MacNalty, Sir Arthur Salusbury (1880-1969), public health administrator

MacNalty, Sir Arthur Salusbury (1880-1969), public health administrator, was born on 20 October 1880 at Glenridding, Westmorland, the son of Francis Charles MacNalty, physician, and his wife, Hester Emma Frances, daughter of the Revd Arthur D. Gardner, fellow of Jesus College, Oxford. He spent his early boyhood in the Lake District. He was educated privately in the south while his father was in general medical practice in Winchester. He was first at Hartley College, Southampton, and later in St Catherine's Society, Oxford, before entering Corpus Christi College, Oxford. He was therefore rather late in taking a degree in natural science (physiology), in which he obtained a second class in 1904; he became MB at the age of twenty-seven, and DM four years later in 1911. In 1913 he married Dorothea (d. 1968), the daughter of the Revd C. H. Simpkinson de Wesselow. They had two daughters.

MacNalty became MRCP in 1925 and was elected a fellow in 1930, having taken the diploma in public health in 1927. His was a slightly unorthodox career in preventive medicine, as he chose to work in the central health department, unlike most of the leading figures in public health, who rose through the services of local authorities in the manner of Sir Arthur Newsholme and Sir George Newman. MacNalty began his career as a clinical physician following a special interest in chest diseases, which led him to the Brompton Hospital, London. Chest diseases at that time meant mainly pulmonary tuberculosis and the central health department—then the Local Government Board—was engaged in the establishment of county and county borough services for the tuberculous. MacNalty was recruited in 1913 to the small team of specialists required to promote a ‘sanatorium’ and ‘dispensary’ service throughout the country. Most of his subsequent career was centred upon this service and he did not move around the special sections as most of the more generally trained medical staff were expected to do.

For many years afterwards both medical practitioners and the lay public were seldom aware of the dominant position of tuberculosis control in local authority health responsibilities from 1910 to 1948. MacNalty played a large part in the central guidance of the development of those services. A succession of departmental reports written by MacNalty, culminating in the 1932 report on tuberculosis, testify to his special interest in the epidemiology and treatment of tuberculous infections. He had, however, contributed substantially to the Ministry of Health's work on other infections—especially virus infections of the central nervous system. He was a close friend of Sydney A. Monckton Copeman, the last member of the departmental staff to become a fellow of the Royal Society, and they worked together on virus diseases. It has been said of MacNalty that he was a medical reporter before all else.

MacNalty was a member of the staff transferred to the new Ministry of Health in 1919, and in 1932 he became one of the department's senior medical officers. With the chief medical officer, Sir George Newman, often away, it was thought necessary to have a substitute, and MacNalty was chosen as the unofficial deputy, possibly on account of his compliant characteristics. This in effect made him Newman's heir apparent, and he eventually succeeded him in 1935. At that time MacNalty was not well known among the public health medical staff in the country, but his standing in his own field of medicine was high.

MacNalty was chief medical officer from 1935 for a little over five years. During this period there were preparations for civilian services in time of war, and the Ministry of Health became involved in the hospital building programmes of local authorities and in the development of specialist services. In December 1936 MacNalty was asked to prepare proposals for the provision of specialist and other diagnostic services. He reported that local authority services ‘were a more appropriate basis for a comprehensive scheme than the National Health Insurance Scheme’, a conclusion supported by his medical colleagues in the department (Webster, 21). The Public Health Laboratory Service was developed from a wartime emergency service, on the basis of a survey initiated by MacNalty. Others were involved in these changes and MacNalty has been given little of the credit for them. In a departmental reorganization in 1940 he retired early, at the age of sixty, to make way for the more dynamic leadership of Wilson Jameson.

In 1941 MacNalty was commissioned by the Nuffield College Reconstruction Survey to contribute to its investigations into the reform of local government. His Reform of the Public Health Services was published in 1943. In the pamphlet MacNalty discusses general public health, the central health authorities, and the reconstruction of health and medical services on a comprehensive regional plan. Of particular interest is his claim that in 1939 he had written a memorandum on research in preventive and social medicine for the faculty of medical studies at Oxford University, in which he advocated the establishment of a professorship of preventive and social medicine. The first chair and institute of social medicine was established at Oxford in 1943, when the post was taken up by John Ryle (1889–1950).

MacNalty then turned to the work for which he will be mainly remembered, as editor-in-chief of the official medical history of the war, which he completed shortly before his death in 1969. He gave this work the same devoted attention he had always applied to his writing, and at the same time he indulged his real passion for history, especially medical history. His knowledge of both history and literature was exceptional and his writing extensive.

At the end of his long life (MacNalty died at his home in Bocketts Down Road, Epsom, Surrey, on 17 April 1969), perhaps none remained who had known his whole range of activity and therefore could make a fair assessment. He was an unassertive and reserved man, few of whose staff knew him well, despite his occasional social gestures. Yet he was well liked by those few who came to know him in his later life. He was unfortunate in being thrust into the most responsible medical administrative post in the country at a time when it was exposed to unprecedented strains. One felt he stepped aside with relief; nevertheless, there are few who are prepared to cede leadership gracefully in that way and turn to another career as he did. MacNalty was an honorary fellow of many societies, including the Royal Society of Edinburgh, and was also a freeman of the City of London. He was knighted in 1936.

GEORGE E. GODBER, rev. MICHAEL BEVAN