493

THE LANCET.

LONDON, SATURDAY, MAY 8, 1847.

THE MEDICAL REGISTRATION AND MEDICAL LAW AMENDMENT BILL.

SINCE the article which follows this notice was written,some circumstances have been disclosed which demand the

earnest and immediate attention of thousands of the sufferingMedical Practitioners of this country. From representationswhich have been made to the SECRETARY of STATE for the

Home Department, it would appear that the exclusive Medi-cal Corporations of London intend to offer a violent oppositionto the enatment of the MEDICAL BILL now before Parliament.

Of course, the SOCIETY OF APOTHECARIES, at Blackfriars, havejoined in this opposition; and the CQUNCIL of the NATIONALINSTITUTE-betraying all the principles which many of itsmembers formerly professed, and the principles upon whichit was founded—have followed the example which has beenset by the Society at Blackfriars. These double-faced pro-

ceedings naturally emanate from such Janus-like associations.The COUNCIL of the COLLEGE of SuRGEO:vs, always delighted atseeing the geese, who have been ensnared into that Institu- ’,tion, plucked and tormented by the infamous quacks who inevery place infest society, have also addressed the SECRETARYof STATE against the Bill, and have solicited the RightHonourable Gentleman to hear the nature of their oppositionfrom a Deputation.The interviews between Sir GEORGE GREY and the Deputa-

tions from the hostile bodies are to take place at the HomeOffice this day, (Saturday, May 8th;) and, disdaining all

secrecy, and the exercise of improper private influence,-spurning and scorning private misrepresentations, and themotives which it is just possible might arise from feelings ofself-interest, the Right Honourable Gentleman has publiclyinvited the Author of the Bill to attend at the Home Office,to be present at the interviews, and hear the objections whichcan be offered against the measure. That invitation has been

accepted. Consequently, the attempt to defeat the measureby secret and private misrepresentation, instead of meetingthe question, fairly, in the House of Commons, has beenthoroughly defeated by the open, bold, honourable, andstraightforward conduct of Sir GEORGE GREY.The example thus set before the profession by such a high

authority, cannot be without its effect upon the thousands ofmedical practitioners of this country. They ought at once torise as one man, and appeal to the Legislature for protectionagainst their persecutors who wield the government of theMedical Corporations, and also against the quacks.

It will be seen, by a brief report in another part of ourJournal, that a MEDICAL REGISTRATION COMMITTEE, consistingof some of the most respectable medical practitioners of themetropolis, has recently been held. Similar committees shouldbe formed in every county and borough of the kingdom.Public meetings should be held, and petitions should be sentto Parliament, not only from bodies of practitioners, but fromindividuals. It has now become a life-and-death struggle forthe profession. If a REGISTRATION BILL cannot be passed,nothing can be accomplished for the profession by Parliament.And why ? Because there are to be found amongst us treason,corruption, and duplicity-not, happily, in the body of the

profession, but amongst those governing authorities, legal and

usurping, which seek to degrade and destroy, rather than toprotect, the very interests which they are bound in honour todefend.

If the Bill should be referred to a SELECT COMMITTEE OF

THE HOUSE oF COMMONS, the objectors will have an opportu-nity of giving evidence as witnesses. The statements of some

of them, we suspect, will be both edifying and amusing. It

will not be sufficient merely to assert an opinion that is hos-

tile to the principles and details of the Bill; but the factswill be demanded on which the objections are founded. The

profession ought to know that Parliament is heartily tired ofthe subject of medical legislation; that the greatest diffi-

culty exists in finding any number of members who

are willing to take an active part in that question;and that, when solicited, nearly all reply, " What can

"be done in the House of Commons, when you can-" not agree in favour of any measure amongst yourselves ?"Such a reply is disheartening; but still, considering howvastly important is our cause to the interests of humanityand science, to the welfare of the public, and to the protectionof the profession, every medical practitioner who estimatesas he ought the position he holds in the ranks of society, andthe part he should bear in the endeavour to improve the cha-racter and respectability of the profession, and to put downquacks and quackery, ought to exert himself at this juncture,as though success were to be achieved solely by the aid of hisown individual exertions. If this view of the question beentertained by the many thousand practitioners of this

country, we could have no apprehensions as to the issue ofthe contest in which we are engaged. If the London Regis-tration Committee should resolve on holding a public meetingin the metropolis, we trust that it will be attended bythousands of practitioners. The voice of the profession oughtto be heard, and must be heard, on the subject.

