SOCIALIST THINKERS in Germany and Austria were a little ahead of their British contemporaries in preparing schemes for basic medical treatment services and it was from one of these, a Dr Ewald Fabian who practised dentistry in Berlin, that a direct stimulus to form a socialist organization came. What has been said about the National Medical Service Association indicates that the political need was already clear to some but had not crystallized in an actual organization. Early in the summer of 1930 Dr Charles Brook, as he tells in Making Medical History, received a letter from Dr Fabian telling him that there already existed in many European countries ‘organizations of Socialist members of the medical profession’. The German organization already had several hundred members and published its own journal Der Socialistiche Arzt (The Socialist Doctor). Dr Fabian edited this journal and wrote to express his surprise that there was no British organization with which he could exchange ideas. Dr Brook’s name had attracted his attention through a report of a speech made at a London County Council meeting. Dr Brook was fighting for better amenities in Tooting, a constituency which he fought in a Parliamentary election and was at first reluctant to take on other work but was finally persuaded by Dr Fabian. (He was later forced to leave Germany and died in New York in 1946.) This part of the story has already been told by Dr Charles W. Brook in Making Medical History which he published in 1946 and from this one quotes at some length. Although Dr Fabian had persuaded Dr Brook of the need for a new organization it was annoyance at a speech by Sir Ernest Graham-Little, MD, then Independent MP for London University, that gave the final stimulus. Graham-Little was a bitter opponent of any step toward a State medical service and a speech he made at this time triggered off the formation of the Socialist Medical Association. Dr Brook wrote to the Daily Herald, ‘inviting medical practitioners who might be interested in forming a body of socialist doctors to get in touch with him.

There was an immediate response and a preliminary meeting late in September 1930, presided over by Miss Esther Rickards, MS, FRCS, quickly decided on setting up a new socialist organization. By November 2, a constitution, which J. S. Middleton then Acting Secretary of the Labour Party helped to frame, was ready to be accepted by a meeting over which Somerville Hastings, MP for Reading, presided. He had decided that it was necessary to take a more political line than that taken by the State Medical Service Association. Hastings and Brook were agreed that if any success was to be attained a Socialist Medical Association must be affiliated to and must exercise its influence through the Labour Party. The constitution of the new organization was framed in conformity with that of the Labour Party, and its three principal aims were set out as:

  1. To work for a Socialized Medical Service both preventive and curative, free and open to all.
  2. To secure for the people the highest possible standard of health.
  3. To disseminate the principles of socialism within the medical and allied services.

It is of interest that the World Health Organization when it was established many years later declared that

‘the enjoyment of the highest attainable standard of health is one of the fundamental rights of every human being’ .

The founder members of the new organization spent some time discussing its name but were finally unanimous in favour of ‘The Socialist Medical Association’. It began to attract attention from the day of its foundation. The time was undoubtedly ripe but it also gained notice from the names of many of its first members. They were already of such eminence as to call for attention and represented a very broad cross section of the profession. Somerville Hastings, MS, FRCS, was already one of the most trusted members of the Labour Party but he was also a senior surgeon at a London Teaching Hospital, and surgeon in charge of the Ear & Throat Department of the Middlesex Hospital. Dr Alfred Welply, who was General Secretary of the Medical Practitioners’ Union and became the first Treasurer of the SMA, was of great assistance in organization. Two Trustees were elected, although as Dr Brook recalls ‘there was no property to be held in trust’. But they were in a way a demonstration of the wide support the Association had. They were Dr V. H. Rutherford who had joined the Labour Party after a period as a Liberal MP and Dr Hector Munro a life long socialist, a close friend of Keir Hardie and a man of original views in politics and medicine. On the first executive committee there were Members of Parliament, Dr Alfred Salter and Dr Robert Forgan; Dr Caroline Maule, a medical graduate of the University of California; Dr A. V. R. Menon, an Indian practitioner, Dr S. W. Jeger who later became MP for South West St Pancras; Dr Oscar Tobin (later known as Watts-Tobin) who had been first Labour Mayor of Stepney; Dr Frank Bushnell, a man of great drive and originality and Dr John Powell-Evans who after thirty years was still a member of the Executive Committee.

