185

THE LANCET.

LONDON: SATURDAY, AUGUST 16, 1845.

SIR JAMES GRAHAMS FOURTH MEDICAL BILL.

A COpy of the FOURTH MEDICAL BILL OF THE GOVERN-

MENT is submitted to the view of the members of the profes-sion of this kingdom, in THE LANCET of this week, p. 188.In a single year we have had four of these measures, and,strange to say, as they multiply in number they deteriorate inquality. The one which has just been presented to Parlia-ment is, probably, the worst of the set. On examining it,we apprehend that the feelings of disappointment which mustpervade the profession will be extreme. The Minister has

.evidently been oppressed and borne down by the " diffi-culties" of his subject, and perplexed and perverted from

:many of his purposes by the importunities -and intrigues of.the existing medical corporations. But there is one altera-

tion which he has made from his original design, that

appears to be wholly inexplicable, and entirely unwarrant-,able. In the first, second, and third Bills it was proposed toestablish a COUNCIL OF HEALTH, which was to consist of six

persons directly nominated by the Crown,-six persons to-represent the Universities, (to consist of the Regius Profes-sors of Medicine and Surgery.in those Universities,)-and Isix physicians and surgeons, (to be elected by the six medi- ’,cal Colleges.) That this was a clumsy and ill-contrivedpiece of machinery for regulating the medical schools of this’,kingdom and the examinations to be conducted in the Colleges,and for controlling the registration of the profession, cannot bequestioned. Still, there existed in it the recognition and

,practical operation of the principle of representation in the

supreme medical Council of the kingdom. There would

.have been found in that Council representatives of all theleading medical institutions, and thus the profession, to aconsiderable extent, and in fulfilment of the long-cherished,anticipations on that subject, would have been placed underthe influence of an electoral system of government. The re-

sponsibilities involved in such a scheme would have belongedto the profession; its duties would have been discharged by.the profession ; and, acting under the stimulus of zeal for theadvancement of the science of medicine, a representativebody,-constantly pressed in the execution of its labours by.the energies of a host of intelligent constituents,-couldhardly have failed to he productive of numerous beneficialJesuits.

In the Bill now before us, that portion of the plan for form-ing the Council of Health which provided for the election of.representatives, by the Colleges and Universities, is, as ourreaders will perceive, wholly and entirely abandoned. The

Council is to consist of one Secretary of State, and such otherpersons, "not more than twelve, as her Majesty, with the-advice of her Privy Council, shall deem fit to be members".of that body. Thus all the members of the Council are to

he the nominees of the Crown; and the affairs of the pro--fession are to be placed under a Government Board, just.s the medical duties in the szrmy are controlled by a Board

attached to that department of the state; or those of the

KaBy, which are managed under a similar system. Is it pos-sible that the members of the medical profession belonging toall the Colleges and Universities will patiently submit to bedeprived of the exercise of all influence in the constitution ofthe supreme medical Council of the kingdom ? P The arrange-ment now proposed by the Minister is in direct antagonismto every demand of the profession on the subject of medicalgovernment during the last twenty years. If the Minister

regarded his first proposition as one that was sound in prin-ciple, if he adopted it, after due investigation, in three Bills, whyis it thus suddenly and abruptly abandoned in the fourth?

Facts, such as these, force the mind to the conclusion thatthe questions connected with medical polity are but ill under-stood, either by her Majesty’s Ministers or the parties whohave lately been diplomatizing with them. Amongst all thechanges which the profession have sought to obtain, there isnot one that has been so zealously laboured for as the intro-duction of the principle of representation in medical go-Yem-ment. In three Bills which have been submitted to the

House of Commons, there has been a,practical acknowledg-ment of those exertions, and a recognition by the Govern-ment of the wisdom which has characterized them. Yet, ina moment, without explanation, and by a mere stroke of the

pen, all the affairs of the medical profession of Great Britainand Ireland (including the subject of education in the medicalschools, the examinations at all the medical colleges, the rightof registration, and other matters, too numerous to be men-tioned) are subjected to a Board consisting exclusively ofnominees of the -Crown! In that Board the representativevoice of the profession is not to be heard, the influence of scien-tific zeal not to be felt. There the leaden weight of patronageand courtly sycophancy will exercise its pernicious effectson the members of the most useful of the learned professions.Anything more disastrous, with reference to-the energetic

