§ Order for Third Reading, read.
§ (12.15.) MR. HEYWOOD JOHNSTONE (Sussex, Horsham)
said that before he moved the Third Reading he had to propose one or two verbal Amendments which would have the effect of carrying out the verbal arrangement which by common consent the House entered into last Friday. It was clearly understood there were two periods to be fixed in the Bill, one the date after which no woman was to be allowed to represent herself as a midwife, and a later period, after which, if unregistered, she was not to be allowed to act as a midwife. The Amendments of which he had given notice would give effect to that arrangement.
§ MR. SPEAKER
I have satisfied myself that these are purely verbal Amendments which carry out the intention of the House. The difficulty arises from a date having been inserted in the wrong place, and without the Amendment the Clause would be nonsensical and ungrammatical.
§ MR. T. P. O'CONNOR (Liverpool, Scotland)
I am in entire sympathy with the hon. Member for Horsham.
§ Verbal Amendments made.
§ Motion made and Question proposed, "That the Bill be now read the third time."—(Mr. Heywood Johnstone.)
§ (12.20.) MR. GRIFFITH BOSCAWEN (Kent, Tunbridge)
said he entirely accepted the verbal Amendment first carried, but he was bound to point out that the House was put to considerable difficulty by the fact that the Bill, although very much altered on the Report stage, had not been reprinted. They had not, therefore, before them the measure which they were asked to read a third time. He had not risen for the purpose of endeavouring to stop the Bill at all; had that been his object he might no doubt have carried it out the previous week. But he fully recognised that the Bill, although a peculiar one, ought to be allowed to go through. Still it was so exceptional in its character that he would not like it to be read a third time without carrying a word or two on it as he was one of those who had always opposed it. 613 The Bill was one which was contrary to the whole course of legislation which had been carried on this question for many years past. Hitherto the object of Parliament had been, so far as possible, to strengthen the law against what he might call quacks and inferior practitioners. That had been the whole tendency of the Medical Acts. At the present time, under those Acts, no doctor might practice midwifery unless he was qualified, not only for midwifery, but also in medicine and surgery. But this Bill entirely reversed that policy, and instead of making the qualification more strict, it rendered it far more easy for a certain number of practitioners registered under the Bill to practice without possessing these qualifications. There were, of course, special reasons why that should be allowed. Although the law laid it down that those high and full qualifications were necessary for medical men, the fact remained that the great bulk of the poorer classes did not resort, in ordinary cases of labour, to the medical profession at all. They resorted to what were called midwives, and those midwives, being untrained, unregistered, and unregulated had undoubtedly been the cause of a vast amount of unnecessary suffering in the past; a great many deaths had resulted from their carelessness and want of education, and much preventable disease as well. The reason why the poorer classes did not avail themselves of the aid of doctors, and why they went to these ignorant people, was, of course, the high charge made by qualified practitioners. They could not afford to pay the doctor, and so they had resource to the unqualified woman whose charges were, of course, very much less. He might point out that, unless the Amendment which was put in the Bill last week had been accepted, the measure would have been perfectly useless, because it would still have enabled unqualified and untaught practitioners to continue their practice as before, and would have merely set up a separate class of trained practitioners, and, just as at the present time, the poorer people, for financial reasons, preferred the unqualified midwife to the doctor, so he had no doubt, if the Bill had passed without that Amendment, the result would have been 614 that the registered midwife would have proved much more expensive than the unregistered; poor people would, in consequence, have resorted to the cheaper practitioner, and the evil would have gone on exactly as at present. He fully admitted that a very great improvement had been made by providing that after 1910 it should not be lawful for any woman habitually, or for gain, to practice midwifery unless registered. But he must point out that, up to that date the promoters would uudoubtedly fail very largely to meet the evils which the Bill was designed to combat, and he could not say he thought much good was likely to result.
There had been very strong objections pressed against that new provision, and he had heard sinister rumours that attempts might be made to remove it from the Bill in another place. He was aware that the right hon. Gentleman the Member for the Bordesley Division of Birmingham, who represented the Home Office, had spoken strongly and indeed felt most strongly against it. He had told them that he could not support the Amendment. Now he had thought a good deal about his right hon. friend's speech; he had read it over three or four times, and he must say he failed to understand the right hon. Gentleman's objection. He had told them that the insertion of the words would not merely prevent unregistered women from nursing in midwifery cases, but that it would also prevent the unqualified woman from doing menial offices and assisting a friend during her period of labour; it would prevent her looking after the ordinary household duties which would naturally be performed by the woman herself were she able to do them. He could not see that that would follow from the Amendment, because it provided distinctly that the woman must habitually and for gain attend women in childbirth. What was clearly intended to be dealt with was the actual nursing of the woman during the course of labour, and not the performance of various menial functions. Of course, if there were any doubt as to the real meaning of the words they could be altered in another place, so as to make it clear that what was to be pro-vented was actual attendance in labour by 615 an unregistered woman. Reference had been made to the case of the agricultural labourer, and a suggestion had been thrown out that his wife would not be able to afford to pay for a trained midwife at all. Then what was the good of the Bill at all? Its avowed object was to prevent untrained women from practising, and if they were still to allow such women to practise amongst the poorer classes the result would be that they would remove the benefit of the Bill altogether from those classes. It was most important, if such a Bill were to be passed, that it should apply to all classes, rich and poor alike, and no real good could result from it unless the words with which he was dealing—or similar ones—were left in the measure. There were one or two other points he would like to touch upon. He would have liked to have seen the Central Board made a stronger body. He agreed with his hon. friend the Member for the Scotland Division of Liverpool that the British Nurses Institution ought to be represented on it.
