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European Healthcare before Welfare States Workshop, 17 February 2017

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The European Healthcare before Welfare States project of the Centre of Health Histories at the University of Huddersfield will be holding the first of two linked workshops on Friday 17 February, 2017. The event, funded by the University Research Fund, will bring together academics from half a dozen countries to examine a range of themes in the structure and delivery of healthcare, mainly before the 1950s. Nations examined will include the four nations of the UK, Germany, Spain and Hungary along with comparative and transnational contributions.

At the centre of the day will be an opening session showcasing the research undertaken by the project RAs in Poland, Hungary and the Czech Republic, the first detailed study of the hospital systems of these nations. The papers will touch on current historiography in Central European healthcare, a survey of national and local archives and contemporary printed sources and some preliminary findings, with a particular focus on the scale and scope of institutional services.

This event will be followed by a second workshop in Prague in late Spring and the publication of a collection of papers. We are also going to use the opportunity to launch a research network on the theme of Healthcare before Welfare States to exchange ideas, work collaboratively on publications and funding applications and establish regular meetings.

We are very grateful to the University of Huddersfield URF for their generous support for this project.

WORKSHOP PROGRAMME

Heritage Quay, University of Huddersfield

Friday 17 February 2017

9.30 Arrival and Coffee

SESSION 1: CENTRAL EUROPE BETWEEN THE WARS, 9.45 – 11.45

9.45 Professor Barry Michael Doyle, University of Huddersfield ‘Comparing Apples and Oranges? Examining Hospital Provision in Three Central European Nations’
10.15 Frank Grombir, University of Huddersfield ‘Catching up, Patching up, Thinking Big: Institutional Health Care in Interwar Czechoslovakia’
10.45 Dr Balázs Szelinger, University of Huddersfield ‘Hungarian Hospitals 1920-1941 – Financial Aspects’
11.15 Melissa Hibbard, University of Huddersfield ‘Hospitals in Interwar Poland’

11.45              Lunch

SESSION 2: HEALTHCARE FUNDING AND MANAGEMENT, 12.30 – 2.30

12.30 Dr Steve Thompson, Aberystwyth University ‘Voluntary Hospitals and the State in South Wales in the 1930s and 1940s’
1.00 Dr Axel Hüntelmann, The Charité, Universitätsmedizin Berlin ‘Accounting, Bookkeeping and Calculative Practices at the Charité Hospital in Berlin, c. 1750-1920’
1.30 Dr Nick Hayes/Eddie Cheetham, Nottingham Trent University Voluntary Action: Community Activity in the East Midlands before 1939

2.30                Tea Break

SESSION 3: INTERNATIONAL COMPARISONS AND CONTEXTS, 2.45 – 3.45

2.45 Dr Martin Gorsky and Dr Chris Sirrs, London School of Hygiene & Tropical Medicine ‘The Rise and Fall of ‘Universal Health Coverage’ as a Goal of International Health Politics, 1925-52’
3.15 Dr George Campbell Gosling, University of Wolverhampton (formerly Warwick) ‘Patient Payments in Britain and Beyond’
3.45 Dr David Brydan, Birbeck, University of London ‘From Prague to La Paz: The Global Entanglements of Francoist Healthcare’ (7-minute intervention)

3.55                Tea

SESSION 4: SPECIALIST PROVISIONS, 4.10 – 6.00

4.10 Dr Alice Brumby, University of Huddersfield A “great landmark in the history of legislation”? Reassessing the Mental Treatment Act 1930-1938
4.30 Assistant Professor Emese Lafferton, Central European University ‘Mental Health Services in 19th Century Hungary’
5.00 Dr Eszter Varsa, Universität Regensburg „Gypsies as objects of health education“: Discourses on Roma in Hungarian medical journals, 1960s-1980s
5.30 Dr Iain Hutchison, University of Glasgow ‘Glasgow’s Royal Hospital for Sick Children 1914-1948’

6.00                Reception

If you would like to attend, please email f.grombir@hud.ac.uk

Gender, Work and the Mid-twentieth century Hospital

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At a recent event I attended on the history of wound care I, possibly rashly, asserted that mid-twentieth century hospitals were run on a daily basis by women with doctors playing only a small part in the quotidian life of the institution. My bravado owed something to my work on inter war hospitals where most of the medical staff were voluntary appointments who possibly visited their patients on a daily round before returning to their private practice. The management of patients was normally in the hands of a small coterie of trainee house staff whose number depended on the size and purpose of the institution and the proximity of a medical school. In the municipal and ex-poor law hospitals doctors were even less common. Normally the institution would have a Medical Superintendent who might be assisted by a deputy and a Medical Officer in charge of obstetrics – though this post was likely to be held by a woman. Even in huge municipal hospitals like St James’ in Leeds resident or even regularly attending medical staff might number five or less.

