§ Order for Second Reading read.
§ THE VICE PRESIDENT OF THE COUNCIL (Sir LYON PLAYFAIR) (Leeds, S.), in moving that the Bill be read a second time, said, he was sorry to remind the House that, since the year 1870, 21 or 22 Bills upon the same subject had been brought before the House; but, owing to the interests affected and the jealousies of different Medical Bodies 237 the measures had all failed. He trusted that the Bill which he now asked the House to consider had removed many, if not all, of the difficulties which previous Bills had met with, and that the House on this occasion might feel itself justified in carrying it through and settling a long and harassing controversy among medical men, who were much disturbed by these Bills being constantly brought forward. There were about 16,000 medical men throughout the country. These medical men came upon the Register and practised through 19 Licensing Bodies. These Bodies were partly made up of the Universities in different parts of the Kingdom, and some of them were Licensing Corporations, such as the College of Surgeons, and the College of Physicians in the three sections of the Kingdom, and the Apothecaries Company. Through any one of these 19 Bodies a medical man could come upon the Register and might practise, and he might receive 50 or 60 titles and licences to practise from these Bodies; and the bewildered public had no idea of what was the value of these—whether they signified a sufficient qualification—which were good and which were bad. Although the public had very little means of judging of the efficiency of these titles, he ought to state at the outset that from the very fact of 21 or 22 Bills having preceded this one in the attempt to reform the Medical Profession very great improvements had taken place in the examinations of the different Licensing Bodies throughout the Kingdom. Still, the law remained in exactly the same state, and a man might—he did not say that it was so—pass a College of Surgeons, and go down to the country and attend medicinal cases—such as measles or scarlet fever—without even having passed a medical examination at all; or he might take a licence by a College of Physicians, and cut a man's leg off without having passed an examination in surgery. Therefore the state of the law—and he was not speaking now of the improved practice—was that, with any single qualification, a surgeon might practise medicine and a physician might practise surgery, and both might go down to the country and, without knowing anything about it, practise in a thickly - populated district midwifery. Since the attempt to reform the Medical Profession the different Medical Corpo- 238 rations had shown a tendency to combine. In England the College of Surgeons and the College of Physicians had combined to have one qualifying examination both in medicine and in surgery; and the House would recollect that Her Majesty, a few days ago, laid the foundation stone of a great Examination Hall, which was to be the conjoint Examination Hall of the two leading Corporations. This was a voluntary combination, and not a statutory one. In Scotland they had done the same thing; but in Ireland they had not yet combined. The College of Surgeons, the College of Physicians, and the Apothecaries' Company in Ireland, all had their separate examinations, without any conjoint examination, so as to cover the whole area of medical knowledge necessary for practice. The leading principle of this Bill was that no man in future could get into the Profession without what he termed a qualifying examination. That examination consisted of this—that a man must pass a thorough examination in medicine, surgery, and midwifery; and with that view the Bill promoted the desire that had been shown by the Profession itself for the Corporations to combine The Universities, and especially the Scotch Universities, examined both in medicine and surgery. The Bill said that they should continue to give the degrees which they now gave, and which they were enabled by Charter to give. It also said that the Medical Corporations, if they desired to form a qualifying examination, must combine together to give a qualifying examination over the whole area which was considered necessary for the Medical Profession. But there might be injustice arising from this. In London, for instance, there was a Body called the Apothecaries' Company, which gave a very useful class of medical practitioners; and it might be shut out by the two Colleges refusing to take it into their combination. In that case the Medical Council, which was established in 1858 to rule the Profession, would, under the Bill, have power to add a sufficient number of examiners, in order by these additional examiners to secure a qualifying examination to the Apothecaries' Company. The next part of the Bill dealt with the constitution of the Medical Council. That Council was established to regulate the Profession, and see that 239 the examinations were improved. There had been great discontent that while its nominees were appointed by the Crown to that Council, and the Universities and Corporations sent members, there was no popular representation of the large body of practitioners throughout the country. By this Bill they gave four popular representatives to be added to the Council, which representatives would be elected by the whole of the practitioners in the Kingdom—two for England, one for Scotland, and one for Ireland. These representatives would add to the strength of the Medical Council. But they might make all these rules, and the Medical