The gloucestershire extension of medical services scheme: An experiment in the integration of health services in britainbefore the NHS

Medical History

Volumn 50, Issue 4, 2006, Pages 491-512

  Gorsky, Martin ^a  

^a LONDON SCHOOL OF HYGIENE AND TROPICAL MEDICINE   (United Kingdom)

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EID: 33846368166     PISSN: 00257273     EISSN: None     Source Type: Journal    
DOI: 10.1017/s0025727300010309     Document Type: Review

References (166)

1. C Webster, The health services since the war. Volume I: Problems of health care, the National Health Service before 1957, London, HMSO, 1988, ch.1.
2. J Mohan, Planning, markets and hospitals, London, 2002, ch.3.
3. Political and Economic Planning (PEP), Report on the British health services, London, PEP, 1937, pp. 119-20. In theory co-ordination was effected through the MOH's role as titular head of both the health and school medical services, although relations were not always harmonious,
4. see B Harris, The health of the schoolchild: a history of the school medical service in England and Wales, Buckingham, Open University Press, 1995, pp. 98-104;
5. National Archives: Public Record Office (NA:PRO), ED 50/35, 'Coordination between SMS and Public Health Staff.
6. J Welshman, Municipal medicine: public health in twentieth-century Britain, Oxford, Peter Lang, 2000;
7. Powell, 'An expanding service: municipal acute medicine in the 1930s', Twentieth Century Br. Hist., 1997, 8 (3): 334-57;
8. A Digby and N Bosanquet, 'Doctors and patients in an era of national health insurance and private practice, 1913-1938', Econ. Hist. Rev., n.s., 1998, 41 (1): 74-94, pp. 81-2, 90-1.
9. B Webb and S Webb (eds), The break-up of the Poor Law: being part one of the minority report of the Poor Law Commission, London, Longmans, Green, 1909, p. 584, paras 29, 30.
10. Consultative Council on Medical and Allied Services, Interim report on the future provision of medical and allied services (hereafter Dawson Report), Cmd. 693, London, HMSO, 1920, pp. 5-6.
11. Ministry of Health, Voluntary Hospitals Committee, final report, London, HMSO, 1921, Cmd. 1335, pp. 12-16.
12. British Hospitals Association, Report of the Voluntary Hospitals Commission, London, British Hospitals Association, 1937, pp. 9, 63-5.
13. PEP, op. cit., note 3 above, pp. 397, 413.
14. Nuffield Provincial Hospitals Trust, The hospital surveys: the Domesday Book of the hospital services, Oxford, Nuffield Provincial Hospitals Trust, 1946, p. 4.
15. Ministry of Health, Department of Health for Scotland, A national health service, Cmd. 6502, London, HMSO, 1944, pp. 7-8.
16. D Fox, Health policies, health politics: the British and American experience, 1911-1965, Princeton University Press, 1986, p. ix.
17. S Sturdy, 'The political economy of scientific medicine: science, education and the transformation of medical practice in Sheffield, 1890-1922', Med. Hist., 1992, 36: 125-59;
18. J Pickstone, Medicine and industrial society, Manchester University Press, 1985, pp. 279-93;
19. A Hull, 'Hector's house: Sir Hector Hetherington and the academicization of Glasgow hospital medicine before the NHS', Med. Hist., 2001, 45:207-42;
20. MGorsky, ' "Threshold of anew era": the development of an integrated hospital system in northeast Scotland, 1900-39', Soc. Hist. Med., 2004, 17 (2): 247-67.
21. Welshman, op. cit., note 4 above, pp. 264-73;
22. B Doyle, A history of hospitals in Middlesbrough, Gazette Media Company for South Tees Hospitals NHS Trust, 2003, pp. 13-14;
23. G Phillips The blind in British society: charity, state, and community, c.1780-1930, Aldershot, Ashgate 2004, pp. 381-92, 400-5;
24. V Marks, Metropolitan maternity: maternal and infant welfare services in early twentieth century London, Amsterdam, Rodopi, 1996, pp. 177-91, 208-9, 214-23, 252-6.