But I was still concerned I may have gone over the top. However, while looking for some information on hospital beds in Sheffield I unearthed a copy of the Sheffield Regional Hospital Board’s report on their first five years of operation following the founding of the NHS. The data wasn’t much use for my purposes but my attention was caught by the photograph section. The images are reproduced here in full as they confirm, vividly, the extensive role of women workers in the region’s institutions and the absence of men in medical, patient management or caring roles.

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The first feature to stand out is the variety of technical roles undertaken by nursing and female scientific and technical staff. In the image above they are working with children to correct squints, a department introduced into Sheffield’s hospitals in the mid-1930s. Immediately below we see a female radiographer while in the next picture two nurses are overseeing a patient in a modern ‘iron lung’. Admittedly in this case the role of one of the nurses is less impressive – she is holding a newspaper for the male patient to read!

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The women in the next two shots are engaged in the kind of work one might expect of female staff in this period – one feeding an infant the other teaching young patients in the hospital school (probably in a TB sanatorium). But the second pair are more challenging. The first shows two you women scientists in the pathology laboratory. Evidence from across the country, and internationally, shows that routine scientific testing was undertaken almost entirely by women at this time. They rarely received credit as the chief pathologist but they were the back-bone of the scientific revolution in the mid twentieth century hospital. Moreover, they also dominated the staffing of radiography, X-Ray and probably radiology departments, the staff member shown here working one of the most up to date pieces of equipment that required considerable judgement to use effectively.

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Certainly men could be found in and around the wards – for example as porters and orderlies or in traditional non-medical trades like decorators, electricians and engineers – but their therapeutic interventions were limited. The available illustrations show them limited to occupational therapy and rehabilitation – supervising in the gym or the workshop. Yet even then there is evidence that nurses supervised much of the early physiotherapy and undertook muscle manipulation and massage.

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Indeed the only senior medical role occupied by a man in the collection of images as tutor in a class for nurses. Interesting, although the caption refers to Student Nurses there are a large number of men in white coats who one can assume are medical students.

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The final two images of staff once again confirm the dominance of women, that above showing nurses, probably at the King Edward VII Orthopaedic Hospital for Children, delivering water therapy for children who spent much of their time bed-bound. The woman below occupied a role which had been identified with female workers from its introduction in the late nineteenth century – the almoner. Initially employed to ensure those who could pay for treatment did so and those who couldn’t or didn’t have to were exempt, by the 1930s they were already engaged in extensive social work activities. By the time the NHS was fully operational they job had become entirely social, managing discharge arrangements, ensuring patients had suitable accommodation and support, possibly arranging convalescence and maybe even charitable support. In the case of this patient it is likely he will not have worked for some time – either because of TB or an accident – and his needs or discharge could be quite extensive.

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Thus, by the time these two characters headed home on their adapted motor trikes it is likely they will have spent almost all of their time in hospital under the ministration of female staff who not only undertook the expected caring roles of the traditional hospital but were also are the heart of the new scientific, technological and therapeutic regimes introduced in the second quarter of the twentieth century. Women may have made beds, fed babies and turned the pages of patients’ newspapers but they also worked the most up-to-date machines, conducted the laboratory experiments and tests fixed squints and ensured the safe discharge of patients. Indeed in the kind of long stay institutions depicted here the doctor was still marginal to the patients recovery but not because these were not curative institutions. As these images suggest women were central to the curative high tech regimes of the mid-twentieth century in a way that is rarely, if ever, revealed.

All the images in this post are taken from: Sheffield Regional Hospital Board, Quinquennial Report upon the work of the Sheffield Regional Hospital Board from 1947-1952 (Sheffield, 1953). The images appear between pages 64-65. There are no explicit acknowledgements but this appears at the end of the book.

