Introduction

The 1886 Medical Amendment Act reinforced the political nature of British medicine. The extension of reciprocity made possible through part 2 of the 1886 Act provided Britain with a mechanism to protect and project its interests in the world, including securing the right to practice abroad for British registered doctors, ensuring access to British medical services for the well-being of tourists and health restoration of the chronically ill living or traveling abroad, and building and sustaining strategic partnerships with territories inside and countries outside the empire.

Yet for all of the benefits associated with reciprocity, the expansion of the jurisdiction of British medicine was not without tension or conflict between the GMC and the state. Reconciling state interests in the world within the framework of the medical register, whose purpose was to serve the public by privileging British doctors, did not always align due to the uneven division of responsibility concerning the jurisdiction of British medicine. The government extended reciprocity as an act of state, and the GMC recognized the medical degrees awarded in a participating territory or country for purposes of admission to the register. Concerns about opening the domestic market to overseas-trained doctors as well as the equitable treatment of British doctors in reciprocating countries surfaced in deliberations and consultations about extending reciprocity. At the same time, enforcing the rights of doctors on the register to the unrestricted practice within the jurisdiction of British medicine was a constant preoccupation of the council. While the reciprocity agreements that Britain entered into created one of the largest medical markets in the world, participating colonial professions attempted to protect their local markets from the resulting competition by mandating conditions that either privileged local graduates or doctors who qualified or worked in the United Kingdom exclusively.

As I will show in this chapter, these reciprocating relationships proved to be critical to Britain during World War I. By the 1890s, the trend in new domestic admissions to the register settled into a fairly reliable annual average of 1,200. This number replaced total departures due to death or retirement, leaving a slight surplus of 300. The relatively tight supply of doctors contributed to the improved economic rewards of medicine before the outbreak of war in 1914.