It is a significant fact that from that moment the Socialist Medical Association was and still is continually represented in the House of Commons: and represented by men whose worth was acknowledged by all. Alfred Salter represented West Bermondsey, but he did more than represent it. He fought for it and for every one of its impoverished citizens. Charles Brook writes of him as ‘the most militant pacifist and dictatorial democrat I have ever known’. He fought for a revolution but accepted every reform he could get while fighting and under his influence Bermondsey became a very changed and much more healthy borough.

Dr Frank Bushnell was a much less tolerant man who twice fought unsuccessfully to get into Parliament. He had been tuberculosis officer in Plymouth and when he retired became a member of that City’s Council. He believed that a healthy nation would be possible only when the workers had realized that they were responsible both for personal and communal health and he founded ‘The Plymouth Workers’ Health Council’ to advance that idea. In 1931 he expanded it into the Socialist Workers’ National Health Council. The work he did was prodigious but unrewarded, partly because as he grew older he found it difficult to convey his ideas in simple form and was in such a hurry to get things done even his most devoted followers could not keep pace with him. The SMA found his views stimulating but tried and failed to persuade him that it was the better organization to do what he wanted, ‘to further the knowledge of the Socialist application of Medicine to public health and well being and to demonstrate that the full advantage of socialized medicine can be enjoyed only in a socialist state’.

That phrase was to occur over and over again in SMA discussions and in one form or another created quite sharp divisions of opinion, usually at times when political discussions in the country as a whole had reached a point of climax. One of the first was when Sir Oswald Mosley formed his ‘New Party’, and drew one of his strongest supporters, Dr Robert Forgan, out of the SMA. He failed, however, to draw it out of the Labour Party toward which the major arguments for a socialized service were now to be directed. At the first meeting of the newly formed Executive Committee, held at the House of Commons in November 19, 1930, a Research Sub-Committee was formed and given the immediate task ‘to devise practical measures for a Free Socialised Medical Service’.

The new young organization was nothing if not daring and the Research Sub-Committee invited various bodies to submit their views. Dr Brook reports his astonishment and satisfaction when the British Medical Association at once agreed and sent the then Chairman of the Representative body, Sir Henry Brackenbury, and the then Secretary, Dr G. E. Anderson, to give their views. Brackenbury had been a member of various committees with Somerville Hastings and this may have prompted the ready acceptance.

A month later, in December 1930, Lewis Silken, later Minister of Town and Country Planning suggested that the SMA should prepare a ‘Health Policy for London’ and this was ready in time for the 1931 London County Council election. The organization had, as yet, no paid staff and Charles Brook recalls how he spent a part of Christmas Day at his home in Balham typing copies of this memorandum. It was work well done for it formed the basis of LCC policy when Labour won control in 1934. Somerville Hastings had a great influence over health policy in London and was for many years Chairman of the Public Health Committee: and in 1944 Chairman of the Council itself.

The SMA was no sooner founded than it was invited to join the International Socialist Medical Association (the first of two brief attempts to establish such a body). It met at Carlsbad in the spring of 1931 and the SMA was represented by Somerville Hastings and V. H. Rutherford. They reported a rather disappointing conference for they had not heard the thrilling propaganda for socialism they had hoped to hear but very lengthy talks on abortion and whether legal abortion should be performed by private practitioners or state doctors. Before another conference could be held many of the moving spirits were caught up in the struggle against Fascism and Dr Ewald Fabian who was then Secretary soon had to leave Berlin. But the SMA was to find itself involved in many international problems and remains committed to international cooperation, especially in health.

The main effort between 1930 and 1934 was to work out a statement of policy and to get that statement accepted by the Labour Party. This was done in two stages. In 1932 Somerville Hastings moved a resolution, which was carried, calling for the establishment of a State Medical Service. But thinking on the subject now advanced rapidly and at the 1934 conference at Southport the Labour Party Conference unanimously accepted an official document on a National Health Service which had been prepared by a special sub-Committee which was largely composed of SMA members.

