UNQUALIFIED MEDICAL PRACTICE.

HC Deb 09 February 1926 vol 191 cc968-1004

Dr. LITTLE

I beg to move: That, in the opinion of this House, an authoritative inquiry, with the object of making recommendations to Parliament for dealing with the whole position of irregular practice in medicine and surgery, is urgently necessary. Before coming to the terms of this Motion, I wish to give a short explanation in order to make my own position quite clear. I speak not with the Olympian detachnient of the retired practitioner, because I am myself now in practice; but if the fact that I am now practising as a physician has some drawbacks, it has some more than corresponding advantages. I am in close touch with the medical opinion of the day, and I represent the views of medical practitioners. The spreaid of unqualified practice is a fact which has been admitted. The reasons given for its spread are many, and perhaps the most important of them is the swollen length of the medical curriculum. The medical curriculum of the day occupies at least six years, and if there were a short cut to the same status and emoluments without the necessity of working through this curriculum, it is obvious that such a method of approach would be very popular. It is not easy, perhaps, for the general public to understand the position of quaified and unqualified practitioners. It is represented sometimes that British medicine is a system of knowledge confined to the British Isles or the British Empire. That is manifestly untrue. British medicine is part of international medicine. But British medicine has had its special chemical bent, and in training students they are taught that they must always have the interests of the patient in view. The instruction, too, is practical instruction.

Let me tell the House of the impression which our British system of teaching has made upon a foreign observer. He was the envoy of the Rockefeller Institute of New York, and he came to this country to study our system of teaching. I had an opportunity of conferring with him on the subject, and he gave it as his considered opinion that in the Great War British medical men were of more practical usefulness than any other body of medical men concerned in that war. The British school pays special attention to clinical treatment; the curriculum of the General Medical Council requires tuition in 30 subjects of scientific value before the student can sit for his first qualifying examination. I make that comparison to show what is the difference, or what is an important difference, between qualified and unqualified practice. Another very important quality of international medicine is that any discovery which is made by one individual is immediately made known to the rest of the world, and in that manner all discoveries become public property, instead of remaining the secret of the discoverer. The note of unqualified practice is secrecy as to the methods employed—

Mr. ERSKINE

Not at all.

Dr. LITTLE

—and absence of opportunities of clinical study. I propose to speak more especially about one group of unqualified practitioners, the osteopaths, because they are most in the public eye at the present time. They are very different in many respects from other groups of unqualified practitioners. In the first place, they claim to be as fully trained in medicine and surgery as are our own students in our medical schools. A third claim on which is a, very important differentiation is that they have invented a new system of medicine and surgery, and that system consists of the application of a formula and a theory which was propounded fifty years ago by a medical practitioner in one of the small towns in the Western States of America. This theory has been examined and rejected by international medicine, and nowhere more thoroughly than in the home of its discovery—the United States. In the census of 1920 the number of osteopaths in the United States was stated to be 5,000 and the number of qualified physicians and surgeons in the same year was stated to be 145,000. Status claimed for these practitioners is that they are all as fully qualified to practise surgery in this country and the British Empire as our own men.

As the claim is made for teaching which is given abroad, it becomes necessary to examine that claim; and I would like to explain that there are at the present time serious complaints in regard to the medical colleges and medical boards which regulate these things. That condition of things has come about because of what we call in this country and in Europe bogus qualifications, which have been largely distributed. Any college can give a certificate of any kind it likes. The result of that excessive amiability is that very considerable confusion has arisen in regard to the quality of American qualifications, because there are colleges which are highly qualified and some which are not.

9.0 P.M.

There are three grades, A, B and C. The students from grade A are allowed to sit for examination in their county without having qualified in any of the preliminary subjects necessary for practising medicine, they can present themselves for the final examination which qualifies them for practice in this country. I think that fact disposes of the allegation that the medical profession is a very close trade union which refuses to admit outsiders. Already 45 such candidates have been admitted to examination by our examining bodies.

Let us examine the position of this development. I want to say that what is being sought now is to make that a qualified diploma of the British Empire. Now that status is nowhere given in the United States. All that the diploma does is that the holder may present himself for examination by the State Boards of Medicine and Surgery, and if his credentials are sufficiently good, only then is he allowed to practice in that state. Another re- striction is that the osteopaths are not allowed to obtain positions in the military and naval service of the United States. I know that the House of Commons is not the proper place to discuss the theory upon which osteopathy is based, but one can say something of its character even to a lay audience. The theory of osteopathy was founded in 1874 by Andrew Still, and it is to the effect that the primary cause of every disease is some interference with the blood supply caused by some derangement of the bones or the nerves of the spinal column. The treatment is a manipulation of the spine.

Let us consider that theory as it is confronted with actual disease, and I will just illustrate what I want to explain by mentioning what are considered to be five great scourges, tubercle, syphilis, malaria, cancer and insanity. Three of these are regarded by people other than osteopaths as being due to bacterial infection, and the bacteria which cause them can be seen under the microscope. In the case of cancer, all the modern work points to a bacterial cause, direct or indirect, and a very large body of the cases of insanity are unquestionably due to bacterial infection. Consider the disease of tuberculosis, and the harm that the manipulation of tuberculous structures, such as joints, may do. Again, with regard to the question of malaria, it is well known that Surgeon-General Gorgas, of the United States Army Medical Corps, and his devoted assistants, made possible by their work the completion of the Panama Canal. That was because they had studied the habits of the malarial parasite, and applied drugs which were known to cure or alleviate malaria. Surgeon-General Gorgas and his assistants might have gone on till the crack of doom manipulating the spines of the workmen engaged on the Panama Canal without achieving any such result. Let me here quote an admission from an osteopath, of which I have obtained a copy. It has reference to the death of his own son, and he mentions it in this way: Billy had diphtheria four days before we knew what he had. I had never seen a case of diphtheria before, and never even thought to look at his throat. Dr. X was called on the fourth day, and diagnosed the trouble at once. He is an M.D., and has had wide experience. He has had a training which many of us have not had. Is not it best to be a physician first and an osteopath afterwards? I now want to say a word about the position of the medical profession with regard to osteopathy and the public. I would liken the medical profession to a generous and wise wife in a happy marriage. I picture the husband as an amorous fellow, but good-hearted, and the osteopath I picture as a flighty young flapper of superficial attractions. I understand that the expression "giving the glad eye" has been raised to the status of a Parliamentary expression by its use by a front bencher—one of the frontest of front benchers. Glad eyes have been exchanged between the husband and the younger lady. The wife at home has not been entirely oblivious of that flirtation, but she has been prudent enought not to impede it in any way. The "Twelve Pound Look" has not yet come into her eyes, the good lady is calmly confident that the usual disillusionment will follow upon this amorous adventure, as it has followed on so many others in the past, and the medical profession is not, I think, unduly disturbed.

It is not, however, from the point of view of the medical profession that I think we should approach this subject at all. It is not the rich who suffer most from unqualified practice, but the poor, and no one can have served, as I have served, as a hospital physician, for 30 years, without being really saddened at the instances one has seen of the dreadful state of the poor from the point of view of the unqualified medical treatment which they get. I refer to the dispensing chemist, to the optician who pretends to be an oculist, to the dentist who is a quack, and who fits new plates upon horribly septic stumps which are poisoning the whole system. It is that kind of unqualified practice the evil of which I think people do not sufficiently realise.

