Benjamin Moore, Science, and Medical Planning in early Twentieth-Century Britain

Summary

Benjamin Moore (1867–1922), physiologist and biochemist, was an eminent member of the British scientific and medical community in the early twentieth century. As a founder and president of the State Medical Services Association (SMSA) from its establishment in 1912 until his untimely death in 1922, Moore was a prominent medical services activist and planner in a period of intense debate on health services reform. As a medical scientist, Moore was also a participant in the campaign by laboratory scientists to obtain a larger role in clinical education, research, and medicine in this period. This article examines the medical services activism and ideas of Benjamin Moore. In particular, it seeks to demonstrate how his health services proposals and those he influenced, including SMSA and Labour Party plans, sought to advance the interests of laboratory scientists.

Acknowledgements

The research for this article was made possible by a three-year Doctoral Fellowship from the Social Sciences and Humanities Research Council of Canada, an Overseas Research Student Award from the Committee of Vice-Chancellors and Principles of the Universities of the United Kingdom, and several travel research grants from Corpus Christi College, University of Oxford. I am grateful to John Stewart, Steve Sturdy, and two anonymous reviewers for their comments on an earlier draft of this article.

Notes

¹Antonica Ineson and Deborah Thom, ‘T.N.T Poisoning and the Employment of women workers in the First World War’ in The Social History of Occupational Health, edited by Paul Weindling (London, 1985), 89–107 (95–96); Harmke Kamminga, ‘Historical Perspective: The Problem of the Origin of Life in the context of developments in biology’, Origins of Life and Evolution of Biospheres, Vol. 18, No. 1–2 (1988).

²G.A.J Pitt, ‘Liverpool: the early years of biochemistry’, Biochemical Society Transactions, 31 (2003), 16–17; R.A. Morton, ‘Biochemistry at Liverpool 1902–1971’, Medical History, 16 (1972). Robert E. Kohler, From Medical Chemistry to Biochemistry: The Making of a Biochemical Discipline (Cambridge, 1982).

³The SMA was affiliated to the Labour Party and instrumental in shaping its health policy up until 1945. Charles Webster, ‘Labour and the Origins of the National Health Service’, in Science, Politics and the Public Good, edited by N. Rupke (London, 1988), 184–202. On the SMA see John Stewart, ‘The Battle for Health’: A Political History of the Socialist Medical Association, 1930–1951 (Aldershot, 1999).

⁴Stewart (note 3); Frank Honigsbaum, The Division in British Medicine: A History of the Separation of General Practice From Hospital Care: 1911–1968 (London, 1979), 256.

⁵Steve Sturdy, ‘Medical Chemistry and Clinical Medicine: Academics and the Scientisation of Medicine’ in Ilana Lowy (ed.) Medicine and Change: Historical and Sociological Studies of Medical Innovation/Colloques INSEREM 220 (1993), 371–93 (372).

⁶Charles Webster, ‘Conflict and Consensus: Explaining the British Health Service’, Twentieth Century History, 1 (1990), 136–37.

⁷D. Stark Murray, Why a National Health Service? (London, 1971); Stewart (note 3), 17–18.

⁸On Murray see John Stewart, ‘Science Fights Death’: David Stark Murray, Science, and Socialism in Interwar Britain, Annals of Science, 51 (2000), 143–61.

⁹R.A. L Agnew, ‘Benjamin Moore and The Defeat of Tuberculosis’, Journal of the Irish Colleges of Physicians and Surgeons, 2 (October 1972), 43.

¹⁰Agnew has carefully constructed the details of Moore's post-secondary education and career prior to his Liverpool appointment and in turn corrected many errors of fact and discrepancies reported in his obituaries in the medical and scientific press and which recur in more recent publications. Agnew (note 9), 43, 46.

¹¹F.G. Hopkins, ‘Benjamin Moore-1867–1922’, Obituary Notices of Fellows deceased: Proceedings of the Royal Society of London, Series B, Containing Papers of a Biological Character, 101, (Jul. 1, 1927), xviii.

¹²Moore's obituaries also differ as to where he qualified in medicine. Nature states that he studied medicine at the Charing Cross Hospital Medical School. Edward Sharpey Schäfer noted in a corrective letter to the BMJ that Moore qualified in medicine at UCL. However, G. A. J. Pitt notes that although Moore may have studied medicine while at UCL, he completed his degree while in Liverpool. Sir Edward Sharpey-Schäfer, ‘The Late Professor Benjamin Moore’, BMJ, 18 March 1922, 459; Obituary, Nature, 109 (1922), 348; The Lancet, 18 March 1922.Pitt (note 2), 17.

¹³Pitt (note 2), 17.

