20 EFFORTS FOR REFORM. A put forward recently by Mr. Carmichael, they would doubtless have succeeded, for the profession was ripe for improvement. It was about this time that the profession had become so overcrowded, that many proposals were suggested for thinning its ranks, especially for preventing such numbers continuing to graduate. This state, indeed, lasted till the breaking-out of the Crimean war. The oppressive, almost despotic measure of numerical limitation was even advocated-a system which has worked most injuriously in Bavaria and elsewhere. Again, it was suggested to increase very greatly the cost of medical education. The proposed fees were so high, that they would deter many a deserving though indigent student, and were altogether unsuited to the impoverished state of the country then existing. In fact, the fees had to be, in 1847, considerably lowered, and they were not again raised to the same rate until 1863. greatly extended period of study was also advocated-a topic which will be elsewhere discussed; but there can be no doubt that if such an overcrowded state should again occur, the appropriate remedies would be an increased preliminary and professional education, and greater stringency of examination. Mr. Wakley, in 1847, attempted to obtain registration and equality of qualification by all the bodies submitting their regulations to the Secretary of State. In more recent years the exertions of Mr. Cowper, Mr. Headlam, Dr. Brady, Lord Elcho, and others in the House, and many an effective pen out of it, are so fresh in the recollection of all, that they need no mention here. The profession has cause for gratitude not only to the professional, but also the general press. Mr. Brady's Registration Bill of 1854 met with great opposition from the quacks, thirtythree petitions from the Medical Botanists, or Coffinites, one signed by 4,180 persons, having been presented against it. The latter name would seem appropriate, for in the four previous years fifteen cases of poisoning by the drug lobelia, given by them, had occurred. THE MEDICAL ACT, 1858, 21 The laudable efforts made by the Colleges of Surgeons during the months of June, July, and August, 1856, to obtain registration and improved preliminary and professional educational arrangements, tended much towards a settlement of the question. The Colleges of Dublin, London, Edinburgh, and the faculty of Glasgow, were unanimous; and Drs. Williams, Hughes, and Maunsell, Mr. Lawrence, Dr. Andrew Wood, and Dr. A. D. Anderson, were chosen by their respective colleges to deliberate on these improvements. These steps gradually prepared the way for, and matured the clauses of the Medical Bill prepared by that eminent sanitarian, the Rt. Hon. W. Cowper, which now rules the profession. On the 2nd August, 1858, Medicine, for the first time, was incorporated as one profession, the previous legislative enactments for separate bodies having only produced anarchy and confusion. Provision was now made for accurately registering practitioners, and thus enabling the public, and authorities in courts of law and elsewhere, to distinguish the legally qualified from the unlicensed pretender. It cannot be concealed that at present it contains no power for suppressing quackery, or preventing some other callings from practising medicine and surgery. It only provides that quacks shall not assume medical titles; but by the crafty omission of letters from these, or the assumption of somewhat similar initials, they escape prosecution. This, the only general act controlling the profession is, however, faulty in many particulars, and has not been amended from want of unanimity among the profession, and from want of interest in the subject evinced by the Home Office. Just now political disturbances are so threatening that this and other social matters must wait for amendment; but two Home Secretaries have suggested that amendments should be entrusted to private members. The council does not appear to be a very favoured child at Downing-street, for the accommo 22 THE CONSTITUTION OF THE COUNCIL. dation of a place of meeting has been persistently refused. As the Medical Act contains more than the average of redundant verbiage, it will be more useful to submit the following analysis of it, notes on its working and suggestions being made upon the several clauses. Preamble. Whereas it is expedient that persons requiring medical aid should be enabled to distinguish qualified from unqualified practitioners, be it, &c. Clause 1. Short title. 2. To begin 1st October, 1858. 3, 4, and 5. General council of twenty-three to be formed by one person chosen by each of the following bodies: Royal College of Physicians, Royal College of Surgeons, England, Apothecaries Society, Universities of Oxford, Cambridge, Durham, and London; College of Physicians, Edinburgh; College of Surgeons, Edinburgh; Faculty of Physicians and Surgeons, Glasgow ; King and Queen's College of Physicians in Ireland; Royal College of Surgeons in Ireland; Apothecaries' Hall, Ireland; University of Dublin, and Queen's University, one conjointly by the Universities of Edinburgh and Aberdeen, and one by the Universities of Glasgow and St. Andrew's. If the combined constituencies could not agree upon a representative, each was to nominate a person either of whom her Majesty was to select. The crown appoints four members for England, and one each for Scotland and Ireland. The council elects a president, who may or may not be a member of the council. The three up to this elected have not been members of council, but have all belonged to the profession. It will be seen that there is no provision for representing the profession generally, except by the nomination of the crown. general practitioners are represented by Mr. Rumsey, and able and indefatigable as that gentleman is, he cannot have much power against so many of those whose interests are identified with the corporations. The It seems but fair that the members of the profession at large, who pay or have paid for the support of the THE CONSTITUTION OF THE COUNCIL. 23 medical council, should have a voice in the election of its members or some of them; but the executive bodies of each licensing institution at once assumed the right of electing the representative, and six were appointed by the crown. In former bills the profession was to be largely represented; under Mr. Warburton's bill the council was to be one-third lay members appointed by the crown, and two-thirds members elected by the whole profession; and under Mr. Hawe's bill one-half the council was to be elected by the medical corporations, the other by the profession at large. With regard to lay members on the medical council, there seems no more necessity for them there than among the hierarchy or the benchers, and so far from the council electing a statesman into the presidency as they were urged to do, they should have petitioned the government to give him a seat in the Upper House. The British Medical Association has declared in favour of sending representatives elected by the profession in the three kingdoms to the council. This could only be arranged by an increase of its numbers, undesirable though the multiplication of senators may be, for none of the corporations will consent to resign a seat, and the crown nominees were sent to represent the interests of the public, and their election by the profession instead of by the crown would confer no advantage. The funds of the council are wholly derived from practitioners; let, therefore, the profession representatives and the crown nominees be paid out of this revenue, and it is just that each licensing body should pay the expenses or remuneration of its advocate. The general desire throughout the profession for such a concession may be estimated by the resolution of the British Association at Dublin, 1867, and by the formation a few months ago of the Medico-Political Association of Great Britain and Ireland for this object especially. Coll. Phys., Edin.-Dr. Alex. Wood. Surg. Dr. Andw. Wood. Faculty, Glasgow.-Dr. Fleming. K. and Q. Coll. Phys., Dub.-Prof. Smith. Apoth: Hall, Dub.-Dr. Leet. Univ. of Edin. and Aber-Prof. Syme. deen conjointly.Univ. of Glasgow and St. Andrew's conjointly.— } By Crown.-Dr. Parkes, Prof. Sharpey, Prof.Thomson. Former Members. Sir T.Watson, Dr. Alder son. Mr. J. H. Green, Mr. Prof. Bond. Dr. J. Watson, Mr. Watt. Prof. Williams, Prof. Prof. Lawrie. Sir C. Hastings. Dr. Quain, England. Sir J. Clarke, Dr. Baly. 6 and 7. Members for each country to be registered, and to act as branch council for England, Scotland, and Ireland. 8. Term not exceeding five years but eligible for re-election. 9. Council to arrange meetings, &c., quorum eight. 10. Council to elect Registrar and other officers. 11. Branch councils Scotland and Ireland to elect or remove registrars. The latter power has in one instance been most arbitrarily exercised. 12 and 13. Regulates fees, expenses, and |