I wish to return to the question of unqualified practice in other countries. I think it is very remarkable that, although we have had so much legislation to improve the condition of the necessitous poor in this country; we have never considered this very important question. There is no robbery so dreadful as the robbery of unqualified medical practice; there is no spoliation of the poor more horrible than that. Let us see what the rest of the world does in the matter of unqualified practice. I think it will really astonish the House to know that England and Germany are the only two countries in the world, apart from uncivilised countries, which do not penalise unqualified practice. We have countries which make no provision for it at all in their legislation. Those countries are India, China, Persia, Morocco, Abyssinia, Zanzibar, and other places of that type. But, with the exception of England, Germany, and five of the Australian States, practically all the rest of the world penalises unqualified practice. On the Continent of America, Brazil sets an excellent example Brazil awards a punishment of one month's solitary confinement. Argentina has a system of direct fines ranging from £435 to £1,740.

In the United States the penalties are different in the different States. The 49 States have different laws, but the average fine is from five to five hundred dollars. In Canada there is no legislation by the Dominion Parliament, and each of the individual provinces has its own rules, but it may be said as a general statement that of recent years Canada has insisted upon a minimum medical education as a qualification, and in Canada, as in other countries, the unqualified practitioner can be punished by fine or imprisonment, or both. The principle which underlies the legislation I have mentioned all over the world, except in our own country and in Germany, is that it is a fallacy to suppose that any individual may be safely permitted to practice any single branch of medicine, however simple it may appear, without first undergoing adequate instruction in the sciences fundamental to the understanding of medicine. There is a minimum of education and training below which it is obviously unsafe to go, and again I would say it is obvious that every country must keep in its own hands the control of that irreducible minimum. It is for these reasons that I have asked for an inquiry which would allow of the examination of these unqualified diplomas coming to us, and for these reasons that I have moved this Motion.

Mr. HILTON YOUNG

I beg to second the Motion.

The best of all proverbs is, that the shoemaker should stick to his last. I greatly fear that the intervention of a mere layman on a subject so technical as this may be looked upon as an instance of that unqualified practice which we deplore. Nevertheless, I am encouraged to claim the privilege of seconding this Motion by a strong sense of the deep public interest involved. We cannot but feel the great debt of gratitude that we owe to the practice of medicine and surgery by qualified practitioners—some more, some less. As a matter of public interest, we cannot but feel, as representatives of the public, that the medical and the surgical professions are the front line in the trenches in the great warfare against disease, and that no effort on our part can be wasted which is devoted towards the maintenance of the discipline and the efficiency of that distinguished art. Let me most seriously recommend this question, then, to the consideration of the Minister of Health, the advantage of whose presence we have upon the Bench to-night. He is the general of the army that is fighting disease, and it is his care to see that the discipline and the efficiency of his troops are well maintained.

But I am further encouraged to-night to take some small part in the support of this Motion by the personality of the Mover. He is not only a distinguished ornament of that profession which has lent so many of its ornaments to this House, with an eminently practical knowledge of the high work of that profession, which he has so amply illustrated in his speech, but he is also the representative of the University of London. The University of London, with its vast, prosperous, highly developed medical schools, is the recruiting ground for those who are to fight in this army of medicine against disease, and any representation made by the elected representative of that body to this House is one that is indeed deserving of attention.

I do not think there ought to be much difficulty in commending this Motion, with its temperate phraseology, to the favourable attention of the House. I would commend it to hon. Members on the benches opposite as a measure of protection of one of the most ancient institutions in the country, an institution which has been the glory of the civilisation and the culture of the country ever since the days when the tribal medical man, in the days of the Heptarchy, trepanned our wounded ancestor and dealt, I have no doubt, with the unqualified practitioner by the simple method of the club.

Mr. STORRY-DEANS

The original chub doctor.

Mr. YOUNG

The hon. and learned Member appreciates the point. I would commend the Motion to hon. Members above the Gangway. Here is an opportunity for striking a blow on behalf of the sacred principles of the trade union. It needs more words but I am encountered with no more difficulty in commending the Motion to hon. Members who sit upon the same benches as myself. The cause we have nearest at heart is that of individual liberty. I refer to the greatest of all champions of that cause, the greatest of all Radicals, John Stuart Mill. In his works we learn that the liberty of some individuals can only be secured by confining the licence of others. The liberty of a law-abiding citizen can only be obtained by confining the liberty of the criminal. The liberty of the honest man can only be obtained by confining the liberty of the fraud. I have not the least intention of suggesting for a moment that the practitioners of osteopathy and cheiro-practice are either criminals or frauds, Of course not. There are many honest, many able men. But I share the view that they are guilty of inflicting something in the nature of an imposition upon the public, and to my colleagues on these benches I would say that the liberty which it is most necessary to secure is liberty from being imposed upon. I am sure we cannot but think there is a good deal of imposition in this practice of osteopathy. When I learned what my privilege was to be to-night, I concerned myself to make some inquiries as to the nature of this practice. I pursued my acquaintances in the Lobby until I came across an instance of it. It was not long to seek. I found a fellow member who had consulted an osteopathist. He was suffering from acute neuralgia. I asked him how the osteopathist had dealt with him. He said, "He asked me to lie down upon my back, and then he pulled my leg." I said, "I think he did." I submit that there is an element of that practice in all the proceedings of the osteopathist and the cheiro-practors.

Let me revert to a homely illustration. I desire to call attention to the word "qualified" in this Motion, and to dwell upon this illustration. We are dealing here with the question of State regulation. Is not the principle as regards that this? There are appropriate regions for efficient State regulation. There are appropriate regions for no State regulation at all. But the thing for which nothing can be said is half-and-half an inefficient State regulation—State regulation which does not serve its purpose—and it is on that point that I desire to produce my homely illustration. It is to compare osteopaths and the sale of his services to the sale of milk. Under the Food and Drugs Act it is a penal offence to sell milk which is not pure. Now let us suppose that those penalties were to be abolished and the only penalty which attached to the sale of impure or diluted milk was that The vendor could not recover the price of the milk, while at the same time the advertised provisions dealing with the guarantee of the sale of pure milk stood upon the Statute Book, but unsupported by any sufficient penalty. We know what would happen. The fraudulent milk vendors—and even in that innocent profession there are people with fraudulent inclinations—those who are inclined to fraudulent profits on diluted milk, would flood the markets with diluted milk because there was no penalty. The public would be entrapped. There would be an apparent provision in the Statute Book to ensure that the milk sold was pure and undiluted, but as a matter of fact there would be nothing to enable the public to know that the milk it was getting was not half water because the penalties were not adequate.

Precisely analogous is the present position with regard to medical services. The State professes to guarantee that the medical practitioner shall be properly qualified, but does not support that with adequate penalty. The only penalty applied is that the unqualified practitioner cannot recover his fees. If the State professes to go into business to guarantee the qualified medical service by State enactments, it should support it by adequate penalties; if it does not, it is simply entrapping an innocent public. Let me illustrate it by another case. Why should the practice as regards doctors be different from that as regards solicitors? Is the practice of medicine any less important than the practice of solicitors? Which is the more vital interest for the individual welfare and the future of the race—that our health should be good, or that our income shall be properly protected by the legal services of a solicitor? It is a mere accident of the history of our country that that is so as regards a solicitor, because by a sort of legal anachronism the solicitor is an officer of the Court, and therefore subject to the penalty of the Court. What would happen to a costermonger if he advertised himself as a solicitor and were to advertise that he could win lawsuits for his clients by tying a knot in the judge's wig? It is not different really from the sort of advertisement of the irregular and unqualified practitioner. Is it more important to protect the welfare of the general public from fraud in the case of his property, or from imposition in the case of his health?

