§ [SECOND READING.]
§ Order for Second Reading read.
§ (12.15.) LORD CECIL MANNERS (Leicestershire, Melton)
In moving the Second Reading of this important measure I may perhaps be allowed to express regret that owing to the fortune of the ballot the responsibility of doing so has fallen on myself and not on one of the hon. Members who have so long worked on its behalf and who are more familiar with it. While firmly believing in the merits and general principle of the Bill, I cannot claim to have made an exhaustive study of the subject. I shall therefore confine myself to a very brief statement of its general aims and objects; and, in consideration of the fact that the subject is perhaps an unusually difficult and inappropriate one to deal with in a "maiden" speech, I shall ask the House to extend to me more than the indulgence it usually grants to those who address it for the first time. This matter has frequently engaged the attention of Parliament. As far back as 1878 a Bill on this subject was introduced, and since then almost every year a Bill dealing with the question has come before the House. The Select Committee of 1892 reported that—No woman should be allowed to call herself or to practise as a midwife, except under suitable regulations.A similar recommendation was made by the Select Committee of 1893, and in the year 1900 a Bill drafted on the lines of this Report passed its Second Reading by a majority of 90. It also got through the Grand Committee stage successfully, but it unfortunately reached the Report stage too late, and consequently came to nothing. The general consensus of opinion in this country is undoubtedly very strongly in favour of the Bill. The General Medical Council in 1889, and again in 1893, passed this Resolution:—That this Council regards the absence of public provision for the education and supervision of midwives as productive of a large amount of grave suffering and fatal disease among the poorer classes, and urges upon the Government the importance of passing into law some measure for the education and registration of midwives.The Royal College of Physicians, in 1891, reported—That legislative action is desirable in order to secure the due education, examination, and registration of midwives.1153 I think that these facts go to prove that the consensus of medical opinion, of those best qualified to speak on the subject, is very strongly in favour of some legislative action being taken. Experts, no doubt, differ as to the precise form that action should assume, and I think the opposition which the Bill has met with in the past has been more due to the fact that the opinions of experts thus differ than to any feeling that legislation is unnecessary.
What is the existing state of things which it is desired to remedy by this Bill? As matters stand at present, any woman, however incompetent, who chooses to put a brass plate on her door or a card in her window calling herself a midwife, is qualified to practise, and there can be no doubt whatever that the system is one which is fraught with the gravest danger to the lives both of women and infants. The Lancet, which I believe may be taken as the leading organ of the medical profession, says—Legislation is absolutely necessary to prevent ignorant and incompetent women from practising for gain to the danger of those women who employ them. A drunken old hag could not obtain a situation as nurse to a hospital or a workhouse, but there is nothing to prevent her putting a brass plate with 'Midwife' under her name on the door. In this simple fact lies the whole question to be solved.I may say I believe that this country is the only civilised country in Europe where there is not some sort of form of registration and regulation of the practice of midwifery in France, Germany, Austria, Russia, Holland, Belgium, Sweden, and Norway, the education of midwives is provided for, and their practice regulated by legislation of long standing. I do not intend to weary the House with long and harrowing details of the evils which undoubtedly result from the practice of these incompetent and ignorant women, but when it is considered that there are about 450,000 cases of childbirth in England and Wales annually, attended by women alone, and that most of these midwives are absolutely untrained and incompetent, I think it will be apparent to all that it is necessary to take some steps to supervise them. It is computed that no less than 30 or 40 per cent. of the cases of blindness in our asylums are directly attributable to the fact that 1154 proper care is not taken at the time of childbirth, and puerperal fever is another very frequent result from improper attention. I think that these facts speak for themselves, and that, therefore, it is unnecessary for me to enlarge on the grave necessity for some immediate legislation.
I should now like to say a word or two on the measures proposed to be enforced under this Bill, although it will, I think, be generally admitted that the details may be more fittingly considered when the Bill reaches the Committee stage. There are two main objects aimed at. The first is to secure the proper training of midwives, and the method by which we propose to effect that, is by the appointment of a Board of seven—four of whom are to be registered medical practitioners. This Board will frame rules and regulations directing the course of training and laying down the conditions of admission to the Register of Midwives. It will also restrict the practice of midwives within proper limits; and it will grant certificates which will enable persons who are in need of the services of a midwife to discriminate between trained and untrained persons—between those who are competent and those who are absolutely incompetent. In this the Board will be closely following the lines of the General Medical Act of 1858, which provides that—It is expedient that persons requiring medical aid should be enabled to distinguish qualified from unqualified practitioners.After all, that merely puts midwifery on a par with kindred branches of the medical profession—with medicine, dentistry, and veterinary surgery. When the enormous importance of this subject is considered, I think it will be admitted to be unfair, in the highest degree, not to put the profession of midwifery on a par with the other professions I have mentioned.
The second object aimed at in the Bill is supervision, and it is proposed to entrust that duty to the County Councils. In this we are following the recommendations of the Select Committee of 1893. The County Councils will have ample powers of delegation to District Councils and the supervision will be ensured by a system of notification similar to that which obtains under the Infant Life Protection Act. That will, I think, be 1155 sufficient, as it will always be possible to ensure the identity of the woman, and trace her qualifications and character.
These are the main features of the Bill, but I may say that the promoters will gladly welcome in Committee any suggestions as regards amplification or improvement. I would ask the House, in consideration of the fact that the services of these women are an absolute necessity, as was admitted by the Committee of 1893–60 per cent. of the total cases of childbirth in this country being attended by them—and that whether legislation is passed or riot midwives will continue to attend these cases, in consideration of these facts I would ask the House, seeing that the women who are affected are almost entirely of the humbler classes, to assent to the principle that they should have an opportunity of being able to distinguish between those who are competent and can give dependable assistance, and those who are not. We do not in the least intend to provide by the Bill that midwives should act absolutely independent of doctors, but we do want to oblige the woman to know her business sufficiently to be able to tell whether things are going right or not, and to judge when it is necessary to call in a doctor. I confidently ask the House to give this Bill a Second Reading, and by so doing to put an end to a state of things which, it is not using too strong language to say, has long been a disgrace to this country.
§ (12.25.) MR. DE TATTON EGERTON (Cheshire, Knutsford)
In rising to second the Motion of my noble friend, I have first to say that he has travelled so thoroughly over the whole ground that I feel rather diffident in dealing with the same points. But he only began at the year 1878, and I think it is on record that as far back as 1813 the Society of Apothecaries tried to induce this House to legislate on the question of midwifery. But still, it was in 1878 when the General Medical Council considered the matter so important that they promoted a clause in the General Medical Act which had reference to the registration and organisation of midwives. In order to carry their Bill, they found it necessary, however, to drop that portion which had reference to midwifery, because it was 1156 found that it might lead to some confusion between midwives and medical men. Since that time the subject has been very well threshed out throughout the country. There have been several Bills before this House to remedy the evils complained of, and I can only call it a disgrace to this country that there is no, restriction whatever upon either the use of the word "midwife" or the employment of unqualified women. The hon. Member for the Malton Division mentioned that this country was almost alone in the whole civilised world in having no distinct and strong legislation on this subject, but he did not inform the House of the dates at which such legislation took place in other countries. In Austria it dated back to 1810, in Belgium 1818, in France 1803, in Switzerland 1864, and in Sweden and. Norway 1810. I have not the date for Russia, but I may tell the House that in most of these countries the regulations with regard to midwives are very stringent indeed.
Let the House consider what has been the character of the opposition to the Bill in the past. There is a general consensus of opinion that legislation is necessary and that there should be some restriction on the practice of midwifery. The General Medical Council has been one of the principal opponents of this Bill whenever it has been brought forward. In the last three or four years they have had a Bill of their own prepared, but they have never thought fit to present it for discussion by the House. They have taken up—I will not call it a dog-in-the-manger position—but while they have never brought in their own Bill they have done all they can on every occasion to wreck Bills brought forward by those whom I have the honour to represent. Yesterday morning as a last attack they brought forward their reasons for opposing this Bill, and one ground of objection is that notification has been substituted for a system of local licences. Every midwife under this Bill is to be registered, but under the old Bill, and according to the idea upheld by the General Medical Council, a nurse, whenever she changes her place of residence, must take out a fresh licence. We simply propose, however, that she shall be notified to the sanitary authority of the district, 1157 who shall annually see that she is residing there and is doing good work. We do not ask that a medical man who comes into a district to reside shall take out an annual licence, and, therefore, why should we impose such a condition upon a midwife? There is no other class of person who has to take out an annual licence in that way. The General Medical Council also object very seriously indeed to the constitution of the Central Board. It wishes to take the whole matter into its own hands, and seems to forget that there are other interests in the country besides its own. I think that a Central Board, the majority of the members of which shall be medical men, and which will include also a representative of the Midwives Institute, which we consider to afford proper representation of midwives throughout the country, as well as somebody appointed by the Privy Council, would possess quite as much authority as the General Medical Council itself, and as, indeed, it requires or ought to have. The proposal in the Bill is, I venture to submit, a sound and just one.
The only other point to which I have to call attention is that within the past three or four years we have had various deputations to the Privy Council, which has assisted us by its advice. The Bill which is before the House is a result of a meeting which has been held in conjunction, not only with the Privy Council, but with the Home Office and Local 'Government Board, Who have sanctioned the proposals contained in it. We have had the most generous support, not only from the doctors associated with these public bodies, but also from the Women's National Association, the Women's Liberal Federation, the Women's Industrial Council, and representatives of the Body of Coroners. The evidence which the Coroners have given to us in the past is of such a nature that, I think, if it were printed and circulated among Members, it would have but one effect. It would demonstrate the absolute necessity for the passing of such a measure as this, and I hold that the House will be wrong if it does not at all events give the Bill a Second Reading, so that its details may be dealt with in a proper manner in Committee. I have great pleasure in seconding the Motion.
1158 Motion made, and Question proposed, "That the Bill be now read a second time."
§ (12.34.) SIR JOHN TUKE (Edinburgh and St. Andrew's Universities)
it is with a certain amount of regret that I move the rejection of this Bill, for it contains certain good points. But it will, I fear, prove a useless Bill, because it is lacking in one essential and vital point—in strength and purpose—and on account of that I conceive it to be my duty to move the rejection of it. I supported the Bill of 1900 generally on the ground that, to my mind, it was an important measure bearing upon public health. I supported it notwithstanding the opposition of a section of the medical profession. The profession was by no means unanimous on the question, but I think that, as regards the present Bill, I am not wrong in saying that 95 per cent. of the members of that profession will be found to be opposed to it. The hon. Member for Knutsford has alluded to the action of the General Medical Council, and spoken of it as being of a "dog-in-the-manger" policy. It is not so. In 1900 I gave voice to the views of the General Medical Council, which is as desirous as I am that a really good and efficient Bill should be presented to this House. I supported the Bill of 1900, although it was opposed by a certain section of the profession to which I have the honour to belong, and I did so on account of the strong belief I held that it conferred very great benefits upon parturient women. But this Bill now before the House does not contain the Clause which rendered the Bill of 1900 an important measure of public health, and the omission of that Clause will, in my opinion, make this Bill inoperative, futile, and, to a certain extent, mischievous. The Bill omits the provision preventing uncertified women from practising midwifery, and that omission, to my mind, constitutes a cardinal objection. I have other grounds of objection, but they, perhaps, can be better represented if the Bill reaches the Committee stage, which, I may say, I trust it will not.
