§ Order of the Day for the House to be put into Committee, read.
§ Moved, "That the House be now put into Committee on the Bill."—[The Lord President.)
§ LORD EMLYMy Lords, I had not the opportunity of making any remarks on the second reading of this Bill; therefore, I trust your Lordships will allow me to occupy your time for a few moments on the present occasion, and I shall presently move an Amendment in Committee, which, if the noble Duke accepts it, will give great satisfaction to the Profession in Ireland. The object of this Bill, as your Lordships are aware, is to amend the Act of 1858. The chief object of that Act was, as far as possible, to provide that no person should be placed on the Medical Register without having passed a proper examination. Unfortunately, there were no fewer than 19 distinct Licensing Bodies, each of which had the power of fixing their own standard of examination. The fact of there being so large a body of co-equal authorities, it was thought, would render them likely to underbid, each other; and many of them might set up a low standard of examination in order to induce students to come to them. In order to meet that difficulty, by the 20th and 21st clauses of the Act of 1858, the General Council was empowered, in case of any of these Bodies falling short in that respect, to appeal to the Privy Council; and if the Privy Council were convinced that the examinations were 1292 not efficient, they were empowered to suspend the right of registration in respect of qualifications granted by the College or other Body in default. Now, I believe that both the noble Duke and the noble Marquess the late President of the Council will testify to the fact that there never has been an instance where this power has been exercised. These 19 independent Bodies, with their separate examinations, have continued up to this day. Now, without troubling your Lordships with any remarks of my own upon that subject, I will state a fact which occurred not long ago as to the way in which they have underbid each other. In February last a gentleman, a licentiate surgeon of the Royal College of Surgeons in Ireland, presented himself for examination before the College of Physicians; but he showed such ignorance, that the Examiners were unanimous in rejecting him. Within a fortnight or three weeks, however, he sought and obtained, after a special examination, a licence to practise medicine from the College of Physicians of Edinburgh. A fact of that sort must convince your Lordships of the absolute necessity of putting a stop to this system of competition amongst these different Bodies, and securing a uniformity of examination. An obvious way to do this was suggested by the noble and learned Lord the Lord Chancellor some eight or nine years ago. What he suggested was, that there should be one Examination Board for the United Kingdom; that nobody should be allowed to present himself before that Body who had not a certificate from one of these 19 Bodies, and that no one should be placed on the Register, and be qualified as a medical practitioner, without having received a certificate from the Central Body. But both the noble Duke and the noble Marquess agreed that there would be so many difficulties in the way of carrying out that proposal, that they could not adopt it. With great respect to them, however, I do not see that these difficulties are so great. I think the thing resolves itself into a very simple one—a question of money. It was, beyond doubt, necessary that the Examining Body should hold the examinations in London, Edinburgh, and Dublin, and it would be impossible to get eminent men to act as Examiners without paying them 1293 highly; but, if only in the interest of the poorer classes, who cannot, like your Lordships, choose the medical men who are to attend them, I think it would be well to defray from the Public Exchequer whatever might be necessary to carry into effect an improved system. All, however, I now ask is to make the scheme of the noble Duke as perfect as it can be made. His scheme is, that there should be a Conjoint Board for each portion of the United Kingdom—that is, one in London, one in Dublin, and one in Edinburgh—and that the examinations should be conducted by these different Boards, to a certain extent under the control of the General Medical Council. This has been described by the College of Physicians of Ireland as a plan by which the Examining Bodies would be reduced from 19 to three—one for each Kingdom. I confess, however, with great respect, that I do not think the noble Duke goes far enough. It appears to me his Bill of last Session, which provided that the General Medical Council should frame the standard of examinations which was to be carried out by the Conjoint Board, was a Bill much more likely to be successful than the Bill now proposed, because that sort of control which he imagines the General Medical Council will exercise over the standard of examinations to be framed by the Conjoint Boards is not likley to be successful. I appeal to the experience of the last 20 years, and I point out to the noble Duke that the General Medical Council have the power to interfere, and they have never once interfered; and, certainly, I think the Amendment which I shall hereafter move will work better than the proposal of the noble Duke. Your Lordships ought to have some security that persons shall not be allowed to practice without having a sufficient knowledge for their Profession. I shall be glad to hear any reasons which the noble Duke may urge why there should not be a uniformity in the examinations, and why this should not be secured by allowing the General Medical Council to fix those examinations. If that is done, there will be much greater hope that the Bill will work successfully.
