schools of England prevails in Scotland under the name of extra-mural teachers, who have a considerable number of students, partly preparing for the Corporation licences, and partly for University degrees. It will, therefore, be observed that Scottish and Irish medical education is essentially different from that in England. Indeed, it more resembles that in Germany, where, out of 25,000 University students, 6,000 are engaged in the study of medicine. The effect of having medical education within Universities is to associate general culture with technical training. Mere professional schools give length, but they do not give breadth to technical training. In the case of the Universities it is different, for their primary object is to give a cultured education, and then to make professional training its natural and logical development. The Royal Commission, and the Government acting upon their Report, were obliged to adapt any new system of licensing to the varying conditions of medical attendance in the three divisions of the Kingdom. This they have endeavoured to do by making the representation on the Divisional Boards in proportion to the part which the Corporations and Universities respectively take in medical education, giving, however, a preponderance to those bodies which both teach and graduate over those which merely influence medical education by systems of examination without teaching. So the Divisional Boards in the three sections of the Kingdom are differently constituted. In England, where the Universities have in the past only trained 50 graduates yearly, the Corporations and Universities have equal representation on the Divisional Board. In Ireland, where both the Universities and the Corporations have medical schools, the Universities have a majority of two. In the Scottish Divisional Board there are eight University representatives to five from the Corporations. At present, I do not desire to discuss whether these are fair proportions between the Universities and the Corporations. This is a subsidiary question, which had best be considered in Committee. At the same time, I entirely uphold the principle of the Royal Commission — that where teaching Universities do much to promote medical training, they ought to have a preponderating influence over mere Examining Boards. The reason for this is obvious, that we desire to promote methodical education, and not mere cram. Unless you encourage Universities to aim at maximum qualifications, the State Boards will have the effect of inducing candidates to work down to the minimum of sufficiency, instead of working up to the higher qualifications of Universities. Examination is not education; it is only a test of what education has achieved; and it is always attended with uncertainties, and very frequently with evils. The Bill abolishes two Examining Boards; but it adds three, so that 20 will still remain if it were not for the tendency of the Corporations to unite in order to form conjoint examinations. Thus, the three Scottish Corporations have united; and, instead of five means of entering the Profession, they will hereafter have only one entrance, so that all the candidates must pass in the throe subjects—medicine, surgery, and midwifery. The London Colleges of Physicians and Surgeons have a conjoint scheme prepared, which will no doubt be ratified by the Medical Council in October, and they will consolidate their examinations in a like way. According to the present Bill, all the candidates for University honours, or for Corporation licences, must pass a final examination before the State Divisional Board. This was necessary when the Corporations gave licences for single subjects, such as medicine, surgery, or midwifery. But now that some of them have conjoined, and give one final examination for all three subjects, the whole question becomes much simpler. Frequent and repeated examinations on the same subjects are an intolerable oppression on candidates. The Medical Council and the subordinate Divisional Boards have to satisfy the public that the examinations for licence to practise are sufficient. This is the essence of the scheme, and with it I have no intention to interfere. If they can do this without ad ding to the number of examinations, it will be an immense gain, no doubt. the whole security for efficiency must be maintained. But this could be done in two ways—either by the Divisional Board instituting a completely new final examination, entirely by its own examiners, or by sending its examiners to take part in the final examinations of the Universities, and of the conjoint examinations of the Corporations. Both these plans were under the consideration of the Commissioners, who, by a majority, recommended a new and separate examination. The two Commissioners of the highest professional authority— Professor Huxley and Professor Turner— dissented, and gave very strong reasons indeed for the second plan of sending examiners from the Divisional Board to the University examinations and to the conjoint examinations of the Corporations. This is, in fact, the present system adopted in Germany. The State sends examiners to the Universities, and, associating the Professors with them, conduct the final examination. Germany first tried the other system of having a Central Licensing Board, but abandoned it, because it was found to lower very materially the medical qualifications of licentiates. I believe that if the majority of the Commissioners had now before them the schemes of conjoint examination since adopted, they would have reported in favour of a combined, rather than of a new and separate examination. Let me show how grievous a hardship an additional examination would be in the case of the University of Edinburgh. The final examination there in medicine, surgery, and midwifery occupies the examiners five or six hours daily for three or four weeks; and then six weeks more are occupied in clinical examinations at the hospitals. Upon that long and searching examination the University grants; its degree. But according to this Bill, the candidate who has been successful at the University has to take his prolonged and harassing examination twice over—once at the University, and once at the Divisional Board. Of course, the result would be that many men will be content with the minimum examination which will put