Health services before the NHS

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Before the establishment of the NHS in 1948, the provision of health care was inextricably bound up with religion and controlling the poor. What is clear is that capitalism has never been able to provide health care for working people and they have been forced to rely on charity and philanthropy. 

Role of religion

Much of the early care for people who were ill was provided by religious communities where care was provided by monks and nuns attached to monasteries.  Some were independent and had their own endowments, usually of property, which provided income for their support. Most hospitals were founded for specific purposes such as leper hospitals, or as refuges for the poor and it was not until later did hospitals become multi-functional. Not all hospitals cared for the sick and there were establishments to house the dying or infirm but the purpose was not cure or even care but to keep the ill poor off the streets.

The Poor Laws

The 1601 Poor Law created a national system for relief, paid for by levying local rates or property taxes. It was essentially to force the poor to work, including children as apprentices, and provide limited relief for those too ill or old to work, the so called ‘impotent poor’. Some older people were accommodated in parish almshouses, though these were usually private charitable institutions. Almshouses were religious institutions in existence from the 10th century - in the middle ages the majority of hospitals functioned as almshouses. For the landowners, poor relief provided a way of controlling the 'lower orders' and reinforced a sense of social hierarchy.

The 1834 Poor Law Amendment Act introduced sick wards in parish workhouses. Although intended for the people in the workhouses, the wards soon became full with sick poor people from the parish in general, prompting the state to assess how best this situation could be dealt with. In 1854 there was a report of a Select Committee on Medical Poor Relief and while much of the evidence given to the Committee favoured extending the medical services of the Poor Law to a much larger section of the population - through schemes such as free dispensaries - this was ignored and the care of ill people was left to a few philanthropists to provide. It was not until 1929 that hospitals were finally transferred from the Poor Law to local authority committees.

The early hospitals

It was not until the eighteenth century that the modern hospital began to appear, staffed with physicians and surgeons. Nine hospitals were established throughout the country but the word 'hospital' was also used for institutions concerned with people and their families who were poor or destitute, as part of the Poor Law provisions.  In London, for example, the only medical hospitals in the 1700s were the Royal Hospitals of St Bartholomew and St Thomas. There were other hospitals for special categories, such as Greenwich for injured sailors and refugees, the Magdalen Hospital founded to rescue ‘penitent prostitutes’ and the Marine Society for Educating Poor Destitute Boys. Between 1719 and 1750 five new general hospitals were founded in London and one of these was Guy’s Hospital, founded in 1724, from a bequest by a wealthy merchant Thomas Guy. Guy was a stock speculator investing in government securities, including £42,000 worth of shares in Britain's official slave-trade organisation, the South Sea Company. He amassed a large fortune but was well known for paying his workers a pittance.

19th century medical care

Medical care was principally private or voluntary and people had to pay for anything they needed. Medical care tended to deal mainly with serious illnesses. Local authorities of large towns provided municipal hospitals, maternity hospitals, hospitals for infectious diseases like smallpox and tuberculosis, as well as hospitals for the elderly. However, due to the social upheaval caused by industrial revolution, there was a large growth in unemployment and poverty. Sickness became a primary cause of poverty so the Poor Law authorities were forced to develop 'infirmaries' for sick people. Although initially resisted by the state, the number of infirmaries grew very rapidly. At first, in order to access an infirmary a person had to be a pauper. However, if a person was classified as a pauper then they were also unable to vote. It was not until 1885 that the law which required people to be paupers to use the infirmaries was abolished.

There were a few philanthropists and social reformers who tried to provide free medical care for the poor. In 1828, William Marsden, a young surgeon, opened a dispensary for advice and medicines - the 'London General Institution for the Gratuitous Cure of Malignant Diseases'. This four-storey house in one of the poorest parts of the city was conceived as a hospital, to which the only passport should be poverty and disease. Treatment was provided free of charge to any destitute or sick person who asked for it - the demand for his free services was overwhelming. By 1844 his premises, now called the Royal Free Hospital, was treating 30,000 patients a year. Despite consultant medical staff giving their services free of charge, they had to rely on money from legacies, donations, subscriptions and fund-raising events. However, in 1920 it was on the brink of bankruptcy and so forced to ask patients to pay towards their treatment, just like every other voluntary hospital in the country.

