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Full text of "Hospital beds by design: a socio-historical account of the 'King's Fund Bed',1960-1975."

Hospital beds by design: a socio-historical 
account of the 'King's Fund Bed*, 1960-1975. 



Ghislaine Mary Lawrence 
PhD., University of London, 2001 



The copyright of this thesis rests with the author and no quotation 
from it or information derived from it may be published without the 
prior written consent of the author. 



Hospital beds by design: a socio-historical account of the 
'King's Fund Bed',1 960-1 975. 

Abstract 

This thesis is an account of the origins and early years of the artefacts 
known in British hospitals as 'King's Fund Beds'. Launched in the late 
1960's, the beds were the result of an elaborate, four-year project run by 
the King's Fund, a charitable foundation supporting London's hospitals. In 
1967 the Fund published a specification for a bedstead 'suitable for 
widespread use in general hospitals'. 

The design work involved was done at London's Royal College of 
Art. It was led by a proponent of 'Design Methods', a movement concerned 
with making the process of artefact design more logical and systematic. 
The movement drew heavily on techniques devised in operational research 
and subsequently applied to decision making and management in many 
walks of life. Because practitioners were unusually reflexive, concerned 
about methods and careful to preserve records of their work however 
ephemeral, the project offers the opportunity of exploring, in some detail, 
the processes resulting in the built form of a mass produced artefact for 
use in a medical context. 

Taking the 'King's Fund Bed' as the explanandum, an attempt is 
made to show how built forms of the bed came to embody not only the 
theoretical preconceptions and methodological preoccupations of the 
designers, which were to a large extent rooted in an empiricist, 



behaviourist account of 'bed use', but also their own aspirations and the 
conflicting interests of different professional groups, government 
departments and manufacturers. The eventual commercial success of the 
'King's Fund Bed' is explored in the light of expansionist and centralising 
policies pursued in the British National Health Service at a time when 
traditional modes of organisation and social relations still largely prevailed 
in hospitals. 

As a whole, the thesis is an attempt to provide a more broadly 
based model for case studies of artefacts. 



Contents 



Abstract 3 

Acknowledgements 6 

Introduction 8 

Chapter One: The King's Fund Bed Project 32 

Chapter Two: How to make a bed 66 

Chapter Three: Specifications and simulations 91 

Chapter Four: 'Real beds': making and selling 124 

Chapter Five: 'Real beds': buying and using 148 

Chapter Six: The success of the King's Fund Bed 169 

Conclusion 231 

List of interviewees 235 

Bibliography 238 



Acknowledgements 

My first debt of gratitude is to The Science Museum, for giving me the 
opportunity to undertake this study. Secondly, I am grateful to my adviser, 
William Bynum, for unstinting support and invaluable advice. Special 
thanks are owed to those whom I interviewed about the King' Fund Bed 
Project. They gave most generously of their time, even if bemused as to 
why, nearly forty years on, someone should be so interested in so many 
long-gone details. Bruce Archer and Kenneth Agnew in particular spent 
many hours discussing the project. 

The staff of the various archives and libraries I have used have 
been unfailingly helpful, especially those of the Science Museum Library, 
and of the Archive of Art and Design at the Victoria and Albert Museum. 
Lastly, I thank all my colleagues and friends, at the Science Museum and 
elsewhere, with whom I discussed my research. Their support, both 
intellectual and practical, was central to the enterprise. 



This page reserved for illustrations. 



8 



Hospital beds by design: a socio-historical account of the 
'King's Fund Bed', 1960-1975. 1 



Introduction 

Detailed case studies of the design of mass-produced medical artefacts 
are rare. When it comes to writing about objects, medical historians have 
shown greater concern with typology, invention, innovation and the 
diffusion and uptake of technologies than with the detailed design of mass- 
produced artefacts in common use, which may be contingent on factors 
well beyond the immediate 'medical' context. 2 Latterly, certainly, the design 



Strictly speaking, there was no such thing as a 'King's Fund Bed'. The King's Fund published 
a specification. Manufacturers whose beds met it were allowed to use the term added to 
their company name, as in, for example, 'Nesbit-Evans King's Fund Bed'. In time the term 
'King's Fund Bed' came into common parlance in hospitals to mean any bed which met 
the specification and I shall use it throughout in this sense unless qualification is required. 



2. 



Typology has long been a central concern of those writing about instruments in medicine. 
See for example V. Moller-Christensen, The History of the Forceps, London, Oxford 
University Press, 1938. More recent studies have explored the relation of theory and 
practice to the invention and use of particular diagnostic or therapeutic technologies. 
Examples include Joel Howell, Technology in the hospital: transforming patient care in the 
early twentieth century, Baltimore, Johns Hopkins University Press, 1995, and J. P. Baker, 
The machine in the nursery: incubator technology and the origins of newborn intensive 
care, Baltimore, Johns Hopkins University Press, 1996. Both the above genres are 
concerned with changes in instrumental design only in so far as they overtly relate to 
changing medical theory and practice (whatever the dynamic of this relationship is held to 
be). For this purpose, prototypes and 'firsts' are of more concern than 'late' production 
models. Design choices embodied in such production models which do not relate directly 
to medical 'function' are excluded from consideration. For example, many of the 
technologies in the case studies by Howell and Baker are now mass-produced with sheet 
metal housing (as of course are many pieces of non-medical equipment), but neither of 
the authors discusses this. 



