For much of the nineteenth century (during which there were 16 Presidents)
events within the College were dominated by widespread demands for medical
reform, culminating in the great Medical Reform Act of 1858. This led to ma
jor changes within the College, including an overhaul of the system(s) of e
lections; the old licentiates disappeared (to be replaced by the new licent
iates), whilst introduction of the membership (by examination) was institut
ed. The style of Presidential elections was also changed. Internal College
activities centred on the Library and on the London Pharmacopoeia. Early in
the century, the College once again moved geographically, this time from t
he City to the West End of London. Regarding contemporary issues, including
medical advances (notably introduction of the 'germ-theory' of disease cau
sation) and important social changes (dominated by Poor Law reform), the Co
llege's input proved minimal.