642 MEETING OF THE GENERAL MEDJCAL COUNCIL.

THE

GENERAL COUNCIL OF MEDICALEDUCATION & REGISTRATION.

THE General Medical Council met on Tuesday last, tl

Sir Henry Acland, President, in the chair. In opening the yproceedings, t]The PRESIDENT said, in conformity with the instructions a

of the Council, I have summoned the present meeting at the tJ

first convenient day after the long vacation. The Council 0:

will remember that the second period of five years, for which s’they had elected the present President, ended on July l8th,but that, since it might be undesirable to meet at that c;

particular date, in view of the Medical Bill then before Sl

Parliament, it was agreed that I should continue in office in d

order that I might call the Council together at the time most n qsuitable either for the winding up of its arrangements under f(the Act of 1858, or for the further discharge of its responsible n

duties under that Act. This accordingly has been now done c

or the latter purpose. The Bill, on which so much labour b

and care has been expended, was withdrawn by the Prime ± t.Minister at the close of the session, after it had passed the s

House of Lords, but not before 185 amendments, in thirteen Ifolio pages of more or less importance, some being in dupli- tcate and triplicate, had been put on the notice paper of the dHouse of Commons. The Council therefore meets now,without delay, both for the election of a President and for r

the grave purpose of considering the situation in which the v

medical education of Great Britain and of the Colonies is (once more placed by causes in large measure unconnected Iwith it. It is not my intention, under these circumstances, !"to make any elaborate address betore retiring from the high foffice in which you have twice been pleased to place me. Itwould not, indeed, be strictly in order to do so, even if it i

were expedient. But I crave your indulgence while I say a i

very few words on the position in which, as the guardian of r

medical education in this country, the Council seems tobe now placed. Government Bills, conferring fresh powers ‘and imposing new duties on the Council, and this year re- Jconstituting the Council, and assigning new and important tfunctions to medical boards, have been four times passed ithrough the House of Lords in the last twelve years, and vhave been four times withdrawn by the Government in the tHouse of Commons without full discussion in that House.Into the causes of this abiding misfortune I will not enter, Jbut I ask your leave to record that this failure has not been idependent on the action of the Medical Council. It is true lthat the work of the Council has been affected by an unusual, i

perhaps unprecedented, state of things. It has been ham- i

pered in its action, both from without and from within, by o

the sense that the powers and duties assigned by the I

Act of 1858 might shortly be modified or transferred. I

The Council, though anxious to act to the full extent of itspowers, was aware that its recommendations and its con-clusions were, pending the new legislation, of late yearsmade at a disadvantage. It cannot fail to be asked,What then is now the duty of the Council ? Is it towait for further attempts at legislation ? Or is it to continueto develop the work which lies before it, and, with thevaried experiences it possesses, to act as though no legisla.tion and no change were impending ? It would ill becomeme to-day to attempt to answer these grave questions. TheCouncil will give its own reply by its actions. But I ventureto hazard the statement that three short clauses, to whichno serious person could object, would, if passed into law,shortly relieve the teachers and students of modern medicinein this country of almost all their present educationaluncertainties. The first, directing the Council not to admitto the Register, after a given date, any person who had notpassed examinations, satisfactory to the Council, in medi.cine, surgery, and midwifery. The second, empowering theCouncil to appoint, in such manner as it deemed expedient,one or more assessors to every examining board, whateverbe their number now or hereafter. The third, making itclear that the Council can, under Clauses 18, 19, and 20 ofthe Medical Act, inquire into the modes of teaching by theschools, as well as into those of examining by the licensing t

bodies. But I might go further, and say that at the presentcrisis it probably is in the power of the existing licensingbodies and school", by a combined effort, to give practicaleffect to these several propositions without legislation, andto secure thereby peacs to themselves, and in great measureto obtain more completely the confidence of the public atlarge. I trust that I have not, in these few words, trangressedthe bounds which you would wish me, at the close of tenyears as your President, to set to these remarks. I donot presume to forecast the future. Of the past I know thatthe work which I have had the honour of sharing with youat this table for twenty-six years since the establishment ofthe Council has been work of the deepest interest, and oftenof great difficulty. During the last ten years it has beensuch as to produce in me sentiments of profound gratitudeand to give confidence that the Council, as the guardian ofmedical education in Great Britain, will deal with the presentcrisis alike in the spirit of patriotism and in the temper ofscientific progress on which modern medicine so largelydepends. Whatever may be the case elsewhere, there is noquestion that within the walls of this Council there can benow only one aim-viz., how to unite in using and regulating,for educational purposes, and in the best attainable way, themany forces which bear on the study of all problemsconnected with the prevention and treatment of disease,both personal and national. These are forces which areever moulding anew the character of the true student forthe common good of mankind. They ever need for theirstudy and their guidance fresh thought and new exertion,I now leave the chair in which you have twice done methe high honour of placing me, that you may discharge theduty under the Act of electing a President.The President’s address was ordered to be entered on the

minutes, and, on the motion of Dr. HUMPHRY, strangerswere requested to withdraw during the consideration by theCouncil-of the election of a President on the retirement ofDr. Acland. On their readmission they were informed thatSir H. Acland had been re-elected for another period offive years.The Business Committee having been reappointed, the

usual returns from the Army and Navy Medical Depart-ments were received and ordered to be entered on theminutes.

