Читать книгу The Thirties: An Intimate History of Britain - Juliet Gardiner, Juliet Gardiner - Страница 20

I regard Nature as perhaps the most important weekly printed in English, far more important than any political weekly.

Arnold Bennett, November 1930

Mr [H.G.] Wells at one time appeared to think that the scientists might save us. Then more recently it was going to be international financiers. But so many committed suicide. So now it is going to be aviators. Perhaps soon we will be told to pin our hopes on a dictatorship of midwives.

Professor F.S. Blackett, ‘The Frustration of Science’ (1935)

In October 1933 the writer H.G. Wells gave a dinner party. Since he had invited too many guests to fit round the table in his flat in Chiltern Court, off Baker Street, the party dined first at the Quo Vadis restaurant in Dean Street, Soho — a building in which Karl Marx had once rented rooms — and then repaired to the flat, where it was promised that Moura Budberg (a Russian aristocrat and probably the common-law wife of the writer Maxim Gorky, who had to come to London as Wells’ mistress, but continued to maintain distinctly shady links with the Soviet Union) would entertain the assembled company by playing the harp. It was a glamorous evening, with the socialite Lady Emerald Cunard ‘in ermine, almost invisible under pearls and diamonds, scenting out the lions’, the novelist Enid Bagnold, now married to the head of Reuter’s, Sir Roderick Jones, ‘brazening out’ a nettle rash by covering her face with an orange veil, Harold Nicolson, Max Beerbohm, and ‘H.G. at the centre, rosily smiling, all the guests talking at once’.

Unfortunately a number of the guests, including Moura Budberg, were taken ill with food poisoning, so there was no music that night, but there was endless discussion, as there always was at Wells’ soirées, including one the month before, assembled ‘to discuss a magnificent idea he has, to unite science to save the world against all its growing dangers: Fascism, Communism, Japanism, Americanism and Journalism … H.G. “chaired” the meeting in his squeaky voice, which becomes quite a handicap in such circumstances. Nothing was decided, naturally, except the need for something, and H.G. will go on giving dinner parties to discuss saving the world.’

‘Saving the world’ from the list of spectres Wells evoked, as well as those of the economic slump and intractable unemployment at home, was something discussed at a lot of top people’s dinner tables in the 1930s. And scientists were at the forefront of such debate, as many were convinced that scientific methods would come up with solutions that inexpert, ill-informed, blundering politicians seemed utterly unable to locate.

Although he was primarily interested at the time in ‘the reproductive physiology of monkeys and apes, and the bearing of any evidence on the evolutionary interrelationship of monkeys, apes and man’, which he was well placed to research as Prosecutor, or research fellow, at the Zoological Society in Regent’s Park (a post he had achieved at the young age of twenty-four), Solly Zuckerman also had a wider range of interests. The atmosphere of the time encouraged him to discuss with some friends, including the young political economist (and great joiner of discussion groups) Hugh Gaitskell and G.P. ‘Gip’ Wells, the zoologist son of H.G., the idea of forming a small dining club. In the autumn of 1931 ‘Tots and Quots’, an abbreviation and inversion of the phrase in Terence’s Phormio: ‘Quot homines, tot sententiae’ — ‘So many men, so many opinions’ — convened for the first time at Pagani’s restaurant in Great Portland Street.

It was a distinguished (entirely male) table: the robustly confident young scientists who assembled to ‘let ideas roam’ over the question of ‘what role science might play in social development’ included the physicist and crys-tallographer J.D. Bernal (reverentially known as ‘the sage’ although he confessed that even his encyclopaedic knowledge had lacunae when it came to ‘fourth century Roumania’), who believed that science ‘held the key to the future’, while socialism had the ability to turn it; the geneticist J.B.S. Haldane, perhaps ‘the last man to know all there was to be known’, with a matchless ability to communicate the complex in public lectures, books and his regular science columns in the Daily Worker; the biologist and author of the best-selling Mathematics for the Million and Science for the Citizen, books he described as ‘primers for an age of plenty’ intended to equip their readers with sufficient knowledge to become effective citizens in a scientific age, Lancelot Hogben, a conscientious objector in the First World War whose acute mind challenged everything; the prehistorian Gordon Childe (another success with what he referred to as the ‘bookstall public’); the sinologist and historian of science Joseph Needham; the zoologist J.Z. Young; the Cambridge economic historian M.M. Postan and the Oxford economist Roy Harrod. Others, such as the literary critic I.A. Richards and the geneticist Lionel Penrose, declined to join but volunteered to ‘clock in’ as guests when the subject under discussion interested them.

Tots and Quots dinners lapsed for a time in the mid-1930s (not helped by the fact that Hugh Gaitskell probably lost the Minute Book), but the club reconvened in 1939 (with a slightly shuffled membership which now also included Richard Crossman) as a ‘platform to proclaim our views … about the vast potential [for the] applications of scientific knowledge when dealing with the complicated problems of war’.

But although ‘Gip’ Wells, who had co-written the best-selling The Science of Life with Julian Huxley at his father’s bidding, resigned after the first dinner, complaining that ‘he had hoped the whole thing would be fun, whereas we were obviously going to become monastic and deadly serious’, the small (fourteen was the average number) group of scientists and economists met regularly during the worst years of the Depression, eating well as they pondered the responsibilities of their discipline in a country shot through with social and economic problems.

In 1934 Ritchie Calder, the scientific correspondent of the Daily Herald, advocated that the House of Lords should be replaced by what he called a ‘Senate of Scientists’. The year before, the Nobel Prize-winning biochemist Sir Frederick Gowland Hopkins, in his Presidential Address to the British Association for the Advancement of Science, had urged the formation of a ‘Solomon’s House’ of the wisest (men) in the land who would assemble to synthesise knowledge, appraise its progress and assess its impact on society. The nutritionist F. LeGros Clark stated that scientists found politics ‘a disreputable game’, which it was their duty to ‘try to transform into a pastime with clean, scientific rules’. Professor Frederick Soddy was explicit: since science was society’s ‘real master’, society should ‘insist on being ruled, not by a reflection of a reflection, but directly by those [scientists] who are concerned with the creation of its wealth, not its debts’. J.B.S. Haldane, writing in Nature in January 1934, had suggested that refusing to apply scientific method to the conduct of human affairs would bring about the failure of Britain’s political and economic system.

When it was suggested to the eminent biologist Julian Huxley that he should stand for Parliament, he dismissed the idea, saying that what guided his life was a passion for truth, not its ‘obscuration’. In the book he was invited to write for a series entitled ‘If I Were Dictator’ (since this was before the full development of Hitler’s Third Reich or Stalin’s USSR, the word ‘dictator’ was not freighted with the same terrible associations it later came to carry), Huxley further showed his disregard for democratic politics, proposing instead a corporatist state in which elections would be ‘superfluous’. A central planning council would replace Parliament, which was little more than a ‘talking-shop’, according to Huxley, and lacked the necessary expertise to the run the country (as, presumably by extension, the electorate lacked the necessary expertise to choose a government).

Social issues in the 1930s had a direct bearing on the scientific community: technological advances were charged with having thrown thousands out of work, and creating machines for military savagery; the Hunger Marches were a symbol of the malnutrition of the unemployed, which Sir John Boyd Orr would quantify in 1936 in his book Food, Health and Income; Oswald Mosley was using spurious ‘scientific’ arguments to inflame anti-Semitism; genetic inheritance was the subject of much debate — the sterilisation of ‘morons’ (defined by the journal Nature as making up ‘a large proportion of the slum population … mental defectives of comparatively high grade … people lacking not only in intelligence but also in self-control, which is the basis of morality, and they reproduce recklessly’) was seriously discussed in Britain and put into practice in Nazi Germany; while the growing threat of war later in the decade rallied scientific expertise to steel defences and develop weapons of destruction.