The hon. Member who moved the Second Reading conceded that the main and great object of the Bill was to provide women in labour with suitable and safe attendance. 1159 No one is more anxious than I am that a measure securing such safety should pass this House, but that is an object to be secured, not merely by providing for the education and superintendence of midwives, but by preventing the practice of incompetent women. It is a matter of common knowledge that amongst the women now acting as midwives there are a considerable number who, as stated by the proposer, by their ignorance, carelessness, filth, and occasionally dissipated habits, constitute a serious danger to the public. Through their evil practices puerperal fever is generated and communicated from case to case, and by their filth that most dangerous form of insanity known as puerperal insanity is often engendered. Many thousands of women suffer for years from the consequences of bad attendance, and in not a few instances the deaths of mother and children are the result. In proof of this it is only necessary to refer to the verdicts found in many Coroners' Courts. The Bill of 1900 was not only calculated to build up a class of midwives who, after receiving elementary education in obstetrics, would be placed as to their practice under regulation and supervision, but by a special clause it was sought to suppress an existing dangerous class. The Bill before the House fails in this important particular. It does not suppress those evils out of which the movement for the registration of midwives has grown. Under the Bill of 1900 only certified women were allowed to use the name "midwife," and what is of infinitely greater importance, uncertified women who habitually and for gain practised midwifery were made liable to a fine of not more than £5.
I ask the House to consider Clause 3 of this Bill. It reads thus—(3) Any woman who, within two years from the date of this Act coming into operation, claims to he certified under this Act, shall be so certified provided she holds a certificate in midwifery from the Royal College of Physicians of Ireland, or from the Obstetrical Society of London, or such other certificate as may be approved by the Central Midwives Board, or produces evidence, satisfactory to the Board, that she bears a good character.Thus any woman who now acts as a midwife can obtain a certificate on producing evidence that she is a respectable woman, and fulfils certain conditions to be 1160 laid down by the Board to be constituted under Section 4 of the Bill. By the penal clause of the Bill of 1900, ignorant, disreputable, or incompetent persons would be precluded from certification. But the very class of persons out of whose irregularities this whole question has arisen is, as the Bill now stands, to be still permitted to practise their work unchecked by any authority or any form of supervision. It is quite true that such a woman cannot put a plate over her door or a ticket in her window calling herself a certificated midwife, nor can she use any designation implying that she is certified under this Act. But anyone who is acquainted with the class of persons among whom such women work must know right well that such a slight disability will have no effect, and, consequently, she will continue under this Act to he a continuous source of danger and evil. It might be argued that already the number of incompetent women is, lessening as a consequence of our extended views of nursing generally, but the evidence obtainable from great manufacturing centres, and from the Metropolis, itself, as well as from district nurses, goes to show that at the present moment the dangerous midwife is still a power in the land.
Now, Sir, I should like to ask the House to consider whether the provisions of this Bill are likely to lessen the number of uncertified midwives. It may be allowed that the Bill might produce a class of fairly well educated women—of women educated in the rudiments of obstetrics and in the first principles of midwifery. But before a woman can get on the register she comes under the jurisdiction of the Midwives Board, one of whose functions is to regulate the course of training and to conduct the examinations. I cannot conceive that this Board would admit to the roll any woman who, not having had previous hospital training, had not studied the subject specially for six months, or who, having had previous hospital training, had not studied it for at least three months. This, I hold, would be an absolutely irreducible minimum. The Board possesses other powers with regard to the supervision of midwives, and under Clause 8 the midwife is to be placed under the immediate supervision of county or borough councils, and she is 1161 to pay fees. All this involves expenditure of time and money and subjection to authority, and in return she gets for it the right to call herself a midwife, and to sue for fees, while alongside of her women who have obtained some local reputation will exercise their trade without expense or subjection to authority. There is one other point I wish to refer to. The Board is to possess penal powers. It can strike a woman off the register for misconduct. But she can still go on practising. Every existing reputable midwife can get on the register under the provisions of the Bill, but it is only for the incompetent and disreputable women that an implied special provision is made enabling them to continue a source of danger. I have heard it suggested that the penal clauses would unduly interfere with the midwives in the remoter parts of Scotland, such as the Highlands and the Islands.
§ *SIR JOHN TUKE
I believe the promoters of the Bill were sincerely sorry when, under the pressure of certain permanent officials, they withdrew the penal clauses, and thereby eviscerated the Bill. What are the reasons adduced? It is suggested that the penal clause would create a new class of offence. This I deny. I refer the House to the Apothecaries Act of 1815, which has not only not been repealed, but which is constantly put in force. Why should not the provisions of that Act apply to midwives in the same way as the same principle has been applied to other professions—like solicitors and auctioneers—and to trades, with the object of excluding undesirable members or persons? I venture to say that the penal clause does not create a new offence, and that it only represents the extension of an existing principle of law to a dangerous class. No measure for the certification of midwives can be made effectual so as to safeguard the public health, and to prevent numerous deaths from puerperal fever and other preventible causes, unless uncertified women are precluded from practice. If they are not, the irregular, incompetent, and dangerous women will increase in numbers, and the object of 1162 the promoters of the Bill will be nullified, while the certified midwife will be found to be in a minority. I think hon. Members will admit that I have not argued this question from a professional point of view. I have attempted to do so from the point of view of a member of the general public, having, however, some knowledge of medical matters. I hold no brief for the profession. If I hold a brief at all, it is for the hundreds of thousands of women who, from necessity or choice, are attended by midwives. I would gladly support this Bill with, perhaps, some modification, were the penal clause to which I have alluded re-introduced. But as an old Parliamentary friend of mine said to me the other day, "You can never make certain of anything in this House." I find it necessary, therefore, to press my Motion. I do so on the ground that this is not a measure to secure the public health, and that it does not secure to lying-in women those advantages which the promoters had in view when they took up this movement.
§ (12.50.) SIR BARRINGTON SIMEON (Southampton)
In seconding the Motion for the rejection of this Bill, I may at once say that I have no professional knowledge of this subject. I only speak as a man who happens to own land, and who, like other landlords in Great Britain and Ireland, takes an interest in the people who live in the villages on his estate. That is the sole reason why 1 take any interest whatsoever in this Bill. I do feel an interest in the welfare of the poor I people who live on my estate, and I am bound to say I hope most sincerely that this Bill will never pass the Second Reading stage. Every gentleman who makes a friend of the Medical Officer of Health in his district, or of the parish doctor, must be well aware that frequently some poor girl who gets into trouble, or some married woman who does not wish to increase her family, begs and implores the doctor to perform a certain operation. I need not say that these gentlemen, being honourable members of a most honourable profession, send these applicants away with a severe rebuke. But I do think that if you give midwives a certain amount of authority in the eyes of poor people, by certifying or registering 1163 them—an authority which the ordinary Mrs. Gamp of the village does not possess, the danger of illegal operations being performed on these girls and women will be enormously increased, and I think that that point should be carefully considered by hon. Members who own estates before they vote for the Second Reading of this Bill. Does this Bill confine itself to the proper practice of m dwifery, and does it protect poor women against incompetent practitioners? If it did I would gladly support it. What it does do is to create a perfectly new class of midwife, who will have some sort of authority in the eyes of the poor people in the country, because they will be able to put some adjective before their names. And poor people will think, more than ever, that, by employing these women, they are perfectly at liberty to save the doctor's fees. In too many cases the result will be that they will leave their husbands to pay the undertaker's bill, while there will be many more cases than there now are of children suffering from ophthalmia and other dreadful diseases which are common among children who are neglected at the time of their birth. Surely the proper authority to take steps for the formation of a Central Midwifery Board is the General Medical Council. But under this Bill it seems to me that the General Medical Council will have remarkably little to do. The final authority in any dispute will be the Lord President of the Privy Council. It is true that the rules of the Central Midwives Board are to be subjected to the approval of the Privy Council, after consultation with the General Medical Council, but in the event of there being any disagreement between the General Medical Council and the Central Midwives Board, the Lord President of the Council is to be called in to settle the dispute, and the General Medical Council will be kept out of the position which it, of all authorities, is most competent to occupy. Again, there is no provision in this Bill requiring the certified midwife to obtain a local licence annually from the sanitary authority of the district in which she Practises. The Bill, as I said before, creates a new class of midwife, whom poor people will think to be as good as a doctor, and who will have a free hand to do exactly as she likes in 1164 the district in which she practises. The local Sanitary Authority will have no authority over her, and neither will the doctor; indeed, nobody will know anything about her except the poor people among whom she may be doing, of course unintentionally, unmitigated mischief. I do not for a moment say that the present state of affairs concerning midwives is satisfactory. Indeed, it is most unsatisfactory. But I could easily imagine a Bill which I would support with pleasure and even with enthusiasm. I take it that if this Bill passes, it will render the present unsatisfactory state of affairs still more unsatisfactory, and it will do much more harm than good. No Bill can be satisfactory which leaves so many things un done which it ought to have done, and which does so many things which it ought not to have done. No Bill can be satisfactory which makes no provision whatever for medical attendance, even in dangerous cases. No Bill can be satisfactory which makes no provision for nursing after labour. No Bill can be satisfactory which must positively create discord and trouble between local doctors and midwives; and, above all, no Bill can be satisfactory which makes this newly invented class of midwives absolutely free from medical superintendence and gives them a free hand to do whatever they please in their own district. On these grounds, and in the interest of the poor, I sincerely trust that this Bill will not pass its Second Reading.
Amendment proposed—To leave out the word 'now,' and at the end of the Question to add the words "upon this day six months.'"—(Sir John Take.)Question proposed—
"That the word 'now' stand part of the Question."
§ (1.0.) DR. FARQUHARSON (Aberdeenshire, W.)
said that his hon. and learned friend who moved the rejection of this Bill made a very temperate speech, and he regretted that it fell to his lot to speak in opposition to him, for they all recognised his distinguished position as a member of the General Medical Council and the authority with which he spoke—an authority which rendered his remarks 1165 well worthy consideration. But he was glad to say that, although his hon and learned friend came to curse, he remained to praise, and there had been no more effective speech made in favour of the Bill, and of the general principle embodied in it, than that delivered by the Member for the Edinburgh University. Although he dissented, and perhaps properly so, from certain provisions, he had given plain and emphatic testimony to the evils going on throughout the country, and had thrown in his lot with those who desired to find some remedy, more or less effective, for a condition of things which they all deplored. He did not think his hon. friend quite fairly quoted the provisions of Clause 3. He omitted the words which provided that the applicant should have a bona fide practice.
§ *DR. FARQUHARSON
said he fully accepted that explanation, but he thought the House should be placed in possession of the fact that, in addition to having a good character, applicants must bring evidence to prove that they had been in bona fide practice for a certain number of years. He took his stand upon the ground that it was high time that something should be done. The evidence given before two Commissions showed that a very great evil existed, which ought to be remedied as soon as possible. He wished to make one quotation from the finding of the General Medical Council in 1899. He desired to do this more emphatically because it had been remarked that the hon. Gentleman the Member for Ilkeston was going to oppose this Bill. What did the hon. Member do in 1899? He moved the following Resolution at a meeting of the General Medical Council—That this Council regards the absence of public provision for the education and supervision of midwives as productive of a large amount of grave and fatal disease among the poorer classes, and urges upon the Government the importance of passing into law some measure for the education and registration of midwives.Although he did not agree with all the provisions of this Bill, he was not one of those who refused something because 1166 they could not get everything. As his hon. friend had stated, no less than 450,000 women in labour were attended by female midwives every year, and they preferred the female midwives. A great many women naturally preferred to be attended by their own sex at a time when the softness and tenderness of women was desirable for softening suffering. He knew that many of these women were ignorant and dirty. They had the testimony of medical men, and some of their leading medical institutes, that many of these midwives were dirty, ignorant, and incompetent from every point of view. Therefore they ought to take steps to educate them and make them less dangerous than they were at present. Parturition was a purely mechanical process, which was perfectly easy and natural, and could be carried out without any difficulty whatever. With savage tribes the process of parturition was quite easy, but there was the greatest difference between civilised and uncivilised people as to the peculiar difficulty with which this process was carried out. It was, however, a simple process as a rule, and two or three months, with ten or twenty lessons, would be quite sufficient to qualify one woman to know how to attend to another woman in childbirth. [Laughter.] Hon. Gentlemen opposite laughed at that, but he would point out that the attendance of six cases whilst in College was considered sufficient for a person to qualify in midwifery. If that was so, would not a woman who had attended 300 or 400 cases know as much as a man about this subject? He thought the women of the future would be sometimes safer guides in matters of this kind than the ordinary medical practitioners, who had not time to attend to antiseptic matters. Those women would be taught to use antiseptics and those modern methods which would abolish the dangers which frequently accompanied the present bad system under which midwifery was practised.
