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The Kilburn Dispensaries: providing health care for the poor

Background
In the Victorian era diseases like smallpox, TB, syphilis, and ‘King’ cholera meant that infant mortality was very high, and children were lucky to reach their fifth birthday. The average life expectancy for a middle-class man was 45, but for working-class men this halved.

  The Silent Highwayman (Punch July 1858)

The ‘Great Stink’ in the summer of 1858 when the Thames was contaminated with untreated sewage forced Parliament to cover the windows with curtains soaked in lime. The government finally decided to fund Joseph Bazalgette’s scheme to build a system of sewers. The initial cost was £2.5M, but the final cost was £4.2M (today worth about £400M). 
 
Work began in the early 1860s in Kilburn as he worked his way across London putting some of the rivers and streams, such as the Kylebourne, in underground culverts. 
 
The huge construction, which was not completed until 1875, carried the sewage to treatment centres and out to the Thames at Beckton in east London. Although this greatly improved the health of Londoners, they still had to pay to see a doctor.

Today to some extent, we forget how the National Health Service started. It began with the economist William Beverage’s report called ‘Social Insurance and Allied Services’ which was published by the wartime coalition government in November 1942. 
 
The Beverage Report identified ‘five giants on the road of reconstruction’. These were: Want, Disease, Ignorance, Squalor, and Idleness. This formed the basis for the post-war Welfare State. It included the creation of the NHS funded by an expansion of National Insurance. This had begun with a 1911 Act where each worker paid 4 pence a week, the employer paid 3 pence and the government paid 2 pence – what Prime Minister Lloyd George called ‘ninepence for four pence’.

The new NHS system was launched by the minister of health Aneurin Bevan on 5 July 1948. The core principles were that it would be free at the point of delivery, it was not means tested, and everyone would be signed on to a local general practitioner.

In this story we look at two local dispensaries, the Kilburn General and the Kilburn Provident.

Kilburn General Dispensary
In 1862 to provide help for the poor as the area expanded, the Kilburn General Dispensary was opened in a large house at 13 Kilburn Park Road. Later this was called the Kilburn, Maida Vale and St John’s Wood General Dispensary. It was funded by donations from local churches, subscriptions from middle-class people, and fund-raising events such as a concert given by the Kilburn Brass Band in 1870 at the Queen’s Arms Hotel. The resident doctor provided medical advice at the dispensary or in the people’s homes. Dental treatment was also available.
 

 Kilburn Park Road looking towards St Augustine's Church

The 1875 annual report showed that 3,180 patients had been treated, an increase of 851 from the previous year. Of these 1,509 were urgent and were seen without the usual introductory letter from a vicar. There had been 8,260 home visits and 33,215 prescriptions for medicine.

By 1900 the number of subscriptions from wealthy locals and the collections from churches had declined. In the 1910 annual report the numbers had fallen to 1,824 patients with letters and 1,046 being treated on an emergency basis. There were 3,163 home visits and 9,649 prescriptions. By 1940 the dispensary was in financial difficulty and it seems to have closed in 1942.

George Edward Shuttleworth was a doctor who worked at the dispensary soon after it opened. Born in Edgbaston in 1842, he was a pioneer in psychiatric services. His case notes from his time at Kilburn in 1863 and 1864 are now deposited at the Wellcome Library. Shuttleworth subsequently worked in several mental asylums and published numerous books and papers. 
 
From 1899 to 1901 he was medical examiner for the London School Board of what were then called ‘defective children’. He was on several committees which led to the Mental Deficiency Act (1913). At the time of his death in May 1928, he was living at Lambolle Road, Belsize Park.

George Edward Shuttleworth (Wellcome Collection)

Travis Robert Montgomery Smith who qualified in Dublin and lived at 13 Kilburn Priory Road, was a long-serving doctor until his death there in February 1933. Robert Newnham Davis who lived at 19 Greville Road, was another of the longest serving doctors. He had qualified at St Mary’s Hospital in Praed Street in 1893 and died in Harrow in May 1946.