Mental Health

Mentally ill people and those with learning disabilities were treated even worse than the poor. They were locked away in large forbidding institutions, not usually for their own benefit, but to keep them out of society. The ruling class was happy to foster the view, especially in the 17th century, that if mad people behaved like animals they should be treated like animals.  The Bethlem Royal Hospital (also known as Bedlam) was the world's oldest psychiatric hospital, established in 1330. Conditions were consistently barbaric and the care amounted to little more than restraint - violent or dangerous patients were manacled and chained to the floor or wall and it became infamous for the brutal ill-treatment given to ‘inmates’. In 1675 it moved to new buildings outside London’s city boundary and by the 18th century people used to go there to watch ‘the lunatics’. Entry was free on the first Tuesday of the month and for a penny a person could peer into their cells, view the "show of Bethlehem" and laugh at their behaviour, often of a sexual nature or violent fights. Visitors were permitted to bring long sticks with which to poke and enrage those incarcerated there and in one year alone (1814) there were 96,000 visits. Conditions in institutions like Bedlam were so bad that many patients became worse, not better.

In 1773 a Bill passed the Commons to regulate private ‘madhouses’ but it was thrown out by the Lords. The following year it became essential to produce a medical certificate confirming insanity before rich people could be locked away. For the wealthy there was also the alternative of being an individual private patient of a doctor or clergyman. However, the rights of poor people were totally disregarded and as they were not a useful commodity to the industrialists, they did not want their healthy workers wasting time caring for their family members who might be mentally ill.

General Practitioners

The first attempt to regulate what we now know as GPs was through the 1815 Apothecaries Act. Apothecary was the also offered general medical advice and a range of services including minor surgery and midwifery. The Act introduced a compulsory apprenticeship and a formal qualification and required individuals to have instruction in a range of subjects including anatomy, botany, chemistry and physics - in addition to six months' practical hospital experience. It also gave the Society of Apothecaries the right to examine and license apothecaries. Soon a licence from the Society became the commonest qualification among GPs, although by 1840 it was estimated that only about a third of those practising medicine were qualified by examination. They sold medicines to surgeons, physicians as well as patients but for the working class the cost of treatment and care was often out of their reach. In addition to medicines they would also sell tobacco! historical name for a medical person who formulated and dispensed drugs but they

 

Beginnings of a welfare state?

It was not until the 1911 National Insurance Act that basic medical cover for the working population was given. Access to a doctor was free to (male) workers who earned less than £2 a week but this didn't necessarily cover their wives or children, nor did it cover other workers or those with a better standard of living. Hospitals charged for services, though sometimes poorer people would be reimbursed. Even so, it meant paying for the service in the first place, which most could not afford. The need for free health care was becoming widely recognised but the capitalists were not prepared to support it.

Throughout history, health services and the medical profession have been used as a means of social control. Whether it’s forced sterilisation of whole sections of the population or as a gatekeeper to services and benefits, the medical profession has always acted to support the interests of the capitalist class.


18th Century Children in London

One of the worst problems affected by the social conditions in London in the early eighteenth century was the large numbers of children either entirely abandoned or thrown on the tender mercies of the parish. Compared with many other European cities London was late in providing welfare for these children as it was common for illegitimate children to be handed over to parish officers for a lump sum. The only provision for illegitimate babies was the parish poorhouses or, from 1722, the workhouses where they frequently died of neglect.

In the 1720-30s poor children were dying at an alarming rate. Mortality rates were extremely high: over 74% of children born in London died before they were five. In workhouses the death rate increased to over 90%. There was no medicine to combat the diseases faced in a number of severe epidemics - typhus, dysentery, measles and influenza. In addition it was estimated that at this time 11.2 million gallons of spirits were consumed in a year in London (roughly seven gallons per adult) so the “Gin Craze” swept the nation with disastrous consequences.

Educate Yourself

  • Educate Yourself
  • The Fundamentals of Marxism
  • Dialectical Materialism and Science
  • Historical Materialism
  • Marxist Economics
  • The State
  • Russia, Lenin, Trotsky and Stalinism
  • Anarchism
  • Feminism
  • Fascism
  • The National Question
  • Revolutionary Strategy
  • Revolutionary History

Socialist Appeal are proud to publish this basic guide to help focus your studies of Marxist theory and practice. Visit the various tabs to find links to introductory articles, classic texts, and audio talks for different topics. We also invite our readers to become acquainted with the more basic ideas of Marxism by starting with the recommended short reading list, going through the FAQ section, reading this article that combats the myths about Marxism, and listening to the following audios:

Why Marx Was Right - Alan Woods

What is Marxism? - Alan Woods

What Will Socialism Look Like? - Fred Weston

What is Socialism? - Rob Sewell

We will be expanding and developing this section over time. Please contact us if you have any questions, or if you'd like any suggestions on what to read next.

Reading the classics of Marxism is the best way to understand these ideas. At first it may seem difficult, but every worker and young person knows that things worth having are worth working hard for!  Patient and persistent study, discussion, and ultimately, the day to day application of these ideas over a lifetime are the key.