Just before going to press we have seen the advertisementof the Council of the National Institute. It is needless to

observe that it is a tissue of misrepresentation and falsehood.We invite every member of the profession, after reading it, toexamine the provisions of the Bill. Before this conflict has

terminated, we are happy to be able to predict, with tolerablecertainty, that the mask will be torn from the countenancesof some men, at least, who, being full of pretension of uphold-ing the best interests of the profession, have been guilty of

basely betraying it. If there be a public meeting, will the. Council of the Institute dare to face their professional

brethren on such an occasion ? All the members of the Insti-

, tute who have written to us on the subject are firmly anddecidedly in favour of the Bill.

THE Medical Registration and Medical Law AmendmentBill is now fairly before Parliament and the profession.

L Every man will read the Bill with a somewhat different view, from his neighbour, and interpret its meaning according to the; mode in which he himself is likely to be affected by its pro-L visions. Motives and intentions will, we have no doubt, be’ assigned by some with truth and candour, and by some from, very different motives, which have never entered the mind of. the framer of this measure. It will therefore not be without

, its use if we endeavour to set forth our opinions of its trueintent and meaning, preparatory to our detail of the proceed-

ings which it will be necessary for the medical body to adopt,

494 THE MEDICAL REGISTRATION AND MEDICAL LAW AMENDMENT BILL.if they sincerely desire that this Bill shall become part andparcel of the law of the land.The simple and honest intention of the Bill, then, is to draw

a line of circumvallation around all regularly educated andqualified men-a line over which no unqualified person shoulddare to pass without incurring pains and penalties. Every-thing else has been held subsidiary and insignificant whencompared with this great object; and if other points aretouched upon, or provided for at all, it has merely been froma single desire to remove or anticipate objections to a nakedsystem of medical registration.

In the first place, it was considered as imperatively neces-

sary to throw all qualified men into one list or register foreach division of the United Kingdom. This is effectuallydone by the ninth, tenth, eleventh, and thirty-first clauses ofthe Bill. But this has been done without any desire to

level the profession, and deprive those who possess edu-

cational dignities of their due. That it was the fair and

necessary plan to present the profession as one body, will, wethink, be conceded by those who examine the subject calmlyand dispassionately, not looking to individual benefits, but tothe good of the whole faculty of medicine. It may be, andwe know will be, said--How so? Where is the fairness or

justice of placing the presidents of the College of Physiciansand the College of Surgeons in the same registry, on the samefooting, and as members of the same profession, with the lastmade licentiate of the Apothecaries’ Society, or the youngestM.R.C.S. We fear this line of argument is but individual

selfishness, or pride, or weakness, warring against the generalgood. Either a man is a member of the profession, or he isnot; and if the former, whatever his rank or degree, theremust be some common ground upon which he stands, and uponwhich the highest dignitaries of the profession, if there aresuch, must also have their foundation. Such a foundation-

such a common ground-we conceive a system of registrationto be. It must fairly be granted that the junior licentiate ofthe Apothecaries’ Society is a medical man; it may be said ofthe president of the College of Physicians that he, too, is amedical man-a " medical practitioner;" and this is the com-mon title which belongs to both. But this in no degreeplaces them in all particulars upon the same level; it willcause no one among the public or the profession to mistakethe specific title of the one for that of the other. It is only asign of just so much concession from the highest to the lowestas is necessary to separate the profession from the public, andwithout which concession the profession must remain, as here-tofore,undefined, admitting any knave or upstart dishonestly toassume, not only its membership, but its highest titles-that ofsurgeon or physician ; and this without education, and with-out a qualification of any kind. This concession between

differently educated members of the profession would be nomore than what obtains in the law and the church. The

barrister whose first powder has not yet been shaken from his

wig is as much a member of the legal profession as the LordChancellor; and the humblest parish curate is as much a

clergyman of the church as the Archbishop of Canterbury.But this is no cause of levelling; no destruction of honoursand distinctions; such a thing is, indeed, never dreamt of, ex-cept in our own unhappy, and we are fain to say, illiberal pro-fession. Of all the professions, it is only in medicine thatreal equality is a bugaboo. We repeat, then, a general

registry is fair and necessary. To those who still object toan amalgamation of the profession into one body, as a first

principle, we would say-What else would you do ? or

what propose ? ?, Would you have physicians, surgeons, and

apothecaries, registered in classes according to their titles ?