§ MR. GRIFFITH BOSCAWEN
said that as the Bill had not been reprinted, and as the Amendments were gone through so hastily in the previous week, it was almost impossible for anyone to know exactly what was contained within it. He was glad to have the assurance of his hon. friend. But that did not entirely meet his views. He thought the local control ought to have been made stronger. He could only say, in conclusion, that he did not intend to vote against the Third Reading of the Bill because he fully recognised that his hon. friend the Member for Horsham, who was in charge of it, had worked for a great many years in order to cope with a great evil. It was a Bill of a very peculiar nature and one which ought not to be oppressive in its action, and it was only because it dealt with a special set of circumstances that he, and other hon. Members who had acted with him, had withdrawn their opposition. He hoped, however, in due time they would revert to the proper principle of making the qualifications required in these matters more strict than at the present time.
§ (12.25.) MR. RENSHAW (Renfrewshire, W.)
said he rose to express views which were in opposition to those of his hon. friend who had just spoken. The hon. Gentleman spoke approvingly of the Amendment made in the Bill on the report stage, but, for his part, he feared that the Amendment to which special attention had been drawn was likely to cause great difficulty in many rural parts of the country. There were many outlying districts in the Highlands where it was impossible without great expense to secure the services of a trained midwife. That was a point which ought to be considered, and if the words which had been inserted in the Bill were to be maintained there he thought they ought to be modified in the direction of making it possible to put some charge upon the public rate so as to meet cases of hardship. There was only one other point to which he wished to allude. His hon. friend had elicited the fact that on the report stage the hon. Member for the Scotland Division for Liverpool secured the insertion of a provision securing representation on the Central Board to the British Nurses Association. He was very glad that the promoters assented to that change, and he would like to make a further appeal to them to also give representation on the Board to the Queen Victoria Jubilee Institute for Nurses. He had a letter in his hands from the Secretary of that Association in which she said that the institute was constantly training nurses and supervising their work all over the country, that, as a rule, they had between 400 and 500 midwives on their books, and that, consequently, it was only fitting they should be represented on the Central Board. He hoped his hon. friend would take steps to secure them such representation when the Bill was under consideration in another place.
§ Mr. FLOWER (Bradford, W.)
said he gladly joined in the appeal which had been made by the last speaker. The Amendment accepted last week did provide in some measure for the representation of qualified nurses on the Central Board, but he strongly held that, in view of the exceptionally valuable work which the Queen's nurses were doing all 617 over the country, it was only right and fitting that their institute should be represented on the Central Board. He knew it was too late to give legislative effect to that suggestion in that House, but he did appeal to his hon. friend the Member for Horsham to hold out to them some hope that the Bill would be amended in that direction elsewhere.
§ (12.30.) DR. THOMPSON (Monaghan, N.)
said there was no doubt that the medical profession throughout the country were by no means satisfied with the Bill, but, in view of the great interest displayed by the hon. Gentleman in charge of it, they had waived many of their objections in the hope that in the near future an amending Bill would be introduced which would meet their views. Now, in Ireland they had an almost perfect system for looking after poor women in the time of labour. They had well arranged dispensary districts with a doctor, in charge, and under him a midwife. The latter could not attend the patient on her own initiative. She had to get written authority from the doctor, and thus the latter was in close touch with the midwife and was called in in case of necessity. He had heard it said in the course of those debates that the process of parturition was easy and natural. But the fact was that, owing to our highly civilised condition, it had become almost unnatural in many instances. In many cases the administration of chloroform was necessary, and he did hold that poor people should have a right to call in medical men and to gel relief from their sufferings equally with the highest ladies in the land Was not the Government as represented by the Home Office in favour of the very necessary Amendment made in the Bill. He heard the Under Secretary say it would be a very terrible thing to deprive the poorer women of the help of the handy woman in time of trouble, as it was necessary to have somebody in the house to look after the children and do the dirty work. But had the right hon. Gentleman never heard of antiseptics—the very things which were used to guard people from dirt and filth. It was one thing to do the menial offices and these handy women could.
