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GENERAL COUNCILOF

MEDICAL EDUCATION AND REGISTRATION.

Session 1866.

ROYAL COLLEGE OF PHYSICIANS.

THE programme of the business on the paper for the pre-sent session of the Medical Council includes subjects of greatimportance. The report from the English Branch Councilof the visitation of examinations in England will be among themost interesting documents to be brought forward. This re-

port will be presented in accordance with the resolution movedby Mr. Syme and seconded by Dr. Andrew Wood, and whichwas adopted as a sort of compromise of the more thorough andsystematic visitation proposed by Dr. Parkes. It was as fol-lows : " That each of the Branch Councils, or such of theirmembers as may be deputed by such Councils, shall from timeto time visit the examinations, preliminary as well as profes-sional, conducted by the qualifying bodies in their respectivedivisions of the United Kingdom, and report the results oftheir observations to the General Council." The value of the

report will of course depend upon the frankness and couragewith which the visitors may feel at liberty to describe officiallydefects which individually all must recognise in the examina-tions conducted by certain of our English examining bodies.A communication announced from the Director-General ofthe Navy, with returns, will also be an interesting docu-ment ; for if it fully describe the real state of affairs, theexposure will be a sad one. Dr. Alexander Wood has anotice of motion: ’’ That when the sittings of the Councilshall extend over a Saturday, the Council shall on that dayassemble at ten A.M., and adjourn at one P.M." But themotion is really hardly likely to be pressed seriously, for theproposition that the London members shall sacrifice their

morning engagements from ten till one o’clock, for the sake ofgiving a half-holiday to their visitors from the North, is pre-posterous and unreasonable. Dr. Mackesy, president of theIrish Medical Association, has addressed a letter to the Councilrelative to defects in medical education-based, we believe,upon some remarks and statements which we have recentlymade. It would seem convenient and desirable that this let-

ter, which is marked as the tenth item in the agenda, shouldbe considered with the fifth-viz., the report of the committeeon the subjects of general education deferred from last session.Dr. Fleming proposes to move a long string of additions to thestanding orders and regulations ; proposing to elect a businesscommittee, including members from each Branch, to meet be-fore the session of the General Council, and specially remune-rated. For our own part, we cannot see that the business ofthe Council is so extensive as to call for this somewhat cum-brous and very expensive addition to the existing machineryof the Council; enough money is already spent, and enoughtime wasted, without any such supplementary means of in-creasing the expenditure, and indulging the cacoethes loquendi.It is anticipated that the business may be completed within aweek.The General Medical Council commenced its sittings on

Thursday, at one o’clock, at the College of Physicians, thePresident in the chair. The following members were pre-sent :-The President, Dr. Alderson, Mr. Csesar Hawkins, Mr.Cooper, Dr. Acland, Dr: Paget, Dr. Embleton, Dr. Storrar,Dr. Alex. Wood, Dr. Andrew Wood, Dr. Fleming, Mr. Syme,Dr. Thomson, Dr. Smith, Mr. Hargrave, Dr. Leet, Dr. Apjohn,Sir D. J. Corrigan, Bart., Dr. Sharpey, Dr. Parkes, Dr. Quain,Mr. Rumsey, and Dr. Stokes.A letter was read from Dr. Christison stating that he should

be detained in Edinburgh by imperative duties during thepresent week.The minutes of the last meeting having been read and con-

firmed,The PRESIDENT said: Gentlemen, in addressing the mem-

bers of the General Medical Council once more from thishonourable position in which I am placed by your favour andconfidence, it is a matter of much gratification to me tofindthat the public business this year did not compel me to sum-mon you in attendance at a time which was to some of youvery inconvenient, as unfortunately was the case last year.As far as I can gather from the opinions of those around me,I believe that our time of meeting has this year proved to begenerally acceptable. Before we proceed, gentlemen, to theelection of our committees, and to make other arrangementspreliminary to the business of the session, it appears tome that some advantages might arise if I addressed to

you a few introductory observations from the chair. Ishall do so in the form of a brief survey of some of themost important parts of our proceedings in our last ses-

sion. I shall endeavour slightly to trace the progress ofevents since we last assembled here, to advert to the specialduties that were then assigned to your Executive Committee,and how far those duties have been accomplished; I willlikewise advert to some important measures which wereunder consideration at our last meeting which were leftuncompleted, and which may probably be profitably re-