The Labour Party document The Peoples’ Health carries the name of Somerville Hastings as author but also carries a warning that it had not at that time been accepted by the Labour Party as a whole. The SMA published A Socialized Medical Serviceand there are just enough differences between the two to show that the author met some differences of opinion in one of the organizations to which the drafts were presented. The SMA, at that time, thought the GP could look after no more than 2,500 people (the 1968 average is just under that figure) but the Labour Party thought 2,000 would be enough. It was in these documents that the definition of Health Centres manned by Home doctors was first clearly set out and it was here too that ‘Group laboratories’ first appeared. For the first time also a ‘regional form’ of unified health authority was advocated but the difficulties of reorganizing local government to achieve this were recognized and a form of county administration was mentioned as a possible unit.

It should be noted that the SMA document did not pass the Second Annual General Meeting in May 1932 without a great deal of argument. Dr Frank Bushnell was particularly concerned at ‘reformist’ tendencies for nowhere was there a clear recognition, to his mind, that both the workers in the health service and all other workers as possible patients, should share control of most parts of the service. There was a little doubt in the minds of some members. as to the wisdom of going for a complete service at one time rather than extending national health insurance first and following up with the hospital service afterwards. This same argument was still to be heard in the 1942-46 period when the lines of the National Health Service were finally laid down.

It was at this same annual meeting that many people later to become better known in politics made their first appearance. Dr Jeffrey Samuel joined and was later to replace Dr Welply as Treasurer; and his wife Dr Edith Summerskill began her long association with politics and health in the SMA and the Labour Party. She suggested that the SMA could and should attract a great deal of notice to itself and make some money which it badly needed by properly organized social events. Such an idea is always welcomed and, as always is handed back to the proposer for the necessary action. So began ‘Someda’, a series of dinner-dances held in conjunction with the Annual General Meetings for the next five years. They attracted not only the members but many well known political figures. Clement Attlee, Herbert Morrison, Christopher Addison, J. R. Clynes, Arthur Greenwood, Ellen Wilkinson and J. B. S. Haldane all attended. The Labour Party was recovering from its setback of 1931 and this was a period of great activity for all in the political field.

In order to broaden the appeal to members each annual meeting was planned to include a ‘Popular Lecture’ and some of those proved over the years to be exceedingly valuable in setting the trend of opinion. In 1934 Esther Rickards spoke on the need for a National Maternity Service and provoked such a discussion that a special meeting was held in the following November to thrash out a detailed policy. On most heads there was general agreement but Miss Rickards and Dr Summerskill took opposite views on the proportions of hospital and domiciliary midwifery a service should plan for and what qualifications those doing midwifery should hold. Dr Charles Brook says ‘this started the campaign for safer motherhood in Britain and thus it can be reasonably claimed that the SMA was the organization primarily responsible not only for making the nation conscious of the needlessly high rate of maternal mortality and morbidity, but for providing the initial drive for the subsequent legislation which had such remarkable results’. Esther Rickards became a member of the LCC Health Committee (and many other bodies) while Edith Summerskill included the subject in her increasing platform appearances.

The SMA memorandum, A National Maternity Service was printed as a supplement to The Socialist Doctor which was then appearing, rather spasmodically, as funds permitted, under the editorship of Dr David Stark Murray. Dr Brook in Making Medical History recalls that Dr Murray had attended the inaugural meeting of the SMA (he had also attended the terminal meeting of the old SMSA) and was elected to the EC in 1931. The son of a former Scottish Labour and Cooperative MP, poet and journalist, he was soon drafting documents and when the publication of The Socialist Doctor was proposed was at once appointed editor. Owing to financial stringency very little money could be spared for this publication and, eventually, through lack of support, it slowly petered out. But later pages will report how it was replaced by a better and more permanent journal. In the years that followed David Stark Murray became both recorder and stimulator of developments in the SMA and wrote hundreds of articles for newspapers under his own name and a number of pseudonyms. (This history is the final outcome of that work.) The propaganda, by written and spoken word, which the SMA carried out in its first fifteen years was not only intense because it was directed to one single aim but was continuous and of surprising volume.

