The State, the Family and the Scottish Health Problem, the work of Dr Leslie MacKenzie, 1891-1928

Abstract

When Dr Leslie MacKenzie was appointed to the post of medical officer of health for Kircudbrightshire and Wigtonshire in 1891, he was to begin nearly thirty years of public service in Scottish health administration. In 1894 he transferred to Leith to become its first full-time medical officer and in 1901 was appointed the Local Government Board's medical inspector and then its medical member. In 1913 he became a member of the Highlands and Islands Medical Board at its foundation and in 1919 a member of the Scottish Board of Health. The only other officials who matched his record were Dr H.D. Littlejohn, who served as part-time medical officer for Edinburgh and the Board of Supervision (1859-1908), and Dr J.B. Russell, who was Glasgow's medical officer (1872-1898) and medical member of the Local Government Board (1898-1904). Surprisingly there has been little detailed comment or analysis of what kind of contribution MacKenzie made to public health, or indeed his relationship to local authorities, the medical profession and the Government. Ferguson in his work on Scottish Welfare acknowledges his presence, but ignores any special impact he may have made.1 There are scattered references elsewhere. For instance, it is known MacKenzie was involved and was used by the Webbs in their attempt to undermine the 1909 Poor Law Commission, but generally there is nothing of the detail of his work.2 Yet, during his public health career, MacKenzie wrote over fifty books and articles on public health which dealt with topics such as 'the Hygienics of County Water Supplies', 'Diphtheria and its Prevention', 'the Administrative Control of Tuberculosis', and 'Scottish Mothers and their Children'. As medical inspector for the Local Government Board, he undertook more than 100 special inquiries into matters such as hospital overcrowding, defective water supplies and the outbreak of infectious disease.3 MacKenzie presented evidence to a number of Government Commissions, including the Royal Commission on Physical Training and the Royal Commission on the Poor Law. He was largely responsible for designing the special scheme of assistance for the Highlands and Islands medical service in 1913 and drafted the topics of inquiry for the Royal Commission on Housing (1917), on which he sat as a member.4 In later life he provided advice for schemes of medical and nursing service in Canada, South Africa and Kentucky and held a number of prominent positions within the professional circuit of public health administration.5 The lack of recent work stands in contrast to the contemporary view that MacKenzie was one of the first in Britain to realise the limitations of the postChadwickian school of public health.6 His obituary notices uniformly support this view and comment on his 'pioneering' contribution to schemes for the control of tuberculosis and the medical inspection of schoolchildre n.7 In 1905 the Conservative