cultivation of medicine, and the enlightened collateral put-suits of that science, than the placing of all the medical andsurgical Colleges of this country in subjection to a Govern-ment Board, could not be devised. Where would be found

the independence of such a body, all the members of it beingappointed by the Minister, and dismissible by him ? Infi-

nitely preferable would it be that the responsibility ofapproving the curricula framed for the schools, and theschemes of examination in the Colleges, should be thrownupon the Minister, as a member of the government, insteadof his being allowed to set up his twelve nominees as so manyscreens for their actual master, the president of the Board.In the earliest infancy of such an institution, its proceedingsmight partake of the enlightened spirit of the times, and ex-hibit sufficient energy and activity; but within a brief periodit would, it is to be feared, too much resemble other govern-ment boards, similarly constructed; and both the public andthe profession know well that such establishments, whatevermay be the complaints that are urged against them, invari-ably find successful defenders, or advocates, in the Ministersof the day. What otherwise can be expected? 2 It is a" Government Board," and, of course, is always protected and

186 THE LAST AND WORST MEDICAL BILL

defended by the Government. If the thousands of members

of our profession,-if all the medical colleges, and the medical ifaculties of the Universities,-be content to sink into this I,abject condition, we must, undoubtedly, submit to participate iin the fate which would inevitably befal the profession ’ithrough wresting from it all those educational and collegiatepowers which it could so well and beneficially control.

I

But we are resolved to offer our feeble resistance to such ascheme, to the last. From us it never shall receive one wordof sanction. We know it to be unsound, injudicious, unjust. ,,

Amongst the members of our profession such a plan can re-ceive no support excepting from the betrayers of professionalinterests, or from those short-sighted mortals who are incapableof appreciating the innumerable benefits which the public canderive from an unceasing cultivation of the curative science andart of medicine. If the board is to consist of twelve persons,

’why, we ask, should not its members all belong to the profes-sion, and be elected by representative Colleges ? It is a medicalCouncil that is wanted, and not a Council of Health, towhich latter body pertain functions that can never be legiti-mately performed by the former. In the clause of the Bill,as it now stands, it is not provided that a single member ofthe Council shall belong to the medical profession; and as itwas, somewhat unblushingly, proposed in the previous Bills,that one-third- of the Council might be laymen, probably itis now intended that lay - authority, exclusively, shall be

supreme in regulating the medical schools, the medical exa-minations, and the medical Colleges of this country. We donot, for obvious reasons, complain so strongly of the Ministerfor making this proposal, as of the advisers by whom he hasbeen deceived and misled; but what is to be thought or saidof men belonging to our profession who have dared to recom-mend that the government of our chief medical institutions’should be rendered subservient to the authority of a Board,consisting, absolutely, of the nominees of the Crown, therebeing no provision that even one person so appointed shall bea physician or surgeon. Coming from any member of amedical or surgical College, such a proposal must be

regarded as disgustingly treacherous. Proceeding from lay-men, it may be described as being, at once, both unfortunateand, in the utmost degree, offensive to the rights, the honour,and the intelligence of the profession.The practical operations of such a Board may, without the

exercise of much sagacity, be anticipated, with tolerableaccuracy, from what has already transpired. As the Ministerwould choose the members of his Board, so has he, already,selected his advisers in medical affairs. The Council of the

College of Surgeons is a Board. How has it acted towards

its members ? Two or three of the Council being in theconfidence of the Minister, and, at the same time, his secret

monitors, have the members, after years of complaint and

anxiety, been enabled to obtain from that Council a singleact of repentance, grace, or redress ? Protected by the

Minister, its friend, the Council, or Board, has treated with

contempt and scorn the complaining and injured parties.At length, provoked by a protracted series of injuries, andpertinaciously excluded from the enjoyment of all corporate

rights and privileges in the College where they obtainedtheir diplomas, they at last, as with one voice, earnestlyraised and persisted in the demand for a new College. That

demand was addressed to the Minister. "Ax EQUAL

COLLEGE !" -equal in law and rank to the one in

which they had been rendered the victims of insult-

ing aggression. The Minister consults with his friends

who are members of the Board. And what follows ? 2 Thefourth or final Bill of the Government is now before us.

