+ All Categories
Home > Documents > ELECTION OF DIRECT REPRESENTATIVES TO THE GENERAL MEDICAL COUNCIL

ELECTION OF DIRECT REPRESENTATIVES TO THE GENERAL MEDICAL COUNCIL

Date post: 30-Dec-2016
Category:
Upload: dokiet
View: 212 times
Download: 0 times
Share this document with a friend
Embed Size (px)
of 2 /2
10 32 ELECTION OF DIRECT REPRESENTATIVES TO THE GENERAL MEDICAL COUNCIL. WE have been requested to publish the following address to the registered practitioners of England and Wales by Mr. Walter Rivington:- GENTLEMEN,—The great interest and active part which I have taken for the last thirty years in questions relating to medical education and examination, and my undeviating support of all measures tending to raise the status and the public estimation of the profession, will, I trust, justify me in accepting the invitation of the Association of Fellows and the Society of Members of the Royal College of Surgeons of England to come forward as a candidate for a seat in the General Medical Council. That I have had the greatest faith in the representative principle in its application to the medical profession is shown by the fact that in my Carmichael Essay on the medical profession, published in 1878 by the Royal College of Surgeons in Ireland, I advocated representation of the profession in the General Medical Council and in the various medical and surgical corporations. This advocacy was repeated and extended in my second Carmichael Essay published in 1887, and since that date I have worked hard as a member of the Council of the Royal College of Surgeons of England, in connexion with the Association of Fellows, and in other ways, both to increase the privileges of the Fellows and Members of the College and to obtain representation for the Members on the Council. In the essay of 1887 all current professional subjects were fully discussed and many suggestions for improvement made in all branches and departments of the profession, and to these I would ask you to allow me to refer as it is impossible to include all that might fairly be included within the limits of this address. 1. The keynote to all professional improvement-the plat- form of real import to every member of the profession- upon which I desire to stand or fall is the necessity, in the interests both of the public and of the profession- interests in reality identical-that the General Medical Council and the medical corporations should be in harmony and sympathy with the wants and aspirations of the pro- fession. This necessity has been acknowledged by most distinguished men both outside the profession and within it. The Royal Commission of 1881 recognised " the vital interest of the whole medical profession in the constitution of the General Medical Council," considered it highly important that the profession should have full confidence in the Council, and added : "The fact that the governing bodies of the medical corporations do not represent the great majority of practitioners makes it advisable to give the general prac- titioner an effective voice in the body which would be the principal authority of the medical profession." Notwith- standing this pronouncement from such men as the Earl of Camperdown, the Bishop of Peterborough, Wm. Henry Ford Cogan, Sir George Jessel, George Sclater-Booth, Sir William Jenner, John Simon, Thomas Henry Huxley, Dr. Robert McDonnell, William Turner, and James Bryce, obsolete objections to the adequate representation of the pro- fession, and even to any representation at all, still prevail in many of our medical bodies. This lamentable distrust of an educated constituency will disappear as soon as the principle is established that the representatives chosen by the medical corporations should represent effectively, not merely the views of their governing oouncils, but also the interests of the constituencies of the corporations. An example has been set through the recent action of the Fellows of the Royal College ot Surgeons of England at their last half-yearly meeting. A resolution was then moved by Mr. Timothy Holmes, seconded by Mr. George Jackson of Plymouth, and carried nem. con. : "That the Council be requested to instruct its representative on the General Medical Council to forward in every way which seems feasible the objects of the Civil Rights Defence Committee in the case of Mr. R. B. Anderson." When this resolution was reported to the Council by the President the Council without demur instructed its representative in accordance therewith. A great effort is now being made by the Civil Rights Defence Committee to induce other bodies corporate and universities to act upon that view on the ground of common interest. If this principle were in full operation you will readily perceive that we should have twenty representatives of constituencies, some small, some very large, comprising the whole profes- sion, and all of them would be as fully impressed with the requirements and interests of the profession as a whole as with any of those separate interests which so often prove to be conflicting. If this principle cannot be established the only ways to secure the conditions specified by the Com- mission of 1881 would be a sufficient increase in the number of direct representatives of the profession in the Council or a redistribution of seats. Reinvigorated by closer contact with the profession directly or indirectly, like Antæus by contact with his mother earth, the General Medical Council would use more freely its extensive and beneficent powers and be able to obtain further powers no less essential to the welfare of the public and of the medical profession. 2. To the lack of professional support-to the absence of the force of numbers behind it-must be attributed the slow progress of the reforms initiated by the General Medical Council and its inability to control recalcitrant corporations and to effect the objects for which it was established. Of the three objects aimed at by the Medical Act of 1858-viz. : (1) to enable the people to distinguish between qualified and unqualified practitioners ; (2) to establish uniformity of education and examination throughout the United Kingdom; and (3) to secure complete reciprocity of practice in all parts of the United Kingdom-the last only can be said to have been achieved with any degree of completeness. (a) The first object has not been attained by the publication of the Medical Register, for this has not taught the public the elementary fact that chemists have not received any medical education and do not possess any medical skill, whilst the famous 40th Clause, which was not so framed as to prohibit unqualified practice altogether, does not afford to the profession sufficient protection against the encroachments of quacks, herbalists, bone-setters, counter-prescribing chemists and others, and requires to be made more direct and effective. The effect of such an amendment would be greatly increased by more stringent provisions for the registration of deaths, including stillbirths. (b) Towards the attainment of the second object im- portant advances have been made by the General Medical Council. Yet after thirty-eight years’ work, the difficulty of which has not always been sufficiently recognised, and after the passing of a second Medical Act to facilitate voluntary combination of corporations, the General Medical Council has not accomplished that great aim of medical reformers, the establishment of a single conjoint examining board in each division of the United Kingdom with uniformity of examinations and educational requirements and equality of fees. The abolition of the evil of competing examining boards in London and Dublin has been prevented by the disincli- nation of Royal colleges to combine with the Societies of Apothecaries. Against the Apothecaries’ Society of London, which had medical obligations thrust upon it by the colleges in 1815, the hearts of the two Royal colleges have been hardened, and to the Apothecaries’ Hall in Dublin King and the Queen’s College of Physicians has had an aversion insuperable, whilst the idea has been entertained that by excluding the apothecaries’ societies they would perish from inanition as medical authorities. It has not been recognised that absorption of those bodies would have been the nobler and more effective policy, and would have prevented the com- plications which have arisen in regard to the Apothe- caries’ Hall of Dublin, complications of which the remedy now, as Sir Walter Foster pointed out, would be the establishment of a strong conjoint board of examination in Dublin by the three licensing corpora- tions. That all that is required in the interest of the public and the profession can now be effected without amending the Act of 1886 so as to give more power to the General Medical Council and without increased direct representation of the profession is very doubtful, for in February, 1887, the Council was unable to induce the Royal colleges in London to combine with the Apothecaries’ Society, although the following strong resolution was passed :- "As it would be contrary to the interests of the public to have two competing examining boards sitting in London, and as it would be desirable that tne Roval College of Physicians of London, and the Royal College of Surgeons of England, and the Apothecaries’ Society of London should arrange to hold a
Transcript
Page 1: ELECTION OF DIRECT REPRESENTATIVES TO THE GENERAL MEDICAL COUNCIL