8 



of large technological systems in the medical field has been related to the 
industrial context. 3 But case studies of single artefact design present rather 
different challenges. Although the explanatory factors invoked may, some 
would say must, be similar, it appears harder to expose, say, the workings 
of power and interest in the articulation of a braking system, or the 
adjustments of a bedstead, than in the location of electricity stations on a 
grid or the voltages adopted for common usage: harder perhaps, but not 
impossible. 

Why study artefacts at all? For at least three decades, historians of 
medicine and science have occasionally lamented the failure of their 
colleagues to 'use artefacts'. Although often described as invaluable 
resources, in practice artefacts have been the Cinderella source in 
historical studies of literate societies. Not surprisingly, much of the 
complaint about this state of affairs has come from those who maintain, or 
are maintained by, collections of historical artefacts. 4 Despite the obviously 
situated nature of these claims for the special relevance of artefacts, it 
seems reasonable to explore how current historical work might usefully 
focus on them. How might they be incorporated into the array of analytical 
modes, tools and sources utilised by historians of various persuasions? 
Part of the problem indeed seems to lie in the undue promotion of 



3 

See for example S. Blume, Insight and Industry: On the Dynamics of Technological Change 
in Medicine, Cambridge, Mass., The MIT Press, 1992, a study of the growth of the 
medical imaging industry around the new technologies of CT scanning, ultrasound and 
magnetic resonance imaging. 

4 

For a recent example see James Edmonson, American Surgical Instruments, San Francisco, 
Norman Publishing, 1997. Edmonson is curator of the Dittrick Museum of Medical History, 
Cleveland, Ohio. 



10 

artefacts as historical sources, as explanans rather than explananda. 
Compared to written sources, artefacts are deeply ambiguous. 5 This is not 
to ignore the huge expansion in textual analysis, the 'linguistic turn' in 
cultural studies generally that has both problematised and enriched studies 
of the written word. But for many historical purposes written accounts, 
treated with due circumspection, are directly useful without extended 
analysis. This is rarely the case with artefacts. The ambiguity, connotation 
and signifying that occurs 'above and beyond' what it is the author of a text 
intended to say is mirrored in full measure by what goes on 'above and 
beyond' what an object is expressly designed and used for, and the 
artefact has no direct notational purpose. 

Until recently, an extremely limited definition of function has been 
employed in much writing on the history of technology. As Buchiarelli 
points out, a chair is 'more than the physics of the device'. 6 A broader 
perspective on function has contributed in large measure to some of the 
more recent work in science and technology studies which problematises 
the distinction between artefacts and human actors, or elides it altogether. 7 
The history of technology is an obvious resource for the study of artefacts 
but has been curiously neglected by many of those writing about medical 



5 

G.M. Lawrence, 'The ambiguous artefact: surgical instruments and the surgical past', in 
Christopher Lawrence (ed), Medical Theory, Surgical Practice, London, 
Routledge,1992, pp.295-314. 

6 
Louis L. Buchiarelli, Designing engineers, Cambridge, Mass., MIT Press, 1994, p. 6 (1996 

edn). 

See for example Madeleine Akrich, 'The De-Scription of Technical Objects' in W.E.Bijker and 
John Law (eds), Shaping Technology/Building Society: Studies in Sociotechnical Change, 
Cambridge, Mass., MIT Press, 1992, pp.205-224. 



10 



11 

and scientific objects. Perhaps one reason lies in the fact that in this 
discourse the emphasis is now very much on the technological object as 
explanandum, rather than explanans. (It is indeed hard to see how 
artefacts might ever have been adequate sources for a history of 
themselves, unless an avowedly technological determinist position is 
adopted.) A concern with the highly situated and contingent nature of 
technological change, and the detail of 'thick description' needed to explore 
these issues, has turned historians of technology to case studies rather 
than surveys and overviews. 8 This thesis is a case study, inevitably with 
somewhat arbitrary boundaries. The lines between object and 'non object', 
artefact and 'context', immediate and wider contingent circumstances could 
have been drawn differently. The limits of a case study are not easy to 
define. 

