PROPOSED NEW MEDICAL LEGISLATION.

New Zealand Times, Volume XXXIII, Issue 5352, 23 May 1878, Page 3

PROPOSED NEW MEDICAL LEGISLATION.

(From The Times, March 21st.) The interests of the public in tills country are so closely interwoven with the good government and with the proper education of the medical profession that the Bill introduced into the House of Lords by the Duke of Rich,mond and Gordon, for the purpose of amending the Medical Acts, is one which deserves to be considered by all actual or possible patients almost as closely as by practitioners themselves. It is of such importance to the community that all who bear medical titles should be possessed of a reasonable amount of skill and knowledge in their calling that there can seldom be any question with regard to the propriety of granting special privileges by which such skill and knowledge may be fostered and encouraged, and although no one would wish, in the present state of civilisation and enlightenment, to render so-called medical practice by unqualified persons impossible, it is at least manifest that these - persons ought not to be able to represent themselves as being other than they are. Until 1858 the state of the lawio relation to the medical profession, and the state also of theprofessiou itself, were exceedingly chaotic ; for the right to practise and to bear some kind of medical title might he derived from any of twenty-one different persons or corporations, some of which possessed only a local authority. The English and Irish Colleges of Physicians and of Surgeons could not enable their members to practise within the territory of the Scottish Medical Corporations ; the physician of Edinburgh or o£ London could not prescribe in Dublin ; the : Scottish or Irish general practitioner could not act' as an apothecary in England ; the English apothecary could not act as such in Ireland ; physicians were lawfully practising even in Manchester, or Liverpool, or Oxford, or Cambridge, who were not legally qualified to practise in Loudon ; and there were eminent practitioners in Edinburgh and in Glasgow who could not legally extend their work from one of these cities to the other. For the removal of Bomo of these absurd anomalies an Act was passed in 1858, and this Act provided for the appointment of a general Medical Council and for the compilation of a register upon which the names of all duly qualified medical practitioners were to be enrolled. The Council, although containing members nominated by the Crown, was in the main representative of the previously existing examining bodies, and it was supposed to be endowed with the necessary powers for the due regulation of the education and the examination of students ; but its powers were really extremely limited, and scarcely extended beyond the moral influence of argument, recommendations, and advice. The Act of 1853 asserted some sound principles ; but it was too completely permissive to produce any marked effect; and, after ten years’ experience of its working, the Privy Council arrived at the conclusion that it must be amended. For this purpose, Earl de Grey and Ripou introduced a Rill in 1570 and carried it through the House of Lords ; but in the House of Commons this Bill was delayed by the great press of public business until late in the session, and was at last withdrawn in consequence of the pertinacious efforts' of 1 a small clique of medical politicians to introduce, into it radical changes in the mode of electing the Medical Council. The changes in question conlcl neither be accepted nor discussed,

and so the Bill was suffered to fall to the ground. The Act of 1853 reduced the number of possible licences to practise from twenty-two to nineteen ; but it still left nineteen independent corporations, most of which examined' only in one branch of medical science, as only in medicine, or only in surgery, but each of which gave a license or diploma which entitled the holder to be placed upon the register, and to practise in all branches, whether competent or not. Moreover, many of these nineteen bodies derived large revenues from the sums which they charged for their diplomas; and some of them were at least suspects i of competing for the patronage of students by the adoption of a low standard of requirement.

When Lord Eipon . undertook the work of legislation, this was the main evil which had to be remedied, and his Bill proposed to deal with it in an effective manner. The principle of the Bill was that the licensing bodies should be amalgamated for the establishmcntof a minimum standard of examination, which should include .all departments of practice ; and that this minimum qualification, or “one portal,” should be, the only way of admission , into the ranks of the profession. If this plan : had been adopted, it would have given security to the public that every registered practitioner was moderately conversant with each of the conventional divisions of the healing art; and .it would have left at full liberty, after the attainment of the minimum, qualification, to adorn himself with any additional titles or distinctions, derived from one dr other of the corporations, which he might choose either to work for or to pay for. It was thought that the competition of practice would induce men, to take the'best and most im-„ posing titles they could get, and that the .privileges of . the old corporations would .be scarcely interfered with by the change. Men . who intended' to be known to the 'world , .as surgeons or as physicians .would not rest upon the minimum qualification, but would seek to connect themselves with one or the . other of the colleges. The Bill whs extremely acceptable to the most enlightened members of the profession ; and soon after it fell through an effort was made to combine the English licensing corporations in a voluntary union of such a nature that a medical student who had passed it merely surgical examination should neither receive his diploma nor be permitted to register until he had passed a medff: cal examination also,, and vice versa. Negotiations with’ this object have been in progress for several years; and the English corporations have agreed upon the main features of a “ conjoint scheme" by which their licensing powers would' for the future be exercised in harmony, instead, of ip competition. Such a scheme, if perfected, would be recognized by the Duke of Richmond’s Bill; but Scotland and Ireland would be left untouched, and would be at full liberty to compete with the English ‘ corporations by easy examinations, and to confer diplomas which would enable the holders to practise in every part of the United Kingdom. ... It would be useless for the English corporations to combine for the maintenance' of a high standard, if the idle and ignorant among London students were able to go elsewhere and thus to obtain a licence which would not have been given to them in their own-metropolis. i The Duke of Richmond’s Bill, therefore, in so far as it leaves all those matters permissive,is a ■ retrogression from that of. Lord Ripon eight years ago, , It contains a number of nice little provisions ’ which are sound and right in their way os far as they go, or which would be sound and right if the first and essential requirements of the case were fulfilled. As it is, these provisions form a sort of ornamental frame, the weak point of which is that it, contains no picture. What is wanted in the interests of the public is that no man shall be permitted to assume a'medical title, or to ’call himself by any name implying » right to practise the healing art, unless he has satisfied a ; competent ’ board of examiners that ho. is possessed of a certain reasonable minimumof knowledgo'both of medicine and surgery. For; the duo fulfilment of this provision 1 it would be necessary, inasmuch as nearly every existing examining board confines itself to one of these 'divisions of practice, that something In the nature of a conjoint‘scheme should'lie, made compulsory in each part of the kingdom,, and .that the Medical Council, or the Privy Council, by the ’agency of inspectors, should see that the minimum or pose examination’ was always and everywhere identical; or as 1 nearly so as possible. The public are ipeu* rably ignorant of the meanings of the nineteen different medical licences and of the differences between them. To the sick man one doctor is as much a doctor as another ; and it is necessary for the protection of the sick man that the stamp of currency should only be impressed upQB ':»etal of a certain degree ol

fineness.' Until" this ia done, the Duke of Richmond's proposed enactments about the admission of foreign and colonial practitioners to the register, about the admission of women, about the registration of-dentists and midwives, and about the care and certification of lunatics, all very right and pretty and symmetrical in their way, will be quite insufficient and' almost ai waste of the time required to convert them into law; though to a. well drawn Medical Bill, calculated to maintain the ■ standard of medical education throughout the United Kingdom and to afford reasonable security to the public, these clauses might bo added with advantage.