There is another most important consideration in this matter of the protection of the health of the public against unqualified practitioners. This is really what drives this point home to me. In this matter of professional services it appears to me that there is a law in operation which is very similar to a law, not unfamiliar to students of economy, and which in the region of currency is known as Gresham's Law. That law is that, if you put a bad coin into circulation, it drives a good coin out of circulation. If you have people carrying on medical practice with the easy qualifications, or utter absence of qualification of the unqualified practitioner, going straight on to the market and able to earn his living in no very reputable way without the long years spent in study and qualification for his job, he makes competition himself with the properly qualified man who has to spend six or seven years qualifying himself. In order to protect the good coin of properly qualified men in the circulation of the practice, you have to prevent competition with the bad coin of the man not properly qualified.

This Resolution is not aimed at any particular theory of the practice of medicine. I dwell again on the presence in the Resolution of that word "unquali- fied." That is the point. I venture to say that even this House, with its great number of Members of highly technical experience, is not qualified to pronounce as to whether this or that theory of the practice of medicine is a sound or true one. What we are qualified to say is this: that whatever be the true theory of the practice of medicine, whether it is the theory of the osteopath or the homepathist or any other pathist, we are entitled to say that that man shall not be entitled to sell his advice to the public under something in the nature of a Government guarantee, unless he has taken the trouble and pains properly to qualify himself to give the advice. The osteopathist may be right; the orthodox school may be right; but no man is entitled to pronounce judgment as to which is right unless he has worked five or six years at the study of medicine. That is the proposal of the hon. Member for the University of London (Dr. Little)—that a man shall not be allowed to practise medicine under something in the nature of a Government guarantee unless he has taken pains to qualify himself to pronounce judgment is to which is the right theory. This is surely a most reasonable Motion, it asks only for an inquiry. The request for such an inquiry based on such grounds is one which the House cannot afford to neglect.

Mr. ATKINSON

I beg to move, in line 2, to leave out from the word "of" to the word "is" in line 3, and to insert instead thereof the words securing the recognition and registration of manipulative practitioners having approved qualifications. One is not surprised that the attitude of the hon. Member for the University of London (Dr. Little) should be one of definite hostility against these practitioners. It is necessary that he should be loyal to the view of his association. I am unable to accept a Resolution which, although merely calling for an inquiry, is framed in such language and contains so obvious a desire to condemn a body of men whom we believe to be doing work of great value. I, therefore, beg to move my Amendment, which, if carried, would make the Motion read: That in the opinion of this House an authoritative inquiry with the object of securing the recognition and registration of manipulative practitioners having approved qualifications is urgently necessary. I am asking the House definitely to accept, a policy of recognition by registration of persons of approved skill. The inquiry could settle what the necessary qualifica tions shall be. It ought not to be a matter of very great difficulty. In America, for example, there are seven colleges working under the supervision of the American Osteopathic Association. The standard they set is high. That standard could be accepted. There are hospitals and sanatoria in America, working under the same supervision, where it is notorious that the work done is excellent and most efficient. One cannot discuss qualifications on an occasion of this sort. I am asking for an inquiry on the basis of recognition by registration. That inquiry can draw the line where it likes, so long as it gives the people of this country the benefit of that branch of the healing art.

We have been reminded of Dr. Still In 1892 there was one osteopath in the world, and that was Dr. Still. In America to-day there are upwards of 8,000 fully qualified osteopaths, and hundreds more are scattered about the) world. The progress in America has been enormous. Why has it not been so here? Simply and solely because of the opposition of the medical profession. We are all familiar with the notorious case of Dr. Axam, who was struck off the medical register because he administered chloroform for a most able manipulator.

I speak feelingly on this point. I am going to mention one or two personal instances which I had not intended to mention, but so much has been said against these people. Twenty-five years ago, my father had an injury to the knee, and for months he was crippled. I forget how many doctors he consulted; but not one of them was able to do him any good. He was faced with the prospect of being a cripple for life, until he went to Mr. Barker, as he was then. My father was absolutely cured in a short time, and was never troubled again. The work of curing involved the infliction of most excruciating pain, again and again. I submit that in a civilised country suffering of that kind ought not to be necessary when there are such obvious means of preventing it.

Is this branch of the healing art of no value? Is the country to be denied the benefit of service of that kind? Here is a branch of service and knowledge which does not happen to form part of the medical curriculum. I agree that the ideal way would have been for the medical profession in this country to bring it within their curriculum. Then, people who showed special skill in that direction could have specialised in that branch of the healing art, and we should have had the benefit of fully qualified men, able to administer this branch of service. But the medical profession declined to do that. Why, I do not know. Because they declined to do it, is our country to lose the benefit of that service?

One does not care much about quoting from one's own experience, but here are some simple, everyday cases which tend to prove my argument. What about tennis elbow? I do not know whether many hon. Members suffer from tennis elbow. The fact is, that when you have tennis elbow it totally prevents you from playing the game. I suffered from it and consulted doctors, who pulled long faces and talked about resting the elbow for a couple of years. I went to an osteopath and after two interviews, lasting a few minutes, I was absolutely cured, and have never been troubled since. Take the complaint of hay fever. That is a very objectionable condition without being a serious complaint. It is objectionable enough to make one's summer a misery instead of a joy. The summer before last I suffered from it. I forget how many doctors I saw, I certainly saw one of the most eminent people in London, but not one could do me any good. Then I went to one of the most eminent osteopaths, and within a week I was perfectly well. What is the use of telling me that these people cannot do one any good, or that they are people who ought to be suppressed.

There are three or four propositions which I want to advance. The first proposition is, that there is a place for this branch of skill in the healing art. I am certain that no one in his heart of hearts can deny that. We must all know of cases where the value of this skill has been demonstrated. Secondly, I say that the doctors know it themselves. Within the last three days I have come across two instances showing that the doctors do know of the value of this class of service. One case was that of a lady who was apparently dying. The doctor in charge of the case was at his wit's end. He frankly said, "I can do no more." But he had the courage to advise the relatives to send for an osteopath. He said, "For God's sake, do not say that I sent you there; do not let anyone know. Of course, I cannot meet him." The osteopath came, and he cured the patient. She owes her life, not merely to the skill of the osteopath, but to the courage and honesty of that doctor. Another case was that of a girl who fell and injured her knee. She was taken to a very eminent doctor who, after a time, advised her father to go to an osteopath. He, too, said, "Do not say a word about my having sent you there. Do not give me away." The osteopath was consulted and the child was cured. There, again, is an illustration that the doctors know that these osteopaths know a good deal more than they do about certain branches of their profession.

