Health Before the NHS: The Road to Recovery
DVD Colour;Black & White Sound 2012 60:00
Summary: Programme about how pre-NHS, ordinary people, GPs, midwives and local councils coped with disease in the community; the struggle to improve the nation’s health; and how new ideas helped create healthcare for all through the NHS. Narrated by Prof. Robert Winston.
Title number: 21049
LSA ID: LSA/27627
Description: Robert Winston narrates. Black and white footage of children, adults and medical treatment at the beginning of the 20th century throughout.
He talks about the poor health of people at the beginning of the 20th century. The life expectancy of men was 48, and childbirth could be life threatening for women.
1’06” People had to pay for doctors and many couldn’t afford to. Ilfra Goldberg says that the doctor was only called when her family were seriously ill.
1’19” Winston says getting hold of treatment could be difficult and therefore many communities organised their own healthcare and some experimented with preventative medicine
2’46” During the 19th Century there were slum clearances and improved sanitation to end epidemics of infectious diseases. Focus shifted from environmental health to the individual at the beginning of the 20th century.
3’31” The poor state of volunteers for the Boer War highlighted how poor individual health was. The problem was described as national degeneration and government committees were set up to look into it, particularly the numbers of children dying in the first year of life. 4’07” Dr Steven Thompson says many reforms were brought in to try to improve the standard of infant health and therefore produce a fit and healthy industrial nation.
4’36” Maternal deaths in childbirth were also high. The focus turned to midwives who for centuries had worked separately from the medical profession and who were untrained, unregulated and often unpaid. 5’28” Dr Tania McIntosh says everything changed for midwifery at the beginning of the 20th century. 1902 saw the state regulation of midwives to ensure compulsory training, registration and professional standards.
6’21” Midwives were self-employed and often had to have additional means of income. Ilfra Goldberg remembers a midwife who was also a chimney sweep.
7’34” By the mid-1930s midwifery was far more professional but there weren’t enough people working as midwives. In 1936 legislation ensured midwives were paid a salary and a pension. New people then became midwives, including Grace Lowe (black and white photos of her). Her daughter, Penny Lowe, talks about how her mother qualified. She then became a midwife in Walthamstow but was not prepared for the realities of the job which were frightening because you never knew how the birth would happen.
9’16” Tania McIntosh says midwives could only take what they could carry so would not generally have gas and air to offer pain relief. She talks about the equipment they had. The reforms in midwifery resulted in infant mortality halving between 1900 and the 10930s. However childbirth was still a threat to women.
10’47” Janet Dunn talks about two of her brothers dying of ‘convulsions’. Pictures of Janet’s family. Her mother developed septicaemia after a miscarriage. She was very ill for 3 months and was expected to die. Janet talks about how frightening it was for her. She was only 8. Against the odds her mother survived but 1 in 200 women died in childbirth.
12’36” For the wealthy the risks were as high but doctors were employed to deliver children. Margaret Smart watches footage of family and her as a baby after her birth in 1935. A monthly nurse would sometimes come and live with the family for the week before the birth and for two or three weeks after to help.
15’10” Tania McIntosh says that it was actually safer to have a midwife as doctors were very busy. They would often pass on an infection because they’d rushed from an illness to a birth. Doctors were self-employed and therefore the more patients they had, the more money they earned. 16’06” Dr Martin Gorsky says doctors practiced in areas where they thought they would make the most money and so access to care differed in different parts of the country. Coverage limited in rural areas.
16’42” In 1920 Mary Phillip’s father got his first job in a large rural practice in Devon (pictures of her parents). Her mother was a nurse. As a qualified surgeon he also did operations. She talks about what his life was like as a doctor.
18’34” Doctors were expensive so if health was to improve the low-paid needed better access. Health Insurance schemes were set up by friendly societies and trade unions. From 1911 onwards the state made a contribution to this insurance for those on low pay alongside contributions from the employee and employer. However it still left almost half the population without help. 20’18” As well as the middle-classes, those who weren’t in work were excluded from the scheme e.g. women in the home and children. These people had to find other ways to manage. For example, for Ilfra Goldberg’s family a doctor would charge for the adults but not for the children but the doctor would only be consulted for serious issues(pictures of the family).
22’06” Cover was given to dependent wives and children by some employees, for example by the Kent coalfields for Janet Dunn’s family. However this ended when her father was sacked. Her mother developed pre-eclampsia and the only help offered was in effectively a poor house. She refused to go and the baby was stillborn.
25’05” Many people suffered huge financial hardship with high unemployment and an economic depression. Brenda Watkinson’s parents struggled to make a living (black and white picture of her family). Her father volunteered in a doctor’s surgery in Bermondsey helping run a local healthcare payment scheme, the PMS, which helped people spread the cost of medical treatment. He had to go out on his bike in all weathers to collect money. Often people were out or hiding. She says times were hard and this was the only way people could eke out some money.
27’06” In Britain the tradition for self-help schemes for medical care started in the early 19thcentury. However workers were often dissatisfied that employers could appoint and dismiss doctors and sometimes employers even profited from the schemes.
27’55” A scheme in Tredegar in South Wales wanted to do its best by its members. Under the Tredegar Workmen’s Medical Aid Society, wives and children were covered and workers did not have to pay a flat rate contribution. Profits built up so that other medical services could be offered. Nearly everyone in the town was a member. John Morgan talks about what the scheme meant to his family (pictures). Future Health Minister Aneurin Bevan was born in Tredegar and his vision of a national health service was shaped by the Tredegar scheme.