sumed in our present session. Although such a 1’ésumê

may appear somewhat needless to those members of theCouncil who take the most active part in our proceedings,and who, since we last assembled here, may probablyhave devoted their thoughts both to our past and to our pro-spective labours, still I flatter myself that such a recapitula-tion may be useful to others-that it may be useful to them tohave their attention recalled to topics of greater or lessinterest which have faded away from their memory, but whichformed the subjects of discussion and deliberation during the

session. The intervals between our annual sessions are soprolonged that it is almost impossible for men like ourselves,who are engaged in constant and engrossing occupations, tohave before our minds, upon re-assembling here and resumingour deliberations, a clear and vivid picture of the subjectswhich were last under our consideration, and which, forvarious reasons, were left undecided, but which may now bemore ripe for solution. It will be in the recollection of theCouncil that last session a select committee was appointed toreport upon the subjects of general education to be inquiredinto in the preliminary examination of students. That com--mittee made their report at an advanced period of the session,and the Council at that time were of opinion that they couldnot duly consider the important suggestions brought forwardby that committee in their report, and the subject was there-fore postponed. This is a question, gentlemen, which willhardly admit of much further delay. It is very important, inorder to complete our various recommendations and regula-tions, that this subject of the preliminary examination of thestudent should be entered into and arranged. (Hear.) I am

happy to inform the Council that our registrar has very lately,.with great pains and great labour, and I have no doubtwith great accuracy, compiled a document which will proveeminently useful to the committee if it should be re-ap-pointed. You will recollect, gentlemen, that in the session of1864 the Council directed the circulation of the report of theselect committee on education among the various colleges-and licensing bodies, and invited those bodies to favour theCouncil with their observations and suggestions upon variouspoints in connexion with professional education.. Many ofthese colleges and public bodies sent in reports full of matterreplete with valuable suggestions. It was quite clear thatmuch time and thought had been bestowed upon the prepara-tion of these reports. As far as I know, this valuable infor-mation has not yet been fairly brought under the considera-tion of the Council, and certainly it has not been utilizedfor the purposes for which it was available. This mass of in-formation, I think, might very fairly be submitted to a digestby a committee, who would report to the Council; and I amsure the information would greatly assist us in determiningseveral points in connexion with professional education whichyet remain undecided. It might assist the Council, perhaps,in determining better than they have hitherto done how farthe number of separate examinations of students might beliminished where a student requires two or more qualifica-tions; and might also materially assist the Council in settling;hat point which has so often been discussed here, but which

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yet remains unsettled,-I mean as to the various starting- that communication (which was printed in the Minutes of thpoints which may be regarded as the commencement of pro- Proceedings of the Executive Committee of June last) statecfessional education. The next point, gentlemen, to which I that he regretted he should be unable during that session t<will allude is one which I think will afford unmixed satisfac- introduce the Bill for the Amendment of the Medical Actstion to the Council. It must do so, I am sure, to all who are of course, therefore, everything with reference to medical edusincerely determined faithfully to carry out the Act of Parlia- cation in that session came to a conclusion. It must be in th<ment which is entrusted to our administration-all who are remembrance of all of you that late in the autumn of last yea]desirous not to allow power to remain dormant, which may her Most Gracious Majesty and her Government, and I thinland ought to be exercised for the gradual improvement of I may say the people of this country generally, sustained gmedical education. I allude, of course, to the visitation of the severe loss by the death of the Prime Minister-the octogenaexaminations of the several licensing bodies by a deputation rian chief, Lord Palmerston. However, later in the autumn;from the Branch Councils. This Council will, no doubt, look as soon as the ordinary official holiday was over, and Minister!forward with much anxiety to the reports from the several had returned to their residences here, it became my duty tcBranch Councils to give them the results of their first or trial consider whether the time had not arrived when some stelvisitations. Gentlemen, what avail all our recommendations should be taken by the Executive Committee to carry out th<and all our regulations with respect to education if the curri- wishes of the Council, and at a meeting of the Executive Comculum of the students be not completed by a well-prepared mittee in the early part of December this subject was brough1and impartial examination? No doubt we, as a Council of under their consideration, and this is adverted to in theMedical Education, are bound to put forward a scheme of Minutes of the Executive Committee of that day. The Exe.medical education. That is one of the duties imposed upon us; cutive Committee then requested that your President ancbut, in my humble opinion, it is of less importance to inquire Registrar should seek an interview with the Home Secretary,as to how a student commenced his studies, or where he pur- and bring the whole subject under his consideration, and ensued his studies, than it is to ascertain that at the conclusion deavour, if possible, to obtain from him a promise that hEof those studies he has acquired that amount of sound informa- would undertake the care of our Bill. We obtained that inter.tion which will enable him to practise with credit to the pro- view, and endeavoured, to the best of our ability, to put thefession and with safety to the public. (Hear.) Therefore, subject before Sir George Grey, who gave us an attentive hear.unless our examinations are conducted with ability, impartially, ing, and promised that we should hear from him before long.and fully, we cannot have that assurance. In the session of After the lapse of a month, no communication-having been re1864, gentlemen, you will remember that the Council appointed ceived from the Home Office, I thought it my duty personallya Committee to take steps for the preparation of a new Phar- to write to Sir George Grey, and put the question beforemacopcela. The Pharmacopoeia Committee made a report to him as concisely and clearly as I could. He courteouslythe Council during the last session, and that report was re- replied to me, and favoured me in confidence with theceived and adopted by the Council. At a subsequent part of perusal of a document in his possession, which was a

