Patterns of municipal health expenditure in interwar England and Wales

Bulletin of the History of Medicine

Volumn 78, Issue 3, 2004, Pages 635-669

  Levene, Alysa ^a,b   Powell, Martin ^c   Stewart, John ^a  

^a OXFORD BROOKES UNIVERSITY   (United Kingdom)

^b UNIVERSITY OF BATH   (United Kingdom)

^c University of Bath   (United Kingdom)

Author keywords

County borough; Expenditure; Health services; Local Government Act; Municipal

Indexed keywords

EID: 6344264004     PISSN: 00075140     EISSN: None     Source Type: Journal    
DOI: 10.1353/bhm.2004.0130     Document Type: Review

References (90)

1. James M. Mackintosh, Trends of Opinion about the Public Health, 1901-51 (London: Oxford University Press, 1953), pp. 131, 132. See also Charles Webster, The Health Services since the War, vol. 1, Problems of Health Care: The National Health Service before 1957 (London: HMSO, 1988), p. 24. On the Labour Party, nationally and in London, see John Stewart, The Battle for Health: A Political History of the Socialist Medical Association, 1930-1951 (Aldershot: Ashgate, 1999); Charles Webster, "Labour and the Origins of the National Health Service," in Science, Politics and the Public Good: Essays in Honor of Margaret Gowing, ed. Nicolaas A. Rupke (Basingstoke: Macmillan, 1988), pp. 184-202. On "regionalism," see Daniel Fox, Health Policies, Health Politics: The British and American Experience, 1911-1965 (Princeton: Princeton University Press, 1986). On the historiography of the formation of the National Health Service, see Charles Webster, "Conflict and Consensus: Explaining the British Health Service," Twentieth Cent. But. Hist., 1990, 1: 115-51.
2. James M. Mackintosh, Trends of Opinion about the Public Health, 1901-51 (London: Oxford University Press, 1953), pp. 131, 132. See also Charles Webster, The Health Services since the War, vol. 1, Problems of Health Care: The National Health Service before 1957 (London: HMSO, 1988), p. 24. On the Labour Party, nationally and in London, see John Stewart, The Battle for Health: A Political History of the Socialist Medical Association, 1930-1951 (Aldershot: Ashgate, 1999); Charles Webster, "Labour and the Origins of the National Health Service," in Science, Politics and the Public Good: Essays in Honor of Margaret Gowing, ed. Nicolaas A. Rupke (Basingstoke: Macmillan, 1988), pp. 184-202. On "regionalism," see Daniel Fox, Health Policies, Health Politics: The British and American Experience, 1911-1965 (Princeton: Princeton University Press, 1986). On the historiography of the formation of the National Health Service, see Charles Webster, "Conflict and Consensus: Explaining the British Health Service," Twentieth Cent. But. Hist., 1990, 1: 115-51.
3. James M. Mackintosh, Trends of Opinion about the Public Health, 1901-51 (London: Oxford University Press, 1953), pp. 131, 132. See also Charles Webster, The Health Services since the War, vol. 1, Problems of Health Care: The National Health Service before 1957 (London: HMSO, 1988), p. 24. On the Labour Party, nationally and in London, see John Stewart, The Battle for Health: A Political History of the Socialist Medical Association, 1930-1951 (Aldershot: Ashgate, 1999); Charles Webster, "Labour and the Origins of the National Health Service," in Science, Politics and the Public Good: Essays in Honor of Margaret Gowing, ed. Nicolaas A. Rupke (Basingstoke: Macmillan, 1988), pp. 184-202. On "regionalism," see Daniel Fox, Health Policies, Health Politics: The British and American Experience, 1911-1965 (Princeton: Princeton University Press, 1986). On the historiography of the formation of the National Health Service, see Charles Webster, "Conflict and Consensus: Explaining the British Health Service," Twentieth Cent. But. Hist., 1990, 1: 115-51.
4. James M. Mackintosh, Trends of Opinion about the Public Health, 1901-51 (London: Oxford University Press, 1953), pp. 131, 132. See also Charles Webster, The Health Services since the War, vol. 1, Problems of Health Care: The National Health Service before 1957 (London: HMSO, 1988), p. 24. On the Labour Party, nationally and in London, see John Stewart, The Battle for Health: A Political History of the Socialist Medical Association, 1930-1951 (Aldershot: Ashgate, 1999); Charles Webster, "Labour and the Origins of the National Health Service," in Science, Politics and the Public Good: Essays in Honor of Margaret Gowing, ed. Nicolaas A. Rupke (Basingstoke: Macmillan, 1988), pp. 184-202. On "regionalism," see Daniel Fox, Health Policies, Health Politics: The British and American Experience, 1911-1965 (Princeton: Princeton University Press, 1986). On the historiography of the formation of the National Health Service, see Charles Webster, "Conflict and Consensus: Explaining the British Health Service," Twentieth Cent. But. Hist., 1990, 1: 115-51.
5. James M. Mackintosh, Trends of Opinion about the Public Health, 1901-51 (London: Oxford University Press, 1953), pp. 131, 132. See also Charles Webster, The Health Services since the War, vol. 1, Problems of Health Care: The National Health Service before 1957 (London: HMSO, 1988), p. 24. On the Labour Party, nationally and in London, see John Stewart, The Battle for Health: A Political History of the Socialist Medical Association, 1930-1951 (Aldershot: Ashgate, 1999); Charles Webster, "Labour and the Origins of the National Health Service," in Science, Politics and the Public Good: Essays in Honor of Margaret Gowing, ed. Nicolaas A. Rupke (Basingstoke: Macmillan, 1988), pp. 184-202. On "regionalism," see Daniel Fox, Health Policies, Health Politics: The British and American Experience, 1911-1965 (Princeton: Princeton University Press, 1986). On the historiography of the formation of the National Health Service, see Charles Webster, "Conflict and Consensus: Explaining the British Health Service," Twentieth Cent. But. Hist., 1990, 1: 115-51.
6. James M. Mackintosh, Trends of Opinion about the Public Health, 1901-51 (London: Oxford University Press, 1953), pp. 131, 132. See also Charles Webster, The Health Services since the War, vol. 1, Problems of Health Care: The National Health Service before 1957 (London: HMSO, 1988), p. 24. On the Labour Party, nationally and in London, see John Stewart, The Battle for Health: A Political History of the Socialist Medical Association, 1930-1951 (Aldershot: Ashgate, 1999); Charles Webster, "Labour and the Origins of the National Health Service," in Science, Politics and the Public Good: Essays in Honor of Margaret Gowing, ed. Nicolaas A. Rupke (Basingstoke: Macmillan, 1988), pp. 184-202. On "regionalism," see Daniel Fox, Health Policies, Health Politics: The British and American Experience, 1911-1965 (Princeton: Princeton University Press, 1986). On the historiography of the formation of the National Health Service, see Charles Webster, "Conflict and Consensus: Explaining the British Health Service," Twentieth Cent. But. Hist., 1990, 1: 115-51.
7. Martin Powell, "An Expanding Service: Municipal Acute Medicine in the 1930s," Twentieth Cent. Brit. Hist., 1997, 8: 334-57.
8. It would be wrong, of course, to suggest that interwar municipal medicine has been entirely neglected by historians. See, with their references, Steven Cherry, Medical Services and the Hospitals in Britain, 1860-1939 (Cambridge: Cambridge University Press, 1996); Anne Hardy, Health and Medicine in Britain since 1860 (Basingstoke: Macmillan, 2001); Webster, Health Services (n. 1). An interesting survey of the rise and form of municipal services and personnel is offered by Steve Sturdy and Roger Cooter, "Science, Scientific Management, and the Transformation of Medicine in Britain, c. 1870-1950," Hist. Sci., 1998, 36: 421-66.
9. It would be wrong, of course, to suggest that interwar municipal medicine has been entirely neglected by historians. See, with their references, Steven Cherry, Medical Services and the Hospitals in Britain, 1860-1939 (Cambridge: Cambridge University Press, 1996); Anne Hardy, Health and Medicine in Britain since 1860 (Basingstoke: Macmillan, 2001); Webster, Health Services (n. 1). An interesting survey of the rise and form of municipal services and personnel is offered by Steve Sturdy and Roger Cooter, "Science, Scientific Management, and the Transformation of Medicine in Britain, c. 1870-1950," Hist. Sci., 1998, 36: 421-66.
10. It would be wrong, of course, to suggest that interwar municipal medicine has been entirely neglected by historians. See, with their references, Steven Cherry, Medical Services and the Hospitals in Britain, 1860-1939 (Cambridge: Cambridge University Press, 1996); Anne Hardy, Health and Medicine in Britain since 1860 (Basingstoke: Macmillan, 2001); Webster, Health Services (n. 1). An interesting survey of the rise and form of municipal services and personnel is offered by Steve Sturdy and Roger Cooter, "Science, Scientific Management, and the Transformation of Medicine in Britain, c. 1870-1950," Hist. Sci., 1998, 36: 421-66.
11. It would be wrong, of course, to suggest that interwar municipal medicine has been entirely neglected by historians. See, with their references, Steven Cherry, Medical Services and the Hospitals in Britain, 1860-1939 (Cambridge: Cambridge University Press, 1996); Anne Hardy, Health and Medicine in Britain since 1860 (Basingstoke: Macmillan, 2001); Webster, Health Services (n. 1). An interesting survey of the rise and form of municipal services and personnel is offered by Steve Sturdy and Roger Cooter, "Science, Scientific Management, and the Transformation of Medicine in Britain, c. 1870-1950," Hist. Sci., 1998, 36: 421-66.