Let us see how the matter would stand. Graduates of the

Universities of Oxford, Cambridge, Dublin, and London, andFellows of the College of Physicians, would be placed cheekby jowl with men from St. Andrew’s, and Aberdeen, and

Glasgow, bearing much the same titles and designations. Wedo not say this in derogation of these latter schools of learn-ing, but simply as a fair illustration of the position assumed.This was, indeed, what the College of Physicians proposed intheir last year’s Memorial. They proposed to admit all

British graduates into the College, and the College lists; only,in place of paying a registration fee, they were to pay a feefor the College licence. Now we maintain that this stoop.ing of the Fellows of the College to the young M.D.s of theeasy universities is quite as great a condescension as it wouldbe to appear in the same registry as that containing the generalpractitioner, the surgeon, the apothecary, or the surgeon-

apothecary. Indeed, it is more; for as the same titles of M.D.,or Doctor, or Member, or Fellow, of a College, would be givento all, St. Andrew’s might well be confounded with Cambridgeand Oxford, whereas, in a general list, Blackfriars could neverbe mistaken for Pall Mall, nor Edinburgh for Aberdeen. If

divisions and castes are to be maintained, the only equitablemode of proceeding would be, to place the members of eachuniversity, college, corporation, or licensing body, and thedifferent classes and castes of each, separately, and then therewould be such confusion and variety, that the different

merits and qualifications would never be understood, and

something like a separate legislation would be required foreach of the recognised bodies in the kingdom. There are,and ever will be,we emphatically maintain, almost insuperableobjections in the way of any registration, unless so much ofconcession as goes to the formation of a general list or

register be made by the whole body in the first instance. To

say that formal classes must be preserved in a system of regis-tration, is equivalent to saying, that no registration whatevershall exist; for angels, much less men, could hardly settle theorder and precedence of the various bodies and titles, licencesand degrees, that would come up to the surface at the biddingof a class registry.And, we would ask, for whom is a class registry demanded 2

For the public, or for the profession ? If for the public, werefer to the proposed " medical registration certificate," whichwould set forth the exact diploma or licence of its possessor;and we further refer to the plan attached to the Bill, contain-ing 11 the names of registered medical practitioners arrangedalphabetically," in which the " qualifications, and their dates,"are minutely set forth; so that there could be no pretence, noscope or opportunity, for false boasting and assumption. To

say that class lists are required for the profession is still moreabsurd. The instincts of the profession are too keen for anyof its members to seem, under such a system of registration,other or better than they really are. In the certificates

granted, and in the alphabetical register, the distinctive titlesare set forth, and their legitimate class distinctions are pre-served in the manner least liable to objection; the apothecaryis but an apothecary, the man in practice before 1815 is simply

495THE MEDICAL REGISTRATION AND MEDICAL LAW AMENDMENT BILL.

set down as such, while the Fellow of the College of Physicians,and the Doctor of the English, Irish, and Scotch Universities,is duly set forth as such. But in the framing of the Act, somegeneric term was imperatively required, and the term fixed onis" medical practitioner." All the levelling of the Bill con-sists in this, that the legitimate qualifications of the highestand lowest of those qualified at all, are set forth individually.If such an Act were passed, it would soon be seen that

the different colleges and corporate bodies would bestir them-selves to keep men in their outward professional doings totheir proper designations, and the Bill itself gives them powerover disorderly members-a power of discipline, the want ofwhich has been often lamented, but never hitherto possessed.This discipline, which, properly exercised, would be fraughtwith the greatest advantages, is ensured by Clause 16, relatingto the " expulsion of registered practitioners for disgracefulconduct," and in Clause 30, which provides for the erasure of11 the names of criminal practitioners."The machinery for carrying the Bill into operation is pro- i

vided for in the first eight clauses. It is as simple as thesubject would admit of, and while the expenses of registrationproperly falls upon the profession, they are, however, so insig-nificant as not to be burdensome to any individual.

Clause 9 provides for the right of a registered practitionerto practise in any part of the United Kingdom, according tothe division in which he has taken out his certificate. This

concession will probably be opposed by some interestedparties, but most unjustly. It is nothing new to say, thatthere are in England, and in Ireland and Scotland, a greatnumber of able and well educated professional men, who,according to the present state of the law, are as much en-gaged in illegal practices as though they had received nomedical education at all. But though they may be calledillegal, there is no adequate power in existence to compelthem to become legal practitioners under the old laws, andexperience abundantly shows that they will not become so.Why, then, should these men be subject to the annoyance,and, legally speaking, the crime, of still continuing subject tothe brand of illegality 1 The moral fault, if such it be, is notmore in them than in the old or partial laws, fitted and in-tended for bygone ages, but which are given up to obsoletismby all decent men in the present day, even by those whoselegal duty it is to carry them out. Even the College ofPhysicians, in its Memorial, wished to fold under its wings allBritish graduates, desiring to give them all legal rights asphysicians ; and the National Association, and its relic theNational Institute, invited all educated men in general prac-tice to enlist under their banner, whether they came from

