Health before the NHS: The Road to Recovery Timeshift

-Aaah.

-Aaah!

At the beginning of the 20th century,

Britain's health was in a sorry state.

Life expectancy for men was just 48.

And for women, an everyday experience like childbirth

could be life threatening.

My mother had a miscarriage, where she was, for three months,

extremely ill,

unconscious for a long time

and really people didn't expect her to live.

What treatment there was had to be paid for by the patient.

Doctors were a luxury that many found hard to afford.

It was only when we were quite seriously ill we asked him to come.

We had all sorts of other scrapes, cuts,

they just were bandaged up and hoped we got better.

In fact, getting access to healthcare at all wasn't easy.

This is a very, very ramshackle, chaotic, disorganised

set of services, there's no doubt about that.

With the system failing to deliver,

many people took matters into their own hands.

They organized their own health care in their own communities.

If people wanted something done they had to do it for themselves

and the best way to do it was by clubbing together.

And others experimented with new ways to stop people

from getting ill in the first place.

We were guinea pigs, it wasn't just me.

We were all guinea pigs. And it changed my life.

This is the story of how ordinary people, GPs,

midwives and local councils coped with sickness

and disease at home and in their communities.

Of the struggle to improve the nation's health.

And of how radical new ideas would eventually help create

a system of healthcare for all.

Efforts to deal with the poor state of Britain's health

had begun during the 19th century.

Newly created public health departments had organised

programmes of slum clearance, and improved sanitation

that brought an end to epidemics of infectious diseases.

The emphasis now switched to the health of the individual.

What had happened was we had lost the epidemics of cholera, typhus,

even smallpox was going into decline

because the sanitary surveillance had been so good.

By the early 20th century, the focus is shifting from the environment

to the person, to the individual.

The general health of people in Britain at the time

was a cause for concern - highlighted by the shockingly

poor state of volunteers for the Boer War.

Most had been rejected for being too small and under-weight.

Government committees were set up to look into the problem of what

they described as "national degeneration", and in particular,

the high numbers of children who died in the first year of life.

There was a growing realisation that the high cost of infant deaths

was weakening the country at that time

and Britain was losing pace with international competitors such as

Germany, America and Japan. So to ensure Britain was producing

a fit, healthy, productive industrial population,

attention came to be focused on infant welfare

and all sorts of different reforms passed

to try and improve the standard of infant health.

In 1900, out of every 1,000 babies born,

more than 150 would die before their first birthday.

Their mothers faired little better.

Maternal deaths in childbirth were as high as they had

been in the 1850's.

So, if the nation's health was to be improved,

the moment of birth was an obvious place to start.

The spotlight turned on midwives.

They delivered most of the nation's babies and for centuries

had worked independently from the medical profession,

who'd shown little interest in them.

They were untrained, unregulated and often unpaid.

At the beginning of the 20th century everything changed for midwifery.

There had been a campaign building up steam throughout the last 20 years

of the 19th century looking at registering midwives

and actually bringing in some kind of compulsory training.

There was also a growing belief that given that midwives

were delivering the vast majority of babies born in the country,

there ought to be some way of knowing who they were

and perhaps policing what they were doing.

The campaign led in 1902 to the first state regulation of midwives.

A Central Board was set up to ensure minimum professional standards

and compulsory registration and training.

But there was another problem.

Midwives were self-employed and without a guaranteed income,

they'd had to find other ways to supplement their earnings.

Ilfra Goldberg remembers the novel approach of her village midwife.

We had a wonderful midwife who doubled up as a chimney sweep

and she used to go through the village in a pony and cart,

white pony and cart and she had her chimney sweep brushes in the cart,

but she also was a qualified midwife

and people would stop her and she would come in and help

with deliveries as well.

I've never heard of a midwife also operating as a chimney sweep,

but it certainly was true that midwives weren't that often

operating purely as midwives. You find midwives taking in washing,

taking in lodgers, minding other people's children,

or doing piece work at home, simply because they could not

earn enough money from delivering babies.

