Scotland's Health, 1919–1948, and: The National Health Service in Scotland: Origins and Ideals, 1900–1950 (review)

Beginning in Britain on the Appointed Day, 5 July 1948, the National Health Service (NHS) was the result of separate legislation for England and Wales on the one hand, and for Scotland on the other. Charles Webster incorporates Scotland into his magisterial history of the NHS¹ but suggests that the differences between Scotland and England and Wales were not significant; other commentators on the origins and early years of the NHS suggest that the differences were so great that these authors limit their accounts to England and Wales. We are now fortunate to have two books that explore the distinctiveness of the patterns of disease and the nature of health care, health administration, and government policies toward health in Scotland during the years leading up to the establishment and implementation of the NHS. The books focus on the same period, from the end of the First World War until 1948, and not only do both authors argue that Scotland differed from England and Wales, but they are the first to elaborate the similarities and differences at length. At the same time, the books differ considerably from each other. Although there is some overlap, their emphases are distinct and, in the end, complementary.

Jacqueline Jenkinson, author of Scottish Medical Societies and a coauthor of The Royal: The History of the Glasgow Royal Infirmary, has written a highly structured and systematic book, concentrating on the personal health services, excluding mental health services and voluntary hospitals. In her introduction she establishes distinctive features of the Scottish population, economy, society, and morbidity and mortality patterns. Compared with England during the interwar years, Scotland displayed a unique combination of concentrated urbanization and heavy industry alongside remote regions of scattered population; deep-rooted poverty; severe housing problems; high levels of unemployment; and high morbidity and mortality rates (infant, maternal, and tuberculosis). Jenkinson then provides two chapters setting out the structure of health administration before and after 1929. In 1919, when the Ministry of Health was set up in England and Wales, a separate Board of Health was established for Scotland, composed not of civil servants but of "experts." In 1929 the secretary of state for Scotland became a cabinet office and the Board of Health became a department run by civil servants and was moved to Edinburgh. Jenkinson clearly describes the changes in administrative structure, and in the process she introduces Muriel Ritson, a pioneering woman health administrator, and shows that Ritson and other health administrators provided continuity through the administrative reorganizations. The next four chapters explore particular areas of health administration of major concern during the interwar period: infant and maternal welfare; the health of school-aged children and controversy over their nutrition; tuberculosis; and national health insurance. In the final chapter she resumes the chronological account, discussing the wartime health services and the creation of the National Health Service. Given the topical structure, there is inevitably repetition, but Jenkinson contributes useful tables setting out the wide variations in health patterns within Scotland. She also employs the Scottish experience to address controversies in the literature over the nature and extent of devolved authority, and over the process of policy formation, as well as historiographic controversies such as that between Charles Webster and Jay Winter over the health consequences of the First World War and economic depression in the interwar years, and Richard Titmus's view that warfare promoted welfare in the Second World War.

W. Morrice McCrae's book is a revised version of his Ph.D. thesis, admirably undertaken in the Department of History at the University of Edinburgh after a successful career as a medical practitioner and administrator in the Scottish Office. He effectively draws...