To an extent, mine have been determined by sources. The paucity 
of detailed single artefact studies is in part attributable to the lack of 
adequate source material. Notoriously, some stages in the design of 
certain artefacts are rarely articulated, let alone recorded. This is a 
commonplace among historians dealing with production processes akin to 
'craft', but probably holds good for many areas of design and technology. 9 



Q 

See Wiebe Bijker, Thomas P. Hughes and Trevor Pinch (eds), The Social Construction of 
Technological Systems, Cambridge, Mass., The MIT Press, 1987, p. 5 for a discussion of 
a new emphasis in areas of technology studies with theoretical aims on 'thick description', 
that is on 'a wealth of information about the technical, social, political and economic 
aspects of the case under study'. 

g 

G. Sturt, The Wheelwright's Shop, Cambridge University Press, 1934, is the classic account 
cited by historians of technology and design as a rare attempt by a craftsman to document 
a craft practice before it ceased to exist. On the difficulties of studying craft practices in 
the history of technology, see A. Pacey, 'The History of Technology', in P. Corsi and 
P.Weindling (eds), Information Sources in the History of Science and Medicine, London, 
Butterworths, 1983, pp.44-60:50. 



11 



12 

For industrially produced artefacts, where records must have existed, they 
are seldom preserved. Engineering drawings, company meeting minutes, 
sales records and customer complaints do not often survive in quantity for 
individual products, certainly in the medical field. 10 For the 1960's artefact 
that is the subject of this thesis, however, extensive archival material does 
exist. The 'King's Fund Bed' was the result of a project to devise a 
specification for a bedstead 'suitable for widespread use in general 
hospitals' which was meticulously documented at the time. 11 Indeed 
analysis of, and reflexivity about, the design process were as important to 
some of those involved as the resulting specification. For the project was 
as much about design as it was about beds. The King's Fund Bed was 
both test case and advocate for a new method of designing artefacts that 
was to replace unexamined intuition with overt, systematic and logical 
procedure, in fields ranging from product engineering and industrial design 
to architecture and town planning. 

Like many 1960's initiatives, systematic design methods were 
rejected and repudiated by many almost as quickly as they had been 
embraced. 12 By the late 1970's what had become known as the Design 



10 
In the medical equipment field, the mergers and take overs which have changed the 

situation from that obtaining in the post-war years, where numerous medium to small 

concerns existed, to the present one where a few large multinational companies 

dominate, have resulted in successive losses of such archives as had been maintained. 

Design of Hospital Bedsteads, King Edward's Hospital Fund for London, 1967, p. 12. 

12 

Bernard Levin characterises the decade as one when it was 'never easier to gain a 
reputation as a seer, never was a following so rapidly and readily acquired . . . however 
temporary their adherence might prove.' Bernard Levin, The pendulum years: Britain and 
the sixties, London, Jonathan Cape Ltd., 1970. p. 9. For other accounts of the post- war 
decades in Britain, see Kenneth Morgan, The People's Peace: British History, 1945-1989, 
Oxford, Oxford University Press, 1990, and Alan Sked and Chris Cook, Post-war Britain :a 
political history, Harmondsworth, Penguin Books, 1979 (2nd edn.1984). 



12 



13 

Methods movement was, according to some commentators, in 'terminal 
decline', and 'in the intellectual climate of post-modernism became so 
passe as to be almost written out of history.' 13 The King's Fund Bed, 
however, went on, and on. British manufacturers still sell it today. The 
assumption that the success of the bed, in terms of its widespread 
adoption, was related straightforwardly to the method of its design is one 
which will be examined closely in this thesis. For the Ministry of Health 
(from 1968 the Department of Health and Social Security), the ultimate 
general acceptance of King's Fund Beds in hospitals represented success 
in a rather separate endeavour. The introduction of a standard design for a 
high profile artefact in the National Health Service, at a time when 
consultants and hospital administrators alike were still wary of increasing 
centralisation, was no small matter, and had considerable economic 
implications. 



Sources 

As indicated above, the archival sources for the King's Fund Bed project 
are relatively rich. King Edward's Hospital Fund for London was 
established in 1897 to provide financial support for London's voluntary 
hospitals. 14 Its archives are deposited in the London Metropolitan Archives. 



13 

Andrew King, review of C.T. Mitchell, 'Redefining Designing', Van Nostrand Reinhold, 1993, 
Journal of Design History, 7, no 1, 1994, pp.61 -63:63. 

14 

For a history of the Fund see Frank Prochaska, Philanthropy and the Hospitals of London: 
The King's Fund, 1897-1990, Oxford, Clarendon Press, 1992. It was known until 1902 as 
'The Prince of Wales Hospital Fund for London to Commemorate the 60th year of the 



13 



14 

They include the Minutes of the Working Party on Hospital Bedsteads 
together with the considerable amount of correspondence, memoranda, 
meeting notes and ephemera generated by the project. I have made 
extensive use of these, together with Minutes of the Fund's Management, 
Hospital Services and Hospital Centre Committees where appropriate. 

The paperwork of the Department of Design Research (and its 
various precursors) at London's Royal College of Art, where the King's 
Fund Bed specification was drawn up, and all the design work for 
prototypes carried out, was hastily deposited in the Victoria and Albert 
Museum's Archive of Art and Design in the late 1980's. This followed the 
closure of the Department in the reorganizations of the College's new 
Rector, Jocelyn Stevens, appointed in 1984. 15 The material includes the 
project files, together with those of related projects from which design 
solutions were 'borrowed', and administrative and policy files of the 
Department. Since the staff were instructed never to throw away so much 
as a scribbled note or sketch, this archive is very extensive indeed and was 
fully maintained as a resource during the life of the Department. 16 The 
hasty manner in which it had to be deposited, however, has sometimes 
made subsequent access problematic in the absence of a complete 
catalogue. 