12. Jane Lewis, The Politics of Motherhood: Child and Maternal Welfare in England, 1900-1939 (London: Croom Helm, 1980); Lara Marks, Metropolitan Maternity: Maternal and Infant Welfare Services in Early Twentieth Century London (Amsterdam: Rodopi, 1996); Elizabeth Peretz, "The Costs of Modern Motherhood to Low Income Families in Interwar Britain," in Women and Children First: International Maternal and Infant Welfare, 1870-1945, ed. Valerie Fildes, Lara Marks, and Hilary Marland (London: Routledge, 1992), pp. 257-80; idem, "Infant Welfare in Inter-War Oxford," in Oxford: Studies in the History of a University Town since 1800, ed. Richard C. Whiting (Manchester: Manchester University Press, 1993), pp. 131-45.
13. Jane Lewis, The Politics of Motherhood: Child and Maternal Welfare in England, 1900-1939 (London: Croom Helm, 1980); Lara Marks, Metropolitan Maternity: Maternal and Infant Welfare Services in Early Twentieth Century London (Amsterdam: Rodopi, 1996); Elizabeth Peretz, "The Costs of Modern Motherhood to Low Income Families in Interwar Britain," in Women and Children First: International Maternal and Infant Welfare, 1870-1945, ed. Valerie Fildes, Lara Marks, and Hilary Marland (London: Routledge, 1992), pp. 257-80; idem, "Infant Welfare in Inter-War Oxford," in Oxford: Studies in the History of a University Town since 1800, ed. Richard C. Whiting (Manchester: Manchester University Press, 1993), pp. 131-45.
14. Jane Lewis, The Politics of Motherhood: Child and Maternal Welfare in England, 1900-1939 (London: Croom Helm, 1980); Lara Marks, Metropolitan Maternity: Maternal and Infant Welfare Services in Early Twentieth Century London (Amsterdam: Rodopi, 1996); Elizabeth Peretz, "The Costs of Modern Motherhood to Low Income Families in Interwar Britain," in Women and Children First: International Maternal and Infant Welfare, 1870-1945, ed. Valerie Fildes, Lara Marks, and Hilary Marland (London: Routledge, 1992), pp. 257-80; idem, "Infant Welfare in Inter-War Oxford," in Oxford: Studies in the History of a University Town since 1800, ed. Richard C. Whiting (Manchester: Manchester University Press, 1993), pp. 131-45.
15. Jane Lewis, The Politics of Motherhood: Child and Maternal Welfare in England, 1900-1939 (London: Croom Helm, 1980); Lara Marks, Metropolitan Maternity: Maternal and Infant Welfare Services in Early Twentieth Century London (Amsterdam: Rodopi, 1996); Elizabeth Peretz, "The Costs of Modern Motherhood to Low Income Families in Interwar Britain," in Women and Children First: International Maternal and Infant Welfare, 1870-1945, ed. Valerie Fildes, Lara Marks, and Hilary Marland (London: Routledge, 1992), pp. 257-80; idem, "Infant Welfare in Inter-War Oxford," in Oxford: Studies in the History of a University Town since 1800, ed. Richard C. Whiting (Manchester: Manchester University Press, 1993), pp. 131-45.
16. Examples of more specialized studies are Linda Bryder, Below the Magic Mountain: A Short History of Tuberculosis in Twentieth-Century Britain (Oxford: Clarendon, 1988); John Pickstone, Medicine and Industrial Society: A History of Hospital Development in Manchester and Its Region, 1752-1946 (Manchester: Manchester University Press, 1985); John Stewart, "Socialist Proposals for Health Reform in Inter-War Britain: The Case of Somerville Hastings," Med. Hist., 1995, 39: 338-57; idem, "'For a Healthy London': The Socialist Medical Association and the London County Council in the 1930s," Med. Hist., 1997, 41: 417-36; John Welshman, Municipal Medicine: Public Health in Twentieth-Century Britain (Oxford: Peter Lang, 2000); Geoffrey Rivett, The Development of the London Hospital System, 1823-1982 (London: King Edward's Hospital Fund for London, 1986).
17. Examples of more specialized studies are Linda Bryder, Below the Magic Mountain: A Short History of Tuberculosis in Twentieth-Century Britain (Oxford: Clarendon, 1988); John Pickstone, Medicine and Industrial Society: A History of Hospital Development in Manchester and Its Region, 1752-1946 (Manchester: Manchester University Press, 1985); John Stewart, "Socialist Proposals for Health Reform in Inter-War Britain: The Case of Somerville Hastings," Med. Hist., 1995, 39: 338-57; idem, "'For a Healthy London': The Socialist Medical Association and the London County Council in the 1930s," Med. Hist., 1997, 41: 417-36; John Welshman, Municipal Medicine: Public Health in Twentieth-Century Britain (Oxford: Peter Lang, 2000); Geoffrey Rivett, The Development of the London Hospital System, 1823-1982 (London: King Edward's Hospital Fund for London, 1986).