25. S Sturdy and R Cooter, 'Science, scientific management, and the transformation of medicine in Britain c.1870-1950', Hist. Sci., 1998, 36: 421-66, pp. 425-30.
26. L Hannah, The rise of the corporate economy, London, Methuen, 1976, pp. 123-30, 139-40.
27. Hospital Saving Association, Annual report, 1929.
28. D Ritschel, The politics of planning: the debate on economic planning in Britain in the 1930s, Oxford, Clarendon Press, 1997.
29. C Webster, 'Conflict and consensus: explaining the British Health Service', Twentieth Century Br. Hist., 1990, 1 (2): 115-51.
30. F Honigsbaum, The division in British medicine : a history of the separation of general practice from hospital care, 1911-1968, London, Kogan Page, 1979, ch.19;
31. Gorsky and J Mohan, 'London's voluntary hospitals in the inter-war period: growth, transformation or crisis?', Nonprofit and Voluntary Sector Quarterly, 2001, 30 (2): 247-75, pp. 264-7;
32. J Stewart, 'The battle for health' : a political history of the Socialist Medical Association, 1930-51, Aldershot, Ashgate, 1999.
33. Gloucestershire County Council, Annual report of the Medical Officer of Health, 1936 (hereafter GCC MOH), Gloucester, 1937, p. 40.
34. Dawson Report, op. cit., note 6 above, p. 7.
35. A Newsholme, International studies on the relation between the private and official practice of medicine, 3 vols, London, Allen & Unwin, 1931-1932, vol. 3, ch. 16, p. 282;
36. Newsholme was MOH for Brighton (1888-1908), then Medical Officer to the Local Government Board (1908-19), and was a strong advocate of comprehensive municipal medical services, see J M Eyler, Sir Arthur Newsholme and state medicine, 1885-1935, Cambridge University Press, 1997, p. 214.
37. NA:PRO MH66/90, A C Parsons, 'Administrative County of Gloucestershire: report on a survey of health services', p. 97.
38. Ibid., p. 90;
39. Orr and J Orr, Health insurance with medical care: the British experience, New York, Macmillan, 1938, pp. 140-2.
40. Charles-Edward Amory Winslow was the chair of Yale's Department of Public Health (1915-45); around the time of the visit he was a member of the Committee on the Costs of Medical Care (1927-32), which examined international experience in its consideration of health services reform in the United States, and an expert health assessor (1927-30) of the League of Nations Health Organisation. See A J Viseltear, 'C.-E. A. Winslow: his era and his contribution to medical care', in C Rosenberg (ed.), Healing and history: essays for George Rosen, Folkestone, Dawson Science History Publications, 1979, pp. 205-28;
41. V Hiscock, 'Charles-Edward Amory Winslow, February 4, 1877-January 8, 1957', J. Bacteriol, 1957, 73 (3): pp. 295-6.
42. PEP, Report, op. cit., note 3 above, pp. 165, 256, 367-8, quote on p. 398.
43. Fox, op. cit., note 12 above, p. 60.
44. J Middleton Martin, Gloucestershire scheme for the extension of medical services, Gloucester, 1920, pp. 4, 6.
45. Ibid., p. 6.
46. Gloucestershire Archives (hereafter GA), CM/M/16/1 'Extension of Medical Services Board of Management Minute Book' (hereafter GEMSS MB), 25 Oct. 1919, 24 April 1920.
47. 'Extension of institutional medical services', Br. med. J., 22 Feb. 1919, i: 218-19, p. 218.
48. J Middleton Martin, 'The problem of medical services', Contemp. Rev., 1922: 364-72, on p. 369; Parsons, op. cit., note 24 above, p. 94.
49. Middleton Martin, ibid., p. 371.
50. GA, CJ/M/16/1 GEMSS MB, 14 July 1920; NA:PRO MH/66/ 91 'Appendix 6', pp. 3, 5.
51. GA, CM/M/16/1/ GEMSS MB, 21 June 1919.
52. Middleton Martin, Gloucestershire scheme, op. cit., note 28 above, p. 7.
53. GCC MOH 1924, p. 33.
54. Middleton Martin, 'The problem of medical services', op. cit., note 32 above, p. 369; idem, 'The medical profession and rate-provided hospitals', Br. med. J., 6 Aug. 1921, ii: 191-2.