them on the Register, and never take the maximum examination required for a University degree. But that would defeat the purpose of the Bill, which is to promote, and not to deteriorate, medical education. It is quite possible that the Corporations might accept the final examination of the Divisional Board, although it would not add to their dignity or to the permanence of their existence; but it would be impossible for the Universities to do so unless they lowered their standards for degrees. Another practical difficulty stands in the way, which would not be felt in a large capital like London, but which is fatal to the proposal of the Bill in a city like Edinburgh, which, it must be borne in mind, contains by far the largest medical school in the country. At present, the clinical examinations in its hospitals require all the patients who can be used with safety to themselves. If a second examination in clinical subjects is enforced by the Divisional Board, one of two things must follow:—either that the hospitals will refuse to place themselves at the disposal of the examiners of the Boards or of the Universities. It must be borne in mind that patients are patients, and that it would be wicked to expose them to the exhausting effects of a double use of their bodies. But this double examination is wholly unnecessary, when Universities and conjoint Corporations are willing to allow the examiners of the Divisional Board to take part in their final examinations in as full and complete a way as the Divisional Board and the General Medical Council may desire. I can answer for the University of Edinburgh in this respect—indeed, I know it to be the opinion of all the medical authorities in (Scotland; and if there are any Universities or Corporations in England and Ireland who object to the introduction of public examiners into their final examination, let them remain under the present provision of the Bill, which provides for a separate and additional examination. All that I ask is, that when Universities or Corporations, acting under a conjoint scheme, are willing, this simple method of sending public examiners should be adopted, for thus the most complete security of efficiency will be given to the public, and the evils which must follow from an additional examination will be reduced to a minimum. I know how difficult it is to command the attention of the House to a Bill of this character, which includes so many technical and professional points. It is this feeling which prevents me from discussing them fully on the second reading. But when the Bill passes into Committee, I hope that we may have ample time to discuss the details. The public interests of a Profession which has to deal with the health, and even with the life, of the people ought not to be hastily continued by the House. The long-considered agitation for amended laws relating to it has prevented the natural growth of the Profession. It is essential, therefore, that we should have permanent legislation on a wide basis. This Bill makes an honest attempt to give us it, and I have resisted many efforts to make me an opponent instead of a supporter. But let me warn the House to keep in view that teaching and training, and not examination, make the physician. A distinguished surgeon, Sir James Paget, has lately claimed for the medical man that, within a generation, he has lengthened human life, decreased pain and suffering, while he has increased the working powers of the people. I admit this, with the qualification that we Legislators may claim some part of this result by our sanitary laws. The results, both as regards medicine and law, are primarily due to the advance of science. The miscroscope, which lately has led to such wonderful discoveries in regard to the small organisms which produce disease; chemistry, which has discovered anesthetics, and enabled us to examine diseased secretions; the investigations which, have led to antiseptic treatment in surgery; the stethoscope, which enables us by sound to know the working of the internal organs—these we owe to advancing science. It is, then, of extreme importance for the future advance of Medicine that medical men should be efficiently trained, especially in those practical means of research which modern laboratories offer to students. Mere examinatian may promote cram, but will not advance science. The Bill recognizes this broad truth by encouraging Universities to continue the training of the Medical Profession. Some of these undoubtedly fear that the Bill will be prejudicial to their higher education, and I admit that it would be in it present form. But I have pointed out how easy it will be to remove this danger either to the Universities, or to those Corporations which have joined together to make a complete examination, without altering in the slightest degree the structure of the Bill, or lessening the powers of the General Council to enact the conditions for licence, and without diminishing the powers of the Divisional Boards to admit to the Register on well ascertained qualifications. I have pointed to an Amendment, which might be inserted in three lines, enabling those Boards to send their examiners to Universities or conjoint Corporations, for the purpose of assuring the Medical Council that the examiners were not only sufficient but efficient. If this were done I think much of the alarm which now prevails would subside. I know that the Scottish Corporations are not at present supporters of the Bill. But their objections are on another ground, and can be fairly considered in Committee. I should deplore as much as they do any prejudice to their prosperity by legislation. They have a useful and important function to perform in promoting the welfare of the Medical Profession. I am sure that they are sensible, although they are Examining Boards, that the scientific training of medical students is far more important as a means of education than the mere stimulus of examination. They, therefore, when they understand the proposal, will not object to the limitation, instead of to the multiplication of the examinations. As to the fundamental object of this Bill, which is that all medical men in the future should have a sufficient knowledge of the three chief divisions of Medicine—medicine, surgery, and midwifery—there is a consensus of opinion in its favour.