A good deal has been said about those who are not qualified, and who are charlatans. Whose fault is it that they are able to deceive the public? It is not the fault of the qualified osteopaths. It is the fault of the medical profession, who have always withstood the registration of the competent. A registration of the competent earmarks at the same time the incompetent. That is the inevitable result, when the medical profession will not fix a standard and give some distinction to people who obtain that standard of skill. In other branches of service, such as the Bar, solicitors, accountants, dentists, a standard is fixed and people who are able to reach that standard are given some distinctive title, of registration or otherwise, so that the world knows that they are, as far as training goes, competent, and that the others are not. If you choose to go to an accountant rather than a chartered accountant, you do so at your own risk. If in this case there were a register of the competent, and you chose to go to the incompetent, you would have nobody but yourself to blame. The fact that there are so many unqualified people purporting to practice is not the fault of the qualified men, but the fault of the profession of which my hon. Friend who moved the Resolution is so distinguished an ornament.

One further proposition. It is intolerable that first-class men, men of the greatest proved ability, should have to carry on their work in such a precarious position. One illustration which puts in a nut-shell what I mean, might be quoted. One of the most eminent of these osteopaths told me the other day that he had been sent for to see a lady who had been attended by two doctors. She was apparently dying of some form of anæmia, and they had told her that they could do nothing more for her. As a last resort the osteopath was sent for. When he got there the two doctors met him. They said that if he took up the case and the patient died, they would do their level best to make it as awkward for him as possible. The osteopath had the courage to take up the case and succeeded in saving the woman's life, and he regarded it as one of his greatest achievements. But is it right that a man should be in that intolerable position, that if perchance things go wrong, that if he does not succeed he should run the risk of the coroner being informed that the patient had been attended by a quack, and that the coroner should be free to say disagreeable things about the matter? It is a horrible position for an eminent man to be placed in. If such men were registered, that sort of thing could not be said. My own view is that no staff of a hospital is complete without a qualified osteopath. The mere idea of a hospital, say for crippled children, without an osteopath, is an absurdity. I ask the House to recognise these men, to use them and to help them.

Mr. BASIL PETO

I beg to second the Amendment.

I wish, first of all, to apologise for the fact that the Amendment is in manuscript, and that, therefore, until it was so clearly read to the House by the Mover, hon. Members had not an opportunity of knowing its terms. I am sure that if time had permitted us to place it on the Order Paper, the right hon. Member for Norwich (Mr. Hilton Young), who seconded the Motion, would have been in my place seconding the Amendment. I notice that practically the whole of his speech was directed to the urgent necessity of separating the wheat from the chaff, of protecting the public from unqualified persons and the whole object of the Amendment is to enable the public to know the qualified man, to set up a registry and a standard as high, if necessary—I think it is necessary—as that in operation now in the orthodox medical profession, for those persons who are permitted to practise the art of manipulative surgery. I will use the term of my hon. and learned Friend who moved the Amendment—manipulative practitioner. It covers the whole of those somewhat obscure titles, osteopaths and cheiropractors and the like.

Lieut.-Colonel FREMANTLE

It includes nurses, too.

Mr. PETO

We do not care in this country for the somewhat abstruse terms which are in favour in other countries. "Cheirapractic" is "manipulative practitioner" in Greek. I prefer English, or the nearest approach to it that- I can get, and that is the reason why my hon. and learned Friend has put it in that form. I noticed in the speech of the hon. Member who moved the Motion that he mentioned the terrible state of affairs in hospitals in the East End disclosed by the work of unqualified people. He said that a dentist who was a quack did all sorts of mischief to the patients. What is the moral to be drawn from that? We have dealt with the question of the dentist who is a quack by passing the Dentists Act. What the Mover of the Amendment is asking is that in precisely the same way these manipulative practitioners should be registered people, when they have a qualification, and that those who have not a qualification should not be allowed to practise.

Undoubtedly the osteopath or manipulative practitioner is just as anxious for and just as much in need of what my hon. and learned Friend proposes as is the public. It is in their interests that we should have a standard of practice in that branch of the healing art, and it is no use anyone coming to this House at this time of day and saying that they ought to be included with herbalists and Christian Scientists and other quacks. The time for that has passed. The Mover of the Motion recognised it. Although his Motion is cer, tainly not couched in terms intended, to say the least, to be complimentary to manipulative practitioners, yet he speaks in the very first words of his Motion of his desire to call attention to the spread of this practice. Things do not spread unless there is a demand for them; they do not spread unless they have proved successful. It is now apparent to us that what my hon. Friend really wants is not the setting up of an impartial Committee to inquire into this question in the public interests, but that he should have a species of inquisition into this irregular practice. What is desired, I believe, is that this inquisition should be able to pronounce a sort of ex cathedra anathema against the whole of these people, including Sir Herbert Barker.

Dr. LITTLE

My words cannot convey that meaning.

Mr. PETO

The Motion refers to "the spread of unqualified practice" by these people "and other irregular practitioners." I think I was not overstating the case in pointing out that what was really desired was that this unauthorised and unorthodox practice should cease. That is the meaning of the Motion. Of course, if my hon. Friend says that that is not his meaning, I accept his explanation. In his speech he mentioned the various pains and penalties which unqualified practitioners incurred in other countries. The one point at which he waxed really enthusiastic was when he mentioned Brazil, where solitary confinement was the fate of any person who dared to practise outside the orthodox trade union of the medical practitioner. I think I am not overstating my case in saying that my hon. Friend really would not very much mind, or, rather, that the effect of his Motion would certainly be, if it were carried out—the result of this inquisition would be a sort of auto da fé of the whole lot of these people who trench on the rights of the orthodox practitioner. I think I am justified in referring to one more matter which the hon. Member mentioned. He said that the secrecy of method practised by these people was one of the things to which he strongly objected. I hope the House will permit me to read, on that, what Mr. Barker, now Sir Herbert. Barker, put before the country during the War in 1917. It is very apposite on this question of secrecy and what these practitioners really desire. He said: I have repeatedly asked for a fair hearing and impartial investigation of my methods. I am perfectly willing to operate before a body of surgeons, acknowledged to be representative of the highest surgical skill, upon a number of cases I profess to deal with selected by themselves. I only stipulate that each case should have absolutely refused to respond to other treatment. Then he says further: Should I succeed in demonstrating the worth of the methods I employ, I would ask to be allowed to treat gratuitously poor persons at a metropolitan hospital on one day a week, before students and surgeons, and give them an opportunity of acquiring a practical knowledge of psycho-therapeutics. He offered, if he was allowed to practise, to give anybody the full power of learning from him all he knew. To characterise people of that sort as those who pursue secretive methods is hardly fair.

I look at this matter in a broader aspect. What we all want is that humanity should have every advantage which it can have from all fresh discoveries in the art of healing, and I think it is notable that nearly all the great discoveries in the art of healing have come from outside the orthodox medical profession [HON. MEMBERS: "Oh!"] I can quote chapter and verse to show that five, at any rate, of the greatest discoveries of this kind came from outside the orthodox medical profession. Cinchona, or quinine, was introduced into this country by a Jesuit priest, who discovered it in South America from the Indians, among whom the merits of this particular drug were first ascertained. Ether, as an anæsthetic, was first administered by an unqualified person. Pasteur was refused a hearing by leading physicians because he had not a degree. Harvey, who discovered the circulation of the blood, was ridiculed as a "circulator" and a quack; and Lister was scoffed at because he advocated the employment of anæsthetics. After that it would be very foolish in this year 1926 to close our eyes to the fact that the last word in the art of healing has not been said.