England, Scotland, or Ireland, from Hall, College, or Univer-sity ; promising them all equal rights and equal privileges inthe New College for which they were to contend. The

principle, then, of exclusiveness, of restricting a man to prac-tise an art and science like medicine, of universal application,within so many miles of the place of his education or licence,must be considered as utterly untenable, as given up by thoseto whom it would most naturally cling.The apprenticeship system is proposed to be annulled in

Clause 13. It is not necessary, on this occasion, to enter intothe abuses of the old apprenticeship system-abuses whichfar outweighed any good to be derived from the old relationbetween apprentice and master.

The Clauses 14, 15, and 20, provide for the punishment ofunregistered persons unlawfully engaged in practice. Everyendeavour has been made to render the remedy easy of ap-plication, and the punishment prompt and effectual. All the

present restrictions have been found wanting when their ap-plication to the restraint of illegal practice has been made orattempted. If in the medical profession there were no otherfeature than this, it ought to be sufficient to stop any impe-diment, from qualified men, to the registration of all classesof the profession in one general list. They cannot prevent,under present circumstances, the most notorious villain fromcalling himself publicly Dr., or M.D., or Surgeon. Respect-able streets in London, the daily advertisements of the news-papers, shoals of works issuing from the press, exhibit

wretches, who, in another age, would have been footpads orburglars, assuming the highest professional titles unmolested.Is not this a disgrace to the profession 1 Does not this bringgreater discredit on the M.D. or the F.R.C.S. who may beinclined to preserve his caste, than any contact by simpleregistry with honest members of this or that hall or college?This alone ought to be sufficient to drive all the fair and

honourable members of the profession, whatever the sourceof their qualification, to combine for an equitable system of

registration. Registration is, in truth, but another wordfor severance from quackery and criminal practice.

, Clauses 23 and 24 offer an attempt at providing for uni-formity of education, the want of which seemed the mostvalid argument against a general registration of the profes-sion. Under these clauses the colleges of higher rank wouldbe able to force the licensing boards of easy virtue to bringup the education and requirements of their candidates to theproper point; or, in default of this, to deprive them of theirpower of licensing or of granting degrees altogether. The

higher bodies, and the men possessing higher qualifications,therefore, need have no fear of being overrun by men andinstitutions of inferior weight or acquirements.

Such is a fair interpretation of the whole measure-onefraught, as we believe, with good to the profession, appealingnot to the selfishness of any parties, but honestly directed tothe good of the whole faculty. Whatever is done must be donequickly; there is time enough to work in the present Session,but no time to waste; and we warn the profession, that unlesssuch a measure pass, quackery and unqualified practice willbecome more rampant and astounding than they have everyet been. Every defeat in any attempt at medical legislationis in effect a triumph of the quack and the impostor over thehonest professional man.

WE beg to repeat most earnestly to all members of the

profession who are favourable to the Registration Bill, ouradvice respecting the necessity of immediately petitioningParliament in behalf of the measure. A good beginning wasmade at the Freemasons’ Tavern on Monday night, and theexample should be followed in every town of the kingdom.The colleges and corporations which are favourable shouldpetition; so should the different societies and associations; themedical communities in cities and towns; and single indi-viduals should omit no opportunity of sending petitions forpresentation to the Members for the places in which theyreside. what is wanted is, an immense number of petitions aswell as a vast number of petitioners. In this way the success

496

of the measure would be promoted. Medical men owe it to

themselves and to their profession to be up and doing. Those

who oppose the Bill-the quacks, on the one hand, and therigid exclusives, on the other-will be active enough, and tothose who are for it, the present is no time for supineness.Let the voice of the profession be heard; if against the Bill,let the measure fall to the ground, but if in its favour, letthem bid it good speed, and success is certain.

AN ANALYSISOf the leading p1’ovi8’ons of the Bill now before the House of

Commons, fae the REGISTRATION OF QUALIFIED MEDICAL

PRACTITIONERS, and for amending the law relating to the prac-tice of Medicine in Great Britain and Ireland.

THE PREAMBLE

refers to the complicated and contradictory nature of the lawsrelating to the practice of medicine, as they now exist, anddeclares that the public possess no certain means of distin-guishing between legally qualified medical practitioners andthe pretenders to a knowledge of medicine, and concludes bystating that it is desirable that the names, qualifications, andplaces of residence, of legally qualified practitioners of medi-cine, should be duly registered by competent authority.