§ DR. THOMPSON
said the best plan would he to establish a proper system of dispensary districts in England, and then there would he no trouble on the score of payment. The cost could be placed on the taxpayers as in the case of Ireland. Like a good many other medical men he began his profession as a general practitioner, but he had long given up that branch of his work, and he could testify, not only to the dangers and frightful results of the work of these unqualified women, but also to the terrible lacerations and other injuries produced by carelessness of the grossest character. His time was greatly taken up in remedying the horrible deformities suffered by unfortunate people through the carelessness of these ignorant women. People in the country did not understand the great danger to which women were exposed in this matter, and a rich country like England might well follow the example set by Ireland in making provision for poor women. There were a great, many defects in the Bill, but there were also some very good things. The medical profession was not a very money-grubbing profession. The other day he was thinking of his own work. He supposed that in the course of the year he attended about 1,000 persons for fees, but the remaining 5,000 paid him nothing. No doubt, that was the experience of every other doctor, excepting, perhaps, those in the very highest positions, and they, of course, had not the time to do it. Wherever they saw suffering, misery, or trouble, they did all they could to alleviate it—for payment; they could get it, but without payment if necessary. He hoped that if the Hill passed through the other House the Government would not attempt to take out the penalising clause which, in his opinion, was absolutely necessary. There was not a doctor in the kingdoms who would not support that clause in the interests of the poor. There was not a clause in the Bill so absolutely necessary. It would prevent the practice of these unqualified women, and he trusted, therefore, that instead of 619 opposing that Amendment in the Bill, any alteration that might be suggested would be in the direction of trying to make the measure of more use to the poor people of this country.
MR. PARKER SMITH (Lanarkshire, Partick)
said he did not think the hon. Member had said a word too much on behalf of the medical profession. Everyone must recognise the enormously unselfish and devoted services gratuitously rendered by the members of that profession. Much of it, of course, might be said to be done for the sake of education and practice, but the vast bulk of it was done by men who came into contact by suffering and who, out of the charity and liberality of their hearts, came to the relief of the poor without any thought of pay or remuneration. They would all like the women of the country to get the best skill available, but how was that going to be arranged? Let them look the facts in the face. They found that a comparatively small proportion of the women of the country could claim the assistance of the medical profession. At present there was, no doubt, an enormous amount of mischief done by ignorance on the part of mid-wives, and the object of the Bill was to endeavour to improve the education of midwives. They must act gradually. He personally would have been delighted if it had been found possible to go further than was proposed in the Bill, and to insist upon higher qualifications for midwives. But he believed that any attempt to make too stringent demands with regard to qualifications would render the measure unworkable. They must be satisfied with advancing by steps, and they could only hope to be able to make further advances in the future. He believed that the step forward made by this Bill would effect a real improvement with regard to the qualifications of ordinary midwives up and down the country. The hon. Member for Tunbridge had suggested that the Bill was contrary to the general tenure of the law. He, on the other hand, would have said it was exactly in accordance with it, because hitherto the object of the law had been to secure the registration of those who were authorised 620 and qualified, and to take every precaution that those who were neither authorised nor qualified should not pretend to be so. One could not stop them from practising altogether, one could not prevent people taking advice from whom they chose in regard to their health and paying for it, but one could make sure that a person in going to somebody who was not recognised by the faculty, was in a position to know that the person so visited was not entitled to claim to be that which he was not. His hon. friend had spoken of the Amendment which had been introduced to prevent unregistered women practising after the year 1910. He was exceedingly glad to see that Amendment put into the Bill; he heartily supported it, and he hoped that no effort would be made to remove it from the Bill in another place. The object of the Bill was to improve the status and education of midwives, and he conceived, that the wide interval of seven years between the Bill coming in force and the prohibition clause becoming operative would afford plenty of time for those women who were now practising midwifery to get more knowledge and experience, as well as higher qualifications, so as to make them fit to be placed on the roll by 1910. There were provisions already in the Bill enabling women practising at the present time to be put on the roll, on showing that they were already in practice and that they were already of good character, and he thought some provision might be added to give them a chance to go on practising after 1910 and to be put on the register on easier terms than those applicable to midwives starting afresh. The Bill had had careful and jealous scrutiny, and, as regarded the feeling of the medical profession at large, he entirely agreed with the hon. Member for North Monaghan that that profession had been simply looking at it from the point of view of endeavouring to get what was best for the women of the country. In his opinion they had sometimes been somewhat impracticable in asking for too much at once; but still, he was sure that, on the whole, their objections and criticisms had been animated by the highest motives.