our meetings the Council thought proper to pass a resolution in memorandum drawn up by the Consulting Counsel of thereference to the Pharmacopoeia, which has led to a certain Home Office, Mr. Thring, upon our Medical Amendmentamount of misconception, which has misled members of the Act. Sir George Grey also promised me that as soon as

Council and people out of the Council into the belief that the the pressing occupations of that gentleman would permit, IPharmacopoeia Committee were called upon or had promised should be put in personal communication with him. It is toto produce a proof-copy of the new Pharmacopoeia to each be borne in mind that at this time, immediately before the re-member of the Council one month before the meeting. This assembling of the new Parliament at the beginning of February,unfortunately has not been done, neither could it be done, her Majesty’s Government, and the Home Secretary and offi-and neither did the resolution imply that it was to be done. cials, were all occupied and deeply engrossed with subjects ofNo doubt the report of the Pharmacopoeia Committee will put great and momentous interest to the country. The cattleyou in possession of the exact state of progress in which that plague which was prevailing throughout England and Scot-work now is, and may explain to you reasons perhaps which land, the Fenian conspiracy in Ireland, the Jamaica outbreakmay have led to some delay in its preparation, and which and inquiry, and the preparation of the Government measurehave prevented the committee at any rate from fulfilling the for the amendment of the representation of the people,-theseexpectations which may have been entertained upon the sub- several questions so engrossed or occupied the time of the Go-ject. I will next allude to the special duties which were vernment and the officials that there was but little chance ofassigned last year to your Executive Committee. I will en- obtaining a hearing for medical legislation. I waited patientlydeavour to explain to the Council what has been done by the therefore for some time, and again applied to Sir George GreyExecutive Committee-that is to say, beyond their ordinary by letter, and intimated to him the necessity of having somework; for every member of the Council is aware of what has definite letter from the Home Office to let me know what werebeen done by the Executive Committee since we last assembled, the intentions of the Government. Immediately before thebecause he has received the minutes of their proceedings. Your Easter recess, in consequence of this application, I was placedExecutive Committee-as far as their limited powers would in personal communication with the Consulting Counsel to thepermit them-endeavoured, in the interval since we last assem- Home Office, Mr. Thring; and I had the opportunity then ofbled, to carry out the public and special business that was en- perusing, in confidence, his drafted Bill of the amendment of thetrusted to them. A most responsible and most difficult duty, Medical Acts, prepared for the Government. Into this amendedhowever, was last year assigned to the Executive Committee; Bill as prepared by Mr. Thring I found two clauses were intro-and it was this : to communicate with the Government in re- duced, one of considerable importance, to the effect that personsgard to the Bill for amending the Medical Act, it being, how- holding diplomas of certain foreign and colonial universities andever, an instruction to the Executive Committee, or it being colleges might, under certain restrictions, be admitted on theunderstood, that no concession should be made by that com- British Register. This drafted Bill, submitted to me in con-mittee inconsistent with the amended Bill as approved of by fidence, required, of course, my most anxious consideration,the General Medical Council. Now, it is but right and re- and I found it necessary to make several suggestions to bringspectful to the Council that they should be made acquainted it more into harmony with what I believe to be the views ofwith all that has been done in reference to this particular and this Council. I have subsequently had several private inter-special business, because the minutes of the Executive Com- views with the counsel of the Home Office, and I am happy tomittee do not contain much of the information which it is my report to you that the drafted Bill is now completed, and, Iduty to give to the Council upon this subject, I have been think. much improved. It contains every clause of our own