Ministry of Health and DHSS archives relating to the project are 

Queen's Reign'. In the mid-1960s the charity became known officially as 'The King's 
Fund'. 

15 

C. Frayling, The Royal College of Art: 150 Years of Art and Design, London, Barrie and 
Jenkins Ltd, 1987, p.198. 

16 

Interview, Kenneth Agnew, 22.6.00 



14 



15 

relatively sparse. Files from the Supplies Division of the Ministry, which 
dealt directly with the project, and whose Controller sat on the King's Fund 
Working Party on Hospital Bedsteads, were among the last to become 
available at the Public Record Office for the period in question. 17 When 
they could be consulted, in the Spring of 2000, it was disappointing that 
none of the files directly relating to this relatively high profile project 
appeared to have been preserved. Not unexpectedly, the overall quantity 
of material selected for preservation from the Supplies Division, together 
with other less 'glamorous' areas such as engineering, was far less than 
that retained from general policy files. While this is understandable, it 
underlines some of the difficulties faced by historians of technology, 
particularly in the field of mass-produced and relatively mundane items. It 
might be noted in passing that the amount of taxpayer's money spent 
annually by NHS supplies officers in the early 1960's was 'more than what 
is spent on the whole of the universities of Great Britain, including buildings 
and staff, more than is spent on law and order, the police, courts, and 
prisons. 18 

Ministry of Health files relating to wider issues, such as equipment 
standardisation and contracting arrangements in the NHS, do survive 
however, and proved particularly useful in tracing the history of changing 
policy on supply from the outset of the Service. 19 This area is largely 



17 File Series MH136. 

1 8 

Sir Bruce Fraser, Permanent Secretary, MOH, to a meeting of the Supplies Officers 
Association in 1963. British Hospital and Social Service Journal, June 7, 1963, p. 676. 

19 MH1 36/11, MH136/13, MH136/17. 



15 



16 

neglected in secondary sources. 20 Other archives holding small amounts of 
material relevant to the project or its protagonists include those of the 
Royal College of Art itself, the Royal College of Nursing Archives at 
Edinburgh, the archives of Chase Farm Hospital on the outskirts of North 
London where prototype bedsteads were trialled, and the BBC Archives at 
Caversham. 

Beyond these archival sources this thesis also relies on interviews 
conducted with some twelve individuals who participated in the King's Fund 
Bed project, whose working lives were affected by it or who were employed 
in the Ministry of Health or the bed making industry at the time. A list of 
these interviewees, together with brief biographical details, is provided as 
an appendix. Although this is not an oral history project per se (in that the 
interviews are merely one among several evidential sources) I have 
referred to recent works on the genre with a view to acquiring, I hope, the 
necessary circumspection when dealing with this kind of evidence. Oral 
History, an Interdisciplinary Anthology, edited by David Dunaway and Willa 
Baum, includes the useful essay, Theory, method and oral history by Peter 
Friedlander. 21 There is a clear spectrum of practice between the more 
sociologically orientated historical methods which seek out the participant 
account precisely because it is a situated one, and may analyse not only 



20 

Webster's official history of the health services alludes to the four reports on the 
organisation of the hospital supplies service since 1 948 in a single footnote. They were 
the Messer Report of 1958, the Hunt Report of 1966, the Collier Report of 1976, and the 
Salmon Report of 1978. Charles Webster, The Health Services Since the War, London, 
HMSO, 1996, Vol II, p.936. 

21 

Peter Friedlander, 'Theory, Method and Oral History', in David K. Dunaway and Willa K. 
Baum (eds), Oral History: An Interdisciplinary Anthology, Walnut Creek, Altamira Press, 
1996, pp.150-160. 



16 



17 

content but the interview situation itself, and more traditional studies which 
anticipate that oral history will be straightforwardly revealing of 'what really 
happened'. 

In terms of secondary literature I have had to consult material from 
widely differing disciplines and disciplinary histories. A full account of the 
King's Fund Bed project involves the history of the National Health Service, 
hospital building, administration and supply, nursing, design and 
manufacturing in Britain, the history of the human sciences and of the so- 
called 'cyborg' sciences 22 . 

For the political and economic dimensions of the hospital service in 
the post-war decades, Webster's official history of the health services in 
Britain is invaluable, together with his shorter history of the NHS, and the 
volumes by Geoffrey Rivett and Gordon Macpherson provide additional 
'insider' perspectives. 23 A rich source for the relatively understudied area of 
hospital administration has been the professional journals, in particular the 
British Hospital and Social Service Journal 24 This, a principal journal for 
hospital managers (and, until the mid 1970's, social workers) contains a 
wealth of material in the form of editorials, articles (authored by supplies 
officers and engineers as well as administrators) and advertisements, 



22 

The term 'cyborg sciences' is used by Andy Pickering, see below. 