From the moment it first met the Executive Committee of the SMA recognized that it would need ‘local’ organization as well as a national body if its propaganda was to be effective. Before the end of 1930 a London and Home Counties Branch was formed with Dr Morgan Finucaine as Chairman and Dr J. Powell Evans as Secretary. In the same year the Association acquired an Honorary Solicitor, a link which has been maintained with the legal profession ever since. The SMA was fortunate from the start in having many prominent women doctors and other health workers as members. In 1931 Dr Caroline Maule, an American physician working in London, acted as assistant Secretary. Miss Esther Rickards led most discussions in midwifery and Miss Amy Sayle on social welfare problems. As we have already noted Dr Edith Summerskill plunged into money raising activities and Dr Dorothy Arning was for a long time member of the EC. Miss Helen Keynes was always prominent in discussions of mental health.

In 1935 the SMA took a very important place in Labour Party affairs when ten of its members stood as candidates in the General Election. They were Christopher Addison, Wm Bennet, Charles Brook, Somerville Hastings, Elizabeth Jacobs, S. W. Jeger, R. A. Lyster, Alfred Salter, Sam Segal and Edith Summerskill. It was not a good year for Labour; only Dr Alfred Salter was elected. Dr Addison later became a Peer, and at the time of writing this book two of the ten, Drs Segal and Summerskill are in the House of Lords.

It is also of interest that the SMA attracted many Medical Officers of Health, a group who did not normally show their own political opinion. Dr Lyster, a founder member was joined by Dr Victor Freeman (who was Chairman of the EC in 1969) and Dr Sam Leff, a great worker for socialism and for health until his premature death in 1964.

During the next two years the SMA began to feel the pressure of political events on the continent of Europe and was soon busy trying to assist refugees from Austria, Germany and Czechoslovakia. The 1933 annual conference protested against Hitler’s persecution of medical workers for political and racial reasons and sent aid to victims of Nazi and Fascist persecution. At home arguments for health service developments continued and in 1936 the SMA submitted its views to the Voluntary Hospitals Commission whose Chairman was Viscount Sankey. Dr Brook records that ‘Somerville Hastings dealt with the need for properly equipped and adequately staffed convalescent hospitals, Esther Rickards urged the necessity of establishing an appointments system in hospital out-patients departments, while I advocated the creation of a central bureau for arranging for the immediate admission to hospital of urgent cases and the pooling of beds for this purpose’. All these ideas were accepted and in particular the Emergency Bed Service for London was inaugurated as a result of the Commission’s report.

Half way through 1936 there arose a pressing need for medical aid for the Republican forces in Spain. The SMA was soon involved in an all out effort to send people and materials but the idea of setting up a Spanish Medical Aid Committee came from Dr Brook on whose shoulders most of the work was to fall. His first approach was to Arthur Peacock who was then running the National Trade Union Club and because of his ready support that became the headquarters of all the Spanish Medical Aid activity. A very hurriedly summoned group met on the Saturday prior to August Bank Holiday and agreed unanimously to set up and work for a Spanish Medical Aid Committee. Dr Brook thought he had done enough in suggesting the committee but by unanimous request became the Honorary Secretary. The majority of the Committee were members of the SMA. Dr Christopher Addison became President, Dr H. B. Morgan, who was medical adviser to the TUC, became Chairman, and Somerville Hastings the Vice-Chairman. Among the other medical members were Harry Boyde, Michael Elyan, J. A. Gillison (LCC) P. D’Arcy Hart, Tudor Hart, S. W. Jeger, R. L. Worrall and Professor R. Marrack. Non medical members included Ellen Wilkinson, Leah Manning, Isabel Brown, Arthur Peacock and the Joint Treasurers, Viscount Churchill and Viscountess Hastings. There was of course opposition to the idea but the Albert Hall was taken for a meeting and Lord Addison presided over a crowded hall. As Chairman, Dr H. B. Morgan had a very heavy task, particularly since he was a Roman Catholic and found himself opposed by pro-Franco elements in the Church. His position as medical adviser to the TUC proved very useful in getting certain kinds of assistance. Somerville Hastings spared no effort in time or money to get the Committee moving.