(12.40.) SIR WALTER FOSTER (Derbyshire, Ilkeston)
said the Bill was 621 one in which he had taken a benevolent interest for some ten years or more, and he would like to say a word or two with reference to its present position. That position was somewhat different when, a week previously, they met to consider the measure and were faced with some seven pages of Amendments. Then apparently it had hardly any prospect of passing. But suddenly, and almost unexpectedly, they were all in harmony with reference to the measure, and it passed through most rapidly, with the assistance of hon. Members on his side of the House. That singular phenomenon was due to a complete change in the character of the Bill with reference to unqualified practice. That change and alteration would, he hoped, be retained in the Bill at all costs, in the course of its future progress. They did not, last week, receive any very explicit declaration from the Government of their adhesion to their now principle introduced in the Bill; on the contrary, the right hon. Gentleman the Under Secretary for the Home Department made a speech of considerable fervour defending the position of unqualified practitioners, especially in rural districts. With that he had the greatest sympathy, because be thought that any measure which deprived the somewhat remote localities, where perhaps medical men did not reside, of the assistance which these persons had hitherto been able to give to poor women in labour would be a serious injury to the poorer classes. But he thought the right hon. Gentleman's fears were exaggerated, and certainly as years went by the difficulty would be overcome, as suitable and deserving persons now practising midwifery would be able to got on the roll of midwives and thus be put in a position to carry on their calling without difficulty. The right hon. Gentleman waxed very indignant with reference to certain terms which had been used in regard to some of these women. But he quite misunderstood the sense in which the word "dirty" had been applied to them. It was in no sense used in the ordinary acceptation of the term. It was applied in its purely scientific sense. The right hon. Gentleman desired that these women should be allowed to be employed in the interests of the poor; and that they should be allowed to be 622 engaged to keep the home cleanly. To that there was no objection. But what was contended was that they ought not to be allowed, from a scientific point of view, to be brought into contact with the patient; ignorant and untrained persons should not, in future, be allowed to perform one of the most delicate and responsible functions which woman could be called upon to perform for one of her sisters. Now, he wanted to elicit from the right hon. Gentleman a pledge that, whatever changes might be made in the Bill in another place, the words "practising habitually and for gain after 1910" should not be interfered with. The so-called compromise of the previous week rested upon the insertion of those words and that date. The opponents of the Bill had given away a great deal by accepting so distant a date, but they had, at any rate, accepted a principle which they believed to be a useful and valuable one, and he would be sorry if anything were done to interfere with the carrying out of it. All that was wanted was, not to protect the medical profession, but to secure that at some date there should be security that the women employed in the performance of these functions were properly instructed for the discharge of duties so serious to those on whom they were performed. He believed the Bill would have to be more or less amended in the near future, and for the reason that the working of it was exceedingly complicated. He was not satisfied with the constitution of the Midwives Board, and he did not think that the relationship of the County Councils to the Bill was sufficiently defined. He feared that the Board would not work altogether without friction, and he would like to see the medical officer of health in every locality made more directly responsible for the supervision of these matters in his district, and put in a position to enforce proper and just demands. Very valuable work might be done by medical officers in this respect, and hence he would throw more responsibility upon them. The expenses under the Bill might be heavy, and that was a matter which the County Councils would have, to take into consideration. He believed, as he had said on previous occasions, that this Bill was only part of a much greater 623 measure of legislation which was needed for this country, and he did not think it should have been left for a private Member to deal with this subject. But now the Home Office had assumed, to some extent, responsibility for the Bill, he hoped they would look after it carefully, and see that it was not altered on the points he had named. It only dealt with a comparatively small fraction of a great public question. There were probably in this country some 3,000 or 4,000 midwives whom the Bill would affect. But there were also some 80,000 nurses who required supervision and control, just as much as midwives, and it should be the duty of the Home Office to introduce a measure for the supervision of the whole of these women who practice delicate functions.
§ (12.48.) MR. BANBURY (Camberwell, Peckham)
congratulated his hon. friend the Member for Horsham on the success which had attended his labours after so many years. Everyone in the House, he was sure, recognised that a Bill of that description was necessary, and was glad that it had fallen to the lot of the hon. Gentleman to pilot it through so successfully. But they must not allow their joy at his success to prevent them examining some of the provisions before it left that House. Everyone would admit that, in the interests of the country, some measure of that sort was required. But at the same time they were bound to take care that it did not cause any hardship which might be avoidable. They had heard several doctors speak in that House on the Bill, and it was curious to note how they differed, irrespective of politics. It must be borne in mind that it would not be a good thing to institute a class of people who would practically do away with doctors. He did not say that in the interests of doctors themselves because personally he did not think it would be possible to institute a class of midwives who would be sufficiently skilled to undertake the duties of their profession in all cases. No one would deny that, under certain circumstances, it was necessary to call in a doctor. But they must remember that many of the people who were attended by midwives were not in a position to pay the expense 624 of calling in a doctor, and, at the same time, of employing a skilled midwife, in addition to somebody else to perform the ordinary duties of the house. There was, therefore, a good deal to be said for the objection raised by his right hon. friend the Under Secretary for the Home Department to the Amendment which was introduced on the report stage a week ago. The hon. Member for North Monaghan had stated that the medical profession were not satisfied with the Bill, and, in answer to an interjection made by the Under Secretary, he said that something ought to be done which was not provided for in the Bill. The hon. Member for Tunbridge had also expressed his inability to understand the objections of the Under Secretary to the new Clause. Now, as he took it, the words introduced in the Bill provided that no woman "shall attend." What was the meaning the word "attend?" They all knew that, in small