¹⁴J. Jones, ‘Science, Utility and the “Second City of Empire”: the Sciences and especially the Medical Sciences at Liverpool University, 1885–1935’ (Manchester University Ph.D. thesis, 1985).

¹⁵Sturdy (note 5), 372. Steve Sturdy, ‘The Political Economy of Scientific Medicine: Science, Education and the Transformation of Medical Practice in Sheffield, 1890–1922’, Medical History, 36 (1992), 125–59.

¹⁶In addition to his appointment in pathology, Boyce also served as bacteriologist for the city of Liverpool. Obituary, BMJ, 1 July 1911, 53.

¹⁷Kohler (note 2), 56.

¹⁸Moore's interest in public health issues was not unusual. Sturdy and Cooter have identified a relationship between public health reform and the early development of experimental physiology in Britain which they suggest has received insufficient scholarly attention. Moore should be included among those physiologists, such as John Burdon Sanderson, Michael Foster and C. Sherrington who were interested in public health issues. Steve Sturdy and Roger Cooter, ‘Science, Scientific Management, And The Transformation of Medicine in Britain c. 1870–1950’, History of Science, 36 (December 1998), 437 (note. 87).

¹⁹Jones (note 14), 161–62.

²⁰Obituary, Nature, 109 (1922), 348.

²¹Obituary, BMJ, 11 March 1922, 417.

²²R.H. Plimmer, The History of the Biochemical Society: 1911–1949 (Cambridge, 1949), 16–20; R.A. Morton, The Biochemical Society: Its History and Activities 1911–1969 (London, 1969); T.W. Goodwin, History of the Biochemical Society 1911–1986 (London, 1987).

²³Ineson and Thom (note 1), 95–96.

²⁴In 1912 a Departmental Committee, chaired by Waldorf Astor, was tasked with recommending a policy to address the problem of tuberculosis in the United Kingdom.

²⁵Obituary, BMJ, 11 March 1922, 417.

²⁶In January 1922, Moore developed influenza, which was complicated by intractable heart failure. He died in Oxford on 3 March at the aged of 55. His son, Thomas Moore (1900–1999), became a nutritional biochemist and Deputy Director of the MRC Dunn Nutritional Laboratory. Obituary, BMJ, 11 March 1922, 417; C.J. Bates, ‘An Appreciation: Thomas Moore’, Proceedings of the Nutrition Society, 58 (1999), 751–52.

²⁷G.R. Searle, The Quest for National Efficiency: A Study in British Politics and Political Though, 1899–1914 (Oxford, 1991).

²⁸See, for example, the ‘Discussion on the social aspects of the falling birth-rate’ at the Section of Medical Sociology at the BMA annual meetings of 1910, BMJ, 20 August 1911, 449–51.

²⁹The BMA's Section on Medical Sociology was established in 1910 owing to the ‘state's growing intervention in medicine’. Moore opened the inaugural session with a paper on the ‘economic basis of hospital management’ in which he called the establishment of a referral and state hospital system in which surgeons and physicians were paid on a salary basis. The Lancet, 30 July 1910; BMJ, 20 August 1910.

³⁰For histories of general practice prior to the period explored in this article see Irvine Loudon, Medical Care and the General Practitioner (Oxford, 1986) and Anne Digby, Making a Medical Living: Doctors and Patients in the English market for medicine, 1720–1911 (Cambridge, 1994).

³¹On the Poor Law medical services see Ruth G. Hodgkinson, The Origins of the National Health Service: The Medical Services of the New Poor Law, 1834–1871 (London, 1967); M. Anne Crowther, ‘Paupers or patients? Obstacles to professionalization in the Poor Law Medical Service before 1914’, Journal of the History of Medicine & Allied Sciences, 39 (1984), 33–55.

³²Anne Digby, The Evolution of British General Practice: 1850–1948 (Oxford, 1999), 94.

³³Digby (note 32), 287.

³⁴The Public Health Act of 1872 obliged sanitary authorities in England and Wales to appoint MOHs to enforce the public health act. The initial responsibilities of MOHs included food, sanitary and housing inspection and the publication of annual reports on their activities and the state of public health in their districts. Lewis, What Price Community Health? The Philosophy, Practice and Politics of Public Health Since 1919 (Brighton, 1986), 4.

³⁵The background and appointment of the RCPL are examined in A.M. McBriar, An Edwardian Mixed Doubles: The Bosanquets versus the Webbs: A Study in British Social Policy 1890–1929 (Oxford, 1987).

