Ashes to ashes: The Royal College of Physicians and the smoking report (1995)

foreign to this presentation is to show how the Royal College of Physicians of London became involved in the public campaign to prevent smoking in this country it is a fascinating story involving the college in its very traditional Regency home beside Trafalgar Square is then president Lord brain and his successor later to become Lord Platt was responsible for the move of the college from its old premises to its new home in Regents Park as well as for the publication in 1962 of its seminal report on the hazards of smoking after the Great Fire of 1666 opponent was cited at its home in Warwick Lane in 1823 it moved westwards to palmout East now the Northern end of Canada house and by the 1950s when the smoking story began the college had been established for 130 years and its place as a part of the medical establishment was more than secure it was therefore something of a shock when in April 1956 Q Clegg the then editor of the British medical journal published a leading article entitled the guild-headed cane which attacked the distinguished president of the college Lord brain specifically for standing for office for the seventh successive year he also took the Carnage to task for failing to come to terms with the emerging world of medicine in the modern welfare state for failing to understand the nature of medicine in the newly established National Health Service and he saw two of the college spent too much of its time haggling over terms and conditions of service for Hospital Consultants in addition he thought the college was doing far too little for postgraduate medical education brain of course accepted none of these criticisms he was a man of extraordinary ability and distinction this is the bust by Epstein which was made for the college when he stood down as president in 1957. brain was a Quaker with all the special conscience of his sect he was a neurologist of great distinction who had treated Winston Churchill through his cerebral vascular episodes he was the author of a classical textbook on neurology but apart from that for the brilliant writer and essayist he was known particularly for his Reflections on genius and essays covering a wide revenge of subjects including Dr Johnson he was also known particularly for an enchanting account of tea with Walter De La Mer he was involved in such sexual issues as family planning and he shared an important Royal Commission on the problems of drug addiction the question it has to be asked of course is whether in his vigorous attack on the age-old traditions of the college Clegg was right in his strictures the evidence of the college response to smoking suggests that he probably was in November 1956 just a few months after the publication of clegg's leading article Francis Avery Jones penned a letter on smoking from his Department of gastroenterology at the center of Middlesex Hospital to the president of the Royal College of Physicians Avery Jones was a particularly appropriate advocate Richard doll was working part-time in his department on the problems of peptic ulcer at that time and in addition he had persuaded a colleague of his the chain smoking high schools to abandon his pernicious habits overnight average earned his letter stressed that he thought the college should make a pronouncement on the effect of smoking he created his colleague Richard doll's work arguing that the death rates from lung cancer had risen from three thousand to nearly 17 000 a year during his professional career and he suggested that the whole question be referred to the Social and preventive medicine Committee of the college brain was a shy and reserved man who was known for his formidable silences whether he would have consulted his college officers on this occasion is not known but if he did and I'm sure he would have done he would have first talked to the registrar so Harold baldero then into the 15th year of his office as registrar a man who was equally reserved and somewhat withdrawn the treasurer was w.g Barnard who was described as having an aloofness that uh in some way uh hid an innate modesty and shyness these college Grande's seem instinctively to have shunned the Limelight in any case they would have paid little attention to the views of a mere medical journalist who had made stinging references to The Reluctant and hesitant contact with the progressing problems of the day for whatever reason brain responded to Avery Jones's letter about a month later this is the carbon copy of the letter preserved in the brain papers at the library of the Royal College brain made it quite clear that he thought there was no steps that the college should take on smoking and carcinoma of the lung he considered that the work of doll and Bradford Hill was well enough known and in any case he thought that the college shouldn't go beyond the facts of the case and that giving advice to the public was not the function of the college well that response illustrates very clearly the highly conservative view of the elitist college that existed at parallel East at that time and which claimed had so severely castigated but things were to change radically and in a relatively short space of time the key event was the election in 1957 of Robert Platt to the presidency of the college in succession to Russell brain Robert Plant was professor of medicine in Manchester