GENERAL COUNCIL OF MEDICAL EDUCATION AND REGISTRATION.

73

I

to the recumbent posture for a little relief ; while for the last GENERAL COUNCIL six or seven weeks she had complained much of pain in the abdomen, ill-deiined in position, and not so severe as to lead OF her to call in medical aid. Her appetite had remainedgood up to the Sunday in question, though she had remarked from time to time that she felt no better for her meals. ller face had looked somewhat shrunken, and very often her pale and hollowed cheekshad presented the flush of hectic. The patient Session 1867. was fair complexioned, with light air, and of short stature. On my arrival, at seven o’clock P.M.,1 found the patient ROYAL COLLEGE OF PHYSICIANS. very weak and pale, and in low -spirits. She was suffering strong and rather frequent labour-pains, chietly felt in her MONDAY, JUNE 3RD. back; but was complaning also of a continuous pain in her DR. BORROWS, PRESIDENT, IX THE CHAIR. of a abdomen ‘lull, severe, achingcharacter. On examination THE PHARMACOPŒIA. per vaginam 1 found the os uteri soft and dilatable, and about the size of a crown piece. The head was presenting, and had THE following Report was read from. the Pharmacopoeia. not entered the pet vis ; the membranes were entire, and proCommittee :truded in a short, loose, conical pouch. During the next pain REPORT. after my examination the membranes gave way spontaneously, The Pharmacopeia Committee, in completing the duty asand a large quantity of liquor amnii escaped, with some admixture of blood. From that time labour progressed rapidly signed to them, have to report that the final revision of the without any further hæmorrhage. The head descended into Pharmacopoeia, was completed at the end ot March during the the cavity of the pelvis, the pains became more severe and present year, and that the revised copy was forthwith placed almost incessant, and at half-past eight P.M. the head was in the hands of the Execu dve Committee, by whom the work since been issued to the public. resting upon the perineum. When interrogated from time to hasThe Committee beg to report that in the progress of the work time as to the whereabouts of sundry little requisites, the have endeavoured to lifdt the expenditure on its producpatient replied quietly and collectedly; but she was far they so far as was consistent with its completeness, its accuracy, from cheerful, and more than once expressed herself as feeling tion, and perfection. The amount cf this expenditure has been ill. The flush on her cheek was often very present, deep up to a quarter past nine. At that hour, without any re £ 676 14s.. composed of the following items : markable outcry, or any expression of a sense of something having given way, all pains suddenly ceased, the child.’s head receded an inch, the face assumed a look of great anxiety and a deathly pallor, t’ae surface became cold aud clammy, and -the pulse a,t the wrist became imperceptible. The patient besought the bystanders to raise her xzp and to give her "breath—breath!" All my efforts were now directecl to the .stimulating of my patient, but without avail ; and she expired at half-past nine, a quarter of an hour after the accident. The Committee, reminding the Council that the sum of On the following clay llv. Hebblethwaite and myself made £300 was placed at their disposal in 1865, have now to ask an examination of the body, confining our attention to the that the abdomen, in accordance witha promise we had given to her £376 14s. treasurers be authorised to pay the further sum of husband. Having thus brought their labours to a close, the Committee Autopsy twenty-three hours after deat7r,.-Body moderately have the satisfaction of testifying to the very valuable services well-nourished ; surface extremely bloodless ; abdomen very rendered by Professor Redwood, III the preparation of the work, mortis marked. The abdomen large ; rigor strongly being to his zeal and ability, not less than to the readiness with a of fluid in the small was found opened quantity bloody peri- which he attention to the suggestions and recommendagave toneal cavity. The pregnant uterus appeared normal with the tions of the Committee. They have also to acknowledge the less in of a not than inches diameter, exception patch, eight at the left inferior aspect, which was so discoloured as to ap- valuable assistance rendered by Mr. Warington, as far as the state of his health enabled him to co-operate with the Compear quite black, shading off at the margin into a deep claret mittee. Acknowledgments are further gladly offered by the colour. The uterus was opened in the median line, and was Committee for the assistance afforded them in the revision of found to contain a full-grown healthy male child, along with fluid blood and much clot. Before disturbing the child the the work, not only by members of the Council, but also by the hand was passed within the uterus, when a rent from four to several eminent scientific gentlemen to whom the work was five inches in length was found in the centre of the dark patch submitted before its publication. The Committee feel that it will not be thought inconsistent with their duty to indicate running longitudinally down the left border of the uterus and the plan which seems to them the most desirable for watching extending nearly to the os. The child was now with considerable difficulty removed, and then the uterine wall, where the over the progress of pharmacy, and for making such additions surface was discoloured, was ascertained to be extremely soft, and corrections as would facilitate hereafter the preparation of next edition of the British Pharmacopœa. They would friable, and so attenuated that the central portion for some the distance around the rent had become as thin as writing-paper. therefore suggest that a committee, constituted like the preMuch clotted blood was found contiguous to the opening, both sent, be appointed for the purpose just indicated, and thatthe of £ 50 be placed annually at their disposal to enable them on the exterior and interior of the womb. On the right side, sum to obtain such assistance as they may think necessary. in a uterine wall was least half the at situation,

I

,1

corresponding

inch in thickness, firm, elastic, and, except for its unusually pale appearance, would have been pronounced natural. The fundus was also normal with the same exception. Manchester Royal Infirmary, May. 1867.

an

THE PHILADELPHIA HOSPITAL.—A writer on the Paris Exhibition in L’Union llTedicale alludes to a model of this hospital, of which he gives the following description :"’Around a square central court-yard 145 wings are placed, presenting the aspect of the spokes of a wheel. These wings have but a ground floor, which rises only about twenty inches above the ground. These buildings contain 3500 iron bedsteads. The outer circle of the whole building measures about a mile, and the inner, half a mile. In the centre of the courtyard are situated the rooms for the resident medical men and the people employed in the institution. To facilitate communication a covered railroad has been built, forming a kind of belt around the hospital, so that a few moments sufnee for the distribution of necessaries."

MEDICAL EDUCATION AND REGISTRATION.

R. CHRISTISON, Chairman. of the report, said : In the adoption moving taking upon myself this office I wisli to isolate myself from. the Committee. ’I took upon myself originally the duty of moving this question, and you, Sir, in your opening address, were good enough to bear more than sufficient testimony to what I have done. I was fortunate enough to enlist the services of a Committee. They did not seek that office, and it was to a certain extent thrust upon them; and I feel it to be my duty, and a most grateful duty it is, to tell the Council how earnestly and zealously they have lahoured. To Dr. Apjohn in particular theCouncil is specially indebted for the immense amount of labour he has bestowed in his important branch. I am sure my colleagues will bear witness that much of the success, the credit, and the completeness of the PharI macopceia is due to what Dr. Apjohn did for us. With regard to Dr. Christison, he gave us the benefit of his vast experience judgment, and helped us over many difficulties. As to Dr. Sharpey, I need only say to those who know his good Dr.

! and

QUAIN,

in

734 qualities that he gave them all to us. His judgment, wisdom, which he concluded that Dr. Quain must have forgotten to and patience were indeed most marked on the many occasions charge the Council with very many items. on which we met. Of yourself, Sir, I have only to say that Dr. CHRISTISON did not wish the Council to suppose that you were never absent, and the Council knows how much there was but little correspondence on the subject. It never assistance we have derived from you. Our work is now com- occurred to him to make any charge for postage, and he suppleted, and we place it in the hands of the Council with great posed that the same view was taken by other members of the satisfaction. With regard to the first part of the report we body. The report was unanimously adopted, with the addition of have nothing to say. If you think well, you will afford the Committee the balance they ask to pay the expenses incurred, the following words after the word "report" in the first parade have thought, with regard to the future, that, seeing that, graph: "That, in accordance with the resolution of the though it may be at some remote period, another edition of the Council, May 26th, 1866, the Pharmacopoeia was submitted to Pharmacopoeia will be necessary, it is desirable that a respon- each member of the Council on Feb. 1st, 1867." Dr. ANDREW WOOD.—It has fallen to my lot to see the very sible committee should watch over what is being done in pharmacy, and keep an annual record, so as to be prepared without large amount of time, trouble, and skill devoted to the preany great labour or hurry to bring out a work which will be paration of the Pharmacopoeia by the distinguished individuals still more perfect than the present. who did us the honour to act upon the Committee, and I feel Dr. STORRAR.—-I have much pleasure in seconding the motion. satisfied that we have no right to command those services I, probably, should not have been so forward had it not been when we have the means of repaying them, without giving that I felt it would not be unbecoming in one who has had no adequate remuneration; and I say so in spite of what we have part whatever, directly or indirectly, in the preparation of this sometimes heard out of doors as to our paying so much for our Pharmacopoeia to express his admiration of the manner in Pharmacopoeia in the way of pecuniary recompense. It has which the Committee have performed their duty. A great been said that if we had committed the task to the hands of deal of criticism and censure has been applied to this Council one or two editors like Mr. Redwood and Mr. Warington, it from the first as to the manner in which they have performed might have been done a great deal cheaper. I admit that, but their duty in preparing a uniform Pharmacopoeia for the three at the same time you must recollect that it is one of the funckingdoms. Anyone who knew the circumstances, and could tions of the Council to prepare a Pharmacopoeia, and the duly consider the great difficulty of the work, would arrive at Council, having accepted the responsibility, had also to select I have now to bear testimony to from their own number the men who in their opinion appeared a very different conclusion. the merits of the really admirable volume which has been best qualified for the task. I say therefore that it would be a issued to the public. I do not think there is any work of a piece of gross injustice were these gentlemen to be left unresimilar character in the world which can be put in rivalry with munerated. These gentlemen are five in number, and I beg it. I heard with great satisfaction from you, Sir, in your to propose that we vote a sum of 500 to them. I may menopening address, that it was your hope that the Pharmacopoeia tion that in the Executive Committee the subject was talked would now be generally adopted by all practitioners in the over, and we thought the case was such a clear case of justice kingdom. Allow me to go a step further and to say that to a to these gentlemen that, in making our calculation as to what certain extent it should shape the education of medical men should be the price charged for the Pharmacopoeia, we allowed coming into the profession. I am not disposed to call in ques- a certain sum to the Pharmacopoeia Committee in case it tion certain advantages which may result from the establish- should please the Council to grant it. In voting this money, ment of a Pharmacopoeia Nosocomii in different institutions of therefore, which I hope will be voted unanimously, the Council this country; at the same time I have a strong impression that will be only voting that which has been fairly earned. To the constant confusion of the Pharmacopoeias has a tendency show the popularity of this edition, I may say that considerto embarrass the whole system. You cannot go into a drug- ably over 6000 have been sold within a very few weeks. The REGISTRAR stated that the number of copies sold was gist’s shop and get into conversation with a druggist without observing that the more intelligent and conscientious he is the about 7000. Dr. BENNETT asked the number of copies upon which the greater is his difficulty in meeting the demands of prescribing physicians and surgeons. He will point to a range of bottles calculation was based. Dr. ANDREW WOOD said that the number of the edition was representing, say, the Pharmacopoeia of the London College of Physicians; to another range representing the Pharmacopoeia 20,000, which would repay all the expenses of the Pharma-of Ireland, to another that of Scotland, and to another repre- copœia Committee, including the £500, and also £600 which senting the Pharmacopoeia Nosocomii. There was one distin- was due upon the last edition. The motion was unanimously agreed to. guished practical pharmaceutist in London who felt it necessary a few years ago to publish an abstract of the Pharmacopoeias COMMUNICATIONS ADDRESSED TO THE COUNCIL. of the different hospitals. Now, I cannot but think that, while it may be very convenient here and there to have special Dr. ALEX. WOOD said that these communications must be forms for certain compositions in different hospitals, it is of divided into two classes, the first consisting of those in which great importance that young men educated for the medical application had been made to register the degrees of colonial profession should have their education so directed that they universities, in regard to which he suggested that a communimay use the national Pharmacopoeia; and I trust we shall have cation should be addressed to the memorialists, stating that, the assistance of the authority of the body in whose hall we however satisfied the Council might be with the education and meet to press upon the attention, not only of the medical prac- examination pursued at the universities in question, they had titioners of the country, but of all persons engaged in medical at present no power by the Medical Act to grant the petition, education, the necessity of training young men to have an in- but that steps had been taken with the view of endeavouring telligent knowledge of the Pharmacopoeia. Of course, this is to obtain that power. With regard to the request made by one reason for urging upon the Council the necessity of keepcertain bodies for the recognition of their preliminary examinaing the Pharmacopoeia on a level with the knowledge of the tions, he frankly confessed that every year’s experience had convinced him that the fewer bodies admitted to licence for day. Dr. A. SMITH said the report omitted to state that the preliminary education over which they had no control the Pharmacopoeia had been placed in the hands of each member safer it would be for the medical profession. If they were perof the Council in accordance with the resolution of last May. fectly satisfied with the curricula established, the bodies might He concurred in the propriety of appointing a standing Phar- be added to the list established from year to year; but he hoped maoopoeia Committee. That was the practice in America, that that list would be entirely abolished, and that the Council would not admit the testamur of any body that did not admit where a new edition was published every ten years. Dr. PARKES thought the Council ought to express its thanks its visitors to test the character of the examinations. The to Dr. Quain for his labours in connexion with the publication Council should exercise great caution in adding to the list. He of the Pharmacopoeia, which he considered a remarkable epoch begged to propose that a letter to the effect he had stated be addressed to the universities of Melbourne, Calcutta, and in the history of pharmacy in this country. Dr. SHARPEY bore testimony to the energy, sagacity, and Sydney, and the Medical Council of Upper Canada. Mr. HAWKINS thought it would be better not to say anyvigilance exhibited by Dr. Quain on the Pharmacopoeia Committee. thing about the Council having taken any step in the direction Mr. RUMSEY bore similar testimony as a provincial member indicated, because it had not originated any such step; and of the Council, and expressed a hope that when another edition that it would be better not to say anything about the excelof the Pharmacopoeia was issued the Committee would have lence of the examinations, of which the Council officiallyknew the services of a secretary as efficient as Dr. Quain. He ob- nothing. served that the charge for postage was only El10s., from Sir D. J. CORRIGAN- said he thought it would not be desirable

