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00:00At the beginning of the 20th century, Britain's health was in a sorry state.
00:25Life expectancy for men was just 48, and for women, an everyday experience like childbirth
00:35could be life-threatening.
00:39My mother had a miscarriage where she was, for three months, extremely ill, unconscious
00:46for a long time, and really people didn't expect her to live.
00:52What treatment there was had to be paid for by the patient. Doctors were a luxury which
00:59many found hard to afford.
01:01It was only when we were quite seriously ill that we asked him to come. We had all sorts
01:07of other scrapes, cuts. They just were bandaged up and hoped we got better.
01:13In fact, getting access to health care at all wasn't easy.
01:20This is a very, very ramshackle, chaotic, disorganised set of services. There's no doubt about that.
01:26With the system failing to deliver, many people took matters into their own hands.
01:32They organised their own health care in their own communities.
01:37If people wanted something done, they had to do it for themselves. And the best way to do
01:41it was by clubbing together.
01:44And others experimented with new ways to stop people from getting ill in the first place.
01:50We were guinea pigs. It wasn't just me. We were all guinea pigs. And it changed my life.
01:59This is the story of how ordinary people, GPs, midwives and local councils cope with sickness
02:07and disease at home and in their communities. Of the struggle to improve the nation's health.
02:15And of how radical new ideas would eventually help create a system of health care for all.
02:42Efforts to deal with the poor state of Britain's health had begun during the 19th century.
02:50Newly created public health departments had organised programmes of slum clearance and improved sanitation
02:58that brought an end to epidemics of infectious diseases.
03:03The emphasis now switched to the health of the individual.
03:08What had happened was we'd lost the epidemics of cholera, typhus, even smallpox was going into decline,
03:15because the sanitary surveillance had been so good.
03:18By the early 20th century, the focus is shifting from environment to personal, to the individual.
03:25The general health of people in Britain at the time was a cause for concern,
03:33highlighted by the shockingly poor state of volunteers for the Boer War.
03:39Most had been rejected for being too small and underweight.
03:44Government committees were set up to look into the problem of what they described as national degeneration,
03:54and in particular, the high numbers of children who died in the first year of life.
03:59There was a growing realisation that the high cost of infant deaths was weakening the country at that time.
04:09That Britain was losing pace with its international competitors, such as Germany, America and Japan.
04:15And so, to ensure that Britain was producing a fit, healthy, productive industrial population,
04:21attention came to be focused on infant welfare and all sorts of different reforms passed
04:25to try to improve the standard of infant health.
04:28In 1900, out of every 1,000 babies born, more than 150 would die before their first birthday.
04:44Their mothers fared little better.
04:47Maternal deaths in childbirth were as high as there had been in the 1850s.
04:55So, if the nation's health was to be improved, the moment of birth was an obvious place to start.
05:04The spotlight turned on midwives.
05:06They delivered most of the nation's babies,
05:09and for centuries had worked independently from the medical profession,
05:13who'd shown little interest in them.
05:18They were untrained, unregulated, and often unpaid.
05:23At the beginning of the 20th century, everything changed for midwifery.
05:28There had been a campaign building up steam throughout the last kind of 20 years of the 19th century,
05:34looking at registering midwives and actually bringing in some kind of compulsory training.
05:40There was also a growing belief that, given that midwives were delivering the vast majority of babies that were born in the country,
05:49there ought to be some way of knowing who they were and perhaps policing what they were doing.
05:53The campaign led in 1902 to the first state regulation of midwives.
06:05A central board was set up to ensure minimum professional standards and compulsory registration and training.
06:14But there was another problem.
06:19Midwives were self-employed, and without a guaranteed income,
06:23they'd had to find other ways to supplement their earnings.
06:26Ilfra Goldberg remembers the novel approach of her village midwife.
06:37We had a wonderful midwife who doubled up as a chimney sweep,
06:40and she used to go through the village in a pony and cart, a white pony and a cart,
06:47and she had her chimney sweep brushes in the cart.
06:51But she also was a qualified midwife, and so people would stop her
06:55and she would come in and help with deliveries as well.
06:59I've never heard of a midwife also operating as a chimney sweep,
07:04but it certainly was true that midwives weren't that often operating purely as midwives.
07:11You find midwives who are taking in washing, taking in lodgers, minding other people's children,
07:18or doing piecework at home simply because they couldn't earn enough money from delivering babies.
07:29By the mid-1930s, the reforms had turned midwifery into a far more professional service,
07:36but the just were not enough of them.
07:45In 1936, legislation was brought in which made local authorities pay midwives a salary and a pension.
07:54The changes attracted an influx of new recruits.