³⁶George Newman was Chief Medical Officer (CMO) of the Board of Education and later became the first CMO of Britain's Ministry of Health. On Newman see Steve Sturdy, ‘Hippocrates and State Medicine: George Newman Outlines the Founding Policy of the Ministry of Health’ in Greater Than The Parts Holism in Biomedicine: 1920–1950, edited by Christopher Lawrence and George Weisz (Oxford, 1998), 112–34; W.F. Bynum, ‘Sir George Newman and the American Way’, in The History of Medical Education in Britain, edited by Vivian Nutton and Roy S. Porter (Amsterdam, 1995), 16–36; S. Sheard and L Donaldson, The Nation's Doctor: the Role of the Chief Medical Officer, 1855–1998 (Oxford, 2005); and Margaret Hammer, ‘The Building of the Nation's Health: The Life and Work of George Newman to 1921’ (Cambridge University Ph.D. thesis, 1985).

³⁷Newsholme was MOH for Brighton (1888–1908) and later CMO of the Local Government Board (1908–1918). John Eyler, Sir Arthur Newsholme and State Medicine: 1885–1935 (Cambridge, 1997).

³⁸J.C. McVail was CMO for Stirlingshire and Dumbartonshire. On McVail see ‘Obituary’ John C. McVail, BMJ, 7 August 1926, 279–83.

³⁹For a detailed description of the origins, rationale, conceptualization and debate concerning these functions at the time of RCPL, see Gordon S. Lawson ‘The Debate on General Practice in England: 1905–1933’ (University of Oxford, DPhil thesis, 2005), 18–79. Report of the Royal Commission on the Poor Laws and Relief of Distress, Cd. 5068 (1910), XLIX, Appendix Vol. 9, 262–288. (Testimony of Mr George Newman 25 February 1908); (Testimony of Dr Arthur Newsholme, 3 February 1908). Dr John C. McVail, ‘Report on the Methods and Results of the present system of Administering Indoor and Outdoor Poor Law Medical Relief in Certain Unions in England and Wales’ Royal Commission on the Poor Laws and Relief of Distress, Cd. 4573. (1909), Vol. XIX, Appendix Vol. 14 (See in particular Memorandum ‘Home Medical Inspection’).

⁴⁰On the campaign of the Society of Medical Officers of Health (SMOH) for a unified poor law and public health services, see Dorthy Porter, ‘Enemies of the Race’: Biologism, Environmentalism, And Public Health in Edwardian England’, Victorian Studies, 34 (Winter 1991).

⁴¹ Report of the Royal Commission on the Poor Law and Relief of Distress, Cd. 4499 (1909), XXXVII, Majority Report, Part 5, 885, 887; ‘The Poor Law Commission And The Medical Profession, BMJ, 3 July 1909, 37.

⁴²Frederick Lawson Dodd (1876–1962) was a successful Wimpole street dental surgeon who served as treasurer of the Fabian Society (1911–1936). He was an early advocate of a state medical service and authored Fabian Tract 160: A National Medical Service (London, 1911). Dodd was a founding SMSA member and launched the Medical World which briefly served as the SMSA's unofficial journal. In 1918, he was appointed to the Labour Party's Public Health Advisory Committee. Arthur Skeffington, ‘F. Lawson Dodd’, Fabian News, 74 (1963), 6. Patricia Pugh, Educate, Agitate, Organise: 100 Years of Fabian Socialism (London, 1984), 347; Honigsbaum (note 4), 82.

⁴³Benjamin Moore, ‘The Nationalization of Medical Service’, BMJ, 4 June 1910, 1345–1346.

⁴⁴B. Bentley Gilbert, The Evolution of National Health Insurance in Britain: The Origins of the Welfare State (London, 1966); E.P. Henncock, British Social Reform and German Precedents: The Case of Social Insurance 1880–1914 (Oxford, 1987).

⁴⁵Sturdy and Cooter (note 18), 438.

⁴⁶Lawrence has applied the name patrician to these elite physicians owing to their aristocratic lifestyles and behaviours. Christopher Lawrence, ‘Incommunicable Knowledge: Science, Technology and the Clinical Art in Britain 1850–1914’, Journal of Contemporary History, 20 (1985), 503–20.

⁴⁷Sturdy (note 5), 377.

⁴⁸On Haldane, see Steve Sturdy, ‘Biology as Social Theory: John Scott Haldane and Physiological Regulation’, British Journal of the History of Science, 21 (1988), 315–40.

⁴⁹For the Cambridge perspective on ‘pure’ and ‘applied’ science see Gary Werskey, The Visible College (London, 1978), chap 1.

⁵⁰Christopher Lawrence, Rockefeller Money, The Laboratory, And Medicine In Edinburgh 1919–1930: New Science in an Old Country (Rochester, NY, 2005), 16, 22, 47.

⁵¹Sturdy and Cooter (note 18), 427.

⁵²Sturdy and Cooter (note 18), 438–39.

⁵³Lawrence (note 46), 507.