Dr. A. SMITH, in calling attention to the returns, said itwas very satisfactory to observe that in those of the ArmyMedical Department there were no rejections, and that inthose of the Navy Medical Department there were only tworejections. It was evident, he said, that the candidateswere better educated than formerly, it being very unlikelythat the standard of examination was lowered.Mr. TEALE called attention to the fact that candidates

from the English bodies appeared to have been the mostsuccessful in obtaining vacancies. Two out of three, or atleast a half, appeared to have been successful, while of thecandidates from the Royal College of Surgeons, Ireland,only one out of twelve had succeeded in obtaining a vacancy,and of the ten candidates from the King and Queen’s Collegeof Physicians in Ireland only one had been successful, andof the eight candidates from the Royal University of Ireland

, one only had obtained a vacancy. Such a result seemedvery curious, and appeared to require explanation.Mr. MACNAMARA said it was gratifying to find that the

education given by the Irish bodies had satisfied the. examiners. It appeared, however, that the education given: in London was still better, since the candidates had been; more successful in gaining places. They had learned the. cause of it in Ireland, and the result was that he was going; to send to London a first-class apprentice of his who knew

his business thoroughly, but the grinders or coachers in Ire-; land did not appear to have the "straight tips" for thei examinations. He was certain that if the gentleman to, whom he referred presented himself for the examination he: would come out qualified but unsuccessful. He (Dr.1 Macnamara) would, however, provide against such a con-t tingency, for he would send him to one of the best coachestin London who had the "straight tip" for the Army and- Navy Examinations.3 Mr. MARSHALL said that the number of licences held by" the candidates ought to be taken into consideration in anyr comparative statement. It would be found from the returnst that eighty-nine licences were held by forty-four candidates,f so that it appeared probable that every one had a doublee licence. In any comparison it was desirable to ascertaing t which candidates had the respective licences.

643MEETING OF THE GENERAL MEDICAL COUNCIL.

Dr. WATSON said he had no doubt it would be found thatthe appointments had been given to those who had obtained a

the largest number of marks. s

Dr. STRUTHERS said it would be very interesting to have e

similar returns from the India Department, and proposed- T"That a copy of the returns of August, 1884, furnished to Ithe Council by the medical departments of the army and E

navy be transmitted by the registrar to the authorities of vthe Indian Medical Department, with the suggestion that tsimilar returns furnished to the Council from that depart- iment would be useful in order to render the statement of íthe medical examinations for the public services complete." !

Dr. HAUGHTON, in seconding the motion, said that the tIndian service was the blue ribbon of medical students, E

and the examination was a totally distinct one, including i

natural history as well as medicine. All the best men C

in the University of Dublin went in for that examina. ition, and he believed that in a return of men who had 1obtained honours in it the students of that university would (

be found at the head of the list. The returns as they were 1laid before the Council were very imperfect, affording no (

information as to the final result of the year’s study passed <<

by the candidates at Netley and Haslar after the exami- lnation. 1The motion of Dr. STRUTHERS having been passed, Dr.

I

HAUGHTON moved, "And that the authorities at Netley and IHaslar Hospitals be requested to forward to the Council a Ireturn of the final examination passed by the medical officersof the Army, Navy, and Indian Services." During the year,he said, the men were severely tested, and the results of theiradditional training ought to be known.

Dr. BANKS seconded the motion, which was adopted.The following communication from the College of Precep- I

tors was laid before the Council :- DEAR SIR,-I beg to submit to you, as usual, a statement of the results

of the preliminary examination for medical students and others, heldby this College on the 9th, 10th, and llth of September. The totalnumber of candidates examined was 274, of whom 188 sat at the Londoncentre, 27 at Bristol, 20 at Birmingham, 23 at Leeds, and 16 at Liver-pool. Of the total number examined, 128 (rather less than half) ob-tained certificates qualifying for registration as medical students, while4 passed in mechanics as a separate subject. Of the 142 who failed toobtain qualifying certificates, 40 failed in one obligatory subject, 24failed in 2 obligatory subjects, 24 failed in 3 obligatory subjects, 23 failedin 4 (or more) subjects ; while 31, who passed in all the obligatory sub-jects, failed to obtain the minimum total of marks required for a placein the second division of the second class, as required by the MedicalCouncil. It will be seen that the results of the recent examination showa marked improvement as compared with the results of former exami-nations, especially in regard to the smaller number of very ignorant orincapable candidates-i.e., those who failed in three or more obligatorysubjects. I am, dear Sir, yours faithfully,October 3rd, 1884. C. R. HODGSON, Secretary.Sir HENRY PITMAN moved that the communication be

entered on the minutes, and that the College of Preceptorsbe thanked for the important information it contained. Hesaid it was somewhat disheartening to find that more thanhalf the candidates for the preliminary examination wererejected. The result, however, was better than that inMarch, when three out of four were rejected. Whether itwas the fault of the students or of the examination itself, itwas not for him to say; but he thought the question wasone which the Council ought to consider. It was a gravematter for consideration that three out of four of those whosought to enter the profession should be found unfit on theground of ignorance.Dr. STORRAR said his impression was that the fault rested

with the candidates. The College of Preceptors was a bodyof most experienced teachers, and most competent to test thequalifications of lads coming from school. There was anextraordinary tendency in young lads to go up for examinationon speculation, and the result was that they were repeatedlyrejected. The effect of the rejection by the College of Pre-ceptors would, however, no doubt, be to raise the generalpreparedness of the candidates, since those who sought toenter the profession would be made aware that they mustbe fairly well educated. At the University of London therejections had been for years 47, 48, or 49 per cent. Whenhe was a young man it was regarded as a disgrace to berejected, but that was by no means the case at the presenttime.Dr. HAUGHTON thought that the result was partly due to

the total ignorance of the candidates and their teachers asto what was expected of them. He considered that the bestexaminations were those at which there was the best rapportbetween the examiners and the teachers, and in which thefewest rejections took place.The motion was adopted.