735 to bind the Council to any future course of proceeding, and mendation. The Queen’s University and other bodies took moved, " That letters be addressed to the University of Mel- exactly the same view, so that moral suasion was in that case bourne, the University of Calcutta, the University of Sydney, ineffectual. Mr. HARGRAVEsaid he was opposed to anything like coerand the Registrar of the Medical Council of Upper Canada, informing them that at present it is not legally in the power of cion, believing that moral suasion was working very beneficially. Dr. ALEX. WOOD, withdrawing his previous suggestion, prothe General Medical Council to recognise colonial degrees, but that an amended Medical Bill is now engaging the attention of posed, " That that part of the memorial of the Cork Medical the General Medical Council, and that the recognition of the Association which relates to preliminary education be referred colonial degrees and licences referred to shall receive full con- to the Committee now sitting on the subject, and that the sideration." The Council had made a mistake in recognising Cork Medical Association be informed that the part of their the degrees of the Universities of Belgium on the introduction memorial which suggests the introduction of clauses giving the of the Bill-degrees which did not even entitle the holders to Council compulsory powers to enforce their educational recommendations will receive the full attention of the Council." be put on the Medical Register in their own country. Dr. ALEX. WOOD withdrew his motion in favour of that proMr. HARGRAvE seconded the motion, which was unanimously "

posed by Sir D. Corrigan, which was seconded by Mr. Hawkins, adopted. A letter was then read from Dr. James Mason, with regard unanimously agreed to. Dr. ANDREW WOOD moved, "That a communication from to the expediency of registering the titles of obstetrician and the M’Gill University, Montreal, praying for the recognition of accoucheur. The Registrar was instructed to acknowledge its matriculation examination, be referred to the Committee on the receipt of the letter. Mr. RUMSEY expressed his conviction that at no distant day Preliminary Education." The motion was seconded by Dr. Parkes, and unanimously the Council would be compelled to take action on the great adopted. question of obstetric medicine; that it would have to decide In answer to a letter from Dr. George Buchanan, addressed whether it would insist on the possession of qualifications in to the Registrar, by desire of the Examiners in Arts of the midwifery on the part of those " persons"-to use Mr. Stuart Apothecaries’ Hall, with reference to some ambiguity stated Mill’s phrase-who wished to practise in this department. to exist with regard to the compulsory subjects in preliminary The Council might for a time ignore the question, but they examinations, it was resolved, on the motion of Dr. Andrew were a Council of Education and Registration, whose duty it Wood, seconded by Dr. Parkes, " That the Registrar be was to see that no one assumed titles of competency without directed to inform Dr. G. Buchanan that the Medical Council possessing that competency. They would some day have to has recommended that, after 1869, the following subjects shall determine the qualifications on the possession of which pracbe compulsory-viz., English language, including Grammar titioners of midwifery would be allowed to register. Some day and Composition; Arithmetic, including Vulgar and Decimal or other the subject must be taken up, unless they abjured Fractions ; Algebra, including Simple Equations ; Geometry, their title. first two books of Euclid; Latin, including translation and The PRESIDENT said he should havebeen glad if the Council, Grammar; Greek; and one of the following subjects at the in answering the letter, had reserved to itself the power of£ option of the candidate-French, German, Natural Philosophy, considering the question of qualifications and registration in including Mechanics, Hydrostatics, and Pneumatics." midwifery. He thought they ought to have such power, and A letter from Dr. W. B. Hepworth relative to the Medical that they would be obliged to exercise it. Acts Amendment Bill was read, and the Registrar was inDr. ALEX. WOOD said that "coming events cast their structed to acknowledge its receipt. shadows before;" but he did not think that the Council was A communication was then read from the Cork Medical Pro- called upon to fight with shadows at present. and

tective Association. Mr. CoorER said they were not shadows, but stern realities. Dr. ALEX. WOOD suggested that the letter should be referred There was no more important branch of the profession than to the Committee on Preliminary Education. The memo- the practice of obstetricy, and it was essential that those who rialists, he said, suggested that the Council should endeavour practised it should be well qualified. Out of 4000 casps that to secure power to make the course of education which they he (Mr. Cooper) had attended he had never lost one. He had considered desirable, compulsory instead of recommendatory, indeed to open the head in cases where the pelvis was small. and that power should be obtained to enforce an arts examina- (Question.) tion upon every student before entering the profession. The PRESIDENT.-We are not now going into the general Dr. ANDREW WooD thought the Council ought not to refer question. to the Committee a question which was discussed and decided Mr. CoopER said he was speaking of the necessity of examion years ago. He then made two or three motions with a view nation in the subject of obstetrics, and he hoped the Council of obtaining such powers, but the Council had decided other- would direct its attention to that important subject. Dr. Acr.4xn said he had not the slightest idea that the wise, and however anxious he might be to persevere in the attempt, he confessed that what he had observed within the Council was to be debarred from entering into the question at last two years had convinced him that moral suasion had very some future period. much more power than he at first thought it would have. If A letter was then read from Dr. Gibson relative to the qualithey could only go on steadily as they had been doing with the fication of Master in Surgery. visitation of the examinations, he should not be disposed to Mr. SvME reminded the Council that the subject was fully seek powers which otherwise he should have thought necessary. discussed several years ago. Mr. SvME thought it was unnecessary to ask for further Dr. ALEX. WOOD said that if the subject was discussed it powers, believing that those which the Council possessed were would have to be gone into very fully, and would probably amply sufficient, if properly exercised. occupy the Council four days. It had been argued at great Dr. ALEX. WOOD suggested that the Cork Association should length by first-rate lawyers at the bar before the Privy Council, be informed that the Council had already decided that it was and the point was decided in favour of the University of Edinnot expedient to obtain compulsory powers to enforce a par- burgh. He had no desire to enter upon a discussion which ticular system of education. would reopen wounds that had been healed over, and disturb Sir D. J. CORRIGAN said it was proposed to state that the amicable relations which had been completely restored after Council had come to a definite and unalterable decision. He considerable asperity. did not pretend to say that the decision would be altered, but Sir D. J. CORRIGAN moved,-" That an answer be returned such an alteration was possible, and it was unwise to bind to Dr. Gibson, to the effect that the question referred to in themselves to the principle that they would not go for compul- Dr. Gibson’s letter is purely a legal one, involving the intersory powers. He for one entertained the opinion that compul- pretation of the Poor-law Acts and Medical Acts ; and the sory powers were requisite, but he claimed the liberty of General "Medical Council, therefore, decline to give an opinion changing his opinion to-morrow if he thought fit, and he was thereon." The motion was seconded by Dr. ArjOHN, and unanimously quite sure that every member of the Council would wish to reserve to himself the same right. He thought the best course adopted. would be to refer the letter to the Committee, and to state The PRESIDENT stated that Mr. Hillier, who had addressed that the suggestion it contained should receive every attention. a communication to the Council, had recently called upon him With regard to the power of moral suasion he wished to remind and desired that it should be withdrawn. the Council that when they decided that a student ought to The letter was withdrawn accordingly. have an arts degree before obtaining the higher degrees in A petition was then presented from Mr. Richard Organ, remedicine, that decision was sent to the licensing bodies, but questingthat he might be allowed to register his foreign cleo the University of Edinburgh declined to obey the recom- gree, or to present himself at one of the examining boards.