By the mid-1930's, the reforms had turned midwifery into a far more

professional service, but there just were not enough of them.

In 1936, legislation was brought in which made local authorities

pay midwives a salary and a pension.

The changes attracted an influx of new recruits.

Grace Lowe was one of them.

Well, my mother left school at 14, as they would in those days,

but she had always been determined that she wanted to be a midwife.

Very much against her parents' wishes that's exactly what she did,

so at 18 she went off to a hospital in Lowestoft

and did her nursing training for three years.

Grace then moved to London

and by 1937 had fulfilled her ambition to qualify as a midwife.

She began work in Walthamstow, in north-east London.

But the training hadn't prepared her for the stark realities of the job.

You never knew people were having twins. They would just appear.

You didn't know if it was a breach birth,

if there was something badly wrong with the child.

There was no signs, no tests, people had very little care,

so they never knew what they were going to

or how it was going to happen.

And she said that used to be really very frightening.

The only equipment you could take, would be that which you could carry,

so very heavy cylinders of gas and air, for example,

midwives didn't tend to take with them so they didn't have any

pain relief to offer women because it wasn't practical.

One of the things that midwives did carry was ergot.

This is a natural ingredient - it comes from mould on rye

and it would be administered to women

who were haemorrhaging after the delivery.

And it acts by contracting the womb,

which would hopefully help to stop bleeding. It was all reusable

so when you have that thing in films where husbands are being asked

to boil water, that's the reason why,

so all this metal equipment could be sterilised.

The focus on reform in Britain's maternity services

had started to have an impact on infant mortality rates.

From the beginning of the century

to the 1930's, they had more than halved.

But for women, pregnancy and childbirth was still a major

threat to their lives and in an age before widespread contraception,

the threat to them and their children was ever present.

There'd be Mary, who was the eldest, myself, Margaret and John.

And I did have two other little brothers - Robert and David.

Unfortunately, they had died

of what was just called in those days - convulsions.

Janet's father was a miner, and in 1929 he left Scotland

and moved the family south in search of work.

The unemployment was dreadful and pits were closing everywhere

and due to the pit closures in Lanarkshire

dad came down to the Kent coalfield

and people were coming from all over the country to Kent.

Janet's father found a job, but life was tough

and her mother's health suffered.

Pregnant once again, she fell ill with a highly dangerous infection.

My mother had a miscarriage and developed puerperal fever

as they used to call it, general septicaemia,

was rushed into Canterbury Hospital

where she was, for three months, extremely ill,

unconscious for a long time and people didn't expect her to live.

Mary was 12 - the eldest, and I was eight

and dad still had to go to work.

If he didn't work, he wouldn't have been paid.

And the terror that we felt - that's the worst terror I've ever felt

in my life was to see mum being taken out.

Against the odds, Janet's mother survived.

But at that time 1 in 200 women died as a result of childbirth.

For the better off, the risks were just as high

but the experience was somewhat different.

Rather than a midwife, they employed a doctor to deliver their babies.

I don't think I was spoilt, was I?

But there seemed to be a lot of attention being paid!

Margaret Smart was brought up in Gloucester

and has a unique record of her birth in 1935.

Her father had a well-paid job and a passion for home movies.

Dad was in insurance, he worked for General Accident.

He started as an office boy and worked up

to be one of...you know, manager or something I think.

And then he bought an insurance broking business,

so obviously we had a car, and a phone, this nice new house.

Families either side were the same really.

When it came to Margaret's birth, like all middle class families,

her parents followed fashion and hired the local doctor.

There was a certain amount of kudos related

to having a doctor come to your house and deliver your baby,

so there was very much an element of pride involved.

They would very often also have what was called a monthly nurse

to come and live in the house perhaps a week before the baby was due.

And then stay for maybe two or three weeks afterwards

and help with breastfeeding, help with caring for baby,

those kind of things.

What a dear little soul, wasn't I?

What else can one say about that except I like biscuits

and I've liked them ever since!

Wealthier families believed that by hiring a doctor,

they were getting a better service.