Where is there in it the recognition of an equal College ?And here we may be pardoned for reminding the readers ofTHE LANCET of our predictions on this subject. Amidst ahost of assailants, when we saw that the interests of the pro-fession were about to be betrayed, we reasserted, with un-abated earnestness, the claims of the profession to a system ofrepresentative government. Of a sudden, the field of medicalreform became thronged with professed champions who hadpreviously been unknown to the cause. Many of them werevolunteers from suspicious quarters. The labours of the old

and tried advocates were overlooked. The state of the pro-fession twenty years since was forgotten. The condition of

our hospitals, the state of our schools, the rank of the generalpractitioner with reference to the position of the pure physicianand the pure surgeon, when a weekly medical journal firstmade its breaches in the citadels of corruption, were no longerremembered. Rapid were the rise and progress of the sur-geons of this country who were engaged in the general prac-tice of their profession, in the estimation and confidence of thepublic. The spuriously-educated and falsely-titled 11 ruBES,"were obliged to yield, in thousands of instances, to the supe-rior qualifications of their long-reviled competitors; and inthe year 1845, when the great body of the surgeons of thiscountry, practising all the departments of their profession,can prove that they are not inferior to any class of medicalpractitioners in the world, it has been proposed,-and we blushin making the acknowledgment,-with the sanction of a con-siderable number of members of our profession, to connectthem with AN INFERIOR COLLEGE, and to class them as

11 AroTnECARiES,"—to stigmatize them as a race of subordi-nate practitioners, and to deprive their successors of the titleof 11 SuRGEON," and deny them the right to recover at lawtheir just and reasonable charges for services professionallyperformed !

Scarcely can we credit the evidence of our senses whifewe place on record such extraordinary and humiliating facts.But they have occurred too recently to be discredited ordenied. We hope, however, that we are justly entitled toexult at the course taken by us throughout the recent myste-rious conflict,-for, assuredly, a mystery it was to behold aconsiderable number of our profession struggling with extra-ordinary zeal to degrade both themselves and their successors.And still more extraordinary was it to witness the encourage-ment they received from a yet larger number of their mis-guided and deluded professional brethren. The ungenerousinsinuations which were then directed against this journalare now answered by FACTS. Misgivings as to the result ofthe contest we had none. On the justice of the cause we

187OF THE GOVERNMENT.

Placed the firmest, the fullest, the most confident reliance.And what is now discoverable ? What circumstances are

actually disclosed ? Well knowing what would be the deci-sion of the profession if time for deliberation were allowed,we strenuously and perseveringly laboured to prevent theestablishment of an inferior College, and the consequent con-nexion of the many thousands of British practitioners in

medicine and surgery with a subordinate institution, and onethat should be subservient to the government of the pures.For pursuing this conduct, which we felt to be, although

a painful yet an imperative duty, we were exposed, for

awhile, to a pitiless storm of abuse and misrepresentation.When we insisted that the new College would not be allowed,by the pures, to possess a single attractive quality, when westated that it would be established with subordinate powers,and endowed with no authority,-that it would be placedlow in the first instance, and kept down by the hostile and

ruling influence of the pures,-our arguments and assertionsreceived merely either impertinent denials, or attempts toward off their probable effects by bestowing upon us pre-cisely that description of vituperation which is sure to ema-nate from parties whose motives and professions are not cor-rectly represented in their deeds.The fourth Bill is now before the profession. Indi-

vidually, we have a right to refer to it with much gratifica- ’,tion. It is at once the evidence and the record of the accu- I,racy of our predictions and arguments, the shame of our ’’

assailants, and a condescending acknowledgment, by theMinister and the negotiating pures, that we could predicatewith certainty what would really be the nature of the newCollege which they designed should regenerate the profes-sion," and restore the insulted members of the College ofSurgeons to their previous rank. Yes, the character which

it is intended that the new College should possess, is no

longer an unsolved problem. The pures have been at work

at it, and all that it possessed which, by possibility, couldconfer upon it any conceivable value, is gone! / The Minister,and his two or three nominees of a " Government Board,"have performed their labours effectually. Verily, the title of" GALLIPOT LoDGE" is almost too dignified an appellationfor such a thing of an institution.Many weeks since it was stated in THE LANCET that the

pures would not allow the word " SURGERY" to be connectedwith the title, and that similar objections had been made tothe word " MEDICINE." Well, what has become of the titleof " ROYAL COLLEGE OF GENERAL PRACTITIONERS IN MEDI-