23 

Webster, op. cit note 21 , also Charles Webster, The National Health Service: apolitical 
history, Oxford, Oxford University Press, 1998, Geoffrey Rivett, From Cradle to Grave: 
Fifty Years of the NHS, London, King's Fund, 1998, Gordon Macpherson (ed), Our NHS: 
A celebration of fifty years, London, BMJ Books, 1998. 

24 

The British Hospital and Social Service Journal continued as the British Hospital Journal and 
Social Service Review from February 1965, then as the Health and Social Service Journal 
from 1972. After 1976 it was known as the Health Service Journal. 



17 



18 

providing insight into the concerns of this key group of hospital staff. For 
nursing, secondary sources are less sparse. The work of Christopher 
Maggs has included reflection on the historiography, as well as the history, 
of nursing. 25 There remains however a dearth of material covering ward 
practice in recent decades. Here nursing textbooks and the procedural 
manuals of individual hospitals are a double-edged resource; not to be 
relied on as accounts of actual practice, they yet represent the official line 
to which designers were required to tailor their products. 

Design history has established itself relatively recently as a reflexive 
discipline, as evidenced by primers with titles such as Design History and 
the History of Design, described on its publication in 1989 as 'the first 
explicitly theoretical examination of the subject'. 26 Nevertheless, for the 
British context, useful bibliographies such as A. J. Coulson's A 
Bibliography of Design in Britain, 1851-1970, were published prior to this, 
as was a fairly small amount of insightful work on the history of industrial 
design and the industrial designer, such as Penny Sparke's Consultant 
Design: the History and Practice of the Designer in Industry 27 The low 
status of industrial designers in Britain until the 1960's, the involvement of 



25 

See Christopher Maggs (ed) Nursing History.The State of the Art, London, Croom Helm, 
1 987, and Christopher Maggs, Sources for the History of Nursing in Great Britain, 
London, King's Fund Publishing, 1984. 

John A. Walker, Design History and the History of Design, London, Pluto Press, 1 989. 

27 

A. J. Coulson, A Bibliography of Design in Britain, 1851-1970, London, Design Council, 1979. 
Penny Sparke, Consultant Design: The History and Practice of the Designer in Industry, 
London, Pembridge Press, 1983. See also Jonathan Woodham, The Industrial Designer 
and the Public, London, Pembroke Press, 1983, and the useful bibliographic essay, 'Notes 
on the Historiography of Design' in Carlo Pirovano (ed), A History of Industrial Design vol 
3, 1 91 9-1 990, Milan, Electa, pp.404-41 3. 



18 



19 

industrial design with the market place, and the general poverty of theory in 
British design have been prominent themes. 

There is a vast literature on the history of the human sciences. As 
an overview, I have found Roger Smith's Fontana History of the Human 
Sciences particularly helpful, together with reflections on the writing of this 
volume and the origins of the term 'human sciences'. 28 It was from the 
variously differentiated disciplines of psychology, applied psychology, 
social psychology and sociology that theory and methods were borrowed 
by those who, in the post-war years, sought to apply the approach of the 
natural sciences to ever-widening areas of practical human activity. On 
methodology per se in the social sciences, and, importantly, its relation to 
practice, nothing comparable to Jennifer Piatt's history of sociological 
research methods in America exists for the British situation, but given the 
US domination of the field in the post-war years this volume still proved an 
insightful guide. 29 

Histories of operational research (or, in the United States, 
operations research) consist in large measure of internalist participant 
accounts which celebrate war-time achievements and/or promote peace- 
time applications. 30 Rather few critical or analytical studies of the 



Roger Smith, A history of the human sciences, London, Fontana, 1997. See also his article 
'History and the history of the human sciences: what voice?', History of the Human 
Sciences, 10, No 3, 1997, pp.23-39 and John Christie, 'The human sciences: origins and 
histories', History of the Human Sciences, 6, No 1, pp.1 -12. 

29 

Jennifer Piatt, A history of sociological research methods in America, 1920-1960, 
Cambridge University Press, 1996. 

30 

For a typical account see the opening chapter, 'The evolution of an attitude' in Patrick Rivett, 
Concepts of Operational Research, London, C.A. Watts and Co Ltd., 1968, pp.1 -13. 



