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