Moreover, world events were enlarging Britain’s scientific community. British scientists were made acutely aware of the pernicious uses to which scientific theories and inventions could be put when Jewish scientists such as the chemists Gerhard Weiler, E.F. Freundlich and Michael Polanyi, who had been dismissed or resigned from their research or teaching institutes after Hitler came to power, fled to Britain, as did the biochemist Herman Blaschko, the biologist Hans Krebs, the physicists Max Born, Hans Bethe, Heinrich Kuhn, Rudolph Peierls and Kurt Mendelssohn. Boris Chain, a young biochemist, left Germany on 30 January 1933, the day Adolf Hitler was created Chancellor, and came to Britain, where he sought the help of J.B.S. Haldane. Chain eventually moved to Oxford University, and in 1945 he and Sir Howard Florey shared the Nobel Prize for their work on isolating penicillin (though the university denied him even a readership).

After Chain, Haldane sought out more young scientists who needed to flee Hitler’s Germany, working alongside Professor F.A. Lindemann (who had himself been born and educated in Germany and later, as Lord Cherwell, would be Churchill’s wartime scientific advisor) and an Oxford Professor of Organic Chemistry, Robert Robinson, on the Academic Assistance Council (AAC — renamed the Society for the Protection of Science and Learning in 1936). The Council, chaired by the physicist Sir Ernest Rutherford, director of the prestigious Cambridge Cavendish Laboratory, had come into existence in May 1933 after William Beveridge (then director of the London School of Economics) wrote a letter to The Times drawing attention to the plight of Jewish scientists in Germany and Austria. Beveridge had been alerted to the situation by Leo Szilard, a Hungarian scientist who had worked with Einstein (who had declared his intention never to return to Germany and to resign from the Prussian Academy of Sciences in protest at Hitler’s racial policies in March 1933), and a young Englishwoman, Tess (Esther) Simpson, who went on to run the organisation.

By 1935 around 25 per cent of all scientists and 20 per cent of all mathematicians had been dismissed from German universities under the Nazis’ harsh race laws. The AAC sought to enable such people to continue their research in British universities or industry or, as so many yearned to do, to move to the United States, thus ‘salvaging’ a number of scientists, in some cases with great difficulty. ‘Brains in Germany seem to be going cheap and we have no tariff for them,’ wrote W.J. Sollas, the aged Professor of Geology at Oxford. By May 1934, sixty-seven ‘wandering scholars’, as Rutherford called them, had found positions at London University, thirty-one at Cambridge, seventeen at Oxford and sixteen at Manchester, greatly enriching the British scientific community.

Although the early 1930s were ‘by far the richest time there has ever been’ for scientific innovation, in the opinion of the chemist and novelist C.P. Snow, with an annus mirabilis in 1932, when John Cockcroft and Ernest Walton succeeded in splitting the atom, and James Chadwick did likewise with the neutron, there was disquiet among sections of the scientific community. Many felt that those outside their profession looked down on scientific activities as culturally inferior to the arts, and they themselves were seen as little more than lab rats producing work only ‘of great value in their own departments’, in the dismissive view of T.S. Eliot. The Bishop of Ripon, E.A. Burroughs, in his address to the annual meeting of the British Association for the Advancement of Science in Leeds on 4 September 1927, had invited the scientific community to declare a ten-year moratorium on research, for the general good of mankind, since while science had undoubtedly advanced knowledge, it had done nothing to increase wisdom. (H.G. Wells had recently in effect suggested a similar — though permanent — ‘holiday’ for the episcopate, also in the cause of human progress.) Society was suffering, in the Bishop’s view, from a ‘moral lag, a gap between moral and scientific advance, for man’s body had in effect gone on growing while his soul had largely stood still or gone back’.

Notwithstanding the Bishop, scientific research carried on, but the Association strove harder to break down public resistance to the advance of science. Some scientists discussed whether by growing more specialised they might have become ‘blinkered’ to the wider concerns of humanity, while others addressed the question of whether science had a particular relevance — even a special duty — to society. And a small number of radical scientists at Cambridge (particularly), London and a few other universities, or assembled round the Tots and Quots dining table, despaired that their agenda for the ‘social responsibility of science’ was not in fact what generally drove scientific endeavour or its public perception. As Zuckerman pointed out, the ‘efforts of scientists are generally misunderstood, because they are not interpreted to the world by scientists themselves, and because few of those who are immediately responsible for the conduct of social affairs are scientists. There are, for example, no scientists in the Government.’ Moreover, as the Marxist mathematician Hyman Levy argued to Julian Huxley in a BBC broadcast in 1931, ‘Since scientists, like other workers, have to earn their living … to a large extent the demands of those who provide the money will, very broadly, determine the spread of scientific interest in the field of applied science … I know of no scientist who is so free that he can study anything he likes, or who is not limited in some way by limitations such as the cost of equipment.’

J.D. Bernal (whose book The Social Function of Science was a manifesto and a blueprint for the unlimited potential of science for progress, especially once it was freed from the shackles of capitalism) took up the theme in response to a criticism from a fellow scientist that ‘Bernalism is the doctrine of those who profess that the proper objects of scientific research are to feed people and protect them from the elements, that research workers should be organised in gangs and told what to discover.’ It wasn’t, he riposted, as if the idea that science had a social function was new. It was ‘palpable and admitted fact’, and that function was ‘largely economic under present conditions and likely to become even more so’. Nevertheless, under capitalism, science was not generally regarded as being capable of ‘solv[ing] completely the material conditions of society’, Bernal wrote in 1935, ‘but rather the best application of science is conceived of as producing such a fatuous and stupefying paradise as … Brave New World [by Aldous Huxley, Julian’s younger brother, published in 1932]; at worst, a super-efficient machine for mutual destruction with men living underground and only coming up in gas masks’.

To Hyman Levy, as to Bernal, Lancelot Hogben, J.B.S. Haldane, Joseph Needham and other radical scientists, only a society transformed along socialist lines into a planned economy producing an abundance of socially useful goods, equitably distributed to all sections of the population who would thus feel ‘practically and morally bound to one another in this great collective endeavour’ would devote sufficient scientific resources to the solution of economic and social problems. For Levy, what had become clear was ‘not only the social conditioning of science and the vital need for planning … but the impossibility of carrying this through within the framework of a chaotic capitalism’ in which scientists felt unlistened to, undervalued and underfunded (only 0.1 per cent of the Gross National Product was devoted to scientific research and development in the 1930s; by the 1960s it was nearer 3 per cent). For Bernal, ‘Science has ceased to be the occupation of curious gentlemen or of ingenious minds supported by wealthy patrons, and has become an industry supported by large industrial monopolies and by the State.’ But in a capitalist society this had resulted in ‘a structure of appalling inefficiency both as to its internal organization and as the means of the application to problems of production or of welfare’. Bernal’s plan, or map, of the future direction of science had analogies with Keynes’ economic plan: government would need to take a centralised directional role in the healthy development of science and technology, as in the economy.

But unlike Keynes, Bernal was and continued to be a Marxist all his life (though his membership of the CPGB lapsed in 1933 — or was allowed to lapse, since at the time the Communist Party entertained a certain suspicion of intellectuals). ‘During the years of the great Depression I began to study in a more serious way the works of the founders of Marxism, and there I found a philosophy … that could be lived and could be a guide to action,’ he wrote. The Social Function of Science was explicit — and much quoted both by those admiring and those critical of the ‘red scientists’ of the 1930s of whom Bernal was at the forefront (‘that sink of ubiquity’, Hyman Levy called him) — in insisting on science’s social responsibilities. Bernal also played a key role in the regeneration of the Association of Scientific Workers: ‘In its endeavour science is communism … In science men have learned consciously to subordinate themselves to a common purpose without losing the individuality of their achievements … Only in the wider tasks of humanity will their full use be found.’

Across the river from the laboratories of London University and the Tots and Quots dining tables, an ambitious building designed for a new way of living was taking shape. In January 1935 the young Frances Lonsdale, who would become both a Somerset farmer (as a near neighbour of Evelyn Waugh) and an acute biographer of Edward VIII, was picking her way behind her future husband, Jack Donaldson, through the ‘dust and rubble of a new building that had recently arisen in the suburb of Peckham. The building, which had been minutely planned to serve an entirely original purpose, had a front elevation of curved glass windows set in concrete two stories high, and was functional, not in the architectural sense of the word in much use at that time, but in response to the needs of an inspired conception … Although built with a flat roof and without decoration, it had an elegant buoyancy which was to remind one, when it was lit up at night, of a great liner at sea … It was not quite finished, and it was for me astonishingly material evidence of what seemed an incredible venture.’ This modernist wonder had been designed by Sir Owen Williams, a noted structural engineer rather than an architect (a species he dismissed as ‘decoration merchants’), who already had to his credit the huge Boots factory in Nottingham and the glittering, black-glass-fronted Daily Express office in Fleet Street. Its simple, airy construction was designed expressly for the occupant: the Pioneer Health Centre, a cause to which Jack Donaldson would donate £10,000, nearly half the money he had inherited from his father. Lord Nuffield was also a donor.

This ‘form following function’ ethos of modernist architecture was particularly salient, since the Pioneer Health Centre was constructed to house a large-scale experiment on the effect of the environment on health, a concentration on preventative rather than curative medicine. The pioneers were a husband and wife team, Dr George Scott Williamson and Dr Innes Pearse, and the new Health Centre was the result of five years’ fund-raising activity by the couple to move their work from a small house nearby to this beacon to their conviction that, like illness, health could also be contagious. Once a patient presented at a doctor’s surgery or hospital ward, Dr Pearce believed that he or she would be in ‘the advanced stages of incapacitating disorder’ — that is, they felt ill. She had been appalled when working in a welfare clinic in Stepney in London’s East End to realise that she had never seen a healthy baby. The only time mothers came to the clinic was in an emergency, and all she could do was to treat the ailing infant. There was no time to enquire into the circumstances of the exhausted-looking mother, and of course she never saw the father.

What was needed were not just health facilities that acted as a ‘sieve for the detection of disease’, but conditions in which people could ‘keep fit and ward off sickness before they were smitten’; these would be provided by a place where the practice of health was distinct from the conventional practice of medicine. Only families, which the Peckham pioneers had decided were the ‘units for living’, were allowed to join, each paying a shilling a week (the Centre was intended to be self-supporting), and every member had to submit to periodic ‘health overhauls’ designed to check their capacity for individual, family and social life. For an additional few pence they could use a wide range of recreational facilities including a gymnasium, badminton court, roller-skating rink, swimming pool, billiards tables, a theatre space, and rooms for sewing parties or gramophone recitals. There were facilities for children (who had to be restrained from using the glass ashtrays for games of curling along the long corridors) and a nursery club for the under-fives, with specially designed equipment (and much note-taking by the staff) intended to improve family life and enhance personal development. While the Pioneer Health Centre was distinctly modern, experimental and forward-looking in its concept, organisation and habitat, it simultaneously looked back to a pre-industrial community in which a doctor knew his patients in health as in sickness, and the circumstances of their lives, a country village (though without the feudal superstructure) recreated in a busy, fractured inner-city area.

Although Peckham had been chosen because it was a densely populated yet reasonably prosperous working- and lower-middle-class area where such facilities might be expected to add value to the inhabitants’ lives, the first survey of five hundred members conducted in 1936 found that 59 per cent suffered from ailments such as diabetes, high blood pressure, tuberculosis or cancer, even though they believed themselves to be healthy. Vindication indeed of the Centre’s prophylactic aims, the pioneers thought.

‘We are not here to dispense charity, nor to seek out the most helpless and unfortunate in order that we may succour them,’ Dr Scott Williamson told the Medical Officer of Health for Camberwell, in whose fiefdom the Pioneer Health Centre was located. Rather the Centre’s aims were ‘social self maintenance’, and the pioneers were ‘scientists hoping to find out how people living under modern industrial conditions of life might best cultivate health, and thus to benefit humankind as a whole’. The subscribers to this pioneer ‘laboratory’ (who described themselves as ‘guinea pigs’) spent their time there in conditions of ‘controlled anarchy’: the staff were instructed, ‘Don’t make rules to make your life easier,’ and Williamson encouraged the idea that the somewhat undisciplined children would eventually evolve their own system of order. Most of the staff lived communally in a large house on Bromley Common, and when not at work in the Centre they ‘wrangled all day long’. From 1935 a home farm established on the Common grew organic vegetables and produced fresh milk — ‘vital foods’ — at cost price for the Centre with the aim of discovering ‘how far the early symptoms of trouble [detected in a “C3” population] can be removed by fresh food grown on organic soil’ — Williamson and Pearse were both members of the Soil Association council.

The Pioneer Health Centre was high-minded, utopian, convinced (‘strong meat’, Donaldson thought) — and ultimately not possible to sustain. Partly as a result of the introduction of the National Health Service in July 1948 the Centre was unable to attract sufficient funding, and it closed in 1950.

While it may have been unrealistic to imagine in the economic climate of the 1930s that Pioneer Health Centres could be rolled out all over Britain, health centres practising medicine alongside welfare clinics (which Williamson and Pearce derided as ‘polyclinics’) were also a rarity (and indeed would be until the 1960s). Although the Dawson Report back in 1920 had advocated a system based on groups of medical practitioners working from publicly funded health centres which integrated preventative and curative medicine, this appeared too much like costly state interference with the autonomy of doctors, and the idea was shelved.

There was, however, a ‘polyclinic’ in the neighbouring (and much poorer) borough of Bermondsey, which opened in 1936 as part of what the radical borough (which had pulled down the Union Jack from the municipal flagpole and run up a red flag instead when the ILP won a majority on the Council in 1924) liked to describe as the ‘Bermondsey Revolution’. It was the brainchild of Alfred Salter, a doctor and the ILP MP for West Bermondsey, and the husband of Ada Salter, the first woman Labour mayor in Britain. Salter was determined to bring together ‘a solarium for tuberculosis, dental clinics, foot clinics, ante-natal and child welfare clinics’, formerly scattered in ‘ordinary dwelling houses’, into one building that would serve as ‘the Harley Street of Bermondsey’, where the range of services would provide the poor of the borough with ‘the best diagnosis and advice that London could provide … as good as any the rich could secure’.

Bermondsey did not rest content with a state-of-the-art health centre. It took its message out into the streets, proselytising about healthy living by means of posters, large-print pamphlets (forty-two were produced in 1932 alone), lectures, and electric signs flashing warnings against spitting, messages about the advantages of drinking milk, and pithy slogans such as ‘Your son and heir needs sun and air’. Furthermore, a disinfectant van was equipped with a cinema projector and a lantern for outdoor showings of short films made by the Public Health Department (the cameraman’s day job was as a radiographer), including such masterpieces as Where There’s Life, There’s Soap (a film for children on personal cleanliness), Delay is Dangerous (about the early signs of tuberculosis and the need to seek medical advice) and one with a slightly admonishing ring, Some Activities of Bermondsey Council, intended to remind the borough’s citizens how much their elected authority was doing for them in the fields of housing and public health (which it undoubtedly was). The open-air screenings took place in the summer months (though not in July and August, as it didn’t get dark until 10 p.m., and in any case many Bermondsey residents were away in Kent hop-picking — a film, ‘Oppin, was made about that too). The Council fitted twenty-four lamp-posts in various parts of the borough with special plugs so that the ‘cinemas’ could be plugged in, and films were shown in the street, in the courtyards of new housing estates, in parks, children’s playgrounds and the new Health Centre. By 1932 there were over sixty shows a year, drawing an audience of around 30,000, though both the number of shows and the size of the audiences had begun to tail off by the end of the decade.