08:00Grace Lowe was one of them.
08:03Well, my mother left school at 14, as they would in those days,
08:08but she'd always been determined that she wanted to be a midwife.
08:12And very much against her parents' wishes, that's exactly what she did.
08:17So, at 18, she went off to a hospital in Lowestoft and did her nursing training for three years.
08:26Grace then moved to London and, by 1937, had fulfilled her ambition to qualify as a midwife.
08:34She began work in Walthamstow, in north-east London,
08:38but the training hadn't prepared her for the stark realities of the job.
08:43You never knew that people were having twins.
08:47They would just appear.
08:49You didn't know if it was a breech birth,
08:52if there was something badly wrong with the child.
08:55There was no signs, there was no tests, people had very little care.
09:00So they never knew what they were going to or how it was going to happen.
09:05And she said that used to be really very frightening.
09:12The only equipment you could take would be that which you could carry.
09:17So very heavy cylinders of gas and air, for example, midwives didn't tend to take with them.
09:22So they didn't have any pain relief to offer women, because it wasn't practical.
09:26One of the things that midwives did carry was ergo.
09:33This is actually a natural ingredient.
09:35It comes from rye, it's mould on rye.
09:38And it would be administered to women who were bleeding after the delivery,
09:41so they were hemorrhaging.
09:43And what ergo does, it acts by contracting the womb,
09:46which would hopefully help to stop bleeding.
09:49This kind of equipment was all reusable.
09:53So when you have that thing in films where husbands are being asked to boil water,
09:57that's the reason why it was so all this metal equipment could be sterilised.
10:07The focus on reform in Britain's maternity services
10:10had started to have an impact on infant mortality rates.
10:15From the beginning of the century to the 1930s, they had more than half.
10:25But for women, pregnancy and childbirth was still a major threat to their lives.
10:30And in an age before widespread contraception,
10:33the threat to them and their children was ever present.
10:37There would be Mary, who was the eldest, myself, Margaret and John.
10:49And I did have two other little brothers.
10:51That was Robert and David.
10:54And unfortunately, they had died of what was in those days just called convulsions.
11:00Janet's father was a minor.
11:03And in 1929, he left Scotland and moved the family south in search of work.
11:09The unemployment was dreadful and the pits were closing everywhere.
11:14And due to the pit closures in Lanarkshire,
11:17Dad came down to the Kent Coalfield
11:19and people were coming from all over the country to Kent.
11:23Janet's father found a job, but life was tough and her mother's health suffered.
11:32Pregnant once again, she fell ill with a highly dangerous infection.
11:36My mother had a miscarriage and developed perpetual fever,
11:42as they used to call it, general septicemia.
11:45was rushed into Canterbury Hospital, where she was, for three months,
11:50extremely ill, unconscious for a long time.
11:53And really, people, they didn't expect her to live.
11:56Mary was 12, the eldest, and I was 8.
12:00And Dad still had to go to work.
12:03If he didn't work, he wouldn't have been paid.
12:06And the terror that we felt, absolutely,
12:10that's the worst terror I've ever felt in my life,
12:13was to see Mum have been taken out.
12:18Against the odds, Janet's mother survived.
12:23But at that time, one in 200 women died as a result of childbirth.
12:32For the better off, the risks were just as high,
12:35but the experience was somewhat different.
12:39Rather than a midwife,
12:41they employed a doctor to deliver their babies.
12:48I don't think I was spoiled, was I?
12:50But there seems to be a lot of attention being paid.
12:55Margaret Smart was brought up in Gloucester
12:57and has a unique record of her birth in 1935.
13:02Her father had a well-paid job and a passion for home movies.
13:06Dad was in insurance.
13:07He worked for the general accident.
13:08He started as an office boy
13:11and worked up to be one of the, you know, manager or something, I think.
13:16And then he bought an insurance-broker in business.
13:17So, obviously, we had a car and a phone and they had this nice new house.
13:19And then he bought an insurance-broker in business.
13:21And then he bought an insurance-broker in business.
13:22So, obviously, we had a car and a phone and they had this nice new house.
13:26The families either side were the same, really.
13:27The families either side were the same, really.
13:31When it came to Margaret's birth, like all middle-class families,
13:34the families were the same, really.
13:38When it came to Margaret's birth, like all middle-class families,
13:40her parents followed fashion and hired the local doctor.
13:45There was a certain amount of kudos related to having a doctor come to your house and deliver your baby.
14:00So, there was very much an element of sort of pride involved.
14:16They would very often also have what was called a monthly nurse to come and live in the house,
14:25perhaps a week before the baby was due.
