5 July 2023 marks the 75th anniversary of the NHS. In 1948, this was a radical rethinking of healthcare provision, making it free at the point of contact. Clearly there had been medical care available before the NHS, as Barry Doyle and Rosemary Cresswell make clear in this piece. They show how people were served in a variety of ways, sometimes at cost. Significantly, one area that remains under-researched is healthcare in or through the workplace (though Vicky Long has done some excellent work on this). So, to mark the NHS’ 75th anniversary, this blog post looks back, to see where medical care appears in our project’s database.
As you might expect, the data contains plenty of references to the ways in which railway workers received healthcare in the pre-NHS world. That makes our work helpful in understanding the nature of people’s experiences and the variety of medical provision that existed. This is something that project volunteer Arthur Moore has touched upon one of his guest posts, here, and guest author Sally-Anne Shearn explored in her post on post-accident treatment.
Sadly, with workers experiencing so many accidents, it was inevitable that treatment of injuries features strongly. In the immediate aftermath of an accident the rapid provision of first aid was important. The railway industry was an early promoter of the idea of training staff in first aid, and encouraged employees to learn basic principles. That paid off – sometimes for the trained individual, as was the case for Frederick Webb in 1922, when his ‘knowledge of first aid work probably saved his life, by his own application of it, and his instructions to those who came to his assistance’ (discussed in this blog post).
Typically where it appears in the database, there is passing reference to first aid rendered. That presupposes the presence of someone first aid trained nearby, and the existence of some form of supplies. These were actually fairly big resource commitments, by individuals and companies. By the time of our project – the late 19th and early 20th centuries – in static locations (stations, or workshops, say) it was relatively straightforward to keep a first aid box accessible. However, for more mobile staff (train crews, or track workers) things might be more challenging.
So it was on 13 May 1934 when Southern Railway track worker EW Young was killed between Seaton Junction and Honiton in Devon. A colleague had had an accident which required first aid treatment, so Young had gone back to where the first aid box was kept. On his way back, he was hit by a train travelling ‘wrong line’ (i.e. running on the set of tracks against the usual flow of travel). The report into the accident noted that when large numbers of employees were working together ‘it is a good idea for them to have first aid equipment with them. This point should be brought to the attention of the Company’ (1934 Quarter 2, Appendix B).
First aid was exactly that – initial, emergency, care. It was designed to minimise the impacts of accident, keeping the individual alive and as stable as possible, until further treatment could be delivered. By far the most numerous mention of healthcare relates to the trip to hospital, made by injured workers.
Sometimes the hospital was rendered unnecessary by the death of the individual concerned. Albert Morris, 49, was working at Bidston in Cheshire as a sub-contractor to the LMS. On 15 November 1936 he was working on some signalling equipment when he was hit by an approaching train. The report into his accident noted ‘Head hit by footboard, died on way to hospital’ (1936 Quarter 4, Appendix C). Nevertheless, the presumption is that, where necessary, workers would be sent to a nearby hospital.
Rather more common in our records are the times when the injured party was noted as having been taken to hospital. The injured person would be taken by the quickest and most direct route possible. Sometimes this involved carrying them by train, either the service that had been involved in the accident or – presumably rarely – an additional service, as seems to have been the case in for John Duncan in 1930.
This of course required a nearby hospital to go to. In towns and cities there might be a hospital close by. In more rural areas, injured workers would be reliant upon cottage hospitals. This was the case for Midland Railway goods guard W Jolly, injured whilst shunting at Berkeley station, Gloucestershire, on 18 January 1900. He appears in our trade union dataset, as he was a member of the Amalgamated Society of Railway Servants (ASRS) union. He was noted as dying at a cottage hospital on 19 January 1900; his dependents received £252.3.5 compensation from the Midland Railway (around £28,900 now).
Whilst recuperating, workers might be expected to receive a Company, state or Union representative. This post-accident ‘interview’ was designed to help determine the cause of the accident. Yet it didn’t always go according to plan. London and North Eastern Railway (LNER) shunter William Rowe, 56, was injured in an accident at Hythe, Essex, on 25 February 1924. He lived for 14 days after the accident, but as the state investigation noted ‘no-one from the Company visited him in hospital’ to ascertain what happened. The LNER was admonished that this was the second time recently that their representative could not account for an accident like this (1924 Quarter 1, Appendix C).
Finally, doctors appear in our database in a few places. They might attend the scene of an accident, to render aid – or to pronounce a casualty dead at the scene. So it was on 3 September 1932, when track worker T Denton made contact with a third rail in wet weather at Harrow South. A doctor was sent for, but nothing could be done for Denton (1932 Quarter 3, Appendix B).
If the casualty was ‘walking wounded,’ they might visit a doctor. In the case of Taff Vale Railway goods porter Evan Davies, 20, following his accident at Ferndale, Glamorganshire, on 4 July 1906, he walked to doctor. He said that he’d been crushed, but little else; unfortunately Davies died (1906 Quarter 3, Appendix C).
The ASRS used doctors to certify that members were medically unfit for work and therefore eligible for Union benefits. It also used doctors where needed to contest claims for compensation. Here we see medical expertise in contest, with railway companies employing or paying their own doctors to examine employees.
One of our datasets reveals more about all sorts of medical aftercare provided for employees of the Great Eastern Railway Company. The ledger of its Benevolent Fund, covering 1913-23, gives detail of treatments provided or paid for, including payment of hospital and doctors’ fees – once again reminding us of the cost of healthcare in the pre-NHS era. We see, for example, doctor’s expenses of £5.5.0 in 1917, for the treatment of passenger guard JR Witing’s dislocated clavicle.
Wider railway provision
What’s found in our database is only a small part of the story of the railway industry’s medical provision – and the close relationships between industry and community. For at least some railway workers there was regular monitoring of key aspects of health necessary for their jobs – particularly loco crews, with vision tests. How far health check-ups extended into other grades isn’t clear, but it would be valuable to know.
Large railway locations – railway workshops – might include hospital provision, as was the case at Crewe and Derby. Swindon, on the Great Western Railway, included medical provision and facilities for staff and their families. And organisations like the Railway Benevolent Institution provided convalescent homes, in which workers who were recovering from ill-health or accident could recuperate.
And of course, from beyond our project, railway workers receiving medical treatment outside the industry generated records. Rebecca Wynter explored some of these in her guest post on railway worker burns.
All of these aspects of medical provision by the railway industry need further research. Hopefully our project can contribute to that, via our database and our ongoing work. In the meantime, it’s worth re-stating that the reason much of this provision was required was because of the dangers of railway work. Those dangers continued beyond our project’s end date – 1939 – and indeed, beyond the nationalisation of the railway industry and creation of the NHS, in 1948.