This Bill represented an honest attempt to regulate and find a remedy for a great evil. The Board was to be constituted by the Privy Council, who would frame the rules and regulations, and they would afterwards have to be accepted and supervised by the General 1167 Medical Council. Therefore, in every case the General Medical Council was the final Court of Appeal. As the Midwifery Board now stood, they were to have an equal number of medical men as against an equal number of others. The great objection which had been raised by his hon. friend was that the penal clauses had not been introduced, bnt he assured him that to expect Parliament to insert them was a hopeless Utopian dream. All they would be called upon to do would be to give some hall-mark which would enable the public to see readily who were qualified and who were not. If they said by this Bill "Here is a hall-mark," then they had given the public all the protection they could expect to obtain, and after that, if the people were too stupid not to find out those things for themselves, the blame would be on their own heads if they employed incompetent persons. He was glad that the hon. Member who moved the rejection of the Bill did not take the usual professional objection which he found running through the speech of the seconder, for he did not like that line of argument. The medical profession had been honourably distinguished for doing good to the general community and not promoting their own selfishness. His hon. friend who moved the rejection said that 95 per cent. of the doctors were against this Bill.
§ *DR. FARQUHARSON
said it had been alleged that the proposed registration would imply a practical repeal of the Medical Act. Those who put forward such views could not have read the fifth sub-section of Clause 1, which provided—The certificate under this Act shall not confer upon any woman any right or title to be registered under the Medical Acts, or to assume any name, title, or designation, implying that she is by law recognised as a medical practitioner, or that the is authorised to grant any medical certificate, or any certificate of death or of still-birth, or to undertake the charge of cases of abnormality or disease in connection with parturition.He had sat on two Committees on this question, and he had been in consultation, not only with the medical faculty, but with many outside who took a deep 1168 interest in the matter. He could hardly believe that any one would seriously oppose the Second Reading of the Bill on its merits. He considered that its principles were well founded. What he thought the House ought to do was to pass the Second Reading so that the Bill might be sent to a Select Committee or a Grand Committee to bring it into a form which would satisfy the medical profession, and give some sense of security from danger to the general community.
§ (1.16.) MR. GRIFFITH BOSCAWEN (Kent., Tunbridge)
I cannot claim to approach this subject with any medical knowledge, but this, after all, is largely a social question, and one with respect to which, though the House listens with the greatest interest to all the medical men have to say, it may very well be decided by the House at large. I must confess to being somewhat amused at the attitude the doctors have taken towards the Bill. It is always said "doctors differ." Today we have had two distinguished doctors speaking on the Bill. One has spoken in favour of it and the other moved its rejection, and it is all the more incumbent on us, who have no medical knowledge, to carefully consider what course we should take. When this Bill was last before the House I moved on its return from the Standing Committee that it should be reconsidered, and that Motion I think was talked out by the hon. Member for Northwest Sussex, who was the parent of the Bill. I think the action I then took was thoroughly justified, because this is a very important matter, and one not to be dealt with lightly. I should like to assure my hon. friends that I have no intention of voting against the Second Reading of the Bill today, and I hope there will not be a vote. Although we may differ—and I differ considerably from the promoters on many details—I certainly hold that the promoters of the Bill are aiming at removing a great evil, and I know that many of them have worked hard to bring this matter before the public, and, if possible, to find a remedy for it. I think we ought to afford the Bill every facility by giving it a Second Beading and allowing it to go to the Standing Committee, where it can be thoroughly thrashed out.
1169 What are the real facts lying at the root of the necessity for this Bill? They are very simple. In the first place it is an absolute fact that in the great majority of the cases that occur among poor people they will not call in a doctor to attend. Secondly, I believe that in the great majority of simple cases there is no necessity to call in a doctor. Thirdly, owing to the fact that no sort of training and no sort of certificate are required on the part of those called in, there is a vast amount of ignorance and a vast amount of dirt, and consequently a vast amount of preventible disease; while lastly, there is this, which to my mind is most important, that in every single case where there is any sort of complication, abnormality, or disease, it should be absolutely necessary, and laid down in black and white, that a doctor should be called in. What seems to me to be required is this. We should endeavour to set up not an inferior class of medical practitioners, but a superior class of trained nurses, and if we accomplish that we shall have done a very good thing. Does the Bill do that? I approach the Bill in the most friendly spirit, but I am bound to say, as was pointed out by the hon. Member who moved the rejection of the Bill, that it does not do that. In the first place it does not prohibit the ignorant person from whom dangers now arise from practising in future. That is the whole point. As the hon. Member said in moving the rejection of the Bill, the danger now arises not from the better class of midwives, but the worst class. You propose to register and grant certificates to the better class, but you will enable the worst class to go on practising in the future as now, and, therefore, you will not remove the danger which exists. The hon. Member for West Aberdeenshire said that no House of Commons would ever think of passing a penal clause prohibiting people not registered from practising. I have only got to point out the fact that in the session of 1900 the House of Commons did pass through the Second Reading, and through Committee, a Bill which contained such a penal clause, and it seems to me to be absolutely essential, if we are to do the good my hon. friend and his supporters desire, that we should pass this penal clause, and enact that no woman should 1170 habitually, and for gain, practise midwifery, unless she has obtained a proper training and certificate. Does the Bill provide adequate training? I am not now in a position to criticise the Midwives Board, but I am told that its composition is open to a great deal of perfectly proper criticism. I think that instead of some of those bodies appointing members, and which seem to have very little qualification for the purpose, it would be infinitely better that the persons appointed should be appointed by the General Medical Council. I mean those who are mentioned in the first sub-section. They should be persons who have been recognised teachers of midwifery in some medical school in England, Ireland, or Scotland. If that were done, you should have certainly some guarantee that the professional people composing the Midwives' Board were competent to grant certificates. This is essentially a matter of nursing, and I think that on the Midwives Board it is most important that that splendid institution the Royal Nursing Association should have a representative If that were done, I think it would go far to meet the objections of some of those who are inclined to criticise the composition.
Another objection to the Bill is that there is no provision for adequate local control. The Bill has really been altered for the worse in this matter. In the Bill of 1900 it was necessary that the local authority should grant a licence or certificate before any midwife could practise in the district covered by it. Now the promoters have taken that out. That provision, I think, was important, because it gave some regular control which had to be renewed year by year by the local authority. Now the promoters have inserted merely notification. The control of the Central Board can be very little indeed. A local body may report to them and they can inquire into a case, but what we want is strong local control and supervision, and that being so I think the provision placed in the Bill of 1900 requiring the renewal of the licence was far better than the provision for notfication which occurs in the present Bill. I cannot see in this Bill—and I would ask the promoters in this matter if I am right or wrong—whether there 1171 is any compulsion on the midwife in cases of abnormality or disease to send for a doctor. I believe it is intended. but certainly the provision is exceedingly weak, if there is any provision for it. I venture to say that unless you make that position strong and insert a penalty you will be doing by this Bill a great deal more harm than good. Surely it is not intended to set up an inferior class of practitioners—people who take out a degree in midwifery alone, whereas the doctor who attends these cases must have a course not only of midwifery, but also of medicine and surgery. Surely it is not pretended that these inferior practitioners are competent to deal with difficult and complicated cases. If that were the intention of the Bill I should certainly oppose it on the Second Reading.
§ MR. HEYWOOD JOHNSTONE (Sussex, Horsham)
May I ask the hon. Gentleman to tell us how these cases are to be foreseen?
§ *MR. GRIFFITH BOSCAWEN
What is really essential is to strengthen the local control. If the local body observes that a case has taken place in which there was evidently some complication but in which the midwife employed did not at once send for a doctor, then the local body should have some power—I shall not attempt to sketch what it should be—to deal with that case in an effective manner. What I wish to press home is that I think it most important in all these complicated matters and all questions of disease that a medical man should be called in. That should be provided distinctly in the Bill. We heard it mentioned by the hon. Member opposite that this Bill does not apply to Scotland or Ireland. I confess I do not know why. I suppose these evils arise in Scotland and Ireland just as much as they do in England. Two of the hon. Members who have spoken on the Bil are, I believe, Scotch, and there are Irish Members who will speak later on. I am told that they manage these things better in Scotland. I do not know how that can be, but if we are to have a Bill at all we should make it apply all round. I apologise to the House for going into some details, but they are important points, 1172 and upon their solution depends whether we are justified or not in opposing the Bill on the Second Reading. I assure hon. Members, both for myself and many others who take an interest in this question, that we do not in the least wish to stop or obstruct their Bill, but we think the means contained in the measure are not calculated in their present form to cure the evil, and we very much fear that they may bring about a state of affairs which would be worse than exists at the present time. For these reasons I intend to support the Second Reading, but I hold myself perfectly free to move Amendments on the lines suggested when the Bill goes into Committee.
§ (1. 29.) MR. EUGENE WASON
I heartily concur with the hon. Gentlemen in regretting that this Bill does not extend to Scotland, but I think the fact is, as has been stated, that these things are managed better in Scotland. The House ought to know that our local machinery is different from what it is in England, and it would have complicated the measure very largely if Scotland had been added. I do not grudge that the predominant partner should take the lead in this matter. If it does, I have no doubt that both Scotland and Ireland will soon follow suit. Great complaint has been made with reference to the Bill. What strikes me is that it does not go far enough. I think that was the tenour of the observations made by the hon. Gentleman who moved the rejection of the Bill. But we must proceed tentatively, and if the Bill can be made stronger in any way I think it would be better for the community at large. But it is admitted that something ought to be done. The Medical Council has done nothing up to the present. I desire to speak with all respect of the medical profession, amongst whom I have many friends, and I am glad my hon. friend the Member for the Scotland Division of Liverpool is present, because he does not take the same view of the medical profession as I do. Of the medical profession he says—There never was a trades union tyranny or an agrarian tyranny in Ireland or elsewhere which could approach in its cruelty the tyranny of legal and medical etiquette.I belong to one of these trades unions of legal etiquette, but I certainly have 1173 never suffered under its tyranny, and I do not suppose that the hon. Member who moved the rejection of the Bill has ever suffered from the tyranny of the General Medical Council. I believe that if this measure is carried it will confer a great boon on the poorer classes of this country. This is essentially a woman's question. It was only ten days ago that a large party of textile workers came up here from Yorkshire and Cheshire with a petition and asked that Members should see them, and when they saw them they asked that they should have a Parliamentary vote. The reason they gave for this was—"That if we had a Parliamentary vote we should be able to make you Members of Parliament carry out measures for the benefit of us women which you do not understand at the present time." Sir, this is one of those measures. I do not say that it is a perfect measure, but I was glad to hear the hon. Member who last spoke say that he was not going to vote against the Second Reading. I hope it will be passed unanimously, and that it will be sent upstairs, where, if it can be, it will be made a better Bill Of course the promoters would have liked to have taken the General Medical Council with them, and they had the choice between taking the Government and the Privy Council with them and taking the General Medical Council with them. And I think the promoters did well in securing the allegiance of the Government and the Privy Council rather than that of the General Medical Council. I do not wish to detain the House at greater length. I would merely say that I received this Bill as a legacy from my predecessor; that it is a question that I have taken a great interest in, and which I have supported in three Parliaments, and I hope the House today will give this Bill a Second Reading without a division.