18. Examples of more specialized studies are Linda Bryder, Below the Magic Mountain: A Short History of Tuberculosis in Twentieth-Century Britain (Oxford: Clarendon, 1988); John Pickstone, Medicine and Industrial Society: A History of Hospital Development in Manchester and Its Region, 1752-1946 (Manchester: Manchester University Press, 1985); John Stewart, "Socialist Proposals for Health Reform in Inter-War Britain: The Case of Somerville Hastings," Med. Hist., 1995, 39: 338-57; idem, "'For a Healthy London': The Socialist Medical Association and the London County Council in the 1930s," Med. Hist., 1997, 41: 417-36; John Welshman, Municipal Medicine: Public Health in Twentieth-Century Britain (Oxford: Peter Lang, 2000); Geoffrey Rivett, The Development of the London Hospital System, 1823-1982 (London: King Edward's Hospital Fund for London, 1986).
19. Examples of more specialized studies are Linda Bryder, Below the Magic Mountain: A Short History of Tuberculosis in Twentieth-Century Britain (Oxford: Clarendon, 1988); John Pickstone, Medicine and Industrial Society: A History of Hospital Development in Manchester and Its Region, 1752-1946 (Manchester: Manchester University Press, 1985); John Stewart, "Socialist Proposals for Health Reform in Inter-War Britain: The Case of Somerville Hastings," Med. Hist., 1995, 39: 338-57; idem, "'For a Healthy London': The Socialist Medical Association and the London County Council in the 1930s," Med. Hist., 1997, 41: 417-36; John Welshman, Municipal Medicine: Public Health in Twentieth-Century Britain (Oxford: Peter Lang, 2000); Geoffrey Rivett, The Development of the London Hospital System, 1823-1982 (London: King Edward's Hospital Fund for London, 1986).
20. Examples of more specialized studies are Linda Bryder, Below the Magic Mountain: A Short History of Tuberculosis in Twentieth-Century Britain (Oxford: Clarendon, 1988); John Pickstone, Medicine and Industrial Society: A History of Hospital Development in Manchester and Its Region, 1752-1946 (Manchester: Manchester University Press, 1985); John Stewart, "Socialist Proposals for Health Reform in Inter-War Britain: The Case of Somerville Hastings," Med. Hist., 1995, 39: 338-57; idem, "'For a Healthy London': The Socialist Medical Association and the London County Council in the 1930s," Med. Hist., 1997, 41: 417-36; John Welshman, Municipal Medicine: Public Health in Twentieth-Century Britain (Oxford: Peter Lang, 2000); Geoffrey Rivett, The Development of the London Hospital System, 1823-1982 (London: King Edward's Hospital Fund for London, 1986).
21. Examples of more specialized studies are Linda Bryder, Below the Magic Mountain: A Short History of Tuberculosis in Twentieth-Century Britain (Oxford: Clarendon, 1988); John Pickstone, Medicine and Industrial Society: A History of Hospital Development in Manchester and Its Region, 1752-1946 (Manchester: Manchester University Press, 1985); John Stewart, "Socialist Proposals for Health Reform in Inter-War Britain: The Case of Somerville Hastings," Med. Hist., 1995, 39: 338-57; idem, "'For a Healthy London': The Socialist Medical Association and the London County Council in the 1930s," Med. Hist., 1997, 41: 417-36; John Welshman, Municipal Medicine: Public Health in Twentieth-Century Britain (Oxford: Peter Lang, 2000); Geoffrey Rivett, The Development of the London Hospital System, 1823-1982 (London: King Edward's Hospital Fund for London, 1986).
22. William A. Robson, The Development of Local Government, 3rd ed. (London: Allen & Unwin, 1954), p. 269.
23. The population threshold was raised to 75,000 from 50,000 by the Local Government (County Boroughs and Adjustments) Act of 1926: Vivian D. Lipman, "The Development of Areas and Boundary Changes 1888-1939," in Essays on Local Government, ed. Charles H. Wilson (Oxford: Blackwell, 1948), pp. 42-43.
24. Stephen V. Ward, The Geography of Interwar Britain: The State and Uneven Development (London: Routledge, 1988), p. 157.
25. John H. Warren, The English Local Government System (London: Allen & Unwin, 1946), pp. 45-46.
26. Lipman ("Development of Areas" [n. 7]) states that between 1929 and 1937 the boundaries of forty-nine county boroughs had been extended, transferring more than the entire population of Brighton, and more than twice the acreage of Birmingham, to the county boroughs.
27. Ward, Geography of Interwar Britain (n. 8), p. 157.
28. At the beginning of the period there were eighty-two county boroughs; Doncaster was given county borough status in 1927, thus raising the number to eighty-three.
