The Belfast Branch of the Socialist Medical Association

Introduction

The Belfast Branch (BB) of the Socialist Medical Association (SMA) was founded¹ in the autumn of 1942, one of 29 branches² of its parent, the SMA of Great Britain [sic]. It consisted of a broad church of doctors, dentists, students, and other health professionals, including nurses. Its monthly meetings attracted 25-40 individuals, but doctors never constituted more than a third of the audience.³ From what had this interest in Socialism arisen in wartime Belfast? It stemmed from a push for a comprehensive State Medical Service which Stewart claimed⁴ was, “…a sign of contemporary optimism about social reconstruction.” As we shall see, there were also local circumstances which fuelled the ambitions of the BB.

The Origins of State Medicine

According to Murray,⁵ two utopian novels paved the way for State Medicine. The first was Samuel Butler’s ‘Erewhon’, published anonymously in 1872.⁶ Its name derived from the rough spelling of ‘Nowhere’ backwards. It posed the question whether health was a right or a duty; if illness was a departure from duty or an act of God; and if medical care was a privilege or something to be denied to those wicked enough to become ill.

The other was Edward Bellamy’s ‘Looking Backward’, published⁷ in 1888. In it, the main character falls asleep in 1887, to wake up in Boston, Massachusetts, in 2000 when illness and disease are still rife. Bellamy rails against social injustice and concedes that those who cannot work should live on the produce of those who can, seeing the principle of universality of services with astonishing clarity. Goods and services were to be paid for with credit cards.⁸ The book contains this remarkably prescient sentence:⁹

No man any more has any care for the morrow, either for himself or his children, for the nation guarantees the nurture, the education and comfortable maintenance of every citizen from the cradle to the grave.

The phrase, ‘from the cradle to the grave’ will recur throughout this account, yet, in some form, it is far from new: Richard Steele, in 1709, wrote,¹⁰ “…a modest fellow never has a doubt from his cradle to his grave.”

One enterprising Belfast man, Frank M’Gibben, followed Bellamy’s lead and in 1897, published¹¹ Belfast in the Year 2000 AD. Frank had been a member of the Bakers Loyal Orange Lodge 245, the only Lodge permitted to meet on Saturday nights because bread was not sold on the Sabbath.¹² After going blind in 1890, Frank took up writing. In his book, reprinted in 2000, Frank predicted the demise of horse traffic and the Orange Order, but one of these predictions proved incorrect.

Another book which influenced the future NHS was AJ Cronin’s The Citadel, published¹³ in 1937. Cronin was a Scottish Doctor, who, while working in Wales, became interested in miners’ silicosis, and spent three years in Tredegar, which in the novel he disguised as Aberalaw.¹⁴ Aneurin Bevan, a one-time miner in Tredegar, benefitted from the The Tredegar Medical Aid Society which served as a template for the NHS.

The State Medical Service Association

In 1911, Benjamin Moore, a Biochemistry professor, suggested¹⁵ that a National Health Service would both ‘strengthen the physique of the race’ and save national resources. The State Medical Service Association (SMSA) was founded in 1912.

The Socialist Medical Association

The SMA replaced the SMSA in September 1930 when Somerville Hastings became its first President.¹⁶ Hastings and a colleague visited the USSR in 1931 and were impressed with the Semashko System,¹⁷ which included ‘Prophylactoria’ or health centres, and by the state medical education which ensured that doctors were drawn from all strata of society.¹⁸

The SMA gained affiliation with the Labour Party, and at a Labour Conference in 1932, Hastings successfully introduced this motion:¹⁹

The country’s health needs can only be effectively provided by the establishment of a complete State Medical Service, giving everything necessary for the prevention and treatment of disease, free and open to all.

Further success came two years later when the Labour Party established a Medical Services Committee on which the SMA was heavily represented,¹⁹ and its report, A State Medical Service, was discussed at the Labour Party conference in 1934. Nevertheless, the SMA’s admission of members of the Communist Party in the mid-1930s dismayed the Labour Party Executive.⁴

The Belfast Branch of the Socialist Medical Association

I learned about the BB from the Labour Historian, Andrew Boyd, the author of Holy War in Belfast²⁰ and other books. He put me in touch with several ex-members of the BB, and I spoke with them initially by telephone. In some, I detected a certain reticence to rake over old ground, as if Socialism was viewed as a youthful indiscretion.

Others were more forthcoming, particularly Drs William Calwell (see Figure 1) and Arnold Elliott (see Figure 2). Dr Calwell had been the BB’s Vice-Chairman, and I visited him in the two years before he died. He had qualified in 1937 and afterwards did a DPH, when he was nicknamed ‘The Bloodhound’ thanks to his constant pursuit of fresh material for his haematological slides.²¹ He attained an MD in 1941,²² spending most of his life in General Practice in Whitehead, Co Antrim.