With such fervour was the cause supported and so much money came in that it was decided something better could be done than simply sending supplies of medicine and dressings. This was to send a completely staffed and equipped Medical Unit and in just three weeks volunteers had been found, vehicles purchased and equipped and the unit was ready to leave. On Sunday August 23, 1936, thousands turned out to accompany and cheer the first British Medical Unit as it went from New Oxford Street to Victoria Station. There in the presence of a very large crowd, including many of London’s Mayors, Arthur Greenwood and Alan Findley, then Chairman o( the General Council of the TUC, despatched the Unit with valedictory speeches.

Dr Brook remained Honorary Secretary of the Spanish Medical Aid Committee until the end of 1936 when its work called for a full time Organizing Secretary. George Jeger, later MP for Winchester was appointed. This committee kept up supplies and found new volunteers until the end of the Spanish Civil War, and was then responsible for bringing to this country doctors and other medical workers who would have been in danger if they had stayed in Spain. Among them was Professor Trueta, already renowned for his surgical work, who settled in this country and became Professor at Oxford. Many lessons were drawn from the war in Spain, where SMA members were in the front line with their surgical and blood transfusion units. One of them, Dr R. S. Saxton, in the issue of Medicine Today and Tomorrow of March 1939 put forward the proposal, later implemented by the Government, that a civilian National Blood Transfusion Service should be set up at once ‘if we are not to be at the mercy of hasty improvisations should hostilities break out’.

Thirty years later that article reads like a description of what we actually do today and under the NHS the transfusion service has fully justified Dr Saxton’s claim that ‘when the Service has been established the fruits of our experience in Spain will enable us to make of it something of inestimable value in the practice of modern surgery’.

It was indeed the knowledge gained in Spain by its own members which led the SMA to take up and publish pamphlets on a number of war-medicine topics we will note in a following chapter. But the years 193739 were years of enormous effort by the SMA collectively and by individual members. It was at this time that the re-examination of policy and the elaboration of new schemes were most actively pursued and the SMA was leading medical opinion in nearly every field. It had, of course, the invaluable asset that its committees were never lopsided but always had the benefit of paramedical personnel, and many laymen with wide experience, sitting with medical men and women. It took a far wider view of problems than any purely medical group could possibly do.

At the same time it could put up teams on many topics whose names were already acceptable in public and in professional circles. General medicine was carried by such experts as Dr Horace Joules, Dr Hugh Gainsborough, Dr Richard Doll, Dr Alan Jacobs, Dr Donald Court, Dr Duncan Leys; Ophthalmology by Professor Arnold Sorsby and George Black; Chest diseases by Dr Philip Ellman, Dr B. K. Cullen, Dr Francis Jarman, and many others; Pathology by Professor J. Marrack, Dr G. Signy, Dr D. Stark Murray, Dr Harry Winner, Dr H. Voss, Dr Len Crome and so on; Psychiatry by Dr Leslie T. Hilliard, Dr Elizabeth Bunbury, Dr Brian Kirman; and general practice by practitioners from all over the country. Many were very prominent in their BMA and Medical Practitioners’ Union local branches. Dentistry was well covered, and opticians were especially active.

The Second World War was to produce many portents of change but it is doubtful if the health services would ever have advanced as they were to do if the SMA had not been busy during the whole period supplying material for discussion and supplying speakers for innumerable meetings. It was something of a phenomenon not always remembered that war did not suppress but rather stimulated public desire for debate on social problems. A glance at the SMA press cuttings book for the period shows that meetings on health and health service questions were being held all over the country and the SMA speakers were in continuous demand. But it was in the years 1937-39 that the policies were elaborated that carried right through to the 1946 Health Service Bill.

What do you think?

Enter your email address to subscribe to this blog and receive notifications of new posts by email.

Follow us on Twitter

%d bloggers like this: