2008 marks the 60th anniversary of the formation of the National Health Service. The idea for this exhibition came about because of this landmark in British health care. In this project we have spoken to people about their experiences and memories of life before the NHS, and its early years.
The Three and Sixpenny Doctor
Like all our work these experiences are within ‘living memory.’ You will read how people were unable to afford even 3/6d for the doctor; how women gave birth at home with no medical assistance or care; how families were often large and infant mortality high. One of our contributors speaks of how three of her siblings died in childhood; one of diphtheria, one of scarlet fever, another of dysentery. For some this was the reality of everyday life in Scotland in the 1920s and 1930s. In the current economic climate we sometimes forget just how radical the National Health Service was in post-war Britain and how central and important it now is in all our lives.
Health And Disease Before 1900
Intensive Urbanisation and Industrialisation
The economic changes brought about in the nineteenth century resulted in increased injuries and disease. Over-crowding, poor work conditions and under-nourishment contributed to the spread of a number of infectious diseases. The worst outbreak of cholera was in 1832, killing 50% of those infected. Other diseases such as typhus, scarlet fever, diphtheria, St Anthony’s Fire (erysipelas), TB and smallpox were also a problem.
Specialist fever hospitals, such as the Royal Victoria Hospital and East Pilton (later the Northern General) were built, but were unable to cope with the large number of patients.
Self-help and Insurance Schemes
Care of the sick was regarded as a private duty. Voluntary organisations, including friendly societies like the Ancient Order of Foresters and Gardeners’ Friendly Society or professional/work-related insurance schemes, would pay for the treatment of contibutors and their families. But there were many families who could not afford to pay into such schemes and whose access to health care was limited.
Through the late 1800s a number of public health acts were passed to control the spread, and improve the treatment of disease. Policies such as improved water, sewage, housing and vaccination were introduced. These procedures were expensive and not compulsory, and so some town councils were often reluctant to introduce them.
Paying For The Doctor
'You couldnae afford to get in the doctor.'
'We had a Dr Butler who was a very blunt man but he became our family doctor. We were very poor and many times he didnae take anything. My mother died in 1935 wi’ cancer, and the doctor’s fee, I recall, was 3 shillings and 6 pence (3/6) and we didnae always have it.' (Rose Minto, born 1920)
'When my son was born in 1946, I had to pay £12 to Simpson’s and when the doctor came to the house, it was usually seven and six (7/6), I suppose the poor ones would get it for nothing, and the ones that could afford it would pay more. Before the Health Service, we had the Free Gardeners and the Rechabites, that you paid into each week. You paid maybe tuppence (2d), for each member o’ the family and you got the panel doctor.' (George Hackland, born 1920)
'The dispensary was in Grassmarket Row, all the Tron Square people went there. You just went in and sat on a chair and the doctor would come out and shout your name. Then you would go into a room and get your medicine. You didn’t have to pay. It was always busy.' (Marie Wren, born 1918)
Care Of The Sick After 1900
Most sick people were looked after by their family or neighbours. Individuals developed a reputation for their knowledge of traditional ‘home’ remedies. Spae wives, bonesetters or wise-women would be consulted as a cheaper alternative to a doctor. Their treatments combined folklore and basic common sense and included patent, over-the-counter remedies, for example Cod Liver Oil, Friar’s Balsam or Thermogene, and culinary ingredients, such as onions, bread and cloves.
The National Health Insurance Act (1911) meant doctors had to provide basic medical services for workers. ‘Sixpenny doctors’ were paid by the state for each patient on their panel. Patients still paid for home visits, doctors charging different rates depending on the economic circumstances of families.
Development of hospitals
Hospital care was provided by voluntary (charitable), municipal, provident and private institutions. Voluntary hospitals – including the Royal Infirmary and Leith Hospital – relied on funds raised by donations and subscriptions. Annual flag days and pageants were popular events, with fancy dress parades and bands.