Sir HENRY PITMAN moved-" That the several collegesand bodies mentioned in Schedule A to the Medical Act,which conduct an examination on the subjects of generaleducation, be requested to furnish annually the GeneralMedical Council with a return of the number of those whohad passed and of those who had failed to pass each suchexamination, together with a statement of the subjects onwhich the candidates had been examined." He said thatthere were fifty-six different examinations, any one of which,if passed would qualify the candidate to commence his pro-fessional studies, but the only one from which returns weremade to the Council was that of the College of Preceptors.Similar returns from other bodies conducting an Artsexamination qualifying for admission to the professionwould, he thought, afford valuable information to theCouncil, and might suggest in what direction improve-ments might be made in the way of recognising the differentbodies. Considering that the subjects were alike in all thedifferent bodies, there ought not to be any great variation inthe number of rejections. The subjects which the candi-dates were expected to pass were specified in the regulationsof the Council, but they were not in reality all passed, andlast year an application was received from one body askingto be recognised, although it excluded one important subject.The subject of mechanics was constantly omitted, and theCollege of Preceptors stated that only four out of 274 candi.dates passed in that subject.

Dr. MACNAMARA, in supporting the motion, said that thepercentage of rejections at the College of Surgeons, Ireland,was about twenty-five.

Dr. HAUGHTON, said it was of very little use to know howmany candidates passed and how many were rejected, with-out knowing the questions that were asked. He would

suggest that copies of the examination papers should be sentwith the other returns, together with a statement of thestandard in which they passed. There were in Irelandthree examinations that were above suspicion-those of theUniversity of Dublin, the Royal University of Ireland, and

, the Intermediate School Board. Dr. Banks could tell the: Council that he would have some difficulty in making a, return like that suggested. There was no special examinationI for medical students, and it would be impossible therefore

for the three bodies he had mentioned to state the numbersI of the medical students passed and rejected. The studentsr were always recommended by the University of Dublin to. spend two full years in arts before going to the medical, school at all. It might be desirable to ask that a special

examination, including mechanics, should be instituted formedical students, and he thought that the University of

i Dublin would not be indisposed to accede to the request.! The PRESIDENT said that Dr. Haughton had opened up a! large and important question, which could hardly be fullyl discussed under the terms of his motion, and he would sug-

gest that the whole subject could be better taken into con-I sideration when Sir Henry Pitman brought forward the; motion, of which notice had been given, for the Council to; resolve itself into a committee to enter fully into the con-! sideration of the subject of preliminary examination.I This suggestion was adopted, and the motion was accord.) ingly withdrawn.i Mr. MACNAMARA moved--(a) "That medical students,

seeking registration as such at the several branch offices ofl the General Medical Council, be required to produce, in’ addition to those certificates at present requisite, a certificateI of moral character which shall be satisfactory to the Regis-l trar, acting under the direction of the Branch Council, to1 the following effect: I, , do hereby certify,r from personal knowledge, that is of good. moral character, and a fit and proper person to be admittedL to the register of medical students.’"

"

(b) "That it be most) strongly recommended to the several medical authorities tot require candidates, previous to admission to their final; examinations, to produce a certificate of good moral character,:i to be signed by a clergyman, a magistrate, or a registered

medical practitioner." He had, he said, divided thet resolution into two parts, because, while the Medical

Register was entirely under the control of the Council,) the medical authorities could only be recommended, nots compelled, to adopt the suggestions of the Council.t In the sister profession of the law, students beforet admission were required to bring a certificate of morala character, without which they were not allowed to commence

their legal studies. It was equally important to the medicalprofession that there should be some guarantee as to the

644 MEETING OF THE GENERAL MEDICAL COUNCIL,

character of the young men who were to be entered upon the R(Students’ Register. Cases had come under his knowledge in wf

which lads of infamous character had been expelled from N4schools, and after passing the preliminary examinations of 5,different bodies had been entered as medical students. If hi:his suggestion were adopted there would, he thought, be fnsome difficulty in a student getting a certificate. As to the thpersons who should give such certificate of character he had tr:advisedly excluded schoolmasters. be

Dr. BANKS said he was glad to find that the College ofSurgeons, Ireland, was about to follow the example of the toKing and Queen’s College of Physicians, which required a tbcertificate of character from its students. Such certificate, re

he thought, should be given, not by clergymen or by magis-trates, but by two registered practitioners. ar

Dr. HAUGHTON thought it would be better not to define m

the kind of certificate required, and that it would be suffi- gicient to state that it must be "a satisfactory certificate of Tcharacter." It would be invidious to leave out the clergy, w

for he thought that the lowest of the clergy in the Church were won a higher platform than the lowest registered practitioners, hi

Dr. QUAIN suggested that the certificate should be one stwhich should be satisfactory to the registrar, bMr. SIMON thought it would be better to say satisfactory o:

to the registrar as instructed by the Branch Council." He

sympathised with the object of the resolution, but he did a,

not see what satisfactory evidence of moral character could w

be obtained. Every man was assumed to be of good moral rl

character until the contrary was shown. If it could be bproved that a man had committed a crime so that he couldbe brought under the criminal law, he could be easily dealt (Iwith, and the medical student might be called upon to sign n

a declaration to the effect that he had not committed any o

such crime. He protested against making any further addi- ption to the dreadtul certificate system, under cover of whichmany false statements were made. a

Dr. LYON also expressed his sympathy with the object of .r

the motion, but said he thought it would be very difficultto carry out the proposed recommendation.