10 32

ELECTION OF DIRECT REPRESENTATIVESTO THE GENERAL MEDICAL COUNCIL.

WE have been requested to publish the following addressto the registered practitioners of England and Wales byMr. Walter Rivington:-

GENTLEMEN,—The great interest and active part which Ihave taken for the last thirty years in questions relating tomedical education and examination, and my undeviatingsupport of all measures tending to raise the status and thepublic estimation of the profession, will, I trust, justify mein accepting the invitation of the Association of Fellows andthe Society of Members of the Royal College of Surgeons ofEngland to come forward as a candidate for a seat in theGeneral Medical Council. That I have had the greatestfaith in the representative principle in its application tothe medical profession is shown by the fact that in myCarmichael Essay on the medical profession, published in1878 by the Royal College of Surgeons in Ireland, Iadvocated representation of the profession in the GeneralMedical Council and in the various medical and surgicalcorporations. This advocacy was repeated and extended in mysecond Carmichael Essay published in 1887, and since thatdate I have worked hard as a member of the Council of theRoyal College of Surgeons of England, in connexion withthe Association of Fellows, and in other ways, both toincrease the privileges of the Fellows and Members of theCollege and to obtain representation for the Members onthe Council. In the essay of 1887 all current professionalsubjects were fully discussed and many suggestions forimprovement made in all branches and departments of theprofession, and to these I would ask you to allow me torefer as it is impossible to include all that might fairly beincluded within the limits of this address.

