¹ Patrice Pinell, ‘Cancer’, in Roger Cooter and John V Pickstone (eds), Medicine in the twentieth century, Amsterdam, Harwood Academic Publishers, 2000, pp. 671–86, on p. 671.

² Robert N Proctor, The Nazi war on cancer, Princeton, NJ, and Chichester, Princeton University Press, 1999; Patrice Pinell, The fight against cancer: France 1890–1940, London, Routledge, 2002; James Patterson, The dread disease: cancer and modern American culture, Cambridge, MA, Harvard University Press, 1987.

³ Pinell, op. cit., note 1 above, p. 675.

⁴ Richard Hough, Edward and Alexandra: their private and public lives, London, Hodder and Stoughton, 1992, pp. 298–9.

⁵ Pinell, op. cit., note 1 above, p. 676.

⁶ For recent literature reviewing the role and effectiveness of MOHs, see Barry M Doyle, ‘Competition and cooperation in hospital provision in Middlesbrough, 1918–1948’, Med. Hist., 2007, 51: 337–56.

⁷ See Barbara Clow, ‘Who’s afraid of Susan Sontag? Or, the myths and metaphors of cancer reconsidered’, Soc. Hist. Med., 2001, 14: 293–312, for Canadian exploration of many of the obstacles to effective cancer treatment that some British MOHs were seeking to address.

⁸ Rosa M Medina Domenech and Claudia Castañeda, ‘Redefining cancer during the inter-war period: British medical officers of health, state policy, managerialism and public health’, Am. J. Pub. Health, 2007, 97 (9): 1563–71.

⁹ This argument contrasts with existing historiography that has explored the ineffectiveness of, and overloading of responsibilities onto, MOHs. Jane Lewis, What price community medicine? The philosophy, practice and politics of public health since 1919, Brighton, Wheatsheaf, 1986.

¹⁰ The MOH in Manchester played an unusually significant role in developing cancer services, and this must be linked to his enviable reputation for successful innovation across a number of public health fields. See John V Pickstone, Medicine and industrial society: a history of hospital development in Manchester and its region, 1752–1946, Manchester University Press, 1985; Niall Johnson, Britain and the 1918–19 influenza pandemic: a dark epilogue, London, Routledge, 2006, pp. 120, 140–1; Alysa Levene, Martin Powell and John Stewart, ‘The development of municipal general hospitals in English county boroughs in the 1930s’, Med. Hist., 2006, 50: 3–28, p. 13; Martin Gorsky, ‘The Gloucestershire extension of medical services scheme: an experiment in the integration of health services in Britain before the NHS’, Med. Hist., 2006, 50: 491–512, p. 510.

¹¹ Manchester’s Christie Hospital remains one of the few non-London institutions whose history and relationship to professional and civic interests has been seriously researched. Eileen Magnello, A centenary history of the Christie Hospital Manchester, Manchester, Christie Hospital NHS Trust in association with the Wellcome Unit for the History of Medicine, University of Manchester, 2001.

¹² Niemi’s work documents the impact of ideologies and service traditions in a range of public health projects. Marjaana Niemi, Public health and municipal policy making: Britain and Sweden, 1900–1940, Aldershot, Ashgate, 2007, pp. 1–24.

¹³ Pinell, op. cit., note 1 above, pp. 681–2.

¹⁴ Ibid., p. 678.

¹⁵ Jeanne L Brand, Doctors and the state: the British medical profession and government action in public health, 1870–1912, Baltimore, Johns Hopkins Press, 1965, pp. 126–31, suggests MOHs had largely failed to extend their influence at an earlier period.

¹⁶ For background to science and policy making, see Anna-K Mayer, ‘“A combative sense of duty”: Englishness and the scientists’, in Christopher Lawrence and Anna-K Mayer (eds), Regenerating England: science, medicine and culture in inter-war Britain, Amsterdam, Rodopi, 2000, pp. 67–106.

¹⁷ We are here concerned not so much with Foucault’s problem of understanding knowledge and the structure of discourses as with Geertz’s celebrated notion of local knowledge. See Clifford Geertz, Local knowledge: further essays in interpretive anthropology, New York, Basic Books, 1983.

