The Social History of Medical Self-Help in 20th-Century England: A Microhistory of a Rural Community. Submitted to the University of Hertfordshire in partial fulfilment of the requirements of the degree of PhD (Schedule A). Fiona Mantle Date: July, 2019. i Abstract This thesis focuses on the health experiences of an Oxfordshire village 1900-1947 and the aim of the study is to obtain a holistic view of the health status and health strategies of one agricultural community. The period under review covers the years of therapeutic nihilism, the start of the therapeutic revolution, the third and fourth stages of germ theory and the start of the epidemiological transition. From a range of archival sources, the thesis examines the effects of climate, environment, housing, diet and the extant medical provision on the health and wellbeing of the residents. These effects in turn informed the residents’ health beliefs and self-help strategies set against the existing medical and nursing provision during periods of depression and war until the establishment of the National Health Service in 1948. Medical and health information from a range of sources, which were available to residents was explored. It shows that the residents were not passive in the face of illness and misfortune but worked together as a community. The importance of this study is its contribution to the historiography of rural health during the interwar years and offers a portrait of rural resilience and stoicism in the face of medical adversity. ii Acknowledgements I would firstly like to thank my supervisor Owen Davies for his patience in trying to turn a social scientist into a historian and for all his encouragement and interest in the subject and Dr. Ciara Meehan and Dr. Jennifer Evans for their valuable contributions. I would like to thank the administrative and library staff of Hertfordshire University who have always been helpful with my many queries. The staff of the Oxford History Centre have unfailingly managed to locate documents and books which have been essential to the thesis. I have had a lot of helpful and friendly support from the residents of Chinnor, in particular my interviewees and our two parish clerks Elizabeth Folley and Jo Wills. I would also like to thank Matt and Nigel for their IT support and to thank my sister Andrea for all her support and who acted as my independent reader, for her very pertinent comments and for patiently reading and re reading the evolving thesis and for the ‘Failure is not an option’ mug. The thesis is dedicated to my parents, Christopher and Lilian Mantle. iii Contents: List of figures List of appendices Chapters Page Introduction 1 Overview of the period Wider historical context Historiography of rural health Locus of care Health and illness Methodology Chapter 1: Chinnor in Context 29 Map of Chinnor 1930s and location Chinnor set in time and geography Makeshift economy Village amenities: village hall, Reading room, schools Social events Sanitation Chapter 2: Availability of Health Provision 52 Early practitioners Rise of general practice Dental care Costs and wages Nursing Midwifery Handywomen The growth of hospital care General and specialist hospitals iv Chapter 3: The Health Landscape of Chinnor, 1900-1948 100 Assessment of parochial data The state of Rural Health Environment and health Chinnor cement works Accidents Childbirth Infectious diseases Tuberculosis Cancer The effects of war National Farm Survey Evacuation Chapter 4: Potential Sources of Health 161 and Medical Information. The spoken word and literacy Family and community care Sex education The need for health information Women’s magazines New media The nation’s health Military medical services Government information Chapter 5: Remedies Self–help Strategies for Health 207 Orthodox healing Herbal medicine v Unorthodox healing The role of advertising The quest for pain relief Tonics Aperients Pregnancy Infant feeding Advertising and war Availability of remedies Home remedies Dig for victory Chapter 6: Conclusion 259 Bibliography 270 List of figures Fig. 1. Ordinance Survey Map of Chinnor circa 1920s. 30 Fig. 2. Contemporary map of Chinnor and its location. 32 Fig. 3. Diphtheria – mortality per million all ages all infants’ mortality all causes per 1500 infants, England and Wales 1901-1999. 203 Fig. 4. U.S. Government Poster VD. 204 Fig. 5. ‘Dig for Victory’. 255 List of Tables Table 1. Number of Allotments Plots. 43 Table 2. Doctors' Fees for Private Patients. 67 Table 3. Census Records Thame Workhouse 1901-1931. 93 Table 4. Ages of Women at first marriage in Chinnor 1900-1939. 129 Table 5. Child Deaths by Season 1890-1949. 133 Table 6. Cause of death and father's occupation. 133 Table 7. Worshipful Society of Apothecaries sales ledger. 