Municipal hospitals developed in the 1930s and treated the chronically sick, infirm and elderly. They were administered by town councils, and their origins lay in parish poor law hospitals and poorhouses, which provided care for the destitute and very poor. The Western General Hospital (St Cuthbert’s, later Craigleith) and Eastern General Hospital (Seafield) were originally poorhouses.
Provident and private hospitals – such as Bruntsfield Hospital and the Edinburgh Lunatic Asylum (later the Royal Edinburgh Hospital) – offered medical care to people who made a small weekly payment through work or private insurance schemes or for patients who could pay.
'I remember Leith Hospital because I was never out of the place.'
'In Leith we had medical wards, surgical wards and a gynaecological ward. We did eye operations, orthopaedics and we did ear, nose and throat, and never had any infection.' (Ena Munro, born 1930s)
'In those days when you went to the hospital, say with a cut finger, they bandaged it up and, when you went home, you had to wash that bandage, boil it, and take it back again.' (George Hackland, born 1920)
'You had to go round and straighten up all the bed covers, and the wheels had to face in the one direction. All the cupboard doors had to be shut, and there were lots of them, before Matron did her rounds. If not you’d get into trouble! I still shut cupboard doors. Old habits die hard. In Ward Three, which I had, there was a pillar in the middle and there was a marble fireplace at either side. It was great when you were on night duty and you stoked up the fire.' (Ena Munro, born 1930s)
‘The hospital belonged to the people of Leith.’
'The poorest o’ the poor helped.You gave what you had and, somehow or other, they built the wing for the kids.' (Joyce Myles, born 1930s)
'If you went to Casualty, and if you had a conscience, which a lot of folk didnae have, you put sixpence in the box. That’s how it was paid for. And the ship-builders and the provision merchants would provide beds. You could donate a bed, and you could keep it going over the years.' (Rose Minto, born 1920)
'The school kids used to get dressed up as Alice in Wonderland and things like that. We used to follow the floats along. Great times. At the Links they had Highland dancing, the fun-fare and the pipes and bands and different things like that.' (Kathy from Astley Ainslie Hospital, memory from 1940s)
'The Boy Scouts went round with a huge oval clothes basket collecting eggs and, when it was full, took it in the tramcar to Leith Hospital. They were hard-up days but everybody gave something. And it meant that the patients, and a lot o’ them were poor, they could get an egg for their breakfast or tea or whatever. And it was very well run. A lot o’ the businessmen in Leith, they donated the money to build the wards.' (George Hackland, born 1920)
'Oh aye, we used to have a pageant every year, same as Edinburgh Royal Infirmary had one, a huge parade thing wi’ floats and all that, bands and everybody collecting money and that paid for the running o’ the hospital.' (George Hackland, born 1920)
Development of the National Health Service During the 1940s
World War II and Beveridge
In 1941, the Coalition Government decided that the health and well-being of the British public would need rebuilding after World War II. William Beveridge was commissioned to assess the situation.
The Beveridge Report (1942) identified five key problems: the ‘Giant Evils of Want, Disease, Ignorance, Squalor and Idleness'. It advocated a system of social welfare which would incorporate a national health service, national insurance and assistance and family allowances. It was believed that good health would mean full employment and increased industrial production, and that ultimately the health service would pay for itself.
State-organised free health care
The post-war Labour Government passed the Health Service Act in 1946 which legislated for the start of the National Health Service on 5th July 1948. Health care would be ‘free to all who want to use it'. However, the progress to a fully comprehensive free health system was not, according to Aneurin Bevan, entirely ‘trouble free'. The government faced criticism from the medical profession, 75% of whom opposed the proposals. The British Medical Association was accused of organised sabotage. General Practitioners did not want to become full-time employees of the state and argued that this would lead to state interference in their work. Eventually agreement was reached.
The nursing profession was not involved in the consultation process but editorials in the Nursing Mirror and Nursing Times in 1945/6 were in favour of the new scheme.