29. Liverpool, for example, was characterized by the Ministry of Health in 1932 as being overly extravagant in its expenditure on social services: "In marked contrast to many other industrial towns there is nothing niggardly in its administration. It carries itself with the air of a merchant prince, thinking in terms of millions, and distributing largesse with a ready hand" (Ministry of Health Survey Report, Liverpool, Public Record Office [hereafter PRO], MH66/721). Such comments are rare in this source, however.
30. For example, Keith Hoggart, Economy, Polity and Urban Public Expenditure (Aldershot: Avebury Press, 1989), p. ii. Robert Millward, in "Local Government Expenditure in Britain, 1870-1914: An Economic Analysis" (University of Manchester: Working Papers in Economic and Social History, no. 27), uses expenditure data as part of a factor analysis that is designed to capture a measure of quality of provision.
31. For example, Keith Hoggart, Economy, Polity and Urban Public Expenditure (Aldershot: Avebury Press, 1989), p. ii. Robert Millward, in "Local Government Expenditure in Britain, 1870-1914: An Economic Analysis" (University of Manchester: Working Papers in Economic and Social History, no. 27), uses expenditure data as part of a factor analysis that is designed to capture a measure of quality of provision.
32. Sally Sheard, "Reluctant Providers? The Politics and Ideology of Municipal Hospital Finance, 1870-1914," in Financing British Medicine c. 1750-2002, ed. Martin Gorsky and Sally Sheard (forthcoming). Examples of studies using local-authority expenditure data are those carried out by Frances Bell and Robert Millward, "Public Health Expenditures and Mortality in England and Wales, 1870-1914," Contin. & Change, 1998, 23: 221-49; Millward, "Local Government Expenditure" (n. 14); Robert Millward and Frances Bell, "Economic Factors in the Decline of Mortality in Late Nineteenth-Century Britain," Eur. Rev. Econ. Hist., 1998, 2: 263-88.
33. Sally Sheard, "Reluctant Providers? The Politics and Ideology of Municipal Hospital Finance, 1870-1914," in Financing British Medicine c. 1750-2002, ed. Martin Gorsky and Sally Sheard (forthcoming). Examples of studies using local-authority expenditure data are those carried out by Frances Bell and Robert Millward, "Public Health Expenditures and Mortality in England and Wales, 1870-1914," Contin. & Change, 1998, 23: 221-49; Millward, "Local Government Expenditure" (n. 14); Robert Millward and Frances Bell, "Economic Factors in the Decline of Mortality in Late Nineteenth-Century Britain," Eur. Rev. Econ. Hist., 1998, 2: 263-88.
34. Sally Sheard, "Reluctant Providers? The Politics and Ideology of Municipal Hospital Finance, 1870-1914," in Financing British Medicine c. 1750-2002, ed. Martin Gorsky and Sally Sheard (forthcoming). Examples of studies using local-authority expenditure data are those carried out by Frances Bell and Robert Millward, "Public Health Expenditures and Mortality in England and Wales, 1870-1914," Contin. & Change, 1998, 23: 221-49; Millward, "Local Government Expenditure" (n. 14); Robert Millward and Frances Bell, "Economic Factors in the Decline of Mortality in Late Nineteenth-Century Britain," Eur. Rev. Econ. Hist., 1998, 2: 263-88.
35. Sally Sheard, "Reluctant Providers? The Politics and Ideology of Municipal Hospital Finance, 1870-1914," in Financing British Medicine c. 1750-2002, ed. Martin Gorsky and Sally Sheard (forthcoming). Examples of studies using local-authority expenditure data are those carried out by Frances Bell and Robert Millward, "Public Health Expenditures and Mortality in England and Wales, 1870-1914," Contin. & Change, 1998, 23: 221-49; Millward, "Local Government Expenditure" (n. 14); Robert Millward and Frances Bell, "Economic Factors in the Decline of Mortality in Late Nineteenth-Century Britain," Eur. Rev. Econ. Hist., 1998, 2: 263-88.
36. Correlation coefficients between the two series were 0.191 for 1922, -0.003 for 1928, and 0.142 for 1934.
37. Roger Lee, "Uneven Zenith: Towards a Geography of the High Period of Municipal Medicine in England and Wales," J. Hist. Geog., 1988, 14: 260-80, on p. 265.
38. Martin Powell, "Did Politics Matter? Municipal Public Health Expenditure in the 1930s," Urb. Hist., 1995, 22: 360-79, quotation on p. 363.
39. Ibid., p. 363.
40. Webster, Health Services (n. 1), p. 12.
41. The source used for the conversion to real expenditure is Brian R. Mitchell, British Historical Statistics (Cambridge: Cambridge University Press, 1988), Prices 10, Ministry of Labour/Department of Employment Indices of Retail Prices, UK, 1892-1980, pp. 739-41.
42. The 1918 Act required local MCW authorities to set up MCW committees, and allowed them to provide a full service of midwives, health visitors, infant welfare centers, and so on: Lewis, Politics of Motherhood (n. 4), p. 34. Cherry (Medical Services and the Hospitals [n. 3], p. 33) also notes the role of the 1918 Act, as well as of the 1907 Notification of Births Act, in promoting the development of the MCW services.
