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MARYLEBONE MEDICAL AND SURGICALASSOCIATION.

A NUMEROUS meeting of the members of this association wasikeld on the 23rd of this month,-the President, Mr. PENNING-ToN, in the chair. The chief object of the meeting was to con-sider the propriety of publishing a " manifesto," which had beendrawn up by a sub-committee appointed for that purpose. - Itappeared from the minutes, and from conversation which tookplace, that a deputation from the society had waited on the

Apothecaries’ Company, with the view of ascertaining what werethe intentions of that body in reference to the movement at

present taken by the profession. The deputation put a series ofvery important questions to the society to answer, which thatbody requested time to consider. In a subsequent communication,the society informed the association that a committee was con-sidering the details of a bill which they were about to submit tothe profession, and which was founded on broad and liberalprinciples, without any reference to their corporate or otherprivileges. Under these circumstances, and being anxious to

adopt some mode of proceeding in which the profession in generalmight join, it was determined to issue the " manifesto" abovealluded to. After a lengthened and animated discussion, inwhich several of the members joined, the " manifesto," with somealterations, was adopted, and it was resolved to take means tocirculate it through the country. After giving an elaborate

description of the present condition of the profession, and moreparticularly of the general practitioner, and shewing what shouldbe the proper objects of legislation in medical affairs, and thatthese objects were not fulfilled by Sir James Graham’s bill, the" manifesto," in reference to the general practitioner, proceedsthus :

" 31. That the first step towards procuring a prompt andefficient remedy for the evils that afflict this large and importantclass in the profession,-the anomaly of position, the defects ineducation, the want of defined privileges and protection,-is, un-questionably, for the great body of general practitioners in thekingdom to combine and form a society of their own.

" 32. That, manifestly, nothing would so effectually secure

the public interests, as the establishment of A COLLEGE OF GENE-BJUL. PRACTITIONERS IN MEDICINE, SURGERY, AND MIDWIFERY,and, therefore, that the further object should be to obtain a.charter of incorporation, and a new act of parliament, or a modi-fication of some existing act, giving an elective Council andCourt of Examiners, with power to frame by-laws, and toexamine and license all future general practitioners.

" 33. That nine-tenths of the profession being general prac-titioners, acknowledging the authority of such a council, andbeing made responsible to it for the integrity of their profes-.sional conduct,’ also receiving from it, and from the laws of thecountry, protection in their professional rights,’ the abuses atpresent existing in the mode of carrying on practice would beeffectually, although progressively, corrected. Its immediateeffect would be a fair adjustment of the respective interests of thechemist and druggist and the professional man, at once putting aStop to many of the practices derogatory to the character of thelatter. It would lead, at the same time, to the requisite improve-ments in the education of the general practitioner, securing tothe public an ample supply of medical men, of the highest attain-ments practicable, upon a gradually increased standard of qualifi-cation, but not so high as to act as a prohibition, and to constitutea monopoly.

" 34. That various plans for securing unity of purpose andaction, for the accomplishment of the desired object, have beensuggested.

" (1.) By the general practitioners consenting to accept thetitle of licentiates in medicine and surgery, as afforded bySir James Graham’s bill.

" (2.) By their adhering to the interests of the College ofSurgeons.

" (3.) By uniting their interests to preserve and augment thepowers deputed to the Society of Apothecaries.

" (4.) By a combined effort on the part of the general prac-titioners in medicine, surgery, and midwifery, to obtainfor themselves an independent organization.

" 35. That the objections to the first of these plans have beensufficiently set forth in the preceding pages.

