§ Order for Consideration, as amended (by the Standing Committee), read.
§ Motion made, and Question proposed, "That the Bill be now considered."
MR. BOSCAWEN (Kent, Tunbridge)said it was rather a strong thing, when a Bill had been read a second time and referred to a Standing Committee, to ask the House, when the Bill came back, to again consider it. But there were reasons why in the case of the present Bill such a course should be taken. He took that 1255 course because the Bill, in his opinion, had never been properly considered by the House. It came on most unexpectedly on a Friday afternoon, upon the Government business having suddenly come to an end, and was therefore debated inadequately in a very thin House; there was a very small division, and then it was sent to the Standing Committee. A Standing Committee was an excellent institution when a Government Bill could not be got through in a reasonable time, but in the case of a private Bill it was most unsatisfactory, except to the promoters. By a little careful whipping on the part of private Members it was always possible to get a private Bill through a Standing Committee with a very inadequate discussion. This Bill, having been inadequately discussed on Second Reading, had been rushed through the Standing Committee, and had now come back to the House; and it was only proper that the House should now consider whether or not it should be allowed to go through without further consideration. It was a most important measure. It was contrary to the tendency of legislation in these matters. The whole tendency of legislation had been in favour of greater medical and scientific methods, and substituting the medical practitioner for the quack. The present Bill was for the purpose of setting up a class of people as being people partially qualified to act in these matters, and he ventured to think that fatal results would follow if it were passed into law. The law as it at present stood provided that the only person who could practise midwifery was a qualified practitioner, qualified in medicine, surgery, and midwifery, and it was now proposed to legalise a class of persons who did not possess these qualifications. If it were a case of natural labour, a knowledge of midwifery would be sufficient; but as in almost every case abnormal symptoms developed it was absolutely necessary that a person should be present who was qualified in all the three subjects. He recognised the excellent object which the promoters of the Bill had in view. There was a very large amount of preventable mortality—something like 10,000 deaths per annum—the whole of which might be prevented if proper care were taken. That was a terrible state of things to contemplate, and one which certainly ought to be stopped if possible; but the Bill before 1256 the House would not stop it, for the reason that poor people would be induced to employ these partially qualified persons much more frequently than was now the case. For all these reasons a Bill of this kind ought to be very carefully considered. The House ought to see that it contained such checks and safeguards that great abuses might not occur. But when this Bill was examined it was found to be so badly drafted that the whole of a Wednesday afternoon would not give sufficient time to amend it by the insertion of those checks and safeguards. There should be, in the first place, full local control, and, in the second, where these persons did anything contrary to their certificate they should immediately be brought to book and fined. There were no such safeguards in the Bill. Under Clause 8 there was a certain control. The county council is to be the board of control in its own area. They may delegate their power to the district council, who may, in their turn, delegate it to a local committee. But the power of the local committee would only extend so far as to send a report to a body called the Midwifery Board, and that Board, when it had made up its mind, would have power only to suspend the midwife and nothing more. The result of this Bill would be that all cases of abnormal labour could be attended simply by a midwife, when it was absolutely necessary that a doctor should be present. There was no control whatever, and, naturally, irregularities would result. Did the promoters really mean that mid-wives were to undertake cases of abnormal labour or not? The Bill at the present time was extraordinarily vague upon that point, and under it the midwives could undertake all cases, whether abnormal or not. He ventured to ask the House whether it was worth while to proceed further with the measure at the present time. He did not speak on behalf of the medical profession, although possibly that suggestion might be made, but at the same time he thought it was hard that the opposition of the medical profession, which was almost unanimous, should be said to be an interested opposition. He begged to move that the Bill be considered this day three months.