'My mother always gave the doctor a glass of sherry.'
'The fuss that was made in the house, when the doctor was called; it was a big event. It was something you paid for and so something you appreciated. The patient was scrubbed within an inch of his life, and new sheets were put on the bed and everything was ironed, stiffened.' (Charles Mercer, born 1929)
'The doctor was a big, broad man, very dour, but he was a good doctor. He aye prescribed aspirins. That was how he got the nickname ‘Aspirin Willie'.' (Ruby Norman, born 1935)
'When we did house calls we carried cardboard boxes of medications. After the consultation we handed them out to the patients. We were given three different colours of aspirin tablets: white, yellow and green. And the idea was that the patient would say, ‘No, these white ones hadn't done me any good, doctor', so you left them a bottle of green ones and the next week perhaps they might say, ‘Oh these are a lot better'.' (Dr Tom Miller, born 1927)
'She was choked and I called the doctor and he came and says, ‘I don't really know what's happened so I dinnae know what to prescribe.' Ten o'clock that night the bell went and here's the doctor standing. and he says, ‘I've been out with my wife and just was remarking about your wee one, how she was so unwell, so I've come back to see her.' Turns out it was asthma.' (Jess Robertson, born 1909)
'The doctor was well respected. He was looked upon like a minister. Most o' them, especially in a workin' class area, were strugglin' to make a livin'. And they'd wives and families to bring up too, but half the folk couldnae pay them. It was all right if they managed to become a panel doctor, they would get so much per patient.' (George Hackland, born 1920)
'Syrup of Squills and Glycerine, Ipecacuanha Wine.'
'If you had a chemist in the block where you stayed that was very handy, he was often very good at giving you advice without going to the expense of getting the doctor.' (Astley Ainslie Hospital, memory of the 1930s)
'You’d go to a chemist and then if you wernae cured, at the last minute you’d go to a doctor.' (Joyce Myles, born 1930s)
'One of my kids had a cough, and it was irritating her terribly, and this old lady said, "You’ll have to go to the chemist and ask him to make up a bottle with, syrup of squills and glycerine, ipecacuanha wine." So I went away and there was an old-fashioned chemist, and it was the only one I could get that would make that up for me. And it was marvellous.' (Helen Mustard, born 1926)
'But just colds and shivers and things like that, the chemist will give you something. He was your doctor, unless you had a broken arm or something, in which case you'd go to the real doctor or the hospital.' (Hugh Sibbald, born 1923)
'You used to always go to Mr Black, the chemist in Gorgie Road, if anything was wrong with you. He’d give you a cough bottle or a cream or whatever you needed. All the folk around Gorgie went to Mr Black instead of the doctor. He didn’t charge for seeing you, but you would buy the medicine from him, so I suppose he got paid in a way too.' (Mary Dunn, born 1924)
'Gentian Violet and Pink Emulsion.'