§ (1.35.) SIR FRANCIS POWELL (Wigan)
said that, as one who sat upon the Committee on Law which considered this question in 1900, perhaps the House would allow him to say a few words on this subject. The Committee at that time devoted their best attentions to this difficult and complicated subject. The Bill was considered 1174 by the Committee for two days, their deliberations were careful, and, he ventured to say, of a highly instructive character. There were several divisions, which marked the pains the Committee took during the investigations, and although the numbers who attended the Committee were not, large, still the majority was emphatic as showing the view which the Committee took respecting the Bill. Now he, having approached this question in this way, desired to consider whether the changes made in the Bill of 1902, the present Bill, were of such a character as to induce him to withdraw his support from this Bill on the Second Reading. He regretted all these alterations and thought they weakened the Bill; but a weak Bill at this stage might be made a strong Bill in the course of subsequent discussions, and although he could not support it on a Third Reading be did support it now in the hope that it would be made more stiff, more serviceable, and more valuable to the community. As to the evil that existed there could be no doubt. It had been proved by the experience of all, and by abundance of evidence brought before the Select Committees, and the opportunity which we had at the present moment for improving the law ought not to be neglected. It was a difficult thing for a private Member to bring in a Bill for Second Reading so early in the session, arid it was still more difficult for a Government with such claims on their time to carry through a matter of this character. He sincerely hoped therefore that the House would give this Bill a Second Reading, in order that it might be rendered such a Bill as would be worthy of its placeon the Statute Book, and such a Bill as would remedy many disastrous evils.
If the House would allow him, he would deal with one or two alterations that had been made in this Bill as compared with that of 1900. One alteration which all would regret was the abolition of the fine; the analogy of the absence of the fine in the medical profession and the absence of the fine in the case of these women did not hold good. A medical man was able to obtain a fee, and if not duly qualified could sue in a Court of Law, but if his information was correct, the payments made to these women partook somewhat of the nature of an honorarium, and it was 1175 very seldom indeed that any claim was made in the County Court in order to obtain these fees. Therefore there was no analogy between the two cases. The proposed condition of the law in the case of these women would render any statute that might be passed practically useless and entirely ineffectual. There was another alteration which was of the most disastrous character, and that was giving authority to the Lord Presidents of the Council. We lived in days when Lord Presidents of Councils or even First Lords were not Admiral Crichtons; they were not versed in all subjects, and generally could only perform the duties of the responsible positions which they held because they were served by highly qualified staffs. The Lord President had no equipment to deal with this matter. During the last twenty years the feeling that had aminated this House had been to reduce the power in many particulars of Lords Presidents, and place a great deal of their work in the hands of other Ministers, assisted by highly qualified and competent staffs. Another alteration was that rules of the Body were to be approved by the Privy Council after consultation with the General Medical Council. In the Bill of 1900 the power was left to the General Medical Council, with power of appeal to the Privy Council. As regarded notification, he thought a change had been made in the wrong direction. He regarded the necessity of obtaining licences as most important. If licences were compulsory, the people to be licensed would be seen, and to some extent it would be possible to ascertain whether they were proper people to perform these duties. All these matters were reasons why the Bill should be altered, but were no reasons for abandoning legislation in the present session; and he therefore hoped that the Bill would be read a second time and referred to a Committee, in order that a long-standing scandal might be removed, the public safety increased, and much suffering and wrong removed for ever from the community.
§ (1.46.) DR. AMBROSE (Mayo, W.)
said that as one who had been in practice for twenty years it might not be out of place if he said a few words on this question, which was one of the most important 1176 which, in his opinion, had ever come before the House. Of the three branches of the medical science, medicine, midwifery, and surgery, there was nothing that required greater coolness, skill and dexterity than midwifery. A man might have a run of luck in midwifery; he might never lose a case in a practice embracing, as his own had done, 6,000 cases, but at any time he might come across a case where it would take him all his time to preserve the life of the child, or the mother, or both. If a medical man, who understood the anatomy of the heart, with all his knowledge sometimes failed to preserve the life of the child or mother, how in the name of common sense could a woman who only went through a preliminary training of two or three months be expected to succeed? He appealed to the promoters of the Bill to think well before they handed over the lives of the poorer women of this country to such an incompetent body. In France three years training was required before a midwife was allowed to practise, but if this Bill were passed into law any women after a couple of months training could go in for midwifery.
§ MR. HEYWOOD JOHNSTONE
Will the hon. Member kindly show me where such a provision is mentioned in the Bill?
§ DR. AMBROSE
said that every Member who had spoken on the Bill had said that two months training was all that was required, even if that did not appear in the Bill, but he would not labour that point further. What did this Bill propose to do? It proposed to provide a class of women who should be able to attend women who were too poor to pay for a doctor, and it was proposed to set up, in order to provide this class of women, a Board which was to be called the Midwives Board, and to give power to that Board to say to any woman, "From hence forward you shall be at liberty to attend confinements ad libitum." Was such a thing likely to be for the welfare of the poor women of this country? This body was to be presided over by the Lord President of the Privy Council. What did that Gentleman know of midwifery? If a man was to be ap- 1177 pointed to preside over a particular body, it only stood to reason that he should know something of the subject with which he would be called upon to deal, but the Lord President of that Council, knowing nothing about confinements, would have it in his power to say who should and who should not attend confinements. A proposal still more ridiculous was that this particular body, in issuing these particular licences, should let loose upon the poor women of this country 20,000 of these women, for he saw from a Return that there 20,000 women in existence at the present moment, without knowledge, who were called in simply because they were "handy" women. It had been said that this Bill was being proposed for the benefit of at least 450,000 women. As he had said, there were 20,000 "handy" women in existence at the present time. If they took only 20 cases a year, which was not a large number, they would attend between them 400,000 out of the 450,000 women for whom this Bill was to be passed. There was no guarantee that these women were to be properly trained; all the Bill said was that the Midwives Board would accept the certificate of the Obstetrical Society of London. No person studying for the medical profession could obtain a fellowship of that Body until he had qualified in the three branches of medicine, but by this Bill this Licensing Body would have power to accept this certificate as a guarantee that a woman was proficient in the art of midwifery. He opposed the Bill because it created an inferior class of practitioner in midwifery — one of the branches of the medical profession—a class over which no control would be exercised by the Medical Council. He opposed the Bill because it created a precedent for a non-elective body applying to the County Councils for the ratepayers' money and spending it; because it made no provision for qualified medical assistance even in difficult cases; because it made no provision for nursing after labour; because it contravened the Medical Acts, which required all practitioners to be qualified in medicine, surgery, and midwifery; because, although the Bill was ordered to be printed on the 21st of last month, it had only been printed on the 1178 12th of this month, the public thus not having had time to consider its merits; and he opposed it also in order that some day an efficient Bill might be brought forward.
§ (1.56.) MR. W. F. LAWRENCE (Liverpool, Abercrombie)
said he had not intended to take any part iii this debate, but he had been pressed by important bodies in Liverpool to advance the interests of this measure in any way he possibly could. Last year a strongly worded petition was presented in favour of this measure, and as that day he received another petition, he felt he could no longer be silent on the question. Up to the present he had abstained from taking part in these discussions because he had the honour to represent a considerable body of the medical profession in Liverpool, and as long as there was any uncertainty in the public mind on this question, he did not consider he was called upon to deal with it; but now that public opinion was focussing itself upon this matter, he thought it was about time that the House came to a decided opinion upon it. He approached the discussion of this Bill with absolutely disinterested motives, and he thought its promoters ought to be content with the discussion; so far as it had gone, there had been no radical objections to the Bill, and the fact that there was no objection to the Bill upon its merits was another reason which justified the action he was taking. Tile real objection appeared to be that the Bill did not go as far as it should, but no doubt the promoters of it would be glad to strengthen it, if they received the permission of the House to do so, and therefore he did not think that the argument that the Bill was not strong enough was a sufficient argument to throw it out. Half a loaf was better than no broad. And the fact that a number of incompetent people were now practising was not a sufficient reason for rejecting the Bill. If the Bill became law, it was quite true that a certain number of incompetent people who were now practising would for a certain time continue to practise, but if it did not, they would practise just the same. He thought it only right that those people who had 1179 been hitherto earning their living in this way should be allowed to continue. A reform of this kind could only be brought about by recognising vested interests. It might be desirable to prevent incompetent people from practising this work, but the only way was to get the machinery in force, and then gradually improve and strengthen it. Some hon. Gentlemen advocated these persons being licensed. It was true that licences did not figure in the Bill, but if it was necessary that these people should be licensed, such a proposal could be considered in committee. As the matter stood, the County Councils were to draw out lists of those who practised, and they would have power to suspend at once any person guilty of malpractices, and when these persons came up for registration any case of improper action would be promptly noticed and the person guilty would be struck off the list. It was quite time a definite conclusion was arrived at on this important question. It was quite certain that on the ground of expense many women would never have a medical man. At present that class received very insufficient treatment at the hands of incompetent women, but under this Bill, if passed, these presumably incompetent persons would gradually die out, and their place would be taken by persons better qualified for this duty. He had no doubt that in the country districts the Parish Councils would only recommend those persons who, in their opinion, ought to have certificates, and in that way a register would be obtained of people fairly competent. The Central Body had been criticised by hon. Members. He saw no special reason for the President of the Council as the initial authority; there was no reason why this authority should not be given to the Local Government Board, who were the Authority on health and sanitation; but whoever the authority was given to, he had no doubt that a good deal of good would be done by passing the Bill and getting a Council at once into operation. He was glad to see there was no longer any jealousy on the part of the medical profession. The Bill was clearly in the interest of the general community, and on that ground he cordially supported it.
§ (2.5.) MR. EMMOTT (Oldham)
desired to say one or two words in cordial support of the measure. It was stated as one of the objections that it did not apply to Scotland or Ireland, but he hoped that would not be taken as any objection. It was a very curious tendency of the time that the principle of what he called separatist Bills—by which he meant Bills which dealt separately with each country—was very much on the increase in the House. It was perhaps strange, and yet on the whole very satisfactory, that both the supporters and opponents of the Bill agreed in the main. Their idea was in this matter to stop untrained midwives attending women at childbirth; and if they desired, as all did desire, that an efficient and Imperial race should grow up, one of the earliest things they wished to see would be the two or three thousand preventible deaths which occurred every year stopped, to see the misery and suffering which women had after child-birth through insufficient care and attention put an end to, and to see instead of weak and ricketty children strong children able to be of some service to the State. But because they wanted more than this Bill gave, that was no reason for opposing it. He would welcome the Amendment suggested by the hon. Member for Edinburgh University, which would prohibit unqualified women from attending other women during childbirth, but this was not the time for heroic measures. Half a loaf, on this as on other questions, was better than no bread at all. It was stated that cheapness only was considered by the poor, and that to make this class of midwife a special class would be that the poor would employ them to the detriment of the doctors. He ventured to differ from that. He did not believe for a moment that the poor would value less than they had done in the past the attendance of properly qualified men. If, however, the newly certificated midwives in time competed with doctors, surely by that time we would be able to advance a step further and have more stringent legislation in regard to this matter. (2.10.)
§ (2.42.) COLONEL SADLER (Middlesborough)
I am in the unique position of having been connected for some 25 year 1181 with the sanitary authority of the constituency which I represent, and during that time I have had some experience of the amount of misery which has been caused to the community by the practices of midwives. Their ignorance and their pretensions, unfortunately, make the poorer classes a very easy prey to them, and it seems to me that it only wants the nickel-plated diploma, if I may so describe it, provided in this Bill to make them a still more easy prey to their pretensions. I therefore trust that this House will hesitate before it reads this Bill a second time, for it contains proposals which will have a far reaching influence amongst the class I have described. I consider that this Bill is entirely unnecessary. If it be true that women desire to be attended by a member of their own sex, I have no objection whatever to that, if the lady possesses the necessary qualifications. I strongly object to your putting a woman who has had only one or two years experience in the position of a medical practitioner. The proposal absurd on the face of it. I have had a great deal to do with the sick poor in the district I represent, and I know that what are wanted are trained nurses. I am glad to say that philanthropic people and the public spiritedness of large communities have risen to the occasion, with the result that we now find a large staff of trained nurses who are available at any time for emergencies of this kind, as well as others. I am not for a moment against trained nurses; I would almost penalise any one who acted as a professional nurse, if they had not some training for the work. I shall oppose this Bill, myself, on the ground that it is not fair to the working classes. The diploma which it is proposed to issue would be magnified into something of a great deal more value than it is really worth, and it is in the interest of the poorer people, and to shield them from what I fear to be a most dangerous imposition, that I shall feel it my duty to vote against the measure.
