The Midwives Bill.

THE MIDWIVES BILL.

532

prospective difficulties about her fees before a county-court judge will never give her pause in her dangerous career. The last Midwives Bill contained a clause fining women who after the passing of the Bill practised midwifery save in conformity with the regulations of the Bill, and the alteration of this clause is a distinctly retrograde step. Again, the present Bill appears to take the control of the purely medical side of the question out of the hands of the General Medical Council by saddling the Lorcl President of the (Privy) Council with the responsibility of seeing to the formation of the Midwives certain that

THE LANCET. LONDON: SATURDAY, FEBRUARY 22, 1902.

The Midwives Bill. THE Bill "to

secure

the better

training

Two years ago the fourth clause of the Midwives Bill read : ’’ On the passing of this Act the President of the General Medical Council shall take steps to secure the Board.

of midwives and

regulate their practice" is down for second reading on Wednesday Feb. 26th and it has obtained a place which makes it likely that it will be read for the second time. formation of a Central Midwives Board," upon which genera} We publish the text of the Bill on page 542 of this issue statement followed the scheme for the constitution, duties, and would remind our readers that it is imperative and powers of the Board. The fourth clause now substithat they should make up their minds what course they tutes "the Lord President of the Councilforthe Presidesire Parliament to pursue, for they must bring without dent of the General Medical Council." Moreover, the delay what influence they may possess to bear in the framing of the rules with regard to the practice of midwives desired direction. For our own part, we have no doubt that is now made subject to the approval of the Privy Council, the Bill to be read next week is a mischievous one, and while in the previous Bill the General Medical Council was responsible for the regulation of the course of training and we are certain that a vast majority of our readers will share this view, or perhaps we should not be so ready to the conduct of examination of candidates for the midwives’ counsel them to give effect to their feelings. In comment- roll. It may be said that the Bill provides for the consultaing upon the Midwives Bill, introduced by Mr. TATTON tion of the General Medical Council by the Privy Council, EGERTON just two years ago, we pointed out, as one but medical men, at any rate, will not be much impressed of the main difficulties of what is known as"the by this concession. Doubtless neither the Duke of DEVOXmidwives question," the fact that both those who SHIRE nor Sir JOHN GORST are permanent officials; but to

"

do and

those

who

do

not

desire

legislation

for

what guarantee have we that future Presidents and VicePresidents of the Privy Council will discharge their duties towards the medical profession in a more efficient manner ?

the

of the practice of midwives can, with equal that their opinion is the right opinion on maintain force, humanitarian grounds and no less on medical grounds. To leave the parturient poor to the mercies of the GAMPS is

regulation

cruel,

but to

supply

The two names

medical

semi-educated grade of If the first course kindness.

them with

a

medical attendants is no leads to disasters the second would seem make for tragedies. True, in the various

did not

members of the Government whose mentioned, when a question of vital

distinguished

we

have

just

importance was know anything

under

discussion, admitted

about the matter because

that

they they had

inevitably to not read the reports of the General Medical Council. What. shapes in which security has the medical profession that advice tendered to’ the Privy Council by the General Medical Council on the a measure for the regulation of the business of midwives has been before Parliament and the public, conscientious scope of the midwife’s duties will not be treated with a like attempts have been made to escape from the dilemma ; but disregard ? It may be remembered that just previously to the second the attempts have not been successful, and the Bill which we publish to-day is worse than some of its predecessors. reading of the Midwives Bill of 1900 we received at this It is in several directions more likely to institute an inferior office, in response to our invitation, 7250 communications order of general practitioners and thereby to work in from English medical men giving their attitude as to. the proposed legislation. An analysis of these replies opposition to the public weal. To begin with, the latest edition of the Midwives Bill con- showed 1547 medical men to be in favour of the Bill, tains no penalty whatever to be imposed upon any woman, 640 to be indifferent, and the remaining 5000 odd to be whatever her absence of qualifications, for " habitually opposed to it. Nothing has happened to make medica] and for gain attending women in childbirth " ; any woman men change their opinions, and, as we have shown, such differences as exist between the Bill of 1902 and the can attend confinements and charge fees for her services. as

become law it will be continue we can see, to any woman to vocation of a midwife, with the single she will not be able to sue for fees. that quacks are unable to obtain in Should this Bill

ever

open, as far as to pursue the

disability that Has

the

the

fact

law-court

payment for medical service rendered in any way contributed to keep down the number of quacks’? Of course it has not, and so long as there is no pecuniary fine to stop the first female who chooses from calling herself a midwife and spreading puerperal fever in return for money we are

,

Bill of 1900 are not for the better. Wethink that the time has come for interference on the part of the General Medical Council. The present Bill does not at all conform

previous directions of the Privy Council that certain points should be conceded by the promoters in deference to the views of the General Medical Council. The chief of these to

views may be summarised in the following words :The unlicensed practice of midwifery for gain as well a the false use of titles should be made illegal. The functions of the Midwives Board should include the framing of the regulations for the conduct and practice of

THE LONDON WATER BIL’L.

midwives, especially for restricting such practice

533

that he brought forward pointed ’’we favour of purchase of the present

to normal

out

.

cases.

;in

no

serious

argument?

water businesses.

