15

THE LANCET.

LONDON, SATURDAY, JANUARY 2, 1847.

THE MEDICAL BILL.-ARGUMENTS IN FAVOUR OF REGISTRATION.

A copy of the MEDICAL BILL of 1847 will be found at

page 17 of this week’s LANCET. The framer of the measure

submits it with confidence, but not without feelings of

anxiety, to the judgment of the whole body of his pro-

fessional brethren.______

As the consideration of the Medical Registration Bill

cannot be begun too soon, we commence the volume and theyear with some remarks upon the proposed measure; and weconscientiously believe that we could wish medicine and

surgery no happier year, than for its chief provisions to be-come the law of the land during the coming twelve months. i

Let us see how some of the sections of the medical bodymost interested in the matter will be affected by the proposedregistration. No one can doubt the importance of such a lawas the one to be contended for during the present year. Thereare certain circumstances connected with any legislation forthe medical profession of a peculiar nature. In ordinarylegislation, no great changes can be proposed, however bene-ficial, without interfering with the previously legitimate in-terests and rights of certain classes of the community. But

though this is an impediment, it is no positive bar to the enact-ment of new laws. The parties who dread injury are calledupon, however large their numbers and great their station, togive way to whatever may, upon full discussion, seem requiredfor the general weal. But at the present time, the lawsrelating to the medical profession are in such an amorphousand chaotic state,that, defacto, there is no law at all, and conse-quently, no actual, living legal rights, to be interfered with. It

is the fact, that the laws and privileges which should exist forthe profession have been, for a long series of years, suffered toremain in almost perfect abeyance, and there is no hope oftheir resuscitation, even if the desire for it existed.Looking to England, in the first instance, let us take the

case of the London College of Physicians. It does, indeed,examine for the licence to practise as physician; and it

elects its fellows and its officers; and it circulates upon a verysmall scale prospectuses claiming to be the one great fountof medical honour in this country. All this, however, occurswithin its own walls. No demonstration towards those who

ride roughshod over its antiquated rights is ever made or

attempted. Its charters lie in the dust of centuries unre-

garded, and probably unknown even to those whose office it

should be to enforce and obey them. The persons without

any proper education who call themselves physicians, andpractise as such, without any interruption on the part of theCollege, are very numerous; while the educated men whopossess medical qualification of even higher character thanthe medical licence of the College, or the merely medicaldegrees of Oxford or Cambridge, amount to many hundreds,probably to thousands. These gentlemen, though occasionallytaunted with being engaged in practice illegally, are neverreally interfered with by the College. The present medical

generation has not seen the College of Physicians lift a

finger aggressively against illegal practice, or defensively in

favour of its fellows and licentiates. We are bound to take

things as they really are. In such a case, custom is strongas law or charter, and it is quite useless to talk of the Collegeof Physicians as having in its charters greater powers andimmunities than any other public body in the empire, whileadministratively it is the very weakest-so weak, that not avestige of its power has been seen for a long series of years.It has no force or ability to defend the public against un-qualified practice, save that of the mere vis inertia belongingto the name of the College, its fellowship, and its licence.As well talk of the strength of a man in a state of coma, orthe activity of a dormouse in its wintry sleep, as of the powerof the College under present circumstances.A Registration of the medical body, then, whether in one

list or in sections, can do no injury to the London College ofPhysicians; they themselves do not prevent any unqualifiedman from calling himself physician, and acting as such, if hebe dishonest enough to do so, without a degree in medicine.Now the Medical Registration proposed, would give to everyman, besides a certificate of qualification, a description of thenature of his qualification, so that no undue assumption wouldthen be allowed. But, we repeat, the Royal College ofPhysicians of London do not even defend the public or theirfellows and licentiates against unqualified quacks, who takethe title of Doctor, cheat the public, and bring disgrace uponthe profession in the most open manner. This the Medical