Corporation might not do their duty and secure efficient examinations. The Bill, therefore, would give the Medical Council power to send Inspectors to see that the examinations were sufficient and efficient, and if they found any Body not doing its duty they might disqualify that Body from giving qualifying examinations; but the consent of the Privy Council must be obtained, so that the Body to be disqualified should have full opportunity of showing that they were giving, or were about to give, these examinations in a fit and proper manner. These were the main features of the Bill. It had perplexed medical men that Colonial and foreign practitioners practising in this country were not recognized on the Register. The Bill provided that if they were properly qualified they would be admitted on the Register, provided there were full reciprocity between the Colonies and this country in this respect. Part III. of the Bill contained miscellaneous provisions, some of them being of great importance. One of these provisions was to the effect that in the event of the Medical Council not doing its duty, and not keeping the Corporation and Universities up to the mark, it might be put in default. In that case the Privy Council would step in and establish the necessary rules to secure efficiency. As yet he had heard of no opposition to this Bill from any part of the Kingdom, either from the Universities or the Medical Corporations. Formerly there was great opposition to these Bills; but in 1884, when the last came forward, he moved an Amendment which received the approbation of every Corporation throughout the Kingdom and of all the Universities. It was upon the basis of 240 that Amendment—that was to say, trusting to the Licensing Bodies in combination to do what they wished, and giving the Medical Council full power to enforce efficient examinations—that this Bill had been brought forward, and he believed that the second reading would meet with no opposition from them. He now recommended the Bill to the House in the hope that it might be a settlement of a long-vexed question, and that they might at last obtain the means of getting upon the Register qualified practitioners who were skilled, by their education and by their examinations, in the great branches of the Medical Profession.
§ Motion made, and Question proposed, "That the Bill be now read a second time."—(The Vice President of the Council, Sir Lyon Playfair.)
§ SIR HENRY HOLLAND (Hampstead)said, he did not rise to oppose the second reading of the Bill, as, from inquiries which he had made, he believed the principle involved in it met with the general approval of all branches of the Profession. Indeed, he ventured to congratulate his right hon. Friend (Sir Lyon Playfair) upon having surmounted the difficulties which had hitherto prevented any advance in reform of the Acts. This he had effected, not by work just done by him since he took Office, but, as they all knew, by work carried on very ably for many years. He (Sir Henry Holland) would only make a few remarks upon that occasion, as he did not wish to stand between the House and others—two of whom he saw on the opposite side of the House—who were more competent to discuss this question. But his right hon. Friend had admitted that some Amendments would have to be made in Committee; and he (Sir Henry Holland), therefore, ventured to bring one or two points under consideration. He could not but express his regret that his right hon. Friend had not seen his way to consolidate the law upon this question. He was, of course, aware that a Consolidation Bill was somewhat more difficult to pass; but in the present case there was, in truth, only one important Act, the Act of 1858, to be dealt with; and he would still urge on his right hon. Friend to consider if he could not in Committee introduce, if not all, at all events a large part of the 241 Act of 1858 into the Bill, and thus make a larger repeal of that Act than was now proposed. For instance, a person fully acquainted with the subject would know that the General Council only held office for a term of five years under the Act of 1858; but an outsider would suppose, from this Bill, that the great majority of the General Council held for life, and that an invidious distinction was drawn between them, and the members of the Council who are termed "representatives of the Medical Profession," but who are only to hold office for five years. As the whole constitution of the General Council was changed by the Bill, why should not the more convenient course be adopted of stating in the Bill the term of the office of all the members? Again, his right hon. Friend would find other sections of the Act practically incompatible with the provisions of the Bill, or rendered unnecessary, and those should be repealed. Thus Sections 20 to 23 of the Act, which dealt with the representation of defects in the examinations and to the remedies for such defects, would, at all events, if they were not altogether incompatible with the Bill, be rendered unnecessary by slightly adding to the provisions of Clause 4 of the Bill. And, again, Section 24 of the Act was materially altered, so far as regarded the quorum of the Privy Council, by Clause 19 of the Bill. Why should not the rest of Section 24 of the Act be embodied in Clause 19; and then the section could be repealed. There were other cases of that kind; but he did not desire to detain the House by enumerating them. Feeling, however, as he did, very strongly the advantage of consolidation, he begged his right hon. Friend to see if he