COLONEL KING-HARMAN

, who had a Notice on the Paper to move its rejection, said, his object in placing a block to the Bill was to insure that a measure of such magnitude should not be taken at a late hour, when it would be impossible to have the discussion on it repotted. Had it come at such a time, the House would probably have lost the benefit of the able and instructive speech of the right hon. Gentleman the Member for the University of Edinburgh. He thought that the House and all branches of the Medical Profession were agreed that the Bill was one which was well worthy of consideration, and would, if passed with proper safeguards, be of great advantage both to the country and to the Medical Profession. Undoubtedly, there were a great many points which deserved to be very carefully considered in Committee; but there was one question of principle in it that he thought was rather lamentable, and that was that there was too much of the principle of centralization in it. The right hon. Gentleman who had just spoken (Sir Lyon Playfair) said that the Bill was opposed on some minor points by two Universities in Scotland, and some of the Corporations there. Now, there was the same objection among the Corporations of Ireland, and, in a minor degree, by some of the Universities. The Corporations in Ireland complained that the Bill aimed, to a very great extent, at minimizing the powers which they had exercised, and, no doubt, exercised worthily; that their funds were being confiscated; and that the means which they had also so worthily used were being taken away from them. The right hon. Gentleman the Vice President of the Council, no doubt, did not desire to do any injustice to any Corporation; and he (Colonel King-Harman) hoped, therefore, he would consider the very strong feeling there was that injustice would be done to Irish Corporations under it, and that he would give his best consideration to the Amendments which he intended to place upon the Paper with regard to this question, so that they might be inserted in the Bill. No doubt, it was in the power of the Government to pass the Bill in whatever form they liked; but, as the object of the Bill was to put an end to agitation, lie thought it ought to be passed in a form which would insure that a fresh agitation should not take place.

MR. BRYCE

, as a Member of the Royal Commission upon whose Report it had been founded, said, he did not intend to oppose the Bill; but he hoped that the right hon. Gentleman the Vice President of the Council would give them some fuller opportunity for discussion of it upon going into Committee. He agreed with the right hon. Gentleman the Member for Edinburgh University (Sir Lyon Playfair) that this was the best of the many Bills that had been presented on this subject. He was not, however, quite sure that it might not have been better to have had no Bill at all. If we had been 30 years ago in the position in which we were now, this question would, perhaps, never have been raised; and now he doubted whether the improvements in medical education and examination effected during recent years had not made superfluous the reforms which were then urgently needed. In moving the second reading, the Vice President of the Council had mentioned the three main points of the Bill. As to the three-fold qualification, he thought that there was no difference of opinion. It was clearly necessary. As to the reform in the constitution of the Medical Council, the right hon. Gentleman had dwelt upon the question of the introduction of the representative element. For his own part, he (Mr. Bryce) could not see that much would be gained by this, or that a Medical Council so constituted would be really more representative of the Profession than the present Council, although it might appear so. The third, and, in his opinion, the most important, point in the Bill was the new provisions, not only for examination, but for the supervision of teaching. Sections 10 and 19 were, he considered, the most critical parts of the Bill, and on this point of it he hoped that they would be able to look for some concessions or modifications. He confessed that he did not see quite clearly what was meant by Section 10. He was afraid that, under that section, there might be established a final examination which would supersede the examinations conducted by the present Licensing Bodies. He should like, in Committee, to have it made plain that it was not intended to substitute one final examination for these examinations, but rather to secure that the several examinations held by the Licensing Bodies should be adequate and satisfactory, and should be accepted as sufficient and final. This matter had a special importance for Scotland, because in Scotland it was the Universities that were the chief teaching bodies. He hoped hon. Members were aware what it was this country possessed in the Universities of Scotland, particularly in the University of Edinburgh. They had a Medical School which, both for efficiency and the number of its teachers, and the completeness of its whole scientific apparatus, had never been equalled in any part of the world, and such as was not dreamt of 30 years ago. They ought to be careful to do nothing to diminish the popularity, the elasticity, the independence of such a school as that. The level of efficiency had risen enormously of late years; and he thought it would be more advantageous to endeavour to secure a good minimum under the present examination system, striking off, if necessary, some two or three of the Licensing Bodies, than to create a new final licensing examination irrespective of any of the present Examining Bodies. He submitted to the House that the main thing they had to look to in the Bill, and in any scheme for the reform of medical education, was to secure the variety and freedom of the Teaching and Examining Bodies; and to avoid the danger, always present in the pursuit of uniformity, of interfering with and checking the efficiency of institutions which had been steadily improving, and of which they had now every reason to be proud.