What we want is an enquiry into manipulative practice, so that the whole thing may be sifted out and settled as to the basis on which it can be legally registered and recognised in this country in order that those who are qualified to practise may be separated from those who are not so qualified. Therefore, as regards the present position of the Amendment and the Motion, I should cordially agree with any inquiries provided that it is directed towards giving people any effective treatment which is available for the ills to which we are all liable and which is likely to help them to healthier lives. We do not want to shut our eyes to the facts. We passed an Act in 1859 giving a certain body the direction of the medical profession, with very autocratic powers by which they are enabled to characterise anybody with whom they do not agree as being guilty of infamous conduct and, as in the case of Dr. Axham, to pursue that vindictive sentence right to the time when a man has almost one foot in the grave. I say the time has come for an inquiry into this matter, and it should no longer be a crime to help suffering humanity by administering anæsthetics for a man like Sir Herbert Barker, who has made more cures than can be laid to the door of any orthodox surgeon in this country.

10.0 P.M.

Dr. DRUMMOND SHIELS

I have a little difficulty in regard to the Motion which has been put forward by my hon. Friend the Member for the University of London (Dr. Little). There has been for some time past a good deal of criticism of the medical profession on various grounds and we must take it that my hon. Friend's Motion to-night is what military men in the House will recognise as a sort of offensive-defensive. Whether that is good tactics or not is another matter, but at least, it shows courage. In regard to the actual terms of the Motion I do not feel that an inquiry such as he desires is necessary at the present time. At the same time I believe that in the public interest observation requires to be kept on unqualified practice. If I am not entirely in favour of the Motion, still more do I disagree with the terms of the Amendment. We may grant at once that the future and progress of the medical profession, if not dependent upon, is helped by a certain amount of unorthodox thought and even of unorthodox practice. There is no doubt also, that there have been considerable contributions to medical progress from certain people who were outside of it. There is, however, a definite limit to the extent to which legal sanction should be given to unqualified persons, and that limit, certainly, is the safety of the public.

There are two main classes of unqualified practice? We have one class which depends on physical means, and a second large class where you have the mental or spiritual or psycho-therapeutic class of treatment. Bone-setting has been mentioned. In practically every little village and town in the country there are bone-setters who are in the habit of attending to sprains, joint injuries, and things of that sort. They are very often humble and uneducated people who may have a local reputation. We have had our attention called to-night to the case of Sir Herbert Barker, who has a national reputation, and I think most of us are ready to admit that he is a man of exceptional ability. I think the medical profession generally would be prepared to admit that he is a man who has done considerable service and is a practitioner of no mean skill. But his is a very exceptional case. What is the medical profession to do in the case of a man even as eminent as Sir Herbert Barker? After all, bone-setting and dealing with joints and ligaments are only a small part of the practice of medicine and surgery. It will be admitted that a general diploma is quite impossible in a case like that, giving a person legal authority to treat diseases of all kinds. No case has been made out, either, for a limited diploma which would confine itself within the qualifications of men like Sir Herbert Barker. I, therefore, think a good deal of the criticism of the medical profession in that connection is really unjustifiable, as they could not treat him, within the limit of their statutes, differently from his less distinguished co-workers.

Then we come to osteopathy, which, of course, is quite a different thing from bonesetting, although Sir Herbert Barker has lately become associated, as far as sympathy is concerned, with osteopathic ideas. Osteopathy was the invention of Dr. Still of the State of Kansas in America. He took a great part in the anti-slavery agitation, became rather unsettled, and never again reverted to the ordinary practice of his profession. He was said to have been given a vision in which he was told that the slaves having been freed it was now his duty to set about the great task of freeing humanity from the thraldom of the use of liquor and the use of drugs. It is interesting to note that while Dr. Still is associated mostly with osteopathy it could be claimed that he was the first inspirer of the movement which has ended in prohibition in America. On contemplating his great task, he came to the conclusion that, as human beings were anatomically designed for perfect health, any deviation from perfect health must be due to some anatomical defect. Working from that assumption he developed his system of osteopathy. He went on a tour through Missouri, preaching his gospel in the villages, and ultimately settled down in Kirksville.

It is a remarkable fact that he did not make a great deal of progress until something happened. He was joined by a Scotsman, a Dr. Smith; and if this is really a great revelation to humanity, then I am proud to think that my country is to be associated with it. Kirksville became the headquarters of osteopathy, and to-day there is a very large college there turning out many graduates. The original ideas which have been described by the hon. and learned Member for London University have been modified to a considerable extent in later years, and it is interesting to find that there has been, even among osteopaths, a very distinct approach to orthodoxy. In Kirksville the study of bacteriology, chemical and microscopic diagnoses, general surgery, and blood tests, are carried on. We are told somefunes that this is done in order to comply with the State Regulation required before a certificate can be given; but they do not deny the usefulness of these things.

I think the point that is not generally understood as to the position of the medical profession is this. The medical proffession do not object to osteopathy practice. They have no objection to osteopathy being developed. All that we say is that before any man or woman gets a legal qualification to practice medicine or surgery, or any system of medicine or surgery, in this country he should have a definite minimum of fundamental knowledge which is essential for the practice of any system of medicine or surgery.

We are dealing with the human body, and, surely, a complete knowledge of the human body is absolutely necessary for any system. He must, therefore, be taught anatomy. He must know how the body works, so has to study physiology. He should also learn the effect that diseases have on the organs of the body, so he must be taught pathology. It is also desirable that the practitioner should be aware of the effect of certain chemicals on the body and the various reactions which take place. We simply claim that the present medical curriculum gives the minimum which is necessary for the practice of any system of medicine. We do not care whether the man becomes a bone-setter or an osteopath or any other kind of path. We say that we must, in the interests of the general public, have a minimum which at present we believe osteopathic colleges do not give. Then we have this curious position. Osteopaths again say "We come in the interests of the general public, because there are those who speak in our name, but who do not practise our faith as it should be practised." One of the students of Dr. Still, a Mr. Palmer, went out on his own and started another college which is now in Davenport in Iowa. There are held classes of as many as 600 students, who are being taught chiropractic, which is the crudest system of osteopathy, and which has the objection able feature that advertising is a subject in the curriculum. There a student, after 18 months' training, with no preliminary educational qualification at all, can become a D.C., or Doctor of Chiropractic. With another six months' training they can become actually Philosophers of Chiropractic, Ph.C.

It is obvious that as osteopaths claim that the public have to be protected from those who are practising their own art in an inferior way, there is no end to this sort of thing if once you start it. Surely our position is a very reasonable one, that the minimum, which, I think, on consideration, everyone will agree is not too low, must be maintained. Then, again, we have various other people whom I do not object to so much, herbalists and naturopaths, who often work on the system of giving people a vegetarian diet, simple drugs, and exercise, which does good in many cases. The hon. and learned Member who moved the Amendment gave examples of a number of cures which had been effected by osteopaths. I do not care what system of medicine you take or what system of quackery you take, you can get a list of wonderful cures in any one of them. Some of the most remarkable cases I know of wonderful cures have been in connection with Christian Science which I have seen myself and know. There is no use in giving a list of cures and saying that it proves that the system is a good one. As a matter of fact, I can bring a list of cases of osteopaths and bone-setters, where the results have been disastrous, cases both in this country and in America.