43. The 1918 Act required local MCW authorities to set up MCW committees, and allowed them to provide a full service of midwives, health visitors, infant welfare centers, and so on: Lewis, Politics of Motherhood (n. 4), p. 34. Cherry (Medical Services and the Hospitals [n. 3], p. 33) also notes the role of the 1918 Act, as well as of the 1907 Notification of Births Act, in promoting the development of the MCW services.
44. Norman Wilson, Municipal Health Services (London: Allen & Unwin, 1946), p. 84. Pickstone (Medicine and Industrial Society [n. 5], p. 213) notes this reliance on Poor Law hospitals in Manchester prior to the 1929 Act by those people not connected to the voluntary hospital system through workers' contributory schemes.
45. Norman Wilson, Municipal Health Services (London: Allen & Unwin, 1946), p. 84. Pickstone (Medicine and Industrial Society [n. 5], p. 213) notes this reliance on Poor Law hospitals in Manchester prior to the 1929 Act by those people not connected to the voluntary hospital system through workers' contributory schemes.
46. William M. Frazer, A History of English Public Health, 1834-1939 (London: Ballière, Tindall and Cox, 1950), pp. 386-93.
47. In Gloucester, for example, the Ministry made it clear that loan sanction for a new maternity hospital would not be granted until the Public Assistance general hospital was appropriated: Ministry of Health survey correspondence, Gloucester, PRO, MH66/628. In the case of West Hartlepool, the minister was even more direct, writing to the council that their block grant was subject to reduction if they did not achieve and maintain a reasonable standard in their health services: Ministry of Health survey correspondence, West Hartlepool, PRO, MH66/991.
48. Wilson, Municipal Health Services (n. 23), pp. 148-49; Daniel N. Chester, Central and Local Government: Financial and Administrative Relations (London: Macmillan, 1951), pp. 288-89; John R. Hicks and Ursula K. Hicks, Standards of Local Expenditure: A Problem of the Inequality of Incomes (Cambridge: National Institute of Economic and Social Research, Occasional Papers, 1943), p. 9.
49. Wilson, Municipal Health Services (n. 23), pp. 148-49; Daniel N. Chester, Central and Local Government: Financial and Administrative Relations (London: Macmillan, 1951), pp. 288-89; John R. Hicks and Ursula K. Hicks, Standards of Local Expenditure: A Problem of the Inequality of Incomes (Cambridge: National Institute of Economic and Social Research, Occasional Papers, 1943), p. 9.
50. Wilson, Municipal Health Services (n. 23), pp. 148-49; Daniel N. Chester, Central and Local Government: Financial and Administrative Relations (London: Macmillan, 1951), pp. 288-89; John R. Hicks and Ursula K. Hicks, Standards of Local Expenditure: A Problem of the Inequality of Incomes (Cambridge: National Institute of Economic and Social Research, Occasional Papers, 1943), p. 9.
51. Sheard, "Reluctant Providers?" (n. 15).
52. The dates of appropriation are drawn from the Ministry of Health survey reports made after the 1929 Local Government Act (PRO, MH66/419-1023). Not all county boroughs have extant surveys, and not all have a clear note as to the date of appropriation, so the actual number of appropriated hospitals was probably higher than forty-four. Some boroughs had more than one hospital, and it is hospitals rather than boroughs that are counted here.
53. The rises in investment in MCW and in mental deficiency are charted in Lewis, Politics of Motherhood (n. 4), and Mathew Thomson, The Problem of Mental Deficiency: Eugenics, Democracy and Social Policy in Britain, c. 1870-1959 (Oxford: Clarendon, 1998), respectively.
54. The rises in investment in MCW and in mental deficiency are charted in Lewis, Politics of Motherhood (n. 4), and Mathew Thomson, The Problem of Mental Deficiency: Eugenics, Democracy and Social Policy in Britain, c. 1870-1959 (Oxford: Clarendon, 1998), respectively.
55. Frazer, History of English Public Health (n. 24), p. 285; Sheard "Reluctant Providers?" (n. 15).
56. Frazer, History of English Public Health (n. 24), p. 285; Sheard "Reluctant Providers?" (n. 15).
57. A good overview of the preoccupation with MCW services in the interwar period and before, and the way in which this fed into the debate over the development of preventive medicine and the setting up of the Ministry of Health, is given by Dorothy Porter, Health, Civilization and the State: A History of Public Health from Ancient to Modern Times (London: Routledge, 1999), pp. 174-218.
58. The minister of health noted in his annual reports of the period that the total number of new cases of venereal diseases was falling, although the number of attendances by confirmed sufferers was increasing. In the report for 1931-32, the minister cited a 46.8 percent reduction in syphilis cases since 1920 (Minister of Health Annual Report, 1931-32, pp. 60-61 [London: HMSO, 1932] ). In 1920, 1,489,000 people attended local-authority VD centers (Minister of Health Annual Report, 1920-21, p. 11 [London: HMSO, 1921]).