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CFP: Boundaries and Jurisdictions: Defining the Urban

Urban History Group Conference 2017

Royal Holloway, University of London, 30- 31 March

 

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Boundaries define towns and cities; jurisdictions legitimate those authorised to manage areas within them. While cities frequently annexed adjacent areas as a means of extending their authority,peripheral townships, regional jurisdictions and individual landowners have often resisted that process of absorption and the consequential loss of identity and autonomy. Do cities transmit ideas and ideologies to areas beyond their boundaries, urging compliance with administrative procedures and participating in infrastructural projects governing health, education, and transport? Were economies of scale in service provision a force for urban amalgamation? How have inhabitants navigated and perceived these boundaries, and what effects have they had on movement or identities? The conference will explore this theme of the urban ‘edge.’
Understanding where and what the edge is, though, is complex. Municipal authority is, of course, not bounded just by the city limits, but also by innumerable internal boundaries; boundaries that are not neutral in their management or their construction. We all live in multiple authorities – parishes, districts (school, medical, electoral), neighbourhoods, conservation areas, economic and regeneration zones. Myriad internal boundaries exist whose spatial extents rarely overlap and authority over them is vested in a mixture of legal bodies and informal authority. Informal authority reigns where the boundaries of mental maps are shaped by custom and practice – ‘safe’ areas, ‘red light’ districts, pedestrian precincts, ethnic and religious concentrations. The mosaic of overlapping boundaries and jurisdictions questions the use of the term city, since urban environments constitute so many different cities.
The conference committee invites individual papers and panel proposals of up to three papers. Papers might be in the form of thematic or case studies, cutting across time and space to draw out the larger-scale historical process at work in relation to boundaries and jurisdictions. Some of the themes, identified by bullet points below, are timeless so contributions ranging from c.1600 to the present are welcome and can be drawn from any geographical area. Contributions from doctoral candidates (see below) are an important feature of the Urban History Group and so these, too, are encouraged and financially supported with modest bursaries.

 

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In framing your paper or making a proposal for a panel you may wish to consider some of the following:

· What is the difference between authority, regulation and jurisdiction, and does it matter?
· How have boundaries and jurisdictions shaped urban behaviour and vice versa?
· How durable are bounded limits like town charters, walls, and trading monopolies?
· How have rules and regulations involuntarily contributed to the creation of boundaries
· What informal mechanisms shape perceptions of boundaries, and how are these ‘edges’ enforced, transgressed or subverted?
· Is ‘Edge City’, rather than a recent phenomenon, a longstanding feature of urban development?
· How durable are mental maps and what are the consequences where they overlap?
· Can we write and talk about ‘the city’ if it is as fragmented as it may seem?

Abstracts of up to 300 words, including a paper or panel title, name, affiliation and contact details should be submitted to urbanhistorygroup2017@gmail.com and should indicate clearly how the content of the paper addresses the conference themes outlined above. Those wishing to propose sessions should provide a brief statement that identifies the ways in which the session will address the conference theme, a list of speakers, and abstracts. The final deadline for proposals for sessions and papers is 21st October 2016.

The conference will again host its new researchers’ forum, which is composed of two elements. The first section is aimed primarily at those who are at an early stage of a PhD or early career research project. New researchers’ papers should be the same length and follow the same submission rules as the main sessions, but need not be related to the main conference theme. Additionally, there will be opportunities for first-year PhD students to present a 10 minute introduction to their topic, archival materials, and the specific urban historiography. This is an opportunity to obtain feedback from active researchers in the field of Urban History, but also to introduce your work to colleagues in the field.
Please submit all proposals to urbanhistorygroup2017@gmail.com marking them clearly ‘New Researchers’ or ‘First Year PhD’ in the subject field and on the abstract.

Bursaries. Students registered for a PhD can obtain a modest bursary on a first come, first served basis to offset expenses associated with conference registration and attendance. Please send an e-mail application to Professor Richard Rodger at richard.rodger@ed.ac.uk and also ask your supervisor to confirm your status as a registered PhD student with an e-mail to the same address. Deadline 16th December 2016. The Urban History Group would like to acknowledge the Economic History Society for its support for these bursaries.

For Further Details Contact:
Conference Organisers
Dr James Greenhalgh
University of Lincoln
Tel: 01522 83 7729
Email: jgreenhalgh@lincoln.ac.uk

Dr Markian Prokopovych
University of Birmingham
Tel: 0121 414 3259
Email: m.prokopovych@bham.ac.uk

For New Researchers
Dr Tom Hulme,
IHR, University of London
Tel: 020 7862 8816
Email: Tom.Hulme@sas.ac.uk

Website:http://www2.le.ac.uk/departments/urbanhistory/uhg/conference-2017/conference-2017

What was middle class healthcare like before the NHS?