§ (2.50.) MR. LUKE WHITE (Yorkshire, E.R., Buckrose)
As one of His Majesty's coroners, I should like to be allowed to say a few words in regard to the Bill. I have had some experience of the great evils at present existing, and I for one, can give my cordial support to the Second 1182 Reading of the measure now under discussion. With regard to the provisions of the Bill, I may say that I do not think it is a perfect measure, but it is one which I think should be fully discussed in Committee, and I have no doubt that if there is a general feeling in this House with regard to the passing of the measure, as I believe there is from the speeches which have been made, it will evolve from the Committee in a much better shape than it is in at the present time. With regard to the principle, I believe that our Coroners' Courts have shown during the last ten or twenty years the existence of a great evil. I can assure the House, in my position as coroner, and from the information I have at my disposal, that there is urgent need for legislation on this question. In the large towns and in the country districts there are a large class of women who are known as monthly nurses, who act more especially under the direction or supervision of a medical man, but the Bill will not touch these persons. There are, on the other hand, a number of women, especially in our great cities and towns, who absolutely hold themselves out to the public as being qualified to act as midwives, and it is to that class of persons that this Bill will especially apply. I think we ought to look upon this question, not from the point of view of the medical profession, not from the point of view of being regarded as giving some support to a class who might be, to a certain extent, in opposition to the medical profession, but we ought to look at it from the point of view of those persons who employ these midwives. They are the poorer portion of the community, and we ought, if possible, to give them midwives who are in some way qualified to perform the duties which they undertake. We should endeavour to give them some safeguard that they have not got at the present time, and it is for that reason that I heartily support the Second Reading, so that the Bill may be referred to a Committee.
(2.54.) SIR WALTER FOSTER (Derbyshire, Ilkeston)
I rise because I have a sense of responsibility with reference to the measure before the House, and the whole subject which has been engaging our attention this afternoon. It was mainly through action on my part that this question came under the notice 1183 of the General Medical Council some years back. I was then struck, as many Members of the House have expressed themselves to-day, with the terrible horrors that occur through incompetent persons attending the poor at the time of labour and childbed, some very startling instances having come under my own personal observation, for at that time I happened to be practising my profession. I felt that something ought to be done to improve the education of midwives, and to put them in a position to render aid to their sisters in trouble without the terrible calamities that occurred then and still occur, I am sorry to say, among the very poor. Holding that view, I moved a Resolution on the General Medical Council in the direction of improving the education of women practising midwifery, and out of that grew in 1889 the measure which was brought before the House, and the agitation which has now been going on for some twelve years. The subject has been brought before the House from time to time in consequence of that action. Having some humble qualification for knowing how this will affect the poor, and putting aside altogether the possibility of the measure affecting the medical profession, I am bound to admit that even at the present moment the problem is most complicated and difficult. Although I am as anxious as any promoter of the Bill can be that it should be solved, I must honestly say to the House that there are still some points which raise difficulties that I cannot get over, and which this Bill fails to meet to a still greater extent than some of the Bills that have preceded it in this House. A problem which is as difficult as this, a problem which has engaged some of the ablest minds in my profession, and which they have failed to solve from the medical point of view, and which a number of hon. Members of this House have failed repeatedly to solve from the public point of view, is not a problem which we can discuss lightly, and which we can draw up a Bill to remedy, or which we can find a cure for in a few hours discussion in this House. It is a subject which eminently demands deliberation on the part of men specially qualified to consider it, and it is a problem which even then would be found 1184 very difficult of solution. So difficult was it, that two Select Committees of this House have had the matter under consideration. The first Select Committee I shall not speak of as having done a great work, but the second Select Committee took a large amount of evidence on this question and presented a Report, in which they did not offer a solution of the problem, but they asked that they might be re-appointed in the ensuing session of Parliament in order that they might come to some conclusion.
§ MR. DE TATTON EGERTON
I think the right hon. Gentleman is wrong. The second Committee did report fully.
*SIR WALTER FOSTER
I am very much obliged to my hon. friend for calling attention to it. I only wanted to point out that it is a difficult problem, which requires a considerable amount of deliberate consideration before we can arrive at anything like an adequate solution of the difficulty. Putting that aside for a moment, and not to press this point, I want to come to closer quarters with the difficulty before us. There is no doubt that it is desirable that we should find some method by which we can approach this question with the view of obtaining more adequate assistance of this kind for the poor in time of difficulty. We are all agreed upon that, and the only thing on which there is a difference of opinion is the question of method. I say this is not as good a Bill, in my opinion and in that of many others, as the Bills previously submitted to the House, and which have been nearly passed into law.
Let me ask the House to consider for a moment the position in which we are placed with reference to the Bill. You must remember that you are dealing here with a subject which has been steadily growing in scientific complexity and difficulty during the last thirty or forty years. I remember the time when the medical profession did not consider the practice of midwifery on a level with the other duties it had to do for the public, and practitioners of midwifery scarcely held the same rank as they hold today. Gradually the scientific practice of midwifery has been developed until it 1185 has obtained a position now in the Statute Book and in the eyes of the scientific world which gives it a greater consideration and a right to be put on a level with the other branches of the medical profession. By the legislation of 1886, when this House in its wisdom took into consideration the position Which the science of midwifery had at that time attained, it was placed on a level with the other branches of the medical profession, medicine and surgery, and it was enacted that no man should go on the medical register unless he had had a training and qualification in all these branches. The consequence of that was that it placed the practitioner in a totally different position. No individual man is now allowed to practice midwifery in this country unless he has had five years training, and has obtained a diploma to practise medicine, surgery and midwifery, so that if a general practitioner wants assistance in midwifery cases he cannot get that assistance in the simplest case of labour from a pupil who has attended all his lectures, and all his prescribed midwifery cases, and passed all his examinations except the final one which entitles him to be put on the Medical Register. That is a very strong position to be taken up; but it is based on the law which this House approved of in 1886, and which has never been interfered with. So strong is that law that the General Medical Council in carrying it out have accused a medical man of infamous or unprofessional conduct for employing assistants who were notably good obstetricians because they were not technically qualified by law. I remember a practitioner of good repute having been brought before the General Medical Council for a comparatively trivial offence. He had bought a practice in the South of London, the vendor of which had had a son as assistant. That assistant had taken out all his lectures, had passed through the whole of his medical curriculum; he had attended many thousands of midwifery cases, and was so skilful a man that the people of the district preferred him to the new principal. But the General Medical Council, carrying out the law of 1886, regarded this man as an unqualified assistant, and had to tell his principal that if he continued to employ him in even the simplest cases of labour, 1186 they would be obliged to call him up for judgment for employing an unqualified assistant. This attitude was taken, not in the interest of the medical profession, but to save the public from the terrible disasters which have been experienced in the past from the practice of illegal and unqualified practitioners. The medical profession, through the General Medical Council, has been exceedingly jealous of maintaining a high standard in its members for the sake of the community at large.
If this Bill were passed, what would happen? All tins structure winch has been erected with so much care to protect the public would fall to the ground. A general practitioner would—especially in populous centres—employ as assistant, instead of a man who has had five years study, who has all the qualifications for registratration as regards lectures, who has passed all his examinations and who has had experience of midwifery cases, a certificated midwife, and would put her into a branch practice, where she would do work which the General Medical Council would not allow a man to do who had twenty times her qualification, training and experience. That is an absolutely unjust and unfair position in which to put students of medicine, and unjust also to the poor of the country, who would have thrust upon them, especially in the manufacturing districts, midwifery practitioners who had only a very few months training. That is an evil so great that we ought to consider it very carefully before we put it on the Statute-book. I do not want to dwell on that point further than to show that, in trying to do good in one direction, we may be doing harm in another. In a case like this, where you have a very compassionate and a very benevolent class of people anxious to do good, there is a danger in making that attempt of opening the flood gates to an evil much greater than that which you are trying to arrest.
I would point out also that the dangers to the public are not adequately met by this Bill. When we conjure up in our minds the evils that occur under the present system we naturally think of those cases, which are the exception, which come before the coroner; but probably for every one of 1187 these there are a score which are never made public, especially among the class of people whom this Bill will not touch. There are midwives in the country districts who do not put out any signboard, but who have their own connection, and who probably attend five labour cases for one by a midwife who has a brass plate on her door. The Bill will not touch these; they will continue to go on in practice, and the evils which form the great basis of this agitation will not be touched. The only effect of the Bill will be to produce a new class of registered practitioners. I am not at all sure that this system of registration is a good one. I remember that in 1887 or 1888 my hon. friend the Member for Northampton protested against the mania for registration, when some Registration Bill was under discussion. Although I supported that Bill, I am not at all sure now that there was not a large element of truth in my hon. friend's contention that registration is a poor protection for the public. What is the agitation in the medical profession? It is not for more registration, but that the penalties against practitioners should be imposed unless they are registered. This Bill does not impose any penalty against a person practising midwifery who is not registered. There is nothing in having a name on a register. You may put the register on church doors, but the public will not read the names on it. They send, when they require a midwife, for the person whose name is in their ears—the person about whom they have heard. Registration would therefore be little protection to the public. It would simply give a certain status to women who take out licences as midwives and make them a class in themselves, by enabling them to recover their fees.
This is a bad Bill as compared with previous Bills introduced into the House of Commons, and I cannot support it, although I am entirely in favour of educating these women for the public good. My objection to the Bill is, first of all, that there is no definition of what a midwife is. We do not know what she is to be, or what her duties are to be. The only definition of a midwife which you find in the dictionary is that she is a woman who attends another woman in labour. But that is not sufficient, nor is 1188 the word abnormality put in the Bill as a limit to her functions. Abnormalities occur only when the midwife is called in, and are often so slight in the first instance that it requires a very experienced practitioner to detect them, and the life of a woman might be lost while a midwife was trying to find out whether there was any abnormality or not. There is also another defect in the Bill. There is no check whatever on the class who do the most harm. They will go on without any penalty or interference with practices which cost hundreds and thousands of lives every year in this country. When the comparatively limited class of midwives who hang out signs and put up brass door plates are brought under the Bill, they will be subjected to no adequate supervision. In the last Bill we had a very salutary provision that they should get an annual licence from the Local Authorities, so that every year they would have to go to the Medical Officer of Health of the district and get his licence to practise for another year on payment of a shilling. What an enormous advantage that would be in keeping people respectable, and in keeping their practice in the proper direction, and away from that class of trouble into which it may easily fall. One of the most unpleasant features of our civilisation is that some women having the diplomas referred to in this Bill or other diplomas are at present in practice in this country, and are undertaking that kind of practice which is infamous in the eyes of everybody. They advertise themselves as "ladies' friends" in the newspapers in our great public centres, and every one of these advertisements means a whole vista of horrors and immorality which we ought to be careful not to encourage. Then, again, we have this further fact. We have not now in this Bill the local control which we had under the old Bill through the Medical Officer of Health, and we have not got the protection of annual licences. All a woman has to do is to go down to any borough in England and say, "I am going to practise midwifery; here is my certificate." Is that sufficient supervision to keep her in that close, straight path which every professional person ought to take? There 1189 is another fact. There is no central medical central now of any kind, such as we fought for in the other Bill. The General Medical Council is practically struck out of the Bill, as it has been put under the Privy Council. That was not the advice of the Lord President of the Council when, in receiving a deputation in 1898, he distinctly stated that above all things the promoters of any measures of this kind should bring themselves into harmony with the General Medical Council; that it was the body to consult in the first instance, and the body to control by laws and regulations afterwards. That is all thrown to the winds. The General Medical Council are to be given the power to consider anything submitted to it by the Privy Council, but the Privy Council will have supreme power in connection with the practice of these women. The central authority to be constituted is, I am afraid, a weak authority. A central authority, consisting of three medical men, and some others added, and the representative of a body I have never heard ofߞthe Midwives Institute—which is not known to my profession, would not be strong enough to control these thousands of women all over the country. We want, in addition, a certain number of local bodies to control them, and above all, the assistance of the medical officers of health in counties, county boroughs, and even smaller areas, acting in direct connection with the central body, to control these women in their practice.
