pears, from the telegram which was EARL DE GREY AND RIPON: In published this morning, to be complete. asking your Lordships to give a second In the meanwhile the Government had reading to the Bill, I will explain the placed Sir John Young, the Governor grounds on which I wish to recommend General of the North Western Territory, it to the House. I may first mention in charge of the district during the time that there are in the three kingdoms no the transfer took place, and he (Earl less than 19 bodies who are empowered Granville) had received a telegram from after examination to grant licences to Sir John Young, reporting that on persons desiring to practice in medicine, the 10th of March the Convention of such licences entitling the holders to the Red River had passed Resolutions have their names placed on the Medical asking for the presence of British troops Register. The regulations of these difto preserve the peace between different ferent bodies are various, and so also sections of the community, and that the are the qualifications required of those Government of the United States had to whom the licences are given. With remonstrated as to a state of things a view of mitigating the inconveniences which affords no security against alleged obviously attending so many varying outrages on the border. The Dominion examinations, the Act of 1858 estabhave already given orders for the pay-lished a General Medical Council, and ment of the sum agreed upon to the gave it to a certain extent a power of Hudson's Bay Company, and they have agreed to the terms proposed as to the composition and payment of the expedition. Her Majesty's Government have appointed Sir John Young Governor of the Hudson's Bay Territory until the transfer is technically effected, and they have assented to Imperial troops forming a portion of the expedition. It is intended that the Imperial troops shall return before the beginning of the winter. I have received from Sir John Rose this telegram, received by him this after

supervision over the licensing bodies. It provided that, if the terms on which licences were granted appeared in any case wholly inadequate, they might represent the fact to the Privy Council, which should thereupon have power to suspend the right of that particular body to grant licences. The Act also enabled two or more of these various bodies to combine for the purpose of holding a joint examination. The power of recommending suspension given to the Medical Council could, it is evident, be exercised only in extreme cases, and, in point of fact, it has never been put into operation, nor has the power of combiRupert's Land Bill passing Commons. Con-nation been brought into practical opecurred in by delegates and Canadian party; in fact, by all in Territory. Expedition will be one of peace."

noon

64

"Sir F. Hincks to Sir J. Rose,

"Ottawa, May 4.

Some of these

ration during the 12 years which have elapsed. The country, consequently, is He (Earl Granville) should be sorry to still suffering from all the inconvenience finish this short statement without an of having 19 distinct licensing bodies, acknowledgment of the great assistance whose licences indicate very different deHer Majesty's Government had received grees of qualification, though all equally from the Governor General and his Ad- entitle the holders to admission to the visers, from the able representatives of Medical Register. This is unsatisfactory the Dominion in this country, and from in more ways than one. the Chairman and Deputy Chairman of bodies examine in medicine only, or in the Hudson's Bay Company. The Minis-surgery only, yet the persons so licensed try of the Dominion seem to him to have in but one branch of the profession are acted during this year with singular admitted to the Register, and thus bejudgment, decision, and conciliation, and come eligible to practice in both, and, to have been rewarded by the success in certain cases, to hold public appointthey appear to have attained. ments. There is, moreover, a constant temptation for these bodies somewhat to underbid each other in their examinations, and the consequence is, that in many instances the examinations at the present day are of no higher character than they were some years ago. many cases the standard is higher now

MEDICAL ACT (1858) AMENDMENT BILL.

(The Lord President.)

(NO. 69.) SECOND READING. Order of the Day for the Second Reading, read.

In

General Medical Council, to which should be given special powers of securing equality in the examinations. How, then, are such Boards to be constituted? One method would be to insert in the Bill a complete scheme for their constitution; another was to confer on some body the power of framing a scheme, to be subject to the approval of a Department of the Government, responsible to Parliament. A good deal might be said in favour of the former course; but the latter seemed more likely to be acceptable to the existing licensing bodies, who have rendered many services to