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In the public mind – and that of many historians – healthcare in pre-NHS Britain was a toxic combination of charity, poor law and unaffordable doctors’ bills. This image, recently heavily revised by academics like Martin Gorsky, Nick Hayes and George Gosling, applies, in the main, to the experience of the working class. The fate of the middle class in this system is largely absent and any views we may have are probably shaped by popular culture with its emphasis on Harley Street specialists or sturdy local GPs. But what did happen to the average middle class person if they needed medical treatment, and especially hospital care, in interwar Britain? The hurdles that they faced were often as complex and worrying as those experienced by the bulk of the working class.

Central to the operation of health care between the wars was the premise that the middle classes could – and should – meet their own medical bills. In the nineteenth century when the middle class was smaller and medical practice simpler, this was probably an achievable ambition – although, as Anne Digby has shown, the precarious nature of many medical livings at this time suggests the system was far from efficient. However, as the century progressed this instability moved sharply against the bourgeois patient, and especially those new entrants who flooded into the black-coated sectors of society in the later years of Victoria’s reign.

 

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Long running television series, Dr Finlay’s Casebook shaped understanding of middle class healthcare

A number of factors were at play but most notable was the rising complexity and cost of medical treatments as drugs, tests, operations and technologies such as the x-ray were adopted by the medical profession. The increasing prevalence of these new practices made institutional responses to medical problems more common as the general practitioner no longer had the room or the facilities, or probably the skills, to meet these new expectations. Referral to a specialist or consultant became more and more common while a group of GPs were willing to tackle some of these challenges themselves and began to make use of institutional settings to extend their treatment portfolio.

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A handbill promoting the Liberal Government’s National Insurance Reforms, 1911

But the middle class patient was also being challenged by the shifting nature of health care entitlement. In 1911 Lloyd George introduced National Health Insurance for workers with a membership salary cap that excluded all but the lowest paid white collar workers. In a similar vein the development of hospital contributory schemes and the breaking up of the poor law in 1929, opened up hospital wards to most of the working class at little or no cost – though again entitlement caps barred lower professionals and even shop floor supervisors. Moreover, these salary caps were strictly policed by doctors to ensure those who should pay were not receiving subsidized treatment at the GP’s expense. This was particularly relevant in urban areas where most general and specialist hospitals relied on the medical staff providing their services for free and so physicians did not wish to see potentially fee paying clients on the general wards.

Thus, unlike the average worker, the average middle class person saw an increasing restriction in his or her healthcare options as costs rose and access declined. Moreover, it would seem that the quality of the care available was also diminishing. In the late nineteenth century GPs and consultants had looked to move their more complex cases, especially the surgical ones, out of the domestic surgery and into institutional settings typified by the nursing home and the rural and suburban cottage hospital. In this transition stage these settings proved adequate for medical practices that still relied predominantly on care and personal attention. But they were not designed for the newer high tech medicine being developed in the leading urban hospitals.

 

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The impressive Bristol St Mary’s Private Hospital in the 1930s – most were not of this standard!

With a few exceptions, like St Mary’s in Bristol, these were small, poorly equipped and under staffed establishments where the matron might be the only qualified member of the permanent staff. They could oversee chronic and mental health patients – often found in the smallest, most poorly equipped operations– many provided maternity services while the better were associated with surgeons like Middlesbrough’s Dr Dickie who opened Ardencaple in 1909 in a purpose built block that he extended in the 1920s to include many modern touches, including lifts. The best were centred on London and the big cities with teaching hospitals where world famous surgeons like Lord Moynihan conducted their private practice. Concerns about the quality of many nursing homes increased in the early 1920s prompting a select committee followed by the introduction of registration and light touch inspection to stamp out ‘the grave abuses – hygienic, medical and social – [that] existed or were suspected to exist in relation to the conduct of many establishments known as nursing homes’ [Dr J J Buchan in Public Health, 1929 p.187]

 

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The cottage hospital in Moretonhampstead Devon, opened in 1900

Although the quality of care in the cottage hospitals of rural and suburban England was usually more consistent, much like the nursing homes the premises were often small and cramped – the average had around 20 beds – the facilities frequently basic – many lacked x-ray equipment, access to laboratories or even adequate operating facilities – and the staff could have limited qualifications. In the 1920s patients generally had to pay a minimum fee while those being treated by their own GP were charged fairly standard rates – normally around three guineas per week maintenance plus the doctors fee. Nursing homes varied in price depending on the service and quality. Around 1929 it was suggested that charges in London ranged from eight to sixteen guineas per week for maintenance with the doctor’s fee in addition. However, in certain cases, mostly small homes for senile and chronic patients, fees could be as low as three guineas a week, a figure Medical Officers of Health and nursing home matrons felt was too low. Admittedly some nursing homes were very impressive – like Dickie’s – and in the big cities the skill of the surgeon was matched by the quality of the surroundings – but also by the cost. While Dickie was probably charging around thirty guineas for a standard operation, surgical stars like Moynihan expected hundred guineas for the same procedure, putting considerable pressure on the wallets of the bourgeois client.