736 The letter was accompanied by an autobiography of the that his heart was as open to pity as that of other genand numerous testimonials. tlemen, but this was not a case for the unnecessary exercise ’’ That the Council, having con- of that quality. They had a duty to discharge to themselves Dr. STORRAR moved, sidered the application of Mr. Richard Organ, see no cause toand to the medical profession. To them was entrusted the alter their decision of the 19th of May, 1866." duty of keeping the Register pure, and he maintained that they Sir D. J. CORRIGAN seconded the motion. not, on any amount of evidence as to the conduct of Mr. SYME suggested that the Council could not pass Richard Organ, now permit his name to be replaced. They all motion without reading the whole of the history of Mr. Organ’s knew how easy it was for criminals so to act for a year or two lite. as to obtain tickets-of-leave by imposing upon chaplains and Dr. ALEX. WOOD said that all that was wanted with regard kind-hearted justices of the peace. The evidence by which to Mr. Organ’s life was already recorded in the minutes. It they ought to be guided was that which was brought forward had been proved against him that he had been guilty of in- when Mr. Organ was himself before the Council, when no exfamous conduct in a professional respect, and no history could pression of regret was uttered, but the most insolent defiance possibly alter the resolution of the Council on the subject. proceeded from the mouth of his solicitor. He did not wish Mr. HARGRAVE very much regretted to hear the observations the Council to show any irritation on that account, but he reof Dr. Alexander Wood. The petitioner had been suffering for ferred to the circumstance to show that little real penitence his delinquencies for no less a period than six years. He had had been exhibited by Mr. Organ. It was only when he found been deprived of his status in the medical profession, no doubt himself completely in the power of the Council that he exby his own conduct; but ought the Council to inflict a lasting pressed his willingness to submit, finding that he could not disgrace upon him, and refuse him the opportunity of retriev- do otherwise. Mr. SYME said that the question for the Council to consider ing his character ? He proposed as an amendment, ’’ That as Mr. Richard Organ has confessed his improper conduct, and as was whether Mr. Organ’s conduct had been so bad as to prehe has repeatedly thrown himself on the leniency and clemency clude the possibility of restoration by any amount of penitence. of the Council, he be permitted to present himself for ex- He thought that Mr. Organ ought not to be prejudiced by the amination before one of the licensing bodies." intemperate and offensive conduct of his advocate. With reto the charge of forgery, he had not been convicted, and Mr. RuMSEY seconded the amendment. Dr. ACLAND said he could not sanction the doctrine that a it was not for the Council to assume that he was guilty. No man, once having been condemned for misconduct, should have doubt the personation was a very grave offence, and was very He wholly objected to justly punished ; but he (Mr. Syme) helieved it was not looked no opportunity of retracing his steps. such an application of the motto " vestigia nulla retrorsum."" upon by all persons in so serious a light. Very many persons He could not propose to condone the fault without a great deal considered it fair to cheat the examiners if they could. He of consideration, and he thought that before the coming to a hoped that the motion and the amendment would be negatived, decision the Council should refer Mr. Organ’s petition and the and that some middle course would be adopted. Mr. RuMSEY said that he seconded the amendment with a accompanying papers to a committee. Nothing had perplexed the Council in its early days as the constant discussions with view of endeavouring to arrest the passage of the motion; but, reference to Mr. Organ, and it was no doubt a serious matter on full consideration, he did not think that either was adapted to to reopen the subject. The petition, however, was signed by attain the object in view, which would, he thought, be accoma number of churchwardens, tradesmen, and other persons acplished by referring the letter and the accompanying docuquainted with Mr. Organ, and the request it contained ap- ments to a committee. He thought it would be a most harsh peared to be a reasonable one. proceeding to state that the petitioner should never be absolved Dr. ANDREW WOOD said there could be no more important from the consequences of his fearful error at the commencefunction of the Council than that of administering justice or ment of his life. He (Mr. Rumsey) hoped that a loc?,t,3 penimercy. He could not vote for the motion nor for the amend- tentice would be afforded ; and that his (Mr. Organ’s) offence ment without knowing what Mr. Organ had to say for himself. might be condoned. His case ought to be impartially conIt was open to the Council to reject the application altogether, sidered, with the desire, if possible, to allow him to conduct but if the question was entertained it was impossible to go to himself during the remainder of his life in a more respectable a vote upon it without hearing all that had to be advanced in manner than that in which he had commenced it. Mr. Organ’s favour. Sir D. J. CORRIGAN said that an appeal to mercy was always Dr. ALEX. WOOD hoped that the Council would decide con- hard to resist, but mercy to a criminal sometimes involved clusively on the subject. The case had been calmly and coolly cruelty to those who ought to be still more considered. It adjudicated upon and settled four or five times. Mr. Organ was not denied that Mr. Organ had paid a man to personate himself had appeared before the Council, and on two occasions him at an examination, well knowing that he did not possess his solicitor attended. If Mr. Organ had anything to adduce the knowledge and information requisite to fit him to take why the sentence passed should not go forth against him, he charge of human life. He did not wish to go into the portion ought to have brought it forward when the case was under the of Mr. Organ’s life previously to his being put upon the Reconsideration of the Council. No doubt there were certain gister, but would confine himself to the crime of personation. offences for which they might feel it their duty to strike a did the army deal with a case of that kind ? As soon as man’s name off the list of medical practitioners, and those such cases’ were discovered, the names of the offenders were offences might afterwards be expiated; but what was the struck off the list, and they were never allowed to return. offence for which Richard Organ was deprived of his position Ought not a man to be treated in the same way who committed on the Register ? Was it an offence which could be condoned a similar crime in regard to human life ? If the present crime by any future course of proceediug ? He had actually hired a were condoned, no man could ever be struck off the Register; person to personate him at an examination for the purpose of for he could not conceive of any greater crime than that comdeceiving one of the licensing boards of the country. When mitted by Mr. Organ with reference to the public and to those his name was struck off the list, he brought an action against who might be entrusted to his care. He did not see how the the Council by a writ of mandagibus, which, however, did not Council could face the bar of public opinion if it pardoned such take effect. Did he then confess his error and throw himself a crime as that. An opportunity had already been afforded to upon the mercy of the CouncilNo; he engaged the services Mr. Organ to bring forward evidence in his favour. He had of a practitioner who was upon the Register, and in partner- had no less than eight years in which he might have presented ship with him carried on his practice, so as to escape the pro- himself to the Council in his present attitude. Sentence was visions of the Medical Act; and, as far as he (Dr. Aléx. Wood) passed upon him in 1858, and it was not until 1866 that he knew, he was still in the same attitude of rebellion and de- requested permission to present himself at one of the examining fiance. But that was not all. It had come before the Council boards. The Council then declined to accede to his request, that Richard Organ had stood at the bar of the Criminal Court and he (Sir Dominic) maintained that the case could not now for forgery, and although he had not been found guilty, it had be reopened. The Council had merely stated that they did not been stated on good authority that his acquittal was owing to consider Mr. Organ fit to remain on the Register of a profession Then the Council that required professional skill and personal honesty. They some technical defect in the proceedings. would not forget the memorial forwarded to the Council, when did not desire tp shut the world against him ; but when he Mr. OrgQ’s case was under consideration, by a number of asked for their irnp1’irnatuy, he (Sir Dominic) thought they respectable practitioners in the district in which Mr. Organ were not in a position to give it. Against the petition preresided, urging that the necessary steps should be taken to sented in Mr. Organ’s favour by the tradesmen of his district remove his name from the Register. Under such circumstances, there was the petition presented against him by forty or fifty would the Council be doing right to respond to the present members of his own profession. To which of these ought the appeal ad 1nÎ8ericordi.a1n to restore .1B11’. Organ’s name? He greater weight to be attached? They all knew the value of

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How

737

petitions presented by persons in other professions than that him, but his own testimony ought not to be altogether ignored. to which a man belonged. They had probably not forgotten In common justice, he thought, the Council ought to adopt some the petition to Lord Derby, sent by bishops and noblemen of course which would enable it to ascertain the exact state of the high rank, requesting him to give a pension to a man for his circumstances, and to come to a proper decision. All that the poetry. (Laughter.) He considered that Mr. Hargrave’s amend- Council could say was that it had no objection to any licensing ment was ultra vires, since the Council had no power to give body examining Mr. Organ; but they had no right to interfere permission to the licensing bodies to examine a candidate. with any such body in the matter. They had no power to permit Mr. Organ to present himself Dr. ANDREW WOOD said that the only legal way in which at an examination, nor to prevent him. If he presented him- Ir. Organ could be restored was by his going before a licensing self to any of the licensing bodies, and obtained a diploma, body with the consent of the Council. The question was then the question would come before the Council as to whether whether Mr. Organ was a person to whom such consent should his name should be placed upon the Register. He did not be given, and that could not be decided unless they knew all think there was much probability of the licensing bodies per- the facts of the case. If the question was referred to a committing him to be examined, but that was a matter with which mittee, he might be able to show that his character was rethe Council could not interfere. Dr. CHRISTISON said that, having been in the chair in the absence of Sir Benjamin Brodie when Mr. Organ’s case was decided, he wished to state that he had not in any degree altered the sentiments he then expressed with reference to the improper conduct of the practitioner. A long period, however, had since elapsed, and the question was whether, under any circumstances, the Council would allow the restoration of a name that had once been removed from the Register. He did not think they could proceed without hearing the documents forwarded by Mr. Organ, or referring them to a committee for consideration. Sir D. Corrigan was no doubt right with regard to the position of the Council in the matter, and he thought that the proper course would be to state to Mr. Organ, that until one of the licensing bodies had given him a qualification it was out of their power to place him upon the Register. If any body, upon full consideration of his case, permitted him to be examined, and gave him a diploma, the subject would then be ripe for the decision of the Council, Dr. THOMSON said that the Council had apparently overlooked the standing order, by which the permission of the Council was required before any licensing body could admit to examination a person whose name had once been removed from the Register. Dr. CHRISTISON said that the Council might refuse to take any step in the matter until application for such permission was made by one of the licensing bodies. Dr. A. SMITH hoped that Mr. Hargrave’s amendment would be rejected, since it would place the Council in a ridiculous position, and lead to the inference that whenever a person had misconducted himself, he would only have to apply to the Council, and to say that he had afterwards conducted himself properly, in order to be restored. The Council ought either to refuse to entertain the application, or to refer all the documents to a committee. Mr. Hargrave’s amendment was then put to the meeting,

formed ; if so, the Council could then decide upon the question, but it ought not to come to a decision brevi manu.

Mr. RuMSEY said there appeared to be a general disposition to extend clemency, if possible, but there was a difference of opinion as to the terms on which that clemency should be extended-namely, whether application for a remission of the sentence should proceed from one of the licensing bodies, or whether the Council should first withdraw its prohibition. It appeared to him that the latter course was the most legal and

rational; that the prohibition having been issued by the Council, the Council should withdraw it.