1. The keynote to all professional improvement-the plat-form of real import to every member of the profession-upon which I desire to stand or fall is the necessity, inthe interests both of the public and of the profession-interests in reality identical-that the General MedicalCouncil and the medical corporations should be in harmonyand sympathy with the wants and aspirations of the pro-fession. This necessity has been acknowledged by mostdistinguished men both outside the profession and within it.The Royal Commission of 1881 recognised " the vital interestof the whole medical profession in the constitution of theGeneral Medical Council," considered it highly importantthat the profession should have full confidence in the

Council, and added : "The fact that the governing bodies ofthe medical corporations do not represent the great majorityof practitioners makes it advisable to give the general prac-titioner an effective voice in the body which would be theprincipal authority of the medical profession." Notwith-

standing this pronouncement from such men as the Earl ofCamperdown, the Bishop of Peterborough, Wm. Henry FordCogan, Sir George Jessel, George Sclater-Booth, Sir WilliamJenner, John Simon, Thomas Henry Huxley, Dr. RobertMcDonnell, William Turner, and James Bryce, obsoleteobjections to the adequate representation of the pro-fession, and even to any representation at all, still prevailin many of our medical bodies. This lamentable distrust ofan educated constituency will disappear as soon as the

principle is established that the representatives chosen bythe medical corporations should represent effectively, notmerely the views of their governing oouncils, but also theinterests of the constituencies of the corporations. Anexample has been set through the recent action of theFellows of the Royal College ot Surgeons of England at theirlast half-yearly meeting. A resolution was then moved byMr. Timothy Holmes, seconded by Mr. George Jackson ofPlymouth, and carried nem. con. : "That the Council berequested to instruct its representative on the GeneralMedical Council to forward in every way which seems feasiblethe objects of the Civil Rights Defence Committee in thecase of Mr. R. B. Anderson." When this resolution was

reported to the Council by the President the Council withoutdemur instructed its representative in accordance therewith.A great effort is now being made by the Civil Rights DefenceCommittee to induce other bodies corporate and universities toact upon that view on the ground of common interest. If thisprinciple were in full operation you will readily perceive that

we should have twenty representatives of constituencies,some small, some very large, comprising the whole profes-sion, and all of them would be as fully impressed with therequirements and interests of the profession as a whole as

with any of those separate interests which so often prove tobe conflicting. If this principle cannot be established theonly ways to secure the conditions specified by the Com-mission of 1881 would be a sufficient increase in the numberof direct representatives of the profession in the Council ora redistribution of seats. Reinvigorated by closer contactwith the profession directly or indirectly, like Antæus bycontact with his mother earth, the General Medical Councilwould use more freely its extensive and beneficent powersand be able to obtain further powers no less essential to thewelfare of the public and of the medical profession.

2. To the lack of professional support-to the absence ofthe force of numbers behind it-must be attributed the slow

progress of the reforms initiated by the General MedicalCouncil and its inability to control recalcitrant corporationsand to effect the objects for which it was established. Ofthe three objects aimed at by the Medical Act of 1858-viz. :(1) to enable the people to distinguish between qualified andunqualified practitioners ; (2) to establish uniformity ofeducation and examination throughout the United Kingdom;and (3) to secure complete reciprocity of practice in allparts of the United Kingdom-the last only can be said tohave been achieved with any degree of completeness.

(a) The first object has not been attained by thepublication of the Medical Register, for this has nottaught the public the elementary fact that chemistshave not received any medical education and do notpossess any medical skill, whilst the famous 40th Clause,which was not so framed as to prohibit unqualifiedpractice altogether, does not afford to the professionsufficient protection against the encroachments ofquacks, herbalists, bone-setters, counter-prescribingchemists and others, and requires to be made moredirect and effective. The effect of such an amendmentwould be greatly increased by more stringent provisionsfor the registration of deaths, including stillbirths.

