Payment and Philanthropy in British Healthcare, 1918–48 SOCIAL HISTORIES of MEDICINE
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Payment and philanthropy in British healthcare, 1918–48 SOCIAL HISTORIES OF MEDICINE Series editors: David Cantor and Keir Waddington Social Histories of Medicine is concerned with all aspects of health, illness and medicine, from prehistory to the present, in every part of the world. The series covers the circumstances that promote health or illness, the ways in which people experience and explain such conditions, and what, practically, they do about them. Practitioners of all approaches to health and healing come within its scope, as do their ideas, beliefs and practices, and the social, economic and cultural contexts in which they operate. Methodologically, the series welcomes relevant studies in social, economic, cultural and intellectual history, as well as approaches derived from other disciplines in the arts, sciences, social sciences and humanities. The series is a collaboration between Manchester University Press and the Society for the Social History of Medicine. Payment and philanthropy in British healthcare, 1918–48 George Campbell Gosling Manchester University Press Copyright © George Campbell Gosling 2017 The right of George Campbell Gosling to be identified as the author of this work has been asserted by him in accordance with the Copyright, Designs and Patents Act 1988. Published by Manchester University Press Altrincham Street, Manchester M1 7JA www.manchesteruniversitypress.co.uk British Library Cataloguing-in-Publication Data A catalogue record for this book is available from the British Library Library of Congress Cataloging-in-Publication Data applied for ISBN 978 1 5261 1432 7 hardback ISBN 978 1 5261 1435 8 Open Access First published 2017 An electronic version of this book is also available under a Creative Commons (CC-BY-NC-ND) licence. DOI: http://dx.doi.org/10.9760/MUPOA/9781526114358 The publisher has no responsibility for the persistence or accuracy of URLs for any external or third-party internet websites referred to in this book, and does not guarantee that any content on such websites is, or will remain, accurate or appropriate. Typeset in 11 on 12 pt Arno Pro Regular by Toppan Best-set Premedia Limited Contents List of figures vi List of tables viii Acknowledgements ix Abbreviations xii Introduction 1 1 Payment in the history of healthcare 12 2 Medicine and charity in Bristol 41 3 Payment and the sick poor 79 4 Middle-class medicine 120 5 The meaning of payment 157 Conclusion 195 Select bibliography 202 Index 213 List of figures 2.1 Major cities in early twentieth-century Britain. Source: produced by the author and Gareth Millward using Ordnance Survey software 42 2.2 Working-class living standards in Bristol, 1937. Source: Herbert Tout, The Standard of Living in Bristol: A Preliminary Report of the Work of the University of Bristol Social Survey (Bristol: Arrowsmith, 1938), p. 11 45 2.3 Party distribution of MPs in Bristol since 1832. Source: Ian Archer, Spencer Jordan, Keith Ramsey, Peter Wardley and Matthew Woollard, ‘Political Representation and Bristol’s Elections 1700–2000’ in Peter Wardley (ed.), Bristol Historical Resource, CD-ROM (Bristol: University of the West of England, 2001) 50 2.4 Hospitals in Bristol in the 1940s. Source: V. Zachary Cope, W.J. Gill, Arthur Griffiths and G.C. Kelly, Hospital Survey: The Hospital Services of the South-Western Area (London: HMSO, 1945), p. 143, reproduced by permission of Bristol Record Office, Item reference InfoBox/30/23 61 3.1 Proportions of patients paying different rates at the Bristol Royal Infirmary, 1922–33. Source: Bristol Royal Infirmary, Annual Reports for 1922–33 87 3.2 Proportions of patients paying different rates at the Bristol General Hospital, 1922–38. Source: Bristol General Hospital, Annual Reports for 1922–38 88 3.3 Proportions of patients paying different rates at Southmead Hospital, 1937–38. Source: Almoner’s List of figures vii Reports in Bristol Medical Officer of Health Reports for 1937–38 91 3.4 Almoner interviewing patients in London hospital, c.1920. Source: from Joan Kennedy, ‘The Lady Almoner’, Hospital and Health Review, 72 (1922), 133. Wellcome Images, L0015450, Wellcome Library, London 101 3.5 Bristol Hospitals Fund schemes depicted as fundraising successes, 1945. Source: Bristol Hospitals Fund, Report for 1945, front cover, reproduced by permission of Bristol Reference Library. Item reference: 29291/1/d 109 4.1 Number of private beds in Britain, 1933–47. Source: The Hospitals Year-Books (London, 1933–47) 124 4.2 Private beds as a percentage of all voluntary hospital beds in Britain, 1933–47. Source: The Hospitals Year-Books (London, 1933–47). 