Unless otherwise noted, the following quotations are from correspondence of the RCP’s Social and Preventive Medicine Committee (MS6352/1).

At the beginning of the First World War, there was virtually no social housing in Britain – municipal authorities owned a total of 24,000 properties. 5 million people lived in overcrowded and unhygienic slum conditions. 

In the wake of the 1917 February Revolution in Russia, the British government hurriedly took steps to quell working-class unrest at home, launching a housebuilding commission in July that year. However, it was largely white collar and better-off workers who benefitted from the new houses, with national slum clearance programmes not begun until the 1930s. Despite these, housing for the poorest workers remained inadequate. By 1943, 90% of houses in Stepney, for example, were without baths, while 12% of houses in Birmingham had no toilet. 

As the Second World War drew to a close, the needs of the British state to stave off dissent in light of the expansion of socialism in Europe, were compounded by the fact that it was now no longer only the most disadvantaged affected by the housing crisis. 475,000 homes had been destroyed in the war, and a further 300,000 damaged. As a letter to the RCP from the Ministry of Health on 30 March 1945 makes clear, the government had been able to drag its heels on housebuilding prior to the war because the problem only affected ‘persons living in slums or overcrowded conditions’; however, they were more compelled to act now that the largescale destruction of homes had impacted ‘a cross section of the population’.

The RCP’s involvement with the initiative began in April 1942, when John Greenwood Wilson (1897-1990) wrote to Charles Newman (1900-1989), suggesting that the Younger Fellows Club (for RCP fellows aged 45 and under) might want to advise on housing policy, given their expressed interest in public health. Wilson was a member of the Ministry of Health’s Dudley Committee, tasked with making recommendations for the post-war ‘design of dwellings.’  Wilson’s letter gives the impression that he was going somewhat rogue from the committee, and he may have hoped that by approaching the Younger Fellows directly he would reach an audience slightly more sympathetic than the wider RCP to the needs of the working class. However, Newman felt ‘it would be more proper to invite the College [as a whole]’ (MS6365/1), and the issue was ultimately placed before the RCP’s Social and Preventive Medicine Committee. 

Committee member, James Macalister Mackintosh (1891-1966) argued that physicians must consider the matter purely from a health perspective, in line with their profession, and disregard matters of cost or profitability. Mackintosh wrote to RCP president, Charles Wilson (1882-1977) on 9 October 1942, to stress the point that physicians should not be focussing on ‘costs and technical details,’ but providing only their ‘unbiased medical opinion about the housing of the people.’ Mackintosh placed himself among the ranks of those ‘who see housing as a problem of the people rather than as a problem of the builder or the estate manager’, in other words those more concerned with the health of residents than with the financial interests of building firms or landowners.

Mackintosh was responding to challenges put to the RCP’s initial recommendations to the government. For example, the RCP’s report had called for ‘no room used for sleeping [to] be less than 100 sq. feet’. Its authors stated that ‘the pernicious doctrine that children require less air-space than adults must be finally scotched […]; on the contrary, the special liability of children to contract infectious diseases calls for the most generous consideration.’ The report added that space should also be provided for a baby, and that its recommendation was that the parents’ bedroom should be large enough to comfortably accommodate a cot.

However, Judith Ledeboer (1901-1990), who was secretary of the Dudley Committee, wrote to the RCP on 13 September 1942, questioning their assertions. She objected that setting a minimum bedroom size of 100sqft would raise the size of rooms ‘very considerably,’ appearing to balk at the suggestion that the ‘accepted standard’ sizes were inadequate. Like most of the government and RCP personnel involved, Ledeboer took for granted that wealthy parents could afford to choose where their baby slept, but that poorer families should have such decisions made for them: ‘Modern practice is tending to place the infant in a room separate from the parents. How far is this practice current with, or desirable for, working class houses?'

Refusing to defer to Daley and Westwood’s ‘feelings’, Mackintosh ‘went out into the slum clearance estates of the city of Glasgow to discover more’ about whether rooms of 70sqft were sufficient for human habitation (see his letter to Charles Wilson on 13 October 1942). He was pleased to report that in fact there were none, claiming that no bedroom in Scotland was less than 90sqft. Mackintosh was backed up in his views by John Wilson (1877-1959) (not to be confused with John Greenwood Wilson), who worked as chief architect for the Department of Health for Scotland (see Wilson’s letter to Mackintosh on 12 October 1942).

In the end, the RCP stood by its original recommendations, reiterating in its reply to Ledeboer on 5 November 1942 that ‘no room used for sleeping should be less than 100 square feet.’ They even ventured to suggest that housing subsidies should be increased to enable working-class families to not only live comfortably but also eat healthily. But although Mackintosh’s side won the internal RCP battle, they lost the war regarding housing standards. In their final report, the Dudley Committee disregarded the RCP’s recommendations, proposing instead minimum sizes of 150sqft for the main bedroom, 110sqft for the second bedroom, and 70sqft for the third. 900,000 permanent houses were built between 1945 and 1951. These were constructed mainly on previously rural land, meaning that travel-to-work costs, as well as relatively high council rents, made them unaffordable to the poorest in society. By 1967, there were still 1.8 million slum houses in Britain deemed unfit for human habitation. Ultimately, Mackintosh was naïve to imagine that housebuilding could be divorced from economics. The state could afford to make certain concessions in the wake of the Second World War, but to maintain profits in the long run it has had to erode the living spaces of the working class. Room sizes have steadily reduced, with the Licencing of Houses in Multiple Occupation Regulations (2018) giving figures of 10.22sqm (110sqft) for the main bedroom, 6.51sqm (70sqft) for the second, and 4.64sqm (50sqft) for the third. Even these are treated as guidelines only, and rooms are often smaller in reality. In Britain today, 112,660 families, including 145,800 children – the highest number ever recorded – are sleeping rough or living in inadequate temporary accommodation. This of course has a detrimental effect on physical and mental health, as the RCP has recognised. Since 2019, at least 55 children have died as a result of the hazards of unfit accommodation, such as mould inhalation.

The newly catalogued housing records illustrate the tussle between those advocating for concessions to the working class and those content with the status quo, and that the most vulnerable in society will continue to pay the price as long as housing is treated as a commodity and not as a right. 

The records are available for anyone to access in the RCP’s reading room.  

 Felix Lancashire

Assistant Archivist