The other dispensary operated on a different principle.

Kilburn Provident Medical Institute
The Kilburn Provident Medical Institute opened on 1 January 1875, close to the High Road at 9 Station Road, later renamed as part of Belsize Road. Its promoters acknowledged the existence of the Free Dispensary: ‘the new Institution does not propose any interference with its working’ and the intention of the new dispensary was to be self-supporting, charging a weekly fee to its working-class members who could then access the medical services on offer. But until enough members joined, the Institute would depend on voluntary contributions to supply the larger part of its funds. 
 
The original weekly scale of fees was set at one and a half pence per adult or husband and wife; families paid 1d for each other member under 16 with a maximum charge of 6d, irrespective of the number of family members. Many middle-class residents donated cash to get the project underway and the largest local employer, the railway signal maker Saxby & Farmer, was among the most generous at five guineas. Others served on the management committee.

Regular adverts appeared in the Kilburn Times giving times the doctors were available at the Institute; patients were either seen there or in their own homes. Two doctors attended daily in rotation and members went to any doctor they liked. Fees paid to the doctors were apportioned according to the number of cases they attended to.

Remaining old houses in Greville Road (Dick Weindling, 2005)

In late 1881, the Institute moved from Belsize Road to 1 Greville Road, a large house on the corner with Kilburn High Road.

1901 marked the 25th Annual General meeting when the membership was just over 4,000, the highest figure ever recorded. Since 1875, over 80,894 members had been entered on the Institute’s books. Their payments totalled £21,220 15sh 6d, ‘a respectable sum’, the speaker said with pride. During the past year, 4,048 cases had been treated at Greville Road with 1,400 home visits. A further 394 members needed dental work. The fees remained at the 1875 level.

Canon Robinson Duckworth was president of the Institute from its foundation to his death in 1911. His popular claim to fame was his link to the children’s story ‘Alice in Wonderland’. Duckworth was a friend of Lewis Carroll (Charles Lutwidge Dodgson) at Oxford and was immortalised by Carroll in the story as the Duck. In his professional life, Duckworth was an eminent clergyman and locally, the vicar of St Mark’s Church in Hamilton Terrace. This was one of several churches that helped raise money for the Institute. 
 
His death was noted with great regret at the 1912 AGM, when the committee also voiced concern about the new 1911 Insurance Act posing a threat to subscription payments to this Institute and other similar concerns. The job of chasing up arrears and lapsed members had been taken on by a newly formed Ladies’ Aid Committee.

Dr Thomas Morton who lived in Greville Road, was a prime mover in setting up the Institute. In the 1878 outbreak of diphtheria he made the important connection between incidents of the disease and drinking milk from two suppliers. After he resigned from the Institute staff in 1889, he was persuaded to stay on as honorary consulting medial officer. 
 
He died of heart failure in 1905 following a severe bout of sciatica and pleurisy and was buried in Paddington Cemetery, Willesden Lane. His obituary in the local press noted that in addition to holding many important posts, Morton had built up a general medical practice ‘second to none in the district.’ A memorial was erected to his memory in St Mark’s Church Hamilton Terrace where he regularly worshipped and a copy of his portrait by West Hampstead resident, the artist Seymour Lucas, was presented to the Institute. 
 
The Kilburn Provident’s doors remained open until 1939, but the Institute is not listed in the local directory the following year. WWII may have prompted its closure: the building was damaged by a high explosive bomb in October 1940 and again in June 1944 when a V1 flying bomb caused widespread damage to properties in nearby streets. The last secretary of the Institute was Dr John Hugh Williams of 74 Brondesbury Road who went on to serve in the medical branch of the RAF at Biggin Hill. 
 
The two dispensaries provided vital health care to the working-class people in Kilburn for 65-80 years before the introduction of the free NHS.




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