Registration Bill would do; it would effect the separationbetween qualified and unqualified persons, simply and

stringently, and in so far, therefore, it would be a boon evento the members of the College of Physicians, while in no con-ceivable way could it be derogatory to them, or take away anyright or privilege which the College would dare in the

present day to assert on their behalf.There are other considerations, too, which might be urged,

to prove that a system of general registration would befavourable to an internal discipline of the College, such aswould raise its influence and power most materially. With

the present jarring elements of the profession, an internaldiscipline would be an impossible task to the most ambitiousPresident. No. External discipline must be the first step.The foundations of the profession must be looked to beforeinternal decorations can be thought of. We repeat ourassertion, then, that the Medical Registration Bill claims noreal concessions from any member of the College of Physi-cians ; on the contrary, it would tend rather to give stability

, and dignity to this institution; and the tendency of other. recent events and proposed changes have certainly been in

an’opposite direction.And as regards the College of Surgeons of England, the

, same line of argument may be justly pursued. The CollegeLhas never done anything really in the way of defending itsmembers or its own honour. Any one knavish enough to do

I so, may take the title its diploma confers, without let or hin-Ldrance on the part of the College authorities. The only( discipline the College has ever attempted, has been, to omit, from its annual list the names of one or two offensive mem-r bers-a point of which very few, even of the members of the

College, are aware, and which is no punishment whatever toIthe evil doers, as they have never hesitated to pursue theirL avocations and use their professional titles as before. The

annual lists of the College are themselves acknowledgments

16 MEDICAL REGISTRATION.-IMPORTANT AMERICAN DISCOVERY.

of the utility of registration, at the same time that they affordarguments in favour of a registration that should be correct,compulsory, and universal. Of these lists, as every M.R.C.S.E.well knows, one-half is composed of the names and addressesof members and fellows, the other is simply a list of some

thousands of names arranged alphabetically, without anyaddresses or means of identification whatever; many of them

being the names of parties who have died, emigrated, or relin-quished the profession. The existence of such a list offers a

direct temptation to dishonest persons to assume the names ofsurgeons. All they have to do is to select some name in the

non-address list, and with common cunning they may adopt itand act accordingly, with only a very remote fear of detection,and none of exposure or punishment.But impostors do not take the trouble even to do this; they

appropriate the name of surgeon to names not in the Collegelists at all, or they even have the barefaced impudence to assumethe names of eminent surgeons, and the College, bearded in thisway, neither defends itself, its members, nor the public. As faras we are aware, the only places at which a real qualificationas surgeon is examined into are in poor-law and hospital ap-pointments. The College is, in fact, utterly defenceless

against the misconduct of its own members, or the assumptionsof unqualified quacks. The world has even been treated with

the spectacle of the College authorities proclaiming publiclythat improper and disreputable persons are members of the Col-lege ; and they can make no other attempt but this vain com-plaint to purify themselves. The College of Surgeons, thenhas no internal or external discipline; and we maintain that asystem of registration, while it would defend all surgeons in

the possession of their titles, and protect them against quacksand impostors, would be a proper basis on which to found asystem of discipline for the members of the College, whichshould conduce to the welfare and honour of the members and

fellows, and of the College itself.What shall we say of the Society of Apothecaries 1 They

have, for the long lease of thirty-one years, held a power ofdefending themselves and their licentiates against unqualifiedinterlopers. And what have they done? î What is the con-

dition of the apothecaries and surgeon-apothecaries at thepresent time ? î They are overrun by unqualified persons anddruggist practitioners, and they look for help to the Society invain. The Society, by public advertisement, gave up thepenal clause in the Act of 1815, and since that time they havenevertheless instituted one successful prosecution against aperson calling himself an American physician-a proceedingjust sufficient to stultify themselves, but of no power to defendtheir licentiates. Subsequently, as our readers will see from thepresent LANCET, they have obtained from the law officers ofthe Crown an opinion that offenders may be indicted, notupon the penal clause, but more summarily, for violating theAct of parliament. And what do they now propose to do ? î

Why, instead of taking the initiative, and testing, the opi-nion by a series of indictments, they send advertisements tothe newspapers, which are inserted in one page, warning allunqualified persons to desist from general practice at theirperil; and they send communications also to the newspapers,which appear in another page, in which they ludicrously cryfor help from societies and private individuals, confessing theirown inability, from want of funds, to act effectively ; and thusthey plainly proclaim that, as far as they are concerned, the

