The British government is struggling to tackle public health issues and today's problems of social exclusion. But social medicine owes much to an almost forgotten committee of young radicals. Philip D'Arcy Hart, its secretary in the 1940s, reminds Geoff Watts of its contribution
“One of my teachers said to me, ‘Hart, you’ve got to make up your mind. Do you want to work in research or have a Rolls Royce?' I decided I wouldn't get a Rolls Royce because I didn't think I was good enough.” So research it was.
It was this self effacing assessment, made in the 1930s, that helped to propel Philip D'Arcy Hart out of his job as a consultant physician at University College Hospital and into a post at the Medical Research Council (MRC). More than 60 years on, looking back at the decision, he can take a dual pleasure in it. The choice was professionally fruitful, and D'Arcy Hart's longevity—he celebrated his 101st birthday in June—has given him a unusually long period over which to enjoy those fruits.
In his early days with the MRC he investigated the health of coal miners. “It was known that miners who worked in rock got silicosis. Men who worked at the ordinary coal face, hewing coal, also had lesions that killed them. But they weren't compensated. With war coming, the government knew it would need the support of the miners. So it decided on some science that would keep them content.”
D'Arcy Hart's report was published in 1942. Through his use of the blanket term pneumoconiosis, coal workers too became eligible for compensation.
After the war he became director of the MRC's tuberculosis unit, and, in collaboration with his deputy, Marc Daniels, and the statistician Austin Bradford Hill, he tested the newly developed streptomycin in what is now regarded as the first randomised controlled trial. Further work on drugs for tuberculosis marked the beginning of the end of the old approach of treatment sanatoriums, and a large study of the benefits of BCG in adolescents lead to Britain's mass vaccination programme.
The first of D'Arcy Hart's several “retirements” came at age 65 when he switched to laboratory research on mycobacterial disease at the MRC's Mill Hill laboratories in London. Although he has now abandoned laboratory work, he remains a visiting scientist and still makes regular appearances at Mill Hill.
Although D'Arcy Hart's hearing is now rather weak and his memory isn't what it was, for a centenarian he's in good condition. But one thing rankles and disturbs his peace of mind: the lack of recognition, as he sees it, afforded to a gathering that flourished briefly but brightly in the early 1940s. The Committee for the Study of Social Medicine was, despite its official sounding name, an informal group comprising mostly doctors and scientists. It first met in 1939; D'Arcy Hart was its secretary.
At London's University College Hospital Medical School, and later at St Mary's, the committee arranged lectures and discussions and offered a forum for swapping ideas. The topic, a common interest of its 40 or so members, was the nature of social medicine, and how it might be applied to a society ripe for the more equitable distribution of what makes for better health.
“I became interested because I was a socialist,” says D'Arcy Hart. Were all the group of a like mind, politically? A pause. “I'm sure there were no Tories in it.”
Unsurprisingly—it is, after all, in the nature of such assemblies—some of the talk was decidedly introspective. “We thought it was a good thing to know what social medicine was,” recalls D'Arcy Hart. “Some people said it was the same as public health. Some said it was Marxist medicine. We tried to find a definition.” And did they? “I can't remember,” he admits. So probably not! But one can imagine the self indulgent pleasures of the endless discussion.
More to the point, the committee produced several valuable pieces of work. These included a study of mothers who did not have their children immunised against diphtheria; a survey of the financial effects of having tuberculosis; and a paper in the Lancet by two of the group on juvenile rheumatism, a disorder found disproportionately in lower social classes.
The committee's activities came to a sudden and premature halt before the end of the second world war when a bomb destroyed its records. After this setback the committee dissolved, never to reform.
A short life span and, it has to be said, a fairly modest set of achievements. So why does D'Arcy Hart rate it as having been so important? Not so much for what the group did, he says, as for who belonged to it. Indeed, half a century later it is remarkable how many of the names are still familiar. The two authors of the juvenile arthritis paper were Jerry Morris and Richard Titmus—later to become, respectively, the first director of the MRC's Social Medicine Research Unit, and the celebrated professor of social administration at the London School of Economics and author of the classic work on blood transfusion, The Gift Relationship.
Who else? There was John Ryle, an eminent physician who left a highly successful practice and the regius chair of physics at Cambridge to become the first professor of social medicine at Oxford. There was Max Rosenheim, later a president of the Royal College of Physicians. There was Tom Garland, who became director of New Zealand's Industrial Medical Service.
There was even—though he was absent for much of the time—a certain Captain A L Cochrane. Archie Cochrane, the man who went on to give his name to the Cochrane Collaboration for evidence based medicine, was detained against his pleasure in a German prisoner of war camp. He did, though, support the committee. And not just in spirit. A £50 donation delivered via his sister was the group's main source of funds.
“The committee obviously had an influence on the minds of the people who took part,” says D'Arcy Hart. “They all went on to become distinguished in their future careers.” It is, he says, a great pity that the committee has been forgotten and so denied the credit it deserves for helping to establish social medicine in Britain—surely worth at least a footnote in the history books, if not a whole paragraph.
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NICK SINCLAIR
Geoff Watts presents BBC Radio 4's Medicine Now