Doctors and the State: The British Medical Profession and Government Action
This study was made by an American, an authority on the contemporary welfare services of her own country. It is significant that people from areas where the necessity and urgency for establishing some national health care is realized should embark upon detailed research into our past, to avoid our mistakes, to recognize and understand existing problems, or to forestall future blunders. Nineteenth-century England witnessed an amazing development in State intervention. The problems posed by industrialization, urbanization and a rapid growth in population made this activity inevitable and progressive. Local and central government took on many new functions, so that reform and expansion in the administrative and executive systems was imperative for effective operation. An efficient civil service and specialists became very necessary. Regarding public health measures, demand and supply reached significant dimensions with the institution of State medical employees who could provide information for public inquiries (a new departure) and for action to be taken subsequently. Progress was assured when the expert on health could reveal officially that an unhealthy people affected economic prosperity and that ill-health cost the nation more than positive measures to ensure good health. Doctors cannot escape their close connection with the community. They were in the last century the one single group in a key position able to observe and to analyse the social evils which existed; they were foremost in recognizing what must be done. Generally aloof from, and therefore unbiassed by political and economic philosophy or practice, they provided one of the great elements in the movement for reform in social welfare. Unfortunately they have received too little historic recognition. During the latter half of the nineteenth century the State doctors formed a new branch of the medical profession, and with the strength which organization gave to them, made forceful demands to improve their status within the country and to achieve recognition within the profession. In assessing the value of their work their dependence on the emergence of another new branch of the profession, the medical scientist and the government-sponsored research-worker, must also be taken into account. This book deals primarily with the development of the Public Health services, in which field members of an extremely independent calling, not only accepted central control but demanded it, at first in the prevention of epidemic diseases and later in securing personal care within the community framework. Albeit doctors did desire more professional representation and always …