THE DUKE OF BUCCLEUCHMy Lords, I have just now presented a Petition from the Faculty of Physicians 1294 and Surgeons of Glasgow, praying that the Bill may not pass in its present shape. They say such an organic change in the mode of granting licences, however desirable, can only be justified for the reason that under the present system there have been evils which call for redress. It appears to me that this measure, so far from inquiring into that matter first, and then legislating upon it if necessary afterwards, is about to legislate first, and then inquire afterwards. What the Petitioners object to is, that the Universities of Scotland are, for the first time, to be deprived of the rights given to them by Charter, and by the Legislature, for the licensing of students for the practice of medicine and surgery. With regard to the Universities of Scotland, there are three which have great medical schools. The students in these schools have to pass the most stringent examinations; they have Professors, who, though they might have large private practices, yet have for their primary duties the duties of instruction; and, in addition to the examination by the Professors, there are independent Examiners selected by the Senatus Academicus from the most eminent men in the Profession. These gentlemen assist in the examinations, and they keep up a very high standard indeed. I believe that the University of Edinburgh, and the School of Medicine in that University, is second to none in Europe. Moreover, at the present moment, large sums are being expended in Edinburgh to make the power of giving efficient instruction greater. I think the best plan would be to send this Bill to a Select Committee or to a Royal Commission, who would be better able to thoroughly investigate it than a Committee of this House. The Bill deals with a subject of the utmost importance; and, judging from the Schedule, it would take a person many hours to ascertain what is the present law, and what is to be struck out of it, and what made new. I object to patchwork legislation of this kind—we ought to go about legislation of this nature properly. The noble Lord opposite (Lord Emly) has stated that he knew an instance of a student having got a certificate from the Edinburgh University within three weeks of having been rejected either in England or Ireland. I shall be glad if the noble Lord will inform me of the name of the individual, 1295 in order that I may make particular inquiry into the matter—for I can hardly conceive such a thing to be possible.
THE DUKE OF RICHMOND AND GORDONsaid, he would not reply to the remarks of the noble Lord (Lord Emly) then, as the whole subject would be raised when they got into Committee on the 15th clause. With regard to the suggestion of his noble Friend behind him (the Duke of Buccleuch)—that the Bill should be referred to a Select Committee—he could not concur with his noble Friend and the Petitioners that any further inquiry on the subject was necessary.
§ Motion agreed to; House in Committee accordingly.
§ Clauses 1 to 4, inclusive, agreed to.
§ Clause 5 (Attaching of licentiate to medical authority by holding medical diploma).
