Rise of Social Medicine

Infant and Maternal Welfare

Lecture 14

Medicine, Disease and Society in Britain, 1750 - 1950

Lecture Aims and Outline

• From public health to social medicine– Physical deterioration and national

efficiency– National Insurance– Mothers and infants as part of national

efficiency• Mothers to blame for child’s ill health?

Emphasis on education

• Shift in interest of the state

- from control of disease ( e.g. sanitary reform & vaccination)to promotion of health

By

- Improving social conditions- Providing health education- Increased provision of services

Social Medicine: 1880-1930

Epidemiological transitiondecline in mortalitydecline in deaths from infectious diseases

Pasteur & Koch isolated disease pathogens but effective treatments remained elusive ( e.g. syphilis and tb)

Historiographye.g McKeown – this decline had little to do with modern

medicine although sanitary improvements and improvements to standards of living did.

Impact of Laboratory Medicine?

C19th Market for Healthcare

Britain was a mixed system:• Access to healthcare was influenced

by the ability to pay. • Access for the poor was by charitable

initiatives – dispensaries, hospitals, • Provision for paupers organised by

the local state under the Poor Law-

1880-1948- Productionist: focus on health of the industrial worker and the armed services

1948-1968- Communitatian: NHS- expansion of services, focus on social inclusion. Rise of the professional

1968-2000- Consumption: Renewed emphasis on market and on lay management to challenge professionals

John Pickstone, ‘Production, community and consumption: The

political economy of twentieth-century medicine’, (2000)

• 4 out of 10 young men offering themselves as recruits to the British army during the Boer War had to be rejected because their bodies weren't up to the job.

• One of the results of the Boer War was the setting up of a specially appointed Committee on Physical Deterioration in 1903. This asked why so many army recruits were rejected on the grounds of health.

• In 1904 the Committee reported that they had found no evidence of long-term physical deterioration in the British population, but they did make these recommendations:

a) Medical inspections of children in schoolsb) Free school meals for the very poorc) Training in mother craft.

The Boer War 1899-1902 and National Efficiency:

• 1909- Old Age Pensions introduced

• 1911- National Insurance Act– Access to GP services via a panel doctor– Hospital treatment not included– Sickness benefit ( replacing lost income)– Administered through ‘approved mutual

societies’.– Benefits limited to the contributor

( worker)- mainly men. Women and children were not covered.

National Insurance and Pensions

‘The Dawn of Hope’ The National Insurance Act of 1911

Public health campaigns tried to halt the spread of TB.

London Open Air Sanatorium from the south-west, c.1907.

In 1898, the newly formed National Association for the Prevention of Tuberculosis acquired an 82-acre site in the middle of woodlands at Bagshot Sands near Wokingham. New buildings

were erected at a cost of £40,000 and the hospital opened in 1901. Operating under the name of the London Open Air

Sanatorium, it could then accommodate sixty-four male patients.

The photographer’s caption for this vivid illustration of domestic poverty was ‘Distressing scenes in the East End. All the food in the house – a little butter, sugar and a nearly empty tin of milk.

July, 1912’.

Opium was easy to come by--physicians dispensed opiates directly to patients or wrote prescriptions for them, and pharmacists sold them over the counter. There were numerous items of patent medication containing opium or morphine as well. Godfrey's Cordial was particularly popular in England, where it was sold by the thousands of bottles, and administered not only to adults, but to infants and toddlers as well. Even Marx reported in Capital about the English habit of ‘dosing their babies’ with opium.

Infant Welfare Clinic. (c.1914)

A charity, founded in 1907, the St Pancras Welcome offered a comprehensive range of services to mothers and babies. These were not free, but available for a small fee.

Leaflet advertising the new Mother’s and Babies’ Welcome in St Pancras, London, 1907.

Carnegie Trust Report on Maternal and Child Welfare in

1917:“The value of population has never been appreciated as it is today, and regrets at the unheeded wastage of infant life in bygone years are as sincere as they are useless, a simple calculation shows that had the annual wastage of male infant life during the last 50 years been no greater than it is at present, at least 500,000 more men would have been available for the defence of the country today.”

Hospital births

• 1927- 15%

• 1937- 25%

• 1946- 54%

Children getting into a train to leave Liverpool with each child carrying their gas mask, 1939

Government propaganda put immense pressure on parents to send their children to the ‘safety’ of the countryside.

Conclusion• Infant and maternal welfare formed an important

part of the state’s provision of social medicine and formed an important part of the state’s aim to improve national efficiency

• Impetus for social medicine – Boer War. Pensions Act 1909 and National Insurance Act followed. BUT also intervention in health of mother and infants - in schools, infant welfare clinics, health visitors etc etc. Typical to blame the mother so emphasis on education

• Why intervention? Crucial for overall health of the nation. Pickstone’s “productionist” part of model