(b) Towards the attainment of the second object im-portant advances have been made by the General MedicalCouncil. Yet after thirty-eight years’ work, the difficultyof which has not always been sufficiently recognised,and after the passing of a second Medical Act tofacilitate voluntary combination of corporations, theGeneral Medical Council has not accomplished thatgreat aim of medical reformers, the establishment of asingle conjoint examining board in each division of theUnited Kingdom with uniformity of examinations andeducational requirements and equality of fees. Theabolition of the evil of competing examining boards inLondon and Dublin has been prevented by the disincli-nation of Royal colleges to combine with the Societiesof Apothecaries. Against the Apothecaries’ Society ofLondon, which had medical obligations thrust upon itby the colleges in 1815, the hearts of the two Royalcolleges have been hardened, and to the Apothecaries’Hall in Dublin King and the Queen’s College of Physicianshas had an aversion insuperable, whilst the idea hasbeen entertained that by excluding the apothecaries’societies they would perish from inanition as medicalauthorities. It has not been recognised that absorptionof those bodies would have been the nobler and moreeffective policy, and would have prevented the com-plications which have arisen in regard to the Apothe-caries’ Hall of Dublin, complications of which the

remedy now, as Sir Walter Foster pointed out, wouldbe the establishment of a strong conjoint board ofexamination in Dublin by the three licensing corpora-tions. That all that is required in the interest of thepublic and the profession can now be effected withoutamending the Act of 1886 so as to give more power tothe General Medical Council and without increaseddirect representation of the profession is very doubtful,for in February, 1887, the Council was unable to inducethe Royal colleges in London to combine with the

Apothecaries’ Society, although the following strongresolution was passed :-

"As it would be contrary to the interests of the public tohave two competing examining boards sitting in London, andas it would be desirable that tne Roval College of Physicians ofLondon, and the Royal College of Surgeons of England, andthe Apothecaries’ Society of London should arrange to hold a

Page 2: ELECTION OF DIRECT REPRESENTATIVES TO THE GENERAL MEDICAL COUNCIL

1033

qualifying examination conjointly, the Council strongly recom-mend to these bodies to re-consider their position with a viewto such arrangement."Had professional opinion been fully reflected in the

General Medical Council and the Corporations, theinterests of the public, which are identical, as I havesaid, with the interests of the profession, would nothave been sacrificed to corporate antagonisms and dis-likes, and the establishment of a single examiningboard in each division of the kingdom would now bean accomplished fact.

3. The interests of the profession and of the general publicequally require that the rights guaranteed to registeredpractitioners under the Medical Acts in order to secure themost eligible men for the service of the community shouldbe preserved inviolate. In the case of Mr. R. B. Andersonthese rights were violated illegally and of malice prepenseby the judges in a West Indian colony, and although ruinedby judicial persecution he is denied redress and deprived ofthe damages (£500) awarded to him by a Middlesex jury onthe ground that the violation of his rights were judicial acts.If such wrongs can be inflicted as judicial acts on one medicalman they can be inflicted on any other medical man, andtherefore the Acts guaranteeing these rights become to thatextent a dead letter and the inducements held out becomeillusory. Hence it becomes the duty of the General MedicalCouncil to take steps to secure the fulfilment of theseinducements of which it is the channel as the authority forcarrying the Medical Acts into execution.

4. The overcrowding of the profession, which causes suchsevere competition as to induce men to accept ill-paidappointments and degrading positions in connexion withmedical aid associations and to undertake professionalengagements on conditions which do not admit of their

proper discharge, would be remedied. "....

(a) By maintaining ana raising tne stanaara both orthe preliminary and professional examinations.

(b) By diminishing the area of unqualified practiceand hospital abuse.

(c) By extending and elevating the Poor-law andsanitary medical services-in fact, by creating a civilmedical service with responsibility to central instead ofmere inferior local authority, adequate pay and pensions,satisfactory terms of promotion, retirement and rewardfor distinguished service, and tenure of office duringgood behaviour in all medical appointments.

The General Medical Council might fairly use its influencein support of the adoption of such improvements, sincethey would raise the status of the profession, diminishthe number of disciplinary cases, and greatly benefit thecommunity by supplying skilled medical service to thosewho now employ quacks and ignorant midwives. To mag-nify its office occasionally would ensure the sympathy andsupport of the profession and increase its influence withthe State, and is certainly a superior policy to that de-clared attitude of indifference to the interests of the

general practitioner which alienates the profession andcauses the good work which the Council undoubtedlyperforms to be insufficiently appreciated.