⁵⁴Benjamin Moore, The Dawn of the Health Age (London, 1911), 104, 106, 109; BMJ, 20 August 1910.

⁵⁵Jones (note 14), 290, 327.

⁵⁶There were scientists, such as Walter Morley Fletcher, who shared Moore's belief that the medical profession should become salaried civil servants in order, in part, to facilitate the academicization of clinical teaching and research in Britain but chose not to engage in such radical activity. Lawrence (note 50), 48, 53.

⁵⁷Andrew Hull, ‘War of Words: the Public Science of the British Scientific Community and the Origins of the Department of Scientific and Industrial Research, 1914–1916’, British Journal of History of Science, 32 (1999), 462–67; Roy Macleod and Peter Collins, The Parliament of Science: the British Association for the Advancement of Science, 1831–1981 (Northwood, 1981); Roy Macleod, ‘Science for Imperial Efficiency and Social Change: Reflections on the British Science Guild, 1905–1936’, Public Understanding of Science, 3 (1994), 155–93.

⁵⁸Moore (note 54).

⁵⁹ The Lancet, 3 August 1912, p. 297.

⁶⁰See for example, Benjamin Moore, ‘First Steps Towards A State Medical Service: An Address Delivered before the Medico-Legal Society of London, January 21, 1913’, State Medical Service Association, BLPES, Pamphlet Collection.

⁶¹Moore (note 54), 2.

⁶²Greta Jones, Social Hygiene in Twentieth Century Britain (London, 1986), 5.

⁶³Moore (note 54), 46.

⁶⁴J. Welshman, ‘The Medical Officer of Health, 1900–1974: Watchdog or Lapdog’, Journal of Public Health Medicine, 19 (1997), 1095–105; Charles Webster, ‘Medical Officer of Health—For the Record’, Radical Community Medicine (1986), 10–14.

⁶⁵Honigsbaum (note 4), 34.

⁶⁶Steve Sturdy, ‘The Development of Government Policy on Personal Health Care’, in Medcine, Health and the Public Sphere in Britain, 1600–2000, edited by Steve Sturdy (London, 2002), 241–59 (250).

⁶⁷‘Memorandum by Mr Sidney Webb to the Chancellor of the Exchequer’, in William J. Braithwaite, Lloyd George's Ambulance Wagon: Being the Memoirs of William J. Braithwaite, 1911–1912 (Bath, 1970), Appendix D, 310.

⁶⁸Searle (note 27), 3, 15–16.

⁶⁹The implicit recommendation of the Minority Report that doctors should ‘search-out’ disease and provide periodic medical inspections was attacked by the opponents of the Minority Report on the basis that it was contrary to British ideas of personal liberty and would be opposed by the public. ‘The Royal Commission on the Poor Law: The Poor Law Medical Officers’ Association and the Report’, BMJ, 17 July 1909, 86; H. Manley, ‘Medical Aspect of the Report of the Royal Commission on Poor Law Reform’, BMJ, 21 August 1909, 196. See also Lawson (note 38), 62–65.

⁷⁰Moore (note 54), 30–31.

⁷¹Moore (note 54), 58–59.

⁷²Searle (note 27). 14.

⁷³‘A State Medical Service’, Nature, 22 June 1911, 547–49.

⁷⁴Moore (note 54), 65.

⁷⁵Moore (note 54), 65. Moore was among several proponents of a state-salaried medical service, including the Webbs and David Stark Murray, who ‘adopted the bacteriological language of the war on disease in the polemical pursuit of their political goals in order to emphasize decisive action, urgency, command, and the need for national virility’. Roger Cooter, ‘Of War and Epidemics: Unnatural Couplings, Problematic Conceptions’, Social History of Medicine, 16 (2003), 294–95.

⁷⁶Moore (note 54), 25.

⁷⁷Moore (note 54), Preface, vi.

⁷⁸‘The Poor Law Commission And The Medical Profession’, BMJ, 3 July 1909, 37.

⁷⁹Moore (note 54), 114.

⁸⁰Moore (note 54), 126.

⁸¹Sturdy (note 5), 377.

⁸²Sturdy (note 5), 377.

⁸³Sturdy (note 5), 378.

⁸⁴Jones (note 14), 218, 220.

⁸⁵Moore (note 54), 142–43.

⁸⁶Benjamin Moore, ‘The Value of Research in the Development of National Health’, Nature, No. 2342, Vol. 94, 17 September 1914, 74–80. Presidential address to the Physiology Section of the British Association.

⁸⁷Moore (note 86).