than it was some years ago, and I make | ment of an Examining Board in each no charge against any particular institu- kingdom, as recommended by the Comtion; but there is considerable variation mittee, under the supervision of the in the value of the qualifications shown by the licences; and cases have been mentioned to me of persons who, after having been "plucked," to use the ordinary expression, once, or perhaps more than once, by one body, have obtained licences at another institution, and have then flourished them in the face of the institution which had refused them. Confusion and complexity thus arise, and the public have no assurance that the appearance of a name on the Medical Register implies any definite amount of medical knowledge. Your Lordships may think that such a statement requires the corroboration of some professional the profession and the public, and are authority. Now, last year, the General Medical Council appointed a committee to inquire into the question of medical education. It was composed of some of the most distinguished members of the Council, including the President (Dr. Paget), Dr. Christison, and Dr. Aquilla Smith, and it reported that one of the greatest evils of the present system was the inequality of the examinations; that the easy examination of one body tended to depress the standard of all the rest a circumstance the more injurious that every licence conferred the right to practice; and that an arrangement should be made to have one Examining Board for each division of the kingdom. That report received the sanction of the Council, and the main provision of the Bill is based upon it. On considering how uniformity of examination and equality of qualification could best be secured, it was apparent to my mind that the most complete mode would be a single Examining Board for the whole country. There was, however, as I saw, great difficulty in arranging the practical details of the plan. Such a Board could not sit exclusively in London, for to expect Scotch and Irish students to come up to London, perhaps, for several examinations, would be unreasonable. If, on the other hand, the Board were migratory, the most eminent members of the profession would be excluded from it; for they could not be expected to neglect the scene of their practice in order to hold an examination at various centres; and the expense, moreover, of that plan would be much larger. The alternative, therefore, was the establish

Earl De Grey and Ripon

entitled to the greatest consideration consistent with the principle of establishing one Board in each kingdom. The Bill proposes, therefore, that the existing licensing bodies, or the majority of them, in each part of the United Kingdom, shall be at liberty, within a certain time, to propose a scheme for the establishing of a Medical Examining Board, to be submitted to the General Medical Council, and, if approved by it, submitted to the Privy Council for confirmation, their sanction being the final step for giving it validity. If, within that specified time, they are unable to agree on a scheme, the duty will devolve on the General Medical Council, who will then be empowered to draw up a plan and submit it to the approval of the Privy Council. This is quite in accordance with the existing Act, which gives power to these bodies to form such a Board; and after 12 years the time for permissive action is obviously over. I hope, and have every reason to believe, that the licensing bodies will take advantage of this opportunity and will prepare a scheme. The three Boards will act under the general supervision of the Medical Council, and the latter will be directed to take care that there is a uniform standard of examination. Your Lordships will bear in mind that the existing bodies are largely represented on the Medical Council. When the Boards have been established, admission to the Medical Register will be obtained, and obtained alone by persons who have passed their examinations, and obtained their licences to practice in medicine and surgery. Now, I am aware that not a few of the

sure, and a hope that it may became law this Session. This shows the prevailing feeling of the profession. I have now stated the main provisions of the Bill; and I think I have sufficiently entered into the subject. I see that the noble Marquess (the Marquess of Clanricarde) has placed a Notice on the Paper, asking for further delay in the progress of the Bill. But, as the Bill has been three weeks before the House, and during that time has, no doubt been well considered, I can see no reason for further postponing the second reading. I believe it will effect a great improvement in admissions to the Register, and will tend to raise the qualifications of medical practitioners. I should regret, therefore, if its progress were delayed so as to endanger its passing during the present Session.

Moved, "That the Bill be now read 2a." -(The Lord President.)

existing corporations would desire that membership in some one of them should be a further condition of registration; but it is unreasonable that persons who must have passed a stringent examination should be subject to any further stipulation. Efficient examinations will be a security to the public that all the persons on the Register possess a certain minimum degree of medical knowledge and experience. The 22nd clause, which I have introduced at the urgent desire of the profession, somewhat extends the existing law as to the penalties to be imposed on persons falsely representing themselves as qualified medical practitioners; but this section is only to be put into operation with the consent of the General Medical Council. There are objections on the part of some of the Universities to some other clauses. Now, I am in communication with the Scotch Universities, with the University of London, and also, through a gentleman who THE MARQUESS OF CLANRICARDE has been good enough to communicate said, no doubt three weeks had interwith me, with Cambridge; while a simi-vened since the Bill was ordered to be lar feeling exists at Oxford. All I can say is, that it will be my desire to meet, not merely the wishes but the feeling of the Universities, and that I am prepared to modify those clauses. They are not of the essence of the Bill, and I desire to make it as acceptable as possible to the Universities. The noble Marquess (the Marquess of Clanricarde) who has just presented a Petition from the College of Physicians in Ireland does not appear, it seems, as the representative of Dublin University. A copy of the Petition which he has presented was sent to me, and I found that some of its objections went to the root of the Bill, while others are fair questions for consideration. I cannot see that to require in future examinations before one Board as a condition of admission to the Register infringes the privileges of the College of Physicians, for it is simply an extension of previous legislation, with the object of securing adequate qualifications. I am happy to say that the Royal College of Surgeons in Ireland take a different view, for I have received a copy of a resolution adopted by their Board, giving a general approval to the Bill. I have throughout received great assistance and information from the Medical Council, and I am glad to say that they also have by a resolution, passed by 15 to 3, ex. pressed a general approval of the meaVOL. CCI. [THIRD SERIES.]

