The Peckham Experiment (1926-1950) was a remarkable English attempt to rethink the role of health and medicine, an attempt that greatly influenced subsequent thinking about community health. We recently learned the the Pioneer Health Foundation, which was set up to finance the Experiment, is still in existence and has a very informative website. The wealth of pictures and documents on the site really brings this piece of history alive.
The story of the Experiment begins in 1926 when two English physicans Scott Williamson, a pathologist, and his (future) wife Innis Pearse set up a small health center in Peckham, a working class neighborhood of southeast London. Located within a small house, the first Pioneer Health Center was a social club which also provided physical examinations (“overhauls”), day-care, social services, and orthopedic consultation.
Williamson and Pearse were struck by the degree of disease they found among the attendees at the Center. Quoting from Pearse (see link):
“Suffice it to say that of all those overhauled, only 10 per cent were found to be without any clinically discoverable disorders. There were some 25 – 30 per cent who knew they had some disease; less than one half of these were under medical treatment at the time of examination. The remaining examinees (some 65 to 70 per cent) all had some pathological disorder of which they were unaware, or which they ignored.” (J Roy.Coll. Gen. Pract., 1970, 20, 147)
Findings like these spurred a rethinking of the role of the center. In the words of Mary Langman, the Center’s Founder Secretary:
“Within a few years Scott Williamson shut this venture down; it had become apparent that whatever abnormalities they found were returning in some form even where they had been successfully treated, on return to the same environment as had caused them in the first place.
Something had to be done about that; but what? The doctors could have no control over the working environment, not over the facilities at home. They had little influence over conditions is schools. Their only point of leverage was small – the limited leisure time available to everyone at various time of their day.”
The logical conclusion was to build a new Pioneer Health Center, this in the form a recreation center. The beautiful new center (shown in the image) was opened in 1935 and included a gymnasium, theater, swimming pool, and school. Nursery facilities were available and a cafeteria served organic food grown at the Center’s farm. [The PHC website has beautiful pictures of these facilities.] To join the center one had live nearby (“within easy pram pushing distance”), pay a small fee, and agree to a yearly, family physical examination.
The Center was seen as a vast experiment to understand what promotes health. Quoting from the website, it sought “to turn the conventional medical viewpoint inside out – to look at what is biologically right whereas pathology and therapeutics look at what is biologically wrong.” Its results profoundly influenced thinking about community health. Here is a brief summary prepared in 1986 of the major findings:
“Basic Concepts and Processes derived from the work of Dr George Scott Williamson and Dr Innes Pearse
1. Health is a positive process and not merely the absence of disease.
2. Health has action patterns and behaviour of its own, and its own laws.
3. The basic unity is the parents and their children.
4. Health is to be seen in the excellent of structure and function – in their individual actions and behaviour of this unity, and in their relationship to each other and the environment.
5. This excellence is established mainly during certain key phases of growth and development, from birth (or before) through infancy, childhood, puberty, adolescence, courtship, mating, parenthood.
6. Each phase has its own developments characteristic of that phase which are integrated into the whole person and the quality and direction of all future action.
7. The potential for this growth and development is inherent in the family and its individual members, and is entirely self-announcing and self-directing.
8. It announces itself in each phase through feelings, appetite, and interest in things pertinent to that particular development, and is characterised by the spontaneous nature of the behaviour.
9. It directs itself through the dedication of the individual or individuals in all the appetitive phases, e.g., in physical achievement or in courtship and marriage.
10. Its completion is accompanied by feelings of satisfaction and fulfilment.
11. The successful completion of such cycles is not only necessary for the acquisition of important skills/capabilities, but also provides a foundation of emotional health and contributes to such qualities as contentment, judgment and courage.
12. Throughout each phase there is a high degree of energy – vitality and drive manifested within the dedication.
13. The emerging skill can only grow and develop if the environment contains the appropriate opportunity/stimulus for exercise and practice.
14. The environment must contain sufficient families to cover the whole spectrum of interests, actions and growth and development, so that each family and its members may find opportunities for its own specific action and development.
15. This population must be one in action, through the full range of phases and interests, and visible and accessible to each member in continuity.
16. This population will develop and exhibit community integration, purpose and achievement in its major and minor actions. What is being manifested is the growth and development of the whole. It is a biological entity in its own right, as well as being the nurtural environment for each individual and family.
17. The growth and development of each family in mutuality with the social whole constitutes biological order.
18. Such a community is cultivable, and is self-sustaining. As was demonstrated by the Peckham Experiment, this is achieved by cultivation of the environment and not by direct cultivation of the individual and family.”
(Compiled by Douglas Trotter and Allan Pepper, November 1986)
The Center was closed during World War II and turned into a munitions factory. It reopened in 1945 but then closed permanently in 1950 due to lack of funding. The Center apparently did not find favor in the new formed British National Health Service. The building is now an apartment house. The Pioneer Health Foundation has remained in business, publicizing the work of the Experiment. For a fuller overview of the Experiment see the 1985 paper by Allan Pepper at this link.
The Peckham Experiment is one of the most influential of many attempts to reconceptualize the role of clinical medicine by integrating it with the life of the community and focusing on health promotion by various means rather than simply the cure of disease using medicines. One is struck by the bold vision represented by the project. Also in this tradition is the work of Sidney and Emily Kark on Community Oriented Primary Care (originally, A Practice of Social Medicine).
posted by Matt Anderson