But it turned out, that their confidence was misplaced.

Curiously although it was fashionable to have a doctor,

it was actually safer to be poor and have a midwife in that period.

Doctors were very busy, they were in a hurry,

they were dealing with lots of different cases,

so you would get them trying to deliver babies

before 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.

One of the reasons that doctors were so busy was

because of the way they earned their living.

They were self-employed - the more patients they had,

the more money they earned.

Doctors would decide where to practice on the basis of where

they thought they could get the best custom

and what that meant in effect is that in some parts of the country

where availability and access to practitioners and specialist care

was actually much better than in other parts of the country.

And people have calculated

that there was something like a six-fold variation

between towns in Britain.

In rural areas, coverage was particularly sparse.

In 1920, Mary Phillips' father found his first job as a doctor

in a large rural practice in Barnstable in north Devon.

They set off on a motorbike and sidecar

to go the way from Sussex to North Devon.

And my mother was in fact a trained nurse.

She would drive the motorbike and dad would ride in the sidecar.

With no special GP training required at the time,

Mary's father, who had qualified as a surgeon, also performed operations

on his patients at the local hospital.

They did a bit of everything, I mean, he delivered babies,

he operated on appendixes and hernias,

he would do a radical breast operation for cancer.

He was on call six days a week,

he had one day off on a Saturday or Sunday.

Of course we had staff - we had a cook

and a housemaid and we had a nanny.

My father got a number of private patients

and they used to come to the house at two o'clock in the afternoon,

and our drawing room was used as a waiting room

and we children were kept out, you know.

We had a maid who wore a frilly apron who used to answer the door

and then Dad with take them into the consulting room.

But the cost of a visit to the doctor

put treatment beyond the reach of most.

If the nation's health was to improve, the low paid needed

better access to doctors.

The answer came from health insurance schemes set up by

Friendly Societies and trade unions dating back to the 19th century.

Using this framework from 1911 onwards, the state would make

a contribution towards health insurance for people on low pay.

This national health insurance scheme

is a very important intervention by the government. It 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.

All workers who earned up to £160 a year

would now be entitled to health insurance.

The 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

and 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.

The aim of the scheme had been to increase the number of people

who could afford treatment.

But it still left almost half the population without any help.

The 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.

And other groups who weren't in work were also excluded.

Women in the home,

and children, people under 16 years.

For those who'd been left out,

it was a case of finding other ways to manage.

Some, like Ilfra Goldberg's family,

had to rely on informal arrangements with their doctor.

As a teacher, her father earned too much to qualify for help,

so the doctor would charge the adults,

but would waive fees for the children.

Money was very tight.

Certainly, some people in the village were charged,

and I think we regarded ourselves as fortunate,

and, in a sense, in debt to the general practitioner

that we weren't charged.

It was a two-way process, in a sense.

Um...we would never have called him unnecessarily.

My parents were very careful that it was only when

we were quite seriously ill that we asked him to come.

We had all sorts of other scrapes, cuts,

quite severe cuts sometimes,

which perhaps nowadays,

one would have gone to an accident and emergency department

or got some further help. We didn't.

Some employers ran health insurance schemes

that did extend cover to dependent wives and children.

The job that Janet Dunn's father had found

was in the newly-developed Kent coalfield

and it came with a tied house

and health insurance for the whole family.

The benefit, of course, would mean that if you became ill,

and my sister broke her arm

and another sister dislocated her shoulder and so on,

things that happened, you would be taken into Canterbury hospital.

And that covered that.

And also, I suppose, it paid for the local doctor.

But the benefits for Janet's family would be short-lived.

Working conditions in the mines were notoriously tough.

The Kent coalfields were very, very deep and hot

and the men used to describe it as Dante's Inferno.

It was really dreadful.

A lot of people who came only did the one shift, collapsed

and were brought out and didn't go back again.

The harsh conditions meant disputes were common,

and Janet's father was sacked after going on strike.

The family was evicted

and their entitlement to health insurance soon ran out.

Her parents had to find other ways to manage.