MR. GIBSON

said, the House was under great obligations to the right hon. Gentleman the Member for the University of Edinburgh (Sir Lyon Playfair), for his extremely interesting and suggestive speech, which he (Mr. Gibson) hoped would not be lost sight of when they reached the next stage of the Bill. The right hon. Gentleman the Vice President of the Council (Mr. Mundella) had expressed much confidence in the future progress of the Bill. He (Mr. Gibson) remembered, however, that similar confidence had been expressed by his Predecessors with respect to a large number of similar Bills, all of which had been thought the best Bills possible. If the Bill succeeded in raising-medical education where it required to be elevated, without lowering the education of those institutions where it was already elevated, it would accomplish the ideal objects of a Medical Bill. It must be remembered, and he hoped the right lion. Gentleman opposite would note it, that a great many of the Universities and Corporations in all parts of the Empire, at present, supplied splendid medical education; that they had behaved in the most spirited manner, and had acted most generously, not only towards this, but towards all preceding Bills; and he trusted that it would not be found that the working of the Bill would tend to the lowering of the standard of medical education in those Corporations and Universities which had so steadily maintained a high standard; and that, while maintaining a reasonable standard of Medicine, the Medical Councils would not fall into the error of encouraging cram, for that would do much harm. The right hon. Gentleman the Member for the University of Edinburgh, in his most important speech, revived an interesting suggestion with respect to examinatious—namely, that of placing an Assessor at the examinations of the different Corporations and Universities, instead of creating Examining Boards, which he had no doubt would attract much attention. From what had fallen from the Vice President of the Council, it appeared that some opportunity would be afforded of discussing that and other matters on going into Committee. He hoped the Bill would be fairly dealt with by the House, and would in an amended form take its place in the (Statute Book. If it succeeded in improving medical education without lowering the standard of existing educational establishments, it would prove a really useful Medical Bill.

MR. J. A. CAMPBELL

said, his right hon. Friend the Member for the University of Edinburgh (Sir Lyon Playfair) had referred to two Universities in Scotland, which were Medical Schools, as not being very friendly to the Bill. Having the honour to represent those two Universities, he (Mr. J. A. Campbell) wished to explain the facts of the case. It was true that those Universities did not look upon the Bill with very great favour in its present form; but he was not sure that even the University of Edinburgh had any great favour for the Bill in its present form. All the Universities of (Scotland which were Medical Schools regretted that the Bill was brought forward in the shape which it had taken, inasmuch as it introduced a greater change than they thought necessary for the excellent object m view. He thought he might say that they would all have preferred if the principle of having coadjutor examiners, which was recommended by the minority of the Medical Acts Commissioners, had been adopted, instead of the views of the majority. But with regard to the general objects of the Bill, he thought there was little difference of opinion. Not only the Universities, but the Medical Corporations of Scotland, were agreed that it was desirable to put an end to the system of licensing men who had not a complete qualification. That would be accomplished by the Bill; but be thought it was very desirable that the suggestion of his right hon. Friend (Sir Lyon Playfair) with regard to the final examination should be adopted by the Government. Both the Universities and the Corporations of Scotland had considerable hesitation about the Bill, inasmuch as they thought it would interfere with their individual independence. The Universities could not very well do without the Medical Corporations, and the Medical Corporations could not do without the Universities; and it was very desirable that both should be supported. He hoped, whatever the shape in which the measure would pass into law, that they would find that neither the individual character nor the individual independence of the different Universities and Corporations had been seriously interfered with. In Committee there would be many Amendments proposed, without which he thought there would be great opposition to the Bill. However, from what he had heard, they might, he thought, assume that all facility would be given for full consideration of Amendments in Committee; and if the right hon. Gentleman the Viet1 President of the Council would accept the suggestion of his right hon. Friend the Member for Edinburgh University, and find some way of getting over the difficulty of final examination, a great impediment would be taken out of the way for the peaceful progress of the Bill.