14:29And then stay for maybe two or three weeks afterwards and help with breastfeeding,
14:38help with caring for baby, those kind of things.
14:44What a dear little soul, wasn't I?
14:50What else can one say about that except that I like biscuits and I've liked them ever since.
14:58Wealthier families believed that by hiring a doctor they were getting a better service.
15:13But it turned out that their confidence was misplaced.
15:17Curiously, although it was fashionable to have a doctor, it was actually safer to be poor and to have a midwife in that period.
15:26Doctors were very busy, they were in a hurry, they were dealing with lots of different cases.
15:32So, you would get them trying to deliver babies before the labour was complete or you would get them passing on infection because they'd been to an illness and then come straight to a birth.
15:45One of the reasons that doctors were so busy was because of the way they earned their living.
15:55They were self-employed. The more patients they had, the more money they earned.
16:01Doctors would decide where to practice on the basis of where they thought they could get the best custom.
16:11And what that meant in effect is that there were some parts of the country where the availability, the access to practitioners and to specialist care was actually much better than in other parts of the country.
16:25And people have calculated that there was something like a six-fold variation between towns in Britain.
16:34In rural areas, coverage was particularly sparse.
16:39In 1920, Mary Phillips' father found his first job as a doctor in a large rural practice in Barnstable in North Devon.
16:48They set off on a motorbike and sidecar to go all the way from Sussex to North Devon.
16:58And my mother was in fact a trained nurse.
17:02She would drive the motorbike and Dad would ride in the sidecar.
17:07With no special GP training required at the time, Mary's father, who'd qualified as a surgeon, also performed operations on his patients at the local hospital.
17:21They did a bit of everything. I mean, he delivered babies.
17:28He operated on appendixes and hernias.
17:34He would do a radical breast operation for cancer.
17:39He was on call six days a week. He had one day off on a Saturday or a Sunday.
17:45Of course, we had staff. We had a cook and a housemaid, and we had a nanny.
17:55My father got a number of private patients.
18:00They used to come to the house at two o'clock in the afternoon, and our drawing room was used as a waiting room.
18:07And we children were kept out, you know.
18:12And we had a maid who wore a frilly apron, who used to answer the door, and then Dad would take them into the consulting room.
18:21But the cost of a visit to the doctor put treatment beyond the reach of most.
18:36If the nation's health was to improve, the low paid needed better access to doctors.
18:42The answer came from health insurance schemes set up by friendly societies and trade unions, dating back to the 19th century.
18:55Using this framework from 1911 onwards, the state would make a contribution towards health insurance for people on low pay.
19:03This national health insurance scheme was a very, very important intervention by the government.
19:11It was the first time that the government had intervened to provide medical services for a group of the population other than the very poorest sections of the community.
19:20All workers who earned up to 160 pounds a year would now be entitled to health insurance.
19:33The way it was set up was that an employee paid in a certain amount of money, the employer paid in some, and some also came from the government.
19:43And that built up an insurance fund which gave them a sickness benefit and the right to access medical care, in other words, to see a GP.
19:59The aim of the scheme had been to increase the number of people who could afford treatment.
20:06But it still left almost half the population without any help.
20:13The middle classes, people above that income level, were obviously excluded, so they were still in the position of having to buy their medical care on the market, as it were.
20:28And other groups who weren't in work were also excluded.
20:32Women in the home and children, people under 16 years.
20:37For those who'd been left out, it was a case of finding other ways to manage.
20:52Some, like Ilfra Goldberg's family, had to rely on informal arrangements with their doctor.
20:57As a teacher, her father earned too much to qualify for help.
21:03So the doctor would charge the adults, but would waive fees for the children.
21:08Money was very tight.
21:12Certainly, some people in the village were charged.
21:15And I think we regarded ourselves as fortunate and, in a sense, in debt to the general practitioner that we weren't charged.
21:27It was a two-way process, in a sense.
21:30We would never have called him unnecessarily.
21:34My parents were very careful that it was only when we were quite seriously ill that we asked him to come.
21:42We had all sorts of other scrapes, cuts, quite severe cuts sometimes,
21:47which perhaps nowadays one would have gone to an accident emergency department or got some further help.
21:54We didn't.
21:55Some employers ran health insurance schemes that did extend cover to dependent wives and children.
22:12The job that Janet Dunn's father had found was in the newly developed Kent Caulfield.
22:17And it came with a tied house and health insurance for the whole family.
22:21The benefit, of course, would mean that if you become ill,
22:28and my sister broke her arm and another sister who dislocated her shoulder and so on,
22:33things that happened, you would be taken into Canterbury Hospital.
22:37And that covered that.
22:39And also, I suppose, it paid for the local doctor.