We have, then, these great defects in the Bill as now drafted, not as compared with an ideal Bill, but as compared with previous measures submitted to the House. The Bill falls off in four or five great particulars, and the House ought to pause before passing the Second Reading. I believe the right course would be, if the Bill is read a second time, to refer it to a Select Committee. It is not a subject that can be adequately discussed in Committee of the whole House or in a Standing Committee, because it requires the deliberate consideration of men who have given years of thought to the subject, aided by others who bring common-sense business principles to the solution of State problems. If we have a Committee of that kind, I believe we 1190 might bring about a final solution of this difficult and intricate problem, a problem so difficult and intricate that I have seen thirty of the best medical members on the General Medical Council unable to arrive at a conclusion regarding it. If these thirty men of scientific distinction, all over the three Kingdoms, with all their technical knowledge, were unable to come to a satisfactory conclusion on some points, surely the House of Commons ought to pause before it takes up a subject of that kind, and attempts to settle it on a Wednesday afternoon by passing a measure which even its promoters admit is a defective measure, and one which does not rise to the seriousness of the occasion. This Bill is not big enough to deal with the problem. It is brought forward with the best motives by gentlemen animated by the highest desire to serve their fellow creatures; but they are grappling with a problem which is too big for them. It ought not to be in the hands of private Members at all. It ought to be taken up by the Government and considered from the point of view of statesmanship. The moment you pass this Bill you will have another Bill for the registration of other nurses, and if there is one evil greater than another it is the want of any such registration. We have scandals going on now because nurses are not under control. There is plenty of documentary evidence at the Home Office in support of the contention that some system of supervision is necessary; and, therefore, I say that this Bill ought to be submitted to a Select Committee in order to be properly shaped, or the Home Secretary ought to rise to the height of statesmanship, and say that this is part of a great scheme that must be placed before the House for dealing with the State control and registration of all nurses in attendance on the sick. If the Home Secretary would do that, he would confer a standing benefit on his time and generation, and would put his name to an Act which would benefit humanity all the world over.
(3.26.) MR. HEYWOOD JOHN-STONE
We have heard a vigorous speech from the hon. Gentleman, but I do not think he was justified in making a charge of inconsistency, because he himself has looked at this question from every conceivable point of view, but, as far as I 1191 know, he has not done anything towards solving the problem. The hon. Gentleman's speech was somewhat misleading. An innocent mind might perhaps be misled in some degree by it. If I had heard that speech and knew nothing else about this subject, I should have imagined that the Select Committee of 1893—the last Committee which considered this subject—had not dealt with it fully or completely, or had not heard all the evidence that might be brought before it. I am afraid that the hon. Gentleman forgot in the heat of the moment that that Committee had before them all the evidence taken in 1892, and gave full and adequate discussion and consideration to this matter. I hardly think that any hon. Member would be justified in laying the Report of the Committee of 1892 before the House and keeping absolutely silent as to the Report and recommendations of the Committee of 1893. We have heard a great deal about the unqualified assistant who rendered such valuable services to the gentleman he was assisting, and whose knowledge of midwifery was learned in long years of practice. We were told that the practitioner was forbidden by the General Medical Council to avail himself of this gentleman's services because he had not passed the requisite examinations. The hon. Gentleman did not make it clear to the House that if the unqualified assistant had chosen to set up for himself there was no law to prevent him. I go further, and point out that the practice of midwifery has never been rendered illegal, and that the effect of the General Medical Act to which the hon. Member referred was that a person should not be entitled to be put upon the General Medical Register because he possessed only one of three qualifications now necessary. Previous to that, a man was entitled to be put on the Register if he qualified in either medicine, surgery, or midwifery, but from the date of the Act he was obliged to qualify himself in all three branches of the profession before he could be entitled to call himself a registered medical practitioner.
Before coming to the general objections which have been raised to the Bill, I should like to make clear once for all to the House one other matter. We have heard from more than one speaker that this Bill is certainly defective in that it proposes a 1192 system of notification instead of the annual licence provided for by the Bill of 1900. The object of the annual licence was simply to secure the local supervision which we all believe to be important and necessary. But that licence would be a mere matter of form, a matter of course, and would be granted to any woman who had a diploma as midwife, without any question as to desert or merit. That system was objected to because of its inconvenience, since it involved the taking out of a licence in every area in which the midwife was practising or likely to practise. If we can effect the same result by a much less troublesome process, I think the House will see we are fully justified in doing so. Many of these women felt that by being compelled to take out a licence they were put on a somewhat low plane, as if they were in the same position as mere applicants for a gun licence or a dog licence. Therefore we tried to meet their objection by substituting a much less cumbersome and much less harassing procedure, viz., that they should give notice that they intend to practise in a certain area; and that would enable them to fall within the jurisdiction and supervision of the local authority of the district where they were carrying on their practice. There is nothing in the present Bill which will diminish the powers of local supervision which the local authorities were given by the Bill of 1900. These local authorities will still have the power to investigate charges of negligence, malpractice, or misconduct; and be able to keep their finger on every practitioner in their area, and, without being unfair to the women, to exercise that care and control which we believe necessary in the true interests of those who would profit by this measure.
I pass on to deal very shortly indeed with a few of the objections which have been taken to the Bill on points of detail. It is objected that the Bill does not contain the provision of the Bill of 1900 which rendered unqualified practice illegal. This Bill gives to a person who needs the services of a midwife the power to discriminate between a woman qualified and a woman unqualified, but it does not go as far as the Bill of 1900, which forbade an unqualified woman from taking practice, under a penalty. 1193 For this we have ample precedent. In fact, the only measure of the kind which ever penalised unqualified practice was the Apothecaries Act of 1815. There is no such provision in the Medical Act of 1858, or in the Dental Surgeons Act. The principle of these Acts is that persons desirous of obtaining medical or dental assistance should be able to make a distinction between those who are duly qualified practitioners and those who are not, and to prevent men practising as qualified practitioners when they are not so qualified. These Bills never imposed a penalty on those who practised but were not qualified. In regard to that I do not think I can do better than quote the words of one who was well known and highly esteemed in this House, and who took a strong interest in this matter. Writing in the British Medical Journal in 1896, Sir William Priestly said—I do not propose to impose penalties on women who attend others in their continement. This in remote districts would be to deprive the poor of help and comfort, imperfect though it be, in their time of trial. And it is quite certain that the House of Commons would listen to no such proposal. In England the principles of liberty are carried so far that men, and women too, insist on their right to employ quacks if they choose, and being treated medically even to their own hurt, if it so pleases them. The only possible limitation, therefore, is to insist that the public shall be able to distinguish between those who have been educated and registered and those who have not, and to impose penalties on those who pretend to be registered when they are not so. This is the principle embodied in the Medical Act concerning the medical practitioners.Upon these principles this House has invariably acted, and we cannot ask this House to go beyond them. It may not be the counsel of perfection which we might desire to see carried out, but we cannot go further in legislation at the present time, however much the General Medical Council may wish it. There is no breach of confidence in saying that we have received information from high quarters that it would be hopeless to attempt to carry any measure if it were encumbered with a clause actually penalising unqualified practitioners. When this fact was brought to my notice I had to consider whether we should bring in a Bill containing such a clause, and allow it to be dropped out in Committee. I thought, however, that 1194 the honest course in dealing with this House was to face the difficulty at once, and not bring forward a clause in the Bill which we did not think would get through the Committee stage. That is a reason for the change which the promotors of the Bill themselves regret.
I am quite aware that the General Medical Councils object to the Bill, although we have sought to the utmost to agree with them. What they ask is that this should be made a stepping-stone towards rendering the practice of unqualified men illegal. That has been their aim all along, but the country is not prepared for it at the present time. We feel that if we can pass this Bill, even in its present state, we shall have gone a long way in dealing with a subject of great difficulty and perplexity, and at the same time of great necessity. In regard to the Bill itself, it aims at securing, first, the proper training of midwives, and secondly, that they should be properly supervised. For the training it is proposed to establish a Central Board, the majority of whom shall be registered medical men. This Board shall, by rule, prescribe both the course of training and the nature of the examinations which the midwives will have to pass. We consider it desirable that these things should be done by rule, but not by cast-iron regulation. We are treading in somewhat unknown paths, and until we have had experience of the working of this measure it is particularly undesirable to lay down hard and fast regulations that the women should have so many months training and no more. Then, we provide for local supervision by placing it in the hands of the County or Borough Councils. This is in accordance with the recommendations of the Committee of 1893, but we give them such ample powers of delegation that they will be able, in every instance, to form local committees, not constituted of their own members, but of those who are likely to be useful. If, as the hon. Member who spoke just before me stated, this is a grave problem, we must realise that that problem has to be dealt with by this House. Everybody who has brought in a Bill must have realised that the promoters can neither get nor give all they desire, for there are always difficulties in the way of doing this. My own attitude in 1195 this matter towards this Bill is that there are an immense number of minor details upon which I have very clear and definite views, andupon which those who speak with me also hold definite views, but as to which the House itself must decide. The House itself is the body which must decide between us, and we commit those details to the House with absolute confidence. Parliament must have the last word in all these matters. It may be that when we come to thresh out all the details of this measure we shall find that there are more points of agreement than of difference. In conclusion, let me give a very few figures which I think are extremely instructive, and I do not think I need to apologise for laying them before the House. I had given to me only yesterday a number of figures dealing with the deaths of women attended by trained midwives called out from some of our large hospital institutions. Trained nurses from eleven nursing institutions attended 13,712 cases, and the deaths were but seventeen in all. That is a death-rate of 1.23 per thousand, as compared with a general death-rate in maternity cases all over the country of 4.66 per thousand. Nothing more is, in my opinion, necessary to show the superiority of trained over untrained nurses, and I commend these figures to the consideration of the House.
(3.50.) M. T. P. O'CONNOR (Liverpool Scotland)
I do not count myself among the opponents of this Bill, but I take up the attitude of a vigilant critic. I congratulate my hon. friend in charge of this Bill who has just addressed the House upon the tenacity, good feeling, and humour with which he has conducted this campaign for many years. Nobody can deny that there is a great evil to be dealt with. The figures which my hon. friend who has just spoken has given to the House in his eloquent appeal are strikingly tragic and unanswerable. I hope, however, that the House will quite understand that I do not stand up here to lay down that the present system should be maintained or that it does not require great and prompt reform. I hope that is clearly understood in regard to my position with reference to this Bill. We who are opposed to this measure admit the 1196 evil, we admit its existence and magnitude, and above all we admit the undeniable feelings of humanity and the desire to improve the lot of the poor which underlie the motives of this Bill. I do not think there was ever a Bill introduced into this House which had a larger number of kindly men and women in its favour. What we ask the House to consider, and what we ask the promoters of this Bill seriously to consider, is whether the remedy which they propose to apply to this admitted evil is not such as will tend to aggravate instead of diminish the evil. I object in principle to the multiplication of registered bodies, and I object to any "ring" or fence to protect any class of the community from open competition. I am so strongly in favour of that principle that I look with extreme suspicion upon every Bill which is brought in the object of which is to increase the number of persons who can practise a certain trade or profession under the certificate of a certain society. My objection is that no cry has led to more unwise legislation in the past than the cry which is summarised in the words "Something must be done." My hon. friend the Member for West Aberdeenshire said that "Something must be done," and so did some other other hon. Members. That is a statement which I will not accept unless I know the proposal is something which is calculated to improve matters and reduce the evil complained of. It is all very well to say "Something must be done," but we must not, under the name of progress, adopt a retrogressive step. We must not allow women to have powers of practising medicine under less severe safeguards and guarantees than are applied to men. My hon. friend has brought before the House, in a very remarkable and well-informed speech, the remarkable fact that all the progress of medical education, especially with regard to midwifery, has been in the direction of strengthening and making more vigorous the education of the persons engaged in it. When I was at college, three years were held to be sufficient to acquire a sufficient medical education for men to practise the medical profession, and now five years is practically the normal time. This very subject of midwifery used to be considered so inferior and easy a portion of the profession that a man could practise 1197 it who was considered to be no good for any other department of medicine, because the could practise it with an inferior qualification. That was an absurd opinion, which has been abandoned, and midwifery is now regarded as one of the most complex and difficult duties of the medical man, upon which he requires the severest kind of training. My hon. friend first laid down his own experience, and then he laid down a doctrine. My hon. friend the Member for West Aberdeenshire said that when he was a young doctor the attendance upon six cases were held to be sufficient to qualify a man to practice midwifery. Was there ever a more scandalous exposure of the inefficiency of medical education than such a statement as that?