villages, the wife of a labourer was often not in a position to pay some one to attend to the ordinary household duties, such as washing the children and cooking the meals, things which had to be done whatever happened. As he understood the Bill, the labourer's wife would be prevented from employing a woman of that sort unless she was absolutely limited to those duties. He presumed there would be nothing to prevent her having a woman as general servant to undertake the household duties, but how on earth could she afford to pay two or even three people? In the first place she would have to have a qualified midwife, secondly there would be the general servant, and finally, if it were a complicated case, the doctor might have to be called in. This was a very serious matter, and, while he quite recognised that a great evil had grown up under the present system, he thought they should be very careful not to create new evils. It was a question whether now that this Amendment had been introduced they would not be establishing a midwife ring. It had been suggested that the tendency of legislation was adverse to quacks practising. But as he understood it all the law provided was that a man should not call himself a doctor unless he was properly qualified. It did not prevent an unqualified man from 625 practising. Before it was altered last week the Bill merely gave effect to the rules and regulations which applied to the medical profession, and he thought that the alteration which had been made went further than was necessary. He did not know whether the Under Secretary, in answer to the appeal of the hon. Member for the Ilkeston Division, was going to give any indication of the line which the Government might take in another place. At any rate he hoped he would not give the pledge asked for by the hon. Member, and that he would not bind the Government hard and fast to support the retention of the Amendment. While he thought there were serious objections to that Amendment, he must say that, on the whole, he held the Bill to be a very good Bill, and he would be glad to see it pass its Third Beading. In one of the speeches which had been made during the debates on the measure a suggestion had been thrown out that if the Bill became law illegal operations would be frequent. He did not believe there was any ground whatever for that suggestion, and he did not think the fears of it were justified. He would only say in conclusion that he hoped, before the Third Beading was agreed to, the right hon. Gentleman would indicate—the intentions of the Government as to dealing with it in another place.
§ (1.0.) MR. T. P. O'CONNOR
congratulated his hon. friend for Horsham on the fact that the Bill was perfectly safe. He did not think the House was likely to divide against the Third Beading, and even if it did he would feel bound to vote for it. He need not, therefore, be alarmed if some debate were thought necessary at that stage. In the first place let him say that he entirely sympathised with the proposals made by one or two hon. Members, that the Jubilee Nurses should be granted representation on the Central Board. It was quite in accord with his views. The reason he insisted on the British Nursing Association having representation, was that he looked on this question as largely one of nursing, and in order to make the Bill effective, it was necessary to have the very best representation of nursing institutions. He hoped, therefore, that 626 the hon. Member for Horsham would see his way to accepting the suggestion as to the Jubilee Nurses. The other day, having obtained what he considered to be reasonable terms, he was very anxious to see the Bill go through, and as a somewhat dangerous point was raised, he did not insist on some of the Amendments he had on the Paper. But he would strongly put it to his hon. friend that the governing body might be further improved. One of the points he would like to draw attention to was that the Board was to a large extent a London Board. No doubt London bodies had a very representative character in regard to other parts of the country, but still it was a London Board, and there was nothing in which the habits of different parts of the country varied more than on the question of midwifery. It was therefore desirable, if they could, to make some change in the governing body, so as to secure better provincial representation. As he read the Bill, the rules adopted by the Central Midwives Board for the regulation of examinations, etc., were subject to revision by the Priory Council, in consultation with the General Medical Council. But he would put it to the House that the rules were of such vital importance that they should also be subject to the supervision and control of Parliament, and might well be laid on the Table for a period of twenty, thirty, or forty days before finally passing into law, for then if it were found that the rules went in anything like a retrograde direction, and if they relaxed in any way the splendid training given in modern times to nurses, they could be subjected to sharp and severe criticism. With regard to the Amendment, which was the outcome of the compromise arrived at a week ago, he hoped that the Home Office would accept the verdict of the House of Commons. The matter had been very carefully considered, and he thought the concession made was a very fair approach to what they asked. He had been twitted with accepting in the House a proposal against which he voted in Committee, but he would remind hon. Members that he was making the best battle he could to get some form of compromise, and at any 627 rate he secured that a fair breathing space was given to the women now practising as midwives. He was considerably impressed and touched by the speech of his right hon. friend last week. No doubt there was some difficulty in regard to working the Bill in country districts. People were poor, and midwifery was simply one of the many occupations by which women earned a livelihood. Let him put this strongly to the House. His hon. friend in charge of the Bill had begun a good work. He hoped he would continue it, and endeavour to assimilate the English to the Irish system. In Ireland they had an almost perfect system, every poor woman in labour was entitled to the assistance of the dispensary doctor without fee or reward. There was attached to every dispensary district in Ireland a thoroughly trained nurse. He insisted that nursing was at the very root of this matter. Midwifery was more a matter of nursing than anything else, and unless a woman got a training in absolute cleanliness in all matters connected with nursing—such as was given in hospitals, she was almost worse than useless at the bedside of a woman in labour. Not only was it true that they had nurses attached to every dispensary district in Ireland, but in some cases where the Boards of Guardians had been foolish enough not to appoint one, a sealed order had come down from the Local Government Board, directing them to do it, and in some cases appointing a nurse over their beads. He thought it a little discreditable to a rich country like England that it should not be willing to pay out of the rates what a poor country like Ireland was willing to pay. But this question could not stay where it was. They had only touched the fringe of the question in that Bill. He was entirely at issue with some of the views expressed by the hon. Member for West Aberdeenshire. As a matter of fact they bad around them innumerable instances where the happiness of homes and families had been darkened by bad treatment at the time of parturition.
