‘Smashed by the National Health’? A Closer Look at the Demise of the Pioneer Health Centre, Peckham

1. The epidemiologist Dr Julian Tudor Hart believed that ‘Far too much was attempted’ at the PHC, and that the Peckham doctors tended ‘to leap far ahead of the real scientific knowledge then available’. Letter to Dr Peter Mansfield, 30 April 1980; in author’s possession. On the ‘medical gaze’ see David Armstrong, n. 8 below. On the PHC’s attitude to the family, see Pyrs Gruffudd, ‘ “Science and the Stuff of Life”: Modernist Health Centres in 1930s London’, Journal of Historical Geography, 27, 3 (2001), 402–3.

2. For example, Dr Margaret Hannah, Deputy Director of Public Health in NHS Fife, is a PHF Trustee. Her book Humanising Health Care (Axminster: Triarchy Press, 2014) is endorsed by Iona Heath, former President of the Royal College of General Practitioners, and Professor Patrick Maxwell, Head of the School of Clinical Medicine at the University of Cambridge. Dr Jack Czauderna, PHF Chair, was for many years a Sheffield GP. Interviews with Dr Hannah (28 April 2015) and Dr Czauderna (13 October 2014).

3. For a full account of the Centre’s origins and achievements, readers are referred to the various publications of those who initiated it and those who worked there, and to the articles which Jane Lewis and Barbara Brookes wrote in the 1980s, based on their study of the Centre’s archival material. Lesley Hall, archivist at the Wellcome Library, where most of the Centre’s papers are lodged, has provided an essential overview of what they contain. Writings by those with first-hand experience of the Pioneer Health Centre include Innes H. Pearse and G. Scott Williamson, The Case for Action (London: Faber and Faber, 1931); G. Scott Williamson and I.H. Pearse, Biologists in Search of Material (London: Faber and Faber, 1938); Innes H. Pearse and Lucy H. Crocker, The Peckham Experiment (London: Allen and Unwin, 1943); G. Scott Williamson, Physician, Heal Thyself (London: Faber and Faber, 1945); G. Scott Williamson and Innes H. Pearse, Science, Synthesis and Sanity (London: Collins, 1965); Innes H. Pearse, The Quality of Life (Edinburgh: Scottish Academic Press, 1979); Kenneth Barlow, Recognising Health (London: Kenneth Barlow, 1988), and Alison Stallibrass, Being Me and Also Us (Edinburgh: Scottish Academic Press, 1989). Jane Lewis and Barbara Brookes, ‘The Peckham Health Centre, “PEP”, and the Concept of General Practice during the 1930s and 1940s’, Medical History, 27 (1983), 151–61; and ‘A Reassessment of the Work of the Peckham Health Centre, 1926–1951’, Health and Society, 61, 2 (1983), 307–50. Lesley A. Hall, ‘The Archives of the Pioneer Health Centre, Peckham, in the Wellcome Library’, Social History of Medicine, 14, 3 (2001), 525–38.

4. Pearse, Innes H. and Williamson, G. Scott, The Case for Action (London: Faber and Faber, 1938), 3.

5. Innes H. Pearse, ‘The Peckham Experiment’, Eugenics Review, 37, 2 (July 1945), 48.

6. Pearse and Scott Williamson op. cit. (note 4), 7.

7. Interview with Mrs Pam Elven, former Centre member, Cranleigh, 8 August 2013.

8. Stallibrass, op. cit. (note 3) 254, 255.

9. David Armstrong, ‘The Peckham Key: Ideal Project and Terrifying Dream’, Bulletin 33 of the Society for the Social History of Medicine (December 1983), 9–10. See also David Armstrong, Political Anatomy of the Body (Cambridge: Cambridge University Press, 1983), 36–38.

10. Gruffudd, op. cit. (note 1), 404, 410, 411, 412.

11. Michael Ryan, ‘Health Centre Policy in England and Wales’, British Journal of Sociology, 19, 1 (1968), 34. The National Health Service Act, 1946 (London: Eyre and Spottiswoode, 1947), 21–22. Very few health centres were actually built in the years following the establishment of the NHS. See Charles Webster, The Health Services Since the War, 1: The Problems of Health Care; The National Health Service before 1957 (London: HMSO, 1988), 380–88.

12. James Mackintosh, The Nation’s Health (London: Pilot Press, 1944), 13, 24, 64. Paul Rotha’s film The Centre was made for the Central Office of Information in 1947 http://blog.wellcomelibrary.org/2015/04/the-pioneer-health-centre-and-positive-health/.

13. The Medical Press and Circular (12 September 1951), 245. Mary Langman, undated typescript of ‘Approximate Dates and Places’ for Scott Williamson and Pearse; copy in author’s possession. Peter Ray, A Field Centre for the Practical Study of Human Ethology (Wellcome Library [hereafter WL] file SA/PHC/C.4/2), iv. John Nye, ‘Reminiscences of St Mary’s Road, Peckham’ (WL/PHC/C.20, Appendix 6). David Goodway, ‘Anarchism and the Welfare State: The Peckham Health Centre’, History and Policy (May 2007).