An impressive modernist ‘drop-in’ Health Centre (designed by the Georgian émigré architect Berthold Lubetkin, who had already designed a prototype TB clinic for Dr Philip Ellman, the Medical Officer of Health for East Ham and a member of the Socialist Medical Association, which was never built) opened in Finsbury in North London, another very poor borough, in 1938. Built like a ‘megaphone for health’, with two wings splayed out from a central axis, it housed a TB clinic, a foot clinic, a dental clinic, a mother and baby clinic, a disinfecting station, a lecture hall and a solarium where the sun-starved children of the borough might benefit from ultraviolet-ray treatment, as well as fumigating facilities and a mortuary in the basement. So representative of a better life for all those who had previously suffered ‘C3’-level health — and health care — was Finsbury that it was depicted on one of Abram Games’ wartime posters urging ‘Your Britain: Fight for it Now’.

But for those not resident in one of those London boroughs and without reasonable means, provision for the unwell in the 1930s remained an example of hotchpotch availability, lack of funding and reluctance to extend state involvement, all resulting in inequality of access to medical services.

Men working in insurable occupations and earning less than £250 a year were covered by a contributory National Health Insurance scheme, introduced in 1913, to (barely) tide them over in times of sickness and provide basic medical treatment and medicines from a ‘panel’ doctor. However, by 1936 only around twenty million people, about 40 per cent of the total population of 47.5 million, including six million working women, were covered. They did not include dependent wives (except in the case of maternity benefit) and children. Those earning over £250 a year would have to make their own private sickness insurance arrangements — though they could contribute to the NHI scheme through voluntary payments if they could afford to.

The NHI scheme did not cover dental or ophthalmic treatment, though some of the larger ‘approved societies’ (usually friendly societies or industrial insurance companies, and a few trade unions) which administered the scheme might offer such fringe benefits to attract customers. This meant that for many working-class men and women tooth decay and premature toothlessness were inhibiting and intermittently painful features of life (‘Teeth, teeth, teeth, they are half the trouble [with women’s health],’ wrote a country district nurse in February 1938), while Woolworths offered ‘do it yourself’ eye tests for those unable to afford to consult an ophthalmologist about their need for spectacles.

There were continual complaints that those who received their treatment from the NHI scheme, known as being ‘on the panel’, got inferior treatment. At least 5,000 doctors remained outside the scheme, and those operating within it in suburban or rural areas often derived most of their income from private patients. A GP employing one assistant could easily have 4,000 panel patients (for each of whom he would receive a capitation fee of about 9s.6d), and it was quite usual for a single doctor to be responsible for as many as 2,500 patients, so those in poor areas with a large percentage of their patients ‘on the panel’ were likely to give only cursory consultations.

In industrial areas the doctor’s surgery would often be housed in a shop where the window would be painted halfway up to ensure some degree of privacy. Patients would queue outside (even when it was raining) until it was their turn to see the doctor. Doctors were not salaried (nor were hospital consultants), so they relied on fees and/or insurance payments, the latter of which were invariably lower, so in general poorer areas, where there were few if any fee-paying patients, were served by either less able or more altruistic doctors. In more prosperous middle-class areas, doctors would usually see their patients in the front room of their own homes. The fee-paying patient would have an appointment and be shown in at the front door by the doctor’s wife (or maybe a maid, if finances and status permitted), whereas panel patients would enter by the surgery door, and sit and wait until the doctor was ready to see them. The surgery would smell of phenol, since most GPs were expected to perform operations such as removing appendixes and tonsils, hysterectomies, hernia repairs and suchlike, although increasingly these took place in the local cottage hospitals found in suburbs, smaller towns and rural areas, which by 1935 provided around 10,000 beds. Or patients might request a home visit (more readily agreed to for private patients), when all the technology available would be the instruments the doctor could carry in his (or very occasionally her) Gladstone bag.

Eileen Whiteing remembered that if influenza or tonsillitis were suspected in her comfortable Surrey home, ‘Dr Cressy would be sent for and he usually prescribed the dreaded “slops” which meant that we were only to be given such things as steamed fish, poached eggs, beef tea, milk puddings and so on, until he called again in a day or so.’ Doctors’ fees varied depending on the area and sometimes on the patient’s ability to pay. A doctor attending poorer families would usually require to be paid cash at the time of a consultation or visit (as earlier ‘sixpenny doctors’ had) rather than sending in a bill. If an operation were needed, the surgeon’s and anaesthetist’s fees would have to be found, plus nursing home fees.

Having a baby for a middle-class woman often meant a private nursing home, whereas for most working-class women it would be a home confinement, possibly but by no means necessarily with the help of a midwife who delivered babies as the sort of community service that ‘wise women’ had provided for other women down the ages, often at low cost and sometimes with inadequate standards of medical knowledge or hygiene, as a ‘Report on Maternal Mortality in Wales’ showed. It was not until 1936 that the Midwives Act obliged local authorities to provide trained midwives, and it was not until 1946 that the number of hospital births exceeded those at home.

So the uninsured, the unemployed who had exhausted their sickness benefit entitlement and whose names were removed from doctors’ lists as ‘ceased to be insured” (although doctors were no longer paid to treat such people, ‘If they were well known to us, we felt morally under an obligation to attend to their wants when asked to’), the dependents of those covered by the NHI and the poor and old, would have to spatchcock together medical care as they did other social services. In the first instance they were likely go to the local chemist for a bottle of patent medicine (almost £30 million a year was spent on patent medicines during the 1930s, and it was not until the 1939 Cancer Act that the advertising of cancer ‘cures’ bought over the counter was banned), and only if that was ineffective would they seek medical advice. They might be able consult a doctor who participated in the Public Medical Services, or be treated by those employed by enlightened local authorities such as Glasgow, Oxford or Mansfield in Nottinghamshire. Most local authorities, though, provided only those services they were statutorily obliged to, mainly concerned with infant and maternity care, or mental and infectious diseases. People might join a doctor’s ‘club’ and pay a small amount each week, or go to the outpatients’ department of a public hospital.

Married women were particularly disadvantaged if they could not afford to pay for their medical care. They were not covered by the NHI scheme, and were considered a poor risk by insurance companies since the mass of burdensome ‘dull diseases’ contingent on their biology would be likely to prove expensive — a burden the Chief Medical Officer of Health, Sir George Newman, admitted privately he was reluctant to enquire into too deeply, since it was ‘a wandering fire to which there are no bounds’ that would create demands way beyond the resources of the Ministry of Health. There were few women general practitioners, since most preferred to work directly with women and children in clinics, and many women were reluctant to take their troubles to a male doctor, so they struggled on with varicose veins, anaemia, prolapsed wombs, phlebitis, haemorrhoids, rheumatism, arthritis, chronic backache, undernourishment and exhaustion without ever seeking medical advice. Death in childbirth remained at much the same level –4.1 per thousand — in 1935 as it had been in 1900, and in the depressed areas of South Wales and Scotland it was 6 per thousand. Better antenatal care as well as improved living conditions might have helped, but the primary cause of death in childbirth was medical, and it was not until the mid-1930s that puerperal fever, which presented the gravest danger, became treatable with sulphonamide drugs.

Hospitalisation was not covered by health insurance, and the choice was between voluntary hospitals, which had originally been endowed by the rich for the care of the poor, and which included some of the most famous London teaching hospitals, and local authority hospitals, many of which had been former Poor Law institutions. The voluntary hospitals were permanently strapped for cash by the 1930s, and were dependent on bequests, fund-raising events such as concerts and fêtes, flag days and patients’ fees. Those on low incomes might have been paying a few pence a week which would give them the right to treatment should they need it (or if they were lucky their employer might have made a block provision for employees in this way), or they might be charged whatever the hospital almoner assessed they could afford. But the days of such hospitals were numbered: it was clear that voluntary contributions were no longer sufficient to keep them going, despite the fact that private patients’ fees, mostly paid through insurance schemes, covered almost half such hospitals’ costs), and by the end of the decade more hospital accommodation was provided by local authorities than by the voluntary sector.

