BILL PRESENTED. FIRST READING. (Hansard, 19 March 1878)

The DUKE OF RICHMOND AND GORDON

My Lords, I rise to call your Lordships' attention to the subject of the Medical Acts now in force, and to point out to your Lordships the way in which they require amendment; and I shall conclude by presenting a Bill which I hope will have the effect of remedying some defects, and of improving the law on the subject. I believe I am right in stating that at common law in England every person is entitled to practise medicine in this country if he is competent to do so; but during the last 300 years many Acts have been passed to regulate the competency of persons so practising and to provide for the mode in which that competency should be ascertained. As far back as the reign of Henry VIII. an Act was passed which provided that no person within the City of London or seven miles thereof should take upon himself to practise as a surgeon without having first been examined by the Bishop) of London, the Dean of St. Paul's, and four professional men; and by the same Act no person was allowed to practise the art in the Provinces unless he had been examined by the Bishop and the Vicar-General. Both those clauses were still on the Statute Book; but, unless I find some opposition on the part of the right rev. Bench, who originally enjoyed the privilege—which I hope for the sake of mankind they no longer exercise—I propose by this Bill to ask Parliament to abolish those enactments. At the time to which I have been referring, it appears to have been assumed that every medical practitioner possessed a double qualification—one in medicine and one in surgery; because I find that section 3 of c. 40 of 32 Henry VIII. runs thus— That, forasmuch as the science of physic doth comprehend, include, and contain the 1582 knowledge of surgery as a special member and part of the same, therefore he it enacted that any of the said Company or Fellowship of Physicians, being able, chosen, and admitted by the said President and Fellowship of Physicians, may from time to time, as well within the city of London as elsewhere within this realm, practise and exercise the said science of physic in all and every his members and parts, any Act, statute, or provision to the contrary notwithstanding. Previously to the passing of the Medical Act of 1858 medical legislation was in a most unsatisfactory condition. There were various bodies in the three Kingdoms all entitled to confer medical or surgical diplomas, and all competing with each other—not always, I am sorry to say, with the view of raising, but, in some cases, with that of lowering, the standard of examination. Some of those bodies could grant diplomas which were good over the whole Kingdom, while the diplomas of others were good only in the particular parts of the Kingdom in which they were issued. While this was the case, the result was that some of the most competent of the Profession in England would have been precluded from practising in Scotland and Ireland; and, vice versa, an equally competent Scotch surgeon might have been precluded from practising in this country. It was not very surprising, therefore, that before 1858 various attempts should have been made to remedy that state of things; but owing to the various persons affected, and, on the part of bodies, owing to the fear of resigning privileges then possessed, no Bill was passed at all. But in 1858 Mr. Cowper introduced in the other House of Parliament a Bill which was approved and adopted by the Government of the late Lord Derby. That Bill had for its main object to raise the standard of qualification in all persons entering the Profession by creating a uniform and sufficient examination; it further provided an authoritative registry on which the names of all qualified persons should be inscribed and their qualifications defined; and it also removed the legal restriction to which I have just referred, as applying to persons who had received their diplomas from bodies whose licensing powers were confined to particular parts of the Kingdom. The Preamble of Mr. Cowper's Bill states it to be desirable that we should be able to distinguish between 1583 competent and incompetent practitioners. I think your Lordships will all agree in that. Well, Mr. Cowper's Bill was approved and taken up by the Government and passed, and I am bound to say that I think it has been to a great extent successful. But since the time at which it became law various things have occurred to show that it is desirable to amend it. That Act provides a Medical Council, and it provides that a single qualification from any of the licensing bodies shall be sufficient to entitle the person who holds it to be placed on the register, which is compiled under the authority of the Medical Council. The 19th clause of the Act suggests a mode in which uniformity of qualification for the Medical Profession might be obtained, and, acting on that suggestion, the English Medical Bodies have for a considerable time been engaged in drawing up a scheme which is well known as the "conjoint scheme," and which has for its object that all bodies licensing in medicine and surgery should, for purposes of examination, be represented by one associated body. Though up to this time difficulties to the establishment of that scheme have constantly presented themselves, those difficulties have not been regarded as insurmountable, and I believe and hope that the English Bodies have been successfully endeavouring to perfect a conjoint scheme, and that before this Bill becomes law—as I hope it may—those Bodies will have come to such arrangements as will enable them to establish a conjoint Board, leaving the Medical Bodies of Scotland and Ireland to come into the scheme after them should they so think fit. There is a difficulty in Scotland arising from the number of Universities and Medical Corporations there, which are somewhat different from Universities and Medical Corporations here. The consequence is that, up to the present time, it has not been found feasible to include Scotland in the conjoint scheme. I trust, however, that this difficulty is not insurmountable; and there are provisions in the Bill which I am now introducing under which the Scotch Medical Bodies can come in and form part of the conjoint Board after the passing of this measure. The Act at present in force does not provide for the registration of persons who have qualified in the Colonies or abroad. 