"peril" of illegal practice is next to nil. They will not evenallow the profession to have the benefit of the legal opinion,and their cautionary advertisements, without a display of theirown counteracting imbecility. They are the legitimate guar-dians of the profession, and they label themselves up as dumbwatch-dogs.Their own system of registration, the list of apothecaries

which appears at intervals of several years, is even more

ineffective than the lists of the College of Surgeons. Whena man passes the Hall, his residence is required of him, andthis is the only clue to his whereabouts the Society obtain.Of course, few men have any special address at the time ofpassing the examination, and least of all are they certain oftheir future location in practice. So they just give theirlodging in town, the residence of their parents, or of the gen-tleman with whom they passed their apprenticeship, or theyguess at their future residence, and this formally passes intoprint in the official list. The Society have no adequate means ofpruning the lists of the names of those who die or leave the pro-fession, so that, besides the incorrect addresses, the last list pub-lished is encumbered with the dead of thirty-one years. Whatbulk it would reach to, and what amount of mortality it wouldcontain, if the same system were pursued for thirty-one yearslonger, we leave our readers to imagine. We are confidentthat, maugre the shadow of protection they may fancy theypossess, there is no class of the English faculty which wouldbe more benefited by a just registration of the professionthan the licentiates of the Society of Apothecaries.We claim, then, the assistance of the physicians, sur-

geons, and apothecaries of England, in obtaining an efficientMedical Registration Bill-one which would clearly separateall qualified practitioners from uneducated and unqualifiedpretenders, and which aims to do this, not by sacrificing theinterests of one branch of the profession to the interests, realor fancied, of another, but prepared with a view to a singleobject, the good of the whole, and as a basis of internal im-provement, and a defence against quacks and surreptitiouspractitioners of every kind. We shall hereafter refer to theposition of the institutions of Scotland and Ireland with

respect to registration.

IN another page we insert an important communication,kindly forwarded to us by Dr. BooTT, of Gower-street,describing the important discovery of an apparently harm-less means of producing insensibility during the performanceof surgical operations. The means of performing operationswithout pain has, in all ages, occupied the attention of theprofession. The realization of such an object, by a meansso simple as the inhalation of the vapour of sulphuric ether,cannot but redound to the great merit and reputation of

the discoverer, Dr. MoRTON, of Boston, America, and to thehonour of the profession to which he belongs. It is almost

impossible to discredit the statements contained in the com-munication referred to, from which it will be seen that a greatnumber of operations, from the extraction of teeth to thegravest operations of surgery, have been painlessly performed.The discovery seems to have a remarkable perfection aboutit, even in its first promulgation. We shall watch its

development in the various branches of medicine and surgerywhich may admit of its application, and carefully recordthem. We suppose we shall now hear no more of mesmerism

17

and its absurdities as preparatives for surgical operations. IThe destruction of one limb of the mesmeric quackery willbe one not inconsiderable merit of this most valuable dis-

covery. The operations of Mr. LISTON, at University CollegeHospital, were performed after the inhalation of ether, bymeans of an apparatus contrived by Mr. SQUIRES, of Oxford-street. It appears, from a communication in another column,that the discovery has been patented for Great Britain andthe Colonies.

THE

MEDICAL REGISTRATION BILLof 1847.

A BILLFOR THE REGISTRATION OF

QUALIFIED MEDICAL PRACTITIONERS,AND FOR

AMENDING THE LAW RELATING TO THEPRACTICE OF MEDICINE

IN

GREAT BRITAIN AND IRELAND.

jP?*e6NK.M6.Ņ’Whereas the laws relating to the Practice ofMedicine in Great Britain and Ireland are numerous, com-

plicated, and contradictory, and the public possesses no certainmeans of distinguishing between legally qualified physicians,surgeons, and apothecaries, and the mere pretenders to aknowledge of medicine and surgery, and it is desirable that

the names and qualifications of the regularly educated prac-titioners in medicine should be duly registered by competentauthority:

1. Registrars to be appointed. - Be it enacted, by theQueen’s Most Excellent Majesty, by and with the advice andconsent of the Lords Spiritual and Temporal, and Commons,in this present Parliament assembled, and by the authority ofthe same, That one of Her Majesty’s Principal Secretaries ofState shall, within one month after the passing of this Act,nominate and appoint three fit and proper persons, being atthe time of such appointment qualified to be registered underthe provisions of this Act, to be the registrars for carrying thisAct into execution, one such registrar to be called the Me-dical Registrar for England," another, the "Medical Registrarfor Ireland," and the third, the " Medical Registrar forScotland," and that he shall also from time to time appointsuch clerks and other officers as he, the said Secretary of.State, shall deem necessary for the assistance of the said re-gistrars in carrying into execution the provisions of this Act;and that the said Secretary of State may at his discretionremoved any registrar or other person so appointed as afore-said; and that upon the death or resignation of any such

’registrar or other clerk or officer as aforesaid, or other

vacancy in either of the offices sofilled, the said Secretary of’State shall appoint other proper persons to be such registrars,clerks, and officers respectively; and there shall be paid tothe said registrars, clerks, and messengers, out of any moniesto be received by the said registrars by virtue of this Act,such salaries as shall be from time to time fixed and allowed

by the Lord High Treasurer or the Commissioners of Her’Majesty’s Treasury, who may also allow such reasonable

travelling expenses as may be incurred by any registrar,

clerk, or messenger in the performance of his duties underthis Act, and such other reasonable expenses for putting andcarrying this Act into execution, as the said Lord HighTreasurer or the Commissioners of Her Majesty’s Treasuryshall think fit.

2. Monies to be paid to Medical Registration Fund of GreatBritain.-And be it enacted, that all monies received by theregistrars aforesaid, in carrying this Act into execution, shallbe paid by them into the Bank of England, at such times andin such a manner as the Secretary of State aforesaid shalldirect, to the credit of the Lord High Treasurer, or theCommissioners of Her Majesty’s Treasury, and in the nameof the " Medical Registration Fund of Great Britain andIreland."

3. Registration of Names &c. of qualified Medical Practitioners.-And be it enacted, that the several registrars shall, withinthirty days after their appointment, and from time to timeafterwards, register, according to the form in schedule (A) tothis Act annexed, in books to be kept for that purpose, andwithout any fee whatsoever, the name and place of residence,together with a description of the legal qualification or quali-fications, with the date or dates thereof, of every physician,surgeon, and apothecary who shall apply to be registered, andwho, prior to the passing of this Act, shall have taken adegree in medicine in any English, Irish, or Scotch Univer-sity, or who shall apply to be registered, and shall produce hisdiploma, certificate, or licence, or other proof of his havingobtained a diploma, certificate, or licence to practise as a phy-sician, surgeon, or apothecary, dated prior to the passing ofthis Act, and granted by any English, Irish, or Scotch Uni-versity, College, or Society, or any corporation, sole or aggre-gate, in England, Ireland, or Scotland, legally entitled to

grant the same; and also of every person who shall apply forthe same, who was actually practising as an apothecary in Eng-land and Wales prior to the first day of August, one thousandeight hundred and fifteen, and who shall sign a declarationaccording to the form in schedule (B) to this Act annexed,and also of every surgeon and assistant-surgeon of the armyand navy, and in the service of the Honourable the East

India Company, who shall apply for the same, and of everyphysician, surgeon, and apothecary, upon the payment of Twopounds, who, after the passing of this Act, shall take a degreein medicine as aforesaid, or produce a certificate, licence, ordiploma as aforesaid, dated subsequently to the passing of thisAct.

4. Registrars to issue Annual Oertificates to Registered Prao-titioners.—And be it enacted, that the several registrars afore-said shall issue a certificate, according to the form in schedule(C) to this Act annexed, to every person who shall have beenregistered as aforesaid, and who shall apply for the same; andbe it further enacted, that the said registrars shall issue suchcertificates for those parts of Great Britain and Ireland onlyfor which they shall severally be appointed to act.

5. Payment of Five Shillings for Certificate. -And be it

enacted, that every person shall, upon his application for suchcertificate, pay to the registrar a sum not exceedingfive shillings,and such certificate shall bear date on the day on which thesame shall be issued, and shall thence continue in force untilthe thirty-first day of December, one thousand eight hundredand forty--, and no longer ; and the said registrars, on