" That the association at present sees, with regret, very littleprospect of practical good under the second head. The same ab-

jection exists to the College of Surgeons continuing the controlof the education of the future general practitioners, as to themixed board proposed in Sir James Graham’s bill. Under thecharter, two grades of surgical practitioners have been reco-

gnised. The higher grade, or fellows, constituted ab iii-itio

mainly of hospital surgeons, for the most part takes the positionof consulting practitioners. This grade only is represented in tMcouncil. Their obvious interests will be, to make the standardof qualification for the fellowship as high as possibleņsuf&eientiyhigh to constitute it a monopoly. They will have an equalinterest in keeping the general practitioners at as great a distanceas possible from themselves; to make the standard of qualifica-tion for the licentiateship in surgery-the lower grade-as low aspossible. Self-interest must be continually opposed to the publicgood. Every possible excuse will continue to be framed, andacted upon, to prevent the great body of surgeons being place!upon an equality with themselves.

" This is obvious, from the letter of the charter, and from thespirit with which its provisions have been carried into effect bythe council of the college.

" That, with the consent and co-operation of the Apothecaries*Company, and some such alteration as the following in its con-stitution, the third proposal might effect the desired object. -

" The company agreeing to separate the professional from thetrading part of their functions, to procure a modification of theiract of parliament, with increased powers, or a new Act to re-gulate the general Practice of Medicine, Surgery, and Mid-wifery.’ To admit into their professional body, to the fullestextent that may be necessary to avoid the imputation of injusticefrom retrospective legislation, every person legally practisingmedicine generally at the present time ; to allow every memberof two years’ standing as a practitioner the privilege of a vote, inthe election from his own body of a council and court of exa-miners. The present examiners to continue their appointments;their number to be increased from twelve to eighteen or twenty-four ; and the whole, or a part of those newly elected, to bemembers of the College of Surgeons, and of undoubted ability assurgeons; the council and court of examiners to frame by-laws;to examine candidates for their diploma in every branch of medi.;..cal science necessary to insure the competency of the futuregeneral practitioner; the fee for examination and admission topractise as a general practitioner to be increased-say, to .624-which would be a saving to the student of .68, since he now paysS32 ; the professional education to extend over a period of five otsix years, and no candidate in future to receive the licence untiltwenty-two years of age.

" This leaves the College of Physicians as it is; it makes theCollege of Surgeons what the council and the governmentwould appear by their acts to desire it to be-a college of puresurgeons, and it would virtually give a college to the general prac-titioner.

" That the fourth proposal is the most comprehensive, andwould immediately and completely satisfy the wants of the greatbody of general practitioners, and serve the public interests atstake, in the medical questions now at issue; but it is open to theobjection-that there being already so many licensing bodies, toconstitute a new one is only to introduce a new element of con-fusion into our medical polity, and that for several obvious rea-sons it might prove more difficult to carry into effect than the onewhich precedes it. The consent and co-operation of the Apothe-caries’ Company might invalidate these objections.

" 36. That it has been further suggested, for the purpose of in-suring unanimity on these important topics, that each local assco-ciation throughout the kingdom should select one or more dele,-gates, to meet three months hence in London, with power toagree upon one general plan of operations, both in opposingthe bill, and at the same time in bringing forward a liberaland comprehensive plan for the government of the generalpractitioner, and that the Medical and Surgical Association atthe borough of Marylebone is of opinion this suggestion deserve-attention.

"37. That the standard of qualification in a new college ofgeneral practitioners of medicine and surgery, or under a newact of parliament, should be such as to justify the College ofPhysicians in admitting every general practitioner, after havingattained a certain age, as at present, on due examination, andwithout any further compulsory educational course, to be ad-mitted as a physician ; and in like manner to justify the Col-lege of Surgeons, after a certain number of years, on- dueexamination, and without any further compulsory education, toadmit any general practitioner to become a fellow of the Collegeof Surgeons.

" 38. That the facts and considerations herein contained applymore especially to the practice of medicine in England, but it is

desirable to secure uniformity of education for the general practi-tioner, with a licence to practise in any part of the United King-dom. For this purpose an agreement between all the licensingbodies, or a parliamentary enactment, is necessary. Any practi-tioner having obtained the diploma of one licensing body should

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have the right of practising within the jurisdiction of either ofthe others, upon authenticating his testimonials, and probablypaying a small fee.