22:44But the benefits to Janet's family would be short-lived.
22:47Working conditions in the mines were notoriously tough.
22:52The Kent Caulfields were very, very deep and hot.
22:57And the men used to describe it as Dante's Inferno.
23:01It was really dreadful.
23:02A lot of people who came only did the one shift.
23:06They collapsed and were brought out and didn't go back again.
23:09The harsh conditions meant that disputes were common and Janet's father was sacked after going on strike.
23:20The family was evicted and their entitlement to health insurance soon ran out.
23:29Her parents had to find other ways to manage.
23:34Dad was wonderful in his little remedies.
23:39I remember my little brother, John, when he was very ill.
23:43And Dad used to go to the pub and bring a little miniature of brandy back
23:47and put a little teaspoonful in with a vitamin egg and some sugar.
23:53And we were all fascinated with this.
23:55We said, well, that smells lovely, it looks lovely.
23:58And he used to just spoon this gently to little John.
24:03But Janet's mother became seriously ill during another pregnancy.
24:07And it was then that the consequences really hit home.
24:10Mother had preeclampsia.
24:14It's a very serious complication of pregnancy.
24:18So, Mum expected, of course, to be taken into Canterbury Hospital.
24:22And she was amazed when they said,
24:26oh, no, you don't go to Canterbury Hospital.
24:28She said, why?
24:30And they said, well, your husband doesn't pay to Canterbury Hospital now.
24:34Because he's unemployed, you're not paying.
24:36So you have to go to Etching Hill to what was really the poorhouse.
24:42And she said, well, I refuse, I won't go.
24:46She did refuse to go.
24:48Dad and I, between us, we nursed her and looked after her.
24:54She came through, but the baby was stillborn.
25:01The hard economic circumstances that Janet's family found themselves in
25:06and out of work were by no means uncommon.
25:09Britain was experiencing the worst depression of its industrial history.
25:14Unemployment reached 25%.
25:17And many people found themselves in and out of work with little warning.
25:25Brenda Watkinson's parents were amongst those who were struggling to make a living.
25:30Mum and Dad were both in shop work.
25:34My father was a gentleman's outfitter in the days when you had pinstripe trousers and a black jacket.
25:40And my mother worked in grocery and provisions.
25:43Brenda's father volunteered at a doctor's surgery in Bermondsey in East London,
25:50helping run a local healthcare saving scheme,
25:52which enabled patients to spread the cost of medical treatment.
25:57The scheme was called the PMS.
26:02I imagine it might have stood for patients' medical scheme.
26:06And my father had to ride round on his bike and collect money.
26:10And it was a thankless task, because he was out in all weathers, often very late at night,
26:15trying to catch up with people who hadn't been there the first time he called.
26:19They were out, or they hadn't got any money, and they were hiding behind the door.
26:23And I remember thinking, gosh, it's getting late,
26:26and Mum and Dad are still pawing over these books.
26:29Sometimes they were there for several hours,
26:31making sure that each person's contribution was correctly into the ledger.
26:35But so many people, their earnings were up and down,
26:40so their only way of making sure they were covered when they were ill
26:45was to try and eke out a bit of money every so many weeks when my dad went round.
26:51Times were hard.
26:52In Britain, the tradition of self-help schemes for medical care
27:06had begun amongst workers and employers in the early 19th century.
27:13It was very, very common for groups of workers in different workplaces
27:16to band together and to create some sort of fund or some sort of organisation
27:21that procured medical services for themselves and their families.
27:27These medical schemes came from employers appointing surgeons to look after their workers.
27:32But workers were very dissatisfied that employers had the power to appoint and dismiss doctors,
27:38despite the fact that it was workers themselves who were paying the salaries of these doctors.
27:42There were instances in which employers actually made a profit from these medical schemes.
27:51One scheme that was determined to do its best by its members
27:55was based in Tredegar, in South Wales.
28:02Tredegar is a very small, knit community.
28:05People are very, very close.
28:06Because everybody knows everybody and everybody knows what's going on.
28:11There's nothing sacred in the town.
28:14At the beginning of the 19th century, the town had a population of just over 1,000 people.
28:22But the discovery of rich iron ore deposits soon turned it into a boom town,
28:28run by the Tredegar Iron Company.
28:31Tredegar was a company town.
28:36Everything revolved around the company.
28:39You either worked for them or you didn't work.
28:43They controlled everything. They controlled people's lives.
28:47Production then switched to steel and coal.
28:52And like most of the men in Tredegar, John's grandfather found work in the mines.
28:56But as demand for coal rose and fell, so did the fortunes of people in the town.
29:05There was a lot of unemployment.