19 



20 

phenomenon exist. An important exception lies in recent work by economic 
historians who have highlighted the close links between notions of 
optimisation in operational research and maximisation of value or utility in 
economic theory. Many of these authors attended a conference at 
Erasmus University, Rotterdam, in 1999 entitled Economists at War. The 
(intended) emphasis was on the Cold War, but the collected papers (as yet 
unpublished) comprise a sophisticated antidote to the 'Boy's Own' history 
provided by participants in operational research. In particular, Philip 
Mirowski's paper provides an exploration of how operational research has 
been constituted in the U.S. and Britain, as well as being a valuable 
bibliographical resource for its history. 31 

Further insights into operational research come from historians of 
science who have studied that group of disciplines which Andy Pickering 
calls the 'cyborg sciences', in contradistinction to the 'traditional' social 
sciences. 32 The cyborg sciences 'elided the difference between people and 
things'. Pickering's 'incomplete list' of cyborg sciences comprises 
operations research, systems dynamics, general systems theory, 
cybernetics, cellular automata, self-organisation, game theory, artificial 
intelligence, neural networks and information theory. Notwithstanding 



31 

Philip Mirowski, RAND/OR: How Operations Research put the Rigor in the Mortis, 
unpublished typescript, 1999. See also 'Cyborg Agonistes: Economics meets O.R. in mid- 
century', Social Studies of Science, 129, 5, October 1999, pp.685-718. 

32 

Andy Pickering, Units of analysis: Notes on World War II as a discontinuity in the social and 
cyborg sciences, unpublished typescript, 1999. See also Andy Pickering, 'Cyborg History 
and the World War II Regime', Perspectives on Science, 3, 1995, pp.1 -48, and Andy 
Pickering/History of Economics and the History of Agency', in J.Henderson (ed), The 
State of the History of Economics, Proceedings of the History of Economics Society, 
London, Routledge, 1997, pp.6-18. 



20 



21 

debates about what it actually was, operational research is often included 
under this umbrella, either as a discipline in its own right or as some sort of 
general precursor of more extensive attempts to apply the sciences of 
information and control to society. Both Pickering and Donna Haraway 
have looked specifically at sciences in the post-war era to which the 
relationships and analogies between machines, humans or societies were 
central. Pickering has examined the disciplinary history of the cyborg 
sciences, or perhaps more accurately the lack of it, as they faced 'the old 
problem of social reproduction: where was the next generation of cyborg 
scientists to come from?' 33 This has connections with a large body of work 
on artificial intelligence into which I have not ventured. Haraway has 
focused on biology, and the transformation of central areas of that 
discipline 'from a discourse on physiology ... to a discourse on cybernetic 
technological systems', with the post-war creation of sociobiology as 'an 
engineering-humanist discourse theorizing about society as a design 
problem in information exchange and control'. 34 Apart from these broadly 
based analyses, which are of relevance to understanding why the 
designers of a hospital bed in Britain in the 1960's should have had 
recourse to methods borrowed from operational research, there is also 
recent historical work on cybernetics, that quintessential 'cyborg' science. 35 



33 

Pickering, Units of analysis, 1999, p. 6. 



34 

Donna Haraway, 'The high cost of information in post-World War II evolutionary biology: 
ergonomics, semiotics, and the sociobiology of communications systems.', The 
Philosophical Forum, XIII, Nos 2-3, 1981-2, pp.244-278: 245, 247. 

35 

Steve Heims, Constructing a social science for Postwar America: The Cybernetics Group, 
1946-1953., Cambridge, Mass., The MIT Press, 1993. 



21 



22 

Post-war 'management science' however, perhaps the most direct 
descendant of operational research, still lacks a full historical account. This 
is in contrast to the number of studies which address pre-war Taylorism 
and time and motion studies. A few works, such as that by Urwick and 
Brech, are relevant but again the emphasis is on the U.S. 36 Critiques from 
the left are to be found in Doray, and in the Radical Science Journal, and 
concentrate largely on the effects on workers. 37 



Structure 

In addition to this introduction, the thesis comprises six chapters. In 
Chapter One I describe the circumstances leading to the setting up of a 
working party on the design of hospital bedsteads by the King's Fund in 
1963 and introduce the concerns of the main protagonists from the Fund, 
the Royal College of Art and the Ministry of Health. Chapter Two outlines 
the design methods which the leader of the RCA team espoused, their 
relation to changing trends in design methodology generally and their links 
with widespread attempts to apply the methods of the natural sciences to 
areas of practical human activity previously considered beyond their remit. 



36 

Lyndall Urwick and E.F.L. Brech, The Making of Scientific Management, 2, London, Pittman, 
1953. On the difference between the British and the U.S. situation, and the relation of 
Taylorism to the post-war scientific management movement, see Kevin Whitston, 'The 
Reception of Scientific Management by British Engineers,1890-1914', Business History 
Review, 71, Summer 1997, pp. 207-229. Whitston goes well beyond the time period given 
in his title. 

37 

Bernard Doray, From Taylorism to Fordism: A rational madness, Free Association Books, 
London, 1988 and Scientism and the Left Radical Science, 13, 1984. 



22 



23 

Chapter Three deals with the main events of the project as it was 
implemented at the RCA and The King's Fund from June 1963 until 
February 1967, when the final specification was published by the Fund. It 
covers the drafting of specifications, the construction of models and 
prototypes and the production of twenty hospital beds to the RCA's design 
for trialling in a district general hospital. Chapters Four and Five deal with 
'real beds', that is beds produced to the King's Fund specification on a 
commercial basis after it was finally published in 1967. Chapter Four deals 
with industry and commerce, Chapter Five with purchasing and use. In the 
concluding chapter I address the issue of the success of the King's Fund 
Bed as a means of unpicking some of the implications that the 
circumstances and methods surrounding its design had for its specification 
and early built forms. Clearly the notion of success begs the question of 'for 
whom', and requires further definition. 