Dr. PAGET supported the motion of Dr. Thomson. If Mr. Organ was told that the Council could do nothing for him until he had been admitted by one of the licensing bodies, it would be going very far to promise him that his name should be restored if he obtained the diploma, and until he (Dr. Paget)

knew much more of the facts of the case he should be unwilling to make any such promise. There were many people whose feelings ought to be considered besides Mr. Organ’snamely, all those whose names were on the Register at the present moment, especially those beginning with 0. (Laughter.) A friend of his, who was placed close to Mr. Organ in the list, felt very much aggrieved at the proximity. Dr. Thomson’s amendment, which was seconded by Dr. Acland, was then put, and carried by a majority of 17 against 3. The amendment was also carried as a substantive motion. Mr. C. Hawkins, at the request of the President, took the chair during the remainder of the sitting. Dr. PAGET moved, "’That the application of a medical student for registration be accompanied by a certificate of his place of medical study." He said that he had been informed that it was likely the motion would lead to a long discussion on general principles. If he had anticipated such a discussion he should not have brought forward the motion, because he did not think the time of the Council would be profitably ocand unanimously negatived. cupied in considering it at any great length. The object was Dr. THOMSON then moved a second amendment,-" That merely to substitute the word" certificate" for "statement," the application of Mr. Richard Organ, together with the ac- in order to make the Student’s Register a little more exact, companying documents, be referred to a committee to examine and to render it less difficult to identify any person who regisand report upon to the Council."" He thought the Council tered himself as a student. It would, no doubt, also have the advantage of giving the Council rather more comought not to shut the door entirely against repentance, and contingent declare that on no account would they permit the reinstate- plete information as to the ways in which students commenced meat of a person whose name had once been removed from the their medical studies. The certificate required would be kept by the Registrar for future reference. The Registrar would Register. Dr. CHRISTISON said he did not think that the Council would not have to consider whether the certificate was satisfactory or be obeying the law if it agreed to the appointment of the com- not, unless it was of a very exceptional character, when he mittee. The proper body to investigate the subject was the might think it necessary to bring it before the Branch Council. present it was found difficult to identify all the students. licensing body, to which application should be made for per- At mission to be examined. He was about to propose that Mr. If John Smith, for instance, living in Manchester, or Thomas in Glasgow, were to send to the Registrar for Organ be informed that the Council could not entertain his Brown, living or Scotland an application to be registered as a medical application to be replaced upon the Register (which was made England and simply give the name of the town in which he by him on the ground of his possessing a foreign degree), or to student, be examined by one of the licensing bodies, until he had first was residing, it would be difficult several years afterwards to made application to one of the bodies for its permission. If I identify him. Dr. ANDREW WOOD considered that Dr. Paget’s motion he made out a good case, his application might be considered; but that was a point on which they were not at present pre- would be an unnecessary piece of legislation. It appeared pared to enter. They must take care to proceed according to that some forty or fifty students had inserted only the name their own regulations. The Council would not forget the diffi- of the town in which they studied. That, however, was the culty it experienced in dealing with Mr. Organ’s case. They fault of the registrar, who ought to have inquired the particular had to consult their lawyers upon the subject; and if they school at which the applicants were studying. If the student owed anything to Mr. Organ it was the knowledge they had was required to send "a certificate,"adifficulty would arise obtained of the mode in which such cases should be proceeded as to the person from whom he was to obtain it. The proposal I would only tend to throw a troublesome duty upon young men with. Mr. SYME said it appeared that Mr. Organ had not made at the beginning of their studies, and he thought every his application in terms strictly in accordance with the rules would be answered by giving instruction to the registrar to ask of the Council; but he ought not to be prejudiced on that all students applying for registration the names of their reaccount, especially as up to the last few minutes there was spective places of study. Mr. HAWKINS said that this was no new proposal, and that hardly a member of the Council who knew what the proper course was. There had been many testimonies adduced against until last year such a certificate was required. -

object

738 Dr. ANDREW WOOD wished to know why the practice was abandoned ? The REGISTRAR said that a " statement" only of the place of study was required, Dr. ALEX. WOOD thought that as little trouble should be given to the registrars as possible, and that complicated forms would be very objectionable. Mr. HARGRAVE said that the Irish Branch Registrar invariably stated the place of study. Mr. COOPER seconded the motion. Dr. EMBLETON considered that the present form was sufficient for all purposes, and that there was no necessity for an alteration. Dr. PAGET said he did not propose to alter the form of the application for registration, but merely to require that the application should be accompanied by a certificate of the place of medical study, Dr. EMBLETON considered that the form of application was in itself a certificate, being signed by the student himself. Sir D. J. CORRIGAN said that after considerable experience the Council was obliged last year to omit the production of the certificate, and he saw no necessity for reverting to the former practice. The resolution did not say who was to furnish the certificate. For anything stated to the contrary, such It a certificate might be given by the boy’s father or mother. had been suggested that the certificate could be obtained from the professors of the school. That proposal, however, opened a very wide question which had never yet been determinednamely, What is a place of study? Some maintained that it was a school where all branches of medicine and surgery were taught; others contended that a place of study was not necessarily a school at all. The College of Surgeons in London, for instance, permitted a young man to commence his study in the house of any practitioner of whom they might approve. The Apothecaries’ Hall in Dublin possessed a similar regulation. A practitioner might reside in any town in England, Scotland, Ireland, or the colonies, r even on the continent; so that the place of study was not necessarily a medical school. A curious difficulty had arisen with regard to one of the Queen’s Colleges, to which he wished to draw Dr. Andrew Wood’s attention. A young man came last year to be registered, having passed a preliminary examination at the Galway College. When he asked for the certificate of his place of study, under the idea that it was still necessary, the Galway professors, with the cleverness for which that part of Ireland was proverbial, refused to give any certificate whatever, telling the young man, " We have power to prevent your going away from Galway; you cannot go on with your studies until you are registered, and you cannot be registered until you have a " certificate ; you must therefore stay in our school." As it would not do to say that they refused the certificate altogether, they passed a resolution, which they forwarded to the Branch Council, stating that they had not refused the certificate, but that they would in the following Easter send the certificates of the preliminary examination of all the young men who were engaged in their studies ; which, being translated, simply meant, "We will not give a certificate, and therefore you must remain with us at Galway, because you cannot register before Easter." Considering all the difficulties in the way, and that Dr. Paget’s resolution stated no source from which the certificate was to come, he thought the best course was to allow the present plan to remain in force at least a year longer. Dr. PAGET said that he did not attach any very great importance to the subject; and he regretted that so much time had been occupied in discussing it. The difficulty of carrying out the proposal was purely imaginary, and the Registrar would state that no inconvenience would arise from it. Sir J. D. CoRRiGAN.—Our experience does not coincide with yours. The motion was then put, and negatived, -

TUESDAY JUNE 4TH

- ,.

-

Dr. PAGET.-I may state to the Council that this morning, before Mr. Walpole’s communication was received, the Committee took into consideration the llth clause with a view of being able to recommend some course to the Council in the event of their being asked what substitute they proposed. A clause was accordingly agreed upon, but there was no intention of communicating it to the Council at the present meeting. It was intended to present it in the programme in order that members might have an opportunity of considering it. On the receipt, however, of a communication from the President respecting Mr. Walpole’s letter I communicated with the chairman of the Business Committee, and he thought the matter was of sufficient urgency to make it desirable that it should be brought before the Council this day. The amended clause that the Committee have agreed to recommend is as follows :" It shall be lawful for the General Council by special orders to dispense with such provisions of the Medical Acts, or with such part of any regulations made by the authority of the said Acts, as to them shall seem fit in favour of persons who shall make application to be registered under the said Acts on foreign or colonial diplomas or degrees. Provided such persons shall have resided in the United Kingdom for a period of not less than twelve months immediately previous to making application to be registered ; provided the holders of those diplomas or degrees have the right to practise medicine and surgery in the countries where they have been granted; and provided the Council shall receive satisfactory evidence that those degrees or diplomas or licences to practise have been granted after a course of study and examinations such as to secure the possession by persons obtaining them of the requisite knowledge and skill for the practice of their profession." This clause the Committee think would leave the Council more freedom in considering and determining the proper regulations to be made than they would have under Mr. Walpole’s clause. Dr. ACLAND suggested that no time should be lost in obtaining an appointment with Mr. Hardy. Mr. RuMSEY.-With great respect for the opinions held and the course taken by the present and former presidents of this Council I humbly conceive that a mistake has been made from the first in not going to that authority with which the Legislature placed us in direct communication - namely, the Privy Council. There is not a word in the Medical Act with regard to the Secretary of State except as to the performance of one duty by that officer which he has never fulfillednamely, that of appointing a place in which we might meet. There are, however, several clauses which place us in a very definite relation to the Privy Council; and 1 think it will be acknowledged by all who know anything of the public business of the country that the Lord President of the Privy Council has much more time to devote to matters of education, science, and literature than has the Home Secretary. Dr. ANDREW WOOD.-I am surprised at the observation by Mr. Rumsey. We have been in communication with the Home Office for two years. We were dissatisfied with our last communication from Mr. Walpole, and we asked him with which member of the Government we should confer. I think that the Council ought to rejoice that they have been referred to the Secretary of State for the Home Department, and ought not to lose a moment in taking advantage of the permission which has been granted. I trust that the Council will request the President to seek a conference with Mr. Hardy for the purpose of obtaining an appointment, and that the Council will then appoint a deputation for the purpose of waiting upon that gentleman. No doubt the first question put to the deputation will be-" If you do not like Mr. Walpole’s clause, have you anything to suggest in lieu of it ?" I think that any deputation would be imprudent in going to the Home Office without full instructions as to what the Council is willing to accept. Mr. RuMSEY.-I think we ought either to leave it entirely in the President’s hands, or, if he declines the responsibility, the whole Council ought to have an opportunity of attending.

(No, no; and Hear, hear.)

The PRESIDENT.-If the proposal of Dr. Acland is carried, I will wait upon Mr. Hardy, and press him to fix an early period The PRESIDENT said that he had received the following for receiving a deputation from the Council. communication from Mr. Walpole :Dr. Acland’s proposition was unanimously agreed to. Balmoral, June 4th, 1867. Dr. ACLAND then introduced the following Mv DEAR SiR,—I have just received your at/sl’s ’In ira aa new neu Illedficcct .L1IedlCa ct. Act. eaablirzg 1I1g LClaeses SuggestIOns jor ena from the Medical Council respecting the amendment of thee Medical Act. As I am no longer the Home Secretary, and 1st. That it is desirable to obtain the following additional in point of fact am not likely to be in London for some days, powers under the Medical Act, with respect to examinations, I have thought it best to send your communication at once to viz.:-Whereas there are now in the United Kingdom nineteen Mr. Hardy. Yours very faithfully, licensing bodies, having power to confer thirty separate licences S. H. WALpOLE. !and fifty-three different titles, and whereas it was the intention Dr. Burrows. THE

MEDICAL

ACT.

communication" .

