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Edited by Morrice McCrae. East Linton: Tuckwell Press, 2003, £25.00 (hardback), pp 278. ISBN 1 86232 216 3
At the back of an old family album is a photograph of a bewhiskered gentleman posing with his wife on the steps of a grand house with a pillared portico, surrounded by his staff including the chauffeur of the Rolls Royce that was de rigeur at that level of society. He was my great-uncle, a successful practitioner in Burslem, and his financial success contrasted with that of his brother, a Glasgow obstetrician, who lived in comfortable but by no means plutocratic style, his earning capacity restricted by time spent with indigent patients in the Duke Street and Royal Maternity Hospitals. This contrast between entrepreneurial and service orientated practice encapsulates the differences between the English and Scottish medical systems in the early part of the twentieth century that are explored in some detail by the author, and which he believes were largely responsible for the relatively easy transition from private to socialised medicine in Scotland.
Scotland of course had the added advantage of an earlier experiment in state provided medicine in the form of the Highlands and Islands Medical Service, and this is discussed in the first chapter of this book. However, the author points out that it had another and even greater advantage that is now all but forgotten. On the day I was born, 2 July 1936, the Report of the Committee on Scottish Health Services (the Cathcart Report) was published. It attracted little attention outside Scotland. The Times of that day, given to me as a birthday present, carried a half column summary of the report, with no editorial comment—contrasting with the two columns devoted to racing at Newmarket. But this report was seminal in providing a blueprint for the later NHS (Scotland) Act, which was actually written before the England and Wales Act, and which ensured that the structure of the NHS in Scotland was quite different to that in England. For instance, in Scotland from the inception of the NHS the teaching hospitals were administered by the Regional Hospital Boards, and were therefore at the centre of service provision, rather than standing aloof under a Board of Governors, a situation that would not be remedied for several decades.
This book is however much more than just a history of Scottish medicine in the first half of the twentieth century; it deals in great detail with the social and economic circumstances that led to the welcome given to the NHS by Scottish doctors. It is also justifiably critical of the failure of the BMA to reflect these feelings, undoubtedly shared by the great majority of the medical profession in Scotland.
Finally, readers may well ask why a non-paediatric book has been sent for review to the Archives. The author is in fact Dr Morrice McCrae, formerly of the Royal Hospital for Sick Children in Edinburgh, and well known in paediatric gastroenterology and cystic fibrosis circles. Morrice has been miraculously transformed into a distinguished historian, and his book will appeal not only to those interested in the development of state provided medicine, but to anyone interested in the social, economic, and political history of Scotland.