Dr. PYLE seconded the amendment.Dr. A. SMITH contended that the Council was quite

prepared to vote on the question, and expressed his con-currence with the views of Mr. Simon and Dr. Lyon. Hehad once said that he would certify to anyone’s moralcharacter except his own. f

Dr. HUMPHRY objected to throwing upon medical prac- Ititioners the responsibility of certifying as to moral cha- i

racter. It was hardly possible that lads of seventeen or I

eighteen could be excluded for want of moral character. He 1

did not think that the proposed regulation would be of theleast value in the profession. IMr. DuNcAN, in supporting the motion, said that the

very fact that such a certificate was required would be ofgreat moral value to the students. No one could escape the Iresponsibility of writing certificates of character; they weregiven in other instances, and he could see no good reasonwhy they should not be required from persons entering themedical profession. He had often to write them himself, andhis practice was to write them as honestly and as liberallyas he could.Mr. MACNAMARA declined to accept the proposal to refer

the matter to a committee, which he said would only have theeffect of shelving it. He accepted, however, Mr. Simon’ssuggestion that the certificate should be " satisfactory to theregistrar of the Branch Council."The amendment was then put and rejected, and the

original motion met with the same fate. The second part ofthe resolution was then withdrawn.

Dr. BANKS moved "That it be a recommendation fromthe Medical Council to the medical authorities that theyshould not confer a degree or licence to practise upon anycandidate until he has attained the full age of twenty-threeyears." He said he believed that the present regulation asto age was frequently evaded. He was strongly of opinionthat in the case of most men there was not time to receive agood preliminary or professional education by the age oftwenty-one. There was only one other country (Germany)in which the period of study for medical students was soshort as in England; and Billroth had declared that it wasshameful that a boy leaving school at sixteen should, afterfour years’ study, be considered qualified to deal with thehealth and lives of the people, when he would not beallowed to deal with his own property. The minimum agein the Church of England was 23, and in the Church of

Rome 24 ; in Austria the time required for medical studywas 5 years, in Holland 6, in Belgium 7, in Denmark 5, inNorway 7, in Russia 5, in Greece 5, in Italy 6, in Portugal5, in France 6, and in Sweden 10. It might be said that ifhis proposal were adopted poor lads would be preventedfrom entering the profession ; but if parents could not givetheir sons a learned profession they ought to send them totrades. It was not well for the profession that there shouldbe too great facilities for entering it.

Dr. HAUGHTON, in seconding the motion, called attentionto the grave responsibilities undertaken by medical men andthe delicate position in which they were often placed inregard to the domestic affairs of their patients.Mr. SIMON said that the case of a clergyman was not

’

analogous to that of the medical man. In the one case themain question was the competence to act as a spiritualguide, and in the other it was the earning of a livelihood.The real question in the case of the medical man waswhether he was fit to undertake legal responsibilities, andwhether he knew his business-a matter to be decided byhis examinations. He did not think they ought to make toostringent rules as to the length of the curriculum. It wouldbe injustice to a young man who was competent at twenty-one to extend the age to twenty-three.

Dr. LYON said that, in the event of the motion beingadopted, some provisions should be made in favour of thosewho had been preparing for examination under the presentregulations. He suggested that the regulation should notbe made until after the year 1888.Mr. DUNCAN thought that such a tremendous revolution

(though he sympathised with the recommendation) oughtnot to be finally adopted without obtaining the deliberateopinions of the various licensing bodies, none of whom atpresent required a greater age than twenty-one.

Dr. STRUTHERS said he would be willing to alter theage to twenty-two, but he thought that twenty-three was.rather overstepping the mark.

The debate was then adjourned to Wednesday. ’

WEDNESDAY, OCT. 7TH.SIR HENRY ACLAND, PRESIDENT, IN fHE CHAIR.

On the motion for the confirmation of the minutes,Mr. MACNAMARA called attention to the title " Mr." pre.

fixed to his name in the minutes, instead of " Professor." Hehad written to the Registrar on the subject, and had received areply stating that " Sir H. Pitman (chairman of the BusinessCommittee) thinks this would be contrary to practice, and,unless the title of ’Professor’ were prefixed to all whoadopt that prefix at the schools where they teach, it mightgive rise to unpleasant feelings." Sir H. Pitman had asmuch right to question his title of " Professor" as he (Mr.Macnamara) had to question the prefix to Sir H. Pitman’sown name, which he had so honourably won. His college(which had a Royal charter) had appointed him as a professor,

and he was therefore entitled to the designation.! Dr. HAUGHTON seconded the motion for the amendment. of the minutes.The PRESIDENT pointed out that the question was one

which would apply to other members of the Council, and’ could not be settled without careful consideration. Hitherto: such matters had been left to the chairman of the Business! Committee.; Sir H. PITMAN thought it was strange that Mr. Mae-

namara, having sat on the Council for ten years, should3 now for the first time raise the question of his title. Hef (Sir H. Pitman) had followed precedent, and if any altera-

tion were made it ought to be under the direction of a com-i mittee appointed to consider the whole question and settle, it once for all.After some further discussion, lasting in all nearly threee quarters of an hour, it was suggested by Mr. SIMON that thes matter should be left to the discretion of the President.11 Mr. Simon also drew attention to the fact that in thea document containing the appointment of Mr. MacnamaraIf he was designated "Rawdon Macnamara, Esq."7) Mr. MACNAMARA accepted the suggestion of Mr. Simon,o and withdrew his motion for the amendment of the minutes.s The PRESIDENT said he desired to make a brief statementir with regard to the very serious business before the Council.e It was no exaggeration to say that a very serious mas ofe complicated and entangled work was before them. What;e they had practically to decide was whether they should wait)f for further legislation, or whether the Council should proceed

645MEETING OF THE GENERAL MEDICAL COUNCIL.

to do the work appointed for it by the Act of 1858, which, r

under various and increasing difficulties, it had been at- ptempting to do during the last ten years. The first impor-tant point to be considered was, he thought, the duty of the t,Council in regard to the medical education of the whole gkingdom. The Legislature of the country had for more than"ten years been endeavouring to solve the question, and had"again failed ; but it had not taken from the Council the SI

duties and powers assigned to it in 1858. The Council bwould have to consider what were the things it could not dowithout further powers. It might be said that the motionsset down on the programme solved the questions to be con- 1-sidered; but he thought it would be desirable that the CCouncil should first consider in committee what were the most d

important changes, if any, in respect to medical education Cand examination which should be made for efficiently carry- t

ing out the intention of the Medical Act : that the several Cchanges, if any, ,be classed into (1) those which could be deffected by the action of the Medical Council, the several v

medical bodies,’.and the recognised medical schools; and v

(2) those, if any, which might require for carrying them into reffect an alteration of the law. He suggested that the repre- s

sentatives of the several licensing bodies should use all due ieffort to obtain the consent of their respective institutions to ssuch resolutions as might be passed by the Council, with a tview of immediately carrying out those which could be effected i

without an alteration of the law, and for their observations ton the importance and desirability of those which could not. (

It might also be desirable that the committee of the wholeCouncil should first deliberate in private, until matters were 1put into such a shape that they could be conveniently sub- smitted as definite resolutions and publicly debated. Notice 1of motion to the effect he had mentioned would appear in tthe programme of business on Thursday. (

Dr. HUMPHRY said he was greatly alarmed at the (

announcement of the President that the notices in the 1programme were to be displaced for a discussion which <

could not be productive of any good result. The thoughtof future legislation had been a hindrance to their work iduring almost the whole of the time he had been on theCouncil, and it was now their duty to proceed without anyreference to such legislation.The adjourned debate on Dr. Banks’s motion to extend

the age of commencing medical practice was resumed.Dr: HALDANE thought that a young man of twenty-one

who passed the required examination ought not to be pre-vented from practising the medical profession, seeing thathe could perform any other legal function at that age.Many men at twenty-one were as well qualified as otherswere at twenty-three 01 twenty-five. It would not do tosend them out as assistants, since they would be legallyunqualified, and to prevent them from earning their ownliving would be a great hardship, especially in the case ofmen of small means.Mr. MARSHALL was in favour of lengthening the curri-

culum, but saw no good reason in setting the proposed limitas to age except with that view.Dr. STORRAR said that the public wants must be met,

and there was a large class of persons who could not affordto pay for the professional services of an expensively edu-cated man. The question of age should be left to settleitself. If the standard were raised too high, the poorer partof the public would go to chemists and druggists and toirregular practitioners.Dr. SCOTT ORR thought that the lengthening of the curri-

culum was more important than the extension of the agefor the commencement of practice. The former questioncould not much longer be shelved now that the list of sub-jects was so much extended. He approved of the sugges-tion of Dr. Struthers that the required age should betwenty-two, which he thought would be tantamount toadding another year to the curriculum.

Dr. HUMPHRY thought that the question should be leftto the licensing bodies. To extend the age to twenty-threewould be a hardship to clever and industrious pupils, whomight be led away to other professions in which they couldearn money at an earlier period.Dr. BANKS, in replying, said his only object in bringing

forward his motion was to raise the status of the profession.He was willing to adopt Dr. Struthers’ suggestion to fix theage at twenty-two. An extension of the curriculum to fiveyears, however, would answer the purpose he had in view,and if that were adopted he would throw over the regulationas to a minimum age. So far from his proposal being

revolutionary, it was really only a return to formerpractice.Mr. SiMOr1 said he objected as strongly to fixing the age at

twenty-two as he did to fixing it at twenty-three. He sug-gested that the motion should not be pressed, but that thewhole question of the curriculum should be reconsideredwith the other recommendations of the Council at the nextsession after conference with the authorities of the differentbodies concerned. ’

The motion was then put and rejected.Sir HENRY PITMAN moved-" That the proposal of the

Royal College of Physicians of London and the RoyalCollege of Surgeons of England to co-operate under thedirection of the Council, do receive the sanction of theCouncil." The scheme submitted, he said, was the same asthat brought forward last year, and it had been before theCouncil for a considerable time. The words " under thedirection of the Council " had been inserted because theywere in the Act of Parliament, and they were also usedwhen the sanction of the Council was given last year to theproposals of the corporations in Scotland. He could notsuppose that the Council would refuse to sanction that whichit had been seeking to obtain during the last fourteenyears. It might, perhaps, be urged that the question shouldbe deferred till the proposals of the President in his notice ofmotion should be considered; but that notice only referredto questions as to which any doubt existed whether theycould be carried into operation without further legislation.There could, he thought, be no question that the Councilhad the power to grant its sanction at once. It might besaid that it was not to the interest of the bodies to combine,but that was rather a question for the bodies themselvesthan for the Council. If they chose to sacrifice any of theirown interests for the good of the profession it was meritoriouson their part: A previous scheme had been under comidera-i tion, but it had been withdrawn, and the sanction of theCouncil was now asked to the new proposal.Mr. MARSHALL, in seconding the motion, said there was: nothing in the scheme which would interfere with any! Medical Bill that might be brought forward. It was limited, in its action, and did not profess to cover the whole ground

of medical reform-an object in which Parliament itself hadt failed. The scheme was a thoroughly practicable one ; the

two Colleges had considered it over and over again ; there3 was a perfect harmony between them, and if the Council- sanctioned the scheme the Colleges were prepared at theirt next sittings to nominate the Committee of Management to. carry it out. It would be unquestionably an advantage tos the student to have but one course of study to pursue in0 order to obtain a double qualification. Simplification andy eonsolidation of the curriculum would be of great importancenon the existing curricula of the College?. The studentf would no longer be troubled with too many lectures, but he

