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"THE MIDWIVES REGISTRATION BILL."
605 under the Medical Acts in respect of such or to assume any name, title, or designation that she is by law recognised as a licentiate or implying practitioner in medicine or surgery or that she is qualified to grant any medical certificate or any certificate of the cause of death." And, further, the rules which under a later clause in the Bill are to be framed by the Midwives’ Board for " regulating, supervising, and restricting within due limits the practice of midwivesare to be approved by the General Medical Council, who surely may be trusted to act alike in the interests of the profession and the public and who will approach the consideration of the subject with an amount of technical knowledge and practical experience which Parliament cannot possibly lay claim to. No one who has any knowledge of Parliamentary proceedings, especially in committee, would desire to see details of this character settled by Parliament, and settled in such a, manner that only an amending Act could repair mistakes or make good omissions, when the rules dealing with them might be framed in the first instance by a board the majority of which would be registered medical practitioners appointed, not by " councils of corporations and public bodies," whether in cooperation with the Privy Council or not, but by the Royal College of Physicians of London, the Royal College of Surgeons of England, the Society of Apothecaries, and the Incorporated Midwives Institute, rules which would be approved and settled by the General Medical Council, which represents ’the vote of the medical profession"as far as any human institution can. I know not, Sirs, what other public body can be named which is less likely to be "at fault over practical points when attempting to decide upon the precise relations that should exist between general practitioners and persons who are to work under them," but I can assure you that if you can suggest any the promoters of the Bill will be thankful for your assistance and guidance. But I trust that I have made this point clear and that your readers will agree with me that the General Medical Council is more likely to devise a satisfactory definition of the sphere of the registered midwife’s duties than the House of Commons sitting in committee; and as this letter is already longer than I had wished or anticipated I will only refer to one other point-the admission to the register of existing midwives, on which it is sufficient at present to say that under the Bill their admission will also be regulated by rules to be approved by the General Medical Council, after they have been passed by the proposed Midwives’
registered
Correspondence. "
Audi alteram
partem."
"THE MIDWIVES REGISTRATION BILL." To the Editors of THE LANCET. SIRS. -I have read your leading article on the Midwives Bill with surprise and keen regret. Your statement as to the
necessity for legislation puts the matter so clearly and so definitely that it is with something of a shock that one finds at the end of it all a declaration of hostility. The Bill must indeed be a bad one if it is so entirely beyond the reach of amendment as to merit no treatment short of absolute rejecIt is of course easy to say, Better no Act than a bad Is it not, however, for those who disagree with its provisions to put their views clearly before Parliament and to leave the question to its decision rather than to incur the responsibility of causing further delay in a matter in which delay means the sacrifice of many lives and exposure to much unnecessary suffering ? I appeal to you, Sirs, now that there has occurred the first real chance of legislation, to assist in making that measure as perfect as possible and not to handicap it by inciting the profession to active opposition. If allowed to pass the second reading, it can be amended to any extent in the later stages. It will be a standing disgrace to us as a profession if, with our present chances, we do not secure the passing of this or some similar Bill during the present session of Parliament. I will not enter into a lengthy criticism of the reasons why you object to our Bill, but I desire to point out that the rules under which it is proposed to place the practice of midwives have to be approved by the General Council of Medical Education. Such a body could not permit a midwife to undertake work for which it has itself imposed a different standard of knowledge. If it did so it would soon cease to exist. This, I venture to state, at once disposes of your contention that a midwife may under our Bill usurp the functions of the medical profession by undertaking what is strictly its work. Surely this provision must be considered to be something more than " a hint" as to the line which is to be drawn between a midwife’s and a medical practitioner’s duties, and therefore it should prove a sufficient safeguard against such usurpation.
tion. one.
T am. Sirq.
vonrs
faithfnliv.
ROWLAND HUMPHREYS. Hon. Sec. Midwives Bill Committee.