CLAUSE 1

requires that the Secretary of State shall, within one monthafter the passing of the Act, nominate and appoint three per-sons, being qualified to be registered under the Act, to be themedical registrars for England, Ireland, and Scotland; and itdeclares, that such Secretary of State shall also appoint suchclerks and officers as he may consider to be necessary for

assisting the registrars in carrying the Act into execution, andthat all the persons so appointed shall be subject to 1’emovalby the Secretary of State.

CLAUSE 2

enacts, that all monies received by the registrars for carryingthe Act into execution, shall be paid by them into the Bankof England, in the name of the Medical Registration Fund ofGreat Britain and Ireland.

clause 3CLAUSE 3

enacts that the registrars, within thirty days after their ap-pointment, and from time to time afterwards, shall register,without fee, the names and places of residence, and a descrip-tion of the qualification or qualifications, with the date ordates thereof, of all persons who were qualified to practisemedicine before the passing of the Act, and shall holda medical degree, diploma, or licence, or who were ac-

tually practising as apothecaries in England or Wales,prior to the first day of August, 1815, and also every

surgeon and assistant-surgeon of the army and navy, and theHon. East India Company, who obtained their qualifications,.and held their offices, before the passing of the Act.

CLAUSE 4 ,

provides for the registration of persons, on the payment by ,,

them of two pounds each, who obtain their qualifications after Ithe passing of the Act.

CLAUSE 5

’

CLAUSE 5

requires that the registrars shall issue certificates accordingto the form in the schedule, such certificates to be issued bythem only for those parts of the kingdom in which they areappointed to act.

CLAUSE 6CLAUSE 6

provides that a pa., 4ent of five shillings shall be made foreach certificate, which certificate is to remain in force from Ithe day of the date thereof until the 31st day of December of ithe ensuing year.

CLAUSE 7

requires the registrars to keep a record of every such certifi-cate, and that in the month of January of every year, theyshall cause to be printed a register of the names and places ofresidence (arranged alphabetically) of all persons to whomthey have issued such certificates, making three distinct re-

gisters, one to be entitled " The Medical Register for Eng-land," another, " The Medical Register for Ireland," andone, "The Medical Register for Scotland." The registrarsare to cause such registers to be sold at a charge not exceed-ing one shilling for each copy.

CLAUSE 8

enacts that a person, whose name has been accidentallyomitted from the register then current, or who shall prove tothe satisfaction of the registrar, that he intends commencingpractice, or changing his place of residence, may obtain a cer.tificate to continue in force until the 31st day of Decemberthen next ensuing, on the payment of twenty shillings.

CLAUSE 9

provides for the repeal of all restrictions on the practice ofmedicine and surgery which are now in force in any Act or

Charter, and that no restrictions shall henceforth have theforce of law other than are to be found in this Act.

CLAUSE 10

provides that every person who is registered, and who pos-sesses certificates such as have been described, shall be en-titled to practise medicine in that part of the kingdom forwhich his certificate has been issued.

CLAUSE 11

provides that all registered practitioners possessing certificatesin force shall be entitled to recover at law, with the full costsof suit, reasonable charges for medical and surgical advice,visits, attendance, and medicines.

CLAUSE 12

provides that after the passing of the Act no person shallrecover at law such charges as are specified in the precedingclause, unless he shall prove that he is in possession of a cer-tificate then in force, or that he was legally practising in thecharacter in which he claims the charge, at the time whenthe debt was incurred.

CLAUSE 13

repeals clause 194, section 15, of the 55th George III., whichenacts that no person shall be admitted to an examinationfor a certificate to practise as an apothecary, unless he hasserved an apprenticeship of five years to an apothecary.

CLAUSE 14

empowers a magistrate to fine any person, on convictionbefore him, in a sum not exceeding five pounds, nor less thanforty shillings, who shall act or practise as a physician,surgeon, or apothecary, without having been duly registered.,and not possessing a certificate according to the provisions ofthe Act.

CLAUSE 15

provides that any person holding a medical or surgical office,for which he is not qualified under this Act, shall be subjectto a penalty of ten pounds every time that he shall act orpractise in such office.

CLAUSE 16enacts, that if five registered practitioners shall complain tothe Council of any College, that a person who has obtainedhis diploma or licence from such College has conducted him-self in any manner which is calculated to bring scandal orodium on the profession, the Council of such College shall beempowered to cite the accused person before thm ; and onbeing satisfied of the truth of the charge, they are authorized