14. Peckham: The Bulletin of the Pioneer Health Centre, 1, 1 (May 1949), 2. The 1938/39 Report is dated April 1940 (WL/SA/PHC/A.2/11); the quotations are from pages 15, 13–14, 15, 18.

15. Correspondence in National Archives [hereafter NA] file FD1/299.

16. Ibid.The O’Brien in question was probably Dr Daniel P. O’Brien, an assistant director at the Rockefeller Foundation. I am grateful to an anonymous referee for pointing this out.

17. Ibid.

18. NA/FD1/299. Section 16 (1) of the National Health Service Act, 1946, states that ‘the Minister may conduct, or assist by grants or otherwise any person to conduct research into any matters relating to the causation, prevention, diagnosis or treatment of illness or mental defectiveness’.

19. NA/FD1/299.

20. Archibald L. Cochrane, One Man’s Medicine (London: British Medical Journal, 1989), 244, 245. Jane Austoker and Linda Bryder (eds), Historical Perspectives on the Role of the MRC (Oxford: Oxford University Press, 1989), 214. The MRC did in fact attempt to come to grips with practical problems, establishing its Social Medicine Research Unit (SMRU) in 1948. But as Shaun Murphy has shown, there was considerable tension between Harold Himsworth, who became MRC Secretary the following year, and Jerry Morris of the SMRU, with Himsworth sceptical about the value of the Unit’s work. In any case, the work carried out by Cochrane in South Wales, for instance, was very different from the work being attempted in Peckham. Cochrane was focused on disease, not health; and – crucially important as a matter of scientific methodology – the data his team gathered were not the result of self-selection, unlike the population being observed at the Pioneer Health Centre. Shaun Murphy, ‘The Early Days of the MRC Social Medicine Research Unit’, Social History of Medicine, 12, 3 (1999), 389–406.

21. NA/FD1/299. Christopher Addison (1869–1951), physician, agriculturalist and politician, had been Chairman of the MRC in 1948.

22. NA/FD1/299.

23. Ibid.

24. J.G.S. Donaldson (1907–98) was a wealthy socialist who, as a young man, gave half his fortune to the Pioneer Health Centre. He served as Minister for the Arts in the Labour government of the late 1970s, later joining the Social Democratic Party. His support for the Pioneer Health Centre was lifelong. WL/SA/PHC/B.6/10. WL/SA/PHC/B.6/1.

25. Mary Langman, unpublished typescript of a talk entitled ‘Management’, with ‘May 1987’ pencilled in at the top, 6–7; in author’s possession. Undated draft letter from Scott Williamson to Gregg of the Rockefeller Foundation (WL/SA/PHC/B.3/13/2).

26. Peckham: The Bulletin of the Pioneer Health Centre (May 1949), 4. London Metropolitan Archives [hereafter LMA] file CL/PH/1/131. A.D. Lindsay (1879–1952), Master of Balliol (1924–49) and founder of Keele University, had provided a Preface for Pearse and Scott Williamson’s The Case for Action in 1931.

27. LMA/CL/PH/1/131.

28. LMA/CL/PH/1/131. Section 21 (1) of the National Health Service Act, 1946, laid on every local health authority the duty to establish health centres providing facilities for general medical, dental and pharmaceutical services; any services local health authorities were required or empowered to provide, and facilities for outpatient and specialist treatment. The Pioneer Health Centre’s aims were quite distinct from these proposed concerns, only a handful of which ever materialised. See Webster, op. cit. (note 11), 380–88.

29. LMA/CL/PH/1/131.

30. Ibid.

31. Ibid.

32. LMA/PH/PHS/1/6.

33. G. Scott Williamson and Innes H. Pearse, The Passing of Peckham (London: Pioneer Health Centre, 1951), 7. The body in question may have been the Rockefeller Foundation, since the South London Observer of 17 August 1950 quoted Mrs Purser as saying that the Rockefeller Foundation would help the PHC if the government was prepared to recognise it officially. (The relevant cutting can be found in LMA/PH/PHS/1/7.) Whatever the truth of this, gaining funds from that body was always going to be difficult for the PHC. For a quarter of a century the Foundation awarded grants to the MRC, enabling it to send abroad British students for advanced training in medical science: appointees had included Sir Howard Florey and the animal geneticist Dr C.H. Waddington. The PHC’s status would have struck the Rockefeller Foundation as very marginal in comparison with that of the MRC. Also, as Robert Kohler’s study of the relationship between charitable foundations and the natural sciences during the first half of the twentieth century demonstrates, towards the middle of the century grants became increasingly hard to obtain as scientific methods grew more complex. The large foundations were ‘cultural transmission belts, carrying business methods and managerial values from the world of the large corporations into academic science’. Kohler concludes that by 1945, ‘The age of “big science” had begun’. Medical science would be dealing with the daunting problems of the post-war world. One can see that the PHC, dealing with a small, self-selected population of reasonably comfortable citizens, might not have struck the charitable foundations as a priority. Raymond B. Fosdick, The Story of the Rockefeller Foundation (London: Odhams Press, 1952), 293. Robert E. Kohler, Partners in Science: Foundations and Natural Scientists, 1900–45 (London: University of Chicago Press, 1991), 395, 396, 406.

