HC Deb 26 June 1884 vol 289 cc1455-63

Order read, for resuming Adjourned Debate on Question [24th June], "That the Bill be now read a second time."

Question again proposed.

Debate resumed.


remarked that it was a subject for congratulation that a measure like this, which promised to terminate the long controversy relating to medical reform, had been introduced into that House. He supported the Bill without much enthusiasm. He was not wholly satisfied with it. If it was carried in its present form it would injure all and probably ruin some of the Medical Corporations in this country. He said in its present form, because if the Amendment so ably brought forward by the right hon. Member for the University of Edinburgh (Sir Lyon Playfair were agreed to it would remove many of the objections felt to the Bill. Such a Bill as that now before the House ought to be backed up by very good reasons indeed. The public opinion on the question had been worked up by the Medical Press, which was entirely a London Press, and not always a safe guide as indicating the feelings of the country on great national questions. His countrymen almost all opposed this Bill. It was feared in Scotland that the Bill would, as regards competition, have a downward effect, and lower the standard. In Scotland the Corporations had always examined in the three subjects of medicine, surgery, and midwifery. It was said that many incompetent men who had failed to pass in London had gone to Edinburgh, where they had obtained their degrees; but exactly the same thing could be said in the converse way, for men who had failed in Edinburgh had come up to London and passed the examinations. But even granting that those things were true, that referred more to the past than to the present. The Corporations had now set their houses in order, and some of the Scottish bodies had formed a conjoint Board for examination. But he was willing to accept the Bill, because it was desirable to put an end to the constant agitation and turmoil which beset the Medical Profession year after year. He was surprised to hear his hon. and learned Friend the Member for the Tower Hamlets (Mr. Bryce) object to the direct representation of the Profession on the Medical Council. It was surely desirable to have all possible interests represented. The objections to the Bill were mainly to details, which might be modified in Committee; and he was glad to support its second reading.