29:08Money was hard to come by.
29:10And living conditions were quite harsh.
29:13There was a lot of overcrowding with a two-bedroom house having anything from 6 to 10 people or even 12 people living in them.
29:20A lot of houses still didn't have running water or sanitary fittings.
29:25There was still a large amount of outside toilets at that particular time and people sharing toilets.
29:34The townspeople were determined to improve conditions for the workers
29:38and by the early 20th century had taken over the running of local medical aid schemes.
29:47The Tredegar Workmen's Medical Aid Society was different to similar organisations in other parts of Britain.
29:53In the first place, the wives and children of worker members also received medical care under the schemes.
29:59Secondly, in South Wales, very, very different to everywhere else in Britain, a poundage system was utilised,
30:08whereby workers paid two or three pence in each pound rather than a flat rate contribution.
30:14This meant that profits could be built up so that other kinds of medical services could be offered within these schemes.
30:20Tredegar became the most comprehensive of any medical aid scheme in the country, providing treatment from doctors and district nurses to dentists and physiotherapists.
30:36By the 1920s, something like almost 23,000 of the town's 24,000 population were members of this scheme.
30:44So it's almost a universal scheme.
30:46In 1915, Walter Conway became its secretary.
30:52He was a good man.
30:54He had this vision that he wanted the best.
30:58He wanted the best in the country.
30:59He wanted the best in the world.
31:01He wanted the best for the people of Tredegar.
31:03If it hadn't been for him, Tredegar the Medical Aid Society wouldn't have been the society he eventually became.
31:10My grandparents and my parents knew that if they fell ill, they could just call along to the doctor
31:15and the service was there, the help was there.
31:18If my father had gone on the sick, he knew that he would have had sick pay.
31:22If my mother needed hospital treatment, she knew that the local hospital would look after her needs.
31:27And if they couldn't treat her in the local hospital, then the best fare would be paid to Newport or Cardiff or Bristol where she would get the treatment that she required.
31:35Tredegar was also the birthplace of the Labour MP and future health minister, Aniram Bevan.
31:45The Medical Aid Society would be a major influence in shaping his vision of a national health service.
31:52But in the 1930s, there were still enormous challenges to overcome.
32:11Despite the progress of the previous century, infectious diseases continue to claim the lives of thousands of people in Britain every year.
32:19Every year.
32:22Diphtheria was one of the worst.
32:25A highly contagious respiratory infection, one of its most frightening symptoms is the swelling of membranes in the throat,
32:33making breathing increasingly difficult.
32:35The disease had a profound effect on Betty Giltonen's family.
32:49My mother contacted tiptheria, and she was only 33, and she didn't survive.
33:00I wasn't aware of the fact that my mother was ill, but I knew that I had to go and live with my grandmother for six weeks.
33:11And then when I came back home, after they'd fumigated the house, I knew mum was missing.
33:18And that was it.
33:21There was my sister Peggy, and sister Enid, and brother Trevor, and there was the baby of five months, and he was Hugh.
33:37Dad realised that he couldn't cope with five.
33:44Dad's brother, apparently his wife could not have a family.
33:50And he came up to see my dad and begged him, could he take Hugh?
33:57And he was adopted, but it was never discussed, you know.
34:16Around the time Betty's mother had died, mass immunisation trials were underway in Canada and America.
34:23By the early 30s, deaths in Canada had fallen sharply, and in some cities, diptheria had been eradicated altogether.
34:39Yet in Britain, little had changed.
34:43The disease was still responsible for a third of all childhood deaths.
34:47Diptheria immunisation in the 1930s was a failure on a number of different levels.
34:57Part of the problem was the dislocation between local and central health responsibilities in Britain.
35:04Immunisations were a local government, not a central government responsibility.
35:09And they're not receiving money from central government for immunisation programmes.
35:15And so they're very much at the mercy of the local town councils as to whether they're going to find the funds to run vaccination immunisation campaigns.
35:26And it's not seen as a priority, despite the fact that between 2,000 and 3,000 children are dying each year in Britain from diptheria.
35:37And those are quite unnecessary deaths.
35:39It would take until the Second World War for central government to act.
35:49Amid fears that cramped conditions in air raid shelters would lead to an epidemic,
35:54they finally introduced an immunisation programme.
35:58Within a decade, diptheria would become a disease of the past.
36:02The country's approach to controlling infectious diseases was a legacy of the 19th century public health system.
36:19This was founded on the belief that local organisations were better placed to deal with health problems in their community than a central authority would be.
36:28As a result, public health departments were run and largely financed by local councils.
36:41And in the 1930s, they had more impact on the health of ordinary people than any doctor.