'My mother would make a porridge poultice and put it in a stocking round my neck 'cause I was terrible bothered with sore throats, until I got my tonsils out.' (Marianne Hendry, born 1940s)
'They were great ones for rubbin' liniment on you, if you had aches and pains.' (George Hackland, born 1920)
'Ring worm went round the classrooms and you had to put on Gentian Violet.' (Cramond Lunch Club, memory of the 1930s)
'I remember getting scabies. It came in between your fingers and it itched like fury. I was put in a bath as hot as I could stand it and my mum insisted on me getting in. I said, 'It's too hot', and she made me get in and I fainted! The hot bath was to open all your pores then she’d put a sulphur ointment on, all over you.' (Cramond Lunch Club, memory of the 1930s)
'I remember for rheumatism, you’d keep an onion in your back pocket.' (Marianne Hendry, born 1940s)
'During the war you got cod liver oil and concentrated orange juice. I didn’t like the cod liver oil but I enjoyed the orange juice. Rosehip syrup was all right. I remember getting stuff called emulsion and it was sort of pink. And they had malt. I liked that. There was other stuff called chemical food which you had to take through a straw ’cause it rotted your teeth, but It was supposed to be good for you.' (Audrey Soutar, born 1934)
'My mother, we called her Lady Iodine, you got iodine plunked on every cut and it nipped like fury!' (Cramond Lunch Club)
'Goose fat and brown paper'
'You'd get Cod Liver Oil and stuff called Virol. I loved Virol, it was good, stacked full of sugar.' (Charles Mercer, born 1929)
'I remember the nit nurse. My mother went absolutely spare. I don't know how I got it, my sister and me, both of us had to get paraffin put on us, and oh, talk about burn, but that treated it.' (Cramond Lunch Club, memory of the 1920s)
'You could use hydrogen peroxide as an antiseptic. A lot of people put a thin solution in their ear to clean them out. I wouldn't allow anyone near my ears with it!' (Astley Ainslie Hospital, memory of the 1940s)
'You were lined up on a Friday, for liquorice and Gregory Powder, for your bowels.' (Rose Minto, born 1920)
'Wintergreen, you used to get a wee drop o' that rubbed on your chest; but I think it was more of a preventative, to go with the liberty bodice!' (Dot Law, born 1940)
'For whooping cough, you'd be wrapped up and taken out somewhere, where they were doing the roads. You'd be standing in front of the tar machine to get the smell of the tar and that was very good for whooping cough. My mother would lift us near the van to get the smell.' (Cramond Lunch Club, memory of the 1930s)
'Mother had seven altogether but three died.'
'I was from a very large family and as soon as we saw the doctor's black bag we thought, 'Oh, another baby!'' (Cramond Lunch Club, memory of the 1930s)
'We'd a woman up the stair that was, a sort of midwife, if somebody was havin' a bairn, she was aye there. And if somebody died, she would lay them out.' (George Hackland, born 1920)
'Mother had seven altogether but three died. Hughie died of diphtheria. He was older than me, and my wee sister was ten months when she died. My dad got the blame for gein' her strawberries, but it was my granny that blamed him, and she was prejudiced. But she died of, I daresay, dysentery or something.' (Rose Minto, born 1920)
'We once went to the side of the Playhouse, Greenside, it was a pretty awful place then, and when we got there the baby was already born. The husband had delivered the baby then he sent for the midwife, she was lying on a mattress in the corner, on the floor.' (Ena Munro, born 1930s)
'It was a drunken old woman attending my mother when Teresa was born. We thought she was gonnae die. Oh, they got paid but they mostly drank their pay. And they werenae clean.' (Rose Minto, born 1920)
'They were born at home because it was not the done thing to go into hospital as you would pay a lot of money. Home births were cheaper.' (Astley Ainslie Hospital, memory of the 1930s)
5th July 1948 - Birth of the National Health Service
The New Health Service
Free health care was now available for all. The public needed to be informed about the new, integrated service. A publicity campaign was launched, which included films and exhibitions. A leaflet, Your Health Service and How It Will Work, was published, explaining what the main principles were and how it would be funded.
What the NHS offered
Consultations with family doctors; prescriptions; hospital treatment; dental services; eye testing and spectacles, and hearing aids were all free. Ancillary services including nursing, midwifery and child health were expanded. Everyone received a medical card and, by the end of 1948, 94% of Scots were registered with a GP. Only 2% of GPs had not joined the scheme.
Prevention of disease
One of the primary goals was the promotion of good health. With improved physical and mental well being, the population would increase its economic productivity which would benefit the whole country and reduce the need for treatment of illness.
Polio and diphtheria vaccination programmes were introduced and mass radiography campaigns for TB were extended. Other health improvements resulted from the availability of new drugs, particularly antibiotics like penicillin and streptomycin.
Life expectancy and infant mortality improved in the 1950s but the increasing costs of new treatments and technology, and the discovery of ‘new’ diseases, put pressure on the scheme, making some of the original objectives difficult to achieve.