compelled as your President to assume in this matter a certain amended Bill, with few alterations, with the addition of theamount of responsibility, because in the communications re- two clauses which I have just adverted to, and I am happy toceived from her Majesty’s Government upon this subject some state to you that at the very moment that I was leaving myhave been addressed to me marked "private" or "confi- home to day I had placed in my hands this packet from thedential," and, therefore, I could not take others to my assist- Home Office, which contains the draft Bill and the opinion ofance ; and at other times the communications required so Sir George Grey as to the best course to be pursued in refe-speedy a reply that no time was allowed for summoning the rence to it. This document, I presume, will be brought beforeExecutive Committee and bringing the matter under their con- you in a formal manner, or will be referred, I suppose, to asideration, and by which the opportunity would have been committee which I see mentioned on your programme, to con-lost for action. However I hope, when I detail to you what sider the amendment of the Medical Acts. Such, gentlemen,has taken place, my conduct will meet with your approval, is the course that has been taken with reference to thisIn the latter part of the last brief session of Parliament special business, and in which I think you will see, from thea communication was received from the Home Secretary, and circumstances I have mentioned, it has been absolutely essen-

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tial that I should take upon myself an individual responsibi-lity. The long intervals between our successive sessions andthe limited powers accorded to our Executive Committee have,from my experience in the chair, convinced me that these arecircumstances which greatly interfere with the transaction ofthe public business of the Council. We are very often unableon this account to give reasonable satisfaction to public bodiesthat communicate with the Council; I mean through the greatdelay that takes place between the successive meetings of theCouncil, and also, I may say, I believe that satisfaction is notalways given to members of the profession who appeal to theCouncil for their assistance or support. These, I think, gen-tlemen, are certainly defects in our organization ; they aresubjects worthy of our consideration, and I see, indeed,by the supplemental programme before me that this isa subject that has occupied the thoughts, as I knowit has done previously, of other members of the Council.’The question is how far we can remedy these defects in ourorganization. Would it be practicable to have more frequentmeetings of the General Medical Council, or would it be prac-ticable in some way to alter the constitution of the ExecutiveCommittee ? No doubt grave and serious objections exist tomore frequent meetings of the General Medical Council-notonly the inconvenience which would arise to the large numberof persons of whom it is composed, but also the very heavyadditional expenses which must be incurred by more frequentmeetings in this metropolis. But would it be impossible toaccept or act upon the other alternative-that is, in some wayto modify or alter the constitution of the present ExecutiveCommittee ? Would it be impossible to enlarge the ExecutiveCommittee, and make it more representative of the opinionsand feelings of the whole Council, by introducing a limitednumber of members from each of the Branch Councils of Scot-land and Ireland ? If an Executive Committee of this kindcould be formed-if an Executive Committee at quarterlymeetings could ensure the attendance of any two members of- each of the Branch Councils of Scotland and Ireland, deputed’by those Councils to attend, then, I presume, more extensivepowers might be entrusted to such an. enlarged ExecutiveCommittee which more fully and completely represented theGeneral Council - more powers, more control than can

now be properly conceded to the present Executive Com-mittee ; and I am quite sure that much of the routine businessthat obstructs the way here could be got through at thosemeetings of the Executive Committee ; the public businessof the Council could be transacted with more credit to our-selves, and I believe more satisfaction could be given to thepeople out of doors. Gentlemen, I commend this suggestionto your consideration. Of course it is not my duty as yourPresident to initiate measures in the course of the session ;but I have not thought it beyond my proper sphere of actionto call your attention to the measures which were under con-sideration during the last session, and to invite your favour-able reconsideration of them during the present ; also to callyour attention particularly to those measures which I believenow are more ripe for solution. I have further thrown out for

your consideration a suggestion the adoption of which I believemight render the Council and its influence for good in the pro-fession more effectual: that that influence should be more sus-tained and more continued, and not of that spasmodic characterwhich is implied by one annual session of the Council. Withthese prefatory remarks I conclude, congratulating you thatsince we last met here so few changes have taken place in thepersonnel of the Council, and that the distinguished memberswhose period of service had expired have been reappointed,and are again present to assist us with their large and variedknowledge, with their sound and independent judgment, andwith their full experience in the conduct of public business-all qualities which are so much required in our deliberations- upon the many varied and difficult questions which are broughtunder the consideration of this Council.