§ DR. FARQUHARSON (Aberdeenshire, W.)
I do not think I expressed any opinion to justify these remarks.
§ MR. T. P. O'CONNOR
My hon. friend gave such an eloquent and picturesque description of the facilities for treatment that I think he rather forgot the natural inference. He was no doubt an excellent doctor, but he had not been in practice for some time, and he rather under-rated the magnitude of the cases where parturition was not perfectly natural. As a matter of fact, a small bit of dirt under the nail of a nurse might destroy the life of the child, or if it did not destroy it, it might poison the life of the child, and even of the mother—as it had done in millions of cases—for the rest of her days. One of his hon. friends near him had had tragic experience of that. Having knowledge of these evils, surely they had been perfectly justified in sternly and vigilantly watching every line of that Bill. With regard to the clause introduced into the Bill, he thought there was a good deal worthy of attention in the speech of the Under Secretary. That remark especially applied to the case of the village, and the policy he would like to see pursued would be the application of a system of gentle violence to those districts, so that by 1910 the difficulty which obtained today would no longer exist. He would like to bring pressure on these localities to imitate the example of Ireland. The Department had a period of eight years in which to cope with the difficult. He had himself been in a rather difficult position as regarded that Bill. He was asked by men of great eminence in the medical world to criticise some of its provisions, and to make certain suggestions. Some of those gentlemen had regarded him as a half-hearted advocate of these views, and he had already been subjected to some reproach because he had not taken advantage of the Parliamentary situation to try and postpone the passage of the Bill for another year. Well, he accepted quite cheerfully the charge of half-heartedness, for he was so conscious of the evils with which the Bill proposed to deal, that he was not prepared at any moment to prevent his hon. friend from taking that moderate step in advance towards meeting them. He insisted on his views as long as he could, and in his heart of hearts he never intended, if he could 629 get anything like a fair compromise, to carry his opposition to the point of destroying his hon. friend's work for another year—work to which many earnest men and women had devoted years of strenuous labour.
§ (1.20.) MR. COHEN (Islington, E.)
said the hon. Gentleman who had just spoken had met the promoters throughout in a very reasonable and conciliatory way, and had never advanced his objections in a manner calculated to defeat the Bill. He entirely concurred with his expression of regret that in this matter England had not imitated the example of Ireland. It was to be regretted that they had not a medical officer attached to every County Council in England who could deal with this question. He rose mainly to reply to the observations of the hon. Member for the Ilkeston Division—observations directed not against the principle of the Bill, or the effect it would have in the direction for which they had been striving, but complaining that it was such a poor contribution to the law on the subject. He thought that criticism a little severe on the Bill. He recognised that it was only a small contribution and would have been glad had that been a large one, but seeing that the measure was in the hands of a private Member and owed its success to the perseverance, industry and ability of the hon. Gentleman they ought to accept it with gratitude. It was, in fact, a substantial and distinct contribution towards the removal of evils which they would be glad to see diminished and, indeed, altogether removed. He did not think the hon. Gentleman the Member for Ilkeston had established any serious charge against the Bill when he spoke of its complexity. They might be sure it would work in the direction they all desired, and if in two or three years they found that in certain directions it required amendment, the experience gained in the interval would be of enormous value in improving it. He entirely endorsed the hope expressed by his hon. friend that the Government would do everything in their power to adhere to the compromise which had been arrived at. The hon. Gentleman the Member for the Scotland Division on 630 Liverpool distinctly accepted the Amendment as a compromise. Personally he would have been glad if the delay had not been so long, but certainly some delay was indispensable, and it was necessary to take care that time should be given to women now practising to get themselves certified. Poor women in the country should not be deprived of that assistance which was absolutely indispensable to them, and which without some delay it would be impossible to secure for them. They therefore accepted gratefully and cheerfully the Amendment which had been placed in the Bill. It was certainly not asked for, and neither was it urged in the interests of the medical profession. It might incidentally—he did not know whether it would—operate to their advantage, but its aim and object was the protection of women desirous of obtaining competent and properly certified persons to attend them in the time of labour. He thought he was expressing the opinion of every Member of the House who had taken an interest in the Bill when he congratulated the hon. Member for Horsham on securing the passage into law of a useful Bill aiming in a direction which they had all been striving for for many years, and he hoped that the success which he had achieved in that instance would be an encouragement to him to pursue his efforts to remove the defects undoubtedly remaining in the law.