° 39. That a national board, or central Council of Health, inthis country, is a great desideratum ; but neither the mode offormation nor the functions of such a council as set forth in SirJames Graham’s bill can be approved of. A Council of Healthshould have nothing to do with medical distinctions, or the detailsof medical education ; its duty should be to register all legally-qualified practitioners ; it should be constituted chiefly of eminentmedical men, competent judges in all the departments of medicalscience ; it should be empowered to receive information from re-gistered practitioners, of the outbreak of contagious and malignantdiseases, and of the occurrence of nuisances, interfering with thehealthiness of localities and districts, and to publish whatever in-formation circumstances might render necessary for the mainte-nance or recovery of the public health; to prosecute individualsin the name of the Queen, who commit any breach of the lawsin force for the preservation of the public health, as those creatingnuisances, or practising medicine without a licence; it shouldadvertise yearly a list of all the drugs, medicines, and chemicalswhich, on proper inquiry, are found to be virulent poisons, andwhich none but qualified medical practitioners are allowed to ad-minister or prescribe; it should be responsible to the country forthe appointment of competent medical officers for medico-legalihvestigations, so as to render as efficient as possible that depart-ment of the administration of justice called medical jurispru-dense and, in fine, it should embrace all the considerations ofpublic hygiene.

" A Council of Health might also, with great advantage to thecommunity, be empowered to constitute a National MedicalRecord Office,’ framing formulse for the registration, on an uni-form plan, of cases occurring in the public hospitals, and requir-ing a return to be made, according to such forms, of everyase admitted into these institutions. These records, like thetablets of the Asclepiadse, but under the advantages of modernscience, would, in process of time, form a monument of prac-tical medicine. They would enlarge the boundaries of medicalstatistics. They should be public documents, and open, on pay-ing a small fee, to the inspection of every qualified medical prac-titioner.. 40. That the association has abstained from entering intothe question of medical reform, as it affects the different classesof the profession more generally; nor has it, in this document,attempted to analyze completely the bill introduced into par-liament by the Home Secretary. It has confined itself as

nearly as possible to the fundamental principle, as far as thepublic welfare is concerned, that the legislature is bound tosecure to the people of this country a numerous, efficient, fairly-3emunerated, and truly respectable body of functionaries;’ andthat, in the existing state of society, these must necessarily con-sist of a body of general practitioners in medicine, surgery, andmidwifery.

(Signed) " R. R. PENNINGTON, President." "

" On perusal of this manifesto,’ correspondence and counselas to ulterior proceedings are invited from the different associa-tions now forming throughout the kingdom, addressed to the com-mittee, under cover, to the Hon. Secretary,

" W. O’CoNNOB, Esq." 69. George-street, Portinan-square.11

- The plan developed in the document just quoted met with themost cordial approbation of the entire meeting.

LAMBETH AND SOUTHWARK.

A general meeting of the members of the medical professionresident in Southwark, Lambeth, and the vicinity, was held, onthe 24th ult., at the lecture-room of the Southwark Literary In-stitution. Dr. SILVESTER, of Clapham, presided. There wereabout three hundred present, including all the leading generalpractitioners in the district, besides several physicians and con-aulting surgeons ; among the former of whom we recognised threeof the physicians attached to Guy’s Hospital.The CHAIRMAN, in addressing the meeting, commented on the

deep interest of the subject they had met to discuss, and on itsvital importance to the public. As regarded the profession, itwas almost a question of its existence. It was a mistake to sup-pose that the bill of Sir James Graham affected only the generalpractitioner, the interest of every branch of the profession was,on the contrary, at stake. In the first clause of the bill variousacts were repealed, and among. others the Apothecaries’ Act,which had done much general good, having raised up anew orderof medico men, equal to the physicians in everything but name.

It had been said, that Sir James Graham brought in his bill at theclose of the session in order to give the profession an opportunityof discussing its merits. So far they were indebted to the HomeSecretary, whom he (Dr. Silvester) believed was friendly to theprofession, and would listen to the suggestions made, and adoptsuch modifications of his measure as were deemed advisable bythose who had the best means of giving a sound opinion on thesubject. (Cheers.)