HeThe rules of the Midwives Board should be subject to the the left his to attack which hemeasure, political opponents approval of the General Medical Council. Provision should be made by Act of Parliament for expected would receive the general support of his own partly, reimbursing the General Medical Council for any expendi- although he had previously said at a municipal-political’ ture which they may incur in performing their duties under ‘ the Act. Smoking at homethat he thought that the Bill might not The conditions under which licences to midwives are altogether please the London people in whose interests it granted should include satisfactory evidence of character as was nominally brought forward. well as of training and experience in the conduct of natural Jabour and in the after-care of lying-in women and newlyThere are certain obvious arguments in favour of the born infants. Bill, many of which will be found in the columns of’ Provision should be made securing that the midwife in our contemporary the Spectator. Briefly, it is urged in cases of abnormality shall seek qualified medical assistance. favour of purchase of the companies’ undertakings that theOn a previous occasion when we published this summary dividends of the companies are likely to increase and that. we received from Mr. HEYWOOD JOHNSTONE, who is among ’’ therefore the companies were an adversary whom it was the most eloquent and fair-minded supporters of the measure, eminently expedient to agree with quickly." There are , a letter referring us to Clause 2 (2) and Clause 4 (1) of facts which point in the opposite direction. Enormous outthe Bill as proofs that the views of the General Medical will immediately be required to place and to keep the Council were safeguarded in the proposed litigation. Butt lays in an efficient state. Most of the Clause 2 (2) of the 1900 Bill has been modified so that un- existing undertakings facts proving this are already known to our readers, for welicensed practice of midwifery for gain carries no penalty. have more than once insisted upon them, but as they bearAnd Clause 4 of the 1900 Bill is the clause the whole directly on the advisability of purchase it may be well to. significance of which has been altered by the substitution recall three of them :of the Privy Council for the General Medical Council. So0 that it would seem that the promoters of the measure nowv 1. One of the companies has insufficient sources of water to supply its customers. before Parliament cannot pretend that their Bill satisfiess 2. Several companies have at present inadequate provision. the deliberate and expressed opinion of the General Medical for the storage and efficient filtration of the water which’ distribute. Council-the governing body of the medical profession. they 3. Constant water service is not given to all those -,vho. And. we can assure them that their Bill is equally objection- have the right to demand it. able to the medical profession at large. It is, moreover, certain that an enormous outlay will soon.

.

-

be

required

exact

The London Water Bill.

to obtain increased

amount

available

from

supplies of

existing

The-

water.

sources

is

not-

far

because information has, as as pos-been the withheld have which declinect, sible, by companies A BRIEF abstract of the London Water Bill was given in in to give particulars in regard to the water levels in theirTHE LANCET on Feb. 8th, p. 392, and in our remarks KS wells, or in regard to the effects which have been caused by in a leading article at p. 384 we on the measure ve persistent depletion of the underground water. It is, how in suggested that at first sight the Bill appeared to be an ever, well known that evidence given before the Balfournhonest endeavour’ to disembarrass the Local Govern-

accurately known,

’’’

ment Board of

arduous of its facts of the

some

of the most useful and the most st

present duties." A consideration of confirms and to point out that

case

all the he

this

strengthens

view, tv,

do not consider the lie measure to be one which metits the support of those ,se m. interested in the public health of the citizens of London. The responsibility of the President of the Local Governnand leads

us

ment Board in the matter of the

we

on of London nd and passed,

water-supply

Commission has turned out to be amount of water which

was

erroneous

and that the-

stated to be available cannot be-

obtained. This matter was fully dealt with in the report of’ THE LANCET Special Commission on the Metropolitan. Water Supply1 and it need only be said now that the Balfour Commission was obviously misled by evidencewhich

was

not in accordance with facts.

There

of the present

reasonable doubt that

although

of

the demand for water is

some

can

be

no,

sources.

increasingofl municipalisation ras was The reconstituted a great effect. City of iut(_ But Westminster and the metropolitan municipalities have, as. a re responsibility, of the weight of which they are had time to get into thorough working order, on carefally kept in ignorance, would be shifted on to the yet, hardly to realise fully the greatness of the work shoulders of the London ratepayers. A Water Board with ith even, perhaps, The City of London proper represents, tied hands would be called into being. The board would be which is before them. an ancient civilisation which is in thorough the working order. compelled by the very terms of its creation to buy the Itscleanly streets are washed daily. streets in theThe ies. undertakings of the present metropolitan water companies. outside municipalities are still to a great extent unwashed. It. Does Mr. LONG seriously believe that the inhabitants ntss is not likely that the people will much longer tolerate this. of " Water London wish to buy these businesses es?) state of things. It is certain that a very largely increased If so surely he might allow his popularly elected Water er amount of water will be used daily for municipal purBoard to decide the matter as to whether purchase would uld London." This will necessitate a, be wise or not in the interests of its constituents. When ben poses throughout "Water in the amount distributed, but it. increase we congratulated Mr. LONG on the ability he displayed in in corresponding

would practically cease if the Bill were he might congratulate himself that the matter " "finally settled as far as he was concerned.

supply

are

failing

and will increase. London will have

In this matter the

"

.

the

speech

in which he introduced his Bill into

Parliament,

1

THE

LANCET, June 21st, 1900, p. 181.