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Marxist theory is the basis upon which our analysis, perspectives, program, and participation in the movement are based. It is our "guide to action." This why Socialist Appeal and IMT place so much emphasis on political education. To this end, we have created an extensive Education Plan to assist comrades in their political development. This is an important resource.

However, it's length and scope may seem daunting to new comrades. With this in mind, Socialist Appeal has compiled a shorter list of classic works and other important writings we think will serve to lay a strong foundation in the ideas and methods of Marxism. We would like to encourage all our supporters and those interested in learning more about Marxism to read (or re-read!) through the works on this list.

This selection of writings is an excellent introduction to many of the fundamentals of Marxist theory. There are many other writings that could be added, but this selection provides a strong basis for those wishing to equip themselves with the necessary ideas for the daily work of fighting for socialism.

Many of these are smaller books or pamphlets; some are more lengthy books; and others are just short articles. This

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Dialectical Materialism is the philosophy or methodology of Marxism. Every political movement, party, or even statement of any kind bases itself, consciously or unconsciously, on some sort of philosophy or world outlook. Marxism is concerned with effecting a radical change in society, and therefore requires an exceptionally clear, thoroughgoing, and systemic set of philosophical principles.

The ideas of Dialectical Materialism, based on the best traditions of philosophical thought, are not a fixed dogma but a system of tools and general principles for analysing the world materialistically and scientifically.

If we are to understand society in order to change it, this cannot be done arbitrarily, since the human will is not master of nature; rather, our ideas and thoughts are reflections of necessary material laws. Instead, we must seek to understand the laws of how human society changes. By following our education plan for Dialectical Materialism, the reader will familiarise themselves with this way of looking at the world so that they too can begin to apply Marxist ideas.

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Historical Materialism is the result of Dialectical Materialism applied to human society and history. It encompasses the general theory of how and why society develops in the way it does. A deeper, more concrete understanding of these principles in combination with a study of real, living history of class struggles enables us to come to a general understanding of where capitalist society is headed and what political strategy is required to successfully influence the course of events.

The basic principles of Historical Materialism are that human society has inherent laws guiding it - its developments are by no means arbitrary or accidental, nor the mere subject of the will of great men and ideas. Human individuals can and do influence society according to their ideas, but only ever within definite material constraints and conditions. Above all, the law determining historical development is that of the development of the means of production - meaning economically productive technology, science, technique etc. The extent of the development of the productive forces determines the social relations of production - i.e. the structure of society, class relations etc. Each social system has its inherent laws of motion. If we want to overthrow capitalist society, we must understand how

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Marxist economics is the study of the laws of motion of capitalist society. Why does capitalism perpetually go into crisis? Why does mass unemployment exist? Are commodity production, the domination of the market, and rich and poor natural, immutable states of being for humanity? Or are they merely the products of this specific mode of production - capitalism? If so, is there any way capitalism can exist without these problems, or by minimising them?

Marxist economics is a “holistic” way of analysing capitalist economy. It starts out by placing it in its real historical context (rather than dreaming up abstract idealisations of capitalism to justify it, as bourgeois economics does), studying all its interconnections and contradictions, rather than artificially isolating one aspect of it. In doing so, Marxist economics lays bare the functioning of capitalism; the exploitation and injustice inherent within it. Those who want to get to the essence of why, in the 21st Century, despite having a more advanced understanding of the world than ever before, humanity seems plunged into perpetual crisis it cannot get to grips with, should look no further than Marxist economics, beginning with the writings of Marx himself.

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Like money, the state is something we are all very familiar with and take for granted, but its real essence tends to elude us. The ideologists of capitalism have tried, in various ways, to justify the capitalist state as supremely rational; a neutral arbiter for society, and the embodiment of justice. For Marxists, the state is not at all neutral, nor just. It is certainly anything but rational. We must strip the vale of mysticism away and reveal the state’s real basis. To do that, we have to treat the state historically - taking in its origins, rise, and eventual fall.

The state has not always existed. It is inseparable from class society. Ultimately, it is the instrument for the ruling class to oppress and hold down the masses, guaranteeing the status quo and the sanctity of property. Although the modern state performs many other functions, these are secondary to its real basis - the protection of a set of property relations. To do this, it needs “armed bodies of men” and a monopoly on the use of violence. To establish socialism, it will not be possible for the working class to use the state as it currently exists - that is, with

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The Russian Revolution is the greatest event in world history for Marxists. For the first time, the working class successfully took and held power. The slaves fought back and won. For these reasons, the name of Lenin and Trotsky, and the entire 1917 episode, has been deliberately dragged through the mud by the bourgeoisie ever since.