could not in Committee embody in the Bill more of the Act of 1858, and thus make a larger repeal of it. There was one point of more importance to which he desired to call attention with reference to the Colonial part of the Bill. He entirely approved of the provisions in Part II., and thought they would be acceptable to the Colonies; but there was one provision the justice of which he called in question. By the Act of 31 & 32 Vict., c. 29, with which he had to deal when in the Colonial Office, Colonial Legislatures were given, and rightly given, full power to enforce registration in the Colonies of persons coming there, but who were already 242 registered here under the Medical Act of 1858; the only Proviso being that such persons were not to be subject to examination, but were entitled to be registered on payment of fees. That Act it is proposed to repeal by Clause 25 of this Bill on and after the "appointed day," and the "appointed day" is fixed by Clause 24 to be in June, 1887. Now, that repeal was quite reasonable when applied to Colonies that came in under the Bill, and availed themselves of the advantages of Clause 11, but unreasonable when applied to Colonies that had not done so, and did not desire to do so. The repeal, therefore, should be limited, and confined to the former class of Colonies. With these observations he supported the second reading.
§ DR. FOSTER (Chester)said, he would support the second reading of the Bill in the interests of a body of 12,000 medical practitioners, who did not, however, support it so cordially as they would have done a larger measure of medical reform, neither could he himself agree that it was in all respects perfectly satisfactory. The Medical Profession, for the last 20 years, had continuously, but so far ineffectually, struggled for the amendment of the Medical Act of 1858; and they naturally felt disappointed to find that, although during that period no less than 20 Bills had been introduced for the purpose of amending that Act, this measure was not wider in its provisions and more sweeping in its reforms. Nevertheless, they could not but recognize that it met two of the main objects for which the Medical Profession had so long struggled. The first was that every medical practitioner in the country should be completely qualified in all the branches of his Profession before being admitted to the legal status; and the other was that the Medical Profession should have a direct representation in the Governing Body. Hitherto they had been taxed to keep up a Medical Council, which had most consistently thwarted their desires, without having been represented in it. When the Act of 1858 was passed, it was said, as a reason for not granting the Profession direct representation, that there was no opportunity of doing so, because there was no register of electors to elect representatives. For more than a quarter of a century the Register had been complete; but the Profession still remained 243 without representation. There had been a good deal said during the last few weeks about taxation without representation; but, although he could not go quite so far as some in what had been said about that principle, he could, nevertheless, as a member of the Medical Profession, heartily sympathize with the views expressed by many of his hon. Friends as to the injustice and impolicy, generally, of any portion of the community being taxed without being represented. The Medical Profession had for 28 years been taxed to keep up a Council in which it had been systematically denied any representation. He was, however, bound to recognize that the Bill under consideration made a considerable concession in that respect; although, when they came to consider the manner in which it was proposed to carry the concession into effect, they would probably be of opinion that its provisions were very inadequate. It was proposed that the Medical Council should consist of 28 members, of whom 13 would represent England, 8 Scotland, and 7 Ireland; but it would be found, on further consideration, that of those 28 members no less than 18 would be the representatives of Universities and Corporations—that was to say, of the very Bodies which it would be the duty of the Council to look after. He could not, therefore, consider that it was very fair to the members of the Profession, who would have to find the money to keep up the Medical Council, that they should only have four representatives out of the whole number of 28 members. In his opinion, that number might be very fairly increased at the expense of the Crown nominees, who were originally appointed in place of the direct representation of the Profession. He also thought the three parts of the United Kingdom were disproportionately represented in the proposed Council, having regard to the medical constituency of each part. England, with 16,978 practitioners, was to have only two directly-elected representatives; Scotland, with 2,372, one representative; and Ireland, with 2,501, also one representative. In Committee he should propose to alter that, as he thought, in the case of England, it was unfair and inadequate. England ought to have four, and the other countries one each. Altogether, including the Corporate Bodies, as the Bill stood, Ire- 244 land would have seven and Scotland eight representatives out of the 28. But, after all, the right hon. Gentleman (Sir Lyon Playfair) was to be congratulated for having produced a measure which had in its simplicity and modesty its best recommendations, and he (Dr. Foster) had much pleasure in supporting it.