Figure 1.

William Calwell (1915-2000)

Figure 2.

Arnold Elliott (1921-2009)

Dr Calwell itemised the concerns that gave rise to the BB: the poverty of the 1930s was central. Arnold Elliott, who dropped his original surname of Epstein, for obvious reasons, when he joined the British Army towards the end of the war, wrote me a wonderful letter in 2007:

The poverty at that time was appalling and unemployment rife. There were inadequately clothed ‘shawly’ women and children walking barefoot. It was this background which motivated me to study Medicine and thus ‘help starving humanity’.

The links between poverty and ill health are overwhelming and were originally categorised²³ by THC Stevenson of Strabane who devised the Social Classification system. Given the poverty of the time, it was little wonder that the health profiles in Belfast were poor. A full exploration of this lies beyond this paper’s scope, so readers should refer to Privilege and Jones’ masterful analysis.²⁴ In any case, the fathers of the fledgling Northern Ireland state bore some responsibility, as Health was evidently lowly ranked among their priorities.

The condition of the poorest in Belfast was dramatically exposed by the Belfast Blitz in the spring of 1941. The Moderator of the Presbyterian Church informed his flock that he was inexpressibly shocked:²⁵

…by the sight of the people I saw walking in the streets …I never saw the like of them before – wretched people, very undersized and underfed…Is it creditable to us that there should be such people in a Christian country… and yet there is evidence of wealth everywhere.

There followed the Carnwath Report²⁶ on the Municipal Health Services of the City in 1941. Thomas Carnwath, also born in Strabane, had been England’s Deputy Chief Medical Officer.²⁴ While the prevention, control and treatment of epidemic disease was generally well catered for, pollution in Belfast Lough was a particular problem. The decline in Tuberculosis was slower than elsewhere and the Council was criticised for not pasteurising all milk; housing, although comparable to other UK cities, was in shorter supply. There were deficiencies in school medical services, children’s nutrition, and the same obtained for Maternity Services: an obstetric flying squad was lacking. The city did particularly badly in comparison to other cities for indicators such as Infant and Maternal Mortality and Life Expectancy.

Tuberculosis was a huge problem in the 1930s, accounting for half of deaths in the 15-24-year age group.²⁶ Elliott recalled:

When I was a student, Tuberculosis was rife and whole wards were filled with respiratory TB cases. Other wards were filled with bony TB. Measles and Diphtheria were endemic and included myself among their victims. I lost a younger brother with TB peritonitis.

There were also problems at Belfast’s Municipal Sanatorium at Whiteabbey Hospital, with accusations of bribery,²⁷ and the Matron and the Medical Superintendent were suspected of having an affair. A letter, signed by the Gynaecologist, Thomas S Holmes, stating that, “…she is in my definite opinion virgo intacta”²⁸ was read out and Holmes confirmed that he had written and signed it. The whistle blower was Henrietta Helen Scott, who had qualified in Medicine two years before. When she attended a wedding in England, she asked for permission to lock her door, but on her return, her door had been forcibly opened.²⁹ To compound this, the Tuberculosis Committee had purchased large quantities of faulty blackout material and was involved in a dodgy land deal. The Inquiry Report, which ran to over 2,000 pages, was published in June 1942 but the recriminations rumbled on for some time, and the full story may never be told.

It was against this backdrop that the BB was established on 22^nd September 1942.¹ Arnold Elliott recalled that it, “… consisted mainly of half a dozen left wing students, half of whom were swimming blues” (see Figure 3). This is interesting given Socialism’s then obsession with physical fitness.³⁰

Figure 3.

Queen’s University Swimming Club (1940-41) Henry McClatchey, seated, 1st from left (one of four Medical students in the photograph), Dr William McClatchey, seated, 5th from left. (Courtesy of Special Collections, QUB Library)

Elliott continued:

The Queen’s debating society was dominated by the left against the right. The leader of the right had a brother who was the Irish university heavy weight boxing champion. He threatened to bash us when we said his brother was ‘nailed to the crooked cross,’ so we had to flee for our lives….We brought Stark Murray over from London.

Murray was an SMA veteran, and the visit probably took place when the BB was being established because, subsequently, all lectures were advertised in the local papers. Indeed, the BB recognised³ its, “…cordial relations with the local press,” and this is confirmed by 42 mentions in the 16 months of the BB’s existence.

At the first meeting it was asserted that medical services in the province were, “…ripe for reorganisation,” … “should be both preventative and curative,” and “…the same for all and free for all.”¹ There was a call for Clinics, such as those which, “were foreshadowed in The Citadel by A. J. Cronin”. In such clinics, different specialists would co-operate, with:¹

…a direct chain connecting the man who makes the first general examination of the patient with the specialist or surgeon who finally undertakes the treatment of a difficult case.