said, that the Bill was earnestly desired by the Medical Profession, and that medical men, generally, have expressed themselves as most eager for it. His words conveyed the impression that there was almost unanimity among medical men about it—indeed, he said 19–20ths of them were in favour of the Bill. But that he (Mr. Dick-Peddie) ventured to say was not the case. The House had heard from the hon. Member for Carlow County (Mr. Gray) that there is very general concurrence of opinion against the Bill among Irish medical men; and he (Mr. Dick-Peddie) could confidently say that it was the same with the Medical Profession in Scotland. His right hon. Friend the Member for the University of Edinburgh, said that two of the Scottish Universities and the three Corporations in Scotland were opposed not to the Bill as a whole, but to some provisions in it. But he thought his right hon. Friend was in error; for, at that very moment, there was a large deputation in London from three of the Universities and the three Corporations who had come up with the intention of opposing the Bill altogether. With regard to Edinburgh University its position was originally one of hostility to the Bill; and it was a moot point with them, to the last moment, whether they should not oppose it, and he understood they had ultimately resolved to support it, only on condition that a clause was added on the lines indicated by the right hon. Member for Edinburgh University providing that assessors should be sent by the Medical Boards to take part in the final examinations by the Universities, and in the joint final examinations of the Corporations. The hon. Member for Carlow had stated that the Bill was opposed in Ireland on account of its centralizing tendency, and because the Corporations were satisfied that its effect would be to extinguish them. In these objections and fears the Medical Profession in Scotland shared. The Universities dreaded the centralizing effect of the Bill, and the Corporations not only dreaded that, but feared that the effect of the constitution of the Medical Boards would be, before a very long time passed, the extinction of the Corporations and of the extra-mural Medical School. No one in Scotland opposed what the Vice President of the Council said was the principal purpose of the Bill—namely, to secure the threefold qualification in all persons added to the Register. All highly approved of this, and the Corporations in Scotland had adopted it in their final examinations. But they agreed with his hon. Friend the Member for the Tower Hamlets that it would have been well if the Bill had gone no farther than requiring that. What was feared, as he had said, was centralization, in consequence of the powers and constitution proposed to be given to the Medical Council. The duty of the Council was to be the exercise of supervision and control over the Medical Boards. The Council was to have the power of regulating everything connected with the Profession of Medicine. It was to have, as the right hon. Gentle- man the Vice President said, "not only the power of recommending, but of enforcing its recommendations." That it had not had that power hitherto had secured moderation in its actings. On this Council thus increased in power Scotland was to have representation much less than it had on the present Medical Council. Scotland now sends a fourth part of the members to the Council; but on the new Council she would practically have only one-sixth of the members as her representatives. The six nominees of the Crown would, as a rule, be taken; from England, and almost certainly; they will be men resident in London. But the proposition of one-sixth of the members of the Council would be most unfair to Scotland. He found from the Minutes of the Medical Council from 1879 to 1883 that of those who went up for final examination in that time 8,457 were in England, 6,673 in Scotland, and 3,368 in Ireland, so that about one-third of all the candidates were examined in Scotland; and it was, therefore, entirely out of the question to propose to give to Scotland such a small representation as the Bill provided. It was feared that if Ireland and Scotland had a decided minority of representatives on the Council, the Council would be apt to regulate matters more with regard to the interests of the Profession in England than to those of Ireland and Scotland. The Corporations in Scotland had special ground to apprehend evil results from the constitution of the Council, as they would likely have no direct representation on it at all. Two of the Scotch members of the Council are to be sent by the Medical Board; and as on that Board there will be a large preponderance of University members, the Corporations believe that the representatives sent to the Council by the Board will be selected from the University members. The Corporations object to the proposed constitution of the Medical Board for Scotland. The proposal of the Bill was that eight members should be chosen by the Universities, and only five by the Corporations. But the Universities examined only 2,333 of the 6,673 candidates examined in Scotland in the years he had mentioned, while the Corporations examined 4,340. Now, what are the powers of this Board? They are to govern all matters appertaining to medical teaching, examinations, and licensing. The Corporations fear that by intrusting these matters to a Board on which the Universities have an overwhelming preponderance, serious injury would result to the Corporations and to the extra-mural schools. He did not suppose that the Professors in the Universities would use means to induce the students to go to their own classes instead of to those of the extra-mural teachers; but the students would, undoubtedly, be influenced by the supposition that by attending the classes of those who were to examine them, they would stand a better chance of passing the examination, and would accordingly forsake the extra-mural classes for those of the Universities. Such a result would be much to be deplored. It would be disastrous to medical teaching in Scotland, and to the Universities themselves. The extra-mural schools had been of the greatest value. They had kept, by the competition they offered, the teaching of the Universities at a high level. Where a Professor had outlived his usefulness it had been of immense advantage to students to have the extra-mural classes to go to, and those schools had greatly benefited the Universities by being a training ground for Professors. Almost every distinguished Professor, for many years past, had received his training, and acquired his reputation first of all, as a teacher in these schools. Why, then, should anything be done by legislation to injure the Corporations and the extra-mural schools. Further, he should state that the Corporations had already adopted schemes for a full examination in medicine, surgery, and midwifery, and had thus already made provision to secure the end which the Vice President of the Council had said was the most important one sought by the Bill. The Corporations knew it would be hopeless to oppose the passing of the Bill. They gave the highest credit to the Vice President of the Council for the zeal he had shown for medical reform; and they acquiesced in the second reading in the hope that the Vice President would make reasonable concessions in Committee, and accept Amendments which would make the Bill less injurious and unjust in its operation than they feared it might be.