⁸⁸The journal Public Health suggested that Moore was unaware of the progress in disease prevention due to the public health service, arguing that the ‘scientific method’ is to ascertain what has already been done in the way of successful prevention, and to build future schemes on the basis of past achievement. Review, Public Health (October, 1911). See also The Medical Officer, 11 March 1911, 129. Moore's book also received a scathing review by B.L. Hutchins, author of Fabian Tract No. 148: What a Health Committee Can Do (1909). B.L. Hutchins, ‘Dawn of the Health Age’, Fabian News, 22 (April, 1911), 39.

⁸⁹Moore (note 54), 27. This terminology may suggest that Moore was influenced by Henry Rumsey's proposals for a salaried general practitioner service in the nineteenth century. In his campaign for the reform of the Poor Law Medical Service Rumsey called for the general practitioner to become a ‘Missionary of Health’. Henry W. Rumsey, Essays on State Medicine (1856).

⁹⁰Moore (note 54), 55.

⁹¹Arthur Newsholme, ‘A Discussion on the Co-ordination of the Public Medical Services’, BMJ, 14 September 1907, 656–60.

⁹²Moore (note 54), 195.

⁹³McVail (note 39). 163–64. On McVail, see note 38.

⁹⁴Moore (note 54), 63.

⁹⁵Moore (note 54), 62–66.

⁹⁶Jones (note 14), 286.

⁹⁷Boyce had sought unsuccessfully to establish a joint research programme with clinicians and laboratory scientists to permit biochemists, physiologists and pathologists to extend their activities into clinical research. Owing to the opposition of clinicians, the cancer programme was primarily laboratory-based. Moore was able to do some experimental work with patients with the help of some of the ‘scientifically-minded’ doctors. Jones (note 14), 286–89, 291–92, 304.

⁹⁸Moore (note 54), 196.

⁹⁹Moore (note 54), 98.

¹⁰⁰Moore (note 54), 57–58.

¹⁰¹Moore (note 54), 55.

¹⁰²Sturdy and Cooter (note 18), 425.

¹⁰³Sturdy and Cooter (note 18), 426.

¹⁰⁴Sturdy and Cooter (note 18), 426

¹⁰⁵Sturdy and Cooter (note 18), 427–28, 439. Moynihan, a patrician, would later feel increasingly threatened by the growing power and influence of laboratory scientists in clinical teaching, practice and research during the inter-war period. In particular, he objected to the assertion that routine practitioners had little to contribute to clinical research. He subsequently joined other elite clinicians, such as Bertrand Dawson, in attacking academic clinical science. David Cantor, ‘The MRC's support for experimental radiology during the inter-war years’ in Joan Austoker and Linda Bryder (eds.), Historical Perspectives on the Role of the MRC (Oxford, 1989), 193–96.

¹⁰⁶Moore (note 54), 51–52.

¹⁰⁷Charles Webster, ‘Doctors, Public Service and Profit: General Practitioners And the National Health Service’, Transactions of the Royal Historical Society, 40 (1990), 202.

¹⁰⁸Moore (note 54),182.

¹⁰⁹Moore (note 54), 38.

¹¹⁰Moore (note 54),188–90

¹¹¹‘Medical Students’ Debating Society (University of Liverpool); Professor Benjamin Moore and State Insurance BMJ, 17 June 1911, 1675.

¹¹²‘Choice of Doctor: The Appeal to the Insured’, BMJ, 27 May 1911, 309.

¹¹³Moore's role in these negotiations has escaped notice from those texts which examine NHI.

¹¹⁴‘Reviews: National Health and Medical Service’, BMJ, 29 July 1911.

¹¹⁵Records of the Socialist Medical Association, University of Hull, Brynmor Jones Library, DSM2, Minute Book of the State Medical Service Association, 2.

¹¹⁶Honigsbaum (note 4), 106; Murray (note 7), 10–11.

¹¹⁷BLPES, Pamphlet Collection, Milson Rhodes, A National Medical Service (Manchester 1912). Lawson (note 38), 128–30.

¹¹⁸F. Lawson Dodd (note 42).

¹¹⁹ The Lancet, 30 March 1912.

¹²¹‘Advocates Meeting at Brighton’, Medical World, 7 August 1913.

¹²⁰Minute Book of the State Medical Service Association (note 115), 2.

¹²²State Medical Service Association Minute Book (note 115), General Meeting, 25 October 1912.

¹²³Sir Victor Horsly, a neurosurgeon based at University College London, was part of Robert Jones’ movement to reform surgery. Sturdy and Cooter (note 18), 427–28.

¹²⁴Oxford University, Bodleian Library, Department of Western Manuscripts, MSS Eng Lett d. 269, Charles Parker Correspondence, Sir Victor Horsley to C.A. Parker, 11 November 1912.

¹²⁵Lawrence (note 46), 511–13. Sturdy and Cooter (note 18). 428.