1584 This Bill does so. The provisions in the existing Act referring to unregistered persons require amendment. Then there is an Act known as Mr. Russell Gurney's Act, which in one respect requires amendment, and that amendment is made by this Bill. That Act was one for enabling women to be examined; but it is so drawn as, by its wording, to enable women to be members of the Corporation and Senate, which was never intended. My Lords, I shall now go through the leading provisions of the Bill. Its principal objects are—first, to require a person registered in the Medical Register to have both a medical and a surgical qualification; second, to allow the registration of foreign and Colonial practitioners; third, to further restrict the assumption by unqualified persons of designations implying qualification; fourth, to make further provision for the uniformity of the standard-in the grant qualification in the United Kingdom; fifth, to make provision for women similar to that intended to be made by 39 & 40 Vict. c. 41, commonly called Mr. Russell Gurney's Act; sixth, to make provision for the examination and registration of dentists; seven, to make provision for the examination and registration of midwives; eight, to make amendments in the Medical Act of 1858 as regards the registers, erasure from the register, the certificates of medical practitioners under the Lunacy Acts, the qualification of medical officers in Colonial ships, and other minor matters. Clause 3 will prevent a person being registered in future unless either he has obtained two of these diplomas—one for medicine and one for surgery—or has obtained a certificate of his proficiency, both in medicine and surgery, from a Medical Board established under the Act and representing two or more of the Medical Authorities of the United Kingdom. A saving is made in favour of persons entitled to be registered before the passing of the Bill. Clauses 5 to 7 enable a person who has obtained a medical diploma entitling him to practise in a Colony or in a foreign country to be registered on proof of good character if the diploma is one recognized by the General Medical Council as representing a degree of knowledge, tested by examination, equal to that which is required for obtaining in the United Kingdom a qualification for re- 1585 gistration. If the General Medical Council refuses to recognize a diploma, an appeal is allowed to the Privy Council. Clause 9 requires Colonial and foreign practitioners to be entered in separate lists distinct from those who obtain their qualifications in the United Kingdom. Clause 13 requires the General Medical Council to exercise the powers of erasing from and of restoring to the medical register the name of a person or an entry by a Committee of their own body, not exceeding five in number, of whom the quorum shall be not less than throe—a large body such as the General Medical Council is unsuited for exercising such a power, which is quasi- judicial in its character. The object of Clause 14 is to extend the power which the General Medical Council possess at present of superintending the examinations for medical diplomas conducted by the different authorities. It does so by allowing them to make, with the approval of the Privy Council and subject to appeal by authorities and persons interested to the Privy Council, rules for regulating the examinations, the conditions of admission, and the standard to be obtained for passing them. The rules are required to provide for the admission of women to the examination, subject to two provisos—1, That a Medical Authority which now is not bound to and does not examine women shall not be obliged to do so; 2, that women shall not be compelled, if they object, to pass the same examination as men. As these examinations are the only means of entering the Profession, and the Bill makes the law against unregistered practitioners more strict, it seems just that the conditions of admission to the examinations should be subject to some general control, such as that of the Privy Council, given by the Bill, and not merely to the control of the Profession itself. The object of clauses from 15 to 18 is to extend the power given by Section 19 of the Medical Act, 1858, to two or more of the Medical Authorities to combine for the purpose of conducting joint examinations. A scheme made for the purpose before the passing of the Act, with the approval of the General Medical Council and of the Privy Council, is confirmed by the Bill. Subsequent schemes will require the confirmation of the Privy Council. The Board established by the scheme for conducting the examinations is to 1586 certify the names of the persons who pass both in medicine and in surgery, and those persons will be entitled to certain diplomas from one of the Medical Corporations. As it will be possible for women to pass those examinations, it is provided that the obtaining a diploma under this provision is not to entitle a person to any right in connection with the Corporation; and it was provided that if women objected to pass the same examination as that provided for men, they were at liberty to be registered after passing a more suitable examination. The first part of Clause 20 allows a Medical Authority, with the approval of the Privy Council, to make a new medical diploma for the purpose of being granted to those who had obtained qualifying certificates from a Medical Board established under this Bill. By this means a Medical Authority will be able to grant a diploma entitling a person to be registered without granting to such person any rights in connection with that Authority. The second paragraph of this clause is to effect the intention of 39 & 40 Viet. c. 41—commonly known as Russell Gurney's Act—which has failed in effect from a technical mistake. Clause 