§ MR. T. P. O'CONNOR
As a matter of fact, it is better, although I am not going to say that it is much better. I understand that twenty cases are required now instead of six, but I do not think that that is a very great improvement. But is my hon. friend arguing that because the education of men with regard to midwifery is still inferior, we are going to make it any better by accepting these low qualifications for women? I say that the whole trend of medical education has been to increase the difficulty of men obtaining the necessary qualifications to practise midwifery. Under these circumstances, are we going to take a retrograde step with regard to women? Is this House to be asked to allow women to practise medicine under less safeguards than are applied to men? My hon. friend the Member for West Aberdeenshire said that three months training was enough to qualify a woman to practise midwifery, but what is there in this Bill about either three or six months training? There is nothing in this Bill to prevent the new Board laying down that a woman should be qualified in three months. There is nothing about the amount of training required; therefore I am entitled to say that we have a right to demand from the promoters of this Bill that they should deal with this question affirmatively and not negatively, and that there should be some safeguard which will insist upon 1198 the adequate training of women. My hon. friend the Member for West Aberdeenshire gave us a description of the practice of midwifery, and he said it was an art so simple that any woman could learn it in two or three months. I would like to ask the hon. Member for Horsham if it is his opinion that a woman would be competent and qualified to practise midwifery after two months training? I notice that while I am putting this question the hon. Gentleman the Member for Horsham adopts an old Parliamentary practice of indulging in earnest conversation with another hon. Member sitting near him.
§ MR. HEYWOOD JOHNSTONE
That would entirely depend upon the woman. I prefer to trust the judgment of the Central Midwives Board much more than the judgment of the hon. Member or of myself.
§ MR. T. P. O'CONNOR
The House has heard this incident, and I hold that it justifies my hon. friend below me and myself in looking with suspicion on this Bill lest there should not be proper precautions taken for that thorough education of women which is held on all sides to be absolutely necessary to give them the right to practise midwifery. I would like the House to bear with me for a few moments while I say something about other countries. The hon. Member for Knutsford said they were adopting in this Bill the practice of foreign countries.
§ MR. DE TATTON EGERTON
I did not say this was the practice of foreign countries. I simply said that in other countries the registration of midwives had taken place nearly a century ago.
§ MR. T. P. O'CONNOR
What happens in France? The system in operation there is an excellent one. When a woman applies for a certificate as a midwife in France she has to show that she 1199 has gone through two years training, and she has also to show that one of those two years has been spent at a general school of medicine under a proper medical authority. I am not defending the whole provisions of the French law, but it lays down the particular things that a midwife can do and the particular things she cannot do. The French law does not leave this an open and vague question, but it prescribes the use of instruments and goes into the question of the drugs she may apply in the case of a confinement; in other words, it takes care that if you give a certificate to a midwife she shall deserve it by proper, an adequate, and lengthy training in the profession she wishes to adopt. That is a practice which I think it would be wise to follow in this country.
I come to the last refuge of my hon. friend. He says that there is a competent Board set up under this Bill which can establish any rules it likes, and he argues that we shall be perfectly safe in leaving the matter to this Board. But that depends altogether upon the composition of the Board. A Board that has these extraordinary powers ought to be a very strong one indeed. But is it a strong Board? I think this is largely a question of nursing, and I believe it is more a question of nursing than of medicine. There is nothing in regard to the treatment of the sick which has shown such extraordinary improvement as the question of nursing. The nurse of today is not merely different, but she is a perfect transformation, from the nurse of the days when Dickens created his immortal character of Sarah Gamp. Nursing has now become not only the occupation of poor people, but it has been undertaken by many of the highest ladies of the land, who have shown themselves only too ready to take their share in that work. And how has this great change been brought about? I maintain that the Royal British Nurses Institution has done more to produce that wonderful and beneficent reformation and revolution in nursing than anybody else. It is a chartered body, under the control of the greatest and ablest men in the country, and with the exception of a few pounds spent upon clerical work the work of the Association is carried on 1200 without a penny of expense. What has this Institution done? It has registered nurses, and, in fact, created a new body of nurses, who, in a great many difficult cases, do far more to procure the recovery of a patient than the medical man who comes in merely for a quarter of an hour every day. I have here a letter from the hon. Secretary of this body, and he is also the resident medical officer of the Middlesex Hospital. This gentleman, who acts as the hon. Secretary of the Royal British Nurses Institution, without fee or reward, objects not to the principle but to the details of this Bill. He puts forward as his objection to this Bill that it will do a great deal to undo the work of the Royal British Nurses Institution. He says that this Institution has for many years worked very hard to secure the efficient education and training of nurses, and has met with the most encouraging success not only in this country but also in the Colonies. He further states that with regard to this Bill he is afraid that it will lower the standard which the Institution has adopted for nurses. Now, what is the standard of the Royal British Nurses Institution? There is no woman gets a position on the register of this Institution unless she has had between two or three years training in a hospital, and they hold that when she has had that training she is in a perfectly competent position to do the work. My hon. friend the Member for West Aberdeenshire may be right in the description he gave of the mysteries of this particular branch of the medical profession, but it is a well known fact that unless a nurse thoroughly understands aseptic principles she is very likely to bring on all those diseases which are so frequent in maternity cases. Therefore, if you want a good and competent midwife, you must see that she is a good nurse, and you cannot get a good nurse under the conditions laid down in this Bill. I earnestly beg my hon. friend in the further stages of this Bill to take this matter seriously into account and help us by insisting upon adequate precautions being taken to see that those who are going to be employed in this important profession shall have proper and adequate training.
I have spoken of the work of the Royal British Nurses Institution, which has revolutionised nursing in this country. 1201 Will it be believed that this great nursing Institution has no representative upon the Board which is set up by this Bill, which has to deal with a subject which, after all, is mainly a question of nursing? I see that there are to be representatives on the Board from the Royal College of Surgeons, the Royal College of Physicians, and the Apothecaries Society, and there is also to be some representation given to the Incorporated Midwives Institution. I say that my friend was disentitled to make the statement he did make on the Bill. He described this as a debate in Committee, and not on the Second Reading of the Bill. This is a Bill with the principle of which we are all agreed. It is the manner in which the principle is carried out—in other words, the details of the Bill we have to discuss, instead of leaving that to another stage. Everything depends on whether the midwife is to receive two months or two years training, and therefore I am entitled even on the Second Reading to criticise the composition of the Board. I put again a question to my lion, friend, who has something of the wisdom of the serpent, as well as the gentleness of the dove, in dealing with this question—I ask him where he discovered the Incorporated Midwives Institute, which is to nominate one of the people who are to decide upon the qualifications of midwives. I do not know whether such an Institution exists, but I would call the attention of the House to the extraordinary fact that the greatest nursing institution in the world is omitted from the nomination, while a nameless, if not imaginary, and certainly an inferior body is given the right to nominate a member. Another point to which I wish to refer is the absence of the penal clause. I must say that I sympathise to some extent with my hon. friend on this point. I think there would be some difficulty in the penal clause, which would immediately deprive of employment thousands of women who have been allowed for years to practise midwifery. I have never favoured legislation which allows people to enter on any occupation whatever, under the protection of the law, and then proposes to throw them out on the street, because of a change in the law. He has put in 1202 the Obstetrical Society of London, whose certificate would protect women practising midwifery. I am told that the certificates of this body are given without the adequate instruction these women ought to get. I thank the House for listening to the detailed criticism of the Bill I have offered.
(4.18.) SIR SAVILE CKOSSLEY (Halifax)
said he had no intention of detaining the House more than a few minutes. He was very glad the hon. Member who had just spoken was in favour of the main principles of the Bill, though he was against some details of it. During the last fifteen or sixteen years he had had some connection with the hospitals of London, and he had the honour to he Chairman of the Hospital Saturday Fund, which was the organisation formed by the working classes of London to collect for the London Hospitals. He was informed by the Fund officials that although the matter had not been brought before them, the vast majority being working men of London were in favour of the Bill, and hoped to see it carried out. It must be quite clear to everyone that there were many cases where it was impossible to obtain the services of a surgeon or doctor on account of the expense, and also on account of the fact that many services performed by midwives could not be performed by doctors. The care of the children and the care of the mother was undertaken by midwives, at the present time, in many cases where a doctor would cost too much. What the poor classes of London required, so far as he knew them, was a midwife who was competent to know when to send for a medical man, and when not to send for him. It might not be generally known that puerperal fever had been entirely abolished, or had ceased to exist, in all the London hospitals. There had been practically no cases of this type of fever for some time past, but there had been many cases in the country which might be taken to prove clearly that unskilled midwives, or women acting as midwives, were largely answerable for the deaths which occurred. In a very good article on the subject, Dr. Cullingworth, obstetric physician to St. Thomas's Hospital, said—The Medical Officer of Health for Glamorganshire, Dr. Williams, recently published a paper, illustrated by maps, showing the relative death-rate from puerperal fever in the various districts and counties of England and Wales. 1203 With regard to Wales, Dr. Williams, knowing the district, was able to give some particularly valuable information. He stated that puerperal fever chiefly prevailed, not in the towns, where doctors and trained midwives were abundant, but in the hilly districts and mining villages, where the confinements are, for the most part, attended by unskilled and ignorant women, who indeed call themselves midwives, and systematically act as such, but who have had absolutely no training, and whose only qualification usually was that they are themselves mothers.It would appear to everyone that the training, such as was advocated by the last speaker, would be highly desirable—a training, lasting not two months, or some short period of that sort, but two years. But they could not go such lengths as that. Every Member of the House knew that if such a regulation had been inserted in the Bill, it would have been absolutely impossible to carry it out. Although, under the present system, improvement had been made in the hospitals in the treatment of puerperal fever, puerperal fever itself had increased instead of decreased. In 1847 there were 748 deaths from that disease, being an average of 1.5 per thousand births. From 1847 to 1853 the figures showed the average number of deaths per thousand births was under two per cent. But from 1882 to 1895 the figures were very close on three per cent., showing that with all the advancement of medical science, the deaths from this terrible cause—a cause which everyone knew might be entirely avoided—had increased very largely. At that late hour of the evening he would not detain the House further. He would only say that he hoped the Bill would be allowed to go to a Second Reading without a division. He was sure it was one which would commend itself to all who were interested in the welfare of the working classes, and he hoped the House would look at it from that point of view, and not from the point of view of any vested interests or any sort of that kind.
§ (4.26.) SIR MICHAEL FOSTER (London University)
I have listened with much interest to the hon. Member for the Scotland Division of Liverpool, but my pleasure in listening to his speech was mixed with alarm, because I felt that if he were right I had wholly misconceived the purpose of the Bill. May I state what I believe to be the purpose of the Bill? Child-birth is sometimes spoken of as a 1204 travail. And it may be likened to a journey through which one may go with the ordinary discomforts of travel, but a journey on which, at any moment, one may be placed in the utmost peril to life. Those who can afford it are able to carry a doctor with them on their journey, so that he may be there whenever an accident occurs. The poor cannot do that; and I take it that the Bill is in the interest of the poor, is in order that a poor woman may carry with her on the journey so full of danger, not a doctor, but one who knows when the doctor should be sent for. I venture to think that the lion. Member opposite has somewhat confounded the words "midwife" and "midwifery." A midwife simply means a person who can take charge of an ordinary child-birth; midwifery means all that science and art can bring to bear on the various events and accidents which take place or may take place in child-birth. If I understand the Bill, it is simply to arrange that the public may know that there are special nurses, different from the ordinary trained nurses, women whose qualifications I take to be mainly these three. First, to know when to send for the doctor; second, to be cleanly, and, what is more important, to know what cleanliness means; and, third, never to drink. My interpretation of the Bill is that it simply demands this; and I should look with terror on any Bill which demands two or three years training in an obstetric school. What we want to get is a better Mrs. Gamp. It is far better for the House to throw itself upon the good feeling and the knowledge of the people than to trust to the enforcement of penal clauses. When the people know that Mrs. Clamp can be trusted, and that Mrs. Harris cannot be trusted, even if Mrs. Gamp charges Is. more than Mrs. Harris, I venture to say that Mrs. Gamp will prosper and Mrs. Harris will disappear, because she will be starved out of existence. There are, undoubtedly, several points in the Bill which need amendment, but I have hope, and, indeed, confidence, that this House will, at all events, give the measure a Second Reading, leaving any improvements which may be desirable to be effected in the Committee.