Buckingham-street, Strand, W.C.,
Feb. 19th, 1898.
To the Editors of THE LANCET. SIRS,-The promoters of the Midwives Registration Bill have no reason to complain of the tone of the temperate and, indeed, encouraging article in THE LANCET of Feb. 19th, which, in its frank recognition of the fact (reported to the House of Commons by Select Committees in 1892 and 1893) that the present system, or rather want of system, is one that requires a remedy, shows a distinct advance both in public and professional opinion. But while welcoming that friendly criticism which the recognised organ of the medical profession is most justly entitled to bestow upon the Bill, and believing that the profession is sincerely desirous of cooperating with us in making it a good Bill, a workable one, and one which will prevent the deaths and mitigate the sufferings of the existence of which every medical man has experience, I should like very briefly to refer to a point which we admit to be a most important one and which, we think, we have dealt with in the Bill in a manner which should be at least satisfactory to the profession, but upon which apparently your main objection to it is founded. What will be under the Bill the limits of the registered midwife’s sphere of action? In the first place it will be as well to bear in mind that under present conditions the sphere of action of the unregistered midwife is only limited by the vigilance of the coroner and by a more or less remote possibility of a prosecution for manslaughter-a condition of things which could hardly be altered for the worse, so far at least as the patient is concerned. But the Bill proposes a statutory limitation by Clause 3 (4) which runs thus : " The certificate of registration under this Act shall not confer upon any woman any right or title to be
certificate
Board.
It seems to me, Sirs, that the main point at issue between is whether the working plans of a measure the necessity of which is admitted should be elaborated by a board mainly composed of medical men appointed by the leading medical societies and approved by the General Medical Council with a power of revision from time to time where experience shows that revision is desirable, or whether they should be settled once for all in the rough and tumble of a Parliamentary committee on a private member’s Bill, and medical men must have much more faith in the wisdom and business capacity of Parliament than I have if they entertain any doubt as to which is the more excellent way, or which is the manner in which the public welfare is most likely to be attained. I am. Sirs. vours faithfullv. J. H. JOHNSTONE. House of Commons, Feb. 24th, 1898. us
THE ROYAL COLLEGE OF SURGEONS OF ENGLAND AND MEDICAL AID
ASSOCIATIONS. To the Editors of THE LANCET. SIRS,-Will you allow me to draw the attention of your readers to the following enigmatical proceedings of the Council of the Royal College of Surgeons of England on the subject of medical aid associations ? At the annual general meeting in November, 1897,I moved the following resolution, which was carried nem. con. :That this meeting, in view of the widespread public and professional evils induced by "medical aid associations" and other companies trading in medical attendance, calls upon the Council to make a clear
pronouncement for the information of Fellows and Members that the
acting as paid servants of any persons who tout and canvass for patients, or who allow the well-to-do classes to take advantage of rates disof payment arranged to meet the necessities of the poor, is graceful in a professional respect"and deserving of censure. "
registered
Correspondence. "
Audi alteram
partem."
"THE MIDWIVES REGISTRATION BILL." To the Editors of THE LANCET. SIRS. -I have read your leading article on the Midwives Bill with surprise and keen regret. Your statement as to the
necessity for legislation puts the matter so clearly and so definitely that it is with something of a shock that one finds at the end of it all a declaration of hostility. The Bill must indeed be a bad one if it is so entirely beyond the reach of amendment as to merit no treatment short of absolute rejecIt is of course easy to say, Better no Act than a bad Is it not, however, for those who disagree with its provisions to put their views clearly before Parliament and to leave the question to its decision rather than to incur the responsibility of causing further delay in a matter in which delay means the sacrifice of many lives and exposure to much unnecessary suffering ? I appeal to you, Sirs, now that there has occurred the first real chance of legislation, to assist in making that measure as perfect as possible and not to handicap it by inciting the profession to active opposition. If allowed to pass the second reading, it can be amended to any extent in the later stages. It will be a standing disgrace to us as a profession if, with our present chances, we do not secure the passing of this or some similar Bill during the present session of Parliament. I will not enter into a lengthy criticism of the reasons why you object to our Bill, but I desire to point out that the rules under which it is proposed to place the practice of midwives have to be approved by the General Council of Medical Education. Such a body could not permit a midwife to undertake work for which it has itself imposed a different standard of knowledge. If it did so it would soon cease to exist. This, I venture to state, at once disposes of your contention that a midwife may under our Bill usurp the functions of the medical profession by undertaking what is strictly its work. Surely this provision must be considered to be something more than " a hint" as to the line which is to be drawn between a midwife’s and a medical practitioner’s duties, and therefore it should prove a sufficient safeguard against such usurpation.
