FOR THEIR OWN GOOD Beier_final4print.indb 1 10/27/2008 3:15:03 PM Beier_final4print.indb 2 10/27/2008 3:15:03 PM FOR THEIR OWN GOOD • The Transformation of English Working-Class Health Culture, 1880–1970 LUCINDA McCRAY BEIER The Ohio State University Press Columbus Beier_final4print.indb 3 10/27/2008 3:15:03 PM Copyright © 2008 by The Ohio State University. All rights reserved. Library of Congress Cataloging-in-Publication Data Beier, Lucinda McCray. For their own good : the transformation of English working-class health culture, 1880–1970 / Lucinda McCray Beier. p. ; cm. Includes bibliographical references and index. ISBN 978–0–8142–1094–9 (cloth : alk. paper) 1. Working class—Medical care—Great Britain—History—20th century. 2. Working class— Medical care—Great Britain—History—19th century. 3. Public health—Great Britain— History—20th century. 4. Public health—Great Britain—History—19th century. I. Title. [DNLM: 1. Urban Health Services—history—England. 2. Attitude to Health—England. 3. Health Knowledge, Attitudes, Practice—England. 4. History, 19th Century—England. 5. History, 20th Century—England. 6. Social Class—England. 7. Social Medicine—history— England. WA 11 FE5 B422f 2008] RA418.3.G7B45 2008 362.10941—dc22 2008023683 This book is available in the following editions: Cloth (ISBN 978–0–8142–1094–9) CD-ROM (ISBN 978–0–8142–9174–0) Front cover photo courtesy of Lancashire County Library and Information Service. http://lanternimages.lancashire.gov.uk link. Cover design by Melissa Ryan. Type set in ITC New Baskerville. Printed by Thomson-Shore, Inc. The paper used in this publication meets the minimum requirements of the American National Standard for Information Sciences—Permanence of Paper for Printed Library Materials. ANSI Z39.48–1992. 9 8 7 6 5 4 3 2 1 Beier_final4print.indb 4 10/27/2008 3:15:03 PM To Elizabeth A. M. Roberts without whose vision, guidance, hard work, and loving spirit this book would not have been written Beier_final4print.indb 5 10/27/2008 3:15:03 PM Beier_final4print.indb 6 10/27/2008 3:15:03 PM Contents • Acknowledgments ix Chapter 1 Introduction 1 Chapter 2 “Every street had its lady”: Working-Class Health Culture before World War II 35 Chapter 3 “We know what’s good for you”: Formal Health Care Provision in Barrow, Lancaster, and Preston 88 Chapter 4 “No fever in our house”: Contagion, Prevention, and the Working Class 145 Chapter 5 “They never told us anything”: Sex and Family Limitation 208 Chapter 6 “With having my mother, I didn’t need any advice off anybody else”: Bearing and Caring for Children 264 Chapter 7 “By gum, we did enjoy it”: Popular Media and the Construction of Modern Health Culture 310 Chapter 8 “The best thing since wearing boots”: Working-Class Health Culture after 1948 347 Appendix Oral History Informants 365 Bibliography 381 Index 393 Beier_final4print.indb 7 10/27/2008 3:15:03 PM Beier_final4print.indb 8 10/27/2008 3:15:03 PM Acknowledgments • It is my pleasure and honor to acknowledge the many individuals and insti- tutions without whom this project could not have been completed. First, I must recognize the 239 oral history informants whose memories first made it clear that there was a book to be written. Their good humor, strength, and collective reconstitution of a world that might otherwise be forgotten taught me far more about both the human condition and working-class Lancashire than this study can ever express. I owe them my deepest grati- tude—as well as apologies for any inadvertent misinterpretations of their life experiences. Thanks to the Centre for North-West Regional Studies, the History Department, and the Library at Lancaster University—especially Jean Turn- bull, Christine Wilkinson, Jacqueline Whiteside, Kenneth Harrison, and Angus Winchester—for their generous support and hospitality, particularly during my research visit in 2004. Thanks also to research assistance from Tom Dixon and to staff members of the National Library of Medicine, the North West Film Archive, the British Film Institute, and the British Library Newspaper Reading Room. I am grateful for the National Library of Medicine Publication Grant (5 G13 LM 008353) that enabled me to spend two years completing research and writing. Similarly, thanks are due to Illinois State University for the sabbatical, internal research grant, and travel funding that helped me complete this project. I also want to acknowledge the expert assistance of Interlibrary Loan and subject matter librarians at Illinois State University’s Milner Library—especially Vanette Schwartz, for whom nothing is impos- sible. In addition, I must thank Cindy Caldwell for photocopying above and beyond the call of duty. Thanks to Sandy Crooms and Maggie Diehl, of The Ohio State Uni- versity Press, for shepherding the manuscript to publication. I also want to acknowledge the recommendations of Graham Mooney, Elizabeth Roberts, Lee Beier, and two anonymous reviewers, which have much improved the final product. I owe a great debt to Jeffrey Richards for