 

V0014882 Royal Masonic Hospital, London: aerial perspective of the wh Credit: Wellcome Library, London. Wellcome Images images@wellcome.ac.uk http://wellcomeimages.org Royal Masonic Hospital, London: aerial perspective of the whole scheme. Process print after C.A. Farey, 1933. 1933 By: Cyril Arthur Farey and Burnet, Tait and LornePublished: - Copyrighted work available under Creative Commons Attribution only licence CC BY 4.0 http://creativecommons.org/licenses/by/4.0/

 

 V0014882 Royal Masonic Hospital, London:  By: Cyril Arthur Farey and Burnet, Tait and Lorne 1933.  Credit: Wellcome Library, London.

 

Some improvement was discernible in the healthcare options of the middle class by the later 1930s. In the face of considerable opposition from medical practitioners, some of the contributory schemes were slowly extended to white collar and lower professional groups. In 1938 the Sheffield Penny in the Pound Scheme was embroiled in a long battle with the local BMA over their willingness to let teachers, office staff and police officers join the scheme, a situation eased by the gradual raising of the income threshold for National Insurance that had provided a proxy limit for the contributory schemes. A more widespread development was the creation of provident schemes for middle class workers. Similar in operation and benefits to the contributory schemes, for a payment of between one and two guineas a year they provided free treatment for the contributor and their family either on the general wards or in the growing number of pay wards in voluntary hospitals. They could also be used to meet the costs in cottage hospitals and even in the small number of municipal hospitals charging private rates.

 

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Pay Ward in the new Miners’ Welfare Block at Sheffield General Hospital, 1937

The emergence of the provident societies was linked to the opening of pay wards or blocks in a number of voluntary hospitals. These wards were introduced to address the increasing disparity between the level of affordable hospital treatment available to working and middle class patients. The case was summed up in 1930 by Col. Tetley, Chairman of the Leeds Hospital for Women, when he noted:

We think there is a demand for this sort of accommodation [pay beds], partly because there are a great many people who can’t afford to pay charges for nursing homes and partly because it is often difficult to find, outside a hospital, the facilities for diagnosis and treatment and for immediate medical attendance in the event of an emergency occurring during treatment, which the ordinary hospital patient receives at a voluntary hospital. Many people…now often feel that in times of sickness they themselves cannot obtain the modern facilities for treatment which they are helping to provide for the ordinary hospital patients.

Academic examination of this phenomenon has been minimal but George Gosling has made some attempt to estimate the number of voluntary pay beds. He found that the number of private beds rose from around 4200 in 1933 to 6500 on the eve of the Second World War and 7500 in 1947, just before the NHS came into operation. There were however, significant differences in the regional distribution of these beds with almost 13% of voluntary hospital beds in London available to the middle class by 1938 but outside the capital just 7%. (Gosling, Charity and Change, Fig 5.2 and 5.3, p.251)

As Tetley implied, charges in this type of accommodation were lower than in the traditional nursing home – varying from three guineas for a shared room to nine guineas for a large single. Physician fees were on top of this but most were agreed the service and treatment were superior – not least because most private wings by the end of the 1930s were brand new. But as the figures from Gosling show, the available stock of pay beds did not cover demand from a middle class keen to take full advantage of the services a modern general hospital could offer.

Thus, it would seem that the arrival of the NHS did much to improve the health options of the middle class, especially the less wealthy crippled by large doctors fees for poor service and denied access to the most up to date and efficient hospital treatment. As with education, the new system made a substantial difference to the family budgets of clerks, lower professionals and even middle managers freeing up income for improved housing, more discretionary spending and even the ultimate status symbol of the 1950s, a motor car – and in the process possibly sowing the seeds of an increasingly sedentary, over-indulgent and unhealthy lifestyle!

