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'Politics is medicine writ large' pronounced the great Rudolf Virchow confronted by the terrible suffering of the poor and destitute during a typhus epidemic in the Prussian province of Upper Silesia. Meanwhile several hundred miles to the east, in Tsarist Russia, the novelist Fyodr Dostoyevsky's portrayal of a young mother forced into prostitution to feed her children evoked the same inextricable link between poverty and illness. 'The agonised, wasted, consumptive face, the parched blood-stained lips, the hoarse voice,' he writes in Crime and Punishment, 'her despairing prayer for help was so piteous that everyone seemed to feel for her.'
Virchow's aphorism may have captured the profound truth that poverty, not biology, was the major cause of disease but, certainly in Britain, the radical political doctor has always been something of a rarity, if nonetheless remarkably influential. The vigorous, and ultimately successful, campaign in the 1930s by Edith Summerskill, Somerville Hastings and others of the Socialist Medical Association for a health service 'free at the time of use financed out of general taxation' echoes the Communist Manifesto pledge 'from each according to his ability to each according to his needs'. Further, it is a mere truism to observe that it is the public health doctors, rather than hospital specialists with their airs and graces, who deserve the credit for that happy state where most now live out their natural lifespan to die from diseases strongly determined by ageing. But these great battles of the past have (for the most part) been fought and won. The powerful sense of injustice that fuelled medical radicalism is more difficult to sustain when the State guarantees a minimum income and when (to pluck just a couple of meaningful statistics at random) 98% of households now have exclusive use of a bath and 91% have a colour television set.
That at least, is how it seemed to Cambridge medical student Patrick Hutt, seduced into medicine by a lecture from the RCGP luminary Iona Heath in which she had extolled general practice as 'the greatest profession in the world'. But now he was afflicted by doubt. The tedium of his preclinical science courses was compounded by the seemingly disproportionate emphasis on molecular biology. Then in his third year, his tutor in history and philosophy of science suggested he write a dissertation on the legendary East End family doctor, political activist and revolutionary polemicist David Widgery. It was, apparently, an epiphanous moment. Widgery was the role model Hutt was seeking—someone whose commitment to the cause of the poor was vivid witness to the continuing relevance of socialist ideas to medical practice. His dissertation, now much expanded, has become Confronting an Ill Society1—part biography of Widgery, part reflection on the significance of the persistent health inequalities within society and what should (or can) be done about them.
David Widgery was always an exotic in the sober world of medicine, a romantic free spirit, an energetic organizer and a witty companion. He sought to fuse the counter-culture of the 1960s (sex, drugs, rock-and-roll) with radicalism (sit-ins, marches, protests of all sorts). He was the antithesis of the 'boring leftie', and according to the BMJ's erstwhile editor Richard Smith, 'about as interesting a person as you could hope to meet'. He was lucky in all this that his time at the Royal Free Medical School preceded the current vogue for continual assessment, for he was preoccupied with apparently more substantial matters. Widgery was at the epicentre of the revolutionary student left of the late 1960s, marching on the American Embassy in Grosvenor Square, editing the (in)famous underground magazine Oz and every Saturday morning perplexing the shoppers in Islington's Chapel Market by urging them to join the International Socialists and get involved in the class struggle. He failed his finals but scraped through at the second attempt and took himself off to London's East End. He worked initially with the veteran Jewish GP and former communist Dr Mike Liebson, with whom he would have long philosophical arguments in the Venus Steak House during lunch breaks. He became involved in the campaign to save the Hackney Empire and organized a lengthy sit-in at Bethnal Green Hospital when it was threatened with closure.
But with Thatcherism in the ascendant and the prospect of imminent revolution ebbing away, he eventually settled in practice with others of a similar persuasion in Limehouse. There he became a sort of modern-day General Booth, conveying through his writings the bleak poverty-ridden lives of his patients, the better to argue the case for political change. He starred in a TV documentary and wrote a book Some Lives!: a GP's East End that skilfully wove sketches of his medical practice with the history of the successive waves of immigrants. When Richard Smith offered him a regular column in the BMJ he became medicine's best known dissident voice.
Under the spell of Widgery's passionate commitment and varied career, Patrick Hutt's enthusiasm for medicine flooded back but as the further researches for his dissertation proceeded, it emerged that all was not quite as it seemed. Widgery's close colleagues, he was almost surprised to learn, were not quite as enthusiastic as they might have been about having this revolutionary hero in their midst. 'Dave' lost his charm when crossed, becoming rude and aggressive, and was not above exploiting his patients to further his career, exaggerating and distorting their misfortunes which he then presented as evidence of their oppression by 'the system'. To this reviewer at least, his portrayal of the East End is quite unrecognizable. Here, for example,Widgery is arguing against those who hold up 'the sanctity of the family', challenging them to spend a few hours in an East End casualty department and 'face the debris, when all the sugary ideals explode, when babies are bounced against the bedroom wall to make them stop crying and wives are loved and honoured and beaten up so thoroughly they can't talk because their teeth are still chattering with terror'. This blurring of the boundaries between honest writing and political propaganda can be dangerous, and one suspects eventually led to his own loss of faith. He died aged 45 from an excess of alcohol, barbiturates and pethidine in his bloodstream. Whether this was intentional or an accidental overdose of recreational drugs is not clear (the coroner recorded an open verdict).
It is difficult to know what to make of Confronting an Ill Society because I suspect the author does not know himself. To be sure, Widgery was (in small doses) a lot more interesting than most in his profession or, as his friend the writer Michael Rosen remarked, 'a walking November 5th, lighting up the night sky'. But the main lesson of his career was that he was wrong about most things, particularly the relevance of his brand of revolutionary politics to contemporary medicine. The essential pillar of his socialist critique, the continuing inequalities of health within society, might seem persuasive but, as Hutt acknowledges, those inequalities are relative not absolute, with scarcely the same resonance they had in the late nineteenth century when Virchow formulated his famous aphorism. It would be good to think that some of those who read this book might be inspired to take up the challenge of practising medicine in our more deprived communities, but they could find better role models than Dave Widgery.