The financial difficulties of the voluntary hospitals and the fact that they were not planned on a national scale according to the needs of the community, gave an opportunity to a group of medical practitioners who had a larger vision for health. The Socialist Medical Association (SMA) had been founded in 1930 with the support of, among others, the first Minister of Health, Christopher Addison, the journalist and propagandist for science Ritchie Calder and medical scientists and practitioners such as Somerville Hastings, a surgeon at the Middlesex Hospital in London and a Labour MP, Charles Brook, a London GP, David Stark Murray, a Scottish pathologist, and Richard Doll, who in the 1950s would prove the link between smoking and lung cancer. The SMA looked to the creation of a socialised medical system which would both streamline the chaotic health provision of the 1930s and ultimately make health care ‘free to all rich and poor’. Furthermore, it wanted to end what it regarded as the ‘lonely isolation’ of the GP by creating salaried posts and locating them in a series of health centres based on municipal hospitals that integrated all aspects of medical care — owing something to the Peckham, Finsbury and Bermondsey models.

Although this blueprint for socialised medicine appears to prefigure the creation of the NHS in 1948, it was at local level — particularly in London — that the SMA came nearest to implementing its ideas in the 1930s. ‘Municipal socialism’ increasingly seemed to be a plausible strategy for undermining the National Government, and during the 1934 London County Council (LCC) elections the SMA produced a health manifesto claiming that the capital’s ill health was due to poverty, bad sanitation and inadequate medical care and treatment (due to lack of resources), for which ‘the anarchy of capitalism’, reflected in uncoordinated health care provision, was to blame. Seeing health as ‘every bit as important as education’, SMA members were appointed to a range of LCC committees when Labour won control, and were able to put some of their ideas into practice, such as increasing the allocation of resources to municipal hospitals, improving the conditions and pay of nurses and other medical staff, providing outpatient facilities at most hospitals for the surrounding community and ridding hospitals of any Poor Law connotations, since ‘every possible suggestion of charity, subservience, and general second rateness must be banished’. Instead London’s citizens should regard ‘the municipal hospitals as their own [since they had] every right to use them and expect the best from them’. But although the reform of London’s health provision was of considerable interest to other authorities, even Somerville Hastings, chairman of the LCC Hospital and Medical Services Committee, recognised that it was unlikely to be fully possible ‘within the limits of existing legislation’.

As well as inadequate hospital provision, the range of remedies doctors could provide was still very limited: during their brief consultation patients would be given a handful of pills, which might come in a range of colours but would in fact probably all be aspirins, though bottles of dilute mixtures of powerful drugs such as kaolin and morphine were also dispensed. A Welsh doctor provided his miner patients with a tincture of chloroform and morphine, effectively an addictive drug, for their chronic chest conditions. Many general practitioners had few aids to diagnosis, a stethoscope, thermometer, ear syringe and maybe a speculum being fairly standard, sterilising instruments was a dispensable luxury, and doctors had to pay for laboratory tests themselves — and therefore tended not to take advantage of new techniques and treatments that were being developed during the 1930s. A Welsh doctor who prescribed little but ‘black liquorice’ for his miner patients’ pneumoconiosis was regarded as a cut above other practitioners in the town, since he had a machine that enabled him to take a patient’s blood pressure.

Aware of their limited therapeutic arsenal, doctors essentially bought time by dispensing medicine, hoping that an illness would turn out to be self-limiting and would disappear, while patients appeared to be satisfied if they left the surgery clutching a bottle of medicine (private patients would have their bottle wrapped in white paper and sealed with sealing wax and usually delivered by the doctor’s errand boy on a bicycle after evening surgery) or, less frequently, a box of pills, for which they had paid two or three pence. Aspirin powder for pain relief had been available since the turn of the century, and a tablet form had been patented in 1914, insulin injections to control diabetes had been introduced in the 1920s, followed by kidney dialysis, radium treatment for cancers, skin grafts and blood transfusions. Salvarsan was effective as a cure for syphilis and pernicious anaemia could now be treated with iron injections (rather than raw liver sandwiches, as previously), while the significance of vitamins began to be appreciated, leading to new therapies using vitamins C and D in cases of scurvy and rickets.

However, there were few things in the medicine cupboard in Eileen Whiteing’s home ‘apart from fruit salts, cough mixture, plus iodine for cuts … and we certainly did not include [the commonplace aspirin] in our home remedies, having to endure headaches and other pains until they went away of their own accord … cod liver oil and “Virol” were favourite remedies for winter ailments … and in the case of nerves or depression, a strong iron tonic would be prescribed, with the advice to “pull yourself together”.’

Diphtheria in children, an infection resulting in the throat thickening and the danger of suffocation, was one of the spectres hovering over the inter-war years, with some 50,000 cases every year. Two thousand children died each year from diphtheria and whooping cough until effective vaccines began to be used towards the end of the decade. Eileen Whiteing recalled that when she and her sister caught ‘the dreaded diphtheria … Mother refused to let us go away to hospital, so a trained nurse was engaged at great expense, and, between the two of them, plus the resident maid, we were nursed safely through the long weeks of fever. Disinfected sheets had to be hung over the bedroom doors, all visitors had to wear white coats and face masks, and the whole house had to be fumigated by the local health officers at the end of the isolation period … People were endlessly kind … since illness was quite a serious event then: I remember hearing the news in hushed tones that straw had been spread over the road outside the house of one of my friends while he lay desperately fighting for his life with double pneumonia in order that the noise of passing traffic should not disturb him until what was known as the “crisis” was past’ and the patient’s dangerously high temperature either fell, or he or she died of exhaustion or heart failure, since in the absence of any effective medication, all the doctor could do was visit several times a day, wait and watch.

It was not until 1935–36 that real advances in medical treatment were possible with the manufacture of sulphonamides, anti-bacterial drugs effective for the treatment of a range of serious illnesses including streptococcal and meningococcal infections, the ‘miracle drug’ of those pre-penicillin years.

Tuberculosis was another killer disease that awaited its antidote: in the first decade of the twentieth century it was responsible for one death in every eight, and although that figure was steadily declining by the 1930s, there were still some 30,000 deaths a year from respiratory tuberculosis, and it continued to be seen as a deadly and frightening disease, freighted with social stigma. George Orwell, the most pungent chronicler of the mid-century, who had first contracted TB in 1938, died from its effects in January 1950, aged forty-six. In 1925 the typical tuberculosis dispensary was described by the Chief Medical Officer of the Ministry of Health as ‘an outpatient department, stocked with drugs that are mainly placebos, or an annexe of an office for the compilation of statistics’, and not much had changed a decade later. Although tuberculosis could be managed to an extent, and a diagnosis was no longer an automatic death sentence, there was no effective treatment until BCG (Bacille Calmette-Guérin) vaccine, after fraught years of trials and considerable resistance from the medical profession, started to be used extensively in Britain in the 1950s. Until then treatment consisted either of radical surgery — usually collapsing a lung, an operation performed on the principle of putting the diseased portion of the body to rest so it could combat disease with its own resources — or exposure to fresh air, on much the same principle of encouraging the recuperative power of nature, since there was not much else on offer.

The notion that sunshine and fresh air helped TB sufferers (and sufferers from other medical conditions) had been popular since the late nineteenth century, and those who could afford it might take the Train Bleu to the South of France or head for the bracing air of the Swiss Alps. The first British sanatorium for the open-air treatment of tuberculosis opened in Edinburgh in 1894, and others followed in Glasgow, Renfrewshire and Frimley in Surrey; they soon spread throughout the country, including one funded by the Post Office Workers’ Union in Benenden in Kent. Some were for the well-off (though the rich usually chose Menton or Davos), many were funded by philanthropists (although, despite its romantic, artistic connotations, TB was regarded primarily as a disease of the poor, and did not attract the same level of donations or research funding as, say, cancer, despite the fact that even at the end of the Second World War it accounted for more deaths between fifteen and twenty-four years of age in Britain than any other condition). Ireland had one of the worst death rates from TB in the world, and although it had been falling since the turn of the century, it started to rise again in 1937, in stark contrast with the rest of the United Kingdom and Europe, due mainly to poverty and a lack of specialist services such as x-ray machines, which barely existed outside Dublin. Faced with the helplessness of the medical profession, those afflicted turned to folk remedies, desperately trusting in the efficacy of a daily dose of linseed oil mixed with honey, swallowing raw eggs or paraffin oil, goats’ milk or dandelion-leaf sandwiches, or positioning themselves in the street outside the Belfast gasworks, since fumes from the vats were reputed to clear the lungs.