§ SIR FRANCIS POWELL (Wigan)
said he heartily congratulated his hon. friend on the conclusion of his long labours. It had been a great pleasure to him to associate himself with the hon. Gentleman's exertions, and he rejoiced that they had now reached a stage when the probability of the Bill becoming law in the near future amounted almost to a certainty. He felt great regret that many of his friends in the medical profession had not regarded the Bill with more favour, but he hoped that, in the course of the interval which would elapse before the measure became operative, their views would change, that they would feel some sympathy with it, and that their fears would be found to be without foundation. The Bill was, no doubt, greatly altered during its passage through 631 the Report stage, and he was gratified to find his hon. friend in charge of it accepting Amendments which, upstairs, he had strenuously resisted. He rose for the sake of consistency to express his satisfaction at the delay which had been provided for in the application of what was practically the compulsory clause. He resisted that clause in Committee, because he felt perfectly sure that the adoption of it at that time would inflict great injustice and cause much hardship. But the delay until the year 1910 had entirely altered the whole situation, for it afforded ample time for the women now practising midwifery to comply with the new conditions. He hoped that they would do so, because he was perfectly sure that, unless they soon evinced an inclination to take warning from the passing of the enactment during the present session, there would be a resumption of activity, and pressure might be reluctantly brought to bear upon the House to initiate further legislation. He rejoiced that their labours might be regarded as complete, and he felt sure that the alteration to be made in the law would be approved in both town and country districts.
§ Mr. SCHWANN (Manchester, N. E.)
said the House would rejoice, and a much wider circle outside Parliament would be equally gratified, at the probable passing of this Bill into law, and he earnestly hoped that no impediment would be placed in its way in another place. During the past twelve years the Bill had gone through as many perils as Ulysses. It had been wrecked sometimes on one point and sometimes on another, but the difficulties in front of it had now practically disappeared, and they might hope that in a short time a Bill which would be productive of the greatest good to the community would have safely passed into law. He would like to incidentally mention that among the petitions presented to the House in favour of the measure had been seven coming from that class of the community which was most likely to be benefited by the change in the law. It must be some satisfaction to the House to know that the working classes had taken that opportunity of showing that they desired to secure properly qualified attendance in 632 I cases of labour. He would like to add his meed of praise and congratulation to the hon. Member for Horsham, who had for so many years worked with untiring zeal on behalf of the Bill. The success which had attended his efforts must be a great encouragement to hon. Members in charge of other Bills to exercise the same energy and pertinacity.
§ (1.30.) MR. JESSE COLLINGS
An appeal has been made to the Government to take charge of this Bill in another place, but it must be evident to the House that the Government can give no such pledge, for the reason that, throughout, it has been perfectly understood that the Bill is absolutely a private Members' measure and not a Government one. I shall vote for this Bill for two reasons. First of all the Bill as it stood without this Amendment was a thoroughly good Bill and was a long step in the right direction. It prevented the word midwife being used by persons unqualified to perform this office. In the second place I feel that after the conciliatory and courteous manner in which the promoter of this Bill has piloted it through the Grand Committee and through this House it would be somewhat uncourteous to attempt to destroy his labours. I have been opposed to the Amendment that was introduced, because that Amendment as it stands will prevent any woman doctor in the future attending a ease of childbirth. That will be the effect of it.
SIR WALTER FOSTER
Not at all. Women doctors practising in our large towns are all legally qualified.
SIR WALTER FOSTER
Yes, they would. They would be in exactly the same position as any other qualified doctor.
§ MR. JESSE COLLINGS
Then I can only say I do not know what the words, "no woman shall attend a woman in child birth" mean. My hon. friend behind me said, "Why should not the rich and poor be treated alike." I wish they could be, but that is not-possible because the poor cannot afford to be treated in the same [...] I would 633 ask the House again to remember that we are contemplating legislation not for the rich but for the poor, or I should say the working classes; persons earning 10s. or 15s. a week. Those are the families most affected by this Bill. These present nurses in the country attend the woman in child birth at the average price of 7s. or 8s. a week, they not only attend the mother in child birth, but do all the work of the house as well. The work they do is not represented by the wages they receive, there is a neighbourly feeling it is impossible to pay for. This Amendment penalises any woman undertaking this duty. When an unqualified man attends these matters he is not penalised and there is no reason why these women should be. I was very glad to hear that the words "dirty, idle and ignorant" were applied scientifically by the hon. Member, but I do not think they should be applied at all to women who as a class are most respectable and honest people, and who, although they are not trained, have had long practice, and have become indispensable to the poor. My hon. friend says "after this matter has been fully discussed." It was fully discussed in the Committee, and this Clause was rejected by a majority of twenty-five to eight. Sir William Priestley publicly stated that he was against the penalising of this class. Putting off the operation of the Amendment for a few years is of little use, for the poor—of whom I am speaking—will not be much better off then than they are now. I quite agree with what was said by the hon. Member for North Monaghan, but he was speaking of and illustrating a system which in England does not exist.