Dad was wonderful in his little remedies.

I remember my brother, John, when he was very ill

and Dad used to go to the pub and bring a little miniature of brandy

back and put a little teaspoonful in

with the white of an egg and some sugar.

And we were all fascinated with this.

It smells lovely, looks lovely.

And he used to just spoon this gently to little John.

But Janet's mother became seriously ill during another pregnancy,

and it was then that the consequences really hit home.

Mother had pre-eclampsia.

It's a very serious complication of pregnancy.

So Mum expected to be taken into Canterbury hospital.

And she was amazed when they said,

"Oh, no, you don't go to Canterbury hospital."

She said, "Why?"

And they said, "Well, your husband doesn't pay to Canterbury hospital.

"Because he's unemployed, you're not paying,

"so you have to go to Etchinghill." To what was really the poor house.

And she said, "Well, I refuse. I won't go."

She did refuse to go.

Dad and I between us, we nursed her and looked after her.

She came through, but the baby was stillborn.

The hard economic circumstances that Janet's family found themselves in

were by no means uncommon.

Britain was experiencing the worst depression

of its industrial history.

Unemployment reached 25 percent

and many people found themselves in and out of work with little warning.

Brenda Watkinson's parents

were amongst those who were struggling to make a living.

Mum and Dad were both in shop work.

My father was a gentleman's outfitter

in the days when you had pinstripe trousers and a black jacket,

and my mother worked in grocery and provisions.

Brenda's father volunteered at a doctor's surgery in Bermondsey in east London,

helping run a local healthcare savings scheme

which enabled patients to spread the cost of medical treatment.

The scheme was called the PMS.

I imagine I might have stood for Patients Medical Scheme.

And my father had to ride around on his bike and collect money.

And it was a thankless task because he was out in all weathers,

often late at night, trying to catch up with people who hadn't been there the first time he called.

They were out or hadn't got any money and were hiding behind the door.

I remember thinking, "It's late and Mum and Dad are still poring over these books."

Sometimes they were there for several hours,

making sure each person's contribution was correctly into the ledger.

But so many people, their earnings were up and down,

and so their only way of making sure they were covered when they were ill,

was to try and eke out a bit of money

every so many weeks when my dad went around.

Times were hard.

In Britain, the tradition of self-help schemes for medical care

had begun amongst workers and employers in the early 19th century.

It was common for groups of workers in different workplaces

to band together and to create some sort of fund

or some sort of organisation

that procured medical services for themselves and their families.

These medical schemes came from employers

appointing surgeons to look after their workers.

Workers were very dissatisfied

that employers had the power to appoint and dismiss the doctors,

despite the fact that it was the workers themselves

who were paying the salaries of these doctors.

There were instances in which employers

actually made a profit from these medical schemes.

One scheme that was determined to do its best by its members

was based in Tredegar in south Wales.

Tredegar is a very small-knit community.

People are very, very close

Er...everybody knows everybody

and everybody knows what's going on.

There's nothing sacred in the town.

At the beginning of the 19th century,

the town had a population of just over 1,000 people.

But the discovery of rich iron ore deposits

soon turned it into a boomtown

run by the Tredegar Iron Company.

Tredegar was a company town.

Everything revolved around the company.

You either worked for them or you didn't work.

Um...they controlled everything.

They controlled people's lives.

Production then switched to steel and coal.

And, like most of the men in Tredegar,

John's grandfather found work in the mines.

But as demand for coal rose and fell,

so did the fortunes of people in the town.

There was a lot of unemployment. Money was hard to come by.

And living conditions were quite harsh.

There was a lot of overcrowding,

with a two-bedroom house having anything from six to ten people

or even twelve people living in them.

A lot of houses didn't have running water or sanitary fittings.

There was still a large amount of outside toilets

at that particular time and people sharing toilets.

The townspeople were determined to improve conditions for the workers,

and by the early 20th century,

had taken over the running of the local medical-aid schemes.

Tredegar Workmen's Medical Aid Society was different

to similar organisations in other parts of Britain.