§ DR. R. FARQUHARSON (Aberdeenshire, W.)said, he had great pleasure in congratulating his right hon. Friend (Sir Lyon Playfair). The Bill would be a memorable feature of his right hon. Friend's tenure of Office if, after the 22 unsuccessful attempts made by other people, he succeeded at last in placing this difficult and perplexing question on a sound legislative basis. A good deal of exaggeration had been brought forward in support of this class of legislation, and imputations had been made against many Medical Corporations—and more especially those of Scotland—which were not borne out by the fact, and certainly not by the Blue Book of the Select Committee; but it was certainly an anomalous state of things that 19 Examining Bodies should be allowed to compete for the right of conferring a qualification on a practitioner. It was quite plain that something was needed in the direction of consolidating those Examining Bodies, and giving the public that protection which they desired. This was, in his opinion, a very much better Bill than last year's. It was a much milder Bill. It did all that was wanted, and would not injure the Corporations much, if at all. There were, however, one or two points in the Bill to which he would refer, in order to call the right hon. Gentleman's attention to them—for instance, Clause 3, dealing with a dual qualification; and he wished to know whether it could not be made a little more elastic, and whether a medical practitioner who had already taken one qualification elsewhere—say, his surgical education in Edinburgh—might not be allowed to take another qualification from one of those Examining Bodies which formed the Conjoint Board, say his medical qualification in London? If there was no arrangement for that, it would be an injustice not only to the Corporations, but to the students and younger men. Again, he did not know if it was absolutely necessary to give, by this statute, the power to the Medical Council of sending Inspectors to exa- 245 minations, seeing that that was a power which they had already, and frequently exercised. He agreed that it had been a great grievance that the Profession had had no direct representation on the Council. The Crown members were men of the highest distinction; but they had always been appointed from the leading members of the Profession, and what was wanted was that some men should be appointed from the rank and file, who knew what were the general wants and wishes. It might be well if the members appointed by the Privy Council were given up, and the direct representatives were increased from four to six or eight. The Medical Council was already too cumbrous and expensive. It talked too much and did too little. It would be well if it could be cut down to one-half or one-third.
§ SIR HENRY ROSCOE (Manchester, S.), in rising to support the second reading of the Bill, said he, also, felt great pleasure in giving vent to expressions of congratulation to his right hon. Friend (Sir Lyon Playfair) on the success he seemed likely to attain in securing the passing of a measure which would settle difficulties of long standing, affecting not only the Medical Profession, but also the public. In one respect it appeared to have a distinct advantage over the Bills which had been proposed before; because it did not suggest any one cut-and-dried State examination, but, by the influence of the Medical Council, endeavoured to bring all the various Medical Examining Boards into harmony, and to raise and establish the standard of knowledge. He was extremely pleased to find that the Universities were to have a fair share of representation; for it was important to bear in mind that it was teaching and not examination which created medical men, and every legitimate power and advantage ought to be given to the Universities in which these subjects were taught to the highest point of excellence of modern science. The modern medical student was a very different man from the students of previous generations, as the amount of scientific knowledge absolutely necessary now was very great indeed; and he was glad, therefore, to perceive that the Universities were to be properly represented. He hoped, however, that in Committee his right hon. Friend would consider the question of the representation of the 246 newest University in the Kingdom—the Victoria University, with which he (Sir Henry Roscoe) had himself the honour to be connected, and in the foundation of which he had had a hand. The proposal at present in the Bill was that the Victoria University should be represented conjointly with the University of Durham. Without saying a word in disparagement of Durham, he would like to point out that the Victoria University was not only the University of Manchester, where they had one of the most flourishing medical schools in the Kingdom, but that other Colleges were connected with it, such as the University College of Liverpool, and it would probably, in a short time, have the Yorkshire College, Leeds; so that the Victoria University represented a very large population—as large, he believed, as the Metropolis. He trusted, therefore, that his right hon. Friend might see his way clear to give that most important, rising, and very active University a representative on the Council, and not tie it down to the University of Durham. He had no other remark to make, save that, while he was sure that the Bill would be received with great satisfaction, he hoped, at the same time, that the recommendations of the hon. Member for Chester (Dr. Foster) would receive due consideration, because he (Sir Henry Roscoe) felt that the Medical Profession was not so fully represented as it deserved to be; and, moreover, it was in England somewhat outweighed in regard to proportionate representation by the number of members from Scotland and Ireland.