There are two obvious initial contexts in which to situate the project: 
hospitals under the National Health Service circa 1960, and British 
industrial design at the same period. The rest of this introduction is taken 
up with brief outlines of these contexts, which will be enlarged on in the 
main text. 



38 

The hospital context 



The early 1960's saw an ongoing review of the first decade of the National 



38 

This outline relies largely on the sources in note 24. 



23 



24 



Health Service. 39 Several large scale initiatives, in particular the Ten Year 
Hospital Plan, created a climate of expansion and increased resources. 40 
Only five new hospitals were built between 1945 and 1964; the Hospital 
Plan of 1962 specified '90 new and 134 substantially remodelled hospitals 
to be started by 1970-71'. Capital expenditure of £200 million for 1961- 
65/66, and £300 million for 1966-70/71 was assumed. 41 Hand in hand with 
increased financial allocation, however, went increased attention to cost 
monitoring and the better use of resources in the light of rising expenditure 
on the NHS during the 1950's. But for some key issues, finance was not 
the major problem. New hospital building led to scrutiny of ward design and 
nursing complements. The perceived shortage of nurses that had beset the 
NHS from the beginning persisted during the 1960's. Against this 
background, a constant round of committees and review bodies debated 
the proper role, remuneration, training, status and organisation of nurses. 42 
In organisational terms, the original structure of the NHS was still in 
place. Hospitals operated largely independently of local authority health 
services and the general practitioners. Their basic administrative structure 
remained the Regional Hospital Boards (RHBs) to whom Hospital 



39 

The period 1948-64 has been characterised as one of 'resource starvation and policy 
neglect', Webster, The National Health Service, p. 30. The Guillebaud Report of 1956 
failed to substantiate suspicions of wasteful overspending, suggesting that more, rather 
than less, resources were required. 

40 A Hospital Plan for England and Wales, (Cmnd 1 604), HMSO, 1 962. 

41 

Ibid, p 13. 

42 

Webster, The Health Services since the War, pp.1 8-1 9, 170-177, 437-441, Rivett, From 
Cradle to Grave, pp.1 02-1 09, 1 86-1 91 . 



24 



25 

Management Committees (HMCs), performing the day to day management 
of groups of hospitals in a district, were responsible. 43 The teaching 
hospitals had retained their own Boards of Governors and a greater 
measure of autonomy. But the 1960's saw intense debate as to the proper 
form of internal administration for hospitals, in terms of structure, personnel 
and methods. The older style, pre-NHS lay management had persisted 
through the medium of the Hospital Management Committees but the 
influence of these Committees had declined since 1948. They were 
increasingly dominated by the Regional Hospital Boards. As development 
money flowed, the power of the RHBs grew. 44 And both lay governance, 
and the old-style hospital administration, were challenged by protagonists 
of a new 'scientific' management, fast gaining ground in commerce and 
industry. 

Within medicine itself, professional interests and allegiances were 
changing as hospital practice became fragmented into increasing numbers 
of new specialties. These included those building on new technologies, 
such as cardiac surgery and radiotherapy, and those which were centred 
on newly identified areas of need, such as geriatrics and paediatrics. As 
well as the creation of new specialities, the 1950's saw the extension of 
specialist care to new geographical locations. At the inception of the NHS, 
planners had given prominence to the fact that consultant services were 
unavailable in parts of the country distant from the metropolis or a major 



43 

Fourteen Regional Hospital Boards were created at the outset of the NHS. Wessex RHB 
was created in 1959, and a separate RHB for Wales in 1974. Rivett, From Cradle to 
Grave, p.29. 

44 

Rivett, From Cradle to Grave, p. 172. 



25 



26 

city. There had been roughly 4,500 consultants in 1948; by 1960 there 
were around 7000. 45 Many of the new posts were created, not in traditional 
areas of medicine and surgery, but in specialties such as anaesthetics, 
psychiatry, pathology and, later, geriatrics. Against this trend towards wider 
geographical availability of specialist care, increasing levels of 
specialisation in high technology areas were soon considered by the 
profession to warrant their concentration in 'centres of excellence', or at 
least where minimum standards of resourcing could be guaranteed. 46 
While the burden, or perhaps opportunity, of policing qualifications and 
training needs was shouldered by the professions, these changes in 
service provision had considerable implication for planners and 
administrators at most levels in the NHS. In particular, the intention to 
centre the hospital service on the concept of the District General Hospital, 
a 600-800 bed unit providing consultant services in all major specialties, 
with psychiatric and geriatric units on site and greatly expanded out-patient 
facilities, brought these issues to the fore. 47 

Factors such as these shaped both the context for development and 
the intended context of use for new artefacts in British hospitals in the 
1960's. It is in these contexts that much material for what has been termed 
'thick description' for accounts of the King's Fund Bed will be found. But the 
hospital context alone is not the only one in which the King's Fund Bed 



45 _ 

Rivett, From Cradle to Grave, p. 137. 