55. Middleton Martin, Gloucestershire scheme, op. cit, note 28 above, p. 6; Br. med. J., 1918, ii: 23-6, 56-9; intriguingly Dawson and Middleton Martin both trained at University College London, though Dawson was six years the elder: C Webster, 'The metamorphosis of Dawson of Penn', in Dorothy Porter and Roy Porter (eds), Doctors, politics and society: historical essays, Amsterdam, Rodopi, 1993, pp. 212-28.
56. F Watson, Dawson of Penn, London, Chatto and Windus, 1950, pp. 155-6.
57. Who was who 1951-60, London, Adam & Charles Black, 1967, p. 227.
58. 'Correspondence', Br. med. J., 27 Nov. 1920, ii: 842; 11 Dec. 1920, p. 916; 18 Dec. 1920, p. 952;
59. Honigsbaum, op. cit., note 20 above, pp. 64-133.
60. Br. med. J., 6 Aug. 1921, ii: 191-2, on p. 191.
61. GCC MOH, passim.
62. Webster, op. cit., note 39 above, pp. 213-16;
63. Sturdy and Cooter, op. cit., note 15 above, pp. 433-4.
64. st March 1918, London, HMSO, 1919, pp. 4-11, 30-1, 36-7;
65. st May 1919, London, HMSO, 1920, pp. 26-7.
66. Newsholme, op. cit., note 23 above, pp. 311-12.
67. 'Extension of institutional medical services', Br. med. J., 22 Feb. 1919, i: 218.
68. Middleton Martin, 'The problem of medical services', op. cit., note 32 above, pp. 367-8.
69. The Medical Directory 1934, London, J & A Churchill, 1934, p. 975.
70. J Middleton Martin, 'An analysis of Gloucestershire statistics, 1901-10', Proceedings of the Royal Society of Medicine, Section of Epidemiology and State Medicine, 1915-16, 9: 1-32;
71. idem, 'Scarlet fever outbreak at Stroud due to milk', Public Health, Dec. 1901, 14: 138-42;
72. idem, 'Schools and infectious disease', Public Health, July 1902, 14: 608-11;
73. idem, 'An inquiry into the distribution of certain diseases (cancer, phthisis, and pneumonia) on the western slopes of the Cotteswold Hills', Public Health, Oct. 1904, 17: 4-31;
74. Eyler, op. cit., note 23 above, pp. 27-41.
75. J Middleton Martin, 'Tuberculosis - dogmas and doubts of sixty years', Br. med. J., Feb. 1939, i: 204-9;
76. Parsons, op. cit., note 24 above, pp. 71-3.
77. Middleton Martin, 'The problem of medical services', op. cit., note 32 above, p. 372.
78. 'Obituary', Lancet, 20 Jan. 1940, i: 149; 'Obituary', Br. med. J., 13 Jan. 1940, i: 74.
79. Harris, op. cit., note 3 above, pp. 81-2.
80. J Middleton Martin, 'Poor law reform and public health', Br. med. J., 28 Aug. 1926, ii: 376-80, on pp. 378-9;
81. Report of the Royal Commission on the Poor Laws and Relief of Distress (hereafter Majority Report), 5 vols. Cd. 4499, 1909, vol. 1, pp. 371-2, 380-1.
82. Webb and Webb (eds), op. cit., note 5 above, pp. 585-7;
83. though authored by Beatrice Webb, these recommendations were informed by Arthur Newsholme, whose pioneering organizational work as MOH for Brighton must have been familiar to Middleton Martin from his contemporaneous stint in the city, Eyler, op. cit., note 23 above, pp. 165, 195-219;
84. A M McBriar, An Edwardian mixed doubles, the Bosanquets versus the Webbs, Oxford, Clarendon Press, 1987, pp. 231-6, 297-8.
85. Majority Report, pp. 384-8;
86. S Sturdy, 'Alternative publics: the development of government policy on personal health care, 1905-11', in S Sturdy (ed.), Medicine, health and the public sphere in Britain, 1600-2000, London, Routledge, 2002, pp. 241-59.