Two days later the paper printed³¹ a letter from, “…a true follower of A. J. Cronin”, wishing them every success. Some of the book’s following may have stemmed from the fact that when it appeared, its publisher, Gollancz, sent 200 free copies to the British Medical Association which was meeting in Belfast.¹⁴ In October the BB sought affiliation with the Northern Ireland Labour Party,³² and by the end of October this was granted,³³ but not in time for the BB to contest a by-election for a vacant QUB seat,³⁴ which was won by the Unionist, Dr William Lyle.

In November, a BB member gave a talk at the newly created Women’s War Effort Association, stressing the importance of a proper balanced diet, rest and good factory conditions.³⁵ A fortnight later, Dr W McClatchey, the BB’s Honorary-Secretary, was promoting better conditions for nurses, who were invited to attend SMA meetings.³⁶ In mid-December, the BB’s first Chairman, Dr O G Edholm (a Physiologist, soon to take up a Chair in London³⁷), passed a resolution welcoming a motion by Dr Lyle calling for the establishment of a Ministry of Health.³⁸ Lyle described the conditions of public health in rural areas as, “…a sordid tragedy.” In December the BB passed a resolution in support of Lyle:³⁹

The people of Ulster have been shocked by the disclosures of Dr. Carnwath in his recent report and demand that the Government take immediate steps to bring the health services at least up to the level of those in England.

The BB stressed the importance of The Beveridge Report which could only be realised through the inauguration of a complete, national medical scheme. Health Centres would be linked to hospitals, with dentists, x-ray units and laboratories. Childcare, Antenatal and Maternity services would be provided with periodic screening of all patients, and lectures, research and ‘health propaganda’ would all be provided.⁴⁰ In fact, their concept of Health Centres was truly wide-ranging.

In January 1943, the BB called for city nursery centres to assist the Women’s War Effort Association,⁴¹ and Dr M Abrahamson lectured on The Beveridge Report.³ In February the lecturer asked, Why Socialism? ⁴² In March, a meeting of 150 nurses was held in the Grand Central Hotel⁴³ (see Figure 4) when pay and conditions, seeking parity with the rest of the UK,⁴⁴ were discussed and another address, Medicine and Socialism, was delivered at the same venue as the membership had swollen to 70. The choice of venue⁴⁵ must have attracted taunts of ‘Champagne Socialism’ and, even worse, ‘Bollinger Bolshevism’.

Figure 4.

The Grand Central Hotel (first spire from the right). It was originally intended as a ‘Grand Central Station’ with underground platforms,⁴⁵ but the City Council opted for a new City Hall instead

In April the BB published³ its first and only Bulletin, in a format based on that of the SMA of Great Britain. It announced that Dr W McClatchey would talk on Health Services in the Soviet Union and gave details of a “…real social success” in the shape of a dance, possibly a fund raiser, held at Miss Foster’s Dance Studio on the Lisburn Road that March with three prizes:³

…presented for novelty dances by non-medical S.M.A. sympathisers.

In June the BB was represented at the Labour Party Conference on Policy,⁴⁶ and pleas for a Health Ministry were repeated. The BB’s Honorary-Secretary, Dr W McClatchey, and his brother H McClatchey, both spoke.⁴⁷

That September the BB called for improved factory conditions and was collecting questionnaire data before a conference in the autumn.⁴⁸ In October it reviewed causes of work absenteeism⁴⁹ and the need for an Industrial Health Service.⁵⁰ October also saw⁵¹ a BB publication, as Murray breezily recalled:²

The Belfast branch produced its own pamphlet Health in Belfast which set the ball rolling on the form of an organised service for Northern Ireland.

The pamphlet of 14 pages,⁵¹ (see Figure 5) marshalled the BB’s major preoccupations, chief among which was the lack of a Ministry of Health. It summarised hospital facilities and the need for Area and Regional Councils. Maternity Services and the Thomson report of the 1930s concerning Maternal Health were referred to,²⁴ and Child Welfare and Housing received attention. It was particularly hard hitting on Tuberculosis and a ‘scheme’ was strongly recommended. The NI Tuberculosis Authority was established in 1946.²⁴ Venereal Disease was highlighted as a particular wartime problem. The pamphlet concluded with the maxim: “THE HEALTH OF THE PEOPLE IS THE CONCERN OF THE PEOPLE THEMSELVES.”

Figure 5.