Since tuberculosis was ‘the principal social disease of our time’ in the view of Britain’s Chief Medical Officer of Health, with implications for the whole community, the government, in conjunction with local authorities, funded a network of sanatoria (sometimes using old Poor Law infirmaries for the purpose) for free treatment, and aftercare to be provided by tuberculosis dispensaries. If possible the sanatoria were in isolated locations, since statistics showed that tuberculosis was more prevalent in urban areas than rural, and TB was regarded with such suspicion that any proposal to build a sanatorium invariably met with stiff local opposition. (Indeed, local authorities could obtain a court order for a person suffering from pulmonary tuberculosis to be forcibly removed from their home, although they rarely did so.) Ideally they were surrounded by pine trees (which were ‘much appreciated for their exhilarating resinous aroma’), recalling Otto Walther’s German sanatorium in Nordach in the Black Forest, ‘an abode for Spartans’ 1,500 feet above sea level and ‘exposed to every wind’, the model for so many dilute British establishments with names such as Nordach-upon-Mendip and Nordach-on-Dee. They were governed by strict rules — visitors one Saturday afternoon a month was not unusual — with a regime regulated by bells which included rest, a great deal of food (though not always of the highest quality), some outdoor exercise whatever the weather, and indoor crafts such as wood whittling, raffia work, crocheting and painting, and absolutely no sharing of cutlery or crockery. Spitting, a not uncommon habit in the 1930s, was forbidden, since sputum was know to be a carrier of the tubercle bacillus.

Belinda Banham, who had trained as a nurse at St Thomas’s Hospital in London, wrote that the treatment provided to tubercular patients in the 1930s by the Royal Sea Bathing Hospital in Margate (founded in 1791 as the Royal Sea Bathing Infirmary for Scrofula)

consisted, for the main part, in exposure to the elements … each ward gave onto two verandahs, one on either side. The verandahs were equipped with shutters which were never to be closed in the day, and at night only with the permission of the night sister. Permission was rarely granted, even when the snow was falling, as it was thought contrary to the patients’ interest. Cloaks were allowed to nurses only in moving to and from the wards. Strength and stamina were essential to survival … It is difficult today to conceive of the patience and heroism of patients occupying those beds. The length of stay was indeterminate and never less than six months. With tuberculosis of the spine … two or three years was common … with patients often immobilised for two years or more … Efforts were made to protect nurses from contracting tuberculosis, mainly by means of an ample diet … nonetheless, several nursing colleagues did acquire the disease and two died in my time there.

When Dr W.A. Murray arrived at Glenafton Sanatorium in Ayrshire in 1934, he found chilblains ‘prevalent among staff and patients’, which was hardly surprising since the wards had no heating and the icy Scottish wind blew in round the ill-fitting windows, raising the linoleum from the floors in waves ‘which made a ward round something like a trip on a roller coaster. Rain also came through the windows to such an extent that a patient with some skill as a cartoonist’ depicted the doctor ‘doing his rounds in thigh boots while a patient sailed a toy boat round his bed!’

Fresh air was also recommended for supposedly susceptible children who might be ‘pre-tubercular’ (though some were actually suffering from malnutrition), and could be removed from their infectious homes during the ‘delicate years of growth’. By 1937 there were ninety-six open-air day schools in England, catering for 11,409 children; a further 3,985 children boarded at open-air residential schools, while those 2,451 children already affected by pulmonary TB might well attend one of the thirty-six sanatorium schools (or one of the further sixty-five schools catering for children suffering from non-pulmonary tuberculosis). Meanwhile, forty of the 221 schools in Glasgow had been constructed on ‘open-air principles’, with open verandahs, sliding doors to the classrooms and plate-glass windows, and two ‘preventoria’ for children who had been exposed to tuberculosis were built. Those children who for whatever reason could not attend such an institution might be shipped out to foster parents in rural areas to get their fresh air that way.

One problem was the reluctance of those who suspected that they had tuberculosis to seek medical advice, since ill-informed prejudice about the disease might well mean that they were shunned ‘like lepers’ by family and friends, lose their job and find it hard to get another even when they were well again, and have difficulty in getting life assurance cover. ‘The world regards the “lunger” as an outcast,’ wrote a sufferer in the Western Mail in November 1938. ‘Filled with an exaggerated dread of any word ending in “osis,” unthinking people recoil from anyone who had “had it” … Every week scores of “lungers” are released from clinics, hospitals and sanatoria … Each patient goes his own way. Yet each one finds himself up against the same problem … He is not wanted; he is avoided; he is feared — and then alack! forgotten … His own relatives are afraid to have him in the house … Jobs are out of reach … Two kinds of suffering have attended me through the battle [to get well in the sanatorium]. One was the distressful horror of the disease itself. The other is the mental agony born of my knowledge that when I emerge from the fight … I am taboo to my fellow countrymen.’ Such considerations sometimes influenced GPs, who were obliged by law to report cases of tuberculosis, which may mean that rates of incidence in the 1930s were actually higher than reported.

Early diagnosis significantly improved the chance of recovery. The information-aware Bermondsey Public Health Department produced a film for their travelling cinemas, Consumption, in 1932 which illustrated how ‘a consumptive, by placing himself under medical treatment and obeying simple rules of hygiene, can live an ordinary life for many years, without fear or risk to himself or those with whom he comes into contact’. Dr Salter himself played the doctor the patient consults after coughing blood into his handkerchief. He is seen sending the young man to a local authority sanatorium where he gradually gets better and is taught a new trade. On his return home he declines to kiss his wife since he is still contagious, and she makes up a bed for him in a shed in the backyard — provided free of charge by the council.

One way that people might receive treatment was to be admitted to Papworth Village Settlement, near Cambridge, founded by Dr (later Sir) Pendrill Varrier-Jones in 1917 along the lines of Ebenezer Howard’s ‘garden city’ of Letchworth, where, as he explained in an article in 1931, if a tuberculosis patient was found to be ‘suffering from extensive and permanent damage he would be able to live and work permanently in a village settlement with his family. The whole tuberculosis problem would be revolutionised. Those who thought they had tuberculosis would present themselves at a very early stage … and the success rate in treatment would be revolutionised’ — not that Varrier-Jones believed that tuberculosis could be cured: treatment was a life sentence.

By 1938 Papworth, which was infused with the same spirit of experimentation (‘studying the mechanisms of resistance’) and holistic treatment as the Pioneer Health Centre in Peckham — ‘We are dealing with persons, not cases,’ Varrier-Jones was fond of saying — offered a hospital and a sanatorium consisting of open-air shelters with canvas flaps constructed in Papworth’s carpentry workshops for which patients were issued with waterproof blankets to keep off the snow: glasses of water holding false teeth froze solid by the beds. A population of a thousand, including 360 children, lived in the 142 semi-detached cottages to which patients were able to move as they grew stronger, with a verandah and a garden, but no ornaments or wallpaper allowed, as these harboured germs, the windows permanently open. They ate a rich diet that included eggs, milk, porridge and cocoa, and were able to make use of communal facilities such as a swimming pool, join clubs for tennis, cricket, athletics and book reading, and to go to the cinema or pub on site. Since ‘not everyone is fitted for a life in Utopia’, the emphasis was on self-discipline externally policed. Patients lived under a strict paternalistic regime that censored entertainments they laid on themselves and the films they were allowed to watch, and leave passes were rigorously controlled. There was a psychiatric clinic to counsel the despairing.