87. Majority Report, pp. 358-9;
88. Middleton Martin, 'Poor Law reform', op. cit., note 56 above, pp. 378-9.
89. Middleton Martin, ibid., p. 377.
90. Middleton Martin, 'The problem of medical services', op. cit., note 32 above, pp. 364-7; idem, 'Poor Law reform', op. cit., note 56 above, pp. 376-8.
91. Middleton Martin, 'Poor Law reform', op. cit., note 56 above, p. 380.
92. J Middleton Martin, 'The medical profession and rate-provided hospitals', Br. med. J., 6 Aug. 1921, ii: 191-2, on p. 191.
93. Stewart, op. cit., note 20 above;
94. J Harris, Private lives, public spirit: Britain 1870-1914, Oxford University Press, 1993; Harmondsworth, Penguin, 1994, pp. 237-41.
95. GA, CM/M/16/1 GEMSS MB, 20 Dec. 1919, 27 March 1920, 24 April 1920.
96. B Harris, The origins of the British welfare state: society, state and social welfare in England and Wales, 1800-1945, Basingstoke, Palgrave Macmillan, 2004, pp. 180-1.
97. GA, CM/M/16/1 GEMSS MB, 10 Oct. 1921, 1 May 1922; CM/M1/4 'Public Health and Housing Committee', 26 Nov. 1921.
98. GA, CM/M/16/1 GEMSS MB, 21 June 1920, 11 Dec. 1920, 12 March 1921; GCC MOH 1936, Gloucester, 1937, p. 56.
99. GA, CM/M/16/1 GEMSS MB, 26 Nov. 1921, 24 June 1922.
100. GA, CM/M/16/1 GEMSS MB, 13 Oct. 1922.
101. Gloucestershire County Council report of the Education Committee for 1922-23 (hereafter GCC EC), p. 32.
102. GA, CM/1 Gloucestershire Education Committee, signed copies of Minutes, May 1921 to March 1923, inclusive, vol. Ixv, 25 Nov. 1922.
103. GCC EC, 1921-22, p. 33.
104. Gloucestershire County Council, Abstract of accounts, 1921-22, 1922-23 (hereafter GCC Abstract).
105. th February 1924, 9 July 1923.
106. GA, CJ/M/8/1 GEMSS MB, 21 April, 7 July, 5 Aug. 1923.
107. GCC MOH, 1921, 1930, 1936.
108. Parsons, op. cit., note 24 above, insert after p. 93.
109. NA:PRO MH/66/ 91, 'Appendix 6', p. 7.
110. Ibid., p. 9; GCC MOH 1933, p. 28.
111. NA:PRO MH/66/91, 'Appendix 6', pp. 10-11.
112. Ibid., p. 5; GCC MOH 1933, p. 32.
113. Harris, The health of the schoolchild, op. cit., note 3 above, pp. 110-13.
114. U.K. Local Government Financial Statistics, 1935-36.
115. Parsons, op. cit., note 24 above, p. 91.
116. Ibid., p. 96.
117. NA:PRO MH/66/ 91, 'Appendix 6', p. 14; GCC MOH 1932, p. 32.
118. NA:PRO MH/66/92, L Harrison, 'Gloucestershire VD Scheme', 9 July 1934.
119. NA:PRO MH/66/ 91, 'Appendix 6', p. 4.
120. GCC MOH 1932, p. 32; this was a national trend, see Harris, Health of the schoolchild, op. cit., note 3 above, pp. 110-11.
121. GCC MOH 1932, p. 31.
122. GCC MOH 1934, p. 35.
123. GA, CJ/M/8/7 GEMSS MB, 2 Dec. 1929.
124. GCC, Abstract, passim; composition of income was reported only for the years shown; from 1934-5 the GEMSS element was not disaggregated from the total school medical service contribution to public health.
125. H Finer, English local government, London, Methuen, 1946, pp. 464-5.
126. st March 1932, Bristol, 1932, pp. 6-7.