Committees relating to the business of the Council, to

finance, and to the amendment of the Medical Acts, havingbeen appointed,

Dr. ACLAND presented a memorial from the Physiologicalsub-section of the British Association assembled in Bir-

mingham in 1865, suggesting that the General Medical Councilshould, by pecuniary grants and the appointment of suitablepersons, undertake investigations into the physiological actionof medicines. Dr. Acland proposed, in conformity with thissuggestion, that :E250 should be devoted to the obtaining in-vestigations or reports calculated to promote a precise know-ledge of the efficacy of remedial agents.

Dr. STOKES seconded the motion.

Sir D. J. CoRRIGAN moved, as an amendment,-" That theproposed investigation does not come within the province of theGeneral Medical Council ; nor, were it within their power,have they any legal authority to expend their funds on suchan inquiry."

After a long debate the amendment was carried by 16 votesto 5.A motion, proposed by Dr. ALEx. WOOD, to fix the hours of

meeting on Saturdays from ten to one, was defeated by anamendment, moved by Mr. C&AElig;SAR HAWKINS, that the periodof meeting should be from one to four.The reports from the Branch Councils of the visitations of

examinations, and from the licensing bodies in accordancewith the resolution of last year, were ordered to be printed.The Council then adjourned to Friday.[We reserve for next week a full report of the proceedings

following the President’s address. ]

Correspondence.

SYPHILITIC INOCULATION IN 1865.

"Audi alteram partem."

To the Editor of THE LANCET.

SIR,&mdash;The natural process of constitutional syphilitic in-fection is now nearly as well understood as that of vaccina.tion. When this action takes place through the skin a cir.cumscribed induration appears at the inoculated part, andthis, after an interval, is followed by well-known constitutionalsymptoms.The profession has as yet received no proof that this kind

of syphilitic inoculation has been produced either in Englandor Ireland during the past year upon patients whose systemswere already under the influence of the disease.

It is true that Mr. James Lane states that he sazv in onecase the secretion from an indurated sore inoculated. Buthe does not refer to the fact that this patient had for nearlythree weeks previously been constantly inoculated with thesecretion from a soft suppurating sore. Nor does he mentionthe fact that the same lancet had been used in the attempts toinoculate from the indurated sore and in the inoculations fromthe soft suppurating sore, before the former became inoculable.Mr. Lane could not have been aware of these facts, otherwise,as an "impartial witness," he would certainly have referredto them.

During the three weeks that this patient was being inocu-lated with the secretion from a soft suppurating sore he dressedhis own ulcerations ; and it is to be presumed that he some-times washed himself. He was not aware that the matter withwhich he was being inoculated differed from that which hehimself furnished. The circumstances were, therefore, mostfavourable for the two secretions to become mixed.That this was originally a case of uncomplicated indurated

sore I can myself attest ; that Dr. Boeck inoculated from itI stated in my lecture; but that it remained an uncomplicatedsore to the end I still very much doubt.Mr. Lane appears to take some exception to my mode of

case-taking. But had I in the present instance, instead of in-vestigating for myself, obtained the " authentic facts" of thecase only through him, I should have missed the real point ofthe case, as he appears to have done. I therefore still thinkthat I could not have done better than obtain the particularsof this case from the patient himself and the surgeon (Mr.Coulson) under whose care he was.

Since my last letter, another knight, the Chevalier Gaskoin,by a side entrance has appeared in the lists. I have also beenfavoured with several other private communications. I shallhope soon to be able to consider at length all the statementswhich have any scientific bearing upon the question, and whichare not of a personal character.

I have been requested to publish the lectures on SyphiliticInoculation in a separate form; and in that case, with Mr.Coulson’s permission, I shall give a detailed account of D-’scase, which, from its having been the only one in which Dr.Boeck was supposed to have obtained positive results from an