59. Expenditure under the heading of "salaries" was for officers such as medical officers of health, health visitors, and sanitary inspectors who did not come under the more specific health categories. Jane Lewis notes that the MOHs were reliant on the British Medical Association for support in salary negotiations, but that in 1929 a new salary scale and minimum wage were agreed on with local authorities: Jane Lewis, What Price Community Medicine? The Philosophy, Practice and Politics of Public Health since 1919 (Brighton: Wheatsheaf, 1986), pp. 17, 25.
60. Jane Lewis, "The Prevention of Diphtheria in Canada and Britain, 1914-45," J. Soc. Hist., 1986, 20: 163-72; idem, What Price Community Medicine? (n. 33), pp. 28-29.
61. Jane Lewis, "The Prevention of Diphtheria in Canada and Britain, 1914-45," J. Soc. Hist., 1986, 20: 163-72; idem, What Price Community Medicine? (n. 33), pp. 28-29.
62. In his Annual Report for 1931-32, the minister of health noted with approval that local authorities had interpreted Circular 1222 of September 1931 (on the need for economy) in a responsible manner, and "have not embarked on any wholesale and ill-considered cutting down of expenditure on essential health services"; clearly, the intention was not that boroughs recklessly cut their expenditure on health in response to calls for economy (Minister of Health Annual Report, 1931-32 [n. 32], p. 46).
63. Charles Webster ("Healthy or Hungry Thirties?" Hist. Workshop J., 1982, 13: 110-29) notes the continued secular rise in economic and social conditions that would have had a positive effect on health standard, despite the thirties' depression (p. 110); he also however, doubts that it was experienced uniformly across the country (pp. 123-25).
64. John Mohan, Planning, Markets and Hospitals (London: Routledge, 2002), p. 24.
65. Hicks and Hicks, Standards of Local Expenditure (n. 26); Lee, "Uneven Zenith" (n. 17), p. 271; Powell, "Did Politics Matter?" (n. 18); Brian T. Preston, "Rich Town, Poor Town: The Distribution of Rate-Borne Spending Levels in the Edwardian City System," Trans. Inst. Brit. Geog., 1985, n. s. 10: 85-89. Hicks and Hicks (Standards of Local Expenditure [n. 26], pp. 10-16) concur with this discrepancy between boroughs of different wealth levels.
66. Hicks and Hicks, Standards of Local Expenditure (n. 26); Lee, "Uneven Zenith" (n. 17), p. 271; Powell, "Did Politics Matter?" (n. 18); Brian T. Preston, "Rich Town, Poor Town: The Distribution of Rate-Borne Spending Levels in the Edwardian City System," Trans. Inst. Brit. Geog., 1985, n. s. 10: 85-89. Hicks and Hicks (Standards of Local Expenditure [n. 26], pp. 10-16) concur with this discrepancy between boroughs of different wealth levels.
67. Hicks and Hicks, Standards of Local Expenditure (n. 26); Lee, "Uneven Zenith" (n. 17), p. 271; Powell, "Did Politics Matter?" (n. 18); Brian T. Preston, "Rich Town, Poor Town: The Distribution of Rate-Borne Spending Levels in the Edwardian City System," Trans. Inst. Brit. Geog., 1985, n. s. 10: 85-89. Hicks and Hicks (Standards of Local Expenditure [n. 26], pp. 10-16) concur with this discrepancy between boroughs of different wealth levels.
68. Hicks and Hicks, Standards of Local Expenditure (n. 26); Lee, "Uneven Zenith" (n. 17), p. 271; Powell, "Did Politics Matter?" (n. 18); Brian T. Preston, "Rich Town, Poor Town: The Distribution of Rate-Borne Spending Levels in the Edwardian City System," Trans. Inst. Brit. Geog., 1985, n. s. 10: 85-89. Hicks and Hicks (Standards of Local Expenditure [n. 26], pp. 10-16) concur with this discrepancy between boroughs of different wealth levels.
69. Hicks and Hicks, Standards of Local Expenditure (n. 26); Lee, "Uneven Zenith" (n. 17), p. 271; Powell, "Did Politics Matter?" (n. 18); Brian T. Preston, "Rich Town, Poor Town: The Distribution of Rate-Borne Spending Levels in the Edwardian City System," Trans. Inst. Brit. Geog., 1985, n. s. 10: 85-89. Hicks and Hicks (Standards of Local Expenditure [n. 26], pp. 10-16) concur with this discrepancy between boroughs of different wealth levels.