36:48And the person in charge was the medical officer of health.
36:54Medical officers of health were the most powerful local government officers.
37:01They ran enormous departments, they had incredible political clout.
37:06They were really the guardians, not only of the health of the population, but to a certain extent the economic health of their towns and cities.
37:16They understand what causes ill health, and sitting as they do in local government, they are in the most influential place that they can be.
37:26By the mid-1930s, public health departments were responsible for a huge range of services, with the emphasis firmly on the prevention of ill health.
37:42St eecleening, s ecleaning,
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37:55ecleanartenbal uinar
38:09programs of housing development working alongside them was another key
38:17department the school medical inspection service its job was to monitor the
38:24health of the country's poorest children in 1929 Stanley Jarvis joined the team
38:32at Liverpool my father was a kindly soul he liked kids he always got on very well with kids and he'd
38:41go around these schools and talk to the children and so forth in those days all school children
38:46had their height and weight measured every term and they had a medical examination when they
38:50arrived at the school and before they left the school and if a child for example lost weight
38:55during a term there was a cause for the medical officer of health to look at them
39:02improving children's health had been a priority since concerns were first raised about the nation's
39:09lack of fitness the school medical inspection service provided free treatment for the country's
39:17poorest children if problems were picked up children were referred to a clinic Peter's
39:24father's was next to one of Liverpool's public wash houses I remember seeing a row of children sitting
39:30with bowls of hot water with wooden spoons bound ground with bandages applying this wooden spoon
39:39with as a hot fomentation to their sore eyes because they had a stye and there was one child I remember
39:45had both eyes swollen and looking back at it now I wonder whether that child hadn't in fact got
39:50acute nephritis acute nephritis practically unheard of now but it was an infectious condition you've got
39:56a good old streptococcal infection and it was spread to your kidneys jiggy your kidneys and you've got
40:00these characteristic signs of nephritis and one of the front was this very puffy pair of eyes
40:04I haven't seen one of those in 40 years
40:07but for some health problems local solutions weren't easy to find
40:20heavy industry and coal fires polluted many of Britain's cities and provided the perfect recipe for poor health
40:29the buildings were black with soot everything was black and when the wind wasn't blowing of course this
40:38pall of smoke settle on the whole place and sat for miles around it was a great dome-shaped hump of filth covering the entire district
40:48it's hardly surprising I got bronchitis every winter and when I got bronchitis they would put
40:57kaolin poultices on my chest front and back this is a large acreage of fuzzy felt stuff and you covered it
41:04with hot pek kaolin and slapped it on just just not quite hot enough to burn you but it went cold in about five minutes
41:11became very clammy and disgusting and I didn't like this and I said so and I was told nonsense boy don't argue you're
41:17it'll do you good but I never did think it did and I still don't think it did
41:24these polluted environments contributed to another condition that affected the health of the country's poorest citizens
41:32rickets many who worked in public health were determined to find a cure
41:40rickets is principally a children's disease the growing bones don't form properly
41:47these x-rays show what has happened on the right is a normal child's knee
41:51on the left is his other knee before he was cured of rickets
41:55rickets is caused by a lack of vitamin D and is prevented by exposure to sunlight
42:02and a diet rich in calcium producing foods like milk eggs or fish
42:13some public health departments offered sunlight treatment to families whose diet
42:17and living conditions made them particularly vulnerable
42:25brenda watkinson's family was one of those who benefited
42:28my mother when she was born in 1901 suffered from rickets from malnutrition and was actually
42:37in leg irons in her early years and when my brother was born born like my mother he was very undernourished
42:44I think he would be probably not older than five he had sunlight treatment also for the malnutrition
42:53it was reckoned to build children up he gradually got better but he was very thin
43:01the link between vitamin D and rickets was discovered by the scientist Edward Mellonby
43:09seen here in home movies he argued that a good diet was essential to health
43:18and advocated giving free supplements of cod liver oil to all children
43:39melenby was one of a group of scientists whose work would have social and political implications
43:50the 1930s was a period in which the science of nutrition was making great strides
43:56and investigators were getting a much better understanding of the biochemistry of nutrition
44:03and that was leading them to draw conclusions about the minimum income
44:08that would be necessary to purchase a diet for healthy living
44:13and what that led on to in turn was actually a critique of government policy
44:20and the scientists weren't the only ones campaigning for change
44:24a growing number of voices from the political left to social reformers and public health officials
44:31were calling on the government to do more to prevent the problems of ill health that stemmed from poverty
44:39this film was part of that campaign
44:43there is a marked difference in the heights of boys drawn from different classes of society
44:47at thirteen years of age the boys at Christ's Hospital School are on an average nearly two and a half inches taller than those from council schools
44:56at seventeen they're nearly four inches taller than working boys of the same age
45:01these differences are largely due to differences between the food they eat
45:06the film shows how the general health of the population was faring
45:12it features the work of a leading campaigner dr george mcgonagall
45:17then medical officer for health for stockton upon teas
