I have a lot to say about health and medicine in the fifties, which was very different to today. I think I have put it off because this post will be a bit rambling and unstructured, but never mind. You can’t stop me that easily …
I am going to start with a picture that most younger people will find hard to believe – the inside of a Doctor’s surgery in the fifties. For the more than ten years we lived there, our doctor, Doctor Segall (not sure of spelling) lived less than half a mile away. His surgery and consulting room were in the ground floor of his house. He was the only doctor in the practice with no receptionist or surgery management. He was very typical of the time. There were no multiple practices (and no practice managers).
I think he held surgeries four times a week, every weekday except Wednesday. If you wanted to see him you turned up at the surgery. There was no such thing as an appointment.
There was a large waiting room. As you went in, you had to note everyone there, who were ahead of you. He would call the next patient and, one at a time, the next one would stand up and go to his consulting room. Eventually when only people who had come after you remained, you knew it was your turn next. (No visible queue. No number system. We just knew who was next. If in doubt you might ask someone if they came before you.)
The doctor would see everyone for as long as necessary and the surgery continued until the waiting room was empty. You never had to wait until another day.
Best not to consider appointments and delays now!
After surgery, the doctor would visit all those in need of help who could not come into surgery. Calling for the doctor was one of the rare things sufficiently important enough to be done by telephone. Again this would take as long as necessary. The need for a house call was not questioned. There was no pressure to attend surgery and certainly no necessity to find a means of transport to get there.
If you telephoned at other times, the doctor would make emergency visits. He was on call every evening, every night and throughout every weekend. If he was called, then it was important enough for him to come out. [This is all from my memories, but at least the general picture is right.] When the doctor went on holiday a locum would give 24-hour cover for two weeks.]
The doctor brought his leather bag with all of his equipment for home visits. An examination would always include use of the stethoscope and he had a small mercury thermometer, which was held under the tongue for a few minutes – a nightmare for modern Health and Safety! [Thermometers were marked in Fahrenheit, where 98.4 degrees was considered to be normal body temperature, unlike the picture above, which uses Centigrade. For a home visit, he would give the thermometer to Mum afterwards for a quick rinse with warm water, so it was ready for the next patient.] Pulse rate came by touching your wrist and using his watch. Blood pressure was the old-fashioned wraparound and pump system. That was about it.
He would make a diagnosis instantly, with no Internet, no computers, no telephone calls and not even the chance to look into a medical book. (OK, at times he must have deferred the decision, but I am generalizing!)
If you needed any medicine, the doctor would write the prescription on a piece of paper and you took it to a Chemist. Doctors were notorious for their illegible writing and no one but the chemist could read a prescription. There were no charges for prescriptions. All tablets were dispensed in bottles with no blister wrapping like today. (You could buy aspirin and all other non-prescription medicines in bottles of a hundred, which facilitated attempted suicides from drugs.)
The medicine did not include a piece of paper listing possible side-effects etc. Al you had was what the doctor told you (which was nothing.) If you had to take, say, two tablets three times a day, this would go on the prescription and the pharmacist would write on the bottle. Nothing else.
Doctors were treated as respected professionals. (See Secrecy.) Nobody questioned a diagnosis or treatment, and it was up to the doctor what he chose to tell the patient. When prescriptions were given, people were just told to take them. They were not told what the medicine would do, or how long it would take, or whether there were any possible side-effects. For minors (in those days this meant under 21) all conversations with the doctor would involve the parents, not the child.
In one of those politically correct decisions, what we used to call Casualty is now called Accident and Emergency (A and E.) I suspect the change, which came long after the fifties, was to discourage too many visits. We only ever visited for fractures where plaster of Paris was routinely used.
As for GPs, there was awe and respect for hospitals, doctors and nurses. People did what they were told and were never given any choices. Patients were not given any information about why things were being done to them and they were not really asked for permission. Life was much easier for doctors. They were under no risk of litigation. When mistakes were made, hospitals might have carried out their own internal investigations, but results were never made public.
Both doctors and nurses dressed more formally. Nurses had very formal uniforms including hats, and a number of different uniforms delineated the various grades of nursing staff. Doctors wore white coats, or in some cases formal suits. (And just in case this was not enough, no doctor ever went anywhere without a stethoscope round his neck.)
Hospital visiting rules were rigid and rigidly enforced – normally fixed hours (an hour each morning and an hour in the evening); two visitors each.
Everything was simpler and the procedures carried out in hospitals were much simpler. Many of the more advanced operations had not been attempted. There were no transplant operations. (I think the only exceptions were corneas. Kidney transplants started in the fifties.)
The management of hospitals was by the usual hierarchical management systems of government in those days, with no NHS Trusts of any description.