§ *COLONEL MILWARD (Stratford-on-Avon), rising to second the Amendment, said he thought the disadvantage of send- 1257 ing a Bill of this kind to a Grand Committee had been very clearly shown from the remarks which had fallen from the hon. Member for Tunbridge. Everybody who had sat on a Grand Committee knew that it was very often extremely difficult to get a quorum. The result was a very small number of Members attended. It was true that Bills were sometimes considered in Committee of the whole House by a small number of Members, but all Members might attend if they chose. This was not so with regard to Grand Committees. When a Bill was sent to a Standing Committee it was withdrawn from the cognisance of the House, and when it came back hon. Members interested in it were in a difficult position, because the easy answer to any Amendment they might propose was, "This Bill has been considered by the Standing Committee." If the Bill had been considered in Committee of the whole House they would not have had this discussion now, but through its being sent to a Standing Committee the whole matter would have to be entered into de novo, and the Report stage would be turned into another Committee stage. He objected to the Bill. Bills for the registration of plumbers and for the registration of architects had been introduced, and now a similar Bill had been brought in for the registration of mid-wives. Where was this system of registration to stop? Two of the hon. Members interested in this measure were country gentlemen, and he did not know why there should not be a Bill for the examination and registration of country gentlemen. He did not allude to physical examination, but when there were such bodies as county councils, district councils, and parish councils, not to mention more important bodies, such as Quarter Sessions and assizes, he imagined it was just as necessary to examine country gentlemen for their qualifications as any other class. He trusted that sooner or later they would go back to the good old time when people had not to be examined and registered in this way. The mover of the Amendment objected to the Bill from the doctors' point of view, and he was right in so doing. If there was to be a class of certificated midwives they should be hedged in in every possible way. He (Colonel Milward) objected to it on behalf of the numberless women who assisted the poor in the capacity of 1258 nurses in the time of their trouble and suffering. The whole condition of the country with regard to lying-in and midwifery would be changed under the Bill. A great many good women in the country attended and nursed their neighbours in their labour, and in the great majority of cases in a proper manner. It was not so dangerous a matter as laymen supposed; in ninety-nine cases out of a hundred no dangerous symptoms supervened, and when they did there was always ample time to send for a doctor. This Bill said that after January, 1902, no woman, as a midwife, should attend a woman in labour under a penalty of £5 unless she was certificated. The reform, if it were a reform, would affect the 21,000 women who were attending their fellow women throughout the country. It was perfectly true that the Bill provided that those women would, with the consent of the medical council, be allowed to continue in practice, but those women would die out in the country districts before they could be replaced by the certified midwives. He was not averse to the general proposals of the Bill, but he thought it was far too drastic, and the House ought to be prepared to safeguard the position of the women who were now doing, and doing well, this kind of work.
§
Amendment proposed—
To leave out the word 'now,' and at the end of the Question to add the words 'upon this day three months.'"—(Mr. Boscawen.)
§ Question proposed, "That the word 'now' stand part of the Question."
§ *SIR JOHN TUKE (Edinburgh and St. Andrews Universities)hoped that the Bill might be allowed to proceed on the ground that it was a measure of great importance affecting public health. The hon. Gentleman who moved the Amendment suggested that all women in labour should be placed under the care of medical men. This would do away with the midwife, who had existed from remote ages, and would exist till the world's end. It had been said that a large section of the medical profession objected to the registration of midwives, but on. the other hand a large section approved. The Medical Council approved generally of the Bill before the House, and had accepted its general principles. They 1259 had made suggestions from time to time, the influence of which was to be seen in the Bill. He would not say the Bill was all that he could wish, but it was a step in the right direction, and he hoped it would be allowed to proceed.