Sir HARRY FOSTER

And also cases of qualified men.

Dr. SHIELS

Yes. We must agree, of course, that doctors make mistakes, and it is true that we cannot prevent that, but what we are entitled to do, as a community and as a House, is to see that at least we absolve ourselves from the responsibility for these mistakes by ensuring that everyone practising medicine and surgery in this country has a minimum qualification of fundamental knowledge. In regard to other classes of unqualified practitioners, I have mentioned Christian Science. That is a very difficult matter to discuss in a few moments, and I do not know that it is desirable to develop it, because it has not been touched upon much to-night. But as I have said, wonderful cures are effected, and yet the law at present condemns such treatment. Prosecutions are actually taking place in that connection.

I think the position of the medical profession, while it may be criticised, is a perfectly sound one. We hear a great deal about the General Medical Council. It must be remembered that when the General Medical Council was instituted there was very little knowledge of public health in the country. Nowadays everyone has a smattering of health knowledge and even a certain amount of technical knowledge. It is a remarkable fact, therefore, not that the General Medical Council has been so much criticised, but that, on the whole, it has emerged from the criticism so successfully. The General Medical Council has probably suffered from a lack of publicity and a lack of complete information as to its doings. There is no doubt that it gives a very much fairer trial, in its penal cases, and a very much more careful trial than the general public have any knowledge of. It is no pleasure to the members of the General Medical Council to score any man off the register, and it is only done when that is in the public interest.

The General Medical Council is a body which is set up purely to look at the profession from the point of view of the public interest, though it is often confused with a body which is working for the interests of the actual members of the profession—the British Medical Association. The General Medical Council has no relation with that at all. I do not want to take up any more time, because there are other speakers, but I hope that I have said sufficient to show that while, as I say, we welcome as much freedom as is consistent with the public interest, we do not think it desirable to menace the public safety by accepting the principle which has been put forward in the Amendment.

Mr. STORRY-DEANS

I can support neither the Resolution nor the Amendment, and I do not want myself to institute anything in 'the nature of a heresy hunt among unqualified practitioners, because everybody knows that there are people who do not call themselves by such classical words as osteopaths and other kinds of paths, but who probably merely call themselves bone-setters, who do effect cures of strained joints and ligaments which somehow or other the ordinary practitioner is unable to accomplish.

Why, I do not know, but I think the last speaker, the hon. Member for East Edinburgh (Dr. Shiels) began to get somewhere near the point, and I want to suggest that a good deal of the public unrest about this matter, which certainly does exist, has been because the public has lost faith in the General Medical Council. I am going, if I may, to make a suggestion to my hon. Friends who have put forward this Motion, something which will at any rate help the public to regain confidence in the General Medical Council, which has been so severely strained. That Council was set up by the Medical Council Act, and was to consist of 22 representatives of universities and other bodies which grant degrees and qualifying certificates for medical practice. It was to consist of five elected general practitioners, and there were also to he—and this I ask the House to note—five persons to be nominated by the Lord President of the Council, and those five, in my view of the matter, ought not to have been five doctors; they ought to have been five laymen.

It was intended that the public should be represented upon this General Medical Council by persons of eminence, persons with a judicial training, who could protect both the public and the humbler members of the profession from anything in the nature of victimisation. What has happened has been that the General Medical Council has become something very like the executive of a trade union, and it has acted in uhat I might call the trade union interest of its members, instead of entirely in the interest of the public. My suggestion—and it is all I rose to make—is that the Minister of Health shall use his influence or his power to place the General Medical Council in the position which, I am sure, it was intended to occupy, that is to say, that it was to consist mainly of medical men, but it was to contain a lay element which should represent specially the interest of the public, and prevent it from becoming merely a narrow-minded professional body.

Mr. BROMLEY

It is with some trepidation that I, a layman, rise to take part in this Debate, but it is chiefly because I fear, from the very innocuous appearance of the Resolution, that it is a heresy hunt., and we must protect the community, whatever respect we have for the medical profession, against the possibility of harm being done to human beings as the result of a heresy hunt. I want to speak with very great respect of the medical fraternity. It is a profession I hold in very high esteem, probably because I have not had to trouble them professionally very much; but we do recognise the sacrifices that the medical profession make in giving their skill free to suffering humanity. We realise some of the terrible happenings they have brought upon themselves with "X" rays and other things, all in the interest of the community. But we also see a danger of their very enthusiasm for their profession running away with them. I would respect this Motion, and all that it may imply, from the trade union standpoint which has been mentioned, although I am afraid the medical profession would not be so enthusiastic in supporting me if I were sticking up for engine-drivers, for instance. The engine-driver, if he makes a mistake, suffers for it. If the solicitor makes a mistake he charges for it. If the doctor makes a mistake he buries it.

What I want to bring to the notice of the House is the fact that some of us who have been workers for very many years in our trade unions do know the splendid nature of the healing that has been done, of relief to cripples, and the suffering which has been eased or prevented by manipulative surgery, and by other than the orthodox practices of medicine. I rather fear from recent happenings which have been mentioned by previous speakers, and which I have no intention, therefore, of enlarging upon, that this chasing from the field of curing and healing of all that are not able to produce certain qualifications is not to the good. Even after Sir Herbert Barker has received knighthood at the hands of His Majesty, the doctor assisting him has still to be hounded into a very serious position. I want to say on behalf of the workmen that it is very much to his advantage and very much to his easement that it is possible for him to have manipulative surgery.

I want to appeal to the House not to support the Resolution because of the possibility of danger to the lay-mind, and of its being over-ridden by the Latin jargon of the medical profession. In looking back over history we note that even the strong views of the medical fraternity have changed from time to time. They are now horrified at the osteopath rising and of manipulative surgery. They are clinging to previous ideas. A few years ago it was all blood-letting for everything. That has been dismissed by the medical men. It will not require an ignoramous like myself to remind them how Dr. Simpson, of Edinburgh, when he first began to study the science of obstetrics was rather reviled by his own profession. Dr. Simpson has now been admitted to be right and his life's work is a memorial to his memory. He was a very clever member of his profession. He suffered exactly the same revilement—not the same persecution—in his early days of study as manipulative surgeons of to-day are suffering at the hands of the medical profession. Yet Simpson was a man sufficiently far-seeing and courageous to be the first to experiment on himself and discover the effectiveness of chloroform as an anæsthetic.

Coming down to the present day we find other professions or other branches of the profession—a very valuable profession—I would be the last to wish to under-rate the medical authorities—but I suggest to the house that, however much respect and admiration we may have for them, we ought certainly in the light of history—and very recent history in the case of Sir Herbert Barker and another man, with somewhat approaching the same skill, Mr. Kinnaird, whose good work many of us in the trade union movement know and recognise—consider these things. There is a danger of us being led away, by the insistence of the medical fraternity for the protection of their craft, to do an injustice. The Mover and Seconder of the Resolution did not exactly explain what it means. I suspect behind it is the intention to drive out practically everyone who does not conform to a certain professional standard.