45:22he looks specifically at how income affected the diet of families in his area
45:27now i've been finding out in my own district
45:33how much the average housewife has to spend and what she spends it on
45:37right down to the last penny
45:39he had two case studies in stockton upon teas
45:45and he could show the difference between the diets and the living conditions in these two areas
45:51and it was certainly income that had the biggest effect on health
45:56and what he did was to calculate whether people could afford adequate diets for health
46:02on the rates of unemployment benefit that they were receiving from the government
46:07and the evidence that mcgonagall found was that no unemployment benefits were not adequate for health
46:13mcgonagall became an increasingly controversial figure with his calls for the government to increase welfare benefits
46:22he took on a very political role and public health has always been political from the 1840s to the present day
46:29he saw his primary responsibility as one of advocacy
46:37knowing what was wrong with his population and knowing what should be done to put it right
46:43and he came into direct conflict and as a result of this he was threatened with disciplinary proceedings by the general medical council
46:55the government resisted mcgonagall's calls to increase benefits
46:59but his campaign had huge popular support and he kept his job
47:03and the focus from people like mcgonagall on ways to improve people's health
47:09also helped generate new approaches to preventative medicine
47:15one of these was a radical experiment based in peckham in south london
47:21it attracted enormous interest at the time this film was made to showcase its work
47:29almost at the foot of big ben you can catch a number 35 tram
47:33after about half an hour through factories and crowded streets
47:37you come to peckham
47:39here you will find the center the pioneer health center
47:43as with mcgonagall's work the experiment set out to discover the factors which influence people's health
47:51and centered particularly on the significance of family relationships
47:57my father
48:01and he he was comparing as he would on a saturday evening with a dance that was going on
48:09let us dance the center walls together
48:17always smile and never mind the rain
48:21pam elvin's family was one of the first 200 who joined the pioneer health center when it opened in 1935
48:29they took me one afternoon and i was overawed i think would be the words i'd use
48:37of seeing this magical place
48:41and it changed my life
48:43membership was by subscription
48:45and open to families in employment
48:47who live within pram pushing distance of the center
48:51the way the peckham center was planned was as a scientific experiment
48:55and what they did was to set out a series of buildings
48:59centered really around a social club
49:01where people would be attracted into the center
49:05there they could be examined and monitored and surveyed
49:09an old-fashioned big brother if you like
49:11the idea came from two biologists
49:17in this pierce
49:19and george scott williamson
49:21and what we are trying to do
49:23is to study health
49:25find out what health is
49:27and strangely enough this is the first time that's ever been tackled
49:31scott williamson wanted to test his theory that by creating the right environment
49:37you could also create the right conditions for the development of good health
49:41in mind and body
49:47when people joined the center they were subjected to three examinations
49:51there was a physical examination the usual sort of medical examination of the body
49:55but also part of it was a consultation with the family
49:59in the 19th century medicine was interested in single separate bodies
50:05so a family of five people would be five separate bodies
50:09what peckham introduced was this idea that the interaction between these people
50:15could tell you something about their health about their lifestyle about how they were going on in their lives
50:19so that the scientists explored their relationships
50:31the members are in fact cooperating in a unique piece of research into social biology
50:37we were guinea pigs
50:39it wasn't just me we were all guinea pigs
50:41it was a complete contrast to what we were used to
50:45i loved it
50:47i had children to play with
50:49i could do things on my own
50:51i mean
50:53my mother didn't know anybody
50:55she didn't know people on the opposite side of the road
50:59and it wasn't until she joined the center that she made friends
51:03one of the families that they met there was doreen heads
51:07i i liked swimming
51:09so i learned to swim down there
51:11my younger brother he was he was quite young
51:13he went into the nursery you know
51:15and my other brother
51:17he liked badminton
51:19so he was always in badminton court
51:21and in the gymnasium and that
51:23and then my sister was that bit older
51:25so she was able to take advantage of the dances on a Saturday evening
51:31within two years
51:33over 650 families had joined the center
51:37and a picture of their health began to emerge
51:39when the peckham doctors examined patients
51:43they found that 93 percent
51:45could be identified as having some sort of abnormality
51:47that means seven percent as they said were truly healthy
51:51williamson and pierce published their findings in 1943
51:57many of the children were found to have worms
52:01deformed toes
52:03and decayed teeth
52:05they had previously broken my arm
52:09and they were very interested in this
52:11and they kept you know looking at the arm
52:13to see how it was
52:15and when it came out of the plaster
52:17they were sort of you know giving me exercises
52:19and things you know
52:21amongst the adults
52:23there were more serious problems
52:25most of the women were anaemic
52:29some had high blood pressure
52:31kidney disorders
52:33and cancer
52:35all the examinations and all the monitoring
52:37was only concerned with
52:39recording these things
52:41there was no treatment
52:43they were said to be advisory
52:45so if they did find anything really serious medically
52:47they advised the patient to go elsewhere
52:49they discovered there was a lot wrong with me
52:53I was anaemic for one
52:55I was deaf for another
52:57so I seemed to have a lot of rheumatism
53:00and the doctor that we had at the time said
53:04oh it's only growing pains mother
53:06but they discovered that I had rheumatism
53:09but how did they do it?
