In moving the Second Reading of this Bill, I would like to refer briefly to what I said about three years ago when I introduced a Bill to extend the rights which the General Medical Council at that time were believed to have with regard to this country to make arrangements and carry on those arrangements to a further date until such time as a new scheme for this country could be thought out. On the Second Reading of that temporary Bill I indicated my own point of view that a change would have to take place and some time later on, after this matter had been subjected to a certain amount of discussion and consideration, a statement was made indicating the point of view which the Executive Council had with regard to the control of medical practitioners qualified and resident in this country. That indication of policy raised a certain controversy to which I need not refer now to any great extent, but at that time it was stated that the policy of the Executive Council was to secure that nationals of this country who obtained their medical qualifications in this country should, during their professional life in this country, be subject to the control of a body composed entirely of Irish nationals, and that the conditions for their obtaining qualifying diplomas and all the conditions under which they studied should be entirely in the hands of that body composed entirely of Irish nationals. This Bill does, in fact, carry out that policy.
On the domestic side—there is an international side which is referred to in the schedules—it is made quite clear that under this Bill there is to be established in the Free State a separate medical register under a Free State Medical Council, and that consequently nobody will be allowed to practise medicine in the Saorstát unless registered in the Free State register established under this Bill. It is further provided that no person can be struck off the Free State register except by the Medical Council of Saorstát Eireann, and as far as qualifications and degrees are concerned, it is established that the curricula of studies, leading to medical diplomas, will be supervised by a Council of Irish nationals. On the other side, it is further laid down, by agreement, that the General Medical Council will continue to register on the General Register whatever persons have been trained and qualified in the Free State, and for the purpose of the keeping of that register will continue to exercise supervision over the curricula bodies which give diplomas entitling to registration on the General Register.
The representation on the General Council is continued as heretofore with one exception. Previously there was a representative appointed by the Crown for Ireland. That situation ended on the setting up of the Free State, and the legal position was under the Adaptation of Enactments Act in England that the right to nominate by the Crown previously for Ireland became the right to nominate for Northern Ireland. That is stereotyped in the agreement, and the representative for the future will be the representative for Northern Ireland, appointed by the Governor-General of Northern Ireland. The reciprocal arrangement is that we here continue to admit persons who are registered in the General Register to registration on the Free State Register on the payment of whatever fees are demanded from our own students.
I need not go through the sections of the Bill. The Bill proposes to set up here a separate council with complete control of the medical curriculum of the bodies giving qualifying diplomas. That Council will have the completest control in regard to the admission to the register of Irish nationals, and to the striking off from that register for felony, misdemeanour, crime, or what is called unprofessional conduct. There is one section as far as the domestic side is concerned, to which attention has already been drawn, and there is another section to which I would like to direct attention myself.
Under Section 28 of this Bill an arrangement is set out to put an end to what has been described as an objectionable feature of the Medical Acts as they have up to this existed. There is laid down here special provision giving the right of appeal in the case of people who are struck off for what is described as infamous conduct in the professional sense. That is a complete change, and a complete break away from the Medical Acts so far as they operated here previously. This is regarded as a very necessary provision.
The other point to which attention has been drawn is the composition of the Free State Council, which is referred to in Section 3. That Council is to be abody of nine, one of whom is to be nominated by the Executive Council, one is to be the joint nomination of the Colleges of Surgeons and Physicians; two are to be elected by the registered medical practitioners resident in the Free State, and the remainder are nominees respectively of the three Colleges of the National University, one representative from Trinity College, Dublin, and one representative from the Apothecaries Hall.
Attention has been called to this section specially because it is alleged to contain an injustice. The injustice is said to be that the Royal Colleges of Surgeons and Physicians are only given a joint nomination, whereas all the other bodies mentioned are given a representative each. The position with regard to this is easily explained. All the bodies who are mentioned in paragraph (b), sub-section (3) of Section 3 do, in fact, give, each and every one of them, a diploma which qualifies a person to practise medicine in this country. University College, Dublin, gives a qualifying diploma in medicine and surgery, which is essential to practising medicine in this country. The Apothecaries Hall gives a diploma which entitles a person to practise medicine and surgery in the country. Trinity College, Dublin, does the same, and the other two colleges of the National University do the same. The College of Surgeons does not give any diploma which entitles the recipient of it to practise medicine in the country. The College of Physicians does not give a diploma which entitles the recipient to practise medicine in the country. The diploma must be a conjoint diploma given after an examination held by the joint bodies. Nobody can be licensed to practise medicine in this country having received merely a diploma from the College of Surgeons. Neither can a person practise medicine in this country having received a diploma merely from the College of Physicians. There has to be a conjoint examination, and there has to be a qualifying diploma given by the joint bodies—the College of Surgeons and the College of Physicians. So that there is definitely given, under this proposal, a nomination to each body which can give a qualifying diploma. It happens in the case of the College of Surgeons and the College of Physicians that these two bodies must join before a diploma which entitles to practise can be given. That is the foundation for the proposal here.