222 vi Appendices Appendix A. Incidence and Causes of Death under Forty 315 Appendix B. Incidence of Infectious Diseases from the 326 Register of Notifiable Diseases and Tuberculosis Notification register Parish Records and Death Certificates Appendix C. The incidence of tuberculosis in Chinnor 327 1 Introduction This happy breed of men, this little world.1 The biggest influence on the health of the United Kingdom was the passing of the 1947 National Health Act and its inception in 1948, making free medical care available to all. This can be demonstrated quantitively by the reported uptake of services during the first year of the Act.2 Prior to the Act, health was dependent on three factors which form the themes of this study: cost, availability and efficacy. This study explores the influence of the three themes on the health status of one village, the residents use of domestic remedies, and self-help health strategies during the period 1900-1948. This lies within the time frameworks of: therapeutic nihilism, therapeutic revolution, the third and fourth stages of germ theory and the start of stage three of the epidemiolocal transition. This will make an original addition to the existing historiography of rural health. The wider historical context The social, medical and historical context of this study lies within the period 1900-1948. Writing in a time and place which anthropologists refer to as ‘ecological release’, it is of historical interest to explore how people coped when disease was rife; grinding poverty with concomitant poor housing and scarce food the norm, with little or no effective treatment, specifically for the infections, which were a major cause of death. Previous historians have examined health and rural work in general: What this thesis offers is an account of the lived experience of health, not only the physical experience, but has taken into account the environmental and psychological effects on residents well-being. By examining one specific village within a specified time frame and using different methodologies, the study has refocused knowledge about rural health at its grass roots. It examines the everyday lives of rural residents, taking a ‘history from below’ approach, to enhance exploration of the topic. With the help of primary and secondary 1 William Shakespeare, Richard II, Act II scene 1. 2 Paul Addison, Now the War is Over: Social history of Britain, 1945-1951 (London, 1985), p. 106. 2 documentation, archival research and the reminiscences of people whose lives have spanned the decades from trial and tribulation to ecological release, this study examines how the people of Chinnor helped themselves, their families and their neighbours during ill-health and sickness before the advent of the National Health Service. It also shows how these factors helped to shape their health beliefs, their concept of good and poor health, their coping mechanisms and resources, and their sources of health information and help. The rapidity of growth over the last century in areas of demography, technology, economics and medicine has resulted in profound changes in society, more marked than at any other time in history. To illustrate this, a person born in 1900 would have been born before the Wright brothers achieved the first controlled, powered and sustained heavier than air human flight (1903), and before the development of antibiotics or blood transfusions. By 1948 these developments were routine and, if the same person lived to the age of 70, they would have lived to hear of the first human heart transplant (1967) and see a man walk on the moon (1969). The time span has been chosen to fall within the memory span of the older village residents, and was a period of medical change including the three stages of germ theory. It was also a period which reflected significant changes in the main influences of the study: medical costs, availability and efficacy. The years 1900-1948 fall initially into the period referred to as Therapeutic Nihilism which means that until the 1930s doctors had very few medicines with which to cure diseases, specifically infections. In 1900 the infant mortality rate was 130 per thousand live births, about 50% of 5-9 year olds in 1911-1915 died of infectious diseases in a period of high birth rate, high mortality and general ill health, when even minor injuries could prove fatal.3 A selection of childhood mortality figures between 1911-1915 show annual deaths from tuberculosis as 46,459, diphtheria 23,380, and measles, 48,986.4 3 A. Omran, ‘The Epidemiological Transition: a theory of the epidemiology of population change’, The Millbank Quarterly, 49, 4, 1 (1971), 731-757. 4 J. Muir Gray, Man Against Disease: preventative medicine (Oxford, 1979), p. 57. 3 Unsurprisingly, the historiography of medicine during this period was concerned primarily with the history of disease and its cure. According to John Burnham, this history of medicine is the history of scientific discovery, and was mainly written by medical practitioners. He suggested that this had the effect of excluding non-medical historians and portraying medicine as being progressive, scientific and authoritative, framing its history in terms of medical specialties.