¹²⁶Sturdy (note 36), 123.

¹²⁷Hill should also be included among those physiologists who had an interest in public health issues. Obituary, BMJ, 5 April 1952, 767–68; Obituary, The Lancet, 771–72; Sturdy and Cooter (note 18).

¹²⁹‘The Ideals of a Noble Profession: Letter from Prof. B. Moore’, The Medical World, 14 August 1913, 5–6.

¹²⁸Leonard Hill, ‘Reorganising The Medical Profession’ (Address given at the Annual Meeting of the SMSA), Medical World, 6 November 1913, 528–29.

¹³⁰C. A. Parker was a distinguished laryngologist and surgeon at the Hospital for Diseases of the Throat and Chest, in Golden Square, London. He authored Guide to Diseases of the Nose and Throat and their Treatment (1906) and was elected president of the Laryngology Section of the Royal Society of Medicine. Parker was the most prolific writer on medical services planning with the SMSA, contributing articles to various popular and professional journals in the period 1913–1914. On Parker's contributions to SMSA thinking on medical planning see Lawson (note 38), 138–41.

¹³¹‘State Medical Service Association: The Annual Meeting’, The Medical World, 6 November 1913, 557–58; Moore (note 60).

¹³²On The Medical World see Honigsbaum (note 4), 82.

¹³³Dr Robert Arthur Lyster was CMO and Chief School Medical Officer for Hampshire (1908–1929) and editor of Public Health (1918–1925). Lyster was a confidant of the Webbs who informed their Minority Report for the Poor Laws as well as a compromise scheme presented to Lloyd George as an alternative to NHI. Beatrice Webb, Our Partnership (London, 1948), 470, 514. Braithwaite (note 67), 116. Robert A. Lyster, ‘Sickness Insurance And Public Health’, BMJ, 4 March 1911, 507–8.

¹³⁴SMSA Minute Book (note 115), General Meeting, 25 October 1912.

¹³⁵F. Lawson Dodd and C.A. Parker, ‘The Trend of Things’, The Medical World, 14 August 1913, 14.

¹³⁶Moore (note 60), 19–20.

¹³⁷C.A. Parker, ‘The Panel Doctor and the Insurance Act: Where the Act Fails, Scheme for Redistribution’ (Reprinted from “The Medical World” September 18 and 25th), BLPES, Pamphlet Collection, 5.

¹³⁸Moore (note 60), 21–22.

¹³⁹In a similar by-pass of general practitioners, C. A. Parker recommended the expansion of the mandates of the school medical service, school and baby clinics and health visitors. Charles A. Parker, ‘Compulsory Medical Treatment’, Reprinted from Educational Times, May 1914, BLEPES, Pamphlet Collection, 10–13.

¹⁴⁰SMSA Minute Book (note 115), Executive Committee Meeting, 23 December 1913.

¹⁴¹Sturdy and Cooter (note 18), 433.

¹⁴²Thomas Neville Bonner, Iconoclast: Abraham Flexner and a life of learning (Baltimore, 2003), 93; ‘Abraham Flexner as Critic of British and Continental Medical Education’, Medical History, 33 (1989), 473.

¹⁴³Sturdy and Cooter (note 18), 443 (note 111).

¹⁴⁴Royal Commission on University Education in London, Final Report, 120–21; para 274; George Graham, ‘The Formation of the Medical and Surgical Professorial Units in the London Teaching Hospitals’, Annals of Science, 26 (1970), 6.

¹⁴⁵Royal Commission on University Education in London (note 144), 111 (para 256).

¹⁴⁶Royal Commission on University Education in London (note 144), 111 (para 257).

¹⁴⁷Sturdy and Cooter (note 18), 443; Steve Sturdy, ‘From the Trenches to the Hospitals at Home: Physiologists, Clinicians and Oxygen Therapy, 1914–30’ in John V. Pickstone ed. Medical Innovations in Historical Perspective (London, 1992), 104–23.

¹⁴⁸Ineson and Thom (note 1), 95–96.

¹⁴⁹Hammer (note 36), 195–96. Newman served on the subcommittee concerned with TNT poisoning.

¹⁵⁰Unlike other prime movers behind the establishment of full-time clinical chairs in Britain, such as Walter Morley Fletcher and the Rockefeller Foundation, Newman admired an English clinical tradition and was sympathetic towards the concerns of the patricians, such as an over-reliance on laboratory knowledge in medical practice. In order to accommodate both the patricians and laboratory scientists in his medical care proposals, Newman articulated a medical holism that embodied, and served to eliminate the tension between, individualized conceptions of illness and laboratory knowledge. He also objected to Fletcher's ‘pure’ science focus and the assertion that routine clinicians had little to contribute to medical research. Lawrence (note 50), 41–42; Sturdy (note 36), 125–29. See also Lawson (note 39), 244–46.