70. Preston, "Rich Town, Poor Town" (n. 38), p. 88.
71. Jonathan P. Bradbury, "The 1929 Local Government Act: The Formulation and Implementation of Poor Law (Health Care) and Exchequer Grants Reform for England and Wales (outside London)" (Ph.D. thesis, University of Bristol, 1991), states that the change in the grant system under the 1929 Act did not adversely affect expenditure on services that had previously been aided by the percentage grants. He does, however, provide evidence of county boroughs where the block grant "confirmed reactionary attitudes" (p. 302), or was used "to arrest even existing development" (p. 305). The poorer boroughs were probably the most adversely affected, especially given the national drive for economy, which prompted many of them to use the grant to reduce pressure on the local rates.
72. Preston, "Rich Town, Poor Town" (n. 38), p. 86.
73. Powell, "Did Politics Matter?" (n. 18), pp. 366-67, 374-79; Elizabeth Howard, "Joint Authorities," in Wilson, Essays on Local Government (n. 7), pp. 204-31.
74. Powell, "Did Politics Matter?" (n. 18), pp. 366-67, 374-79; Elizabeth Howard, "Joint Authorities," in Wilson, Essays on Local Government (n. 7), pp. 204-31.
75. Sheard, "Reluctant Providers?" (n. 15).
76. West Hartlepool, for example, justified their low level of spending on health by their prioritization of housing programs as a better long-term policy toward healthy conditions; in this case the borough council, in the early 1930s at least, were averse to increasing their expenditure on health services, suggesting that prioritization was not an ongoing concern: Bradbury, "1929 Local Government Act" (n. 40), pp. 307-8; Ministry of Health Survey Report and Correspondence, West Hartlepool, PRO, MH66/988 and 991.
77. West Hartlepool, for example, justified their low level of spending on health by their prioritization of housing programs as a better long-term policy toward healthy conditions; in this case the borough council, in the early 1930s at least, were averse to increasing their expenditure on health services, suggesting that prioritization was not an ongoing concern: Bradbury, "1929 Local Government Act" (n. 40), pp. 307-8; Ministry of Health Survey Report and Correspondence, West Hartlepool, PRO, MH66/988 and 991.
78. Frazer, History of English Public Health (n. 24), p. 450; Ministry of Health/Nuffield Provincial Hospital Trust hospital survey, 1945-46 (London: HMSO, 1945-46).
79. Pickstone, Medicine and Industrial Society (n. 5), p. 53, notes that towns such as Oldham were hard hit by foreign competition in coarse spinning.
80. William R. Garside, British Unemployment, 1919-39: A Study in Public Policy (Cambridge: Cambridge University Press, 1990), pp. 9-11. Garside maintains that the government was never genuinely committed to bringing down unemployment in the depressed areas, convinced instead that it was an inevitable part of cyclical economics (pp. 240-74). The Northwest, Scotland, and Wales also had unemployment at a similar level to the Northeast.
81. Ministry of Health Survey Report, Gateshead, PRO, MH66/619; Ministry of Health Survey Report Correspondence, Gateshead, PRO, MH66/622.
82. Ministry of Health Survey Report, Gateshead, PRO, MH66/619; Ministry of Health Survey Report Correspondence, Gateshead, PRO, MH66/622.
83. Ward, Geography of Interwar Bntain (n. 8), p. 181.
84. Ministry of Health Survey Reports, Middlesborough and South Shields, PRO, MH66/754 and 890.
85. Martin Gorsky, John Mohan, and Martin Powell, "British Voluntary Hospitals, 1871-1938: The Geography of Provision and Utilization," J. Hist. Geog., 1999, 25: 468-74.
86. Bradbury, "1929 Local Government Act" (n. 40), p. 304.
87. This region is called "London" in the 1945-46 Nuffield/Ministry of Health Hospital Survey, but since we are not considering the metropolitan boroughs, we have renamed it for clarity's sake.
88. Philip J. Waller, in Town, City and Nation: England 1850-1914 (Oxford: Oxford University Press, 1983), notes the large expansion in the seaside and pleasure resorts in the late nineteenth century, which would have meant that their character was well established by the interwar period (p. 4). By 1911, 55 percent of English people went on day trips to seaside resorts, and a class element had arisen in their appeal: while Brighton, Bournemouth, and Eastbourne tried to appeal to the middle classes and the retired, Blackpool was always popular with the working classes. The established appeal to the retired and wealthy was reflected in the former towns in the construction of private hospitals and rest homes and middle-class leisure facilities such as golf courses (pp. 131-44).
89. Martin Powell, in "A Tale of Two Cities: A Critical Evaluation of the Geographic Provision of Health Care before the NHS," Public Admin., Spring 1992, 70: 67-80, also notes that "while . . . the south did tend to have more beds than the north, the North-West region was relatively well provided with 6.7 beds per thousand population, making it second only to the London region for these categories" (p. 73).
90. Thomson characterizes the mental deficiency service after the 1913 Mental Deficiency Act as one that carried the hopes of many specialists for a new, humane, and expert institution-based system, but that was neglected by the legislature, and was frequently derided for the cost of building new "colonies" (Problem of Mental Deficiency [n. 29], pp. 76-77).