As well as families, Papworth admitted single men from 1927 and single women (most of them former domestic servants) from 1929, their hostels sited some distance from each other, with ‘a tumulus heaped up’ between them to help maintain segregation. However, several inter-patient marriages did take place, and on such occasions Dr Varrier-Jones would present the happy couple with an engraved glass vase.

Varrier-Jones had hoped that the settlement would become financially self-sufficient through farming and market gardening — and in any case he thought it essential that those that could, should work, or they would soon ‘“throw up the sponge” if they were treated as permanent invalids’. However, the income thus generated turned out to be too little, so he set up a factory turning out travel goods and furniture. Patients were also employed in signwriting, printing, boot repairing and jewellery making, plus some horticulture and poultry farming. By 1930 Papworth’s turnover was £85,000, and by 1937 this had increased to over £130,000, with a number of Cambridge colleges purchasing pieces of the well-made furniture.

The incidence and treatment of tuberculosis provides something of a metaphor for a nexus of 1930s attitudes. The clean, sweeping design of tuberculosis hospitals, sanatoria and health centres that rejected Victorian and Edwardian decoration — curtain rails with heavy plush curtains, flocked wallpaper, cornices and curlicues that might harbour dust and therefore bacilli — the fervent belief in the health-giving properties of fresh air, ‘aerotherapy’ as it was sometimes known, and sunlight, and therefore the use of glass, wipeable venetian blinds, open-air balconies, the curved buildings looking like great ocean liners, such as the expanded Benenden sanatorium, or Harefield hospital, built in Middlesex in 1938 in the shape of an aeroplane floating in the verdant countryside. The Finsbury Health Centre had been explicitly designed to catch the changing angle of the sun, and the interior murals by Gordon Cullen urged ‘Fresh Air Night and Day’ and ‘Live Outside as Much as You Can’.

Flexible interiors were also part of the ethos: Peckham Health Centre had moveable glass partitions which meant that almost whatever they were doing, its members could be observed by the experts like goldfish in a bowl. Such buildings united zealous democratic (and usually socialist) reformist urges with modernist architectural forms that let light into what were formerly dark and hierarchical spaces. Above all there was the debate about what ‘caused’ tuberculosis. Was it hereditary — the Leicester Schools’ Medical Officer was of the opinion that parents with tuberculosis should be prevented from having more children (How? Celibacy? Segregation? Sterilisation?), and the city’s Medical Officer of Health made sure that patients were handed a leaflet when they left the sanatorium advising them not to marry or have children. Was it unhealthy living conditions or an inadequate diet that was responsible? Did poverty cause tuberculosis? Or was it that tuberculosis caused poverty (through lack of earnings)? Could an individual take charge of his or her own medical destiny by clean living, or were environmental factors beyond individual agency responsible?

Average life expectancy was increasing: by 1930 it was 58.7 years for men and 62.9 for women, whereas in 1900 it had been 48.5 for men and 52.4 for women, and infant morality was slowly falling. But this was only part of the story. Relief at the decline in the incidence of infectious diseases (such as tuberculosis) overlooked indicators of poor health such as anaemia, debility and undernutrition, and failed to differentiate between different parts of the country. In fact the death rate was rising: between 1930 and 1931 it increased from sixty per thousand to sixty-six, and in the depressed areas of Lancashire, Teesside, South Wales and Scotland the picture was bleak, with the death rate in the early 1930s as high as it had been before the First World War. Infant mortality rates rose, and not just in the depressed areas. There were marked differences between classes: in Lancashire and Cheshire the number of childhood deaths varied from around thirty-one per thousand among the well-off to ninety-three in the poorest class. Deaths in childbirth were 2.6 per thousand in the South of England, but 5.2 in the North and 4.4 in Wales. Surveys indicated that 80 per cent of children in the mining areas of County Durham and the poorest areas of London showed signs of early rickets, which was put down to both poor diet and lack of sunshine under the smoke-laden industrial skies (hence the preoccupation with sunlight of the health centres); modern estimates suggest that between a quarter and a half of all children living in areas of economic depression survived on a diet that was inadequate to maintain normal growth and health.

The charge that there was a connection between ill health and government policies was consistently contested during the Depression. Again tuberculosis provides an exemplary study, with the Chief Medical Officer of Health, Sir George Newman, attributing the rise in deaths from the disease in the industrial areas of South Wales (from 131 per 100,000 in young men aged fifteen to twenty-five in 1921–25 to 197 per 100,000 in 1930–32, and for young women from 185 to 268 in the same period) to ‘geographical features of coalmining districts’, by which he meant the lack of sunlight in the deep valleys in which the villages were located. He also allowed social factors, such as ‘the tendency to crowd into small rooms and halls, some lack of playfields and facilities for open-air recreation, sometimes an unsuitable diet and the tendency to conceal the presence of tuberculosis’, while for the mortally afflicted young women it was a question of ‘migration to domestic service’ and not returning home until the disease was in its terminal stage. Nonsense, a member of the Committee against Malnutrition riposted: ‘There is no evidence that the valleys are deeper and narrower today than formerly, and migration to service does not account for the increase in male mortality.’

Although the Ministry of Health declined to draw a correlation between poverty and the disease, citing ‘a complex interaction of a considerable number of factors’, those on the ground had no such doubts. A former MoH for Cardiff was unequivocal: ‘Poverty has long been recognised as a prime factor in the causation of tuberculosis, principally through its effect on nutrition,’ he wrote in 1933. A tuberculosis officer for Lancashire, asked to conduct a survey in Durham, concluded that ‘The principal means by which poverty is found to cause tuberculosis are the overcrowding and undernourishment which are the chief distinguishing features between the poor and not poor families [some 3,000] studied,’ and considered the link between tuberculosis and undernourishment to be more significant than that between tuberculosis and overcrowding.

In Jarrow, the death rate from tuberculosis was higher in 1930 than it had been before the turn of the century, at a time when rates across the rest of the country were falling by 50 per cent. The fact that there were fewer cases of spinal, bone and joint tuberculosis in Jarrow than might have been expected could be put down to the fact that fewer of the people who lived there were able to afford fresh milk. (In the 1930s almost 30 per cent of non-pulmonary tuberculosis deaths and 2 per cent of the pulmonary strain were caused by tubercular cows’ milk or infected meat: in 1931 a thousand children under fifteen died of tuberculosis of bovine origin, and many more were crippled, but by the end of the end of the decade still less than 50 per cent of milk was pasteurised.) ‘There is no mystery about the high tuberculosis rate of Jarrow,’ flatly asserted ‘Red Ellen’ Wilkinson, the Labour MP for the town (so named by virtue of both her politics and her flame-coloured hair), scourge of the National Government’s policies towards the unemployed. It was not caused by the supposed facts that ‘“the women do not know how to cook … The Irish have a racial susceptibility to tuberculosis … The families are too large … The geographical formations are unfavourable” … all of which reasons have been put forward by various medical authorities’. Rather, it was caused by the vicious cycle of ‘bad housing, underfeeding, low wages for any work that is going, household incomes cut to the limit by public assistance, or Means Test or whatever is the cutting machine of the time … these mean disease and premature death’.

But still there were those who preferred to see tuberculosis as an individual responsibility, a sickness of advanced civilisation, when the simple life in the fresh air had been abandoned in favour of irregular hours, too little exercise, the stress of modern life, even ‘the thoughtless misuse of leisure time’. All of which were ills that could be rectified by a stiff dose of self-help, rather than costly programmes of social welfare.

As the number of unemployed inexorably mounted month on month to over three million by 1931, politicians, economists, scientists, writers and commentators investigated, pronounced, theorised, constituted themselves into committees and wrote reports, and gathered together to lunch and dine, all in an effort to find reasons for and solutions to Britain’s economic and social problems. In October, November and December that year the BBC invited a selection of prominent public figures to ruminate in front of a microphone on ‘What I would do with the world’. Out of ten speakers, three advocated eugenics.