¹⁸ Pickstone, op. cit., note 10 above, p. 290; Rodney Lowe, The welfare state in Britain since 1945, 2nd ed., London, Macmillan, 1999, p. 173; Lewis, op. cit., note 9 above, p. 15.

¹⁹ Growing medical amenities reflected not only professional priorities but patients’ capacities to influence both the terms and outcome of medical intervention. See Paolo Palladino, ‘Between knowledge and practice: on medical professionals, patients, and the making of the genetics of cancer’, Soc. Stud. Sci., 2002, 32: 137–65, p. 152.

²⁰ Pinell, op. cit., note 1 above, p. 676.

²¹ Patricia Jasen, ‘Breast cancer and the language of risk, 1750–1950’, Soc. Hist. Med., 2002, 15: 17–43; David Cantor, ‘The frustrations of families: Henry Lynch, heredity, and cancer control, 1962–1975’, Med. Hist., 2006, 50: 279–302.

²² Jennifer Dale and Peggy Foster, Feminists and state welfare, London, Routledge & Kegan Paul, 1986, pp. 37–8.

²³ Sandra Morgen, Into our own hands: the women’s health movement in the United States, 1969–1990, New Brunswick, Rutgers University Press, 2002, pp. 143–5; Ann Withorn, ‘Helping ourselves: the limits and potential of self help’, in Peter Conrad (ed.), The sociology of health and illness: critical perspectives, 7th ed., New York, Worth Publishers, 2005, pp. 472–81.

²⁴ Ornella Moscucci, ‘Gender and cancer in Britain, 1860–1910’, Am. J. Pub. Health, 2005, 95 (8): 1312–21; idem, ‘The “ineffable freemasonry of sex”: feminist surgeons and the establishment of radiotherapy in early twentieth-century Britain’, Bull. Hist. Med., 2007, 81: 139–63.

²⁵ Leslie J Reagan, ‘Engendering the dread disease: women, men and cancer’, Am. J. Pub. Health, 1997, 87: 1779–88.

²⁶ The different experiences of male and female cancer patients have been explored in Sarah Payne, The health of men and women, Cambridge, Polity, 2006, pp. 165–8; Mike Luck, Margaret Bamford and Peter Williamson, Men’s health: perspectives, diversity and paradox, Oxford, Blackwell, 2000, pp. 6, 78–9, 224. Also Penny Kane, Women’s health from womb to tomb, New York, St Martin’s Press, 1991, pp. 140–2, 159–61.

²⁷ North American research confirms males disproportionately suffer from stomach and lung cancers, usually with grim prognoses compared to (say) breast cancer. Canadian cancer incidence atlas: vol. 1, Ottawa, Canada Communication Group, 1995, pp. 42–3, 54–5; and Lillian M Axtell, Lester Breslow and Henry Eisenberg, ‘Trends in survival rates of cancer patients: Connecticut and California’, in Tavia Gordon, Margaret Crittenden and William Haenszel (eds), Cancer mortality trends in the United States 1930–1955, Bethesda, US Government Printing Office, 1961 pp. 49–67, table 2, p. 65.

²⁸ S A Henry discussed a number of male-dominated occupations in Cancer of the scrotum in relation to occupation, London, Oxford University Press, 1946.

²⁹ Epitheliomas and chrome ulcers were a serious, widespread health problem in British industry before the 1930s. Peter Bartrip, The Home Office and the dangerous trades: regulating occupational disease in Victorian and Edwardian Britain, Amsterdam, Rodopi, 2002, pp. 283–9.

³⁰ Alan Fowler and Terry Wyke (eds), The barefoot aristocrats: a history of the Amalgamated Association of Operative Cotton Spinners, Littleborough, G Kelsall, 1987, pp. 184–96.

³¹ Sir Thomas Legge, Industrial maladies, ed. S A Henry, London, Oxford University Press, 1934, pp. 12–16.

³² This was a different, and obviously later, debate to that concerning cancer amongst older soldiers which had prompted investment in services by the French government in 1917–1918. Pinell, op. cit., note 2 above, pp. 67–8.

³³ Pinell, op. cit., note 1 above, p. 678.

³⁴ For maternalism and its contribution to state welfare, see Bernard Harris, The origins of the British welfare state: society, state and social welfare in England and Wales, 1800–1945, Basingstoke, Palgrave Macmillan, 2004, pp. 22–3.