739 of the Medical Act to produce a uniform and sufficient standard in the examinations conducted by the said licensing bodies, and whereas the power of combining the examinations of the said licensing bodies under Clause 19 of the Medical Act has been sparingly used; whereas the visitation of the examinations of so many bodies by different visitors is a cumbrous form of procedure, and one ill calculated to produce the uniformity sought for, and that further concentration of the examinations will tend to the accomplishment of that object: it is desirable that the General Medical Council shall have to combine with any of the licensing bodies mentioned power in Schedule A of the Medical Act, in conducting examinations, by the appointment of assessors, visitors, or examiners, conjointly with such bodies, in such number and with such duties as shall be agreed upon between the Council and the bodies agreeing to conduct such joint examination. That the examiners, assessors, or visitors so appointed shall not be members of the Council, and shall be paid in such manner and at such rate as the General Council, subject to the approval of the Treasury, shall decide. That the qualification so conferred may be entered in the Medical Register. That if the qualification so conferred shall be granted after examinations in Medicine, in Surgery, and in Midwifery, it may be accepted by any public bodies who have heretofore required a so-called ’double qualification.’ That nothing in this qualification shall debar the holder from obtaining the further title of Physician, Surgeon, Doctor, Master in Surgery, or Fellow of any College, or the like, on such terms as the bodies mentioned in Schedule A respectively may determine; nor from obtaining separate qualifications from such bodies as at present. " 2nd. That in order to encourage the study of hygiene and State Medicine,’ it is desirable that the Council shall, in combination with any of the licensing bodies, have power to institute examinations in hygiene andState Medicine,’ and to give certificates of competency therein; and that these certificates may be entered upon the general Register as an additional qualification or title of registered persons. " 3rd. That whereas it is the duty of the Medical Council to republish, alter, and amend the British Pharmacopoeia lately published (Clause 54, Medical Act), and the Council have resolved that they do not consider that they have power under the Medical Act to expend any funds in inquiring into the utility of articles introduced into the Pharmacopoeia, but only how to prepare such articles ; it is desirable that the Council shall have power to expend such sums as it may see fit from time to time, with the approval of the Treasury, on investigations calculated to perfect the knowledge and to test the utility of articles of reputed or probable value, whether recently discovered or otherwise, with a view to including them in, or rejecting them from, future editions of the British Phar-

to diminish those evils to the utmost.

pire like

"

macopaeia.

He said: It may be as well, in order to save the time of the Council, that I should at once state the object I have in view in proposing a motion which involves consequences of so wide a nature. My object, then, is to elicit from the Council a full expression of opinion as to whether it is desirable to obtain an extension of powers in certain specified directions, and to bring on a

for

discussion

as

to the

manner

in

which, and the purposes

desirable, should be obtained. I venture to ask your permission to discuss the constructive clause conferring the examinations first, and then to consider which, those powers,

if

the other clauses at your convenience. I do not pretend to say that all the powers which the Council needs are contained in the notices before you, but I do think that at the present juncture especially, now that we are about to ask a further interview with the Government, it happens most fortunately that there is nothing of more vital importance before us. The first clause aims at making the best possible examining boards. The second clause proposes to organise another order of experts, much needed, I venture to think, in public departments, and to provide for their licensing and examinations. The third proposes a plan for meeting a want that has been already considered by the Council--an acknowledged want in reference to therapeutics. The last proposition I shall not enter upon at present, and I shall be as brief as possible with the first. It is hardly necessary that I should state why so much importance is attached to a motion which at first sight may appear to make only a very small change in our power; but if the means be small, the result may nevertheless be very great. We all know that examinations virtually regulate the course of study. It may be a misfortune that this should be so, but it is a fact. The examinations may have evils attendant upon them, but it is the object of this Council, and of every good examining body,

Examinations

neces-

sarily regulate the standard of the knowledge of the students. and the qualifications which they profess to confer. The examinations therefore of an imperial body such as sits round this table should be of such a character as that to impugn their verdict should be impossible. The Council ought to have at this moment examining bodies who are not only practically competent to their work, but who are absolutely above all cavil and suspicion. Language, however, has been not unfrequently used concerning the existing examining boards which, whether just or unjust, is equally to be lamented in a national point of view. Under these circumstances, four questions appear to me to arise-What is the best medical examining body in an em-

present

’I

Great Britain ? What is the most reasonable kind of examination that can be conducted ? Do our present boards fulfil the requisite conditions ? Can we make the boards which It would be highly unnow exist the best that can be made ? in me if I were to go into any details on subjects of becoming this kind with persons so competent as are the members of this Council; but perhaps you will allow me to remark that for many years it has been admitted that our present arrangements Combinations of boards, as we well are not likely to be final. know, have always been contemplated, and they are suggested by the Act itself, so that we are quite justified in considering the kind of combinations which may be best suited for our purposes. It has been rumoured that a combination is contemplated between two great English corporations. It would be highly improper for me to assume that it will take place, still less to prejudge the value of a combination of that kind. But we may very properly ask ourselves in the public interest -supposing that great and important combination should take place-does it furnish all the conditions which we desire, and which under the present circumstances are possible ? And we may still further ask whether there are other elements which In the present are available for further public advantage? state of medical corporations and of the universities, and of the existing legislative powers, I naturally ask myself what combination would be best to give us a permanent and satisfactory basis, and a conclusion of the great difficulties which have occupied our minds for so many years ? I have no hesitation in expressing my opinion-it may not be worth much-that, as far as England is concerned, the existing machinery and the existing institutions appear to furnish elements for the best possible combinations-that is, for the construction of the best possible examining boards, supposing the Medical Council has a direct voice in the constitution of such boards. I will now offer one or two suggestions as to the operation of such a board as I have imagined. It is well known to us all that there are a great many examining boards throughout the country conducting their examinations in their own way, according to their own previous history, and their own particular qualifications. Now, supposing that all these bodies agreed to combine under the power given by Clause 19 of the Act, and each to furnish its own quota of examiners to one great examining board. It is obvious that the elements for the most powerful and best possible staff of persons would thus be produced. It is to be remembered that in questions of this kind we speak of pass examinations, not of examinations for honours or fellowships, but simply examinations for the purpose of passing into the profession a sufficient number of qualified persons. Now, supposing the medical corporations in London combined, and that the universities joined them in appointing a board of examiners, you would necessarily have a combined body of the best possible description. There are many subjects to be examined upon by such a board; and in London you could get the best persons appointed by different institutions for the particular subjects, and great facilities would be afforded as to the places where the examinations were held. Certain examinations, for instance, would be conducted most advantageously in the hall of the Apothecaries’ Company, where every convenience is at hand. So with regard to surgery and other subjects, there are immense conveniences at no great distance from the centre of the metropolis which would greatly facilitate the holding of these examinations. So that whether I contemplate the combination of the persons who would be appointed, or the practical working of such a combination, there are no objections to the proposal; but the greatest possible advantages would attend it. It so happens that at this very time there has been formed a combination of all the teachers in the different schools of the metropolis, for what purpose I do not know. These teachers are persons engaged in all the hospitals, and such a combination might be of the greatest possible service in relation to the difficult question of clinical examination. It seems

740 me that if such combinations are to be sought, they had comment I venture to make upon it is, that there is no place better be complete and thorough; and that if such a one as I in the country where that matter is more thoroughly underhave supposed could be devised, which should bring to the stood than it is in this room. The whole progress of this board all the mature experience of the persons composing it, Council under extraordinary difficulties has been gradually to the technical office work would be simplified and reduced to a approach the point at which we may freely and calmly discuss, minimum, and such a board would be above all cavil and cen- with the all but certainty of success, sooner or later, anything sure, as is the case with the Civil Service examiners, a highly which regards, I will not say the welfare of the profession, independent body, whose conduct and character it would be but the welfare of the country, and at which any petty jealous idle to impugn. The question before us is, how far combina- opinions, if advanced at this table, would speedily be put tions of this kind should be encouraged by the Council ? The down. I will not presume to suppose that what I have just Council has of course no power to interfere in the matter, and said is the best that might be devised, because on that point I my proposal is contained in the suggestion that the Council wait with deep anxiety for the expression of opinion by the should have power under the Act to appoint paid assessors, eminent teachers and authorities who are sitting at this table. visitors, or examiners. The imperial examining body to which It is certain that it is a matter of peremptory necessity that I am alluding is one which might be made entirely independent this matter should be discussed, when such passages as I have of the Couned. It might constitute itself to-morrow. There no c read have been published by an eminent professor in a is no reason why to-morrow a meeting should not be held in great university. With regard to the other two clauses, I this hall, and why the four English universities and the three think they had better be deferred and taken separately; but London corporations should not agree to combine on such terms in order to make the argument consecutive, you will perhaps as they think fit, without the Medical Council at all. Then I allow me, without entering into the question of the next clause, may be askedwhy I move in this matter. I believe any two to point out one reason why it is almost necessary that this or more colleges or bodies in the United Kingdom menshould be considered, and if I forestall what is to be said in tioned in Schedule A may, with the sanction and under regard to the second clause now, it will save the time of the the direction of the Council, unite or co-operate in con- Council hereafter. ducting examinations. Now, I do think that something The PREsIDENT.-This subject is one of such great importof that kind is exceedingly desirable. I cannot help think- ance that 1 did not feel that I could at a subsequent period ing that it would be a positive advantage that, supposing take part in or preside over your deliberations with satisfaction such an imperial examining board were constructed, the to myself unless T heard something of the reasons brought forMedical Council should nominate its quota of examiners, not ward by Dr. Acland. That is my excuse for not having retired necessarily members of the Council. Of course, those gentle- sooner to seek Mr. Hardy. I will now go to the Home Office, and will ask Mr. Syme to take the chair in my absence. men would have to be paid the same as the others, and that is The President then left the chair, which was occupied by one reason why I think it would not be desirable that they should be members of the Council. The Council might reserve Mr.Syme. to itself the power of visiting this imperial examining body. Dr. ACLAND, resuming his speech, said: Before venturing to Such a board as I have described would not only be a most introduce this motion on the subject of hygiene or State medivaluable examining board, but it would be of inestimable value cine, I thought it right to communicate with two members of as an educational agent. As I said just now, I feel strongly the Council who have paid great attention to the subjectthat examinations are an evil. Those who have had ex- namely, Dr. Parkes and Mr. Rumsey. I did not, however, ask perience in the education of youth know perfectly well that their leave, nor did I request them to bring the subject forward, the stress which is laid upon a student in preparing to get so that they are now perfectly free to adopt any course they through a certain amount of work on a certain day is pe2- se an think fit. It was under the consideration of some persons at evil, which operates upon him more or less during all his edu- Oxford to institute an examination on this subject, and I have cational career; and I have heard persons of great experience learned that a similar proposition was considered at the Unisay that the large, free, unfettered development of human ’, versity of London. Dr. STORRAR.-A committee was appointed on the subject, power in the youth of this country would be materially jeopardised by the increase of examinations as a mere instru- ’, but it never met. ment; that the way in which the great minds of the country were!, Dr. ACLAND.—You constantly find that Poor-law officers formerly trained and their qualities evoked was by their being i will appeal to any medical man on the Register for information set by their teachers upon a certain course of work, and being upon some of the most difficult and abstuse questions relating allowed to pursue that work in the way they thought best. to this subject, of which perhaps he has no knowledge. There There are many instances of the success of that method in the is no doubt that special education on this subject is now lives of the great engineers of the country, and also of members wanted. Supposing one of these bodies should start this subof the medical profession. But it is absolutely necessary that ject, you would have a dozen or more qualifications entered those examinations should be carried on, and strict rules should upon the Register in addition to the fifty-three titles already be laid down for their conduct by the most experienced per- existing. This, I think, is one reason for diminishing the sons, and I doubt whether many persons in our profession are number of licensing bodies or qualifications which have to fit to be examiners who are not themselves constantly engaged appear on the Register. I beg now to move the first clause,as teachers. Before I sit down I should like to read a passage, " That it is desirable that the General Medical Council shall perhaps has been read by every member of the Council, have power to combine," &c. which Dr. STOKES.-I beg to second the proposition of Dr. Acland. in a pamphlet that has been lately published and freely circulated by Professor Bennett, of Edinburgh :-" The Medical I quite agree that this resolution involves a question of deep Council would vindicate its claim to public confidence by an interest to the profession; that these are questions eminently endeavour to merge the conflicting interests of licensing boards worthy of the careful deliberation of the Council. Even if and universities into the catholic desire of elevating the edu- they do not come to any resolution on the subject, a debate cation of the profession to the same standard throughout the which would elicit the opinions of the representatives of diffelength and breadth of the land." The Council will not suppose rent medical bodies must have a beneficial effect. If this that by reading thispassageI am of opinion that the Cuuncil method were adopted, it would tend to remove the objection stands in need of a reminder of that kind. He then goes on which I most strongly hold to the system of Council visitato say : " In a profession such as that of medicine that there tions. I will not now enter into my objections to that system. should exist, not only in the same country, but in the same I simply refer to the debate of last year, in which the real obcity, various examining boards so managed that the candidate jections to it were strongly put forward by Sir D. Corrigan. incapable of passing one should rush to another with almost The simple fact that we are reporting upon one another is to a certainty of obtaining his licence, is a scandal to the my mind quite conclusive, and quite sufficient to render these community. Such should be abolished, and little jealousies visitations untrustworthy in the eyes of the public. Then it and sneers as to the value of this or that qualification ought is not to be supposed that this duty can be undertaken without to cease. Then, by a like education, a like examination, and payment, and then comes the objection that we are taking a like qualification, we should learn to respect each other, and public money for the payment of ourselves-an imputation diminish the petty feelings which opposing legislation and which I am sure any gentleman at this table would not like to regulations have fostered ; and, by union and a combined effort, sit under. This system of Dr. Acland’s would render the exafree from suspicion, and do away with the necessity not only solve those problems which agitate our science, but place the whole body of its cultivators in a just relation to the" of visitation. It would render the Council more and more the Government on the one hand, and to the public on the other." body to which the Government of the country would look for This opinion is not singular, and it is not original; but it is counsel and for reference. It would give to the qualification just, it is very prevalent, and it is to the point. The only (which is simply a pass qualification, and not intended to in-