CINE, SURGERY, AND MIDWIFERY" We refer to the Bill,and no such title is to be found! The words " MEDICINE,SURGERY, AND MIDWIFERY" have vanished. The nominees

of the Crown, the friends of the Minister, had an appetitefor them. They are torn from the title and devoured. The

name, as it now stands, has no connexion with any existingscience! ! In the former Bill, persons who were enrolled inthe new College were to be styled " FELLOWS." The pures

objected, and that title has disappeared. It is now providedthat they shall be called " MEMBERS."But of infinitely greater importance even than the erasure

of the words " MEDICINE AND SURGERY" from the title, isanother change that has been made with regard to the authorityof the institution. That College was to be the licensingbody for practitioners in medicine, surgery, and midwifery.Without the diploma or licence of that College no personcould act in England as a general practitioner. What are

its functions now, as an examining body ? So effectuallyhave the pures laboured in the work of reduction and de-

struction, that the powers of the College are embraced in amere proviso of Clause 10. The projected College can insti-tute only a preliminary examination, and it is not to be em-powered to grant any diploma or licence whatever, to prac-tise in any, even the most insignificant, department of

medicine.

Such is to be the result of substituting the new institutionfor the Court of Examiners of the Society of Apothecaries,consisting of general practitioners, whose powers, under theAct 55th GEORGE III., in England and Wales, are paramountto the authority of all the medical and surgical colleges! !Yet it is said that the individuals who propose to relinquishthose powers for the purpose of establishing a new institutionin which certain offices shall be provided for needy specit-lators, were not proposing to place in jeopardy the respect-ability of the great body of English general practitioners!But we strongly suspect that Sir JAMES GRAHAM now under-stands the plot which was invented,-that he has acquired adistinct knowledge of the evils which would attend the strip-ping the great body of English practitioners of their title andcharacter as surgeons and, in order to avert the perniciousconsequences of forming another medical corporation, he hasrendered the projected College, by the changes in his Bill, toocontemptible an establishment to be accepted even by theporters of Apothecaries’ Hall. Although this device mayeffect his purpose, still it was not the best mode of getting ridof the project. The retention of the scheme, in its mutilatedform, has had the effect of greatly encumbering and dis-figuring the provisions of the measure, and even of renderingportions of it absolutely unintelligible. In the third Bill, it

was provided that the general practitioners who passed theirexaminations in Scotland and Ireland, should obtain theirlicences from joint boards formed by the Colleges of Physiciansand Surgeons of those countries. Now, in order to harmonizewith two examinations here,-that is, the preliminary exami-nation before the College of General Practitioners, and theexamination for the licence before the joint board of the Col-

leges of Physicians and Surgeons,-that excellent arrangementin Scotland and Ireland is to be disturbed, and there are tobe separate examinations before the Colleges in each of

these countries. This arrangement has been made for thesake of obtaining uniformity; in other words, because it hassuited the interested views of certain persons in London to re-

quire that there shall be examinations before two distinct bodies.There must be the same number of examinations in Scotlandand Ireland, the numerical amount being made a matter ofmore weighty consideration than the quality of the mentalproof, and the pecuniary cost to the candidate.

.

We quit the subject for the present, with a promise to ex-

188

tract the substance of each clause of the Bill, and submit it, iin intelligible language, to the consideration of our readers,in the next LANCET.

HOUSE OF COMMONS.

THURSDAY AUGUST 7TH, 1845.MR. WAKLEY moved for an address to the Crown, pray-ing for-

Returns from the Colleges of Physicians and Surgeons, the’Societies of Apothecaries, and the Universities of Great Britain,and Ireland, showing, for the three years ending the 31st day ofDecember, 1844, the number of candidates examined in eachCollege, Society, and University, for diplomas or licences in"medicine and surgery, the numbers of such diplomas or licencesactually granted, and a definition of the rights and privilegeswhich such diplomas or licences have conferred on their pos-sessors.

The motion was carried.

FRIDAY, AUGUST 8TH.The fourth Medical Bill of the Government having been

delivered to members on Thursday-Mr. WAKLEY gave notice, this evening, that early in the

next session of Parliament he should move for leave to bringm a Bill to amend and consolidate the laws for regulatingthe profession of physic and surgery, and the practice ofpharmacy, in Great Britain and Ireland, with a view toobtain—

i.

The Registration of " every person who, at the time of thepassing of the Act, shall be legally practising, or entitled topractise, as a physician, a surgeon, or an apothecary, in somepart of her Majesty’s dominions."

II.

An equality of rights and privileges for registered medicalpractitioners throughout the kingdom.

in.

Representative systems of government in the Colleges ofPhysicians and Surgeons. !