34. Scott Williamson and Pearse, op. cit. (note 33), 8, 10.

35. WL/SA/PHC/B.4/4.

36. Mary Langman to Douglas Trotter, 2 January 1984; letter in author’s possession. Interview with Henrietta Trotter, 27 June 2006.

37. Mary Langman to Douglas Trotter, 2 January 1984; letter in author’s possession. WL/SA/PHC/B.6/1. Jane Lewis and Barbara Brookes, ‘A Reassessment of the Work of the Peckham Health Centre, 1926–51’, Health and Society, 61, 2 (1983), 341.

38. WL/SA/PHC/B.5/16/1.

39. Scott Williamson to R.P. Winfrey, 2 January 1951 (WL/SA/PHC/B.15/5). Scott Williamson and Pearse, op. cit. (note 33), 3.

40. James Le Fanu, The Rise and Fall of Modern Medicine (London: Abacus, 2012), 224, 230. It may be that Le Fanu has over-simplified for dramatic effect. Rosemary Wall has argued that ‘from the 1920s to the 1940s, Horder publicly supported specialisation in general in medicine, not just within the laboratory’ and ‘was happy to use specialists, diagnosing patients away from the bedside’. Nevertheless, she records that he became worried about his patients’ increasing faith in technology and in experts, and their concomitant scepticism about their clinician’s depth of knowledge. Le Fanu’s identification of the trend towards a more specialised, technologically based medicine remains valid. Rosemary Wall, Bacteria in Britain, 1880–1939 (London: Pickering and Chatto, 2013), 58, 62.

41. Austin Bradford Hill and I.D. Hill, Bradford Hill’s Principles of Medical Statistics, 12th edn (London: Edward Arnold, 1991), 5.

42. H.I. Winner, ‘The End of the Peckham Experiment?’, Scientific WorkerV, iv (July 1950), 19. Sir Henry Dale, ‘Scientific Method in Medical Research’ British Medical Journal, 2 (1950), 1189.

43. Austoker and Bryder, op. cit. (note 20), 212, 27, 29. A. Landsborough Thomson, Half a Century of Medical Research, 1: Origins and Policy of the Medical Research Council (UK) (London: Medical Research Council, 1987), 2; Half a Century of Medical Research, 2: The Programme of the Medical Research Council (UK) (London: Medical Research Council, 1987), 9–10.

44. Landsborough Thomson, op. cit. (note 43), Vol. 2: 352–70. Peter Medawar, Memoir of a Thinking Radish (Oxford: Oxford University Press, 1991), 136. Landsborough Thomson, op. cit. (note 43), Vol. 2: 3.

45. Chemistry and Industry, 11 January 1947, 21, 20; 26 July 1947, 457; 10 September 1949, 637–8. The statistician and eugenicist R.A. Fisher worked at Rothamsted from 1919 to 1933, Russell being instrumental in employing him there. Sir E. John Russell, The Land Called Me (London: Allen and Unwin, 1956), 131–2.

46. Lewis and Brookes, ‘A Reassessment’, Health and Society, 61, 2 (1983), 336. On the founding and early years of the Soil Association, see Erin Gill, ‘Lady Eve Balfour and the British Organic Food and Farming Movement’ (unpublished PhD thesis: University of Aberystwyth, 2010), 73–168. For the wider context, see Philip Conford, The Origins of the Organic Movement (Edinburgh: Floris Books, 2001), and The Development of the Organic Network, 1945–1995 (Edinburgh: Floris Books, 2011), 40–70.

47. This parallel between agriculture and human development is explicit in Scott Williamson’s Preface to K.E. Barlow, A Home of Their Own (London: Faber and Faber, 1946), 5–7.

48. Le Fanu op. cit. (note 40), 234–47.

49. Chemistry and Industry, 21 July 1951, 621–23: 623.

50. Ivan Illich, Limits to Medicine (London: Marion Boyars, 1976); Thomas McKeown, The Role of Medicine (London: Nuffield Provincial Hospitals Trust, 1976); Ian Kennedy, The Unmasking of Medicine (London: Allen and Unwin, 1981), 17–22, 34–36. Jonathan Gathorne-Hardy, Doctors: The Lives and Work of GPs (London: Weidenfeld and Nicolson, 1984), 239.

51. Rodolfo Saracci, Epidemiology: A Very Short Introduction (Oxford: Oxford University Press, 2010), 10–11. Letter, Julian Tudor Hart to Peter Mansfield, 30 April 1980; in author’s possession. Peter Mansfield, when a young academic medical researcher, was profoundly influenced by the ideas of Dr Innes Pearse; interview with Dr Mansfield, 6/7 November 2008.