said, he must congratulate the right hon. Gentleman (Mr. Mundella) on the introduction of the Bill. At the same time, considering the great advance that had taken place in medical science within the last 25 years, it might be a question whether it was not rather risky for the Legislature to step in and interfere with a number of Medical Bodies, under whose work it was recognized that material improvement had taken place. The Bill, which dealt with a most complicated subject, touched several of the interests of the Profession, and affected the position which it occupied in relation to the public. There were many difficulties in the way of dealing with this subject which, perhaps, had not been fully realized even yet by the right hon. Gentleman who had introduced the Bill. There was, perhaps, no human calling- in regard to which the public was so much at the mercy of the practitioners as in the case of the Medical Profession; and therefore it was desirable, in the interests of the public, not only that the Medical Profession should consist of men of the highest attainments in the science of medicine, but it was also of the greatest importance that the high moral tone of the Profession should be to the fullest maintained. That tone was in part clue to the influence exercised over students and practitioners by the corporate Bodies with which they were bound to be connected, in order to obtain the degrees or licences, without which they could not legally practice. Under this Bill it was not only possible, but probable, that a very large number of medical men would in future not be intimately associate with any Corporation or University. The Bill would establish a kind of compound Institution, to which the Universities and Medical Corporations would each of them contribute a contingent of examiners. The qualification which the students would gain would not be such a qualification as would attach them to any Corporation, and no undefined Body of that kind would be able to exercise influence over them. No inducement would be held out to them to seek the honours and distinctions of the Universities and Medical Corporations; and, therefore, the connection of the Medical Profession with those Bodies would be broken. It must be borne in mind that these corporate Bodies had, generally speaking, no funds of their own; and, therefore, the majority must die of sheer inanition. He knew that fears of that kind were profoundly entertained in London and elsewhere. He had heard it stated that in London these corporate Bodies would not be in existence in 10 years; and if that were so, what must be the case with Corporations in other parts of the country, which now found it difficult to make both ends meet? Having no funds, they must ex necessitate rei die out. That was a very serious consideration for the right hon. Gentleman and the Government, and it would certainly be his duty to see that the matter was fully considered in Committee. These Corporations performed very useful functions, and, looking to that and the length of time during which they had existed, he should regret extremely the suppression of any one of them. In the Bill, as it came from the House of Lords, he found that the two Corporations of apothecaries who were the most ancient of the Medical Bodies in Ireland had been omitted. These Bodies performed most useful functions. The apothecary was undoubtedly the poor man's friend, and was always ready in the most generous manner to give him the benefit of his advice. It would, therefore, be very seriously felt if anything were to happen which would destroy the great body of apothecaries, who were the custodians of medicaments by which people were healed, and were the necessary complement of physicians and surgeons. He trusted that that House, which represented the popular element, would restore the apothecaries to the position to which they were entitled, and it would certainly be his duty to endeavour that that should be done.


said, he did not think that a Bill of this character ought to be pressed forward at the present time, when there were other measures of much greater public importance, interesting to a large portion of the community, which required the attention of the House. For several years past Bills on the subject had been introduced; and although none of them had become law, they had produced reforms in the Medical Licensing Bodies. Tear by year the necessity for a measure of this character had steadily grown less, and since last year a most important step had been taken in the shape of a conjoint scheme of the Scottish Medical Corporations, and the resolution that for the future they would issue no more single licences. There was strong evidence to be adduced from the Report of the Commission on Medical Degrees that the principle on which this Bill was founded was unanimously repudiated in Scotland, as prejudicial to the interests of Scottish medical education. The Bill practically disregarded what had been urged by the most influential minority of the recent Commission, and went entirely contrary to the ideas of the Scottish Medical Profession and the Scottish Medical Authorities. He was willing to allow that the present Bill was an improvement on the Bill of last year, both in regard to the constitution of the Board and other matters. It was much to be regretted that the Government had taken this measure into their hands. The Medical Authorities in Scotland, however, were willing to bring the long struggle on this subject to a close, by accepting the proposals of the Bill, if the Government would agree to certain modifications. He thought there would be but little opposition to the measure, if the Government could give an assurance that in Committee they would accept the proposed Amendment of his right hon. Friend the Member for the University of Edinburgh (Sir Lyon Playfair) with reference to medical examinations.


could not agree with the hon. Member who had just sat down as to the time at which this Bill should be brought forward. A question which involved the interests of the Medical Profession was one of the most vital and important that could be discussed by the House. He hoped, therefore, that no time would be lost, but that the Bill would become law, with certain necessary Amendments, during the present Session.


said, he was willing to admit that the Bill dealt with an important subject, which demanded attention; but, in his opinion, it was not the outcome of any general feeling in its favour on the part of the Medical Profession, but of professional jealousies. Medical gentlemen generally preferred to carry on their business without mixing themselves up in any agitation of this character, and on that account were easily manipulated to the opinions of any ring which might be formed. He submitted that undue influence was given to the Universities, some of whom, such as Trinity College, Dublin, or Oxford, really had no medical school of any consequence, while great institutions like the Apothecaries Hall were eliminated by the scheme. He failed to see how the operations of the Bill would strengthen the action of the Medical Council. In Committee, it would become his duty to move a considerable number of Amendments.

Question put, and agreed to.

Bill read a second time, and committed for Monday next.