In Cologne: Cash and Care

Cologne is a wonderful city. This much is immediately obvious, emerging from the main train station to find the Dom (the cathedral) towering over you and the Rhine just behind you. It’s also my kind of city. Gay couples hold hands openly. The graffiti lives up to my high standards. If you’re drinking their local Kölsch beer, unless you put a beermat over your glass to say you’ve finished, they just keep topping you up – which in my book is good hosting. And I plan to spend the next few days digging deeper into a city with great bars and some impressive record shops, as well as checking out a few the art galleries and museums (not least the Chocolate Museum!) But what brought me here was this year’s conference of the European Association of the History of Medicine and Health.


This year’s theme was cash and care, which suited me perfectly. My first book, which I had hoped would be out in time for this conference is all about cash and care. It examines what it meant for patients to pay the hospital where they received treatment before the British National Health Service – something that was only normal practice for three decades until the 1940s. Before this time, the hospital was an institution overwhelmingly dedicated to treating the poorer sections of society, and the model of a philanthropic transfer whereby the well-off donated funds for the poor to be treated free governed. Deviations from this were widely condemned as ‘abuse’. Under the NHS, treatment free at the point of use became a common right of all British citizens, with NHS hospitals charging for services quickly becoming and remaining today a controversial matter. It’s a timely episode for us to consider with self-funded services growing within the NHS, but it also tells us something important about the fundamental changes Britain was undergoing in the second quarter of the twentieth century. The story here is one of how through these relatively short-lived payment schemes money mediated the transition from class segregation of the sick to the universalism of the welfare state.

Cologne - Gosling
Paparazzi by Gareth Millward

The issue of paying patients cropped up in a few other papers. I’ll need to find out more about the Swedish public system Marie Clark Nelson (Linköpnig University) spoke about. At the turn of the twentieth century this determined who should pay for hospital care not only by dividing patients into those of means, little means or no means, but also taking into consideration age and the amount of tax they paid. It was interesting to hear from Joan McMeeken (University of Melbourne) that it was historically controversial for Australian physiotherapists to take private consultations, since these were not coming from medical referral and therefore undermined a central pillar of their professional identity. While Fallon Mody (Melbourne/Kings College London) brought to my attention those doctors who fled Britain for Australia to escape working for the NHS, with preserving private practice a major concern for leading figures such as Dr Charles ‘Ted’ Gawthorn. Along with Eureka Henrich (University of Leicester), Joan and Fallon presented an excellent Australian history panel – one of my highlights of the conference.

Others took a focus on money and medicine in a different direction. The society’s incoming president, Octavian Buda (Medical University Bucharest), for example, spoke about the funding of late nineteenth-century medical research and the personalities and networks so important in Romania and Bulgaria. Ian Hutchinson (University of Glasgow) and Claire Jones (KCL) considered what hospital finances might reveal about the history of infection control in British hospitals. Keynotes from Nancy Tomes (Stony Brook University) and Wendy Kline (Purdue University) brought in the business dimensions of their topics, pharmaceutical advertising and home birth respectively. Matt Smith (University of Strathclyde) took an economic approach to history and policy – drawing on the postwar US history of social psychiatry to put forward a case for a universal citizens’ income. If my paper sought to understand medicine as charity, one of my favourites of the conference framed it explicitly as business. This was Barbara Brookes’ (University of Otago) paper on Dr Anna Longshore Potts, that rarity of a woman doctor in the mid-nineteenth century who ended up travelling the world speaking to women. Hers was a story of fame and scandal, challenging the medical establishment and making huge amounts of money.

The NHS had a good representation. Martin Gorsky (London School of Hygiene and Tropical Medicine) examined the impact of the first phase of Health Economics on attempts to deliver on Nye Bevan’s promise that the NHS would universalise the best through the ugly-named RAWP (the Resource Allocation Working Party). Sally Sheard (University of Liverpool) offered an insightful look at efficiency and productivity in the NHS via the drive for shorter hospital stays. And beyond this conference, NHS history is in a healthy place right now. As we get ever closer to the service’s 70th anniversary, the Wellcome Trust has funded three major projects through their Investigator Awards scheme that help us make sense of its extraordinary place in British history and culture. Martin’s means a team looking into Health Systems, Sally’s has another looking into medical, economic and management expertise in the NHS, while I’m just starting work for Roberta Bivins and Mathew Thomson on theirs at Warwick University which turns attention to the arena of meanings, representations and feelings in the history of the NHS. It’ll be interesting to see how the conversation between these research groups develops.

Dr Hannah Newton winning the book prize for 'The Sick Child in Early Modern England, 1580-1720'
Dr Hannah Newton winning the book prize for ‘The Sick Child in Early Modern England, 1580-1720’

There are always more good papers than it’s possible to attend at conferences like this, and I had a particular problem of finding papers that spoke directly to my research up against each other. But my overall impression was that the cash and care theme was firmly in the background and sometimes entirely missing. On one level, it’s nice to see the field isn’t full of people who’ve beaten me to it. And even those whose topics were more generally medical history had some really interesting contributions to make.

Hilary Marland (University of Warwick) and Catherine Cox (University College Dublin) presented some of their work mental illness and prison in late nineteenth-century Liverpool, especially the workings of the ‘separation system’, throwing up some fascinating questions of isolation. Laurinda Abreu’s (Universedade de Évora) work on the professional disputes between the University of Coimbra in Portugal, the Major Physician and the Major Surgeon made me think of the sixteenth century in new ways. Jonathan Reinarz (University of Birmingham) showed that the development of burns units can offer a useful window into some major changes taking place in the modern hospital, a worthwhile case study not least because of its revealing atypicality. And Virginia Berridge’s (LSHTM) keynote address brought into focus the role of the medical historian in policy and public debate. Professionals and policymakers don’t need us to inform what they already know about the past, our job is to provide what she calls ‘history to make you think’.

All in all I’ll be looking forward to the next EAHMH conference. Those who skipped the closing committee meeting to fit in one last museum missed it being introduced very entertainingly by the incoming president, who will host it in Bucharest, Romania in September 2017. The topic will be The Body Politic: States in the History of Medicine and Health.

Cologne - Berridge
EAHMH 2015 keynote lecture from Professor Virginia Berridge

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