‘Health in Belfast,’ cover design by Marjorie Olley, Belfast College of Art. (Courtesy of Belfast Central Library)

The BB’s Standing Joint Conference (of the Trades Union Council) took place in Clarence Place Hall that November.⁵² The Chairman was Wilfred Brennen, who qualified in 1935 (II^nd Class Honours), subsequently attaining an FRCSI in 1938.⁵³ Dr Marc Daniels presented the questionnaire results while Dr W McClatchey accepted that the results were not as conclusive as desirable owing to poor response rates.⁵⁴

In December 1943 Dr William Lyle again called for the establishment of a Ministry of Health.⁵⁵ In rejecting the call, Sir Dawson Bates piled the blame for poor health on Local Authorities, thereby undermining his own case, as the Ministry of Home Affairs had clearly failed to cope with the problem. By late January 1944, the establishment of a Ministry of Health was being recommended,⁵⁶ and by late March it was accepted that a Ministry of Health and Local Government should be established in place of the Ministry of Security.⁵⁷

WHATEVER HAPPENED TO THE BELFAST BRANCH?

After November 1943, there were no further mentions of the BB in the local press. What had transpired? It was unlikely that the ‘cordial relations’ had soured badly, so it must have been that the chief aim of the BB, the establishment of a Ministry of Health, had been satisfied. Paradoxically, this was realised thanks to actions of the winner of the seat that the BB wished to contest, and a Unionist to boot! Also, Wilfred Brennen, the Chairman, was soon to be appointed Consultant Surgeon to the District Hospital, Magherafelt.⁵⁸ William McClatchey had qualified in 1940, and taken a DPH in 1941.59 His brother, Henry McClatchey, qualified in 1946.⁵⁹ Arnold Elliott qualified in Medicine in 1944, and then served as a doctor on the troop ships.⁶⁰ He went into General Practice in the home counties, remained a lifelong Socialist, and a passionate champion of the NHS. It is likely that other student members may have gone off to serve in the forces. At this distance it is difficult to be sure that other factors weren’t involved too.

The Carrick By-Elections

The only member of the SMA to enter mainstream politics was William Calwell. He fought the Carrick by-election in August 1943. Calwell was beaten by 2,496 votes by John Campbell, the Unionist. It was a bruising contest for Dr Calwell who told me that graffiti appeared accusing him of being “De Valera’s Secret Agent”. Dr Calwell left a hand-written account of the by-election:

The Unionists began the election campaign with 19^th century cat-cries – certainly in harmony with the sanitation and living conditions of the people. When Labour did not ‘bite’ they borrowed the progressive programme outlined by Labour and repeated parrot like all the things that Labour had said the previous night…. Not to be side-tracked Labour stuck to its programme, Infantile and Maternal Mortality which in NI are the highest in the United Kingdom and nearly twice as high as in England. The tuberculosis death rate again the highest in the UK, chaotic medical services and the Housing, ‘In Sale’ and ‘Rent Rackets’ so prevalent in Northern Ireland with their consequent effect of overcrowding, the ally of Tuberculosis.

Dr Calwell fought another Carrick by-election in April 1945. This time the Unionist majority was 4,164.⁶¹

The Advent of the National Health Service

Winston Churchill is generally credited with having first used the phrase, “from the cradle to the grave” in relation to National Insurance:⁶²

National compulsory insurance for all classes for all purposes from the cradle to the grave.

According to Fraser, however, The Daily Mirror had used the phrase in a headline on the 2^nd December 1942:⁶³

Beveridge tells how to Banish Want, Cradle to Grave Plan, All pay, all benefit…one weekly payment for all citizens – from duke to dustman.

In fact, this was by no means the first citation in the newspapers.

Delivering the National Health Service was far from plain sailing, with the majority of the Medical Profession set against it.⁶⁴ Aneurin Bevan played one side off against another, and by introducing Distinction Awards, “Stuffed consultants’ mouths with gold”, to achieve it.65 This subterfuge may have exacerbated any previously existing gulf between Hospital Medicine and General Practice, a far cry from the SMA’s “sunlit uplands”⁶⁶ of a ‘Health-centred panacea’.

Conclusion

There is no doubt that the SMA informed the health policy of the Labour Party, but in terms of the entire Medical Profession, they represented a tiny minority.⁶⁷ It seems that once the BB saw that its main objective, the establishment of a Ministry of Health, had been met, it quietly dissolved. We can only guess at the forces that were operating, with the younger members of the profession gaining free rein in the absence of their slightly older colleagues who were away fighting the war, who may have expressed their disapproval of what was being transacted in their absence. It is a fact that many western intellectuals were taken in by Stalinism in the 1930s.⁶⁸ To Unionists, ‘Socialist’ may have seemed all too redolent of the political philosophy which shaped Irish Nationalism.

In any case, a State Medical Service was established although it fell short of the SMA’s expectations. The SMA continued its activities but changed its name to Socialist Health Association in 1981.⁶⁹ Perhaps the last words should be left to Aneurin Bevan: in promoting the concept of the NHS he employed the mantra, “We are going to Tredegarise you,”⁷⁰ and his epitaph, rich in political cynicism, for the SMA was, “Pure but impotent.”⁷¹