§ THE MARQUESS OF RIPONMy Lords, before this clause passes, I wish to say a few words in reference to it. I do not propose to divide the House; but I must say the clause appears to establish an inconvenient and clumsy system. I know very well what are the difficulties which beset this question; and I am so well satisfied with having obtained, under previous clauses of the Bill, the establishment within no very long period of Conjoint Boards of Examination in each of the three divisions of the Kingdom, that I will not press my noble Friend to strike out this clause at the risk of the failure of the main principle of the Bill, more especially because I am convinced that, if this Bill pass, this clumsy inconvenience will not be found in existence very long. I may be allowed to call your Lordships' attention to the system which this clause establishes. Under clauses already passed, there are set up three Conjoint Boards of Examination—one in each division of the Kingdom—one in England, one in Scotland, and another in Ireland. After their establishment, no person will be able to get his name placed on the Register until he has passed an adequate examination before one of these Boards, which examination is to be of such a character that it will give the public the security that every person whose name appears upon the Medical Register has a certain definite minimum amount of medical and 1296 surgical knowledge. It would seem natural, when that system is established, that the man who passed such an examination should be at once put upon the Medical Register; but the Bill, as it stands under this 5th clause, proposes to interpose between the examination and the placing of the individual upon the Eegister—a process of this description: a person who has passed an examination, and who is therefore proved to be qualified to practise, is required to make application to one of the 19 Medical Bodies of the country, to ask them to attach him to their body. If the authority he petitions should either refuse to attach him, or neglect to do so for one month, he can go to the registrar, with his qualifying certificate, and get his name placed upon the Register. It appears to me that this would establish a very inconvenient system, which would be disadvantageous alike to the public and to the Medical Corporations and to the individuals who have to pass the examinations. It would be inconvenient to the public, because it would tend to deprive them, at least in appearance, of the great advantage of the system of examinations. That great advantage is that, whereas now the fact of a man's name being on the Register does not show that he possesses a definite qualification, hereafter he is not to be put on the Register without having a defined and distinct qualification. Having established particular and uniform examinations throughout the Kingdom, the 5th clause will introduce a sort of vague and imaginary distinction between the persons whose names will appear on the Register. Under the clause, they will be divided into practitioners attached to Medical Authorities and practitioners who are not. There will be no difference in the qualification, for the certificates will have been given at the same examinations. It will simply imply that some Medical Body, in their own discretion, has attached one man and refused to attach another. The public will think this implies some disqualification on the part of the person who has not been attached. This clause will prevent the Medical Register from bearing that simple and single character of qualification, to secure which is one of the objects of this Bill. It seems to me that the clause will not operate to the advantage of the Medical Corporations them- 1297 selves. As the clause stood before the noble Duke amended it, it would undoubtedly have operated to their financial benefit, as they would have been able to charge fees for attaching. But my noble Friend, who never intended that this should be done, has cleared up the matter by the Amendment he has introduced. What will happen? Why, either that the Medical Corporations will attach everyone who applies, that the whole thing will become illusory and a sham, or they will largely exercise their power of refusing to attach; and after a time, when the public finds that those who are attached and those who are not attached have exactly the same qualification, the tendency will be to discredit attachment to the Medical Corporations, and probably to discredit the Corporations themselves, or, at all events, to lower the value of attachment to those belonging to the Corporations. I have no doubt the system established under this clause would be rapidly swept away if there were a considerable number of persons left unattached. As regards the individuals who pass the examinations, I do not think it is right that, when a person has passed a strict examination before one of these Conjoint Boards, which, on the hypothesis on which the Bill is founded, gives all adequate security for his competence to practise medicine and surgery, you should force him, whether he likes it not, to go and ask one of these Corporations to attach him to their Body, at the same time that you place no relative obligation on the Corporation to accept him when he so applies. I consider that this clause will place those who have passed a satisfactory examination in an unfair position, or, at least, in one to which they ought not to be subjected. It seems to me to cast an unjust slur upon persons who do not obtain the attachment which, under this clause, they are required to sue for. It may be asked why I do not ask you to strike out the clause? It may not be expedient that I should do so, though I am satisfied that the clause is an unnecessary one, and that it will prove a sham in its working. The noble Duke had, no doubt, some reason for introducing it, and it may be that he could not very well have done without it. I felt it my duty to make this protest against the clause in question, though, so far as the Bill itself is concerned, I 1298 hope it will pass through Parliament without any very material alteration. I do not propose to divide the House upon the clause; but it was due to your Lordships and to the public that I should explain my view upon the point.