³⁵ Virginia Berridge and Kelly Loughlin, ‘Introduction’, in Virginia Berridge and Kelly Loughlin (eds), Medicine, the market and the mass media: producing health in the twentieth century, London, Routledge, 2005, pp. 1–16. For related voluntary sector effort, see Ina Zweiniger-Bargielowska, ‘Raising a nation of “good animals”: the New Health Society and health education campaigns in interwar Britain’, Soc. Hist. Med., 2007, 20: 73–89.

³⁶ For discussion of initiation and implementation of health policy, see Sally Sheard and Liam J Donaldson, The nation’s doctor: the role of the Chief Medical Officer 1855–1998, Abingdon, Radcliffe, 2006, pp. xvi–xvii and passim.

³⁷ Using tuberculosis as a case study, Worboys has discussed how MOHs’ conceptions of disease, which frequently differed from those of clinicians and researchers, possibly hampered effective control measures. Michael Worboys, Spreading germs: disease theories and medical practice in Britain, 1865–1900, Cambridge University Press, 2000, pp. 1–6, 232. The problems created by the MOHs’ multifaceted, but sometimes confused, response are explored in Neil McFarlane, ‘Hospitals, housing and tuberculosis in Glasgow, 1911–51’, Soc. Hist. Med., 1989, 2: 59–85.

³⁸ For discussion of cancer and other death rates, see Harris, op. cit., note 34 above, p. 221.

³⁹ H W Harwood, ‘The making of our municipality’, in J J Mulroy (ed.), The centenary book of Halifax: the story of the town that bred us, Halifax, Mulroy, 1947, pp. 16–35.

⁴⁰ Patricia A Dawson, ‘Liberalism and the challenge of Labour: the 1906 progressive election in Halifax’, Trans. Halifax Antiquarian Soc., 1994, 2 (n.s.): 107–24.

⁴¹ J G Washington, ‘The history of the Halifax General Hospital’, Trans. Halifax Antiquarian Soc., 1998, 6 (n.s.): 94–116.

⁴² Halifax Local Studies Centre (hereafter HLS), 352 HAL, Halifax County Borough Minutes (hereafter Halifax CB minutes) 1901–1902, pp. 670–4. A report on the Royal Institute of Public Health Congress, held in Exeter in August 1902, by the MOH and Alderman J F Coe, Chairman of the Health Committee.

⁴³ Halifax Corporation rebutted claims of extravagance. Bernard Harris, The health of the schoolchild: a history of the school medical service in England and Wales, Buckingham, Open University Press, 1995, p. 97.

⁴⁴ J G Washington, ‘The origins and development of the Halifax Royal Infirmary, 1807–1995’, Trans. Halifax Antiquarian Soc., 1996, 4 (n.s.): 68–86. HLS; 614 HAL, Annual reports of the health of the borough (hereafter Halifax MOH reports), 1938, pp. 18–19, lists details of cancer services including municipal support for the RHI radium clinic run in conjunction with the Royal Infirmary, Bradford. The clinic was first referred to in the MOH report for 1932, although a discussion on the use of radium to treat cancer of the cervix appeared in 1930. Halifax MOH reports for 1930, p. 25, and 1932, p. 20. National Archives, Kew (hereafter NA) MH 66/1071, Halifax County Borough Public Health Survey Report by Dr D J Williamson (hereafter Halifax PH Survey), paragraphs 1079, 1080 and 1100.

⁴⁵ Report on RIPH Congress, op. cit., note 42 above, mentioned an address by Professor Sims Woodhead “dealing with the needs and requirements of to-day, in prosecuting the study of the nature and cause of cancer, infectious diseases generally, and allied subjects”.

⁴⁶ Halifax MOH report for 1925, pp. 14–15, following format introduced by circular 648.

⁴⁷ Halifax MOH report for 1937, pp. 20–1.

⁴⁸ Among the 178 deaths registered, stomach cancer claimed 26 males and 12 females, while cancer of the uterus caused 21 deaths, breast 9 and ovary 6. Only four cancer deaths (three prostrate and one urethra) were identified as diseases of male organs. In 1932 a single scrotal cancer death was recorded, with two more in 1933. Halifax MOH reports for 1932, pp. 20–1, and 1933, pp. 20–2.