That is one way of looking at the position of this Council. There are, possibly, other ways by which the Council might be built up. The one that was taken was the institutions which held examinations, the result of which entitled to practise medicine and surgery in the country. There may be other ways of looking at it. One way has been rather suggested already, and that is, that one should take the institutions and see the number of students that were qualified by those bodies. Unfortunately those who have adopted that line of argument have failed to make a distinction between the students who enter for medicine and the students who ultimately emerge as qualified men. To take the entrants to medicine in any year in any of those colleges and to found any argument upon that makes no allowance for the large number who disappear at various stages of the medical course. If that, or anything like that, is to be the foundation upon which this Council is to be raised, it should be the graduates who have qualified in medicine in those institutions.
I have here a series of figures which shows the graduates who qualified in medicine in the five years 1921 to 1925. I have not the figures, as yet, for 1926, but I can get them quite soon. They may be interesting to use for purposes of debate afterwards. In the University of Dublin in the five years 1921-1925, there were qualified respectively, 51, 72, 98, 75 and 95, or a total of 391. In the Royal Colleges of Physicians and Surgeons—the conjoint examination—in these same five years, the graduates who qualified numbered 65, 53, 64, 55, 58, or a total of 295. In the three Colleges of the National University—I have not those divided, but I can get them segregated later—in the same five years there were qualified: 149, 163, 132, 185, and 190, or a total of 819. Those qualified from the Apothecaries Hall in the same period were 6, 6, 2, 6, and 2, or a total of 22. So that as far as graduates qualified in those places in the five-year period are concerned, the totals were:—From Trinity College, Dublin, 391; from the National University of Ireland, 819; from the joint Colleges of Physicians and Surgeons, 295, and from the Apothecaries Hall, 22. Leaving the Apothecaries Hall out of consideration for a moment, if one was to take it as between Trinity College, Dublin, the National University of Ireland, as a group, and the Colleges of Surgeons and Physicians together, the comparison is very nearly what the allocation of nomination would be—very nearly what is, in fact, set out in the Bill: one to Trinity College, Dublin; one to the joint Colleges of Physicians and Surgeons; something more than two, but less than three, on the proportion, to the National University.
There may be other ways, perhaps, of forming this Council, but the procedure that was adopted was, more or less, what was found to hand: that the qualifying institutions should be allowed to nominate, but when one came to look at those qualifying institutions, one segregated those which of themselves can give a diploma which entitled to practise. When that was done the College of Surgeons had to be joined to the College of Physicians, as only by that junction can a qualifying diploma entitling to practise be given. There should be in addition to those a member nominated by the Executive Council and some number of members —two it is stated here—to be elected by the practitioners of the country. It is obvious that the qualifying bodies should be given representation as separate entities, and that the whole representation should not be given to the vote of those practising in the country, because a great part of the duty of the Council will be to supervise the educational system, the courses of training, that the medical student has to get, and it is necessary that those who are in control of the authorities that do give diplomas should have a fairly substantial representation on that body.
But there is a further point that has to be borne in mind, if one is to go on numbers—that this Council is to take charge of the professional lives of those doctors who elect to remain in this country for the period of professional practice, and that a mere allocation of seats on the Council determined by means of an enumeration of the students who qualitfy would not be fair. This Council is to be the body dealing with those who elect to remain at home, and there would have to be some appreciation of the percentage of students who qualify in any of the qualifying institutions mentioned, and who, in fact, do remain at home for their professional lives. If that percentage be taken, I think it would be roughly accurate to say that a great deal more than fifty per cent. of the students of the National University of Ireland do intend, and do, in fact, make their practice at home; that much more than fifty per cent. of the students who qualify in Trinity College, Dublin, do, in fact, go abroad, and that about fifty per cent. of those who qualify from the Colleges of Surgeons and Physicians do go abroad. So that on the percentage of those who, in fact, are being trained to look after the nationals of this country, those figures would have to be subjected to still further division. An argument may be used afterwards founded upon those figures and I leave the matter for the time being.