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Some wartime writings by Professor John Ryle MD

Anthony Ryle’s father, John Alfred Ryle, was a doctor in both general and hospital practice, as well as teacher and researcher at universities. At the outbreak of the Second World War he was Professor of Physic at Cambridge, and after a stint at Guy’s Hospital during the Blitz, he was appointed to the new post of Professor of Social Medicine at Oxford. He was a life-long pacifist, though he had served as an Army doctor in France in the First World War, and in the 1930s, deeply concerned about the rise of Fascism, supported the republican movement in Spain, in particular by assisting refugees. His home in Cambridge, where Anthony spent the early years of his life, was a venue for anti-Fascist discussion groups and other left-wing causes. During his training and early practice at Guy’s Hospital in the 1920s John Ryle got to know many patients from the east London working class, and to understand the conditions in which they lived. This, and his experience as an Army doctor, strongly affected his subsequent attitude to the profession of medicine.

It was a point of principle with him that doctors should reach out beyond their specialist disciplines and engage with any issue affecting the well-being of individuals or communities as a whole. He saw the doctor’s task as not merely to fix sick bodies, but to observe and understand the broad conditions in which sickness became a social commonplace. By recording and collating their observations they could provide the basis for an extension of medical science to understand the circumstances which would promote health in the whole community, not just cure disease. From this interest he developed the discipline of ‘social medicine’, and he devoted his later career to promoting and teaching this idea. He was also—partly as a consequence of his commitment to a medical practice for the whole community—a strong believer in a publicly funded, universal health service, and worked towards this through his contributions to medical professional organisations.

Life and death

In the 1920s and ‘30s he published a number of articles on specialist topics in medical journals, and as the ideas for reforming British health institutions developed during the war he also wrote more general articles about medical education and health policy. His view of the breadth of interest doctors should take in human well-being led him to publish a number of essays in which, from his medical experience, he discussed two of the largest questions a doctor and patient face together—the fear of death, and the sense of purpose of an individual life—making particular reference to the war which was bringing these questions, especially death, so much to mind at the time. These essays were published together in a small book called Fears may be Liars early in 1941.

His book, Professor Ryle wrote, was ‘for ordinary men and women who in this, “their finest hour,” yet find themselves groping sometimes in the black­out of the mind for a match or a torch to guide them towards a friendly door’. It was, however, written from a particular point of view, offering  ‘prescriptions both for natural and superstitious fears’. Some of the latter are obviously the stock in trade of traditional religions. He hopes his prescriptions ‘may bring somewhat of help and comfort both to those who accept and those who cannot accept the tenets of the churches’, and he sets out what is, by implication, his own position: ‘The agnostic or rationalist ... is not necessarily an irreligious person. He is only anti-religious in what seems to him error in the method or doctrine of the churchmen, and he is intolerant not of their Christianity (for who could dispute the essential teaching of Christ) but of their failure to advance with the times and accept the truths which science reveals.’ The doctor’s task ‘is that of healer, and one of his chief functions as such is to explain and reassure. Most of his explanation and reassurance is for private ears, but in times of public distress, having no pulpit, he needs must discover some wider channel of approach to other minds’.

Death and pain and fear ... are necessities. They have their place and use in the general scheme of the universe. Had pain or fear been omitted it would not have been possible for the higher species to survive on earth. Without death there could have been no life. They are things to be studied and understood, not shelved or shunned or made into mysteries. The better we understand them the fewer mistakes we shall make and the more wisely we shall meet them. Indeed, a wider knowledge of these and other biological forces and of their proper manage­ment will help us at last to eradicate the great mistake of war.

Thoughts about death and religion also feature in Anthony’s diary, but they are not just private speculations. He discussed religion—or rather his opposition to it—with other boys and masters at school. Sometimes it interfered seriously with his relations with both boys and masters. He discussed his father’s article ‘Of Death and Dying’, which had appeared in the Lancet, and was later included in Fears may be Liars, with a teacher, who gave Anthony a relevant, but unnamed, book (entry for 29 Oct. 1940).  He noticed that a more senior boy—one with whom he discussed his atheism—was reading a magazine with an item about his father’s article. (27 Feb. 1941).  He recorded that ‘Daddy’s “Fears may be Liars” has been put in the Biology Lab.’ (20 July 1941). His father’s writing thus gave a context beyond school for these conversations.

Here is the article ‘Of death and dying’.

Medicine and society

Anthony noted in his diary for 17 Mar 1942 that he had received an ‘article by Daddy on State medicine—very good’. It was an article from the British Medical Journal entitled ‘A whole-time state medical service’, printed in a series discussing policy options for the reform of health services after the war.

John Ryle was a member of the Medical Planning Commission, set up in 1940 by the main professional bodies concerned with the work of hospitals and general practice, to consider the evolution of a policy for post-war medical services in the light of changes already made to cope with the demands of war. Emergency measures to deal with wartime conditions were already transforming the organisation of health services, and returning to the pre-war situation, which everyone acknowledged to have been unsatisfactory, was not going to be an option anyway. John Ryle’s contribution to the BMJ on this occasion argued in favour of a system in which all doctors would be salaried staff, employed by central or local government, allocated to publicly funded health centres according to the requirements of the area, and linked to local hospitals. He believed that measures such as these were required if adequate medical care was to be extended to those currently excluded from it by poverty, and by living in districts where it was not economic for doctors to set up practices under the existing system. It was to be

a national system planned and organized to secure a more equitable distribution of health services, better co-ordination within those services, payment for those services from central sources, and universal contributions instead of directly from the patient's pocket, often at a time when he can least afford it.

His views on the subject, including developments ‘to be introduced gradually with a system of five-year plans and appropriate priorities’, echo his interest in the medical services of the Soviet Union, which had been attracting some attention since the 1930s, but became of far more concern in Britain after the German invasion of Russia in 1941, and the formation of the Anglo-Russian military alliance. He was a founding member of the Anglo-Soviet Medical Committee which aimed to promote relations between the British and Soviet medical professions, provide practical aid to the Soviet medical service, and exchange information. At the Committee’s inaugural meeting, the President of the Royal College of Surgeons siad, ‘that medical men in this country had been intensely interested in the colossal experiment in environmental and social medicine carried out in the Soviet Republic. There could be no more laudable object at present than to bring into association the medical professions of the two countries’.

There was considerable resistance to John Ryle’s idea for a medical service which would eventually be entirely nationalised, and an argumentative correspondence followed his BMJ article. The article can be found here: ‘A whole-time state medical service’ by Professor John Ryle

John Ryle’s ideas about the organisation of a health service and on the practice of social medicine were consistent with each other, but they were independent. Most of his writing during the war years was intended to encourage an interest in social medicine as an element of medical practice in general, regardless of any precise arrangements for healthcare, and he was at pains to distinguish social medicine from the far more controversial issue of a state medical service.

 An idea of the outlook on medicine which he hoped to promote in his teaching and writing can be gathered from the passages out of articles and letters to the press collected here: on social medicine.