tion. one.
T am. Sirq.
vonrs
faithfnliv.
ROWLAND HUMPHREYS. Hon. Sec. Midwives Bill Committee.
Buckingham-street, Strand, W.C.,
Feb. 19th, 1898.
To the Editors of THE LANCET. SIRS,-The promoters of the Midwives Registration Bill have no reason to complain of the tone of the temperate and, indeed, encouraging article in THE LANCET of Feb. 19th, which, in its frank recognition of the fact (reported to the House of Commons by Select Committees in 1892 and 1893) that the present system, or rather want of system, is one that requires a remedy, shows a distinct advance both in public and professional opinion. But while welcoming that friendly criticism which the recognised organ of the medical profession is most justly entitled to bestow upon the Bill, and believing that the profession is sincerely desirous of cooperating with us in making it a good Bill, a workable one, and one which will prevent the deaths and mitigate the sufferings of the existence of which every medical man has experience, I should like very briefly to refer to a point which we admit to be a most important one and which, we think, we have dealt with in the Bill in a manner which should be at least satisfactory to the profession, but upon which apparently your main objection to it is founded. What will be under the Bill the limits of the registered midwife’s sphere of action? In the first place it will be as well to bear in mind that under present conditions the sphere of action of the unregistered midwife is only limited by the vigilance of the coroner and by a more or less remote possibility of a prosecution for manslaughter-a condition of things which could hardly be altered for the worse, so far at least as the patient is concerned. But the Bill proposes a statutory limitation by Clause 3 (4) which runs thus : " The certificate of registration under this Act shall not confer upon any woman any right or title to be
certificate
Board.
It seems to me, Sirs, that the main point at issue between is whether the working plans of a measure the necessity of which is admitted should be elaborated by a board mainly composed of medical men appointed by the leading medical societies and approved by the General Medical Council with a power of revision from time to time where experience shows that revision is desirable, or whether they should be settled once for all in the rough and tumble of a Parliamentary committee on a private member’s Bill, and medical men must have much more faith in the wisdom and business capacity of Parliament than I have if they entertain any doubt as to which is the more excellent way, or which is the manner in which the public welfare is most likely to be attained. I am. Sirs. vours faithfullv. J. H. JOHNSTONE. House of Commons, Feb. 24th, 1898. us
THE ROYAL COLLEGE OF SURGEONS OF ENGLAND AND MEDICAL AID
ASSOCIATIONS. To the Editors of THE LANCET. SIRS,-Will you allow me to draw the attention of your readers to the following enigmatical proceedings of the Council of the Royal College of Surgeons of England on the subject of medical aid associations ? At the annual general meeting in November, 1897,I moved the following resolution, which was carried nem. con. :That this meeting, in view of the widespread public and professional evils induced by "medical aid associations" and other companies trading in medical attendance, calls upon the Council to make a clear
pronouncement for the information of Fellows and Members that the
acting as paid servants of any persons who tout and canvass for patients, or who allow the well-to-do classes to take advantage of rates disof payment arranged to meet the necessities of the poor, is graceful in a professional respect"and deserving of censure. "