The Middy 24 June 1999

NHS – a victim of its own success

Today, we take free medical treatment for granted. Clean the water, better diets and medical advances have prolonged peoples lives.

Nowadays, people commonly die of heart disease and cancer – illnesses associated with old-age. But in the first half of the century the picture was very different.

Just after the turn of the century, the average life expectancy for a man was 52 years and 55 for a woman. The infant mortality rate was 142 deaths for every 1000 live births and infectious diseases such as typhoid and tuberculosis claimed thousands of lives.

A limited national insurance scheme introduced in 1911 gave some cover to skilled workers if they were ill. But their wives and children fell outside the scheme. So too did workers on low incomes – agricultural labourers, domestic servants and self-employed.

These groups relied on private schemes to help meet the cost of treatment.

The minimum subscription to the Sussex Provident scheme in the mid-1920s was 12 shillings a year which provided free treatment at Haywards Heath’s King Edward the seventh Memorial Hospital .

The subscription covered a man, his wife and all his children under 16, But had to be paid in full before they qualify for treatment.

Families who were too poor to pay into such schemes relied on the discretion of the hospital or doctor, outdoor relief and charity.

Haywards Heath resident Blanche Carlin, grew up in impoverished circumstances in the 1920s. There was no child allowance in those days and Blanche was one of the eight children.

Milk was too costly to buy on a regular basis and bread and margarine formed the mainstay of the families diet. Jam and butter got expensive along with fruit and meat.

A visit to the doctor was a luxury they could not afford and Blanche's mother died of tuberculosis at the age of 39.

Gladys Mitchell, who grew up near America Lane, Hayward Heath, fell ill with a chest complaint as a child and her father, who earned £1 a week as a farm labourer, paid half a crown for her to see a doctor – about an eighth of his weekly wage.

Eye tests and dental treatments were beyond the pockets of most poor families.

Gladys recalls: "a trip to the dentist was far too much and people in those days pulled their own teeth and wore dentures. If you needed dances you went to Woolworths and chose to pay yourself."

Cheap spectacles of Woolworths were a boon to families on low incomes but it wasn't until 1934 that a branch opened in South Road, he was Heath.

Families relied on her vast range of home remedies to ward off and cure minor ailments. Friar’s balsam was inhaled at the first sign of a cold and cough, and brown sugar, mixed with an onion and left overnight, produced a thick juice used as cough mixture.

A chest infection was treated with Thermogene vapour rub, manufactured in Haywards Heath in the Thermogene factory at the junction of Sydney and Queens Road.

John Lawrence recalls: "a strong acid chemical smell was given off in production which penetrated houses on very still days.”

An alternative remedy for a chest complaint was to rub warm goose grease on your chest and cover it with brown paper.

Dr John Pendered who came into practice as a doctor in Haywards Heath in 1950, recalls: "in those days there was much less stress related illness but more chronic intractable illness –there were no hippo knee replacements or medication for heart condition, apart from digitalis and glycol trinitrate.

"There were no oral diuretics – only Weekly injections, and no effective medication at all for raised blood pressure.

"There were no tablets for diabetes, only insulin injections, and there was no dialysis for kidney failure.

"There were no anti-inflammatory drugs for arthritis and rheumatic illnesses – only aspirin.

"There were no antidepressants or anti-psychotic drugs. There was no treatment at all for Parkinson's disease; only ephedrine tablets and adreline injections for asthma – there were no inhalers or steroids."

Doctors held surgeries in their own homes and made frequent visits to see their patients at home and in hospital – often working six or seven days a week.

Midwives and district nurses worked independently and relied on fees for their livelihood.

Cuckfield is first district nurse and midwife was nurse Stoner.

Although her job carried a certain amount of prestige, her wage was pitiful – £40 a year in 1912 – less than the annual salary of many farm labourers.

It was cost me then friend us to stay in the home of the patient if it was a confinement or major illness.

The lodgings are often primitive with no running water or adequate heating.

In her diary, nurse Stoner recalls one cottage that was bitterly cold with no fire in the house despite snow on the ground and a "cold Northeast wind blowing."

When she was invited, sometime afterwards, to pay the family a social visit she declined, recalling; “Really, I was afraid of the fleas."

Better housing and sanitation gradually improve the general health of the population and the stoners experiences were rarely repeated.

Health weeks organised in the Cuckfield district in the 1930s and 40s reflected the growing national trend toward public awareness campaigns, with lectures on the benefits of fresh air, a healthy diet and vaccination against diphtheria.

A wave of legislation in the 30s and 40s introduced subsidised milk for pupils, school medicals and hot school dinners at Anne culminated in the introduction of the NHS in 1948.

Fifty one years on from its inception, the NHS is perhaps the victim of its own success. Free access to medical treatment has prolonged people’s lives putting pressure on hospital bed and waiting lists.

It is a different world to the one in Nurse Stoner’s day and arguably a more impersonal one.