In the first place, the wives and children of worker members

also received medical care under the schemes.

Secondly, in South Wales, very, very different to everywhere else

in Britain, a poundage system was utilised, whereby workers paid two

or three pence in each pound, rather than a flat rate contribution.

This meant that profit could be built up so that other kinds

of medical services could be offered within the schemes.

Tredegar became the most comprehensive

of any medical aid scheme in the country,

providing treatment from doctors and district nurses,

to dentists and physiotherapists.

'By the 1920s, something like almost 23,000'

of the town's 24,000 population were members of this scheme,

so it's almost a universal scheme.

In 1915, Walter Conway became its secretary.

'He was a good man.

'He had this vision that he wanted the best.'

He wanted the best in the country, he wanted the best in the world.

He wanted the best for the people of Tredegar.

'If it hadn't been for him,

'Tredegar Medical Society wouldn't have been the society it eventually became.

'My grandparents and my parents knew that if they fell ill,

'they could just go along to the doctor

'and the service was there, the help was there.

'If my father had gone on the sick, he knew he would've had sick pay.

'If my mother needed hospital treatment,

'she knew that the local hospital would look after her needs.'

And if they couldn't treat her in the local hospital,

then the bus fare would be paid, to Newport, or Cardiff,

or Bristol where she would get the treatment she required.

Tredegar was also the birthplace of the Labour MP

and future Health Minister, Aneurin Bevan.

The Medical Aid Society would be a major influence

in shaping his vision of a National Health Service.

But in the 1930s, there were still enormous challenges to overcome.

Despite the progress of the previous century,

infectious diseases continued to claim

the lives of thousands of people in Britain every year.

Diphtheria was one of the worst.

A highly contagious respiratory infection,

one of its most frightening symptoms

is the swelling of membranes in the throat,

making breathing increasingly difficult.

The disease had a profound effect on Betty Giltinan's family.

'My mother contracted diphtheria'

and...she was only 33.

And she didn't survive.

'I wasn't aware of the fact my mother was ill,

'but I know that I had to go and live with my grandmother

'for six weeks and then when I came back home,

'after they'd fumigated the house',

I knew mum was missing... and...

..and that was it.

'There was my sister, Peggy, and sister Enid

'and brother Trevor'

and there was the baby of five months and he was Hugh.

'Dad realised that he couldn't cope with five.'

Dad's brother, apparently his wife could not have a family

and he came up to see my dad and begged him, could he take Hugh?

And he was adopted, but, um...

..it was never discussed, you know.

Around the time, Betty's mother had died,

mass immunisation trials were underway in Canada and America.

By the early 30s, deaths in Canada had fallen sharply

and in some cities, diphtheria had been eradicated altogether.

Yet in Britain, little had changed.

The disease was still responsible for a third of all childhood deaths.

'Diphtheria immunisation in the 1930s

'was a failure on a number of different levels.'

Part of the problem was the dislocation between local

and central health responsibilities in Britain.

'Immunisations were a local government,

'not a central government responsibility.'

They're not receiving money from central government

for immunisation programmes

'and 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 and it's not seen as a priority',

despite the fact that between two and 3,000 children are dying each year

in Britain from diphtheria and those are quite unnecessary deaths.

It would take until the Second World War for central government to act.

Amid fears that cramped conditions in air raid shelters

would lead to an epidemic,

they finally introduced an immunisation programme.

Within a decade, diphtheria would become a disease of the past.

The country's approach to controlling infectious diseases

was a legacy of the 19th century public health system.

This 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.

As a result, public health departments were run

and largely financed by local councils.

And in the 1930s,

they had more impact on the health of ordinary people than any doctor.

And the person in charge was the Medical Officer of Health.

'Medical officers of health'

were THE most powerful local government officers.

They ran enormous departments, they had incredible political clout.

They were really the guardians,

'not only of the health of the population,

'but to some extent the economic health of their towns and cities.

'They understand what causes ill-health'

and sitting as they do in local government,

they are in the most influential place that they can be.