§ MR. ADDISON (Ashton-under-Lyne)said, he felt bound to express his surprise and astonishment that the previous speakers, who represented the interests of the Medical Profession in a far greater degree than himself, had not referred to what he considered to be a serious defect in the Bill, and in the law of England. It had been stated that this Bill was for the protection of the public; but he desired to point out that, at the present time, there was no protection for the public whatever in any of these Bills. It was true that the Bill permitted one general qualification for the Medical Profession, so that a medical man might not cut off a leg, or attempt to cure the measles without it; but there was no law at present to pre- 247 vent the most ignorant and unqualified person from practising medicine as he pleased, or from attempting to cure the measles without any qualification whatever. He was aware of the offences created by the Medical Acts, and also of the offence in the eye of the law, if a person implied that he was a medical practitioner, when in reality he was not. At the same time, it was well known that persons might really practise surgery and medicine without being guilty of an offence, provided that they did not say they were licensed practitioners. That was a peculiarity of the law of England, and was not the case in any other civilized country. When they were so particular about the qualifications of medical men, and were dealing so admirably with the question as was done in this Bill, he hoped, if this was to be the final legislation upon the matter, the right hon. Gentleman opposite (Sir Lyon Playfair) would attempt to introduce some protection to the Medical Profession and to the public against those who were not only not duly qualified, but were not qualified at all.
§ THE UNDER SECRETARY OF STATE FOR FOREIGN AFFAIRS (Mr. BRYCE) (Aberdeen, S.)said, that he had been a Member of the Royal Commission which had considered this question some years ago, and he was glad to say that he could assure hon. Members that this was a Bill which would probably have received the unanimous support of that Commission, because it entirely avoided the objections and difficulties which had caused so much difference of feeling among that Royal Commission, which had made no less than four separate Reports. The Bill was practically in full accord with the opinions of the Commission on those points on which they were in full agreement, and did not propose to increase the number of examinations, but merely to secure greater efficiency by providing that the qualification should, in all cases, be a qualification based upon examination in the three leading subjects. It was, therefore, in accord with the recommendations of the Commission; and, on account of its avoidance of the objections found by the Commission, he had no doubt that it would commend itself to the approval of the House. With regard to the suggestion of the hon. Gentleman the Member for South Man- 248 chester (Sir Henry Roscoe), whose scientific eminence increased, if possible, the weight which his opinion would otherwise have as a Member of that House, the Vice President of the Council would give full attention to his suggestion, but was unable at present to express a positive opinion. They knew how much the Victoria University had done for education in the North of England, and believed that it had a great future before it; and they would wish, if possible, to find a place for it in the arrangements to be made by this Bill; but no promise could be given at the present moment, for it must be remembered that representation given to it would be at the expense of some other institution. With regard to what had fallen from the hon. and learned Member for Ashton-under-Lyne (Mr. Addison), as to unqualified men practising medicine, while fully admitting the importance of the question, he thought that it was one which did not arise in that Bill, but was one which, if necessary, ought to be treated in a special Bill. This Bill was one for the better securing of those persons who had qualifications; and he would suggest that it would be better not to load it with any new subject of controversy such as that suggested by the hon. and learned Member.
§ Question put, and agreed to.
§ Bill read a second time, and committed for Monday 17th May.