LAUSR

The coronavirus pandemic of 2019/2020 has put the spotlight on the role and personality of the Chief Medical Officer for England to an extent that has rarely been the case since Sir John Simon (pronounced Simone), first held the equivalent position in 1855. This prominence in the public eye of the latest incumbent, Professor Chris Whitty, has led to his being described by the Sunday Times as Britain’s most powerful unelected official and ‘Captain Sensible’. The increase of over 20% in the number of applications to medical school in 2021 is being attributed to his contribution during the greatest public health emergency for 100 years. So how does that contribution compare with that of his predecessors and what does it tell us about the characteristics most needed to fulfil the roles and responsibilities of The Nation’s Doctor? The origins of the post of Chief Medical Officer date back to the early work of local public health pioneers who cut their teeth on the cholera epidemics in the slums of Victorian England. Best known among these are Liverpool’s William Henry Duncan, who became the world’s first full-time city Medical Officer of Health and the widely celebrated John Snow. Born in York, Snow completed a medical apprenticeship in Newcastle upon Tyne before making his way to the Hunterian school of medicine in London to complete his formal medical education, going on to achieve notoriety and fame for pioneering the use of anaesthesia in Queen Victoria’s last two confinements and taking the handle off the pump in Broad Street, Soho to intervene in the local cholera outbreak there in 1854. These local figures had their national equivalents in the London utilitarian philosopher, Jeremy Bentham, for whom what mattered in public policy was ‘the greatest good of the greatest number’, and his disciple, Manchester-born lawyer and social reformer, Sir Edwin Chadwick. Chadwick’s ‘Report on The Sanitary Condition of the Labouring Population of Great Britain’ was the first example of a national analysis of inequalities in health and paved the way for local public health action at the local level, shepherding through the first Public Health Act of 1848 as Commissioner of the Central Board of Health together with its medical adviser, Southwood Smith. Chadwick was a force of nature who did not suffer opponents to his ambitions for sanitary reform lightly, alienating many, including The Times newspaper that published a letter declaring that ‘we would prefer to take our chance with cholera than be bullied into health’. The General Board of Health was abolished in 1854 to be replaced by a new Board of Health in which medical advice was given a much more prominent place than that sought by Chadwick, who had been much more enamoured by the contribution of engineers. It was into this space that stepped John Simon making his claim to the provenance of Chief Medical Officer that we understand today, although it was to be a further 70 years before the various iterations of the Board of Health with its relationships to the Poor Law and local government administration would lead to the formal position within the new Department of Health in 1919. When Simon was appointed in 1855, he brought with him seven years’ experience as Medical Officer of Health for the City of London, the first such position to be created under the 1848 Act, which had drawn on the Liverpool experience in creating a general enabling power for local authorities to create such positions. Simon was to prove a formidable operator during his 21-year tenure providing a blueprint for the role for many of successors who were drawn from a background as local Medical Officers of Health, were imbued with a commitment to evidence-based practice, drawing down timely statistics to inform policy and practice, supplemented by investigations, inspections and surveys. Simon pioneered and initially secured the professional independence of his advisory role with both right of access to ministers and right of report to the public. In managing the tension between serving the public, the government or his professional Journal of the Royal Society of Medicine; 2021, Vol. 114(9) 451–453