By the mid 1930s, public health departments were responsible

for a huge range of services,

with the emphasis firmly on the prevention of ill health.

Street cleaning...

..public laundries...

..bath houses...

..and maternity clinics.

And in some cities like Liverpool,

ambitious programmes of housing development.

Working alongside them was another key department,

the school medical inspections service.

Its job was to monitor the health of the country's poorest children.

In 1929, Stanley Jarvis joined the team at Liverpool.

'My father was a kindly soul, he liked kids.

'He always got on very well with kids

'and he'd go round the schools and talk to the children and so forth.'

In those days, all school children had their height and weight

measured every term and they had a medical examination

when they arrived at the school and before they left the school

'and if a child, for example, lost weight during a term,

'this was a cause for the Medical Officer of Health to look at them.'

Improving children's health had been a priority

since concerns were first raised about the nation's lack of fitness.

The school Medical Inspection Service provided free treatment

for the country's poorest children.

If problems were picked up, children were referred to a clinic.

Peter's father's was next to one of Liverpool's public wash houses.

'I remember seeing a row of children sitting,

'um, with bowls of hot water,

with wooden spoons bound round with bandages,

applying this wooden spoon as a hot fermentation to their sore eyes,

because they had a stye.

And there was one child I remember had both eyes swollen

and looking back now I wonder if that child hadn't got acute nephritis.

It's practically unheard of now but it was an infectious condition,

you got a good old streptococcal infection

and was it spread to your kidneys, jiggered your kidneys

and you got these characteristic signs of nephritis

and one of them was this very puffy pair of eyes.

I haven't seen one of those in 40 years.

But for some health problems, local solutions weren't easy to find.

Heavy industry and coal fires polluted many of Britain's cities

and provided the perfect recipe for poor health.

'The buildings were black with soot',

everything was black and when the wind wasn't blowing of course,

this pall of smoke settled on the place and sat for miles around.

It was a great dome-shaped hump of filth, covering the entire district.

'It was hardly surprising I got bronchitis every winter.

'And when I got bronchitis, they would put kaolin poultices on my chest

'front and back. This was a large acreage of fuzzy felt stuff'

and you covered it with hot kaolin

and slapped it on just, not quite hot enough to burn you,

but it went cold in about five minutes

and very clammy and disgusting.

I didn't like this and I said so and I was told,

"Nonsense, boy. Don't argue, it will do you good."

But I never did think it did and I still don't think it did.

These polluters of environments contributed to another condition

that affected the health of the country's poorest citizens...

..rickets.

Many who worked in public health were determined to find a cure.

"Rickets is principally a children's disease.

"The growing bones don't form properly.

"These x-rays show what has happened.

"On the right is a normal child's knee.

"On the left is his other knee before he was cured of rickets."

Rickets is caused by a lack of vitamin D

and is prevented by exposure to sunlight

and a diet rich in calcium-producing foods like milk, eggs, or fish.

Some public health departments offered sunlight treatment

to families whose diet and living conditions made them particularly vulnerable.

Brenda Watkinson's family was one of those who benefited.

My mother, when she was born in 1901, suffered from rickets from malnutrition

and was actually in leg irons in her early years.

When my brother was born, like my mother, he was very under nourished.

I think he would be probably not a lot older than five.

He had sunlight treatment, also for the malnutrition.

It was reckoned to build children up.

He gradually got better.

But he was very thin.

The link between vitamin D and rickets was discovered by the scientist, Edward Mellanby.

Seen here in home movies.

He argued that a good diet was essential to health

and advocated giving free supplements of cod liver oil to all children.

Mellanby was one of a group of scientists

whose work would have social and political implications.

The 1930s was a period

in which the science and nutrition was making great strides.

Investigators were getting a much better understanding

of the bio-chemistry of nutrition.

That was leading them to draw conclusions about the minimum income

that would be necessary to purchase a diet for healthy living.

What that led onto in turn, was actually a critique of government policy.

And the scientists weren't the only ones campaigning for change.