127. Finer, op. cit., note 95 above, p. 462;
128. Harris, Health of the schoolchild, op. cit., note 3 above, p. 92.
129. GCC, Abstract, 1918-19.
130. Welshman, op. cit., note 4 above, pp. 135, 176, 181, 258-9.
131. Parsons, op. cit., note 24 above, pp. 5, 8; the comparison was made with Cornwall, Shropshire, Berkshire, West Sussex, Bedford, Dorset, Devon, Somerset, Wiltshire and Hampshire.
132. GCC MOH 1921, p. 41.
133. GA, CM/M/16/1 GEMSS MB, 1 May 1922.
134. GA, CJ/M/8/1 GEMSS MB, 6 Oct. 1923.
135. NA:PRO MH/66/ 91, 'Appendix 6', p. 9.
136. GA, CJ/M/8/1GEMSS MB, 8 Sept. 1923; CJ/M/8/8 GEMSS MB, 5 Oct. 1931.
137. GA, CJ/M/8/4 GEMSS MB, 4 Sept., 4 Dec. 1926; CJ/M/8/8 GEMSS MB, 5 Dec. 1932; CJ/M/8/12 GEMSS MB, 7 June 1934, 4 March 1935.
138. GA, CJ/M/8/11 GEMSS MB, 6 Nov. 1933.
139. Parsons, op. cit., note 24 above, p. 91; GCC MOH 1929, p. 31.
140. GCC MOH 1933, p. 27.
141. Ibid., p. 27.
142. Parsons, op. cit., note 24 above, pp. 189, 191-2.
143. GCC MOH 1932, p. 30.
144. NA:PRO MH 66/92 'Gloucestershire CC Post survey', 'Annex to 664/4201/2', 2 Feb. 1934; 'Previous history of the services transferred from the Guardians', n.d. 1936.
145. Ibid., 'Previous history'; and 'Post survey', 'Gloucestershire County Council' 2 March 1937, typescript of meeting.
146. Cowan went on to be MOH for Essex County Council, 1949-54, then Chief Medical Officer to the Scottish Department of Health, 1954-64, Who was who, 1971-1980, London, Adam & Charles Black, 1981, p. 177.
147. GA, CJ/M/8/15 GEMSS MB.
148. GA, CJ/M/8/15 GEMSS MB, 3 Jan. 1938.
149. Ibid., 5 July 1937; GA, CJ/M8/17 GEMSS MB, 4 Sept. 1939, 29 April 1940.
150. T Willis, 'The Bradford Municipal Hospital experiment of 1920: the emergence of the mixed economy in hospital provision in inter-war Britain', in M Gorsky and S Sheard (eds), Financing medicine: the British experience since 1750, London, Routledge, 2006;
151. Gorsky, op. cit., note 13 above;
152. Pickstone, op. cit., note 13 above, pp. 276-83.
153. Sir A Newsholme, Medicine and the state: the relation between the private and official practice of medicine with special reference to public health, London, 1932, p. 29; for Newsholme, see notes 23 and 57 above.
154. Sturdy (ed.), op. cit., note 58 above, pp. 242-9.
155. 'Interim report on encroachments on the sphere of private practice by the activities of local authorities', Br. med. J., Supplement, Nov. 1928, pp. 185-95, esp. paras 16, 17.
156. GA, CJ/M/8/10 GEMSS MB, 7 Nov. 1932.
157. Parsons, op. cit., note 24 above, p. 27.
158. Eyler, op. cit., note 23 above, pp. 324-33;
159. Harris, Health of the schoolchild, op. cit., note 3 above, pp. 98-102.
160. Fifteenth annual report of the Ministry of Health, Cmd. 4664, PP 1933-34, XII 265, pp. 45-54.
161. Parsons, op. cit., note 24 above, pp. 127, 189-90, 200.
162. GCC MOH 1929, p. 30.
163. NA:PRO MH 66/90 Minute Sheet, 24 Dec. 1932, H MacEwen to Wrigley.
164. W A Robson, The development of local government, London, Allen & Unwin, 1954, pp. 194-5,
165. cited in Welshman, op. cit., note 4 above, p. 253;
166. Eyler, op. cit., note 23 above, pp. 387-8.