MR. GRAY

said, that while heartily sympathizing to a certain extent with the objects of the Bill, he could not but regard it with a certain amount of apprehension. Its centralizing tendency, which he distrusted, might be extremely applicable to England; but the effect of that centralizing tendency would in Ireland be disastrous. The hon. Gentleman the Member for the Tower Hamlet (Mr. Bryce) said he did not oppose the Bill on principle, though he had opposed it in its details; but every argument that the hon. Member used was an argument not against the details of the Bill, but against its principle. The principle of the Bill was to destroy independent Local Corporations. Now, he (Mr. Gray) did not set himself up to speak as a judge of the Medical Profession of England and Scotland, or the manner in which the Corporations in those countries performed their duties; but he maintained that the effect of the Bill would be to extinguish, eventually, the Medical Corporations of Ireland. [Mr. MUNDELLA: Not at all.] He might be permitted to have his opinion, and that opinion, as well as the opinion of men of a leading position in the Medical Profession, was that the eventual effect of the Bill would be to extinguish the Irish Medical Corporations; and he maintained they did not deserve the fate the Bill would bring on them, for they had had a long and an honourable record. They had striven manfully, in spite of great difficulties and great temptations, to elevate the standard of medical qualifications in Ireland; and it was no reason, because one or two Corporations in one part of the United Kingdom appeared to think more of the fees to be received than the maintenance of the standard of education, why they should now endanger all the other great Medical Corporations of the three countries. No doubt, the annals of Parliament were full of abortive Bills dealing with medical education, and he was reluctant to oppose any well-considered scheme on the subject; but he objected to any measure endangering the old established Corporations for the sake of a theoretic change. He viewed, with a considerable amount of distrust, Bills introduced late in an afternoon, the principle of which every person appeared to admit, but the details of which were condemned on all sides. The manner in which such Bills were introduced always pointed to one thing —an agreement by which the opponents of the Bill were squared by the Government. He would like to know why the Government would not apply, in this matter, the arrangement which worked so satisfactorily for many years in connection with it? own Medical Service? The Government were not satisfied with the medical degrees conferred by the existing Corporations, and insisted on a second examination at Netley; but, although they had a separate examination, no candidate was admitted to that examination until he passed through some of the existing Bodies. That was a satisfactory arrangement; but the effect of the present Bill would be to drain away the resources of the existing Medical Corporations and transfer their revenues to the new Government Boards. Now, the very limited experience he had of Government Boards disinclined him very much to believe that any great improvement would be effected by the introduction of another of them into Ireland, more especially when the effect of their introduction would be to destroy the independent institutions already in existence there, of which every Irishman was proud. He also objected to the undue importance given to the Universities under these new Boards. What title had the University of Dublin and the Royal University to the appointment of four members to the Irish Examining Board, while only three members each were given to the College of Physicians and the College of Surgeons? Another serious objection to the Bill was that it would destroy an ancient Corporate Body in Ireland known as the Board of Apothecaries, which was analogous to the Pharmaceutical Society of England. [Mr. MUNDELLA: That is not the proposal of the Bill.] Of course, that was not the proposal of the Bill in so many words; but the Bill did not propose to give the Board of Apothecaries any representation on the new Board; and, not being represented, it need hardly be said the effect of the new system would be to destroy that Corporation. The examinations of that Body might not be as high in their standard as those of the Universities, but it by no means followed that they were inadequate. To suppose that a uniform standard of examination ought to be in- sisted on both, for a skilled specialist and a gentleman supplying the wants of the poorer classes was absurd.

It being ten minutes before (Seven of the clock, the Debate stood adjourned till this day.

The House suspended its Sitting at five minutes to Seven of the clock.

The House resumed its Sitting at Nine of the clock.

Notice taken that 40 Members were not present; House counted, and 40 Members not being present,

House adjourned at five minutes after Nine o'clock.