46 

Cardiac surgery, for example, and the treatment of major accidents, were regarded as 
requiring special units of this kind. 

The District General Hospital, HMSO, 1961. 



26 



27 

may be situated. As noted above, the project was as much about design as 
it was about beds. 



British Industrial Design, circa 1960 

For much of the twentieth century, British industry had remained committed 
to 'an anonymous staff designer who received little or no public 
recognition'. The situation described in 1931, whereby the designer was 
understood by the manufacturer to be somebody who was going to earn a 
very moderate wage all his life '.. not., as much as a dentist, or a lawyer, or 
a doctor ... the journeyman in industry and . . . treated as such' was 
largely unchanged in the post-war years, despite the rise of the consultant 
designer in the United States. 48 A very small number of industrial design 
consultants on the American model existed in London in the 1950's. A very 
few large manufacturing companies had employed resident designers 
before the war, but this was far from the norm. 49 In any case, after the war 
much of British manufacturing was still in the hands of small to medium 
sized firms. If a 'designer' was to be found in such concerns, he was likely 
to be a single draughtsman preparing drawings for the workshop. This was 



48 

Penny Sparke, 'Great Britain: Eclecticism, Empiricism and Anti-Industrial Culture' in Carlo 
Pirovano (ed), A History of Industrial Design, vol 3, 1919-1990, Milan, Electa, 1992, 
pp.1 82-1 97:1 82. 

49 

The moulding division of British Industrial Plastics appointed a staff designer in 1 931 . This 
was almost unheard of except in the decorative art industries such as textiles and 
wallpaper. John Vale, 'Designing for Moulded Plastics in the Post-War Period', N. 
Hamilton (ed), From Spitfire to Microchip: Studies in the History of Design from 1945, 
London, Design Council, 1985, pp. 67-71:67. 



27 



28 

certainly the prevailing situation in the medical equipment field. 50 

The post-war decades saw rising consumption not matched by 
growth in manufacturing, together with the loss of traditional colonial 
markets. Concern over Britain's failing exports fuelled new initiatives to 
promote design, such as the Britain Can Make It exhibition at the Victoria 
and Albert Museum in 1946, and the formation of the Council of Industrial 
Design in 1944. 51 The precursor of the Council was the Design and 
Industries Association, in existence since 1915 in order to 'encourage a 
more intelligent demand among the public for what is best and soundest in 
design'. The Times approved: 'entirely practical ... not vaguely artistic'. 52 
The close connection of industrial design with commerce and utility 
perhaps made practitioners particularly susceptible to an overall 
conservatism which characterised the mainstream of British design for 
much of the twentieth century. Numerous commentators have identified 
this tendency, together with the lack of any theoretical underpinning after 
the decline of the Arts and Crafts movement of the late nineteenth 
century. 53 Such theoretical writing that was produced largely strove to 
situate British design in relation to the Modernist movement, and the British 
version of Modernism lacked the political radicalism of its European 



50 

Interview, Peter Siddall, 19.6.00. 



51 

Raymond Plummer, 'Fitness for Purpose: the Story of the DIA.', N. Hamilton (ed), Design 
and Industry: The effects of industrial design and technological change on design, 
London, Design Council, 1980, pp. 5-11. 

Ibid, p. 5. 

53 

See for example Sparke, 'Great Britain: Eclecticism, Empiricism and Anti-Industrial Culture' 
p.182. 



28 



29 



counterpart. There was no British equivalent to the Bauhaus, or its 
successor at Ulm, where the purpose was 'to establish as one entity 
professional ability, cultural design and political responsibility'. 54 This 
theoretical vacuum was a matter of frustration to some but also of 
opportunity. The proper source of design theory was not at all obvious, and 
there were some surprising contenders. When increasing numbers of 
industrial design courses had been set up by the end of the 1960's, 
entrants might find themselves studying 

. . . synergetics, general systems theory, theory of games, chemistry and 
physics, topology and projective geometry, cybernetics, 
communications, meteorology, geology, biology, science of energy, 
political geography, ergonomics and production engineering, 
(and/or) sociology, anthropology, psychology (perception, human 
engineering factors, ergonomics) and, in fact, all the behavioural 

55 

sciences . . . 



54 

Kenneth Frampton, 'The Ideology of a Curriculum' in Herbert Lindinger, Ulm Design: The 
Morality of Objects, Berlin, Ernst and Sohn, 1990, pp.1 30-1 43:1 31. 

55 

Misha Black, 'Engineering and Industrial Design', Proceedings of the Institution of Mechanical 
Engineers, 186, 74/72, 1972, pp.897-91 2:908, quoting R.Buckminster Fuller and V. 
Papanek. 



29