5. With regard to the proposed registration of midwives ormidwifery nurses, and certificates granted, or to be granted,to the same persons, the following facts should be borne inmind. The Medical Act of 1858 provided for the admissionto the Medical Register of any practitioner possessingeither a medical or a surgical diploma. Midwifery did notreceive recognition as an integral part of medicine andsurgery, childbirth being still regarded as a natural functionwhich any one might superintend; but, either by accident ordesign, separate midwifery qualifications were inserted inSchedule A as entitled to be registered. The consternationcreated in 1876, when it was found that certain ladies couldnot be refused admission to the examination for the special ’qualification in midwifery at the Royal College of Surgeonsof England, and if possessed of this licence could be regis- tered, engage in practice, and recover their fees, will not beforgotten. The spirited resignation of the Examiners in (Midwifery alone prevented this result. The Medical Act of ]1886 reformed this altogether and provided that a personshould not be registered unless he had passed a qualifying examination in medicine, surgery, and midwifery. Thusmidwifery has been inseparably joined by statute tomedicine and surgery, and any countenance that may now be given to the independent practice of ‘midwifery without qualification, equally in medicine,

surgery, and midwifery, will directly contravene both thespirit and letter of the Medical Act of 1886. The ten tofifteen thousand ignorant midwives in England and Walesare ten to fifteen thousand too many, and the 450,000 to600,000 cases of childbirth annually attended by them arequite lost to medical education and medical practice. Torescue the poor from the operations of ignorant midwivesand to reclaim as far as possible the cases attended by them,since no confinement can be described as natural until it is

normally concluded, proper medical attendance and obstetricnursing, where not already provided, should be placed withinthe reach of all poor child-bearing women. For the inde-

pendent and ancient midwife should be substituted medicalpractitioners, medical students at the end of their third orfourth year acting as assistants to such practitioners, afterpassing a qualifying examination, and obstetric nurses undermedical control. The assistants referred to, however, shouldnot be permitted to take sole charge of patients or to signdeath certificates. In this way, while the interest of prac-titioners would be enlisted in the cause of medical educa-tion, all the advantages without any of the disadvantages ofthe old apprenticeship system could be secured, and un- .

qualified assistants and midwives as independent practitionerswould become extinct.These are some of the goals which earnest effort is re-

quired to reach and the attainment of which will be pro-moted by the strength of professional opinion which maylie behind the representatives whom you may elect. I thankthe Association and the Society for the honour done me ininviting me to stand for the General Medical Council on sucha platform and for the generous and gratifying recognitionthat their principles and objects are my own. Without theinvitation of a body of general practitioners like the Societyof Members of the College I should not have ventured tocome forward, much as I sympathise, and have always sym-pathised, with the difficulties and aspirations of the profes-sion at large. With the support of the Society I am

encouraged to solicit the confidence and votes of the greatbody of Members of the College who are general practitionersand of all fellow practitioners not already pledged.

I am, gentlemen, yours faithfully,WALTER RIVINGTON,

M.S., M.B., B.A. and Fellow (Member of Senate) of the Univer-sity of London, L.S.A., F.R.C.S. Eng., 3lember of theCouncil of the Royal College of Surgeons of England, Oneof the Representatives of the Council on the Civil RightsDefence Committee, and Vice-President of the Associationof Fellows, Royal College of Surgeons of England.

A MEETING of general medical practitioners in support ofthe candidature of Dr. F. H. Alderson as a direct repreeenta-tive on the General Medical Council was held on Tuesdayafternoon, the 6th inst., at 299, Lavender-hill, by the kindpermission of Dr. Barkwell. Dr. Alderson addressed the

meeting at length on the principal subjects which he con-sidered called for notice-viz., the amendment of theMedical Act, the reform of hospital and other kindredmedical charities, the sweating of the profession by so-calledmedical aid associations, the inadequate number of directrepresentatives (general practitioners) on the General MedicalCouncil, and in particular the safeguarding the professionfrom any invasion by midwives. A vote of confidence inDr. Alderson was passed.

OPENING OF THE MEDICAL SCHOOLS.

MOST of the London medical schools, whether the formalintroductory address to students has fallen into desuetudeor not, have inaugurated their winter session with a dinnerattended by the past and present students or some othersocial gathering. Among the exceptions must be notedUniversity College Hospital, where no function took placeout of respect to the memory of Sir John Eric Erichsen, thelamented President of the College, whose death has occurredso recently.

ST. BARTHOLOMEW’S HOSPITAL.The dinner of the old students of this foundation was

held in the great hall of the hospital on Oct 1st. Includingvisitors about 120 persons were present, and Dr. Champneyswas in the chair. Among the invited guests were


Recommended