would have three examinations instead of two. The firsti- examination would be under the authority ef the examinerst of the two bodies. Years ago he had proposed such a pre-

liminary examination for the College of Surgeons but withoutt, success; his proposal, however, had since been accepted and itd worked well, attracting many new candidates to the College.t- The division of the examination was also matter of greate importance, and if it were for that alone the scheme deservedt the consideration of the Council. The period at which ao man could finally get his licence was prolonged, and by

dividing the examinations the candidate would be able toi- take time over each subject. If a man were at all diatrust-;e ful of himself, he was thus encouraged to take thingsn separately and quietly. It might be said that the present)- licence of the College of Physicians was all that a mang- wanted, since " physic included surgery. Admitting that)e the College of Physicians had the right to examine and? qualify a man in surgery, what were the actual facts ? He

had analysed one-tenth of the names on the Medical Registerft for 1884, and out of that number (1450) there were 153;e licentiates of the Royal College of Physicians, only six ofLo whom were contented with the single qualification, and, ofld those six, two lived in Canada (having no doubt a Canadian

qualification also), two in London, one in Hampstead, andig one in the provinces. Of the remaining 147, 139 were alsoo. members of the Royal College of Surgeons of England.ae That was very satisfactory as showing that the licentiatese were anxious to secure good surgical qualifications.v, If the College of Surgeons were giving up any legal right,m they ought to be complimented on their self-sacrifice inig behalf of the public. The proposed scheme was not opposed

646 MEETING OF THE GENERAL MEDICAL COUNCIL.

to any of the existing lines or tendencies of the medical qustudent, but in reality encouraged them, and he thought ofthat the Council could hardly exercise its power of refusal to prisanction a scheme which had been submitted by two such hahonourable bodies as the College of Physicians and the fo;College of Surgeons. As to the question of fees, the familiar WE

"three courses " presented themselves : first, to raise the Ifees ; secondly, to lower them ; and thirdly, to leave them Wunaltered. An increase of the fees would have raised an si(uproar at once, because it would be said " You are saving WI

money by combining your forces, and yet you demand more co

money." If the fees had been lowered, it might be said that rei

the Colleges were bidding for candidates in competition inwith other bodies. Under all circumstances, it had been ththought desirable to keep the fees as they were-fifteen Hguineas at the College of Phy icians and twenty-one mguineas at the College of Surgeons, thirty-six guineas in ar

all. It was found that the cost of conducting the first ptexamination was very considerable; many candidates did S(not go through the entire examination, some dropped off es

early, and the candidates for the final examination gradually mdiminished. The cost was more than if all the candidates tbwent through the whole examination, and hence it had not gEbeen considered desirable to reduce the fees. As to the funds tbwhich the College expected to possess, it would not do to w

count their chickens before they were hatched. When the itCollege was in possession of the funds it would be right to Tre-open the question of fees, and see whether they could be ttassimilated to those of the College of Physicians. To lower blthe fees at present would, he thought, be open to serious lecriticism. He earnestly hoped that before many hours the v

scheme would receive the sanction of the Council. ojDr. QUAIN said he had a very strong impression that Mr. sl

Marshall had drawn largely on his imagination for his facts. tlHe had boasted of the character of the examinations about w

to be established jointly, but he should have told the Council bthat they were almost identical with those now carried out tiby the College of Physicians, The present movement on t]behalf of the Colleges originated in the College of Phy- tisicians. Proposals were sometimes made by one of the IColleges and at other times by the other ; but in October, h1882, one of the most distinguished Fellows of the College dof Physicians proposed this resolution: "That, whereas Cthe Royal Commission on granting medical degrees has bnow affirmed the principle of diminishing the number of v

examining boards for medical licences, the Royal College Sof Physicians takes the opportunity of reaffirming that a

principle, already adopted and acted on by it." The r

effect of the resolution proposed by the College of Phy- s

sicians would be, not to reduce the number of boards, 1but to increase them. The College of Physicians must be c

ready to examine candidates who came from the Collegeof Surgeons in Ireland, in Edinburgh, or elsewhere, and theCollege of Surgeons of England must be ready to examine 1candidates coming from other bodies; so that there was a 1new board added, and it was a perfect delusion to think that I

there was any diminution of the number of boards. The fobject of the second portion of the resolution-namely, thatthe President should be requested to name] a committee toconsider what combination the College might best enter intofor examination purposes, so as to secure without further idelay one complete examining board, which should be satis-factory to the profession, the Medical Council, and theGovernment-was that there should be a board in Englandthat should license to practise in England, and that no oneshould receive a licence from either of these bodies if he didnot pass the examinations of both boards ; but in the noteto the scheme now before the Council it was stated thatanybody coming from Edinburgh might go to the College ofPhysicians and say, "Examine me for my licence," or hemight go to the College of Surgeons and say the same, sothat there was no advantage or benefit whatever to bederived from the scheme. Mr. Marshall had alluded tothe fact that the scheme for the Scotch union was passed with-out question, but that scheme was totally different from thepresent one, which was not truly for union or combination.The Scotch Colleges combined; the London Colleges proposedonly to co-operate. In Scotland there wss a common fund,and all the fees were paid into it, but in London theexaminers could be appointed by the separate Colleges andthe fees would remain just as at present. Each Collegewould also pay its own examiners. Under these circum.stances he regarded the proposed joint board as a sham. Ifanybody came to the College of Physicians with a sulgical