printed; but that was no long time for the consideration of a measure which affected the medical corporations and practitioners in all the three kingdoms, and required consideration of every one who stood in need of medical aid throughout the land. In the Medical Council itself there had been many discussions, and several amendments had been suggested. Everything showed that the measure was one which required much consideration. He regretted that the measure proposed no change in the election of the Medical Council, for there was a feeling in the profession that the Council ought to be put on a wider basis. The Bill would create too much of a monopoly, and would shut out practitioners who might have a preference for methods of treatment differing from those which were generally adopted. The principle of uniformity might be carried too far. tremendous power would be given to the Privy Council; and it was idle to say that there would be responsibility to Parliament, for Parliament could not hold the noble Earl responsible for any error of judgment committed by the Boards. He presumed the Privy Council would be advised by their Medical Officer, who, no doubt, was a distinguished and able man; but this was a life appointment, and during the life

K

A

one of the existing licensing bodies. I getting any legislation through the other only desire to call attention to this, which House, we have had a good many in reis an important point, and to express a cent years; it cuts the knot of difficulhope that the noble Earl will allow ample ties of legislation by enabling the Gotime for the consideration of this subject vernment to hand over questions of before the Bill goes into Committee. detail to a permanent Department to LORD TALBOT DE MALAHIDE legislate as it pleases. The mode of said, that having given much attention doing it is in the Bill concealed by certo this subject, he fully concurred in tain provisions, which enable the medical what had been said as to the importance authorities to submit any number of of having an uniform system; but there schemes for the approval of the Privy was one point which was not clear, and Council; but, after all the pantomime, upon which he desired to have some in- the Privy Council has power given it formation; and that was the point to make, alter, modify, or confirm whatwhich had been discussed in a corre- ever rules it pleases. In fact, the Privy pondence between the Medical Council Council is constituted the permanent and the Queen's University in Ireland. legislative body. If the Privy Council They were at issue upon the nature of meant my noble Friend, or the distinthe preliminary examination to be passed guished statesman who serves under him, by a person desiring to practise; and political differences apart, there are no the educational bodies of Ireland were two men I would sooner intrust with disposed to insist on a higher standard legislative power. But we all know the of education than the Medical Council enormous powers possessed by the perwas disposed to grant. It was most de-manent officials of the Department-by sirable to insure some kind of unifor- those who look after the education and mity in the general qualifications of the medical profession; and he, therefore, desired to ask whether, in the proposed regulations which were to be approved of by the Privy Council, there was any idea of including arrangements for a preliminary examination.

THE MARQUESS OF SALISBURY: This Bill may be shortly described as an attempt on the part of that voracious body-the Privy Council-to eat up all the licensing bodies of the United Kingdom, some of them being Universities. The noble Earl opposite (Earl de Grey and Ripon) says this Bill has been before your Lordships for three weeks. What is the fact? The noble Earl lays this Bill on the Table, and gives us the first hints we get of it on the day that noble Lords separate for the Easter Recess, and on which the members of the Universities separate for their vacation; and about a week after they have returned he comes down to this House and says he has heard of no objections to the Bill from the University of Oxford. It seems to me, from the haste with which the noble Earl is pressing forward this measure, that he is perfectly aware that if the various licensing bodies had time to look at it a little longer, however little they like it, they will like it less. The truth is, this is one of a class of Bills which, owing, I suppose, to the difficulty of

the health of the people and the diseases of cattle; they all write under that mythic name, "My Lords," and exercise almost undisputed powers; but I confess I am not prepared to abolish these 19 licensing bodies for the purpose of installing Dr. Simon in their place. I do not dispute the high standing of that officer, but I am not inclined to foster the power possessed by these permanent irresponsible officials at the expense of independent corporations, which have done so much to make England a self-governing and prosperous country. I hope, therefore, we shall have from the noble Earl an assurance that the demand for this enormous legislative power is not to be pressed, and that he will reserve to the Privy Council what alone it has a right to-the power of approval. With respect to the other portions of the Bill, I fear the great danger is it will destroy the independent schools of medicine in this country. In the House of Commons my noble Friend was one of the most ardent worshippers at the shrine of examination; but he would not be willing to have his leg amputed by a man who had done nothing but read about cutting off legs; and, therefore, I say that in the matter of medicine, and still more in that of surgery, it is absolutely childish to be satisfied with your examination. I think the public bodies and the public will be dis