Lord D’Abernon, a former Ambassador to Berlin and then Chairman of the Medical Research Council, suggested that ‘A wise dictator would devote his attention in the first years of his dictatorship to measures calculated to improve the human race,’ since ‘By excessive latitude given to the weak-minded, by imposing burdens in the shape of taxation on the hard-working to help out the improvidence of the inefficient and less capable, we are doing for the human race exactly what every intelligent breeder avoids in the animal world: we are stimulating breeding from the weak, the inefficient, and the unsound.’ Sir Basil Blackett, a director of the Bank of England, agreed that he would ensure that ‘we make ourselves and the human race better fitted intellectually and physically to use the scientific knowledge which the twentieth century places so freely at man’s disposal’. His programme would make the study of eugenics ‘a compulsory item in the training of every man or woman who is destined to take up administrative service in any part of the world’, while at home ‘we [cannot] afford much longer to follow the aggressively dysgenic course of breeding mainly from the unfit’. Leo Amery, a former (and future) Conservative Minister, decried what he called the ‘short-sighted sentimentalism’ that he felt had characterised the whole trend of British social and fiscal policy in recent years, discouraging ‘thrift and self-reliance’ and encouraging ‘the actual multiplication of the improvident and the incompetent’.

The term ‘eugenics’ was first used by Francis Galton, a cousin of Charles Darwin, in 1883. Its etymological roots lie in the Greek words for ‘good’ or ‘well’ and ‘born’. Eugenics was to be the science (and practice) of improving human stock ‘to give the more suitable races or strains of blood a better chance of prevailing speedily over the less suitable’. The Eugenic Education Society (as it was originally called) was formed in 1907 in order to spread the knowledge of hereditary factors and how they could be applied to the improvement of the race — the ‘self direction of evolution’, as the logo for the Second International Eugenics Conference in 1921 proclaimed. Membership declined after the First World War, but revived again — though never reaching the same level — in the late 1920s and early 1930s, and by 1932 it had reached 768. Obviously this was a select number, but the Eugenics Society never sought a mass membership: rather it aimed to influence the legislative process by permeating the medical profession, the media and universities, and in the 1930s some very distinguished people took an interest in its work, including Julian Huxley, G.K. Chesterton. George Bernard Shaw, J.M. Keynes, J.B.S. Haldane, Richard Titmuss and A.M. Carr-Saunders (Director of the London School of Economics from 1937).

Central to eugenics was the conviction that a large part of those who came to be known as the ‘social problem group’ of the dependent and destitute were the result of genetic defects. But how could this be relevant to the Depression, when the number of unemployed (those who were necessarily economically and socially dependent, and sometimes all but destitute) had risen to three million, since three million people could hardly be congenitally ‘unfit’? How did eugenics shed any light on the fact that unemployment was regional, concentrated in certain industries like shipbuilding, mining and heavy engineering, and not in other occupations?

Eugenicists were sceptical of the notion that poverty and ill health were linked to social and economic factors: rather they blamed the fecklessness and feeble-mindness of the lower orders. Many tended to be persuaded not by the findings of Dr Corry Mann, whose research in the London docklands led him to conclude that poor health was caused by low incomes, and that better pay resulted in better food, with consequent health benefits, but by investigations such as those undertaken by two academics in Glasgow. ‘What is not demonstrated,’ they wrote, ‘is that simple increase in income would be followed by improvement in the condition of children. Bad parents, irrespective of their income tend to select bad houses, as the money is often spent on other things. The saying “what is the matter with the poor is poverty” is not substantiated by these investigations.’

To eugenicists, the ever greater numbers of unemployed served as vindication of what they had ‘known’ all along: the threat posed by the differential birthrate, whereby those of low intelligence reproduced at a greater rate than those of higher intelligence, and the fear that society was threatened by a small minority of the hereditarily inferior who would ‘swamp’ it if they were not controlled. If, as eugenicist doctors such as Raymond Cattell ‘proved’, the unemployed had low IQs, were ‘hereditarily defective individuals’, ‘social inefficients’, as the Eugenics Review had it, they would just go on breeding more unemployables, a veritable ‘standing army of biological misfits’. Unless they were stopped.

The upper and middle classes were clearly producing fewer offspring than those lower down the social scale. For Julian Huxley, the differential birthrate was already dysgenic by 1925: ‘The proportion of desirables is decreasing, of undesirables increasing. The situation must be got in hand. But it is impossible to persuade the classes which have adopted contraceptive methods to drop them by appeal to self-control. The way to stop the rot is to diffuse these practices equally through all strata of society.’ Although the first birth control clinic had been set up in London by Dr Marie Stopes in 1921, and in 1930 the British Medical Association reluctantly gave qualified approval to doctors providing contraceptive advice to married women, the eugenicists feared that it was upper- and middle-class wives who were making rather too effective use of such knowledge, while those who in their view needed it most were confounded by the mess of pessaries, jellies, douches, ‘womb veils’, ointments, douches, tablets, condoms and diaphragms on offer, and relied instead on unreliable methods such as coitus interruptus or unsuitable domestic substances. What was needed was a foolproof means of contraception — preferably ‘the regular consumption by mouth of a substance preventing fertilisation, taken at daily, or better at weekly or monthly intervals’ — which ‘even the stupidest and therefore the most undesirable members of society’ could manage, a Eugenics Society Memorandum concluded.

But ‘the pill’ was decades away, so would ‘diffusion’ mean compulsion? ‘No public assistance without control of birth rates’, the psychologist Raymond Cattell bleakly sloganised. Julian Huxley’s solution to the tendency (as he saw it) ‘for the stupid to inherit the earth, and the shiftless and the imprudent and the dull’, was much the same: to make unemployment relief conditional upon a man’s agreement to father no more children. ‘Infringement of this order could possibly be met by a short period of segregation in a labour camp. After three or six months’ separation from his wife he would be likely to be more careful the next time.’ The zoologist Dr E.W. MacBride, who had managed to ‘demonstrate’ the innate inferiority of working-class children, went further, suggesting in 1930 that ‘In the last resort compulsory sterilisation will have to be inflicted as a penalty for the economic sin of producing more children than the parents can support,’ though he did suggest that before that last resort was reached, ‘Citizens should receive instruction from the State in the means of birth control.’

In 1932 the Minister of Health appointed a committee to make recommendations on the sterilisation of the ‘feeble-minded’ in England and Wales. Under the chairmanship of Sir Laurence Brock, the Committee included three enthusiastic eugenicists, one of whom was Brock himself. After untangling the family histories of so-called defectives and assessing whether they produced feeble-minded offspring themselves, the Brock Committee concluded that a quarter of a million people in Britain were suitable candidates for voluntary sterilisation on account of being ‘mental defectives’. It was unanimous in believing that it was justified in allowing and even encouraging ‘mentally defective and mentally disordered patients to adopt the only certain method of preventing procreation’: sterilisation. In reaching this conclusion, the Committee had privileged any studies that suggested that defectiveness was hereditary — ‘Broadly speaking stupid people will produce stupid children,’ Dr MacBride had asserted — despite dissent from such witnesses as J.B.S. Haldane and Lancelot Hogben, who argued that there could be no scientific certainty on this point, rather that the evidence suggested environmental factors were more likely to be to blame. The Committee did, however, reject compulsory sterilisation.

The Eugenics Society was delighted with the Brock Committee’s findings, and confident that if ‘the general public could be educated to distinguish between sterilization and castration many members of the Social Problem Group would avail themselves of facilities for voluntary sterilization in order to prevent the birth of unwanted children’.

However, no legislation was forthcoming. It was considered that the public was not behind such a programme, the Roman Catholic Church believed that sterilisation violated the God-given right to reproduce, and by the time the Brock Committee made its recommendations in the summer of 1934, the Nazi Party had embarked on a compulsory sterilisation and euthanasia programme in Germany which increasingly discredited the eugenicists and made repugnant to most people the idea of sterilising — even voluntarily — groups and classes of people.