the first academic and the first provincial to be elected to the presidency of the college the bmj pointed out that his election broke a London Monopoly on one of the high positions in the world of Medicine and they perceptively pointed out that his approach was likely to be refreshingly direct it certainly was he had once instituted a program of postgraduate medical education at the college and it was Platt who masterminded the move from the archaic premises in Palmdale East to a new site in Regents Park where Dennis nasdan's remarkable modern building provided an architectural counterpart to the sort of changes that Platt wanted to see in the rather stuffy college that he had inherited so it's not surprising that the response of the new president to smoking was radically different to that of his predecessor he was first approached on the subject via Charles Fletcher then translated from his position as director of the mrc's pneumoconiosis Research Unit in Cardiff to be a respiratory Tradition at hammersfield there he was working in those years that followed the last raid smog in 1952 on the question was smog masks and in late 1958 he was visited on this topic by an official from the Ministry of Health at the end of his discussion when the official was leaving Charles Thatcher asked him what on Earth the ministry was doing about smoking since everybody widely felt that the ministry was dragging its feet well the upshot of that comment was an invitation to lunch by the then deputy chief medical officer of the ministry George godba George godwell was particularly frustrated by Ministry attitudes to smoking at that time ministers were doing nothing the chairman of the standing advisory committee on cancer was Sir Ernest Rock Carling who was himself a committed smoker and it was known that the chief medical officer Sir John Charles really did much unless responding to an outside spur and fetcher therefore decided that it would be appropriate to sound out Robert Platt on the question of forming a committee within the college on smoking George godbert as a Ministry official could do little more himself than encourage and it would agree that Fletcher should telephone Robert Platt fetch a telephone plat to ask whether he could come and see him plant in his direct way asked what about Fletcher replied that he and others thought that the college should put out a report on the hazards of smoking of course we should was Platt's immediate reply by January 1959 Avery Jones had heard what was going on and he lent his very strong support the idea that the college should put out an authoritative report on smoking the first informal meeting to discuss smoking and carcinoma of the lung was held at the college on the 16th of February 1959 and in April of that era the commissioner of the college its ruling body agreed to set up a committee to discuss smoking and Atmospheric pollution in relation to carcinoma of the lung and other diseases are slightly broader remit the committee first met formally on the 15th of July 1959 Charles Fletcher became secretary and wants to be the moving Spirit behind the report his initial outline of the proposed report makes interesting reading for at the end of his suggestions Fletcher wrote government should take action exclamation mark something that we are still trying to persuade it to do more than 30 years later two smokers were persuaded to join the committee both of whom gave up smoking during the preparation of the report the final version smoking and health was published in 1962 and unquestionably represents the most important contribution to Health by the Royal College of additions this century the report was widely lauded and it had an important influence in the United States where the Surgeon General produced a comparable report two years later which had a major impact on policy over smoking in the United States the British medical journal was gracious enough to hail the report at a turning point in the approach to one of the most challenging opportunities for preventive medicine so the smoking report for the highly significant event in the history of the college coming as it did as it was evolving from a selectively elitist organization in its ancient building in Palmdale East to an institution which was increasingly involved in matters to do with the public health in postgraduate medical education and in encouraging within its new premises others involved in the human health to have meetings with them on their new site it had all been a remarkable evolution of a college which Clegg had described in 1956 as a stuffy old-fashioned Club whose antique mosque worn on its official occasions shorted too well with its present confusion of purpose Clegg very nearly paid a high price for his temerity for the BMA Grande's many of whom of course were friends of the senior officers of the college tried to sack him from his posted editor mercifully he won his case thereby striking an important blow for editorial freedom as well as encouraging those attitudes within the college that led to the publication of the smoking report well in conclusion may I just express my warmest appreciation to Dr Stephen Locke for having allowed me access to his unpublished paper on Hugh Craig and the Goat Head it can and also express my apologies for not being present at what promises to be an extremely interesting and important Symposium thank you very much