to

.

minations

741 terfere with the higher qualifications that educational bodies selves fettered by those restrictions, will the corporate bodies, may bestow) a stamp of central authority, and it would faci- will the universities, will the great body of the profession, who litate the union between examining bodies which is anticipated do not belong to the corporate bodies or universities, feel themin the end. I believe that in a very large number of cases the selves bound by the restrictions which we have imposed ? The examinations hitherto have been no protection to the public. other day we had a communication from an important medical Dr. STORRAR. —rise to express, in the fewest possible body, showing that they were prepared to take action for a words, my decided opposition to this motion of Dr. Acland’s. new Bill, but, coupled with that, was an intimation that they We are not here building up a new state of things ; we are would not take action precisely in the direction we had indidealing with an organisation already established so as to arrive cated, but would go into an inquiry with regard to other matat the greatest amount of practical good under given circum- ters. When we come to urge our medical Bills, and to go stances. If the wave of revolution had passed over this through the controversy which seems to be impendin, how do country as it has passed over some States of Europe, and we you know that views such as those which have been indicated had to remodel our schemes anew, I should think Dr. Acland’s by Dr. Acland will not again be maintained? Are we not proposition somewhat more appropriate. I deeply regret that warranted in thinking that such views will be entertained and in past years a great deal of most valuable time has been urged ? and does it not become us to express our own views on wasted in this Council in bringing forward transcendental the subject ? I believe that no Bill was ever introduced into opinions of medical perfection. We have seen what they all Parliament equal in efficiency to that of Sir James Graham, end in. We have now come to more moderate opinions ; and which but for an unforeseen accident would havebecome law. I ask the Council to consider how much more efficient such a we recognise the fact that we are servants of the public, appointed under an Act of Parliament to carry out definite func- measure would have been than the miserable Bill under which tions. It is true the public asked of us a larger amount of pro- we are now acting to the best of our ability, but which we find tection for those gentlemen who are on the Register than it impeding us at every turn. It has been said that steps should be taken to simplify the education and examination of medical was in the power of the Council to give; and that has led some members to negotiate with the Government for the introduc- students. It has been said at this table that there is no tion of a Medical Amendment Bill. Now there cannot be a greater evil than the multiplication of examinations to which doubt that some of the efforts we have been making during medical students are exposed. What better remedy for these the last two years have been fraught with great success : we evils can there be than that in which each of the examining have found the medical bodies responding to our efforts with bodies should be represented at a general board, so that no medical student should be allowed to receive any licence or an amount of unanimity to which we hardly looked forward. I freely admit that the provisions are very remote from per- diploma who had not passed the examination at that general fection ; nevertheless, they put into our hands the power of board ? That plan was proposed in the House of Commons, doing a great deal of good. Now, what would be the result and I remember the Scotch bodies being complimented upon of the Medical Council embarking on this wide sea? It is the ready way in which they merged their petty differences, proposed to take away certain functions of the medical cor- and consented to what would be a great boon to the medical porations, and to combine with the universities for the purpose student, to the profession, and to thepublic. I do not know of establishing a general practitioner, and then to mix up the that such a time may not come again. It is true there have Medical Council with this organisation. The result will in- been acrimonious discussions; perhaps the gulf which sepaevitably be that the medical bodies, and probably the univer- rates these bodies may have been widened by heat and intemsities of this kingdom, would be at daggers drawn with this perance on both sides; but I think I may appeal to you Council. I exceedingly regret that on this the sixth day of whether in the last two or three years these gulfs have not been bridged over-whether there has not been an increasing our meeting, after the Council has been engaged in carrying out, as far as possible, the Act that has been placed in our union amongst the bodies represented at this table ? because hands, we should have this wide subject thrown down upon it has been seen that the representatives of each were in the table; and that we should find ourselves we know not earnest, and unselfishly doing what they could to improve the where, and with no goal in view. I do most entirely object interests of our profession. Under these circumstances, I to this proposal. I cannot venture to go into all the argu- think the discussion introduced by Dr. Acland is one of pecuments of Dr. Acland, or engage in a struggle with Dr. Stokes liar value. From the day when that letter from Mr. Walpole in regard to some of the views he has expressed. There is one was read at your table, the discussion of the Medical Bill was expression of his, however, to which I must allude. He con- taken to a great extent out of your hands. You will now find siders that, in appointing and paying ourselves, an imputation that the whole subject will be canvassed from one end of the is cast upon us. I do not think so. Are we not paid for kingdom to the other; you will have all sorts of suggestions meeting here ? How many gentlemen would come here if they and schemes thrown upon you, and if you refuse to listen to were not paid ? Did wenot yesterday acknowledge with deep them they will be thrown upon the House of Commons, and gratitude the diligence and ability that had been devoted to you will have to frame a Bill ab initio out of the chaos into the preparation of the Pharmacopoeia, by voting a sum of money which it seems we are entering. to the members of the committee ? Did Dr. Stokes hold up Mr. HARGRAVE said that the proposal of Dr. Acland would his hand against that? I think not. I think it most appro- only add to the number of examining bodies already in existpriate that whoever undertakes this task of visitation should ence. He had evidently not taken sufficient pains to ascertain have some kind of remuneration for his services. whether the licensing bodies would support him in carrying Dr. ALEX. WooD.-I have listened with some surprise to out his views. As far as the College of Surgeons of Ireland the remarks of Dr. Storrar, who speaks as if the views promul- was concerned, it could not join any other bodies, because the by Dr. Acland were altogether new to the profession. It charter compelled it to examine students independently. The gated effect of Dr. Acland’s motion would be to introduce into Engis peculiarly gratifying to me to hear from the lips of Dr. Acland, and supported by such an authority as Dr. Stokes, land the officier de santé of France. Dr. PARKES.-I cannot agree with Dr. Storrar that this views of medical reform that were advocated many years ago, when I first began to take a part in this discussion, and which motion would act like a revolutionary wave. The work proI may remind Dr. Storrar (I am surprised that so old a medical posed is by no means one of demolition, but rather of reconreformer as he is should have forgotten it) wereembodied in the struction. It is impossible to disguise from ourselves the Bill of Sir James Graham, which would probably have passed but extreme boldness of the suggestion of Dr. Acland; at the same for a very unlucky accident. I cannot see that Dr. Acland has time, bold as it is, I believe it is also statesmanlike; and if in any way wasted the time of the Council by bringing under the Council will but consider what they are about, they will its consideration one of the most important subjects which see that no topic has ever been brought before them which can could by possibility have engaged it. I have now learned for compete with it in importance. It is, in fact, sweeping away, the first time that there is one member of this Council who is in a certain sense, the old system, and inaugurating, as Dr. satisfied with the Bill as it at present exists. I had always Acland has said, an imperial one-blotting out the petty divi’understood that the Bill was a compromise between two or sions hitherto existing, and creating one grand examining three conflicting interests-that it gave no satisfaction to any board which shall deal with the whole kingdom. I really one body or any one member of the profession. That it is not conceive that we shall all agree in principle; but the question a satisfactory Bill is clearly demonstrated by the very attitude is, can it be done ? can we harmonise the various institutions ? No doubt we must have regard to vested interests. Perhaps we are in at present-an attitude that has forced our President to leave the meeting to-day to take steps in regard to the Dr. Acland has been wrong in going so far into details. I amendment of the Act. It is true that our committee have think he should have contented himself with the first paralaid down certain restrictions in regard to the way in which graph of his proposal, and then moved for a committee to see the Act is to be amended, but however we may consider our- in what way the powers which the Council intend to assume