32’06” There were still many challenges in the 1930’s and many deaths from infectious diseases such as diphtheria. Betty Giltinan talks about her mother dying from diphtheria leaving 5 children (pictures of the family). The disease was still responsible for a third of childhood deaths. Sally Sheard talks about the problems with immunisation in Britain. It wasn’t until the second world war that central government brought in an immunisation programme making diphtheria a disease of the past within a decade.
36’13” In the 1930’s public health departments were run and mainly financed by local councils. The person in charge would be the Medical Officer of Health who would be very powerful. By this time there was an emphasis on the prevention of ill health including street cleaning, public laundries, bath houses and maternity clinics.
38’18” The School Medical Inspection Service worked alongside the public health departments in order to monitor the health of the poorest children. In 1929 Stanley Jarvis joined them in Liverpool. His son, Peter Jarvis, talks about him and the monitoring that happened in schools. The School Medical Inspection Service provided free treatment for the country’s poorest children.
40’19” There was a lot of industrial pollution and this contributed to the condition Rickets caused by a lack of vitamin D from sunlight and calcium producing food like milk, eggs and fish. Some public health departments offered sunlight treatment to the most vulnerable. Brenda Watkinson’s mother had had rickets due to malnutrition as did her brother. He received sunlight treatment and gradually got better.
43’05” Scientist Edward Mellanby discovered the link between vitamin D and rickets (home movies of him). He advocated cod liver oil for all children. The science of nutrition made great strides in the 1930s and looked at the minimum income necessary to buy a healthy diet – this lead to government policy to be looked at. More and more people were calling on the government to look at ill health caused by poverty. 44’42” Film which was part of the campaign, focuses on the height difference in boys from different classes due to nutrition. The work of leading campaigner, Dr George McGonagle, is featured in the film (footage of him). He looked at the effects of income on diet and he found that unemployment benefits were not adequate for health.
46’20” McGonagle called on the government to increase benefits and saw himself as an advocate for the poor in his area. He was threatened with disciplinary action by the General Medical council but he kept his job.
47’09” New approaches to preventative medicine were tried including a radical experiment in Peckham. Film made to showcase it. Footage of Big Ben and the No 35 tram travelling to Peckham. Shot of the Pioneer Health Centre in Peckham. People using the swimming pool in the centre. The experiment set out to discover the elements which influenced people’s health, and the significance of family relationships in this. Pam Elven watches footage of her father who would compare at Saturday night dances. Pam Elven’s family were one of the first 200 who joined the centre when it opened in 1935 (photo of the family). She talks about the centre and how it changed her life. Footage of activities in the centre. Membership was by subscription to employed local people.
48’56” Professor David Armstrong talks about how the experiment set out a series of buildings with a social club at the centre. People would be examined and monitored like an ‘old fashioned big brother’. Innes Pearse and George Scott Williamson were the two biologists who had the idea for the experiment (photo). Footage of Williamson talking about how the aim was to find out what health is. He felt the right environment could promote good physical and mental health.
49’54” When people joined the experiment they would have individual medical examinations but also family consultations with the view that family interaction could inform about health and lifestyle (continued footage of Williamson and Innes and the centre). Elven talks about being guinea pigs in the experiment. She says she loved it and that the centre was the first place her mother made friends in the area. Doreen Head talks about her family’s experience there.
51’36” Over 650 families joined the centre within two years. The doctors at the centre felt that only 7% of people at the centre were truly healthy. Williamson and Pearce published their findings in 1943. They found many of the children had worms, deformed toes and decayed teeth whilst the adults had more serious problems like anaemia, high blood pressure, kidney disorders and cancer. Patients were not treated at the centre but advised to go elsewhere if they had a problem.
52’54” Pam Elven said they discovered a lot wrong with her at the centre including rheumatism but that her mother said she went from being a sickly child to being a healthy child within 18 months of being at the centre.
53’40” The centre doctors believed in the importance of good food and a farm was opened in Kent (footage of people working on and enjoying the farm). Families stayed here at weekends and helped. Elven says here time spent around the centre were probably the best years of her life.
54’29” The outbreak of World War II brought a temporary break in the experiment and also prompted wider discussion of health reform. People were promised better lives in exchange for their part in the war effort. Aneurin Bevan, who was health minister in the 1945 Labour government, came up with a new vision for health. He used the Tredegar system of comprehensive healthcare as an example of how a national system could work.
55’43” The new NHS was controlled by central government and so the Tredegar Medical Aid Society came to an end. The Peckham centre reopened after the war but later Pam Elvin and her fiancée (pictured) found out it was going to be closed within a few days by seeing a notice on a notice board (newspaper clippings). She says people were very upset. Footage of the Peckham Centre seguing into it in modern times. Although the Peckham Experiment finished, it laid the groundwork for the consideration of risk factors in modern medicine.
57’46” When the NHS was brought into force in 1948 it recognised that access to healthcare should not be dependent on individual circumstances.
Credits: Stuart Gordon (Composer); Michael Lansdell (Editor); Jane Harris (Editor); Wendy McLean (Producer); Wendy McLean (Director); Bertil Mulvad (Camera operator)
Cast: Dr Sally Sheard
Dr Steven Thompson
Dr Tania McIntosh
Dr Martin Gorsky
Keywords: Bermondsey; health; Poverty; Peckham; Medicine