If it were the question of the mere quack, the quack who secretly gets at people who are suffering from very serious diseases and sells them all manner of nostrums that are supposed to cure everything, from sore eyes to wooden legs, I do not think there is a person in the House who would not support that for a moment. I think those people ought to have been dealt with much more severely years ago. They are not dealt with sufficiently severely to-day. Here, however, are people who do not deal with bacteriological disease, I understand, but with manipulative surgery of the bone, or muscle, or nerve, and I think they ought to have an opportunity of proving their curative skill, as apparently they have begun to do. On behalf of working people who have suffered and who have been cured and eased by these very people, I appeal to the House to consider seriously what they are doing before supporting the Motion.

The MINISTER of HEALTH (Mr. Neville Chamberlain)

Before this Debate comes to a close, I think the House would probably desire that, as the Minister responsible for the public health, I should say a few words on the subject of this Motion. The Motion was presented by the hon. Member for the University of London (Dr. Little) with a great deal of learning and a great deal of sound argument, and he was reinforced, somewhat unexpectedly and very powerfully, by the right hon. Gentleman the Member for Norwich (Mr. Hilton Young), whom I do not now see in his place. The right hon. Gentleman appealed to me, as the "general of the army," he said, to see that the forces which I command are kept in a proper state of efficiency and discipline. I think he was forgetting that the forces which were being criticised by the hon. Gentleman who moved the Motion are not my forces at all. They are irregular troops. They may have, of their own accord, embarked alongside of the regular troops, and the question really is whether their aim is sufficiently well established to make it desirable that we should use them, or whether we are to say that these irregular troops—some of them, at any rate—are likely to do more harm than good, on the whole, and that therefore we prefer to do without them altogether.

I do not think it can be denied that there are dangers in unqualified practice, dangers of two kinds. There is the positive danger that actual harm may be done by the practitioner—I am not speaking merely of osteopaths or cheiropractors, but all kinds of unqualified practitioners—by too violent treatment or by the administration of harmful drugs. On the other hand, there is a sort of indirect harm that may be done by inducing the patient not to seek qualified assistance, consequently postponing application to a man who really could cure him until, perhaps, the disease has gone so far that it is too late. Those are the dangers in unqualified practice. The hon. Member for the University of London has told us that in many other parts of the world unqualified practice is totally prohibited. Is that what he wants? May I take it, although the Resolution is rather carefully worded, that we are to read into it that he desires to see all unqualified practice totally prohibited?

When we come to consider whether that is desirable or not, one must take account of the fact that education is continually growing in this country, and that with the growth of education and general intelligence the tendency of people to go to those who really are not sufficiently skilful to be able to treat their cases grows less and less. It is always among the most ignorant that you will find recourse to the most crude and unskilled kind of treatment. Therefore I do not think there is the danger in this country that might exist in a country less civilised amongst people less educated. Really the discussion has ranged around particular practices which were called by the hon. Member for Barnstaple (Mr. B. Peto) those of manipulative practitioners.

The hon. and learned Gentleman who moved the Amendment gave a number of instances of remarkable cures that had been effected by these particular practices, and he said that he went to an osteopath and he was completely cured of tennis elbow. I congratulate him, but he must not draw too large a conclusion from that fact. I had myself tennis elbow, and I was completely cured, and I did not go to anybody, but it would not be safe to draw the conclusion from that fact that every disease would cure itself. Nevertheless I admit that there are cases of particular practitioners where undoubtedly valuable public service has been done, and where cures have been effected by special manipulative skill in cases where the most skilful ordinary practitioners have not succeeded in making a cure. I agree with the argument that we do not want to cut ourselves off from being able to take advantage of the skill of any man, qualified or unqualified, if it is distinctly understood that anyone who goes to an unqualified man goes at his own risk, and is prepared to take the consequences. That being so I could not advise the House to accept the Motion which stands upon the Paper.

I must now come to the Amendment, and I find it equally difficult to recommen the House to adopt it. What does the Amendment mean? Here, again, I am going to give my own interpretation of it. It means that not only should osteopaths be permitted to practice in this country, but that they should be recognised and that they should be registered. That is to say, they should be given what the right hon. Gentleman the Member for Norwich calls a Government guarantee, and it means that they should have some sort of official status which would undoubtedly lead to a very much larger resort on the part of the public to such treatment. The Amendment reads: to secure the recognition and registration of manipulate practitioners having approved qualifications. The hon. and learned Member who moved the Amendment said very little about that part of it, and, indeed, in referring to it, it was very significant that he did not use those words, but spoke of the people who had "approved skill" and not "approved qualifications." Those are quite different things. Apparently what he was thinking of was that he was prepared to register those who had approved skill. How are you to register those who have approved skill? What board can assess or measure it, or lay down rules for the tests which are to be applied before you can set up a register? In practice the thing breaks down at once. There is no measure that you can apply; there are no qualifications by which any board can distinguish between osteopaths and enable them to be put upon a separate register. You would be put in this position, that you would have to fall back upon the diplomas which have been given by American colleges, over whose curricula no body in this country has any control whatsoever. I think the House will agree that to ask us in this country to accept diplomas from another country, into the value of which we really could not pretend to examine, and over the qualifications for which we have no control, is really not a practical proposition.

Mr. B. PETO

If my right hon. Friend will excuse my interrupting him for one moment, it is hardly fair to say that we are asking that American degrees in osteopathy should be recognised in this country. The British Osteopathic Association wish to set up their own college, with their own course of training, and to give their own degree to British subjects, and stop the importation of American practitioners.

Mr. CHAMBERLAIN

I was coming to that point, but I want to say first that the hon. and learned Member who moved the Amendment was quite mistaken in saying that the practice of osteopathy—or manipulative surgery, as I would prefer to call it—ought to be, but was not, a part of the present medical curriculum in this country. That is quite a mistake! As a matter of fact, the subject is taught in the medical schools under the curriculum of the General Medical Council, and the General Medical Council is the body to which is entrusted the curriculum for medical education in this country. There is no reason why any properly qualified medical man, should not specialise, if he likes, in osteopathy, and, as a matter of fact, some of the most celebrated in this country have done so. They are properly qualified, and they specialise in this particular branch. There is no reason why that should not go further.

My hon. Friend says it is not fair to suggest that they are asking that diplomas of American Colleges should be recognised. I am glad to hear that they do not ask that. I certainly thought that some, at any rate, who desire registration did desire that these diplomas should be recognised, and that request has before now come before me officially. My hon. Friend asks why the osteopaths in this country should not set up their own colleges with their own diplomas. Why, indeed? I know of no reason to stop them, and it seems to me that that is the only way in which they can achieve what they desire. If they want to have a register of osteopaths set up in this country, the first thing for them to do is to start colleges of their own. Let them do so; let them give these diplomas. They will be forced eventually, I prophesy, to do what has been done in America, and what the hon. Member who moved the. Motion said they were doing there; that is to say, their curriculum would gradually have to conform to something very nearly approaching the normal curriculum in this country. The more that is the case, the more easy it will be to form a register, if they still desire to form one.

I am afraid that, in the circumstances, I myself cannot vote either for the Motion or for the Amendment, and I hope that, from the account I have given to the House of how this matter appears to me, my hon. Friends will see that it is really very difficult for one to give a vote upon this matter in the present state of knowledge and discussion. I have tried to indicate the direction in which I think progress can be made by those who favour further encouragement for what is called osteopathy. I do not think it is necessary to prohibit, and I do not think public opinion will be in favour of prohibiting, unqualified practice, but, on the other hand, the other proposal seems to me to be practically impossible of achievement. On the whole, therefore, I think my hon. Friends will do best to leave things to develop in their own natural, normal fashion.

