The Thirties: An Intimate History of Britain. Juliet Gardiner

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      So the uninsured, the unemployed who had exhausted their sickness benefit entitlement and whose names were removed from doctors’ lists as ‘ceased to be insured” (although doctors were no longer paid to treat such people, ‘If they were well known to us, we felt morally under an obligation to attend to their wants when asked to’), the dependents of those covered by the NHI and the poor and old, would have to spatchcock together medical care as they did other social services. In the first instance they were likely go to the local chemist for a bottle of patent medicine (almost £30 million a year was spent on patent medicines during the 1930s, and it was not until the 1939 Cancer Act that the advertising of cancer ‘cures’ bought over the counter was banned), and only if that was ineffective would they seek medical advice. They might be able consult a doctor who participated in the Public Medical Services, or be treated by those employed by enlightened local authorities such as Glasgow, Oxford or Mansfield in Nottinghamshire. Most local authorities, though, provided only those services they were statutorily obliged to, mainly concerned with infant and maternity care, or mental and infectious diseases. People might join a doctor’s ‘club’ and pay a small amount each week, or go to the outpatients’ department of a public hospital.

      Married women were particularly disadvantaged if they could not afford to pay for their medical care. They were not covered by the NHI scheme, and were considered a poor risk by insurance companies since the mass of burdensome ‘dull diseases’ contingent on their biology would be likely to prove expensive — a burden the Chief Medical Officer of Health, Sir George Newman, admitted privately he was reluctant to enquire into too deeply, since it was ‘a wandering fire to which there are no bounds’ that would create demands way beyond the resources of the Ministry of Health. There were few women general practitioners, since most preferred to work directly with women and children in clinics, and many women were reluctant to take their troubles to a male doctor, so they struggled on with varicose veins, anaemia, prolapsed wombs, phlebitis, haemorrhoids, rheumatism, arthritis, chronic backache, undernourishment and exhaustion without ever seeking medical advice. Death in childbirth remained at much the same level –4.1 per thousand — in 1935 as it had been in 1900, and in the depressed areas of South Wales and Scotland it was 6 per thousand. Better antenatal care as well as improved living conditions might have helped, but the primary cause of death in childbirth was medical, and it was not until the mid-1930s that puerperal fever, which presented the gravest danger, became treatable with sulphonamide drugs.

      Hospitalisation was not covered by health insurance, and the choice was between voluntary hospitals, which had originally been endowed by the rich for the care of the poor, and which included some of the most famous London teaching hospitals, and local authority hospitals, many of which had been former Poor Law institutions. The voluntary hospitals were permanently strapped for cash by the 1930s, and were dependent on bequests, fund-raising events such as concerts and fêtes, flag days and patients’ fees. Those on low incomes might have been paying a few pence a week which would give them the right to treatment should they need it (or if they were lucky their employer might have made a block provision for employees in this way), or they might be charged whatever the hospital almoner assessed they could afford. But the days of such hospitals were numbered: it was clear that voluntary contributions were no longer sufficient to keep them going, despite the fact that private patients’ fees, mostly paid through insurance schemes, covered almost half such hospitals’ costs), and by the end of the decade more hospital accommodation was provided by local authorities than by the voluntary sector.

      The financial difficulties of the voluntary hospitals and the fact that they were not planned on a national scale according to the needs of the community, gave an opportunity to a group of medical practitioners who had a larger vision for health. The Socialist Medical Association (SMA) had been founded in 1930 with the support of, among others, the first Minister of Health, Christopher Addison, the journalist and propagandist for science Ritchie Calder and medical scientists and practitioners such as Somerville Hastings, a surgeon at the Middlesex Hospital in London and a Labour MP, Charles Brook, a London GP, David Stark Murray, a Scottish pathologist, and Richard Doll, who in the 1950s would prove the link between smoking and lung cancer. The SMA looked to the creation of a socialised medical system which would both streamline the chaotic health provision of the 1930s and ultimately make health care ‘free to all rich and poor’. Furthermore, it wanted to end what it regarded as the ‘lonely isolation’ of the GP by creating salaried posts and locating them in a series of health centres based on municipal hospitals that integrated all aspects of medical care — owing something to the Peckham, Finsbury and Bermondsey models.

      Although this blueprint for socialised medicine appears to prefigure the creation of the NHS in 1948, it was at local level — particularly in London — that the SMA came nearest to implementing its ideas in the 1930s. ‘Municipal socialism’ increasingly seemed to be a plausible strategy for undermining the National Government, and during the 1934 London County Council (LCC) elections the SMA produced a health manifesto claiming that the capital’s ill health was due to poverty, bad sanitation and inadequate medical care and treatment (due to lack of resources), for which ‘the anarchy of capitalism’, reflected in uncoordinated health care provision, was to blame. Seeing health as ‘every bit as important as education’, SMA members were appointed to a range of LCC committees when Labour won control, and were able to put some of their ideas into practice, such as increasing the allocation of resources to municipal hospitals, improving the conditions and pay of nurses and other medical staff, providing outpatient facilities at most hospitals for the surrounding community and ridding hospitals of any Poor Law connotations, since ‘every possible suggestion of charity, subservience, and general second rateness must be banished’. Instead London’s citizens should regard ‘the municipal hospitals as their own [since they had] every right to use them and expect the best from them’. But although the reform of London’s health provision was of considerable interest to other authorities, even Somerville Hastings, chairman of the LCC Hospital and Medical Services Committee, recognised that it was unlikely to be fully possible ‘within the limits of existing legislation’.

      As well as inadequate hospital provision, the range of remedies doctors could provide was still very limited: during their brief consultation patients would be given a handful of pills, which might come in a range of colours but would in fact probably all be aspirins, though bottles of dilute mixtures of powerful drugs such as kaolin and morphine were also dispensed. A Welsh doctor provided his miner patients with a tincture of chloroform and morphine, effectively an addictive drug, for their chronic chest conditions. Many general practitioners had few aids to diagnosis, a stethoscope, thermometer, ear syringe and maybe a speculum being fairly standard, sterilising instruments was a dispensable luxury, and doctors had to pay for laboratory tests themselves — and therefore tended not to take advantage of new techniques and treatments that were being developed during the 1930s. A Welsh doctor who prescribed little but ‘black liquorice’ for his miner patients’ pneumoconiosis was regarded as a cut above other practitioners in the town, since he had a machine that enabled him to take a patient’s blood pressure.

      Aware of their limited therapeutic arsenal, doctors essentially bought time by dispensing medicine, hoping that an illness would turn out to be self-limiting and would disappear, while patients appeared to be satisfied if they left the surgery clutching a bottle of medicine (private patients would have their bottle wrapped in white paper and sealed with sealing wax and usually delivered by the doctor’s errand boy on a bicycle after evening surgery) or, less frequently, a box of pills, for which they had paid two or three pence. Aspirin powder for pain relief had been available since the turn of the century, and a tablet form had been patented in 1914, insulin injections to control diabetes had been introduced in the 1920s, followed by kidney dialysis, radium treatment for cancers, skin grafts and blood transfusions. Salvarsan was effective as a cure for syphilis and pernicious anaemia could now be treated with iron injections (rather than raw liver sandwiches, as previously), while the significance of vitamins began to be appreciated, leading to new therapies using vitamins C and D in cases of scurvy and rickets.

      However, there were few things in the medicine cupboard in Eileen Whiteing’s СКАЧАТЬ