¹⁵¹Sturdy and Cooter (note 18), 443; Graham (note 144), 1–22.

¹⁵²Lawrence (note 50), 47; idem ‘Still Incommunicable: Clinical Holists and Medical Knowledge in Interwar Britain’ in Lawrence and Weisz (note 35), 94–111; Martin Edwards, ‘Good, Bad or Offal? The Evaluation of Raw Pancreas Therapy and the Rhetoric of Control in the Therapeutic Trial, 1925’, Annals of Science, 61 (2004), 86–90. Edwards analyses the conflict between laboratory scientist-physicians and clinicians, mainly general practitioners, in the debate in 1925 concerning the effectiveness of consuming raw pancreas as a treatment for diabetes.

¹⁵³For detailed accounts of the establishment of the Ministry of Health see Frank Honigsbaum, The Struggle for the Ministry of Health (London, 1970); idem (note 4), 22–40; B. Bentley Gilbert, British Social Policy: 1914–1939 (London, 1993), 98–132.

¹⁵⁴Honigsbaum (note 4), 32.

¹⁵⁵Ray Earwicker, ‘The Labour Movement and the Creation of the National Health Service, 1906–1948’ (Birmingham University Ph.D. thesis, 1982), 99.

¹⁵⁶Earwicker (note 155), 101.

¹⁵⁷Charles Webster, ‘The Metamorphosis of Dawson of Penn’, in Roy Porter and Dorothy Porter (eds.), Doctors, Politics and Society: Historical Essays (Amsterdam, 1993), 212–28 (215).

¹⁵⁸ The Lancet, 20 April 1918, 571–73; 8 June 1918, 804–6; 15 June 1918, 844–46.

¹⁵⁹ The Lancet 15 June 1918, 845.

¹⁶⁰On Mackenzie see Alex Mair, Sir James Mackenzie MD 1853–1925: General Practitioner (London, 1986); Robert McNair Wilson, The Beloved Physician (London, 1926); Thomas Osborne, ‘James Mackenzie, General Practitioner: a modest contribution to the archaeology of clinical reason’, Sociology of Health and Illness, 15 (1993), 525–46. On Mackenzie's articulation of general practitioners as a researchers and his critique of the laboratory sciences, see Lawson (note 39), 70–76; 151–55; 170–83. 202–3.

¹⁶¹James Mackenzie, ‘The Aim of Medical Education’, Edinburgh Medical Journal, 20 (1918), 31–48. Mackenzie would develop these ideas further in The Future of Medicine (London, 1919).

¹⁶²Joan Austoker, A History of the Imperial Cancer Research Fund 1902–1986 (Oxford, 1988); ‘Walter Morley Fletcher and the origins of a basic biomedical research policy’, in Austoker and Bryder (note 105), 22–33.

¹⁶³ The Lancet, 15 June 1918, 845–46.

¹⁶⁴ The Lancet, 20 April 1918, 573; 8 June 1918, 804–6; 15 June 1918, 844–46.

¹⁶⁵On the patricians’ opposition to salaried state medicine see Lawrence (note 50), 47–48.

¹⁶⁶ The Lancet, 20 April 1918, 573.

¹⁶⁷Benjamin Moore and C.A. Parker, ‘The Case For A State Medical Service Re-stated’, The Lancet, 20 July 1918, 85–87.

¹⁶⁸Sturdy and Cooter (note 18), 433 (note 66).

¹⁶⁹Sturdy and Cooter (note 18), 433.

¹⁷⁰Roger Cooter, Surgery and Society in Peace and War: Orthopaedics and the Organisation of Modern Medicine, 1880–1948 (London 1993), 122.

¹⁷¹Cooter (note 170), 122; Cooter and Sturdy (note 18), 433.

¹⁷² The Lancet, 20 April 1918, 572.

¹⁷³George Bernard Shaw was very much a part of the movement for a state-salaried medical service. He was an active participant in the development of the Fabian Society's medical policy. In 1907, Shaw was tasked with reviewing a paper on ‘socialism and doctors’ by F. Lawson Dodd which was subsequently published as a Fabian Tract. F. Lawson Dodd (note 41); BLPES, Fabian Society Archives, Minutes of Publishing Committee (E3), 18 October 1907. He was one of two figures sought by the SMSA to address the association in 1912. Shaw subsequently delivered a speech at a public meeting organized by Moore in 1913. ‘Advocates’ Meeting at Brighton: Mr G. B. Shaw on a State Medical Service’, The Medical World, 7 August 1913, 16–18. For a discussion of Shaw's ideas on medical planning, see Lawson (note 39), 116–23.