A growing number of voices from the political left,

to social reformers and public health officials, were calling on the government

to do more to prevent the problems of ill health that stemmed from poverty.

This film was part of that campaign.

There is a marked difference in the heights of boys

drawn from different classes of society.

At 13 years of age, the boys at Christ's Hospital School

are, on average, nearly two-and-a-half inches taller than those from council schools.

At 17, they're nearly four inches taller than working boys of the same age.

These differences are largely due to differences between the food they eat.

The film shows how the general health of the population was fairing.

It features the work of a leading campaigner, Dr George McGonigle,

then Medical Officer For Health for Stockton upon Tees.

He looked specifically at how income affected the diet of families in his area.

Now I've been finding out in my own district,

how much the average housewife has to spend

and what she spends it on, right down to the last penny.

He had two case studies in Stockton Upon Tees,

and he could show the difference between the diets

and the living conditions in these two areas.

It was certainly income that had the biggest effect on health.

What he did was to calculate whether people could afford

adequate diets for health on the rates of unemployment benefit

that they were receiving from the government.

The evidence that McGonigle found was that, no, unemployment benefits were not adequate for health.

McGonigle became an increasingly controversial figure,

with his calls for the government to increase welfare benefits.

He took on a very political role

and public health has always been political from the 1840s to the present day.

He saw his primary responsibility as one of advocacy.

Knowing what was wrong with his population and knowing what should be done to put it right

and he came into direct conflict.

As a result of this, he was threatened with disciplinary proceedings

by the General Medical Council.

The government resisted McGonigle's calls to increase benefits

but his campaign had huge popular support and he kept his job.

And the focus from people like McGonigle on ways to improve people's health

also helped generate new approaches to preventative medicine.

One of these was a radical experiment based in Peckham, in south London.

It attracted enormous interest at the time.

This film was made to showcase its work.

Almost at the foot of Big Ben, you can catch a number 35 tram.

After about half an hour, through factories and crowded streets,

you come to Peckham.

Here you will find the Centre, The Pioneer Health Centre.

As with McGonigle's work, the experiment set out to discover the factors,

which influenced people's health and centred particularly

on the significance of family relationships.

That's my father.

He was compering, as he would

on a Saturday evening, with a dance that was going on.

# Let us dance a Centre waltz together

# Always smile and never mind the rain... #

Pam Elven's family was one of the first 200

who joined the Pioneer Health Centre when it opened in 1935.

They took me one afternoon

and I was over-awed, I think, would be the words I'd use,

of seeing this magical place

and it changed my life.

Membership was by subscription and open to families in employment,

who lived within pram-pushing distance of the Centre.

The way the Peckham Centre was planned was as a scientific experiment

and what they did was to set out a series of buildings,

centred really around a social club

where people would be attracted into the Centre.

There they could be examined, monitored and surveyed.

An old fashioned Big Brother, if you like.

The idea came from two biologists,

Innes Pearse and George Scott Williamson.

And what we are trying to do is to study health.

Find out what health is.

And strangely enough, it's the first time it's ever been tackled.

Scott Williamson wanted to test his theory that by creating

the right environment, you could also create the right conditions

for the development of good health, in mind and body.

When people joined the Centre, they were subjected to three examinations.

There was a physical examination, the usual medical examination, of the body,

but also part of it was a consultation with the family.

In the 19th century medicine was interested in single, separate bodies.

So a family of five people would be five separate bodies.

What Peckham introduced was this idea that the interaction between these people

could tell you something about their health, about their lifestyle,

about how they were going on in their lives.

So the scientists explored their relationships.

The members are co-operating in a unique piece of research into social biology.

We were guinea pigs.

It wasn't just me, we were all guinea pigs.

It was a complete contrast to what we were used to.

I loved it.

I had children to play with, I could do things on my own.

I mean, my mother didn't know anybody,

she didn't know the people on the opposite side of the road.

It wasn't until she joined the Centre that she made friends.

One of the families that they met there was Doreen Head's.

I liked swimming, so I learnt to swim down there.

My younger brother, he was quite young, he went into nursery.

