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Continued from the June 1997 Newsletter
The charge against Dr Deys was that "primarily or to a substantial extent for the purpose of promoting her own advantage she sanctioned or acquiesced in the publication of an article ... which commended and drew attention to her professional skill, knowledge and services." In relation to the alleged facts she was charged with serious professional misconduct.
Mr Peter Baylis, solicitor appearing for the complainant, the Medical Defence Union, presented the case against Dr Deys. He began by reading out the whole of the Sunday People article (5) and then used Dr Deys’ own letter of response to the GMC as evidence of her acquiescence in its publication. This was not in dispute. When, however, Mr Baylis attempted to prove a pecuniary motive for Dr Deys’ sanctioning of the article he was reduced to suggesting that "the article could lead to her employers giving her a greater number of sessions, that she could have been encouraged to give up work at the clinic and go into private practice and that the article might have enabled her to obtain more remunerative employment and professional work" (6). He was interrupted by Mr Robert Alexander QC, appearing for Dr Deys, and asked to stop speculating and explain in what respect she had sought to promote her professional advantage. Mr Baylis replied that he could not particularise the charge any further and withdrew the allegations that Dr Deys had tried to attract patients or gain financially from the article. Thus, the prosecution case petered out.
If her accusers were handicapped by a weak case unimpressively presented Dr Deys could have every confidence that her own rebuttal would be skilfully handled. Her Counsel, Mr Robert Alexander QC, described by Lord Denning as the best advocate of his generation, was later to become chairman of the Bar Council and a life peer. He was to achieve national fame in 1987 when he undertook Jeffrey Archer’s libel case against Express Newspapers securing for his client half a million pounds in damages, then a record amount in a British court (7). The defendant was transferred from the dock to the witness box to elaborate generally on her family planning convictions and specifically on why she had assisted in making the subject of vasectomy known through the popular press to a readership "who were hardly likely to read medical journals." Dr Deys’ innocence of the charge of seeking financial gain - indeed her complete indifference to monetary rewards - was clearly demonstrated. She had initially refused to accept the full £10 sessional fee for her work at the Clinic because of her felt lack of experience. She later took the full fee and by 1972 was earning £26.40 per week for her two sessions out of which she paid her own travelling expenses not only to and from the Clinic but to the patients she visited in their homes as a consequence of the service she had initiated. Within the doctors’ group at the Clinic she had always opposed salary rises in favour of keeping down the costs to patients and on two occasions when she had appeared on television she had donated the fees, amounting to fifty pounds, to the Marie Stopes Clinic.
Those who had written in to Dr Deys’ solicitors offering to testify to her professional integrity included the Provost of King’s College Cambridge, the Bishop of Kingston, the Secretary of the Association of Family Planning Doctors and others who had worked with her at the Marie Stopes Clinic and elsewhere. Amongst those called by her Counsel, Dr Wilfrid Harding, the doyen of MOHs, described Dr Deys as "a dedicated colleague, motivated by an aim in which she believes and tries to produce as effective a service as possible."
Defending Council clearly felt at this point that he could dispense with a closing address and the MDU’s Counsel nodded in agreement when the GMC’s Legal Assessor indicated that Dr Deys was almost certain to be cleared.(8)
After the General Medical Council had considered the case in camera, the President announced the inevitable verdict: acquittal. In all the circumstances, however, it was a grudging statement robbed of all gracefulness by its negatives and qualifications. "Dr Deys", he began, "it has been admitted by you that you sanctioned and acquiesced in the publication of an article by Helen Speed in the Sunday People .... The Committee, however, have not found proved that this was done ‘primarily or to a substantial extent for the purpose of promoting your own personal advantage’. The Committee therefore find that the charge has not been proved to their satisfaction and they have accordingly recorded a finding that you are not guilty of serious professional misconduct in respect of the matters to which the charge relates."(9)
Sub judice considerations had not inhibited comment by either the lay or medical press in the six month period between the issue of the summons and the GMC inquiry. That comment was universally condemnatory of the actions of the GMC and sympathetic to the ordeal of Dr Deys. Freed by the verdict of all inhibitions, press condemnation of the GMC and of the Medical Defence Union now became widespread and outspokenly derisory. "THE GMC’s TURN TO STAND IN THE DOCK" was the Observer headline(10); "Accusation that failed puts disciplinary procedure on the spot", Doctor(11) ; TOO MANY JUDGES", World Medicine(12) ; "A predictable end to an unnecessary case", General Practitioner(13) were some of the other headlines which prefaced perhaps the most outspoken criticism the medical "establishment" has ever faced.
"I am spluttering with rage" declared a columnist in Pulse (14), at "what I see as a historic betrayal of every professional decency ... I do not blame the anonymous doctor (who instigated the complaint). If you are born without professional courage and possessed of a squalid malice, it is quite right that you should not want anyone to know about your misfortunes. There is always a chance that as the years roll on your spirit will become suffused by as much integrity as you would find in any barrow boy. The Medical Defence Union could be renamed the Medical Offence Union to describe its activities more accurately. The GMC appears to have behaved with a culpable clumsiness. Regrettably - indeed tragically - the brave young members of the GMC from whom we expect so much seem to have remained silent. Was money, their retention fee, the only cause they thought worthwhile as a basis for their well-publicised fight?"
This was, of course, a birth control trial from beginning to end.(15) However the GMC (and the MDU) attempted to dress it up as an advertising charge, it was clearly propelled through its various stages by a medical distaste for the underlying issue. Dr Philip Addison was a Roman Catholic and a known opponent of the 1967 Abortion Act. As Donald Gould (charitably) commented: "While it may safely be assumed that he would not allow his religious beliefs or personal prejudices to influence his professional conduct in the least, it would none the less have been politic for such a man to avoid becoming involved in disciplinary proceedings so closely concerned with abortion and vasectomy."(16) As at its start, likewise at the end of the case, the real issue emerged in Lord Cohen’s summing up to members of the GMC Disciplinary Committee which began: "I know that some of you may not approve of the operation of vasectomy, or indeed of birth control, but...." (17) before going on to suggest acquittal.
Aficionados of English birth control history will recognise in the Dr Deys case an almost frame-by-frame re-run of an earlier birth control trial - that of the Leeds medical practitioner, Dr Henry A Allbutt. Allbutt was also a person with a mission. A member of the Malthusian League he had, in 1879, accompanied Dr Charles Drysdale to an international medical conference in Amsterdam where he heard three French doctors maintain that contraception was not medically harmful; as a consequence he persuaded the Malthusian League to set up a medical group to spread this information amongst doctors "and for his pains became its secretary" (18). His commitment to birth control also like that of Dr Deys derived from his experiences of the problems of the Indian sub-continent. With Bradlaugh he was involved with Indian social and political aspirations and in 1882 he was invited to be the Patron of a Hindu Malthusian League in Madras.(19)
In 1886 Allbutt published a sixpenny booklet, The Wife’s Handbook, whose declared object was to render "the lot of the poor, happier, better, more comfortable and more moral." Later described as "a decent popular medical treatise designed to diffuse among the general populace hygienic knowledge, but especially information on pre-natal care and the management of the baby" (20), included in the Handbook was a chapter on "How to prevent conception when advised by the doctor" which summarised the major methods of contraception then in use but especially recommended soluble quinine pessaries and - for the first time in an English publication - the Mensinga diaphragm or the Dutch Cap.
The book was brought to the attention of the General Medical Council by the Secretary of the Leeds Vigilance Association. The GMC sent a copy to the Royal College of Physicians of Edinburgh which revoked Allbutt’s Licence and Membership "for having published and exposed for sale an indecent publication .... and having published and attached thereto advertisements of an unprofessional character, titled Malthusian Appliances". In May 1887 the GMC set up its own enquiry and in November Allbutt was summoned before the Council which declared him guilty of having published The Wife’s Handbook "and at so low a price to bring the work within the reach of the youth of both sexes, to the detriment of public morals." (21) The GMC found this to be infamous conduct in a professional respect and Allbutt was struck from the Medical Register.
The British Medical Journal’s comment on the case was "Injury is done to the medical profession by one of its members publishing in a cheap and popular form information which, however legitimate in its proper place, may be used for the worst purposes. Mr H A Allbutt may, no doubt, have been actuated by the highest motives in making his pamphlet accessible virginibus puerisque, but that does not lesson the harmful effects ... It is probable ... that Mr H A Allbutt might have ventilated his views without let or hindrance from professional authority had he been content to address them to medical men instead of to the Public".(22) The same distinction, that had Dr Deys contented herself with publication in the medical press, rather than in the popular newspapers, she would have escaped the wrath of the GMC was made by the prosecuting solicitor during her trial but when repeated by the medical journals the irony was now unmistakable.
In 1972, as in 1887, the effects of the GMC’s actions were the opposite of what must have been intended. In 1889 Allbutt wrote to the editor of a Leeds newspaper that despite the GMC’s attempts "to try and crush me ... I am in a better pecuniary position, have a better practice, better fees and more reputation than ever and can afford to snap my fingers at the Council."(23) And the Wife’s Handbook went on to become one of the most popular birth control tracts ever published in Britain; by 1926 it was still in print having sold half a million copies and been translated into French, Swedish and German.(24) Similarly, Dr Deys after her acquittal continued to work her two sessions at the Marie Stopes Clinic where, by 1975 when she left for the United States, she had performed 4,750 vasectomies. And in a letter to World Medicine the Secretary of the Kingston Co-operative Clinic reported that vasectomies carried out there had now reached 1,000 per year and that "We feel that the article in the People, publicising the work of Dr Caroline Deys, who works for another charitable organisation similarly involved to ourselves, may well have contributed to this."(25)
In the quarter century since Caroline Deys’ ordeal at the hands of the GMC, vasectomy has assumed a paramount role in the sadly limited and altogether inadequate armoury of contraceptive methods in use at the end of the twentieth century. It is the most widely used of all available techniques and world-wide prevents more pregnancies than any other method whilst generally being held to be safer, cheaper and subject to fewer side effects than its alternatives. Dr. Deys’ part in helping to establish the acceptability of vasectomy was a significant and honourable one. The Galton Institute (of which she is an esteemed life Fellow) can perhaps claim a slight glimmer of reflected glory from her story which is a further chapter in the history of the Eugenics Society’s management of the Marie Stopes Clinic from 1960 to 1976.
5. Evening Standard, 23 November 1972
6. Daily Telegraph, 23 November 1972
7. Michael Crick, Jeffrey Archer: Stranger Than Fiction, Hamish Hamilton, London 1995, p 292 ff.
8. World Medicine (Editorial), 13 December 1972
9. British Medical Journal Supplement, 9 December 1972 p 89
10. 26 November 1972
11. 7 December 1972
12. 13 December 1972
13. l December 1972
14. 23 December 1972
15. Whilst Dr Deys was being arraigned, members of the British heart transplant team were enjoying celebrity status as television personalities and the subjects of pandering newspaper interviews and profiles. The GMC showed no interest in this nor in the numerous doctors who, at the same time and under their own names were writing popular books on smoking and weight dieting.
16. New Statesman, 17 November 1972
17. General Practitioner, (Editorial) 29 November 1972
18. W H G Armytage, "We want what France has but we want it without the Revolution". The University of Leeds Review, Vol 22, 1979. p 8.
19. ibid, p 9.
20. Peter Fryer, The Birth Controllers, London, Secker and Warburg 1965, p 170.
21. ibid p 170.
22. "H A Allbutt v the General Medical Council", British Medical Journal 13 July 1889, p 88.
23. The Leeds Times, 13 July 1889 p 3. Allbutt was able to continue to practice because although he had been struck off by the Royal College of Physicians (Edinburgh) and by the GMC in England he remained a Licentiate of the Society of Apothecaries, vide Fryer op cit p 171.
24. Armytage recounts that Henry Allbutt’s cousin, Dr T Clifford Allbutt was the Leeds Commissioner for Lunacy and that it was widely claimed that no good Yorkshireman could rest quietly in his grave unless he had seen Dr Clifford Allbutt whilst no true Yorkshirewoman got married without reading Dr Henry Allbutt’s Wife’s Handbook, Armytage, op cit, pp10-11.
25. 18 December 1972 Vol 8, No7, p 14.