Themselves Writ Large: The British Medical Association 1832-1966 (review)

Peter Bartrip follows his history of the British Medical Journal (Mirror of Medicine: A History of the BMJ [1990]) with an account of the society that sponsored it. Whereas the BMA’s origins were regional, in the Worcester-based Provincial Medical and Surgical Association, the Journal moved by mid-century to the capital, where it successfully supported its parent through difficult times. The BMA’s headquarters did not move to London until the 1870s; by the end of the century, as a national rather than provincial body, its members included about half the qualified medical practitioners of Britain, with thriving offshoots in the Empire. By then it was the mouthpiece of the profession, and government has recognized it as such ever since.

The role of the BMA in many standard histories has been contentious. It has been used as an example of how professionals may further social improvement by fighting for proper training for physicians, the eradication of quackery, and state involvement in public health. More cynically, it is presented as an effective example of “occupational closure,” in which a profession guards its income and status by forcing out rivals. Although it began as an association for provincial physicians, it is often seen as falling into the hands of self-interested metropolitan consultants, the “swell doctors” who confronted Lloyd George in framing the National Insurance Act of 1911, or Aneurin Bevan at the inception of the National Health Service. There is plenty of scope for a history that arbitrates between the congratulatory narratives of the past and the aloofness of sociology.

Peter Bartrip feels obliged to defend himself from the charge of writing “in-house” history, since this book was commissioned by the BMA. The defense is hardly needed, for this is a well-balanced book, giving the Association its moments of triumph (the promotion of scientific medicine; the mobilization of medical manpower in both wars)—and of ignominy (the farcical decision to exclude women after inadvertently admitting Elizabeth Garrett Anderson; the public acrimony during the formation of the National Health Service). Bartrip’s most surprising contribution to this story, however, is his revelation of the structural inefficiency of the BMA. It will be difficult, in future, to present the Association as a disciplined medical hierarchy acting promptly and rationally on behalf of its members. In fact, its early history was characterized by much bickering and a great deal of administrative ineptitude. As Bartrip argues, without the BMJ and its charismatic editor Ernest Hart, the BMA might well have ended up as one of the plentiful local medical societies, devoted to “science, suppers, and socializing” (p. 352). Even after its decision to capture the politics of medicine, it was hampered by its decentralized nature and by the difficulty of speaking for the profession as a whole. Understanding this, the BMA leadership was particularly careful to canvass its members during the crucial political maneuvers in 1911 and 1948, belying the accusation that it spoke for medical elites only. Given this interesting line of approach, it is a shame that Bartrip does not have space to discuss the work of any of the BMA’s regional branches, which were often vigorously independent.

Bartrip’s work on the BMA and its major publication is the most substantial so far, and he gives a satisfying account of the difficulties in operating a medical pressure group, even one as apparently powerful as this. Inevitably, the story after 1948 seems to fragment, as he discusses selected aspects of the BMA’s involvement in such diverse areas as contraception and the clinical use of heroin. The conclusion is disappointingly brief; it would have been useful to have summarized the main themes more forcefully. There is no bibliography. One irritating feature of this otherwise instructive book is the very high cliché count, both within quotation marks and in Bartrip’s own prose, which hints at overexposure to the archives of BMA after-dinner speeches.