¹⁷⁴George Bernard Shaw, ‘Preface on Doctors’ (1911) in The Doctors Dilemma (London, 1908), 14.

¹⁷⁵F. Lawson Dodd (note 42), 8

¹⁷⁶Sturdy and Cooter (note 18), 434.

¹⁷⁷Dawson, The Nation's Welfare: The Future of the Medical Profession (London, 1918), 13.

¹⁷⁸David Smith, ‘The Use of “Team Work” in the Practical Management of Research in the Inter-War Period: John Boyd Orr at the Rowett Research Institute’, Minerva, 37 (2004), 276–77. I am grateful to Steve Sturdy for bringing this article to my attention.

¹⁷⁹Smith (note 178), 277–78. See Smith's account of the debate of January 1919 concerning teamwork in The Times. The assertion that the Secretary of the MRC, Walter Morley Fletcher, was not interested in teamwork and was primarily concerned with providing support for ‘relatively autonomous researchers and ‘relatively “pure” researchers’ should be qualified. During the inter-war period Fletcher placed a great deal of emphasis on teamwork which he did not see in opposition to pure science. Indeed, according to Lawrence, for Fletcher the future of medicine lay in the ‘collaborative labour of basic scientists’. Lawrence (note 152), 100. Moreover, Fletcher sought to introduce teamwork in hospital-based clinical practice and research. Lawrence (note 50), 47, 49; Maisie Fletcher, The Bright Countenance. A Personal Biography of Walter Morley Fletcher (London, 1957), 168. On the concept of teamwork in medical research see also Andrew J. Hull, ‘Teamwork, Clinical Research, and the Development of Scientific Medicines in Interwar Britain: The “Glasgow School”, Bulletin of the History of Medicine, 81 (2007), 569–93.

¹⁸⁰On Hastings see John Stewart, ‘Socialist Proposals for Health Reform in Inter-War Britain: the Case of Sommerville Hastings’, Medical History, 39 (1995), 338–57.

¹⁸¹Stewart (note 3), 19.

¹⁸²Labour Party, Memoranda Prepared by the Advisory Committee on Public Health: The Organisation of the Preventative and Curative Medical and Hospital Services And Hospital And Laboratory Systems Under a Ministry of Health; The Position of the General Medical Practitioners in a Reorganized System of Public Health; The Ministry of Health (1919), 2; Earwicker (note 155), 102.

¹⁸³LHASC, Archives of the British Labour Party, J.S. Middleton Papers, JSM/PH/1–24, Minutes, Advisory Committee on Public Health (PHAC), 18 May 1920.

¹⁸⁶Labour Party (note 182), 2.

¹⁸⁴Webster (note 6), 137.

¹⁸⁵Labour Party (note 182) 2, 4, 8.

¹⁸⁷Roger Smith, ‘The embodiment of value: C. S. Sherrington and the cultivation of science’, British Journal for the History of Science, 33 (2000), 91.

¹⁸⁸Webster (note 157), 215.

¹⁸⁹Webster (note 157), 214.

¹⁹⁰Webster (note 6), 136–38. Honigsbaum (note 4), 67–68. Stewart (note 3), 20.

¹⁹¹Dawson (note 177), 15, 21.

¹⁹²Dawson (note 177), 18.

¹⁹³Honigsbaum (note 4), 81–82.

¹⁹⁴Dawson (note 177), 31.

¹⁹⁵LHASC, Archives of the British Labour Party, J.S. Middleton Papers, JSM/PH/1–24, Minutes, Advisory Committee on Public Health (PHAC), 20 July 1920. ‘Re-organisation of Medical Services And Hospitals’, Labour Bulletin 1 (1921), 184.

¹⁹⁶Dawson (note 177), 29.

¹⁹⁷The SMSA met only once in 1921 before it was partially revived in 1928 as the National Medical Service Association; this organization had its last recorded meeting in 1931. Stewart (note 3), 20.

¹⁹⁸Murray (note 7), 14; Quoted in Stewart (note 3), 21.

¹⁹⁹George Newman, An Outline of the Practice of Preventive Medicine: A memorandum Addressed to the Minister of Health, Cmd. 363 (London, 1919). For a detailed analysis of this document, see Sturdy (note 36).

²⁰⁰Stewart (note 3), 21.

²⁰¹Stewart (note 3), 21.

²⁰²Stewart (note 3), 25; Trades Union Congress and Labour Party, The Labour Movement and the Hospital Crisis, 1922.

²⁰³Honigsbaum (note 4), 256; Stewart (note 3), 18, 79–80.

²⁰⁴Stewart (note 8), 143–61.

²⁰⁵I am indebted to Steve Sturdy for this observation. Personal Communication, 28 February 2007.