During its sixty years, the NHS has undergone several reorganisations but has continued to provide care and treatment for all.
The Start of the NHS
'There was a sense o' everybody wanting everything done for them for nothing.'
'There was a tremendous run on the services after the NHS. Everybody got false teeth and spectacles. Specs and teeth.' (Charles and Netta Mercer born 1929, 1930)
'When the men came home from the war they wanted things to be better. People needed houses and health care, and something needed to be sorted out.' (Astley Ainslie Hospital, memory of the 1940s)
'I remember in a very early locum job, in a small country practice, being left in a branch surgery with a pad for prescriptions. I was faced by a large, perfectly healthy, man who sat down and wanted a prescription for cotton wool. He said, 'It's just for the hoose.' In other words people were, to some extent, taking advantage of the fact that medicines were now free. He pressurised me by his personality. And I confess that I wrote that prescription.' (Dr Tom Miller, born 1927)
'We were all grateful when the NHS came. People’s health started to get a bit better. But a lot of people played on it.' (Jo Laing, born 1925)
'When the NHS came in, what came to light was that there was a lot of women with gynaecological problems, a terrible amount of prolapsed wombs that had never been treated. People could not afford to go to the doctor.' (Audrey Soutar, born 1934)
'All her clothes and school books were burnt for the infection.'
'I had scarlet fever and I was in the City Hospital. You had a number, depending on the severity of your condition, and it was put in the paper. The numbers told you who was seriously ill, critically ill and making progress. This was because people were not allowed to visit. My mum and dad tried but they didn't get in to see me. I was about nine or ten and, oh boy, did I miss them. There was a sort of a corridor and it was encased in glass and you could go down and mum and dad were on the other side and just used to give me a wave.' (Helen Mustard, born 1926)
'I got taken to the City Hospital. There was beds and beds down the front, and they put me right under a light. I was in for two or three days and I didn't have scarlet fever and they said, if I didn't pick it up with bein' with all them, I'd be immune for the rest o' my days.' (Joyce Myles, born 1930s)
'Tuberculosis was rife in the 1940s.'
'One o' my older brothers, he went into Leith Hospital wi' a poisoned stomach. And they xrayed him and they said to him, 'Cough' and he coughed. They says, 'How long have you been doing that when you cough?' 'Oh,' he says, 'since I was a laddie.' They says, 'You've got a rib stickin' in your lung!' He'd jumped in Newhaven Harbour to save his pal who'd fallen in and couldnae swim. His pal had kicked him but he thought nothin' o' it. He got a lovely silver watch from the Humane Society. And the doctor says, 'That's been in your lung the whole o' your life. That's why, when you cough, you're holding yourself.' They says, 'You've got TB. You've had it all thae years.' He died a young man, twenty-seven.' (George Hackland, born 1920)
'I remember one time being taken to a doctor's surgery during my mother's illness and she was a bit upset. I do not know how she caught it or developed it, but TB was rife in the 1940s. She could not bear to be parted from my sister and I as we were very young at the time. And there was a bit of a stramash when she discharged herself from hospital. She was away from home for a long time and aunts used to look after us. But sadly after many months in hospital she passed away at the age thirty-four from pulmonary tuberculosis.' (Bill McLean, born 1944, whose mother died when he was five years old)
Children in Hospitals
'They put a mask over your face and sprinkled the chloroform on it and it took six nurses to hold me down.'
