Fit to Practise: Empire, Race, Gender, and the Making of British Medicine, 1850–1980 by Douglas M. Haynes

Abstract

166 BOOK REVIEWS Douglas M. Haynes, Fit to Practise: Empire, Race, Gender, and the Making of British Medicine, 1850–1980 (University of Rochester Press, 2017). ISBN: 978-1-58046-581-6 (HB). 246 pp. In Fit to Practise, Douglas Haynes presents a well-researched political history of the British General Medical Council or GMC, describing the processes by which admission into the GMC register since its creation in 1858 was deployed as a political tool, to promote and protect Britain’s interests. Haynes examines the admission of marginal groups to the register—women, Jewish refugee doctors, overseas doctors of colour—as reflecting the ‘fictive homogeneity’ of politically-constructed images of ‘British medicine’(p. 6). These imaginings are shown to be in constant negotiation, reflecting the tensions of changing and competing imperial, colonial, and national interests. In exploring which doctors were fit to represent British medicine between 1850 and 1980, the continuity of primarily protecting British-trained doctors’ interests, projecting British medicine as a global standard, and preserving the local profession as normatively white and male is also revealed. In constructing this narrative, Haynes draws on a wide array of institutional and state records, as well as publications of the GMC, Privy Council, and governmental committees. Fit to Practise is structured chronologically, and in two parts. Part 1 examines the key developments in the ‘invention of British medicine’ from 1858 to1948, marked by changing British imperial power and the impact of two world wars. Part 2 examines the ‘remaking of British medicine’ from 1955 to 1980 in an era of increasing globalisation. The first chapter provides background, tracing the negotiation of territorial, racial, and gender boundaries of British medicine. Subsequent chapters discuss critical developments in the political history of regulating the GMC register, from the negotiation of reciprocal recognition with Italy and Japan at the turn of the century (Chapter Two), to the changing power relations as former colonies and dominions—including Canada and New Zealand— exercised authority in curtailing access to their local medical markets (Chapter Three). A central concept explored in this book is the rise and fall of the principle of medical reciprocity as a regulatory mechanism by which nation states could forge alliances of mutual benefit. Haynes argues that the GMC cherished this reciprocity from its introduction at the turn of the twentieth century, as it enabled it Health & History ● 20/1 ● 2018 167 to balance its sometimes contradictory goals of protecting the privilege of British-trained doctors, whilst promoting British medicine internationally. Through reciprocal recognition, Britain could mobilise a global medical market to fulfil its political will. This was exemplified in both world wars when Commonwealth and foreign qualifications were temporarily admitted to the register to mitigate British military and civilian shortages in medical labour. This narrative of national gain is tempered by an exploration of the implications of moulding the medical register to suit changing British interests. In the case of Jewish doctors who sought refuge in Britain in the 1930s, for example, Haynes highlights how in exercising the reciprocity clause to prevent their registration, ‘the council became complicit in extending pre-war anti-Jewish laws in the United Kingdom’ (p. 92). Similarly, Chapters Five to Seven highlight how the intersecting debates over socialised medicine embodied in the new National Health System brought to the surface racial tensions as the departure of British-trained doctors increased the visibility of incoming Indian, Pakistani, and non-white doctors in the NHS. Their growing presence ignited calls for increasing temporary registration, as well as mandatory testing of language and medical competence of potential registrants, which Haynes argues was underpinned by a desire to preserve the whiteness of the local profession. Perhaps the one aspect that this book does not deliver on is in the analysis of gender. In part, this reflects the limitation of the primary subject of this book—the GMC medical register as a political instrument—as a basis for such an analysis. Once women were able to overcome barriers to gaining a recognised medical qualification, their admission into the register was no longer subject to legal obstruction. Although gendered barriers continued to operate, the GMC’s remit was to regulate standards of medical education. For...