Introduction

Shortly after the return to peacetime in 1919, challenges to the reach of British medicine emerged that would persist throughout the interwar period. The national and imperial boundaries that had opened the world to British medicine during the war now shrunk in response to the preferences of reciprocating nation-states and Britain's evolving political relationships with territories and countries within and outside of the Commonwealth. These challenges varied in scale. On one end of the spectrum was the retraction of reciprocity with Belgium in 1922. This came as no surprise because Belgium had originally agreed to reciprocate only for the duration of the hostilities. The demands of Italy and the newly created Irish Free State did not so much undermine the influence of British medicine as underscore the political nature of reciprocity. Separately, they conditioned the continuation of reciprocal relations with Britain on replacing the British Order in Council—which facilitated the implementation of the reciprocity provisions of the 1886 Medical Amendment Act—with a bilateral agreement. This demand was more about the form of reciprocity than its substance. Neither agreement fundamentally altered the GMC's statutory authority in regulating admission to the medical register as originally set out in the Order in Council. For these two nation-states—one that had just come into existence after a prolonged civil war and the other now led by fascist nationalists— a bilateral agreement symbolized equality within the community of nations as much as the equality of professionals. For its part, Britain benefited as much as the other parties to the agreements. The creation of the Irish Free State may have territorially shrunk the United Kingdom. But the continuation of the regulation of the Irish profession through the GMC preserved the boundaries of British medicine. It also ensured the continuation of economic and social ties in the archipelago. The agreement with Italy ensured that resident British nationals would have access to British doctors. Correspondingly, Italian doctors operating within the boundaries of British medicine in the world would not be subject to differential treatment.

On the opposite end of the spectrum, conflicts in the Commonwealth increasingly called into question the legal rationale for the enforcement of the rights of registered doctors with third country qualifications to practice in another reciprocating territory or country. For most of the 1920s, the GMC defended the rights of registered doctors to local registration.