qualification, he was not asked a question about the Collegeof Surgeons and its course of education. What was theprice to be paid for this supposed advantage ? The Councilhad aimed at a board examining all round, and that amiablefox living in Lincoln’s-inn-fields, which never had a tail,went to the College of Physicians and said, 11 how beautifulI am without a tail !-do drop your tail and be like me."When the Medical Act of 1858 passed, the College of Phy-sicians particularly felt that the privileges of the Collegewere almost swept away, and they considered how theycould best adapt themselves to the new position. Theyresolved to do away with the extra licentiates and toinstitute an examination for licentiates. They foundthat the old word "physic," as it was used in the time ofHenry VIII., meant medicine and surgery, and that theywere empowered to have one single examination for physicand surgery. From the old Charter it appeared that everyphysician was entitled to practise medicine and surgery.Some doubt having been thrown upon that view, no oneexerted himself to get the surgical qualification recognisedmore than Sir Henry Pitman himself. Why, then, shouldthe College of Physicians give up the examination in sur.gery ? The scheme, too, broke in on the great principle ofthe single examining board, and the object of the proposalwas to help the College of Surgeons out of its difficulty, asit had at present only power to give a half qualification.The College of Physicians only accepted the scheme underthe impression that it was going to establish a grand nationalboard. Ninety-three per cent. of the licentiates of the Col.lege also got the qualification of the College of Surgeonsvoluntarily, but what was more strange was that 30 per cent.of them got the licence of the Apothecaries’ Society. Whyshould men who did this be compelled to go to this andthat particular College? and why should a man whowas willing to give fifteen guineas to get a perfect diplomabe compelled to go to the College of Surgeons and paytwenty-five guineas more? For his own part, he felt thatthe Council would make a very great mistake if it sanc-tioned such a partial and incomplete examining board.The number coming up to the College of Physicians hadincreased so rapidly that there were more than 200 licentiates

, during the past year. That was what had stirred up the. College of Surgeons. It was, in fact, the old story of thebattle of shops. He would move as an amendment, "That: while the Council approve of the resolution of the College of

Surgeons that it will not grant its diploma to any candi-; date who has not passed all the examinations required for a! registrable medical diploma, it is not prepared to sanction an. arrangement by which the Royal College of Physicians would, become a partially qualifying body, and thus entail additional

expense and inconvenience upon candidates for its licence."; The amendment was seconded by Dr. PYLE.s Mr. MACNAMARA approved of the Scotch scheme owinge to its comprehensive character, including, as it did, alla the bodies ; but the present English scheme was veryt different, omitting one important body, the Apothecaries’e Society. If that Society had been included he would have,t voted for the scheme.o Mr. TEALE said he was at first greatly disappointed witho the scheme, but he did not think the Council could refuse tor sanction it. The step was one in the right direction, and its!- effect would be greater than might appear at first sight. Ite would settle the curriculum for the students ; and the quali-d fication would be universally recognised as a high one. ThatLe it was a co-operation instead of a union was somewhat the.d result of the difficulty of conducting negotiations betweenGe two large bodies, each of which had its own interests, andtt one of which was involved in great pecuniaryresponsibili-of ties. He regretted that there was to be at first no reductionie of fees, but hoped that such reduction would in future takeM place. The additional examination proposed would involve)e considerable additional cost to the students; but that might beto modified if the preliminary examination could be conductedb.- by men sent into the country from the central body to co-ie operate with the teachers of the schools. The long attend-n. ance in London was very costly. The paper examinations;d might be conducted in the country; and the candidates whod, were rejected on the paper examinations ought not to behe required to come to London for the viv&acirc; voce examinations.id The provincial schools were becoming large and importantge bodies, and were entitled to every consideration.]1. Mr. SIMON expressed his dissent from the views of Dr.If Quain as to the claim of the College of Physicians to give a:al qualification in medicine and surgery. The statute of

647INTERNATIONAL MEDICAL CONGRESS.-HOSPITAL FESTIVITIES.

Henry VIII. no doubt stated that the members of the I

College of Physicians were entitled to practise surgery ; but s

that was very different from giving licences to practise topersons not members of the Corporation. The College ofPhysicians had, indeed, never examined in surgery, except (through Fellows of the College of Surgeons. The point had

1once come before the College of Surgeons, in connexion with the conjoint scheme, whether it would be justified in refusing to examine a man in surgery who had not a medical qualifi- ]cation. It was an open secret that the College was advised ]that it had that power, but on taking further advice (at his ]recommendation) it appeared that it had no such power, andaccordingly the College obtained an empowering Act ofParliament for the purpose, so that it could now, if it enteredinto combination, refuse a separate examination. He believedthat the College of Physicians had not obtained such an Act,and if so the difficulty appeared to him to be insuperable.The PRESIDENT said that a second amendment had been

handed in, moved by Dr. Chambers and seconded by Mr.Simon, to the effect that the Council was prepared tosanction the scheme "provided that full facilities wereafforded to the other licensing bodies in England for co-operating with the above-named Colleges under the direc.tion of the Council."The debate was then adjourned to Thursday.

THURSDAY, OCTOBER 9TH.The Council resumed the adjourned debate on Sir

H. Pitman’s motion sanctioning the proposed conjointscheme of the College of Physicians and the College ofSurgeons. The amendment moved by Dr. Quain was put,and rejected by thirteen votes against five. The amend-ment of Dr. Chambers was then discussed, and was alsorejected by fourteen votes against four. Dr. Lyon moved,and Mr. Collins seconded, a third amendment, proposing tosend back the scheme to the Colleges, to consider whether somearrangement could be made to include the Society ofApothecaries. This amendment was rejected by thirteenvotes against four. A fourth amendment was moved byMr. Bradford, and seconded by Dr. Chambers, sanctioningthe scheme on the understanding that the two Collegesshall not be at liberty to refuse the further co-operation ofany other of the English licensing bodies if offered on termswhich the Council deems proper." The amendment was re-jected by fourteen votes against six, and Sir H. Pitman’smotion was put and carried.The Council then adjourned to Friday.