742 could be carried out. I will support him if he will move for a on the part of those bodies, such as to render it undesirable to committee to see how this great object of his can be carried moot the question, and fully to discuss it. Mr. SYME said that the University of Edinburgh conducted out with due respect for all vested interests. If it can be shown that no injustice will be done to any licensing body, 1 its examinations by means of the medical faculty together with think we may fairly go to the Legislature and ask for these I assessors from the College of Surgeons and the College of Phypowers. If we succeed in getting them, Dr. Acland will have i sicians, and the same system prevailed in other universities. the credit of initiating, or bringing forward again, one of the There was no impracticability in such a combination as had greatest improvements that have ever taken place in connexion been proposed. No doubt there might be difficulties in carrywith the medical profession. ing it out. Teachers frequently regarded the power of examias of the greatest importance in inducing students to Dr. Au LAND said he was quite willing to adopt the suggestion of Dr. Parkes with reference to the appointment of a attend their lectures, and on this ground no doubt some opcommittee. He should have adopted that form of motion had position would be made to the proposed scheme. he not thought it best to go m 1nedia13 7es, in order to save Dr. ANDREW WooD.-Last year there was a proposition time. that came upon me like a thunderbolt from Sir D. J. Corrigan, Dr. A. SMITH thought there was a want of precision in Dr. that we should apply for a Royal commission to settle the Acland’s motion, which gave the Medical Council power to affairs of the medical profession. I was afraid that under the combine with any of the licensing bodies, but left those bodies influence of such a powerful sledge-hammer we must succumb, the power of defeating the object unless they were disposed to but in the hour of need a champion came to our assistance; agree to the combination. He (Dr. Smith) agreed in the prin- that champion was Dr. Acland, and now we have a thunderciple of establishing a general board, and thought that there bolt from him. This appears a very simple motion, but it is should be power to compel the licensing bodies to combine. neither more or less, so far as my humble talents can make At this stage of the proceedings, out, than a regular reagitation of that which led us to a thirty The PRESIDENT, on resuming the chair, said : I have to in- If years’ war some time ago. I recollect Dr. Acland stating that form the Council that I have been to the Home Office, and Sir Dominic Corrigan was greatly mistaken if he thought that seen Mr. Hardy’s private secretary, Mr. Perceval, who had ’, all the existing interests could be swept away with ease; that received our letter from Mr. Walpole, and made himself master ’, we should accommodate ourselves to the state of matters as it of its contents. I did not see Mr. Hardy, and his reply then existed, and not endeavour to legislate for things as they through his Secretary was that he should be obliged to the might or ought to be. I think Dr. Acland has forgotten his Medical Council if they could spare him an interview at the own advice. The qualification that he now proposes by his present moment, as he is so much engaged. I then said that resolution is meant, not only to compete with all other qualiany statement on paper would not be satisfactory to thefications, but, if possible, to put an end to them. If you are Council, and that I thought it would be a great saving ofprepared for that. well and good ; if not, you must look at what labour and time if he could spare half an hour to receive a de- you are doing. Dr. Acland says in his preamble : " Whereas putation. Mr. Hardy then kindly replied that if the matter;, there are now in the United Kingdom nineteen licensing bodies was so urgent, and it was the desire of the Medical Council to ’, having power to confer thirty separate licences and fifty-three see him personally, he should be happy to receive a deputation ’, different titles." I admit that is a melancholy fact, but still on Thursday at half-past twelve. (Hear, hear.) , we must take things as we find them, and I confess I have no The discussion on Dr. Acland’s motion was then resumed. wish to sweep away many of those time-honoured bodies which have done good service in the past. It is true that the bodies Dr. BENNETT.-I feel that I should be wanting in a sense duty if I did not rise to thank Dr. Acland for bringing this have not combined as they might have done; I take no blame for that, for I have never ceased to urge it at this board. In matter before us. So far from thinking the time I think it is exceedingly opportune. I confess that I came i Scotland we made use of the powers given to us under the into this Council with a very deep impression as to the imper- Act of Parliament, and we have never regretted it. Although fections of the Act of Parliament by virtue of which we sit I it has been sparingly used, are there not signs that this use is here, and of the almost insuperable difficulties that surround coming to be less sparing ? If there be such an arrangement the Council in carrying out many of those great measures as has been mentioned between the College of Surgeons and which the public look to it to effect on behalf of the profession. the College of Physicians, it will do much more to concentrate I think it will generally be admitted that this Council have examinations and produce uniformity than entering on a ten honestly attempted to carry out the purposes for which it was i or twenty or thirty years’ conflict. I think the introducinstituted, and I think the public will be prepared to give us tion of the motion at the present time is out of season, greater powers than those we have hitherto possessed, remem- because the very mooting of it may tend in some degree bering our past conduct, and having confidence that any to interfere with the carrying out of the object which I greater powers will be exercised with the same caution and trust before we meet again in session will havebeen accomdiscrimination as were manifested in the exercise of the more plished. I do not mean to say that the present system of imperfect powers that we possessed. I therefore do not anti- visitations is the acme of perfection; but what do we find cipate so much difficulty as some members appear to anticipate from the reports of the visitors ?-that they have been everyin seeking to obtain an Act that will considerably add to our where courteously received. I can speak for my own body, powers. I should not be sorry to find the present Amendment that not only havewenojealousy of being visited, but that Act fail altogether. If we should not succeed this or even we have again and again invited Mr. Syme and Dr. Christison next session, it would not be to me a matter of any great to come to us. I believe that there is not a single body repreregret, because I am persuaded that sooner or later we shall sented at this table that will not welcome any visitation from have an amended Act, and that the longer that is deferred, the Council, and be thankful for any hints which may be given the more perfect the Act in all probability will be, because we to improve its examination. The College of Surgeons of Engshall have the opportunity of introducing such matters as land is a model of loyalty to the Medical Council; for we find these, and perhaps others of equal importance. The question that the visitors of last vear suggested some alterations, which before us is one of such extent that it is vain to suppose that were adopted without delay. The College of Surgeons has we can fully enter into it on the present occasion. It is well introduced an enlarged physiological examination, and alsothat Dr. Acland has elucidated his own views on the subject, what I consider one of the most important things accomplished if it was only for the sake of showing us some of the difficulties in our own day-a practical surgical examination ; and I have by which it is beset; but I do not think we are prepared now no hesitation in saying that I believe that example will have be followed by every qualifying surgical body throughout to go into its details. (Hear, hear.) I think it is impossible to carry out the present system of visitations very much longer. the kingdom. Is it to be said that these are cumbrous, useless The plan is essentially an invidious one, and one which the visitations ? and that, as we are making no progress, and prolicensing bodies may very naturally feel repugnant to have I ducing no effect upon those bodies that are all wrangling continued. They have willingly and graciously acceded to it amongst themselves, there must therefore be a complete boulehitherto; but if you go beyond what you have hitherto done, by the introduction of a kind of Staats examen—a new your difficulties, I think, will be increased. I believeyou qualification to be put in Schedule A to the Medical Act ? I must adopt some other plan, and I think therefore that a say that no case has been yet made out. Let us try the pregeneral scheme of this sort comes in very opportunely. Dr. sent system at all events for a few years. What charge have Acland is likely to know what the feeling of his own university you to bring against the licensing bodies ? Will you say that would be on the subject; and if such a university as Oxford they are recalcitrant, and disinclined to go on improving themwould be likely to accede to a general plan, I do not see why selves ? I see no symptoms of it. We hope in a few days to the other universities should be squeamish on the subject. I bring up a report on these visitations, and we hope to be able see no reason why we should anticipate any extreme jealousy to make the suggestions of these visitors still more available