[It’s hard to get a good picture of nurse’s uniforms of the times. Search engines give a mixture of too early, too late and erotic fantasy. This one is probably too modern. The picture at the top of this post, from Call the Midwife, is too early.]
In the fifties most deliveries took place at home. The trend in the sixties and seventies was towards almost universal hospital deliveries, but since then the reverse trend once again sees the popularity of home deliveries rising.
As with doctors and nurses, midwives simply told the expectant mothers what to do. What we now call the Delivery Suite was then the Labour Ward. There was no element of choice in delivery procedures or anything else. (Lots of sweeping generalizations in this blog!) There were no epidural anaesthetics, no Birth Plans and virtually no elective Caesarean Sections.
Treatment for infertility was relatively basic. In vitro fertilisation (IVF) came only in the late seventies. (I will look at contraception later in another post.)
Dentists and Opticians
Dentists all gave National Health treatment and it was all free. Basic treatment was probably as now with drills for fillings (often mercury amalgam) and gas for extractions. I hated the smell of the gas.
In a way they were similar to the doctor’s surgeries described above, with no management. Even in the nineties my dentist kept paper-based records and managed appointments himself, sometimes with an assistant while doing fillings – sometimes he was on his own. Now, in the same building, my dentist has a separate large waiting room with three staff doing reception, two hygienists and a permanent assistant.
Opticians were also part of the National Health System and most glasses were free. Contact lenses were much rarer. I can’t say too much about these as I managed to live into the nineties before needing glasses.
This is not the place to discuss the details of our modern inoculation system – but it has effectively eradicated many childhood diseases that were almost accepted as routine.
Most children at some stage as they grew up had measles, mumps and chickenpox. These were probably the main causes of home visits by the doctor. For most families, rubella, which was then known as German measles, was particularly associated with problems during pregnancy. If you knew someone with German measles and had girls under puberty, you would try to get them to catch it while it was too early for such complications.
Scarlet fever, smallpox and polio had virtually disappeared. Smallpox was declared to be ended worldwide in 1977, after its eradication through vaccinations. Polio had left its mark and I knew a few people with partial paralysis from polio earlier.
We had vaccinations by inoculation, hypodermic needles. I can’t remember the details but they were done at school. We all had them and I was not aware of our parents having any choice. We would just queue up for the procedure. (I could be wrong, but I am sure disposable needles were not used. The same needle could cover several vaccinations.)
The last one was the BCG for Tuberculosis (TB), somewhere around the fourth form at Ilford County High School. This was done in the hall of the church just next to the school (now Barkingside Methodist Church on Google Maps.) We were given timed appointments and missed part of a lesson. BCG involved a pre-test and left a small scar on the shoulder.
The use of a sugar cube for this polio vaccination was a few years too late for us. I don’t think we had polio jabs.
There were times earlier, probably mostly at Primary School, when we had other visits from medical staff to check our general health. We had eye tests and dental check-ups with referral onwards where necessary. And there were visits by the nurse to check hair for nits.
I also remember a general medical check-up by a doctor at ICHS, at around puberty – earlier than the BCG, probably in the same place. The doctor’s request to cough was recognized and incorporated into our boyish banter and humour.
Health in General
There are so many ways in which our health has improved and medical diagnosis and treatment has improved.
Average life expectancy has consistently gone up and we now live at least twenty years longer. Even in the sixties, on average we lived only just to about 65. Now we almost expect to live to eighty or ninety. (I will consider elsewhere the economic effects of this. An old age pension used to be something that maybe be lasted two or three years. Now it has to pay for perhaps thirty years of life in continuing inflation, and expensive medical life-extending treatments.)
Because cars were uncommon, we walked and exercised more. Food produced by cooking at home was in many ways healthier – and sugared drinks were not in popular use. So obesity was not common.
On the other and, smoking was much more common. It was generally socially acceptable. People routinely smoked at home, at work, in shops, pubs and elsewhere. So smoking related diseases were presumably more prevalent. Alcohol was more controlled, never seen on the streets, and much less of a problem. (Now it seems to be acceptable to drink from cans anywhere, or from bottles, or coffee in paper cups. Sweeping generalization – but we did not eat or drink except sitting down at a table.)
Drug problems were much less. Although there was some culture of cannabis use amongst the youth, hard drugs such as Cocaine and Heroin were much rarer. Drugs such as Ecstasy did not exist.
Without computers or complex machinery, many of the (expensive) treatments and operations of today were unavailable and because of this there were not the controversies about where scarce funding should be directed. There were no kidney transplants or heart transplants, no routine hip replacements, no laser surgery for eyes, no statins routinely prescribed as preventative medicine.