Naturally they are aided in this task by the degeneration of the revolution and by the existence of Stalin’s monstrous dictatorship. However, Stalinism represents the opposite of Bolshevism’s real traditions, which readers can read about in this section, as well as the Marxist explanation for why Stalinism took place and what this means for our movement.

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Radicalised youth, seeking to understand how to change modern society, naturally tend to look to both Marxism and Anarchism in equal measure. The question as to which philosophy, or which combination of the two, has the best answers, has long been at the forefront of the minds of revolutionaries.

Anarchism is naturally attractive to all those correctly alienated by bureaucracy in the revolutionary movement. Anarchists are certainly correct to reject Stalinism and careerism. However, it is not sufficient simply to reject these phenomena. We need to understand why bureaucracy and oppression exist and what role they play, in order to understand how to avoid them. We believe that, for all its opposition, Anarchism has little to say about the alternative to bureaucracy. Instead, it is Marxism’s historical materialist method that allows us to understand these problems. In this section the reader will find a series of articles dealing with anarchism and the issues that anarchism raises.

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The discrimination and oppression of women is integral to class society, such that Engels even referred to it as the “first class oppression”. Along with the class system itself, the oppression of women often takes on the appearance of being natural, immutable and eternal, since it has been with us for so long.

But Marxism is a historical science, concerned with understanding the fundamental changes that society goes through. It cannot be satisfied with comfortable prejudices. A study of the origins of human society, as Engels famously conducted in his book The Origins of the Family, Private Property and the State, reveals that the oppression of women is by no means natural and was not even known for much of our history. As Engels explains, the oppression of women arose with the emergence of class society and private property; it will fall with it.

Marxists are fully in solidarity with feminists: we are irreconcilably opposed to the oppression of women and fully support the struggle for their emancipation. We believe this will be achieved through the class struggle, since that is the basic locomotive of history in a class society such as ours. However, Marxism represents a distinct set of

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Fascism is something of a bogeyman in modern British society, and has an almost mythical character in bourgeois public opinion. But despite constant talk of it, very little is said about why it happened and how it may or may not happen again.

Fascism is really the death agony of capitalism and the “distilled essence of imperialism”. The fascists in Germany, Italy, Spain and other countries were only able to come to power on the back of defeats of the working class. Ultimately, the madness of fascism expresses the historic crisis and dead-end of capitalism that had arrived by the early 20th Century, alongside the inability of the working class to take power and replace capitalism with a workers’ state, due to the corruption of their leadership, in the form of both reformism and Stalinism. Fascism could and should have easily been avoided had the working class possessed a militant and united leadership prepared to take power.

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The question of nationalities - that is, the oppression of nations and national minorities, which has characterised capitalism from its birth till the present time - has always occupied a central position in Marxist theory. Once again, the historical materialist approach of Marxism dissolves the apparent “natural” role of the nation as a necessary expression of human society. Nations have by no means always existed, nor will they always exist in the future.

The nation as we know it today is a product of the development of capitalism and its need to unify peoples into units of a certain size (depending on the level of the system’s development – e.g. more recently formed nations tend to be much bigger) to consolidate the market. The contradictions and tensions between nations are a result of capitalism’s “combined and uneven” development. The contradictions of the capitalist mode of production itself force each ruling class to expand outwards, developing a global market and imperialism in the process.

The violent tensions that this process breeds in turn give rise to nationalism, racism and wars. There is no way a successful world revolution, abolishing the global capitalist system, can take place without a careful and nuanced understanding of the

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Socialist Appeal is the British section of the International Marxist Tendency, which is active in around 40 countries. Our aim is to spread the ideas of Marxism, in an organised fashion, in the labour and youth movement. Only the British working class has the ability to change British society, because of the central role they play in production and their shared interest in establishing socialism.

However, we must carefully study the history and traditions of the British working class in order for Marxist ideas to connect with them. There are all too many groups who simply declare themselves the vanguard of the British working class, and have a dismissive attitude to the class’ real traditions.

In this section readers will find a series of articles explaining our position on the class struggle in Britain, the key points in the history of the British working class and the lessons to be learnt from them, and the strategy of the Marxists in relation to the movements of the masses.

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The ideas of Marxism and the need for a revolutionary party are not the result simply of a single individual, but arise from the study of history - the history of class struggle. In this respect, the revolutionary party is often referred to as being the memory of the working class, and our task is to learn the lessons from history in order to prepare for the revolutionary events taking place today and in the future.

In this section we present a series of articles and audios covering the key revolutionary struggles in history - from the early class struggles in Rome to the tremendous movements of the working class in the 20th Century. By reading and listening to these, our readers should gain a good overview of the history of the revolutionary movement and the main lessons to be learnt from these.

For analysis of 21st Century revolutionary movements, check out the News and Analysis sections of the website!

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