⁴⁹ Halifax MOH report for 1925, pp. 14–15.

⁵⁰ Gary Firth, Bradford charity and the public purse: a history of Bradford hospitals from 1780, Bradford, Bradford Hospitals NHS Trust, 2001, pp. 45–52.

⁵¹ NA, MH 66/30, Cornwall Public Health Survey Report (hereafter Cornwall PH survey), 1931; NA, MH 66/58, Administrative County of Devon, Public Health Survey Report (hereafter Devon PH survey) by Allan C Parsons, 1931; NA, MH 66/608, Exeter CB, Public Health Survey, sec 104 1929 GA by Dr A C Parsons, 1930 (hereafter Exeter PH survey 1); NA, MH 66/611, Exeter County Borough—further survey report by Dr Allan C Parsons, 1935 (hereafter Exeter PH survey 2); NA, MH 66/818, Plymouth CB, Public Health Survey, 1930.

⁵² Cornwall PH survey, p. 58.

⁵³ Ibid.

⁵⁴ West Country Studies Library, Exeter, Exeter MOH report for 1943 by G B Page, p. 25.

⁵⁵ Some examples are given in Exeter PH survey 1, pp. 55–9; Devon PH survey, pp. 47–58; and Cornwall PH survey, pp. 58–9.

⁵⁶ Devon PH survey, pp. 31–2, listed radium provision at the Royal Devon and Exeter Hospital, and at hospitals in Torquay, Newton Abbot, and Totnes, as well as at the East Devon and West Cornwall Hospital in Plymouth.

⁵⁷ Devon PH Survey, pp. 31–2.

⁵⁸ Halifax PH survey, paragraphs 925–6 and 994–5.

⁵⁹ Martin Powell, ‘Coasts and coalfields: the geographical distribution of doctors in England and Wales in the 1930s’, Soc. Hist. Med., 2005, 18: 245–63, pp. 256–7; Ian R Whitehead, Doctors in the Great War, London, Leo Cooper, 1999, pp. 34, 47.

⁶⁰ Exeter PH survey 1, pp. 7–8, 32–5, 60.

⁶¹ The re-survey of Exeter provision was more positive about potential developments but regretted the absence of a definite scheme for “the ascertainment of people suffering from cancer”. Exeter PH survey 2, pp. 44–5,

⁶² Ibid.

⁶³ Cornwall PH survey, pp. 58–9; and Devon PH survey, pp. 37–8.

⁶⁴ Exeter PH survey 2, pp. 44–5.

⁶⁵ This was discussed with the MOH who tentatively linked the increase in “pulmonary carcinoma” to “tarred roads”, Exeter PH survey 2, p. 44.

⁶⁶ These points in relation to cancer receive particular attention in Devon PH survey, p. 10, and a more general discussion appears in Exeter PH survey 1, pp. 3–5, 9–10.

⁶⁷ Halifax PH survey, sections on “general character and resources” (paragraphs 1–24); “vital statistics”; and institutional accommodation (paragraphs 855–973).

⁶⁸ Plymouth and West Devon Record Office, 1363/10 County Borough of Plymouth, Medical Officer of Health annual reports, 1914, pp. 42–3.

⁶⁹ An approach endorsed by Ministry of Health officials. Halifax PH survey, paragraphs 1–24.

⁷⁰ Halifax MOH report for 1925, pp. 14–15.

⁷¹ NA, PIN 12/33, ‘An enquiry in regard to the cause of spinners’ scrotal cancer’, by James Robertson, MB, DPH, Medical Officer of Health, Darwen, March 1926.

⁷² Moscucci, both references, note 24 above. An emphasis on services provided by women for women helps explain close links between some family planning clinics and gynaecological clinics which potentially provided another source of cancer referrals. Audrey Court and Cynthia Walton, 1926–1991: Birmingham made a difference. The Birmingham Women’s Welfare Centre: the Family Planning Association in Birmingham, Birmingham, Barn Books, 2001, pp. 11–17.