 

Voices of Madness

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An International and Interdisciplinary Conference
Hosted by the Centre for Health Histories and Mental Health Nursing, University of Huddersfield
September 15th and 16th 2016

In the thirty years since Roy Porter called on historians to lower their gaze so that they might better understand patient-doctor roles in the past, historians have sought to place the voices of previously, silent, marginalised and disenfranchised individuals at the heart of their analyses. Contemporaneously, the development of service user groups and patient consultations have become an important feature of the debates and planning related to current approaches to prevention, care and treatment. The aim of this conference is to further explore and reveal how the voices of those living with and treating mental illness have been recorded and expressed. Over the course of the conference we will consider recent developments in these areas with a view to facilitating an interdisciplinary discourse around historical perspectives of mental health and illness.

Featuring Keynote addresses from:

Prof. Catharine Coleborne (University of Newcastle, Australia), ‘Talk, Dissent, Silence: Narrating Madness in the Twentieth Century’.

Dr. Tommy Dickinson (University of Manchester), ‘“Curing Queers”: Mental Nurses and the Patients, 1935-1974’.

To view the programme and book your place at this innovative conference visit:

http://www.hud.ac.uk/research/researchcentres/chphm/conference/

The cost of registration covers entry to the conference, refreshments, lunch on both days, and attendance at the conference dinner (subject to availability).

For updates follow us on twitter @voicesofmad2016 and join the conversation #voicesofmad2016. For more information contact Dr Steven Taylor (s.taylor@hud.ac.uk) Dr Rob Ellis (r.ellis@hud.ac.uk) or Dr Sarah Kendal (s.kendal@hud.ac.uk).

PERSPECTIVES ON THE PAST: HERITAGE, IDENTITY AND PRACTICE

A Postgraduate Conference
University of Huddersfield
20 – 21 June 2016
Programme of Events

Jointly sponsored by the Royal Historical Society and the University of Huddersfield

Day 1: Monday 20th June

9:15 – 9:45 Arrival and Coffee

9:45 – 10:00 Introduction and Welcome

10:00-11:30 Session 1: Medieval Histories Chair: Andy Holroyde, University of Huddersfield

Dave Halloran, Construction and Representation of Medieval Identities: the cases of Queen Melisende and Queen Isabella

Daniel Greenwood, Masculinity and Kingship: King Richard “The Lionheart” and King John “Lackland”

Dean A Irwin, On the Margins of Historiography: Bringing a Medieval Divorce Case from the Periphery to the Centre

11:30 – 11:45 Break

11:45 – 13:15 Session 2: History from Below Chair: Nicole Harding, University of Huddersfield

Miranda Reading, The Geography of the Past: Mapping ideas, identity and individuals in the battle for moral reform

Eve Hartley, Provincial Mechanics’ Institutes and early Public Heritage Engagement

Iain Riddell, What’s wrong with ‘Genealogy-fever’?

13:15 – 14:15 Lunch

14:15 – 15:15 Session 3: Cultural Identity outside of the UK Chair: Adam West, University of Huddersfield

Emily Webb, Nabob to Sahib: The Creation of the Anglo-Indian Community of the Raj, 1764-1858

Antony Stewart, “Heritage makes you rich, as it can make you poor” Haiti’s contested African Heritage and its consequences, 1928-1948

15:15 – 15:30 Break

15:30 – 17:00 Session 4: Cultural Identity within the UK Chair: Dave Halloran, University of Huddersfield

Adam West, Remembering the Holocaust: Approaches to Holocaust memorialisation following the Second World War in Great Britain and Germany

Shabina Aslam & Joe Hopkinson, “Bussing Out”, and issues with Researching Black and Asian Histories in Britain

Amerdeep Singh Panesar, Sikh memorial culture of the First World War in the UK

17:00 – 17:15 Roundup of the day

18:30 Conference Dinner

Day 2: Tuesday 21st June

9:00 – 9:30 Welcome and article submission

9:30 – 11:00 Session 5: Heritage in Practice Chair: Joe Hopkinson, University of Huddersfield

Sarah Taylor, Battlefield Burial Practices: What happened to the dead?

