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  • Fit to Practice: Empire, Race, Gender, and the Making of British Medicine, 1850–1980 by Douglas M. Haynes
  • Roberta Bivins
Douglas M. Haynes. Fit to Practice: Empire, Race, Gender, and the Making of British Medicine, 1850–1980. Rochester Studies in Medical History. Rochester, N.Y.: University of Rochester Press, 2017. x + 246 pp. $99.00 (978-1-58046-581-6).

There is much of value in Douglas Haynes's latest monograph, not least his demonstration that battles about medical registration and regulation in imperial and postcolonial Britain extend far beyond such now-familiar domestic controversies as the tensions between metropolitan medical elites and provincial medical masses, or indeed between allopathy and its alternatives. Here, Britain's General Council of Medical Education and Registration (GMC), and the Medical Register that it exclusively controlled, are revealed as engines of medical empire building, spreading and to a degree enforcing a particular vision of "British medicine." In the process Haynes usefully reminds readers of the ways in which controls placed on medical registration mediate access to regulated medical marketplaces and can work to limit or exclude the entrance of women, foreign, and colonial medical graduates to the profession.

Haynes's findings for the nineteenth and early twentieth centuries, the subject of the first half of this volume, are important if unsurprising: domestically trained white males of British origin were privileged by Britain's territorial and social boundaries and hierarchies, and this privilege was perpetuated by GMC and other bodies regulating entry to medical profession in Britain. More innovatively, this four-chapter section also tracks the ways in which British medical licensing was significantly shaped by European and extra-European medical markets and regulatory regimes, and the effects of significant disruptive factors—from war to decolonization—on the apparatus of medical mobility. Case studies explore the negotiated emergence of "medical reciprocity" (that is, the right of non-U.K.-trained and -qualified practitioners to practice in the United Kingdom without reexamination, and vice versa) with Italy and Japan, and for Jewish medical refugees and Dominion and colonial practitioners in the United Kingdom. Together, they illustrate that medical registration and professional rights followed the boundaries and political trajectories of the British state, acting as tools for the projection and reflection of international influence. [End Page 469]

Only in the final quarter of part 1 do the themes of race and identity suggested by Haynes's title emerge, as Haynes begins to argue for "the imperial nature of the authority of British medicine" (p. 72). This work continues in the volume's part 2, also comprising four chronological chapters, exploring medical licensing in Britain's postwar National Health Service. As an increasing number of authors have now argued, the new health service was profoundly reliant on overseas staff. Haynes portrays this form of medical mobility as an unappreciated transfer of wealth from Global South to Global North, and in human capital terms this is certainly correct. However, his arguments about the NHS are at times overstated and undercontextualized. After 1948, for example, medical resistance to the NHS was a minority view; medical out-migration, though a source of profound unease and an evergreen propaganda tool for the British profession, was often exaggerated, particularly by the medical journals that serve as important primary sources for Haynes.1

Across part 2 Haynes's attention to the minute detail of medical registration will provide expert readers with a useful narrative of previously unexplored regulatory territory, while Haynes's figures invaluably document the "global profile" (p. 114) of medical staffing in Britain's NHS. However, his narrow focus hampers a fuller exploration of the meanings and impacts of this combination of nationalization and globalization within a single health system. Haynes advances a host of interesting claims—that English-language competency became a key (but ironically incommunicable) marker of professional belonging in the NHS (p. 151); that the regulatory environment was particularly hostile to nonwhite clinicians (p. 183); and that this reflected public unease about the visibility of racialized medical staff in the NHS. These tantalize, but remain largely unsupported. Moreover, Haynes's heavy and at times uncritical reliance on what are professional views of the British medical profession—accounts...

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