'I remember, once, a baby dying and I burst into tears and Sister happened to see me and she said, 'Pull yourself together or you'll never make a nurse.'' (Isobel Balmain, who started her nurse's training in the Royal Edinburgh Hospital for Sick Children in 1925)
'I had a tonsillectomy done when I was five or six, and I’d been told l'd get ice cream. I remember lying in the theatre, and being given an anaesthetic by a doctor who was very frightening. He was tall, had dark hair and a moustache. There was no talk about what he was going to do, he just put the mask over my face and it was horrendous. I remember coming to on a ward and being sick. To my horror I was vomiting blood. And I started to cry and across came a nurse and she said, 'Behave yourself!'' (Netta Mercer, born 1930)
'It was a diseased bone at the back of the ear. So they took me right in. Well, you didn’t get anaesthetic like you do now. They put a mask over my face and sprinkled the chloroform on it and it took six nurses to hold me down. They were holding my head and my feet. I wouldn't keep still. It was a horrible smell. Then all of a sudden I was away to sleep. When I came to, I didn't know where I was.' (Jo Laing, born 1925)
Seeing the Dentist
'I want them all oot!'
'I had pyorrhoea of the gums and they had taken all my teeth out and the dentist said, 'I could give you alum and all that to close the gums but you're better leavin' them. Try eating toast. It’ll be sore at first but it'll clean the gums. They'll close naturally and when you get your teeth, your gums are settled properly'.' (George Hackland, born 1920)
'I'd be six or seven when I went with my dad to the dentist in Dalry Road. And I was sitting watching, and see when they started pulling his teeth and throwing them about and there was all this blood, I must've went kinda white and the dentist said no to look. There was no anatheastics but my dad never said a word, he was a tough wee character. He'd to go back and get his false ones. He'd to pay for them; and to get them out.' (Mary Dunn, born 1924)
'You didnae hear of folk getting fillings. They just got their teeth pulled.' (Ruby Norman, born 1935)
Children and Dentists
'Inside the mask was a horrible, sickly smell.'
'The school dentist, in Lauriston Place, was terrible. My brother, he got too much gas and his mouth stuck! And he couldn't speak. But when he got home, my mother says, 'That sounds like him singing.'' (Calton Centre Group, memory of the 1930s)
'I remember the dining room table was taken out into my bedroom and I was laid out on it and then the dentist came in with the mask and, oh my face, I was quite young, I was terrified. I didn't know what an earth was going to happen to me. I think I got four teeth out; I was quite young so they were baby teeth.' (Cramond Lunch Club, memory of the 1930s)
'I remember it was on Easter Road and I remember the big table. I was about four and the dentist called out my name and I just looked up at him and, something told me to run, and I ran round and round this table and he kept trying to catch me and I went under it. Well he caught me, and I was screaming and I got gassed then and had a tooth out.' (Cramond Lunch Club, memory of the 1930s)
'He was a butcher that man, a rough man, and you know his face was all pitted. My father and mother used to go to him and once they took me, and when I saw him I shot off up the road.' (Calton Centre Group, memory from the 1930s)
Sex and Contraception
'The colloquialism was, to jump off at Haymarket.'
'I learnt about sex from dirty jokes in the school playground. My mother told me to, 'Keep away from boys!'' (Calton Centre Group, memory of the 1930s)
'My Aunty Mary had this great long bolster to keep her apart from her husband and she had only two children, where her sister, my mother, had seven and my Aunty Annie had about ten!' (Rose Minto, born 1920)
'I was very wee and I didnae understand what was going on but they must have been discussing sexual intercourse, 'cause I heard the woman say, 'I telt him to wrap it up in bandages.'' (Audrey Soutar, born 1934)
'I heard of people taking things when they maybe had ten or eleven bairns, and they had a thing called Pennyroyal.' (The herb Mentha Pulegium still carries a warning not to be taken by pregnant women.) (Rose Minto, born 1920)
'There used to be that shop up the back of Rose Street, where the old Woolworth’s was. That was where you went for Durex.' (Nancy Comber, born 1930s)
'I worked for a herbalist, after the health service came in, and I couldnae understand why people were paying for all these herbal concoctions when they could get medicines free on the health service. But they had a great belief in it, and that was when abortion was still illegal and people used to come in for great quantities of Elm Bark. They seemed to think that would induce an abortion.' (Audrey Soutar, born 1934)