taking the time to talk to me about the history of film. In addition, I am grateful to my col- leagues in the Social Science History Association and the American Asso- ix Beier_final4print.indb 9 10/27/2008 3:15:03 PM x Acknowledgments ciation for the History of Medicine, who over the past decade have listened to and constructively critiqued various iterations of the arguments appear- ing in this book: you know who you are. Thanks to the Bulletin of the History of Medicine and the Social History of Medicine for permission to reprint substantial portions of articles. Finally, I want to express my affectionate gratitude to those who nur- tured the writer—and therefore the project—during its long evolution. For making me feel at home, thanks to Judith and Roger Addison, Katy and Thomas Woods, and Elizabeth and Hugh Roberts. Thanks to Hollis Web- ster and Alice Berry for letting me explain. Thanks to my dog-girl, Scout, and the blue bike for balance, harmony, inspiration, and problem solving. And, as always, my loving gratitude to Lee for listening and caring, as well as to Joe, Jesse, Jake, and Zach, my wonderful Lancashire lads. Beier_final4print.indb 10 10/27/2008 3:15:03 PM Chapter One • Introduction ORIGINS Most books are autobiographical—at least in the sense that they reflect the author’s interests and emerge from some important insight or experience. This book is more autobiographical than many. It would not have been written had I not in 1978, as a new bride and a graduate student of the social history of health and medicine, moved from the American Midwest to northern England and begun participant observation of a medical cul- ture that was quite different from my own. While the biomedical theories and therapies were similar to those I grew up with in the United States, care environments, personnel, and a range of expectations (from routine infant care to financial obligations) were very foreign to me and specific to my new home.1 White-uniformed midwives delivered my babies in a hospi- tal that had a tea lady but no billing department; our general practitioner made house calls or saw us in a “surgery” that looked more like a study than an examining room; and well-child examinations and immunizations were offered one afternoon a week by health visitors and doctors at a clinic in our neighborhood. When I took my children to pediatricians during summer visits to the United States, I found myself translating cross-cultural information and making unexpected decisions: Should I have my little boys circumcised (usual in the United States, but not in England)? Should I have them immunized against whooping cough (greater concern about side effects in England than in the United States)? These similarities, differences, and negotiations, which permeated my experience of illness, childbearing, and health care during twelve impor- tant years, also informed conceptualization of the research I did during the 1980s and ’90s on early modern English suffering and healing.2 Eager to 1. A short article describing my personal experience of health services in Lancaster appears as “My twelve years in the UK health system,” Health Affairs 19:3 (2000): 185–90. 2. Publications from this research include Sufferers and healers: The experience of illness in seventeenth-century England (Routledge and Kegan Paul, 1987); “Seventeenth-century English 1 Beier_final4print.indb 1 10/27/2008 3:15:04 PM 2 Chapter One explore what Roy Porter most famously was beginning to call the “patient’s view,” I was prompted by my own experience to broaden my perspective from the doctor-patient relationship to the larger social and cultural arenas where health is maintained and ill-health managed or endured.3 Using dia- ries, autobiographies, and casebooks, I searched the past for the contexts within which people gave birth, suffered injury and disease, received or provided treatment and care, and died. I found complex circumstances, where information, authority, decision making, and services straddled the porous boundaries between practitioners, sufferers, and their families, and where gender, class, resources, and community settings influenced people’s choices, roles, and experiences. However, my sources were patchy and rarely transparent. Because their creators were long dead, it was not possible to ask for clarification or amplification. When in 1987 I was given the opportunity to work with Elizabeth Rob- erts, Administrator and later Director of the Centre for North-West Regional Studies at Lancaster University (United Kingdom), on an oral history proj- ect concerning familial and social change in mid-twentieth-century work- ing-class Lancashire communities, I brought my questions about the ways people thought about and dealt with health and ill-health to the project.4 The opportunity to talk with living informants and to review transcripts of interviews Roberts conducted during the 1970s and early ’80s was both lib- erating and far more informative than I could possibly have predicted.