Medical ethics in Britain during the long nineteenth century tends to have a bad name among scholars. Jeffrey Berlant and Ivan Waddington have claimed that doctors’ ethics in that period were self-serving, aiming more at supporting the interests of the profession than at protecting patients. In particular they have suggested that regular doctors used ethics as a strategy to demarcate themselves from unlicensed and unorthodox practitioners and as an instrument to mitigate competition within their profession by focusing on rules for maintaining smooth intra-professional relationships between physicians, surgeons and apothecaries, and between consultants and general practitioners. Furthermore, medical ethics was characterised as a trust-inducing device vis-à-vis the public and as a tool for monopolisation of the healthcare market.² In addition, bioethicists Laurence McCullough and Robert Veatch have suggested that after promising beginnings in the late eighteenth century, British medical ethics lost its way: while the well-known lectures of Edinburgh professor of medicine John Gregory on the duties and qualifications of a physician of 1772 had been influenced by contemporary Scottish Common Sense philosophy, so the argument goes, subsequent writers on medical ethics got too much embroiled in intra-professional issues and lost the connection with moral philosophy.³

Moreover, Roger Cooter has suggested that one should not adopt unreservedly Berlant’s and Waddington’s characterisations of the historical medical profession, because at the time of their writing, in the 1970s and early 1980s, the emergence of an apparently lay-driven bioethics would have stimulated them to focus on, and criticize, the self-interested features of the professional ethics of medical men.⁷ Historical accounts of the rise of bioethics during the second half of the twentieth century, especially by the field’s pioneers, have indeed emphasised the role of non-medical protagonists, such as theologians, philosophers and lawyers, who were keen to put patient and public interests into the foreground of debates on ethics in medicine.⁸ Bioethicists who wished to demarcate the ‘old’ medical ethics from their ‘new’ interdisciplinary ethics may have unwittingly distorted historical perspectives by paying too little attention to the patient-related aspects of doctors’ traditional ethics.⁹

During this period the GMC dealt with over 400 such cases.¹⁴ Legal and quantitative analysis of the GMC’s cases from 1859 up to 1990 by Russell G. Smith has led to the criticism that the Council sometimes disciplined medical practitioners before giving them specific ethical guidance on the issue concerned.¹⁵ However, the disciplinary cases, when read in greater detail and in their specific contexts, do reveal the ‘ethical compass’ of the Council’s physicians and surgeons who had been invested with the state’s authority to decide on the professional fate of other medical practitioners. Referring to a variety of cases, ranging from fraudulent registration, sexual misconduct, and breach of confidence to alleged negligence in post-mortem examination, covering of unqualified assistants, and advertising, I suggest that the medical men of the General Council tried to implement values that lay in patients’ as well as doctors’ interests.

The General Medical Council and its Register

Before going into specific cases, we need to clarify who the members of the GMC were that sat in judgement over their colleagues. Initially, the Council comprised twenty-four members: nine represented the medical Royal Colleges of London, Edinburgh, Glasgow and Dublin, the Society of Apothecaries in London, and the Apothecaries’ Hall in Dublin; seven represented the four English and three Irish universities and two the four Scottish universities; and six were nominated by the Queen on the advice of her Privy Council. All members were medically qualified men and can be seen as representing the professional establishment of the time.¹⁶ Only after a new Medical Act in 1886, five additional members were directly elected by the registered medical practitioners of the United Kingdom, a step which reflected the increased importance of general practice at that time.¹⁷ It also then became a requirement for registration that practitioners had certified proficiency in all the three main branches, ‘medicine, surgery and midwifery’, rather than just in medicine and/or surgery.¹⁸ In the period that I am looking at, 1858 to 1914, the General Medical Council had nine Presidents – eminent physicians or surgeons, from Sir Benjamin Brodie (term of office 1858–1860) to Sir Donald MacAlister (term of office 1904–1931).¹⁹ By the early twentieth century, the Crown and the universities could appoint laymen to the Council, but did not choose to do so until 1926. From the 1880s, however, it became customary that the Council’s solicitor and a barrister, as Legal Assessor, were present during disciplinary proceedings, and the accused medical practitioners also brought (or sent) their defence lawyers. The disciplinary proceedings thus adopted a format that was similar to court proceedings.²⁰ Britain was not alone in institutionalising medical discipline in this quasi-legal manner; Prussia, for example, legally introduced so-called medical courts of honour for this purpose in 1899.²¹

The preamble of the 1858 Medical Act stated that its purpose was to enable ‘persons requiring medical aid […] to distinguish qualified from unqualified practitioners’.²² That was in essence the function of the Medical Register, on which only those practitioners who held a recognised qualification from one of the above-mentioned licensing institutions represented on the Council, or who had been practising medicine in 1815 were admitted. In 1859, almost 15,000 names were on this register, and the number increased to about 23,000 by 1880, and c. 50,000 by 1924.²³ Being unregistered, however, did not prevent someone from practising medicine. Registration was only required for fulfilling official functions, such as issuing a death certificate, or for holding positions in public employment, e.g. serving as a medical officer or practising under the 1911 National Health Insurance scheme. Also, only registered practitioners were entitled to sue in the courts for their fees.²⁴ Nevertheless, the prestige and professional legitimacy that registration brought are not only reflected in the rising numbers of registered practitioners but also in disciplinary cases in which practitioners erased from the Register keenly sought to have their names restored. For example, Leeds doctor Henry Arthur Allbutt, who had been struck off in 1887 for publishing a booklet including contraceptive advice which was considered detrimental to ‘public morals’, took the General Council to court to have his name placed back on the Register and to seek damages for libel.²⁵ Other practitioners wrote to the Council with long apologies or detailed justifications of the conduct that had led to erasure of their names, hoping to have them restored.²⁶

Examples of Disciplinary Cases and their Interpretation

It is therefore unsurprising that a series of early disciplinary cases were concerned with fraudulent registration, i.e. with practitioners who falsely declared to have a registrable qualification or tried to obtain one by fraud. If the Council found practitioners guilty of such an offence, they were erased from the Register.²⁷ While these decisions were recorded without much comment one can safely assume that the Council aimed to fulfil here its task of enabling the public to identify qualified practitioners. One might, of course, also take the more sceptical line of interpreting those erasures as a process of professional boundary demarcation from the ‘unqualified’, carried out in the economic interest of the ‘qualified’ practitioners. The issue of fraud in medical titles was as such not new: already in the early 1850s there had been complaints about this matter in connection with the publication of the (unofficial) British Med...