21 is to effect what has been effected in the case of the University of London and the College of Surgeons and the Society of Apothecaries by special Acts—namely, to enable them to remove any obstacles to their combining in the joint scheme for the Medical Board which arise from any of their acts or charters. Clause 22 extends very largely the provision against the assumption by unregistered persons of designations which imply that they are duly qualified practitioners in medicine or surgery. It does not prohibit any unregistered person from practising—that is impossible—but it prohibits a person who practises for gain from assuming certain designations. It further prohibits persons who practise for gain from assuming any of the medical or surgical designations to which they are not entitled. The clause also imposes a penalty upon a person who gives any certificate which is invalid when signed by an unregistered person. It also restricts the right of prosecution by private persons without the consent of the General or a branch Medical Council. The clause is justified on the ground that in the Bill every person who really possesses proper 1587 qualifications, whether obtained in the United Kingdom, or in a foreign country, or in a Colony, will be free to be registered without any restrictions or condition based on grounds other than that of ignorance or of improper conduct. Clause 23 enables the Medical Council, with the consent of the Privy Council, to, in effect, legislate by means of a scheme for the examination, licensing, and registration of dentists. The clause requires them to enter in, any register which is made, the existing practitioners, and also foreign and Colonial dentists. The clause provides that if a scheme is made a person not registered either in the "Medical Register," or in the "Dentist's Register" shall not be entitled to recover his fees, and shall not be allowed to assume the designation of dentist or any designation implying that he is duly qualified to practise dentistry. This provision will avoid the objection raised to the Dental Practitioners' Bill of Sir John Lubbock, which has been introduced in the other House, and has excited considerable opposition from the Medical Profession, in that it prohibits surgeons from practising dentistry or calling themselves dental surgeons. Clause 24 allows the Medical Council, with the consent of the Privy Council, to, in effect, legislate by means of a scheme for the examination, licensing, and registration of midwives. The clause requires the register to include existing practitioners, but makes no provision for foreigners or Colonists. The clause enables local authorities to undertake at their own expense any duties of examination or registration which the scheme throws upon them, but does not compel them to do so. If the scheme takes effect, a person not registered in the "Medical Register," or in the "Mid-wives' Register," will not be able to use any designation implying due qualification to practise midwifery. It also allows them to attach conditions to their Orders. The object of Clause 29 is to remove a difficulty which has arisen under the Lunacy Acts. There are separate sets of Lunacy Acts for England, Scotland, and Ireland. Under each set a certificate from a medical practitioner is required in certain cases—for example, for removing a lunatic to an asylum; and penalties are imposed for giving a certificate improperly. I thought it right, as your Lordships may 1588 imagine, to send this clause to the Lunacy Commissioners. They have informed mo that they were not altogether satisfied with it; but, as they forwarded no proposed amendment, I thought it better to leave the clause as it is. When, however, we receive the suggestions of the Commissioners, any Amendments they may propose will receive our best consideration. The Law Officers advised that as the penalty in each case is made recoverable only in that part of the United Kingdom for which the Act was passed, the certificate must be given by a medical practitioner resident in that part; because if a medical practitioner in Scotland gave a certificate for the removal of a lunatic to an asylum in England, he would not be punishable if he gave a false or improper certificate. This had led to some inconvenience and to a conflict between the Scotch and English Authorities. The clause provides that the certificate may be given by a medical practitioner residing in any part of the United Kingdom, and that he shall be punishable for any false or improper certificate. Clause 30 will remedy an injustice as pointed out by the Board of Trade. It is caused by Section 36 of 21 &22 Vict. c. 90, preventing a person not registered under the Act from holding an appointment in any vessel, even though the vessel may be the vessel of a Colony, and the person may be a registered medical practitioner in that Colony. The provision of the Bill allowing a Colonial practitioner to be registered in England will not quite meet the case, inasmuch as it would be hard to require every surgeon on a Colonial ship to be registered in this country; and, secondly, he might be unable to obtain registration because he had not practised for more than 10 years out of the United Kingdom, and might technically be domiciled in the United Kingdom. Those, my Lords, are the principal provisions of a measure dealing with a subject of great importance, but one of great complexity; and which, when legislation is proposed in respect of it, requires great consideration in numerous details. The subject is one for which there should be no hasty legislation; and I should hope that by the time the Bill comes on for a second reading, we shall have the benefit of being in possession of the views of all persons in the country who may be interested in its details and who are com- 1589 petent to give advice on the matter. I hope I need not add that we shall be most ready to give an attentive consideration to all suggestions which maybe offered with the object of securing a good and useful measure, and one which will be satisfactory both to the Medical Profession and the public at large.