Nicole Harding, Creating tradition; the Gott Collection and rejection of industrialism

Hannah Rogers, “Git Thi’sen dawn t’recruiting office”: Individuals and Identity in Local Military Heritage

11:00 – 11:15 Break

11:15 – 12:15 Session 5: Local Histories Chair: Amerdeep Singh Panesar, University of Huddersfield

Michael Reeve, Making sense of war: ‘war cultures’ and local identity in Hull, Whitby and Hartlepool during the First World War

Martyn Richardson, “Coal is history Miss Mullins” Mining Community Heritage and Representation in the Yorkshire Coalfield 1947-1984

12:15 – 13:15 Lunch including launch of the second volume of the Postgraduate Perspectives in History journal

13:15 – 15:15 Session 6: Disability and Mental Health Chairs: Shabina Aslam and Robert Piggott, University of Huddersfield

Part 1: Papers (60 mins)

Amelia Grace Sceats, Tudor Perceptions of Mental Illness

Andrew Holroyde, Remploy: The Changing Face of Disability Employment, 1944-1979

Break: (10 mins)

Part 2: Panel and discussion (50 mins) Nicole Harding & Andrew Holroyde, Disability and Mental Health in Higher Education: our personal experiences

15:15 – 15:30 Roundup and thanks

15:30 Departure

Booking details here: https://www.eventbrite.co.uk/e/perspectives-on-the-past-conference-tickets-25021231176

 

Is air pollution an overlooked element in the mortality decline?

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‘Sheffield’, Harper’s Magazine, 1884

At the economic history society conference in April 2016 I attended a panel entitled Social Infrastructure featuring papers from Nicola Tynan (Dickinson College), and colleagues on ‘Who should own and control urban water systems? Disease and the municipalisation of private waterworks in nineteenth-century England’ and Bernard Harris & Andrew Hinde Public works loans, social intervention and mortality change in England and Wales, 1850-1914. Both papers were more or less concerned with the role of urban infrastructure in the mortality decline, provoking a heated discussion from an audience with a fair smattering of urban historians who challenged the findings of the two research teams. In particular, there was a call for less aggregate data and more specific case studies to allow us to understand the factors that may be influencing investment decisions and social and health change.

This session came to mind when I was preparing a recent presentation on Pollution and Public Health in early twentieth century urban England. The paper built on an article I published a few years ago on tackling pollution in Middlesbrough, extending that research by the inclusion of data on Leeds and Sheffield. Given their key roles in the industrial revolution of iron, coal and cloth, smoke was an everyday reality in these towns, a symbol of work, progress and prosperity. Yet it is apparent that historians – concerned with water-borne diseases and sanitation – have paid little attention to what was, by the 1880s, a more deadly public health problem. This is a strange situation, for as historians like Simon Szreter have noted, a key flaw in the McKeown argument is the rising mortality from non-tubercular respiratory diseases like pneumonia and bronchitis just as the old killers like typhoid were in decline. So this post will consider why air pollution has not attracted the attention of historians of public health.

First off we need to prove there was a link. Interestingly, for much of the 19th century Medical Officers of Health (MOHs) were reluctant to make an explicit link. Even in the most smoke blighted cities – like the iron and steel towns of Middlesbrough and Sheffield – council officials treaded carefully for fear of upsetting powerful local interests. Thus, in 1899 the newly appointed MOH for Middlesbrough, Dr Dingle, satisfied himself with a quote from Dr Harvey Littlejohn’s recent comments on smoke in Sheffield which he condemned for:

  1. Its power for conducing fogs and rain.
  2. Its power in shutting out sunlight and depriving us of certain qualities of light.
  3. By depositing smuts and rendering houses dirty, thus causing an unnecessary expenditure of labour and soap.
  4. Separation of the classes.
  5. Destruction of natural and architectural beauties

Yes this was skirting round the issues for even a cursory reading of the mortality figures for Middlesbrough raised the strong prospect of a causal link between smoke and respiratory diseases. By 1910 the MOH, along with external Local Government Board Inspectors, was admitting that 400 tons of ash a year were probably at least predisposing causes for chest related mortality twice the national average.

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Doyle, ‘Managing and Contesting Industrial Pollution in Middlesbrough’, Northern History, (2010)

Certainly by the late 1920s municipal medics were more willing to make the link. At the meeting of the Royal Sanitary Institute in Sheffield in December 1929 the assembled group discussed Smoke. Local politicians, representatives of gas and electricity concerns and a slew of MOHs, including the influential Dr Veitch Clark of Manchester and Dr Johnstone Jervis of Leeds, made demonstrable links between smoke and increased mortality and morbidity. Indeed Veitch Clark illustrated his insistence that ‘the evidence against smoke as a factor in the production of ill-health, disease, and defective development is overwhelming’ with ‘paintings of the lung…which demonstrated the way in which smoke pollution reached the innermost organs of the body’ [‘Congress at Sheffield’, Journal of the Royal Sanitary Institute, L.6 (1929) Sadly these illustrations were not included in the article.]

