1940’s Book on Medicine Before the NHS

Future Medicine Pic

I found this book, The Future of Medicine by D. Stark Murray (Harmondsworth: Penguin 1942) in one of the second hand bookshops in Cheltenham. Its writer was a medical doctor and science writer, and the book was published when the National Government was discussing the establishment of something like the modern NHS with the Beveridge Report. The book is basically a description of the terrible state of health care as it was in the early 1940s, and the possible reforms which would create a better healthcare system.

Amongst the problems it discusses are the fees charged by contemporary doctors, and the inability of the poor to afford them. These could be so costly that some patients were going to the hospitals for cheaper treatment instead.

Whatever relations the doctor has established between himself and his patients, and generally with the public in the area in which he lives and works, the greatest barrier to perfect human relations is that sooner or later the question of fees will arise. Medicine remains a service that is sold by the doctor and much be purchased by the patient, since the doctor operates in a competitive system. To earn his living and to pay the cost of his practice he is bound to make a charge every time his services are utilised. For the patient this is great drawback, which in some cases amounts to an insurmountable difficulty, for the more ill he is the more medical care he will require and, theoretically at least, the more he will be called upon to pay. where sickness means complete loss of income, the illness becomes not merely something that jeopardises his life but part of that nightmare which is the lot of those whose economic stability is balanced precariously. (Pp.28-9)

Doctors also use their right to vary their fees as a way of getting rid of individuals or sections of their practice which they do not consider remunerative or otherwise attractive. “Night fees” fall into this category, and the doctor who has grown tired of going out in the middle of the night and who has a practice which is paying him a good income, may see the end of all but most urgent night calls by charging a sufficiently high additional fee for this service. (p. 29).

On occasions the difficulty is a totally different one. The patient is able to pay the doctor’s ordinary fee for a short illness but unable to face the kind of bill that would mount up if daily visits proved necessary over a long period. In other cases the patient may be able to pay the doctor’s maximum charge but unable to face bills for extras, food delicacies, expensive drugs, nursing assistance, and so on.

This very significant figure shows to what extent the patient has doubted the efficiency and quality of the service obtainable by the panel and private fee systems, leading him to look for something better at hospitals which have acquire a reputation for sound medical work. Whether these people went to the outpatient department through the agency of their own doctor or did so on their own initiative, the significant point is that they are exchanging the personal service of the isolated general practitioner for the organised and therefore possibly more efficient but strictly impersonal services of the doctors attached to the hospital…

Nevertheless it is significant that so many turn to the hospitals for a service they cannot obtain otherwise. This need not be regarded, as in some medical quarters, as a blow at the medical profession as a whole, nor accepted with complacency by those who control the hospitals as proof their perfection; but rather as an indication of the patients’ demand for something more than they get today. That demand is not for a “friend of the family” with a bedside manner, but for a service or chain of services in which the general practitioner and the hospital should be mutually dependent links. (P. 26).

This was the state of healthcare in Britain before the establishment of the NHS, and it’s still the state healthcare in America, where 20 per cent of the population could not afford private medical insurance until the introduction of Obamacare. Medicine is immensely profitable, which is why the Tories under Jeremy Hunt, the Health Secretary, are doing their level best to privatise the NHS. They must be stopped.

Capitalist Healthcare

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One Response to “1940’s Book on Medicine Before the NHS”

  1. sdbast Says:

    Reblogged this on sdbast.

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