HOSPITAL FESTIVITIES.

UNIVERSITY COLLEGE MEDICAL DINNER.

SIR WILLIAM JENNER graced with his presence in thechair a most successful dinner held at the Freemasons’ "

Tavern on the 4th inst., when at least 175 sat down. Thechief object of the dinner, now celebrated for the second time, is to promote the social consolidation and good fellowship of 1

the living aggregate of past and present students of the Faculty ]of Medicine of University College, London. In a warm-

hearted and telling manner Sir William interested his largeaudience by stating the reasons which had led him to accept the invitation to the chair on that occasion. These maybe summed up thus :-The social nature of the gatheringprecluded the necessity of formal speech-making; and SirWilliam’s long connexion with the institution, of which he felthimself to be the pure outcome since he had established thefoundation of his knowledgenowherebutatUniversity College,and had never drunk of the muddy waters of the Danube. In

proposing the toast of " The Health of the Chairman," Mr.Erichsen remarked in fitting language that Sir William hadspoken of the good gained from University College,but not of the debt which the medical school owed him.The general cheerfulness of the evening was added to byvocal music rendered by Dr. F. T. Roberts, Mr. Price, andDr. Beevor to the pianoforte accompaniment of Mr. H. A.Powell. A vote of thanks to Dr. Poore and Mr. C. Stonhamfor their services in organising the dinner was carried withacclamation, and it was announced that the same gentlemen

had kindly undertaken to resume their functions at the nextannual dinner.

THE LONDON HOSPITAL.

The East of London was quite en f&ecirc;te on the first ofOctober, partly, let us hope, in expression of the feeling ofthe people of these regions that that institution is a veritableand kindly home to them in the dark days of sickness, butpartly doubtless on account of the magic influence of the LordMayor, whose arrival was, though somewhat late, evidentlyhighly popular, not only to the crowd of spectators outside,but to the gay company assembled within under a tent erectedfor the purpose. The proceedings were very interesting,including speeches from Mr. Buxton, Sir Andrew Clark, Mr.Jonathan Hutchinson, the Lord Mayor, and others; alsothe giving prizes to the successful pupils of last sessionand to the nurse probationers. The school promisesto have a very large entry, and is altogether in a

healthy and progressive state. After a hundred yearsof most creditable work, as Sir Andrew Clark said,they are entering on another century with a fixeddetermination to carry on and to carry higher the art ofhealing and medical teaching, and the grave moral teachingwhich physiology and medical experience carry with them.Mr. Hutchinson’s address was a feature of the evening, andit is to be regretted that he had not more time and leisureto develop his views as to the claims of poetry on the scantytime and thought of medical students and medical men.Few of us probably are prepared to substitute the poets forthe prophets, but it was interesting to note the place theytake in a mind so thoroughly practical, and, we will add,reverent as Mr. Hutchinson’s. His favourites among livingpoets are Longfellow, Browning, and especially Wordsworth.The Lord Mayor expressed his high view of the calling ofmedicine, and the whole proceedings were wound up with aspectacular entertainment in the grounds of the hospital whichwe have already noticed.

THE MIDDLESEX HOSPITAL.

The annual dinner of the past and present students ofthis institution took place at St. James’s Hall on the even-

ing of the 1st inst., under the presidency of Mr. Henry; Morris, M.A., M.B., surgeon to the hospital. The gather-, ing was well attended, and the occasion very successful. Thetoast of the evening, " Prosperity to the Middlesex Hospital

and its Medical School," was proposed by the chairman, whotook occasion to contrast the earlier history of the hospitalwith its present condition, and who paid a well-meritedtribute to the devotion and fostering care of the weeklyboard. Mr. A. H. Ross, M.P., the chairman of the weeklyboard, and Mr. J. W. Hulke, F.R.S., responded to this toast." The Health of the Lecturer of the day " was given by Dr.Spencer Cobbold, F.R.S., and acknowledged by Dr. D. W.Finlay. Mr. B. T. Lowne proposed " The Past and PresentStudents," which was responded to by Sir Oscar Clayton

e and Mr. C. L. Hudson. An admirable selection of musicwas given by Herr Ganz, Mr. D. Hepburn, and others, and

, the proceedings lasted until a late hour. In connexion withf this hospital, it may be mentioned that on the occasion ofy the distribution of prizes which followed the introductory

lecture, the chairman (Mr. A. H. Ross, M.P.) announcedthat Dr. Frederic Hetley of Norwood had forwarded him a

cheque for &pound; 25 to be expended in a clinical prize, and hadexpressed his intention of providing a similar sum annually.y The announcement was received with loud cheering.g =

SOCIETY FOR THE STUDY AND CURE OF INEBRIETY.-it A meeting of this Society was held in the large room of theLe Medical Society on the 7st inst. The president, Dr. Norman

Kerr, who occupied the chair, showed specimens of the kola-. nut of South Africa (Sterculia acuminata), the professed anti-

dote to drunkenness; containing a considerable proportionr. of caffeine, with a lesser amount of theobromine and tannin,Ld it was a stimulant and tonic. Dr. Alfred Carpenter read ae, paper on the "Study and Cure of Inebriety." Inebriety,n. he said, was often induced by nervous shock and other)y physically disordered states of the nervous system. Theid worst effects were seen in the children of young drunkards.

Penalties and imprisonments were useless. Total absti-,m nence was essential to a cure. Mr. Oakley Hall describedth American legislation for the inebriate as being immeasur.en ably ahead of legislation in England.