So why haven’t historians taken the problem seriously. First, there were few legislative instruments for public health officers to deploy. The main legislative tool was the 1875 Public Health Act which permitted councils to produce by-laws to regulate smoke pollution in some industries – although metal making was one of those exempt. When a new act entered the statute book in 1926 it was widely regarded as ineffective, a victim of business lobbying which actually eased some of the more restrictive by-laws. Under both pieces of legislation the process of bringing a prosecution was cumbersome and rarely effective.

More significantly, tackling smoke pollution didn’t require any capital expenditure on the part of the Council. There was no heroic engineering solution. Rather the task was labour intensive and deeply unromantic, with Sanitary Inspectors spending hours on end observing chimneys to see if they exceeded the local maximum number of minutes of black smoke in an hour – usually 5-6 but as high as 10 minutes in Middlesbrough and just 3 in Leeds. In the mid-1920s the inspectors of Leeds watched over 6,000 chimney in the year or more than twenty a day. If they caught a boiler offending they rarely opted to prosecute, choosing persuasion and education over the full force of the law. As Dr Clinch MOH for West Ham explained in 1929:

Briefly, the only method by which the local authority can abolish the black smoke of the boiler furnace is one of friendly cooperation with both owners and men, coupled with legal action if they are so foolish as to resist any other method.

Moreover, the engineering solutions that existed lay with the owners – technology like the mechanical stoker – which would only be adopted when the economic benefits outweighed the cost of pollution. There is much evidence to suggest this did happen as industrial air pollution fell sharply from the 1880s through to the 1930s as steam power was replaced by gas or electricity, smokeless coke was deployed or new technologies acquired. So on the face of it public health departments couldn’t even take direct credit for the improvements secured!

Hunslet Brit from Air

Hunslet, in South Leeds – note the large number of domestic chimneys

In part that was because the smoke was still there – generated now by the domestic coal fire. Dr Jervis, MOH for Leeds, felt more than 60% of atmospheric pollution was caused by the household grate, with he and his colleagues lining up to condemn the coal fire ‘fetish’ while accepting ‘the average Britisher will be a long time before he is prepared to sacrifice his open grate’ (Cllr Asbury, chair of the Sheffield Health Committee, 1929). Once again the public health department had few options beyond urging the population to switch to smokeless alternatives, like gas or electricity or take the expense and inconvenience of the newly created smokeless coke which few were keen to try. Propaganda in Health Week may convert a few but the reality was over one third of urban homes did not have electricity by 1938, many more could only access gas if their landlord was willing while in most of the industrial areas coal remained cheap and plentiful until the Second World War.

Finally health officials had to face what might be called the banal disamenity of smoke. On the one hand belching chimneys were seen by townsfolk as a sign of work and affluence – as the mayor of Middlesbrough asserted in 1888 ‘we are proud of our smoke’. This made it very difficult for council officials to pursue polluting businesses and often when they did they found magistrates reluctant to prosecute. But of equal importance was public acquiescence in  the continuation of the smokey gloom with ‘air and light…habitually.. forgotten…because our supply of both in urban communities is so bad. I suppose, that we have become blind to it.’ (Cllr Asbury)

Faced with these problems it is little surprise that the professionals and politicians at city hall chose to move either the people or the problem. They built their new estates (usually) at some remove from the worst industrial areas while supporting the zoning of industry. In both these they were aided by businesses choosing new sites outside the city for transport or cost reasons – as happened with the movement of the main iron and steel works out of Middlesbrough between the wars – and by private builders erecting their new estates in smoke free suburbs invariably to the south and west of the cities. Moreover, new houses were often equipped with gas and electricity and few, if any, coal fires – Leeds council restricting their own council houses to one coal fire per household! Ultimately the big the final push to major reform came in 1952 when a smog descended on London (metropolitan concerns determining national policy). Smokeless Zone legislation followed and the public – faced with the cost of Coalite – abandoned their coal fires.

As we can see, historians seeking greater understanding of the processes by which the mortality decline was effected in late nineteenth and early twentieth century Britain should pay much more attention to the role of air pollution and especially the deleterious impact of black smoke. But identifying its causes and effects and charting the course of the long and arduous war of attrition fought by the municipal authorities will require close attention to the local archives not just the returns of government departments or the legislation they promoted.