THE DUKE OF RICHMOND AND GORDONthought that after the statement of the noble Marquess it was incumbent upon him to say a few words. He was glad to find that the clause was not to be opposed. He did not think, however, that the noble Marquess, had he even been sitting on that side of the House, would have felt justified in taking any other course than the one he had taken. In legislating on this subject, their Lordships were bound to pay attention to existing Bodies on matters of this kind; and after considerable communications with them on this subject, he found that he could not anticipate the successful issue of the Bill without that clause.
§ Clause agreed to.
§ Clauses 6 to 14, inclusive, agreed to.
§ Clause 15 (Examination rules for securing uniformity of examinations for qualification).
§ LORD EMLY,in accordance with what he had stated, proposed to amend the clause by placing in the hands of the General Medical Board the duty of framing the rules and regulations for the examination of persons desiring to be placed on the General Register, to be applicable to all parts of the United Kingdom. He proposed to strike out the first words of the clause—"The Medical Authorities of each part of the United Kingdom. … shall, subject to the approval of" the General Medical Council, frame, &c., the effect of which would be to place upon the General Medical Council itself that duty. He intended also to move an addition to the first section—
So that in all respects the curriculum of study, subjects for examination, standards for passing, and fees payable, shall be alike in each part of the United Kingdom.
§ Amendment moved, in line 1, leave out from ("The") to ("approval of,") in line 6, both inclusive.—(The Lord Emly.)
§ THE MARQUESS OF RIPONsaid, he certainly thought that the proposal which his noble Friend made was one which, if 1299 adopted, would improve the Bill. The proposal of the noble Duke was, that the existing Medical Authorities should have the preparation of these examinations and rules, and when they had prepared them, they should be subjected to the approval of the Medical Council. In all previous Bills the proposal had been that the Medical Council should have the preparation of these rules. Now, as the great object was to secure that these rules should be practically uniform for the three Conjoint Boards, it did appear to him that the most certain mode of obtaining that desirable end was that they should be prepared by one and the same Body. The Medical Council consisted of representatives from all parts of the United Kingdom; and he did certainly think, if they wanted uniformity, they could not better obtain it than by agreeing to this Amendment.
§ LORD O'HAGANalso supported the Amendment. There was the strongest feeling in the Medical Profession in Ireland in reference to this part of the Bill. They had a proper appreciation of the efforts of the Government in introducing this measure, and they had an equal appreciation of the difficulties which surrounded the subject; and he certainly hoped the noble Duke would see his way clear to accepting the Amendment. There ought to be uniformity in the qualification of medical men in the three Kingdoms. He was familiar with the North of Ireland, and had had experience derived at the Assizes, where he had seen most miserable exhibitions arising from persons professing to be qualified men, but who were scarcely possessed of any qualification at all. It required no argument to show that a single Body could act with more uniformity than many in settling the rules for qualification; and, therefore, if the noble Duke could do anything to equalize the qualifications, by having it with a single Body acting on a single principle and a single view, it would be far more effective than two or three Bodies. As far as this cardinal point of the Bill was concerned, he thought this was a wise and salutary Amendment, and one which ought to be adopted.
THE DUKE OF RICHMOND AND GORDONsaid, that the question of the rules in reference to the qualification of Medical Practitioners was an important one, and it had been his duty to look 1300 into it in consequence of the various representations which had been made to him from different parts of the three Kingdoms. He had thought that the proposition contained in this clause was the best mode of dealing with the subject, though he admitted that it differed from the course he proposed last year. But, inasmuch as he had the greatest possible confidence in the General Medical Council, which was composed of some of the most scientific men in the Medical Profession of the three Kingdoms, and as he wished to obtain as much uniformity of action as possible in those who would frame the new rules and regulations—indeed, uniformity was the great object of the Bill—and also feeling the weight of the observations of the noble Lord opposite, he would not oppose the first part of the Amendment proposed by the noble Lord—that part relating to the standard. He should, however, reserve to himself the question of the fees.
§ Amendment amended, by omitting the words "and fees payable," and agreed to.