§ DR. FARQUHARSON (Aberdeenshire, W.)said he entirely sympathised with the hon. and gallant Member for Stratford-on-Avon who supported the rejection of the Bill. A great many, too many, Bills were sent to Standing Committees. Owing to his position on the Committee of Selection he was debarred from assisting at those Committees, and not only himself, but many other hon. Gentlemen were unable to take part in measures in which they were interested, because they were sent upstairs. They ought to be discussed in the House itself. He did not associate himself with the objection to the registration of mid-wives; doctors were registered, and all it was proposed to do was to put an inferior class of practitioner on the same scale as to registration as the higher branch of the medical profession. He did not agree that the Bill had been insufficiently discussed. It had been discussed before the Standing Committee, and if it had not been discussed at greater length upon this occasion it was through the pure accident of the position it held on the Paper. A large number of doctors opposed it, but an equally large number were in favour of it, and the one balanced the other. Two-thirds of the poor women were attended when in labour by their own sex, and there was a very strong feeling against what was called men-midwives. But these women who attended were usually stupid, old, and unqualified to perform these duties, and were not uncommonly both dirty and ignorant. They ought to be trained and registered. Puerperal fever could be eradicated entirely by cleanliness and proper care and precaution, and if these women were qualified it would disappear. He hoped when the Bill came up again a good measure would be the result, but at the same time he supported the principle of it.
§ MR. PARKER SMITH (Lanarkshire, Partick), in supporting the measure, said the mover of the Amendment addressed the House from the point of view of the 1260 doctor. The hon. Gentleman who seconded it pleaded for liberty for mid-wives pure and simple. Those gentlemen represented vested interests of one kind or another, but the House ought to consider the matter from the larger standpoint of the interests of the women of England and the coming generations; that was the standpoint from which the great majority of the medical profession regarded it. The hon. Gentlemen who opposed this measure did not realise that the great majority of the births of this country were attended not by doctors but by women of no qualification. What was required, and what the Bill was intended to provide, was that some sort of qualification should be made compulsory, although too high a qualification could not be given at once. Had the mover of the Amendment been in this country and able to take part in the discussion when the Bill was before the Standing Committee, he would have seen that the Committee considered all the points he had raised and did their best to meet them. The importance of the measure went far beyond the interests of either doctors or midwives. The evils it endeavoured to meet were tremendous. Thousands of preventable deaths took place every year. Puerperal fever could be eradicated, and the numberless deaths of infants, together with the blindness of children, could be prevented. A comparatively small amount of training would be sufficient to avoid those dangers, and a little knowledge would let these women know when abnormal cases or dangerous symptoms occurred, and when the doctor ought to be summoned. This knowledge on the part of the midwives would make abnormal cases infinitely safer, because the doctor would then be summoned at the proper time. He hoped the Bill would receive the consideration of the House.
§ SIR WALTER FOSTER (Derbyshire, Ilkeston)considered the measure one of considerable importance, and for that very reason he wished it to be postponed. It was one for which he believed he was himself to a certain extent responsible, for the reason that some years ago he had been struck by the horrors which had been referred to, and had moved the Medical Council in the matter. He was not prepared, however, to vote for a Bill that would abrogate the Medical Acts of 1857 and 1886 1261 by creating a new class of practitioner, which was unnecessary in the interests of the public. What was required was that in child-birth women should have properly educated nurses to look after them, whose knowledge was sufficient to enable them to judge when the local practitioner was necessary. In that position these women would do an infinite amount of good, but if they were put upon a register they would be put in a position to become independent practitioners. He did not think that any law would attempt to prevent a woman giving aid to another in her time of tribulation and danger. What was required in the interests of public health and in the interest of the mass of the people was that they should have properly qualified women to attend as monthly nurses or midwives. The Bill under consideration did not do that, and provided no security for it, and in his opinion the House ought to give it further and longer consideration. Fourteen Amendments had been put down on the very morning of the day it came on for consideration, and there were a score of Amendments which would necessitate considerable discussion. He did not know whether the Government were prepared to back the Bill in its present form —he believed not; and, for the reason that it had not been properly considered, he thought the House ought to support the Amendment before the House. It was in his opinion too large a question to be initiated by a private Member, and he hoped in another session the Government would take the matter up and bring in such a Bill as could be passed into law.
§ MR. HEYWOOD JOHNSTONE (Sussex, Horsham)agreed in wishing that this matter should be dealt with by the Government of the day—
§ It being half-past Five of the clock, the debate stood adjourned.
§ Debate to be resumed To-morrow.