With Fit to Practice, Douglas Haynes has once again underlined the centrality of empire to the past and present of British medicine. In his words, the work offers “an institutional history of the General Council of Medical Education and Registration of the United Kingdom and its management of the register between 1858 and 1978” (1). However, as Haynes makes clear, Britain's medical register has always been a political tool. As such, in detailing its history, Fit to Practice traces the persistence of racial and gendered hierarchies in British medicine, and the ways in which the council consistently privileged the interests of white male British graduates over their colonial and gendered others.

Haynes organizes the book in two parts. In part one, he analyzes the council's management of the register in relation to the shifting dynamics of empire. Chapter 1 establishes the importance of the 1858 Medical Act to the character of the profession. Although failing to provide a monopoly of practice for “legally qualified” practitioners, the Act defined portals of entry to the register, reserved public posts for registered doctors, and demarcated a jurisdiction in which such doctors could practice medicine: not just the United Kingdom, but all of its imperial territories. It details how male privilege was initially preserved through the barriers to training and assessment faced by women and outlines the ways in which racial boundaries were maintained through requirements for registration dependent on British qualifications (and through formal race bars in certain colonies). After examining the origins of the 1886 Medical Act, which provided a mechanism for the mutual recognition of qualifications and practitioners’ rights in reciprocating territories, the rest of part one explores how the council managed the changing political waters of empire, nationalism, and global war until the late 1940s. As Haynes highlights, reciprocation offered benefits to British medicine and the imperial state. It provided a means to secure imperial projects, to reinforce strategic diplomatic relations, and, in times of conflict, to find new sources of international labor to materially and symbolically contribute to British war efforts. However, along with the increasing registration of women, reciprocation also provided challenges to the composition of the profession, and mutual recognition of qualifications and rights also entered the council into turbulent international relations, especially as white settler dominions asserted political autonomy.

Through formal and informal bars to service, as well as new forms of limited registration and employment, the racial and gender hierarchies of British medicine were preserved during this turbulent period. However, in part two of the work, Haynes highlights how such hierarchies “at home” faced considerably greater challenges in the postwar period. Specifically, Haynes examines the tension between Britain's need for a globalized workforce to support growing domestic needs and Britain's racist, anti-migratory politics that found expression in riots and legislation. Antipathy to (post)colonial “others,” Haynes argues, was also present within the leading institutions of Britain's medical profession, and overseas doctors were increasingly cast as a danger to the public rather than as an asset maintaining Britain's services. Particularly from the 1960s onwards, a political consensus developed around the need to ensure extra safeguards for overseas doctors accessing Britain's national medical register. Crucially, Haynes proposes, persistent doubts over the linguistic and cultural competence of overseas doctors—and a vocal professional concern for expanding access for European over South Asian labor—revealed the ongoing influence of the belief that British medicine should remain a white, male social institution.

In making these claims, Fit to Practice provides a welcome new perspective on the history of both the General Medical Council and British medicine more broadly. It is meticulously researched and clearly argued. It does, nonetheless, lose sight of gender for most of its second half, and it suffers slightly from its institutional focus. For instance, Haynes outlines how professional dissatisfaction with the council, and particularly with its composition and function, intersected with moves to reform the council's management of the registration of overseas doctors, yet we get only a glimpse of the ways in which concerns with overseas doctors’ standards of education and practice related to the groundswell of popular, political, and professional frustration with medicine in the 1960s and 1970s. Indeed, nascent concerns with professional standards and accountability permeated these decades, and it would have perhaps added to the power of Haynes's analysis to have incorporated these discussions. Similarly, the text has a tendency at points simply to refer to political, social, and professional prejudices rather than explore them fully. Haynes's claims about the postwar prevalence of anxieties around the social composition of medicine, as well as the effects of such anxieties on the medical profession's marginalized “others,” might have landed with even greater impact had they been developed with further excerpts from letters, articles, and other primary sources.

Ultimately, though, these issues are not sufficient to undermine Haynes's persuasive analysis, and they are quibbles that stem from a desire to spend more time with the text. Fit to Practice makes a valuable intervention in the historiography of Britain's modern medical profession, and as such it also makes an important postcolonial contribution to its social history. It reminds historians once more of the extensive temporal and geographical effects of Britain's empire on its domestic institutions, and it deserves a wide readership.