124 4.3 Growth in number of private beds in Bristol voluntary hospitals, 1933–47. Sources: The Hospitals Year-Books (London, 1933, 1935, 1944 and 1947); V. Cope, W. Gill, A. Griffiths and G. Kelly, Hospital Survey: The Hospital Services of the South-Western Area (London, 1945) 126 4.4 Private beds as a percentage of total provision in voluntary hospitals of different size in Britain, 1933–47. Source: The Hospitals Year-Books (London, 1933–47) 129 4.5 Proportion of all private beds in different size voluntary hospitals in Britain, 1933–47. Source: The Hospitals Year-Books (London, 1933–47) 130 5.1 Contributory scheme membership depicted as a family duty, 1943. Source: Bristol Hospitals Fund, Report for 1943, back cover, reproduced by permission of Bristol Reference Library. Item reference 2929/1/c 172 5.2 Contributory scheme membership depicted as an ‘anchor’, 1946. Source: Bristol Hospitals Fund, Report for 1946, front cover, reproduced by permission of Bristol Reference Library. Item reference 2929/1/e 177 List of tables 2.1 General practice surgeries in Bristol, 1919–39 56 4.1 Entirely private hospitals in England, 1938 131 4.2 General and private beds in all voluntary hospitals in Bristol, 1938 133 4.3 Private beds in local, regional and national voluntary hospitals by type and size of hospital in 1938 135 4.4 Private beds in voluntary hospitals per population by English region, 1938 139 4.5 Private beds in voluntary hospitals per population in the South West areas, 1938 140 5.1 BMA recommendations for income limits, c.1926 167 5.2 Average weekly working-class household expenditure, 1937–38 181 Acknowledgements I wrote this book in the hope of answering a question my Nan asked me over a decade ago. By the time I went to Bangor in North Wales to study History, I had already learnt her origin story. This had less to do with her childhood in St Werbrughs, a working-class neighbourhood in Bristol, or marrying a respectable Methodist scout leader, and more to do with his sudden, untimely death in the days following Christmas in 1965 – leaving her with two teenage daughters. After this she quickly began wearing trousers, learnt to drive and trained as a teacher. When I met her a couple of decades later, she was an impressive woman – a gifted educator, inspiringly self-taught on a vast range of subjects from world religions to art history, and who gave a mean rendition of ‘Do Your Ears Hang Low?’ When I returned from university and told her I was switching to joint honours with Social Policy, she asked me what that was. When I explained I was writing an essay on Lloyd George’s introduction of health insurance as part of the National Insurance Act of 1911, her immediate response was to ask me a question. She told me of the ‘dispensary ticket’ system she remembered from her childhood. She recounted what was expected of her as a small child between the wars when her father was sick – walking from the east of Bristol to the city’s north to go cap in hand to the vicar to get a ticket, then down into the city centre to the dispensary where the ticket could be cashed in for medicines, which then needed to be taken home. In total over six miles up and down some serious hills – a long journey for little legs. Why, she asked me, was this necessary? Why was there not a National Health Service so he could simply see a doctor? x Acknowledgements In the time I’ve spent finding out and making sense of what I found, a great many people have been incredibly generous with their time and support. I would not have been studying History if not for my good friend Andrew Harman. The help of Steve King and John Stewart in setting up the research project was invaluable, and I am especially grate- ful to Glen O’Hara, Barry Doyle, Kate Bradley, Peter Grant, Roberta Bivins, Mathew Thomson and Pat Thane for their encouragement over the years. Despite common complaints about academia, I have always found my colleagues to be amazingly kind and giving people. The Vol- untary Action History Society provided an especially useful intellectual home-from-home during my doctoral years. In the final stages, the Social History Society and my colleagues on the Cultural History of the NHS project at the University of Warwick have taken on this on this role. I am grateful to them all. In conducting that research, the assistance of staff at numerous archives has been priceless. Amongst them, particular mention should go to the Bristol Record Office, the University of Bristol’s Special Col- lections, and the staff at BCWA Healthcare (now part of Simply Health) who allowed me to rummage through boxes of the uncatalogued archive. I am especially grateful to the Bristol Reference Library, not only for their support in my research, but also for allowing me to use a number of photographs of items in their collection as illustrations in these pages. Undertaking this work would simply not have been possible without the support of the Wellcome Trust.