IV.

The election, by those Colleges, of a National MedicalCouncil, having for its President a Principal Secretary ofState.

v.

The introduction of comprehensive systems of education in’the Schools of Medicine and Pharmacy.

VI.

The appointment of Courts of Examiners by the Collegesof Physicians and Surgeons of England, Ireland, and Scot-land.

VII.

The admission of the Examiners into the hospitals andother public institutions, for the purpose of enabling them totest the knowledge of the candidates, for diplomas in medi-cine and surgery, at the bedsides of the sick.

VIII.

The repeal of those sections of the Charter that was

granted to the College of Surgeons of England in 1843,which displaced the members of that College from the profes-sional rank they had previously enjoyed.

IX.

The right of every registered practitioner in medicine and

surgery to recover reasonable charges for medical and surgicaladvice and attendance, without other licence than the registry.

x.

The examination and registration of chemists and druggists,in England and Scotland, by the Royal PharmaceuticalSociety of Great Britain; and, in Ireland, by the Society ofApothecaries of Dublin.

XI.

The more effectual protection of the public against thedangerous proceedings of unqualified medical practitionersand unlicensed chemists and druggists, by maliing theoffences of such persons questions for the summary jurisdic-tion of magistrates.

XII.

The prohibition of the sale, by retail, of certain poisons,except by licensed chemists and druggists.

xni.

The separation of the practice of physic and surgery fromthe sale of drugs and medicines.

A BILL

(AS AMENDED BY THE COMMITTEE, AND ON RE-COMMITMENT) FOR REGULATING THE PROFES-SION OF PHYSIC AND SURGERY.

(Prepared and brought in by Sir James, Graham and Mr. MannersSutton; and ordered, by the House of Commons, to be printed,28th July, 1845.)

[N.B.-The Clauses marked (A.) to (D.) were added by the Committee, andthe Clauses mm’ked No. 1. and No. 2. were added on j’e-commitment.]

- Pyeam&6.—epecc/ of Statutes. -Whereas the laws now inforce concerning the profession of physic and surgery require tobe amended; be it enacted, by the Queen’s most excellent Majesty,by and with the advice and consent of the lords spiritual and tem-poral, and commons, in this present Parliament assembled, and bythe authority of the same, that an Act passed in the third year ofthe reign of King Henry the Eighth, intituled, "An Act for theappointing of Physicians and Surgeons," and also another Actpassed in the fifth year of the same reign, intituled, "An Acteoncerning Surgeons to be discharged of quests and other

things;" and also two Acts passed in the thirty-second year ofthe same-reign, respectively intituled, "for Physicians and theirprivilege," and "for Barbers and Surgeons;" and also anotherAct passed in the session of Parliament holden in the thirty-thirdand thirty-fourth years of the same reign, intituled, " A Bill thatPersons being no common Surgeons may minister Medicines,notwithstanding the Statute;" and another Act passed in the firstyear of the reign of Queen Mary, intituled, " An Act touching theCorporation of Physicians in London;" and also an Act passed inthe session of Parliament holden in the sixth and seventh years ofthe reign of King William the Third, intituled, " An Act forexempting Apothecaries from serving the offices of Constable,Scavenger, and other Parish and Ward offices, and from servingon Juries;" and so much of every other Act as continues thelast-recited Act; and so much of an Act passed in the eighteenthyear of the reign of King George the Second, intituled, " An Act formaking the Surgeons of London and the Barbers of London twoseparate and distinct Corporations," as does not relate to the sepa-ration of the said Corporations, or to the master, governors, andcommonalty of the mystery of barbers of London; and also so muchof an Act of the Parliament of Ireland passed in the fortieth yearof the reign of King George the Third, for establishing a com-plete school of physic in Ireland, as may be construed to preventthe separation of the professorship of anatomy and chitmrgeyinto two professorships, and the establishment of a professor ofsurgery and a professor of anatomy, to be severally maintainedby the University of Dublin, instead of the professor of anatomyand chirurgery, as provided by the said Act, or as imposes anyrestriction on the place where the lectures of the several pro-fessors of the school of physic shall be given; and also the wholeof an Act passed in the fifty-fifth year of the reign of KingGeorge the Third, intituled, " An Act for better regulating thePractice of Apothecaries throughout England and Wales," exceptso much of the last-recited Act as confirms such parts of theletters patent granted by King James the First to the master,

wardens, and society of the art and mystery of apothecaries of