§
THE DUKE OF RICHMOND AND GORDON moved to add, at end of first sub-section, the words—
And it shall be the duty of the General Medical Council to see that the examination rules in each part of the United Kingdom are so framed that the qualifying certificate shall as nearly as possible he granted on equal terms, so far as regards the curriculum of study examinations and standard.
§ He would hereafter consider whether he could accept the proposal about equality of fees.
§ LORD O'HAGANhoped that an arrangement would be made by the noble Duke that the fees to be paid by students should be equal everywhere. He looked upon the three Conjoint Boards under this Bill as three parts of the same General Examining Board, and, under all the circumstances of this new legislation, the different Medical Bodies should charge the same fees.
§
Motion agreed to; words inserted accordingly.
Sub-section 3 (The examination rules shall determine the conditions of admission of candidates to the examinations, and shall provide for the admission thereto on special terms of medical students who have begun their professional studies before the passing of this Act
1301
and of persons who have obtained medical diplomas in or studied in any British possession or foreign country, or have passed other examinations).
§
THE DUKE OF BUCCLEUCH moved an Amendment, to add at the end of the sub-section the words—
("And shall further provide that every member of a university who shall have passed the professional examination at such university for the degrees in medicine and surgery conferred by it, shall he exempted from any separate or further examination for a qualifying certificate under this Act, provided that such department of such professional examination, so far as regards all those subjects on which the medical board is required under a scheme to conduct examinations, shall have been conducted before a board of examiners of whom one half in number at least shall be examiners appointed by the medical board of that part of the United Kingdom in which such university is situate.")
§ The noble Duke contended that the Medical School of the University of Edinburgh was second to none in Europe, that the Medical School of the University of Glasgow stood very high, and Aberdeen, though not so large, was equally carefully conducted; but St. Andrews had not a regular Medical School. If there were any rivalry in those Schools, it was as to the standard of excellence, and thus for the good of the public. It was plain that if the standard of the Medical Board was lower than that of the Universities, the students would go to the Medical Examining Board and not to the Universities. He desired that the reputation of those Medical Schools should not be depreciated by the operation of this Bill, and therefore he moved this Amendment, which he did not consider to be in any way contrary to the principle of the Bill.
THE MARQUESS OF LOTHIANsupported the Amendment, as he believed that, if the Bill passed as it stood, it would be a serious injury to the Scotch Universities. There could be no doubt as to the thoroughness and efficiency of the Medical Examinations in Scotland, and nothing ought to be done to impair those Examinations. Although some of the Profession might have private practice, yet their first duty was to teach, and they had the most absolute appliances for carrying out the theoretical or practical part of the education of their students. With reference to what had been said with regard to uniformity, the object of the Bill was to have a fixed 1302 uniformity for a minimum of education, but there was to be no fixed uniformity of the maximum of education. He trusted their Lordships would agree to the proposal which had already been stated.
THE DUKE OF RICHMOND AND GORDONsaid, he was aware none of their Lordships would expect to hear from him any remarks attempting to depreciate the Universities of Scotland, as he had the honour of being the Chancellor of one of them. His noble Friend the noble Duke behind him (the Duke of Buccleuch) had stated—what was no less than true—that the reputation of the University of Edinburgh as a Medical School was world-wide. That was admitted on all sides—but he was sorry to say that on this occasion he was unable to accept the principle contained in his noble Friend's Amendment. He was very much astonished to hear from his noble Friend who spoke last that if this Amendment was accepted it would in no way affect the principle of the Bill. He conceived that the proposal of his noble Friend went to the root of the Bill. The object of the Bill was that there should be one portal of admission to the Medical Profession; and this it was proposed to attain by establishing a Conjoint Board in each division of the United Kingdom, in order to put a stop to the anomalies that now existed, and which resulted from there being 19 Medical Licensing Bodies in the three Kingdoms. He did not think his noble Friend could have thoroughly considered the effect of the Amendment which he had proposed, which was, that instead of having one Body for each division, they would have no less than 13 altogether. According to his noble Friend's proposal, he would admit the four Universities of Scotland. He was surprised to hear the noble Marquess (the Marquess of Lothian) say he spoke in the interests of the Universities. He was not attempting to legislate in the interests of the Universities, but was trying to legislate in the interests of the whole community. But if it was a great advantage to have the power which the clause proposed to give to the four Universities of Scotland, they would have to give the same power to the four Universities of England; because, if it was an advantage to the Scotch Universities, it would be equally an advantage to the English Universities 1303 to have the power. Then the two Irish Universities would, no doubt, also ask to be put in the same position; and, with the three Boards which it was proposed to constitute under this Bill, they would have no less than 13 Licensing Bodies in the place of the 19 Bodies they had now. The Amendment of his noble Friend, therefore, went to the very root of the Bill; and he did not hesitate to say that, if it was carried, it would be equivalent to moving that the Bill should be passed upon that day six months.