Dr. GREENWOOD, of Horsleydown, proposed the first resolu-tion. In doing so he took the opportunity of reviewing thestruggles for medical reform which had been going on for nearlyhalf a century: the association of the apothecaries in 1812, thepassing of the Apothecaries’ Act in 1815, the beneficial effects ofthat measure, and its influence on the production of the presenthighly educated class of general practitioners. An opinion,however, had gradually grown up since 1815, and had nowbecome universal, that some general measure was required to re-gulate the profession generally. With the view of carrying sucha measure a great deal had been done and tried, hitherto, how-ever, without success. The failure of the bills of Messrs. War-burton and Hawes, and the heads of other measures propoundedby various associations, shewed that it was useless to attempt theintroduction of any general measure without interesting thegovernment in the question. The government had at lengthbecome interested, and the result was, the measure of Sir JamesGraham.’JIJ.aJ.J.Q,U.l.

Resolved,-" That this meeting, impressed -with the urgentnecessity for legislative interference for the better regulation ofthe medical profession, views with satisfaction the introduction ofa measure for that purpose by Sir James Graham."Mr. HOOPER seconded the resolution. He was thankful to Sir

James Graham for bringing in a bill; but here his satisfactionended, for in this bill the general practitioner, whom it was evi-dently intended to degrade, was not even mentioned. He believedthat Sir James Graham meant to do good, but the Home Secretaryhad evidently been " earwigged," as Mr. Wakley had said, bypersons by no means friendly to the great body of the profession.He (Mr. Hooper) objected to the repeal of the Apothecaries’ Act,unless some more efficient protection was afforded. He objectedto the constitution of the Council of Health; indeed, the bill pos-sessed so much of evil that he feared it contained little of good.(Cheers.)

Mr. PRIOR, of Walworth, here, amid much interruption andlaughter, proceeded to make some comments on the Apothecaries’Company, and on the treatment of general practitioners by physi-cians and pure surgeons ; after which

Mr. DENDY rose to propose the second resolution. He spokeof the difficulty of legislating for a body in such an anomalouscondition as the medical profession. The bill of Sir James Gra-ham possessed good and bad points. He (Mr. D.) consideredthat the present condition of the general practitioner was owing tothe Apothecaries’ Company, for though that body had acted withthe best intentions, and raised the standard of the general practi-tioner by the enforcement of a curriculum of study, yet they hadlinked the profession with a trade. He thought much evil hadbeen done to the profession by members of it keeping open shops.He considered it absurd to suppose that we could not do awaywith quackery by penal enactment; it was as absurd not to legis-late for the suppression of quackery as it would be to do awaywith punishment for murder because murders were occasionallycommitted. He spoke of the necessity of unanimity, and of a meet-ing of delegates from all the societies in existence, shewing to thegovernment what were the combined wishes of the profession.Resoled,-" That while some of the provisions of the bill are

excellent, it contains others which, if passed into a law, would begreatly to be deplored."

Mr. DApviL.TL, of Walworth, seconded the resolution. Let itbe recollected that " union was strength." The profession owedall its evils to its disjointed condition. This disunion encouragedthe enemies of the profession to give bad advice to those high inpower.

Mr. HAVERS, of Lambeth, in a powerful speech, proposed thethird resolution, and Mr. CHURCHILL, of Clapham-road, secondedit.

Resolved,-" That the abrogation of all laws which enforce anexamination as a test of medical competency, and the removal ofall restrictions on illegal and unqualified practice, would not onlybe destructive of the respectability of the profession, but wouldbe highly detrimental to the interests and health of the commu"nity."The fourth resolution was proposed by Mr. GAZEMns, who

entered into an elaborate review of the entire bill, and forcibly o1J..served how in many particulars it was injurious to the interests ofthe general practitioner.