§ (4.30.) MR. JOHN BURNS (Battersea)
There is not much more to be said 1205 in support of the Second Reading of the Bill after the very weighty speech of the hon. Gentleman who has just addressed the House. I represent what is known as a working class constituency, and any man who lives in a big city, and who knows the short and simple annals of the poor, especially of women folk, or who is a Member either of this House or of a municipal body, is soon brought into contact with the facts of the domestic life of the poor, which are the underlying foundations of this Bill. I have discussed this question with the doctors in my district, and they have asked me to support the Bill, and so have also the sisterhood of nurses in my constituency. If there is any fear in the minds of Members in this House that this Bill might, lead to a diminution in the standard of medical education, or to laxity in the practice of male practitioners, I venture to say that that question should be left to the doctors themselves, who are, in this matter, thoroughly well qualified to look after themselves.
If the hon. Member for the Scotland Division will allow me, I would just like to traverse one or two of the arguments he used. He admitted the evils with which this Bill deals, and he also admired the motives of kindly sympathy and humanitarianism which prompt those who are in favour of the Bill, but he went on to say that the remedy proposed for the evils with which the Bill deals must be adequate. However, he did not suggest the remedy himself, although, curiously enough, he indirectly suggested a very strong practical remedy, which is only in modification of some of the details of the Bill. He eulogised nurses, and in that we are all agreed. There is no comparison between the nurses of to-day and those of twenty, or even ten years ago. But how has that change been brought about? By precisely the same provision of training, examination and registration which this Bill will secure to the Sarah Gamps and Mistress Harrises of the future. The hon. Member said he hated registration where unnecessary. So do I, and for that reason I opposed the Plumbers Registration Bill and other Bills of a like nature. But if it is necessary to register doctors, to educate 1206 them, and to exalt, as I am glad to say the doctors are doing, the standard of their qualifications, then surely sick-nurses and midwives ought to be highly trained and registered. The doctors must depend on the midwives for the cleanliness and care of the patient. When the hon. Member for the Scotland Division, with that language which sometimes charms the House, spoke about six cases of midwifery qualifying a midwife, and rather ridiculed such a qualification, he seemed to think that that was an argument against the Bill, because a doctor had to attend before qualification twenty cases instead of six. But anyone knows that six bad midwifery cases are of more value, so far as training is concerned, than 120 or 150 cases of natural labour.
I can only say that if this Bill had been passed, the career of a woman in my parish would have been prevented. The woman is dead now, and therefore I may refer to her without impropriety. We have had in London for far too long unqualified midwives, dirty and drunken, who trade on the poverty of the poor, who are pests to good doctors, and a curse to people to whom they administer so-called help. Apart from being dirty, untidy and drunken, many of them practise abortion. The woman I referred to was the celebrated Mistress Barinbold, who for many years was the pest of my own district. Had that woman been subjected to the conditions of this Bill, she would soon have been found out, and she would have been brought before the local Board and suspended. Although under suspicion of the authorities, she was able to pursue her mischievous course for many years, and I am sorry to say the doctors in the neighbourhood believe that she was responsible for the death of many children who might have lived, and of many mothers. The hon. Member for Scotland Division has an exalted love for the medical profession. I have the same, but the hon. Member stood up for the very narrowest views of the medical profession. For myself, I stand up for the doctors, for I believe that they do for the help of the poor more unpaid work than any other profession. The average doctor is like the average Bob Sawyer in his sympathy with the poor in our large cities; and I believe the doctors do not want the support which the opponents 1207 of this Bill are giving them. If this Bill is passed, and we had qualified midwives and nurses, many children would be born into the world better children, and hundreds and thousands of poor women would be saved untold suffering and misery. All the objections which have been stated to the Bill are objections to details which can be altered, if necessary, in Committee. I am quite content to leave the conditions of the training of midwives to a Board composed of either surgeons or physicians. It is because I believe this Bill will be a boon and an immense advantage to the poor of London and other large cities that I shall follow the excellent example shown by the hon. Member for West Aberdeenshire and the hon. Member for the London University, and support the Bill in the hope that it may be placed on the Statute-book.
§ (4.38.) THE. SECRETARY OF STATE FOR THE HOME DEPARTMENT (Mr. RITCHIE, Croydon)
I do not suppose it is necessary for me to occupy the attention of the House for more than a few minutes or to say much in support of this Bill. I think there is a general consensus of opinion in all parts of the House to give the Bill a Second Reading. The only Member who has attacked the Bill root and branch was the hon. Member for the Ilkeston Division, who, adopting the familiar mode of getting a subject shelved, asked for more inquiry before we deal with this subject. The hon. Member, however, answered himself when he told the House that there had been inquiry after inquiry, and Bill upon Bill, on this particular subject, and that hitherto we had never got beyond inquiry, and that no Bill on the subject had ever become an Act of Parliament. Why is it that a principle on which we are all agreed has not yet got to the stage of effective legislation? It is because a certain number of gentlemen, who are not opposed to a change in the law, desire much more than anything that is suggested in this Bill. They want more inquiry in order to make the Bill more drastic, comprehensive, and complete. I venture to say that these are the wrong lines altogether to go upon in this matter. Everyone is agreed that great evils exist, and this is a modest Bill to deal with these evils. It proposes 1208 to place at the service of women, who, require the attendance of someone to help them at a time of peril, the means of judging whether or not the person they are compelled to call in is qualified and trustworthy in their time of difficulty. I know there are some people who desire to go very much further than that, and who wish that the person called in should have gone through a very long course of training. But that would mean that in a large number of towns and villages throughout the country the poor would be deprived of this assistance. They would not be able to avail themselves of the assistance of anyone but a medical man, who would be beyond the reach of many, and who, possibly, would not be within call when wanted. It must be remembered that more than expert knowledge is required, and to pass a measure which would be so drastic as to prevent people being able to avail themselves of assistance in time of need would, in my opinion, be most unfortunate.
There are, no doubt, matters of detail in regard to the Bill which may very well be considered in Committee, but there are two perils which the House, if they wish this Bill to be rendered effective, will, I trust, avoid. One is the peril of a Select Committee, which the hon. Member for the Ilkeston Division pressed upon the House. It may be taken for granted that a Select Committee will, at any rate for this session, be the grave of the Bill. There is another peril, and that is the well-meaning effort to make this Bill stronger, and to alter it from the simple Bill it is to one more complex. That again, in my opinion, will prove the grave of this measure. We have in this Bill a simple remedy, nothing heroic, for what everybody admits to be a great evil. Do not let us refuse to take this remedy because it does not go the whole length some of us desire. It has been very carefully considered by my hon. friend, who has devoted so much time and attention to it, and by a large number of ladies and gentlemen who have taken the greatest interest in this matter for many years. All of them desire that it should pass, though, perhaps, the measure does not go as far as some of them would like. I hope, therefore, that 1209 the House will not only give the Bill a Second Reading, but will send it to a tribunal which will deal with it without delay, and enable it to be passed into law in the present session.
§ MR. HEYWOOD JOHNSTONE
rose in his place, and claimed to move, "That the Question be now put," but Mr. Speaker withheld his assent, and declined then to put that Question.
§ (4.48.) MR. CAINE (Cornwall, Camborne)
I do not intend to make a speech, but it will greatly help the promoters of this Bill in the division if they can make it clear what "The Incorporated Midwives Institute" really is. I do not know this Institute; I do not know even if it exists. I asked several hon. Members about it, but could obtain no information. It will greatly help if the hon. Member responsible for the Bill will let us know where or what it is.
§ MR. HEYWOOD JOHNSTONE
I happen to know that the body has had a most useful existence for a considerable number of years, and the hon. Member may be quite certain that they would not have got a charter of incorporation unless they were a responsible body, doing good work under a responsible government. It is really a question for the Committee, and I will undertake to supply them with the necessary information.
§ Question, "That the word 'now' stand part of the Question," put, and agreed to.
§ Main Question put and agreed to.
§ Bill read a second time.
§ Motion made, and Question proposed, "That the Bill be committed to the Standing Committee on Law, &c."—(Mr. Heywood Johnstone.)
§ *SIR WALTER FOSTER
I beg to move an Amendment, that the Bill be referred to a Select Committee. In doing so I should like to say, in answer to the hon. Member for Horsham, that when I referred to the Select Committee of 1892, I quite forgot for the moment the Select Committee of 1893, which reported at length. That Report, however, is now nearly nine years old, and 1210 in that time there has accumulated a great deal of material for reconsideration.
SIR JOHN TUBE
formally seconded the Amendment. Amendment proposed—To leave out the words 'the Standing Committee on Law, &c.,' and insert the words 'a Select Committee.'"—(Sir Walter Forster.)
§ MR. T. P. O'CONNOR
I would appeal to the hon. Gentleman to accept this Amendment. I can say for myself, and on behalf of my hon. friends, that we entirely repudiate the idea which has been put forward by the Home Secretary that we want to use a Select Committee as a means of killing the Bill. I did not challenge the Second Reading of this Bill; I stated quite frankly I was in favour of its principle, and certainly I have no intention of considering the Bill in anything like a spirit of malignity. But I think it is a Bill of such a complex character as to require most careful consideration. I have had experience in Grand Committees on this Bill before, and no hon. Member has, as we would say in Ireland, a more soothing manner than the hon. Member for Horsham; but he is one of the most uncompromising and unyielding supporters of the Bill. Whenever we endeavoured to get any concession from him he was always able to execute that most difficult Parliamentary manœuvre of giving a promise to the ear, while leaving himself at perfect liberty to break it in spirit. I do not, of course, impugn the hon Gentleman's good faith, but he is one of these dangerous genial fanatics who are the most difficult to deal with, and I am sure that, with the best intentions in the world, he has got this Bill so on his mind that he regards everyone who utters any criticism on it as almost breaking some sacred or divine law; and we have very little chance of getting from him that serious consideration of details if he has the rapid and guillotine machinery of a Grand Committee. I assure him that a Select Committee would not be against the final passage of the Bill. No man would oppose the Bill passing into law this session. I agree with my hon. friend that it is full time this question was settled. I do not at all dispute that the question has been too long before Parliament, and certainly I have no idea whatever of using the 1211 machinery of a Select Committee for any purpose than for a more elaborate and critical examination than would be possible in the Grand Committee.
§ MR. HEYWOOD JOHNSTONE
I have served on several Select Committees to consider Bills, and as far as I am aware no single one of them ever reached the Statute-book. I am not going to be led away by any Amendment of this kind, but I would ask my hon. friend to give us his valuable assistance on the Standing Committee on Law.
§ MR. GRIFFITH BOSCAWEN
Although I have criticised this Bill, I cannot support the proposal to refer it to a Select Committee. This is a Bill as to the main principles of which we are all more or less agreed. We differ only on details, and that being so, a Standing Committee is precisely the Committee to deal with it. Every opportunity will be given for threshing out the Bill in the Standing Committee, and then it will be sent back to the House.
§ Question, "That the words proposed to be left out stand part of the Question," put, and agreed to.
§ Main Question put, and agreed to.
§ Bill committed to the Standing Committee on Law, &c.