§ Amendment negatived.
§ Sub-section 5 struck out.
§ Sub-section 6 amended consequentially to the first Amendment.
§
THE DUKE OF RICHMOND AND GOBDON moved, at end of clause, to insert as a new sub-section—
All rules made in pursuance of this section when confirmed by the Privy Council, and all rules made in pursuance of this section which do not require to be submitted to the Privy Council, shall be laid before both Houses of Parliament as soon as may be after such rules are confirmed and made respectively, if Parliament be then sitting, or, if not, as soon as may be after the beginning of the then next session of Parliament.
§ Motion agreed to; words added.
§ Clause, as amended, agreed to.
§ Clauses 16 to 18, inclusive, agreed to.
§ Clause 19 (General provisions as to scheme for Medical Board).
§
THE DUKE OF RICHMOND AND GORDON moved, in page 12, line 6, to leave out from the first ("scheme") to the end of the clause, and insert—
("The scheme shall also provide for paying out of the said fees the expenses of the examinations and of carrying into effect the scheme, and for paying the cost of continuing to maintain under the control of any medical corporation any such medical museum or medical library, or both, as may before the passing of this Act have been ordinarily maintained for general public purposes by such corporation in their capacity of granters of qualifications for registration under the Medical Act, 1858, and have been so maintained out of fees paid by applicants for such qualifications, and may be of such importance to the promotion of knowledge in medicine or surgery as to deserve to be maintained out of fees payable for examinations for qualifying certificates and for applying the surplus, if any, towards the public purposes of any medical corporation in connection with the examinations.
1304
An annual account of the receipts and expenditure in respect of such fees shall be submitted to the Privy Council at the time and in the form required by them, and shall be laid before both Houses of Parliament.")
§ THE MARQUESS OF RIPONsuggested that the rules of the scheme for the Conjoint Boards should also be laid before Parliament, as well as the examination rules.
§ Motion agreed to; Amendment made accordingly.
§ Clause, as amended, agreed to.
§ Clause 20 agreed to.
§ Clause 21 (Power of medical authorities to constitute diplomas).
§ THE MARQUESS OF RIPONsaid, that it seemed to him essential that the Authorities should grant one and the same diploma to all persons coming up for attachment. He would therefore propose to add to the clause words to the following effect:—
Provided always, That one and the same medical diploma shall be granted to all persons for the purpose of being so attached.
THE DUKE OF RICHMOND AND GORDONsaid, he was inclined to agree with the noble Marquess, but asked that the matter should be left until the Report.
§ Clause agreed to.
§ Clauses 22 to 24, inclusive, agreed to.
§ Clause 25 (Scheme for examination, licensing, and registration of midwives.)
THE DUKE OF RICHMOND AND GORDONsaid, after considering this subject, he came to the conclusion that he would strike the clause out now, and bring the subject up again on Report.
§ Clause struck out.
§ Remaining clauses and schedules agreed to.
§ The Report of the Amendments to be received on Friday, the 28th instant; and Bill to be printed as amended (No. 31.)