Kidderminster Politics and Public Health

The Battle for Public Health

Living today, when the battle for public health has largely been won, it is generally accepted that access to medicine, clean drinking water and good sewerage is an entitlement for all.

It can come as something of a surprise, then, to read about the clashes that Lionel and Samuel had with local politicians and industrialists to get money spent on public health improvement. If there is anything that will come between politicians and "doing good", it is usually the idea of parting with money: the Stretton story certainly highlights this. While contemporary Victorian life saw many similar local struggles, it serves to remind us that as much of Lionel's lifetime was concerned with public health, politics and fund-raising as it was with medicine and surgery.

How Health was Financed

This was an era when hospitals were expected to finance themselves through public and private subscription. In practice, any attempt to increase staff numbers, or to raise money for capital improvements and for training, generated a stream of opposition. Complaints about "the pressure on local rates", the cost to local industry and criticisms of those who did not pay their way can be found in many records of meetings of the time. This was still the era of "the deserving poor", when the lower middle and working classes were expected to practise self-improvement. It was also one where poverty meant the workhouse. Destitution and ill-health were often only a small industrial accident, unemployment or a bout of fever away.

Not that the charitable spending of the virtuous well-off stopped them complaining when those who could not afford the subscriptions that the Victorian and Edwardian Kidderminster hospital system required, wanted access to treatment. The collection of workplace-based subscriptions from workers in the local carpet factories was a thorny issue that led to many clashes between Lionel and local business owners. Even though he eventually won many of these, the hesitancy of local industrialists to create workplace subscriptions and their unwillingness to pay into them was a constant brake on attempts to expand the scope and effectiveness of the hospital and public health services.

The Idea of Public Health

We should remember that the very idea of "public health" was a growing science. The concept had hardly existed before 1850, except when there was a crisis or an epidemic. But it became one of the great Victorian and Edwardian crusades that went hand in hand with industrialisation. It was not, after all, so easy to ignore poverty and unhygienic conditions when they backed on to your house (as they did, for example, with the practice in Church Street), as it was when it was spread unseen amongst the hamlets and cottages of farm labourers in the countryside.

Both Lionel and Samuel before him campaigned over many years for public health improvements, for their hospital and to improve the conditions of the very poorest. Nigel Gilbert in his book "Dr Stretton, I presume" sets out this battle with local government in much more detail. Part of our admiration for Samuel's and Lionel's legacy has to be our recognition of the work they put into getting the advances in local health they wanted, as well as their improvements to surgery and nursing.  Both Lionel and his father were heavily involved in campaigns to raise funds for expanding Kidderminster's hospitals, battling for workhouse improvements and in calling out for local sanitation work to be carried out.

Fundraising, Workhouses and Hospitals

Two areas highlight this struggle - the workhouse infirmary and the growing arguments about local hospital funding that Lionel was part of in Edwardian times and after the First World War.

Workhouse Infirmary

It took the patchy response to the smallpox epidemic of 1883 to create sufficient local panic to get the local authorities to recognise that their provision of 6 cottages to isolate such an epicemic was a totally inadequate response to outbreaks of this kind.

Both Lionel and his father, Samuel, were amongst the local doctors who wrote on Christmas Day, 1893. "Dear Mr Mayor ...... None can regret more than we do the non-compliance with our request, made some years ago, for a small hospital for such emergencies, feeling assured as we do that such epidemics would not then have occurred, and profound misery and expense would have been saved."

Although the construction of the infectious hospital was started folowing the outbreak, the tension that always existed between the desire of the local authorities to get people to pay for their hospital treatment rumbled on for many years. A request to treat paupers at the infirmary was turned down and there was more than one dispute about how to get patients from outside the town to pay.

Although, these conflicts may seem rather absurd to us today, we have to recognise that, prior to "national health" schemes, the costs of treatment and patient stay still had to be paid for. Even today, in coutries like the USA, this differentiation still exists between available funds and the "deserving" nature of the patient. It still comes down to money.

Kidderminster & District General Hospital

The role that Lionel Stretton played in fund raising and the creation of a new Kidderminster Hospital in the 1920s shows that this tension had not gone away. Running deficits at Kidderminster Infirmary persisted during Edwardian times and after the First World War. Despite the National Insurance Act before the war, and the contributions of the Ministry of Pensions which helped to support the treatment of pensioners as in and outpatients, the extension first proposed as a war memorial in 1918, the hospital struggled to get local businesses to add to their own workers contributions (the extensions of the early subscriptions from Victorian times). Many of the carpet manufacturers just did not want to pay.

Numerous minutes from the time show just how much pressure the hospital was under to prove that every penny it spent was being spent well. In 1924, the local council turned down funding for extending the hospital and refused a compulsory levy on the local rates.

The building and subsequent opening of the hospital in 1926 was largely due to Lionel's tireless work in the face of all the opposition. As the local paper, the Shuttle wrote at the time:

The task of raising the large sum of £25,000 was no mean undertaking, and none but one imbued with the enthusiasm for the work and a true appreciation of its needs, could have carried it out in the face of a sceptical, and at times hostile, criticism. Dr Stretton deserves well of the town.... Posterity will be the true judge of the magnitude and success of this task.

Local Industrialists and Private Patients

Local industrialists played a big part in the politics of the time. Sometimes leading figures were pivotal in getting much needed change through. Samuel, Lionel's father, seems to have benefitted several times from an alliance with the then Chairman of the Board of Guardians, John Brinton, who was also the owner of a local carpet-making business.

More often the conflict left a sour taste. Lionel had a long running feud with the Tomkinson family. Michael Tomkinson, as Mayor of the Kidderminster, constantly berated the management committee of the Infirmary for overspending on drugs, salaries and improved nursing facilities.

After the First World War, there were clashes between T H Charles, a local Industrialist and Employer, and the hospital doctors over the fees paid by private patients which were, in Charles' view, excessive. The unfair implication was that doctors lined their pockets. These were followed by a reluctance by industrialists to put their hands in their pockets to support the subscription schemes of the workers during the 1920s, previously mentioned.