My other brother, he liked badminton.

He was always on the badminton court in the gymnasium and that.

Then my sister, she was that little bit older,

she was able to take advantage of the dances on a Saturday evening.

Within two years, over 650 families had joined the Centre

and a picture of their health began to emerge.

When the Peckham doctors examined patients

they found that 93% could be identified as having some sort of abnormality.

That means 7% were truly healthy.

Williamson and Pearse published their findings in 1943.

Many of the children were found to have worms, deformed toes and decayed teeth.

I'd previously broken my arm and they were very interested in this.

They kept looking at the arm, to see how it was

and when it came out of the plaster they were giving me exercises.

Amongst the adults there were more serious problems.

Most of the women were anaemic, some had high blood pressure,

kidney disorders and cancer.

All examinations, and all the monitoring was only concerned

with recording these things. There was no treatment.

They were said to be advisory.

So, if they did find anything really serious, medically,

they advised the patient to go elsewhere.

They discovered there was a lot wrong with me.

I was anaemic for one, I was deaf for another.

I seemed to have a lot of rheumatism.

The doctor that we had at the time said, "It's only growing pains, mother."

They discovered that I had rheumatism.

How did they know? They sent me off to one of the hospitals in London,

where I had some tests done. I was a sickly child,

but my mother reckons she saw me grow into a very healthy child,

within perhaps 18 months of being there.

The Centre doctors also believed in the importance of good food

and this farm was opened in Kent.

Here, the families helped with the crops and used it for weekend camps.

Life for people like Pam had come to revolve around the Centre.

Mixing with other people,

we were enjoying life with a lot of other people.

It was probably the best years of my life.

The outbreak of the Second World War in 1939

brought a temporary halt to the Peckham Experiment

but it was also the trigger for wider discussion

about health reform on a grand scale.

From this point onwards, the British state asked its citizens to make various sacrifices,

both on the battlefield and on the homefront and

in return had to offer the prospect of a better society in the post-war world.

So what you see during the war years is a great many plans being formulated,

a growing pressure and opinion in favour of substantial social reform,

including reform in the area of medical care and services.

The future...

And the vision of the future for Britain's health services

came from Aneurin Bevan, Minister Of Health in the Labour government of 1945.

It was a vision in which the Medical Aid Society in Bevan's hometown of Tredegar

had played a key part.

Their example of comprehensive health care

showed how a national system could work.

But the new NHS would be controlled by central government

and there was no room for local initiatives.

With the formation of the NHS,

the board from the Medical Aid Society went to Bevan

and pleaded for a special case to be made

on the Tredegar Medical Aid Society.

At that time, Bevan actually turned to the Board and said,

told them, that basically they were a victim of their own success.

That was the end of the Tredegar Medical Aid Society as we knew it.

The Peckham Centre faced a similar fate.

It had reopened after the Second World War

and members like Pam Elven and her fiance, Adge,

were completely unprepared for life without it.

The first we knew, all of us knew,

was a notice that went up on the notice board

to say that the Centre was going to close that Saturday.

We just couldn't believe it.

It was like a death knell.

We were going around silent, as if someone had died.

People were weeping, you know.

Shaking their heads, "What are we going to do without the Centre?"

It affected everybody from children to grandparents.

The experiment was over.

But the Peckham doctors' focus on good health, and the factors, which contributed to it,

would eventually find a place in modern medicine.

It formed a blueprint for what could happen later in the century.

There's a new idea comes into medicine, risk factors,

and we all have risk factors, in terms of the food we eat,

and the exercise we take and the lifestyles we have.

And those risk factors which now dominate our thinking about health,

were first laid down in the Peckham Experiment.

When the National Health Service began in 1948,

it brought order to the chaos of previous decades,

and recognised for the first time that access to health care

should not be dependent on individual circumstances.

The new system wasn't perfect, but it did ensure that when people were sick

there was no barrier to seeing a doctor and being treated.

And from now on, the health of the nation would be linked inextricably,

to the health of all its citizens.

Subtitles by Red Bee Media Ltd