⁷³ Pamela Dale, Janet Greenlees and Joseph Melling, ‘The kiss of death or a flight of fancy? Workers’ health and the campaign to regulate shuttle kissing in the British cotton industry, c.1900–52’, Soc. Hist., 2007, 32: 54–75.

⁷⁴ Reagan, op. cit., note 25 above.

⁷⁵ Carolyn Malone, Women’s bodies and dangerous trades in England, 1880–1914, Woodbridge, Boydell Press, 2003; Barbara Harrison, Not only the ‘dangerous trades’: women’s work and health in Britain, 1880–1914, London, Taylor and Francis, 1996.

⁷⁶ For debates regarding benefits of specialism and separatism, see Rosemary Stevens, Medical practice in modern England: the impact of specialization and state medicine, New Haven, Yale University Press, 1966, pp. 38–52; Louise Westwood, ‘Separatism and exclusion: women in psychiatry, 1900–1950’, in Pamela Dale and Joseph Melling (eds), Mental illness and learning disability since 1850: finding a place for mental disorder in the United Kingdom, London, Routledge, 2006, pp. 91–111, on pp. 92–3.

⁷⁷ Archives and Manuscripts Collection, Wellcome Library, London, SA/FPA/A11/20, letter from Roe (Halifax MOH) to Mrs Freeth, 27 Aug. 1935, noted that the birth control clinic was detecting gynaecological conditions. Dr Hynemann described the clinic as “health and life saving” at its 1937 AGM. Calderdale Record Office, Misc. 190:1, Halifax Women’s Welfare Club/Halifax Family Planning Clinic, notebook of minutes 1934–1938.

⁷⁸ Moscucci, both references, note 24 above.

⁷⁹ Thomas McKeown and C R Lowe, An introduction to social medicine, 2nd ed., Oxford, Blackwell, 1974, p. 287.

⁸⁰ David Hirst, ‘The early school medical service in Wales: public care or private responsibility?’, in A Borsay (ed.), Medicine in Wales c. 1800–2000: public service or private commodity?, Cardiff, University of Wales Press, 2003, pp. 65–85.

⁸¹ Halifax MOH report for 1934, p. 7.

⁸² Ibid.

⁸³ Halifax PH survey, paragraph 287.

⁸⁴ Pamela Dale, ‘Tension in the voluntary– statutory alliance: “lay professionals” and the planning and delivery of mental deficiency services, 1917–1945’, in Dale and Melling (eds), op. cit., note 76 above, pp. 154–78, on p. 168.

⁸⁵ Halifax PH survey, paragraphs 925–6 and 994–5.

⁸⁶ NA, 66/289, Yorkshire (WR) CC – LGA, 104 PH Survey 1934 (hereafter WRCC PH survey), paragraphs 87 and 120.

⁸⁷ Halifax PH survey, paragraphs 1080 and 1099–1100.

⁸⁸ John Welshman, Municipal medicine: public health in twentieth-century Britain, Oxford, Peter Lang, 2000, p. 258.

⁸⁹ Harris, op. cit., note 34 above, pp. 178–80.

⁹⁰ One example is anthrax, widely known as “wool sorters’ disease”. Ian Mortimer and Joseph Melling, ‘“The contest between commerce and trade, on the one side, and human life on the other”: British government policies for the regulation of anthrax infection and the wool textiles industries, 1880–1939’, Textile Hist., 2000, 31 (2): 223–37.

⁹¹ E M Brockbank, Mule spinners’ cancer: epithelioma of the skin in cotton spinners, London, H K Lewis, 1941, pp. 5–7, for a brief synopsis of work by Wilson, Southam and other researchers. See also A H Southam, ‘Mule-spinners’ cancer’, in Manchester Committee on Cancer, Lectures on cancer, Manchester, Blacklock, 1927, pp. 103–7. Southam favoured early surgery.

⁹² Report of the Departmental Committee appointed to consider evidence as to the occurrence of epitheliomatous ulceration among mule spinners [Bellhouse Committee Report], London, HMSO, 1926.

⁹³ The work of the committee and its conclusions are summarized by Brockbank, op. cit., note 91 above, pp. 5–10.