§ DR. THOMPSON
said it worked very well in Ireland, and he saw no reason why it should not work well in England.
§ MR. JESSE COLLINGS
If the Bill had been left where it was when it was originally introduced, you would have had this class of trained midwives gradually created, and local charity and charitable societies would have supplied trained nurses for the working classes to take the place of the nurses who now attend them. But you now penalise this really necessary class before the system which is recommended to take its place is established. 634 Why not let the Bill have grown by natural means gradually, instead of putting in this Amendment? I shall vote for this Bill. I have made my protest on behalf of a class of people who will be harshly and unjustly treated if this Amendment remains in the Bill. It is difficult for some of us who can afford to have servants and everything necessary to combat sickness, but we are dealing with a large percentage of population where everything in the household is done by one pair of hands, and it is a very hard case that that class is to be denied the only help that their poverty will allow them to have. Though I support the Third Reading, I heartily protest against this Amendment.
§ MR. HEYWOOD JOHNSTONE
said a strong application had been made to the promoters of the Bill to strengthen the governing body by introducing one of the nurses of the Victoria Nursing Home as a member of the Committee. He had no objection whatever to that being done. He admitted that the Bill was by no means a perfect final and complete settlement of this extraordinarily important question, and it might be that it was but the beginning of that better state of things which they had been told prevailed in Ireland; a state of things which he hoped might prevail here. He was only too thankful that the necessity for legislation in this matter had been recognised by the unanimous decision of the House. He was not wedded in any shape or form to particular details or arrangement, if a beginning could only be made towards a better state of things He was certain that in thirty years, with experience, knowledge and information, legislation on this subject would stand on infinitely firmer ground than it could stand in this case, or at this time. The discussion this afternoon had been mainly upon the words inserted on the previous occasion, penalising unqualified practice, but the House must bear in mind that the insertion of those words was the result of a compromise suggested and assented to. He could only say that he could neither directly nor indirectly be a party to any attempt to upset that compromise, and he ought not to be approached on the subject, either privately or publicly, and he 635 ought to abstain from giving any indication as on which side his preference lay. There were great and weighty arguments to be adduced on both sides. He was able to approach this matter from an impartial standpoint, because it had been his duty to argue the matter from both sides. It only remained for him to say that the Bill left him with great memories of generous kindness, sympathy, and help tendered and given by many valued friends known or unknown, and many useful criticisms and helpful suggestions by those opposed to the Bill, in which, if there was any animus, that animus was soon merged into respect, which respect was succeeded by goodwill.
§ MR. TOMLINSON (Preston)
said a great deal of argument had taken place between hon. Members who represented different views and had taken different attitudes upon this question about the compromise which had taken place, and it was obvious that this Bill would have had no opportunity of passing into law if that compromise had not been arrived at. But besides those Members who had taken sides, there was another section of the House who were not parties to the compromise, whose only desire it was to see a good Bill passed, and whose views he thought ought to be considered. Those who looked at this Bill from that point of view could not look at it without some anxiety. He was strongly in favour of the enactment of a Bill of this kind, and he hoped that care would be taken to ensure that while the measure should be made as efficacious as possible the poorer classes should be protected from injury.
§ LORD HUGH CECIL (Greenwich)
said before the Bill passed its Third Reading he had one question to ask. He had listened to the interesting speech of the Under Secretary for the Home Department; but he had not quite gathered from the right hon. Gentleman whether he spoke on behalf of the Government or not. He thought the hon. Gentleman should explain what was the precise position of the Government with regard to this Bill—whether they proposed to make it a Government Bill or not.
§ MR. JESSE COLLINGS
said he thought he had been plain upon that point. What he said was that it was not a Government Bill; that it was a Bill that the Government regarded as being entirely in the possession of the House.
§ LORD HUGH CECIL
said that, as he understood it, the Government did not regard themselves as bound in any way by the compromise.
§ The SECRETARY OF STATE FOR THE HOME DEPARTMENT (Mr. RITCHIE,) Croydon
I thought that was made quite clear when the compromise' was arrived at. I myself would infinitely prefer the Bill without this Clause, but I would rather have this Bill as it now stands than no Bill at all.
SIR WALTER FOSTER
pointed out that the right hon. Gentleman, when the compromise was arrived at, had said in answer to a question that he would not oppose it.
§ Question put, and agreed to
§ Bill read the third time and passed, [1.53.]