Mr. RHYS DAVIES

It is now quite clear that this is not a subject which should be left exclusively to those who are interested in medicine and surgery. Nothing has been said, of any moment, at any rate, as far as I remember—and I have listened to most of the Debate—regarding the powers of the General Medical Council. The Debate has ranged over a very wide area indeed, and my objection, both to the Resolution and to the Amendment, is that neither of them deals with what is fundamental in an issue of this kind. The community as a whole, I feel sure, if they knew the whole of the facts, as some of us do, would object to the present wide powers of the General Medical Council, and I am certain would object to giving them any more powers. In fact, the General Medical Council, so far as a layman can understand its functions, is a law unto itself, a Court and a magistracy all on its own account. There is no appeal whatever from its decisions, and I suggest that when a subject of this kind comes under discussion again the Minister of Health should inquire as to whether some lay representative should not sit on the General Medical Council instead of allowing all the power to remain with the representatives now dominating that body.

The other observation I desire to make is this. I dislike the Resolution because it presumes the infallability of a man merely because he has qualified by education through colleges and otherwise. We on these benches know full well that In Workmen's Compensation cases, when one doctor is engaged by the employer and another by the worlunan, they somehow or other differ on specific cases; and you get an opinion from one fully qualified man in a given case quite contrary to that given by the other. During the last year or so, so unsatisfactory was the certification of the paned doctors wilder the National Health Insurance Scheme that the Ministry of Health was compelled to set up what are called degional Medical Officers to give a second opinion to that given by the panel doctors themselves should not like to be too critical of what is undoubtedly a very honourable profession; but I am sure it is not correct to presume that merely because men have passed through six years' training in a medical college, they are to be the only persons to practice medicine and to be deemed infallible in the way suggested by the Resolution. To emphasise the point that has been made, that nearly all innovations in connection with medicine and surgery have come from outside the medical profession, I need hardly give the classic case of vaccination. 40 or 50 years ago almost every medical man in the land declared that vaccination meant the sure prevention of small-pox. There are hundreds of qualified men to-day who would probably dispute a statement of that kind. [HON. MEMBERS "No!"] It just shows the Conservative nature of the medical profession.

A statement was made to-night from more than one side of the House that it was not correct to declare that the medical profession was a Conservative profession and that men have instituted ideas from outside the profession. I have looked up a case uhich I feel sure will not only satisfy the House that that is so in relation to cases submitted by my hon. Friend below the Gangway; but I have turned up the history of Charles Darwin himself, who I understand has contributed more to this realm of science than any other Englishman. His brother said of Charles Darwin, she author of the "Origin of Species": "He went to Edinburgh in 1825 to prepare for the medical profession for which he was totally unfitted by nature." I venture to say that the General Medical Council, if Charles Darwin was alive to-day, would deem him to be an incompetent and unqualified medical man. It would not allow him to join the profession at all. In fact, there are cases over and over again where men outside the profession have achieved results, which the profession itself has been unable to produce.

I am not challenging the honour or the capacity of the medical profession to do their work. What I am challenging is the organisation that they have set up in order to provide a status for the profession which I am not sure it always justifies. I feel sure the community as a whole is becoming a little apprehensive of the power of the medical profession in its organisation. I trust the Minister of Health will bear in mind the suggestion I have made that whenever the General Medical Council comes under his purview, and if a change has to be made, he will make a change in the direction of securing lay representation on that council.

Colonel SINCLAIR

As the only member of the General Medical Council in this House, perhaps I may be allowed to make a few observations. The General Medical Council has been blamed, not only inside the House, but outside and in the Press, for many of its decisions. I think that many who have criticised it in a hostile sense have not taken the trouble to consider its mode of procedure, how the cases come before it, and how members receive and weigh the evidence and eerie to a decision. Moreover, its clemency is much greater than many Members of the House understand. Many of those who are deprived of diplomas are only deprived for one year or thereabouts, and, if not guilty of the offence again, they are reinstated in many cases within the year.

The General Medical Council does not proceed against osteopaths and cheiropractors. It really cannot recognise them, because it has no means of inspecting their skill. It has no means of understanding or estimating the nature of the education furnished or the standards of education and examinations which they take. It would not be in the public interests to take the American diplomas at their face value. Many of these are granted by organisations some of which are of a proprietary nature and are not recognised in the United States. It would be hazardous to include all these practitioners in the general register unless there was some provision made for inspecting the colleges, the nature of the instruction given, and of the examination passed.

In the case of dentists, when the country some years ago was flooded by a large number of unqualified men, the Dental Act of 1921 was passed for the protection of the public. It was then made, with great severity, a penal offence to practise dentistry unless the name of the dentist was on the dental register. Therefore, it appears to me to be right in the public interest that there should be an inquiry respecting the persons entitled to practise medicine and surgery, including manipulative surgery and plastic surgery, lest great damage should be done to the suffering public by unqualified people carrying out manipulative surgery with great energy and even rough handling. Practitioners who desire to practise manipulative surgery should provide a guarantee that they have been properly instructed in the anatomy of the human body, physiology and pathology, so that they would be able to distinguish those patients to whom they ought not to apply manipulative surgery, and who ought to be treated by other means. It ought to be borne in mind that the General Medical Council does not put a veto on the class of practice which its registered members may adopt. All that it requires is that they shall have been trained in medicine, surgery and midwifery. They may practise manipulative surgery, homeopathy or other forms of service provided they show that they have graduated at some recognised institution, and that they have a thorough knowledge of anatomy, physiology and pathology.

The General Medical Council is a much maligned body. It has been suggested that it ought to be reinforced by the addition of lay members. We have no objection to the addition of lay members. The machinery exists already for their introduction. If the Privy Council would use its power of nomination for the purpose of placing lay members on the General Medical Council, it is quite within its competence to do so. Moreover, the Universities of the Kingdom might send lay professors to the Council instead of medical members. That is within their competence. The difficulty is that people cannot be got to take an intelligent interest in the work of the General Medical Council unless they are medical men, because three-fourths of the work of the Council has to do with medical education and registration. It is difficult for the laity really to understand and to keep a sustained interest in the regulations of the medical curricula and the medical examinations. [HON. MEMBERS: "Divide."]

Mr. KIRKWOOD

Time is up!

Colonel SINCLAIR

Much has been said with respect to the cures effected by the bone setters. I do not deny that they have effected these cures. [Interruption.] I think it is hardly fair to the general medical profession to say— [Interruption]—I do not deny that the manipulative surgeons have done good work, but the general medical profession have done equally good work.

Lieut.-Colonel Sir JOSEPH NALL

rose in his place and claimed to move, "That the Question be now put," but Mr. SPEAKER withheld his assent and declined then to put that Question.

Colonel SINCLAIR

It is not fair to say—

It being Eleven of the Clock the Debate stood adjourned.

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1. SUPPLY. 10 words
2. CIVIL SERVICES AND REVENUE DEPARTMENTS SUPPLEMENTARY ESTIMATES, 1925–26.
3. CLASS I.
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4. LABOUR AND HEALTH BUILDINGS, GREAT BRITAIN. 103 words
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5. ADJOURNMENT 16 words