nation

of inopportune,

to

versement

743 of our examinations. If we find next year that the ther it is practicable. I do not think it is, in its present shape, of the Council have been adopted, we may be because it requires us to begin with a tabulcc rasa. I do not thankful that we are advancing in the right road; and we agree with Dr. Acland and some other members that the should not endeavour to excite an agitation which will stir up visitors of the examining bodies should not be members of this a great deal of bad blood, and will not terminate for many Council. I hope to be able to show that this would be a misyears. If we adopt this motion, Mr. Hardy will tell us, when take. I do not say that we ought not to have some gentlemen who are not members of the Council; but I do not think we go to him, ’’ I see you are abusing the Medical Act, and calling it a miserable Bill. You say that the bodies are quar- it would he right to commit ourselves to the proposition that relling among themselves, and doing all sorts of mischief. I none of the visitors should be members of this body. I think will have nothing to do with the Bill. Go away, and quarrel we should see what can be done by the procedure in which we among yourselves; do not come bothering me at the Home are now engaged, that of supervising the examinations of the Office." I say, if you adopt this resolution you will do the different licensing bodies. It is said that an improvement has utmost in your power to prevent the passing of a Medical Bill been already effected during the very short time these visitawhich is loudly called for and much required. Mr. Syme said tions have been in force. I can add my testimony to the same that the Edinburgh University had assessors to assess in their effect. Although I have been from various circumstances examinations. That, no doubt, is an excellent thing. That is unable to take that share in the visitations which I had invery different from establishing a new board and a new quali- tended, so far as my experience has gone, the effect of them fication. I say that this proposal would plunge us into chaos has been to improve the examinations generally. I would beg at the very moment when, out of the smoke that has been the Council to understand that those members who have not been engaged in the investigation can hardly know, and still rising about us, we see a gleam of light. Sir D. J. CORRIGAN.—I should not be justified in voting less can the public know, the many advantages which result against this resolution if I did not explain as briefly as pos- from these visitations, because many of the improvements that sible my reasons. This fact has already grown out of our dis- have taken place have been accomplished through private concussion, that Dr. Alex. Wood stated-and he was received versations amongst ourselves. with cheers-that the Act of 1858 was a wretched Act; and Dr. THOMSON.—Without entering into the details of this Dr. Bennett said that he looked upon the Amendment Act motion, I may say that I object to the form in which it is about to be introduced as not very much better, and that by brought before us. I think that the duty proposed to be a little delay we should, perhaps, obtain an Act that would be assigned to us is not a part of the proper functions of this acceptable to the profession and to the country. Now, with Council. At the same time I think that a much greater exthis expression of opinion from several sides of the table, we tension of the principle of combination among the different are placed in a very awkward position with regard to Mr. licensing bodies will be attended with the greatest possible Hardy; because, if we go to him on Thursday, we are in the benefit. As a teacher, I have observed that the education of ridiculous predicament of not being agreed among ourselves. medical students has been conducted of late years under great If a deputation is appointed, it must consist of persons who difficulties, especially on account of the great multiplication of entertain different views ; and it will be exceedingly awkward examinations. Some cure should be attempted for this evil. to find that those gentlemen necessarily contradict one an- I think that Dr. Acland’s proposal scarcely meets the case, other. I would suggest that it would be advisable to write at except in so far as it may tend to increase that combination once to Mr. Hardy, and to say that, considering the great among the bodies which would lead to the granting of a genelabour thrown upon him at this late period of the session, the ral qualification by a much smaller number of boards. Council have determined not to trouble him with a deputation. Dr. SHARPEY.—The object proposed by Dr. Acland is adNow, coming to the question before us, it raises a very impor- mirable, and if central examining boards could be established tant issue. I quite coincide with Dr. Acland, with Dr. Stokes, in the three kingdoms it would be a great advantage ; but the Dr. Alex. Wood, and Dr. Bennett in their expression that we question occurs to me, might we not, without going to the labour under great evils at the present time. But the admis- Legislature for increased powers, obtain practically something sion that evils do exist is a totally different thing from adopt- of this kind ? In England we are likely very soon to obtain ing a particular measure for the remedying those evils. I have it; in Scotland it is obtained already; I do not know what is read the resolution which Dr. Acland has laid before you, and, taking place in Ireland. It is not necessary that the indiin my opinion, it at once doubles the number of licensing bodies viduality of the different boards should be abolished or superin the The nineteen bodies at present existing will seded, but they might by combination obtain the object which be increased to thirty-eight ; and the thirty separate licences we have in view without going to the Legislature. I think any will be increased to sixty. The resolution states that it is such application at present would tend to frustrate our endeadesirable that the Medical Council should have power to com- vour to pass the Medical Bill upon which the Council has bine with any of the licensing bodies. Then, of course, it agreed. This is a much wider change than any that we have would have power to combine with them all. Now suppose, proposed, and we can scarcely expect to carry it without the in the first instance, it combines with the College of Surgeons consent of the medical corporations. It would never do to of Ireland, and then with the College of Physicians, then with introduce a measure into Parliament that was likely to be Apothecaries’ Hall, with Trinity College, and the University, opposed by bodies of influence. I do not say that the proposed in that case we shall have no less than ten boards. (No, no.) measure should be lost sight of, but we cannot entertain it as Yes we shall; for, if you look at the last few lines of the reso- a practical measure. It may, I think, form one of the subjects lution, it says " that nothing in this qualification shall debar to be referred to the Executive Committee, upon which they the holder from obtaining separate qualifications as at present." might report to the Council. Dr. EMBLETON.—I think the wisest plan to pursue would be Now, those powers remaining, have we not added nineteen licensing bodies to the nineteen already existing? But suppose that pointed out by Dr. Sharpey. At the present time, when we are about to seek an interview with the Government, I some of the bodies do not agree, then we have got double the number of those that do agree. Then the whole measure, in think it would be unwise to introduce any alterations in the my opinion, is useless; because if any of the bodies stand out present Bill. It would be an excellent thing to have the difthe whole measure falls to the ground. This is a very serious ferent corporations and universities united for the purpose of matter, for it sweeps away all the licensing bodies at once. It conducting medical education. Either the corporations might says that the qualification so conferred may be entered in the be united in each capital of the three divisions of the kingdom, Medical Register, and accepted by public bodies. I agree with or all the corporations in the three kingdoms might be united Dr. Andrew Wood that this is an interference with vested together. In either case you would reduce the number of exrights, and that it involves a very serious consideration. Mr. aminations. No doubt there are many practical difficulties in Syme has told us of the admirable method adopted at the the way, but the greatest benefit would result to the profession University of Edinburgh; but there is no analogy between the if such a combination could be carried out. It would be a great two cases. If I am right, Edinburgh gives no degree unless boon to students and to the public, and would very materially on an examination conducted in this way ; but the proposal save the time of the members of the Council, who, instead of of Dr. Acland is to establish another body, formed out of men having to supervise nineteen examinations, would only have who are called assessors or visitors. I will not detain the to visit three, or at the most six. The proposal seems to Council longer ; I will only express my regret that I cannot border upon revolution, and we are entering on a new phase in medical reform agitation. This appears to be an era in which support Dr. Acland’s motion. lTr. CooPEr thought that the visitations had proved very great things are accomplished by external pressure upon deliberative bodies. We have seen the effect of such a pressure to be continued. serviceable, and Dr. CHRISTISON.—We must be all satisfied that the object upon the House of Commons, and we may live to see the effect of this motion is a most excellent one. The question is whe- of it upon the Medical Council.

for the

use

suggestions

kingdom.

ought

744 Dr. BENNETT said he would propose as an amendment, That a committee be appointed to whom the subject of Dr. Acland’s proposition might be referred with a view of ascertaining how far it might be practicable to carry out the objects "

proposed.

Mr. HAWKINS.—There appears to be great difference of opinion as to the precise meaning of this motion. Sir D. Corrigan supposed that the Council are to have the power of combining with any one or two of the licensing bodies. But the combination of licensing bodies among themselves appears to be in part involved in this proposal. No doubt that is an excellent thing so far as it can be carried into execution, so as to diminish the number of examinations; but this motion says that the Medical Council is to have the power of combining ,with any of the licensing bodies by the appointment of visitors, assessors, or examiners conjointly with such bodies. This would be totally altering the constitution of the examining boards, and introducing entirely new boards. The motion states that the qualification so conferred shall be entered on the Medical Register. I do not know whether this applied to a great number or to one. This appears to be taken up as a State’s examination superseding all the others. Allusion has been made to the combination of two great bodies in London. They are now forming some joint rules that they will adopt for the benefit of the whole profession, and 400 or 500 persons may go up every year before them for examination. But what is the use of such a combination if there is to be this new board to which all practitioners are invited, and to which probably 99 in 100 would go ? I cannot vote for the clause as a whole, and feel great doubt whether I shall vote for the amendment referring the subject to a committee, interfering as it will materially with the success of the existing Bill, and leading in the Legislature to endless discussions and, perhaps, to the entire destruction of the Council, and of all the benefit it has hitherto

accomplished.

The PRESIDENT ruled, on a point of order, that Dr. Bennett having once spoken on the motion, could not at a subsequent period bring forward an amendment to meet this difficulty.

Mr. RuMSEY said he would propose the amendment of Dr. Bennett referring the subject to a committee. Dr. LEET seconded the amendment. Dr. ACLAND, in replying, thanked the Council for the calm and serious consideration it had given to his proposal. He denied that it was either revolutionary or novel, and said that the want of some system of combination had been recognised by every speaker, the only question being how it could be best effected. He had no desire to sweep awav existing institutions. Representing the University of Oxford, where but few medical degrees were granted, such a notion was absurd in the extreme. The combination must be a voluntary one. He did not believe that the passing of the motion would in any way interfere with the passage of the present Bill. The amendment was then put, and the numbers were-For, 11; against, 10. It was accordingly declared to be carried, and was put as a substantive motion. Sir D. CORRIGAN said it would be impossible for the Council to go to Mr. Hardy if the amendment passed as a substantive

motion. Dr. ANDREW WOOD opposed the motion, and maintained that the scheme proposed was utterly impracticable ; that it was like an invitation to the different bodies to join in a country dance with the Council, and that nothing but confusion would arise. It would be a mockery to go on with the Bill if such a motion were sanctioned. Dr. ALEX. WOOD said that the two questions were totally distinct, and that the passing of the motion need not interfere with the application to the Home Office. It was vain to expect that the Bill, when introduced into Parliament, would be passed unaltered. It would be pulled to pieces, and examined in all its details by every medical body and every medical politician, and it would be wise in the Council to be prepared beforehand by a consideration of Dr. Acland’s proposal and any others that might be brought forward, showing that they were ready to listen to any reasonable suggestion that might be made. Dr. QUAIN opposed the motion on the ground that it involved a roundabout mode of procedure. The motion was then put, and the numbers were-For, 11; against, 12. It was accordingly lost.

DR.

MASSEY, the chief of the sanitary department

of the army, has replaced Dr. Logan in the periodic inspection of the military hospitals in the Chatham and Woolwich district.

Reviews

and

Notices of Books.

&c. By THOMAS B. St. Thomas’s Hospital. Second Edition. pp. 204. London : Churchill and Sons. IT is nearly nine years since the first edition of this work appeared. Its author was well known then as a pathologist with much more than ordinary power of thorough work, and whose scrupulous accuracy in detail lent a peculiar value to any book which issued in his name. And time has only served to confirm the common estimate of Dr. Peacock’s powers; whilst his recent presidency of the Pathological Society was felt as especially appropriate, so intimately associated was his name with the progress and success of that admirable Society. The present work is well known to the profession as the most exhaustive treatise upon its subject ever yet published in English. It is only those accustomed to scientific labour, however, who can thoroughly appreciate the enormous amount of work that such a book as this represents. In the nature of things the volume is not one which appeals to the every-day reader, and it is not likely, therefore, to bring its author that general but fleeting popularity which is the common reward of many works of great repute and very little merit. But to the thoughtful student of science, whose constant observation of the human heart only serves to show him how completely in its infancy is still our knowledge of the organ, such a book as this is most acceptable. To the practitioner, also, the book commends itself as the best guide to the knowledge and prognosis of cases of malformation, many of which occasion no little perplexity as well as anxiety.

On Malformations of

the Human

PEACOCK, M.D., Physician

Heart,

to

S’urgeryOperations about the Face. By MAURICE HENRY COLLIS, M.B. Univ. Dubl., F.R.C.S.l., Surgeon to the Meath Hospital and County Dublin Infirmary, &c. Surgical Reports. By GEORGE H. PORTER, M.D. Univ. Dubl., F.R.C.S.I., Senior Surgeon to the Meath Hospital and County Dublin Infirmary, &c. THESE pamphlets are both reprints from the Dublin Quarterly Journal of Medical Science, and are abundantly illustrated with excellent lithographs and wood engravings. Mr. Collis narrates some interesting cases of plastic operation about the nose and mouth ; and gives the details of two extraordinary cases of disease in the nasal cavity: one of fibroplastic growth from the periosteum of the cavity, which, by means of a curved incision along the side of the nose and into the nostril, which permitted a flap of bone to be reflected so as to expose the growth, was removed with very little deformity; the other, a case of rare affection-exostosis of the vomer, which was also successfully removed. The latter part of Mr. Collis’s an résumé contains excellent of the literature of the pamphlet of removal of the for cancer, and includes operation tongue a table of no less than thirty-three cases of the operation by various surgeons. The several cutting methods proposed by Syme, Regnoli, and Collis, and the ecraseur operations of Nunneley, Paget, and Holt are described; and the author details a successful case operated upon by the last-named gentleman’s plan. Mr. Porter narrates and comments upon three interesting cases : 1, a case of epuloid disease of the upper jaw, successfully removed ; 2, a case of strumous disease of the elbow, for which excision was performed; and 3, a case of large epulis of the lower jaw, which was removed. These contributions to surgical knowledge by Dublin surgeons are of great value; and they reflect the highest credit upon the school from which they emanate. Contributions to Operative

*

A HANDSOME surgical pocket-case and ophthalmoscope

have this week been presented to Mr. J. J. H. Bartlett, late resident medical officer to the Kensington Dispensary.