53:11because they sent me off to one of the hospitals in London
53:15where I had some tests on
53:17you know I was a sickly child
53:19but my mother reckons that she saw me grow into a very healthy child
53:25within perhaps 18 months of being there
53:36The centre doctors also believed in the importance of good food
53:40and this farm was opened in Kent
53:42Here the families helped with the crops
53:52and used it for weekend camps
53:54Life for people like Pam
53:56had come to revolve around the centre
54:00mixing with other people
54:14enjoying life with a lot of other people
54:18it was probably the best years of my life
54:22The outbreak of the Second World War in 1939
54:28brought a temporary halt to the Peckham experiment
54:32but it was also the trigger for wider discussion
54:35about health reform on a grand scale
54:38From this point onwards
54:42the British state asked its citizens
54:44to make various sacrifices
54:46both on the battlefield and on the home front
54:48and in return had to offer
54:50the prospect of a better society
54:52in the post-war world
54:54So what you see during the war years
54:56is a great many plans being formulated
54:58a growing pressure and opinion
55:00in favour of substantial social reform
55:02including of course reform in the area
55:04of medical care and services
55:08The future
55:14And the vision of the future
55:16for Britain's health services
55:18came from a Nyram Bevan
55:20Minister of Health in the Labour Government
55:22of 1945
55:24It was a vision
55:26in which the Medical Aid Society
55:28in Bevan's hometown of Tredega
55:30had played a key part
55:32Their example
55:34of comprehensive health care
55:36showed how a national system could work
55:38But the new NHS
55:40would be controlled by central government
55:42and there was no room
55:44for local initiatives
55:46With the formation of the NHS
55:48the board from the Medical Aid Society
55:50actually went to Bevan
55:52and pleaded for a special case
55:54to be made of the Tredega Medical Aid Society
55:56But at that time
55:58Bevan actually turned to the board
56:00and told them
56:02that basically they were
56:04a victim of their own success
56:06And that was the end of the Tredega Medical Aid Society
56:08as we knew it
56:12The Peckham Centre
56:14faced a similar fate
56:16It had reopened after the Second World War
56:18and members like Pam Elvin
56:20and her fiancé, Adge
56:22were completely unprepared
56:24for life without it
56:30The first we knew, all of us knew
56:32was a notice that went up on the notice board
56:34to say that the centre was going to close that Saturday
56:38and just couldn't believe it
56:42It was like a death knell
56:44We were going round silent
56:46as if someone had died
56:48and people were weeping, you know
56:50shaking their heads
56:52What are we going to do without the centre?
56:54It affected everybody
56:56from children to grandparents
56:58We were going round
57:00The experiment was over
57:02The experiment was over
57:04But the Peckham doctor's focus on good health
57:08and the factors which contributed to it
57:10would eventually find a place
57:12in modern medicine
57:14It formed a blueprint
57:18for what could happen later in the century
57:20There's a new idea that comes into medicine
57:22risk factors
57:24and we all have risk factors
57:26in terms of the food we eat
57:28and the exercise we take
57:29and the lifestyles we have
57:30and those risk factors
57:32which now dominate a lot of our thinking about health
57:34were first laid down
57:36in the Peckham experiment
57:38When the National Health Service began in 1948
57:46it brought order to the chaos of previous decades
57:50and recognised for the first time
57:52that access to healthcare
57:54should not be dependent
57:56on individual circumstances
58:02The new system wasn't perfect
58:04but it did ensure that when people were sick
58:06there was no barrier to seeing a doctor
58:08and being treated
58:12And from now on
58:14the health of the nation
58:16would be linked inextricably
58:18to the health of all its citizens
58:36to
58:46the
58:50the
58:52the
58:54the
58:56the
58:58the
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