⁹⁴ Manchester University provided the laboratory facilities and its control of the MCC increased noticeably after 1930, though R Veitch Clark, S A Henry and E M Brockbank (the last chairing Manchester’s branch of the British Empire Campaign) all retained a presence on its Consultative Committee. Report of the MCC for the years 1925, 1926 and 1927, pp. 2–5. Copies in John Rylands Library, Manchester University. For the Lancashire MOHs, see Janet Greenlees, ‘“Stop kissing and steaming!”: tuberculosis and the occupational health movement in Massachusetts and Lancashire, 1870–1918’, Urban Hist., 2005, 32: 223–46.

⁹⁵ The division of responsibilities between the Factory Department of the Home Office and the new Ministry of Health was a source of frustration for senior officials who wanted to extend their work into the field of factory hygiene. See Arthur Newsholme, The Ministry of Health, London, G P Putnams Sons, 1925, pp. 114–25.

⁹⁶ Cancer services are discussed in WRCC PH survey, paragraphs 73–5. Comments by ministry officials, drawing attention to recent circulars, were apparently designed to support the newly appointed MOH who was struggling to impose his authority and expand services against resistance from senior lay council officials.

⁹⁷ One cause for caution was the 500,000 disability pensions the Ministry paid by 1938. Lyn MacDonald, The roses of no man’s land, Harmondsworth, Penguin, 1993, pp. 303–4.

⁹⁸ Jeffrey S Reznick, Healing the nation: soldiers and the culture of caregiving in Britain during the Great War, Manchester University Press, 2004, pp. 128–9.

⁹⁹ The care of Halifax veterans suffering from tuberculosis was a heavy duty for the tuberculosis officer. Halifax CB minutes 1925–26, Health Committee 21 July 1926, p. 1225. On the other hand, the sanatorium at Tehidy Park was provided by the Cornish War Memorial Committee. Cornwall PH survey, p. 32.

¹⁰⁰ NA, PIN 15/4041, Medical Research Council, ‘Cancer arising in pensioners and ex-servicemen’, 26 Nov. 1937, preamble explains that the Memorandum had been prepared following the Ministry of Pensions’ request for advice “as to the present state of knowledge bearing on the question of the possible role of previous war injuries in the causation of malignant growths”. It followed a conference held on 12 Nov. 1937.

¹⁰¹ NA, PIN 15/4041, letter from C R Stewart (copy to DGMS), 29 July 1937.

¹⁰² ‘Cancer arising in pensioners and ex-servicemen’, op. cit., note 100 above.

¹⁰³ NA, PIN 15/4041, Report on conference between Medical Officers of the Ministry of Pensions and representatives of the Medical Research Council, 12 Nov. 1937, comments attributed to Dr Hebb.

¹⁰⁴ NA, PIN 15/4041, letter from J H Hebb to Sir Edward Mellanby, MRC, 8 Oct. 1937.

¹⁰⁵ ‘Cancer arising in pensioners and ex-servicemen’, op. cit., note 100 above, section A, paragraphs 1–2.

¹⁰⁶ Halifax MOH report for 1925, pp. 14–15.

¹⁰⁷ ‘Cancer arising in pensioners and ex-servicemen’, op. cit., note 100 above, section B, paragraph 3.

¹⁰⁸ NA, LAB15/151, undated pamphlet (c. 1943?) ‘Mule spinners’ cancer: a paper of great importance’, Manchester, The Manchester Oil Refinery, reviews the research and chronology of government responses.

¹⁰⁹ Pinell also notes the difficulties of preserving an “official oncology” in the inter-war period, op. cit., note 1 above, p. 680.

¹¹⁰ Harris, op. cit., note 34 above, pp. 220–1.

¹¹¹ Sheard and Donaldson, op. cit., note 36 above, pp. 27, 195; Harris, op. cit., note 34 above, p. 220.

¹¹² Pinell op. cit., note 1 above, pp. 680–1.

¹¹³ Investment in expensive treatment facilities yielded limited results unless patients presented themselves for medical examination and doctors improved diagnoses and treatment. In the hands of non-specialists, radium therapy could pose a threat to patients. Harris, op. cit., note 34, p. 221, for summary.

¹¹⁴ David Silbey, ‘Bodies and cultures collide: enlistment, the medical exam and the British working class, 1914–1916’, Soc. Hist. Med., 2004, 17: 61–76.