The Thirties: An Intimate History of Britain. Juliet Gardiner

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СКАЧАТЬ 11,409 children; a further 3,985 children boarded at open-air residential schools, while those 2,451 children already affected by pulmonary TB might well attend one of the thirty-six sanatorium schools (or one of the further sixty-five schools catering for children suffering from non-pulmonary tuberculosis). Meanwhile, forty of the 221 schools in Glasgow had been constructed on ‘open-air principles’, with open verandahs, sliding doors to the classrooms and plate-glass windows, and two ‘preventoria’ for children who had been exposed to tuberculosis were built. Those children who for whatever reason could not attend such an institution might be shipped out to foster parents in rural areas to get their fresh air that way.

      One problem was the reluctance of those who suspected that they had tuberculosis to seek medical advice, since ill-informed prejudice about the disease might well mean that they were shunned ‘like lepers’ by family and friends, lose their job and find it hard to get another even when they were well again, and have difficulty in getting life assurance cover. ‘The world regards the “lunger” as an outcast,’ wrote a sufferer in the Western Mail in November 1938. ‘Filled with an exaggerated dread of any word ending in “osis,” unthinking people recoil from anyone who had “had it” … Every week scores of “lungers” are released from clinics, hospitals and sanatoria … Each patient goes his own way. Yet each one finds himself up against the same problem … He is not wanted; he is avoided; he is feared — and then alack! forgotten … His own relatives are afraid to have him in the house … Jobs are out of reach … Two kinds of suffering have attended me through the battle [to get well in the sanatorium]. One was the distressful horror of the disease itself. The other is the mental agony born of my knowledge that when I emerge from the fight … I am taboo to my fellow countrymen.’ Such considerations sometimes influenced GPs, who were obliged by law to report cases of tuberculosis, which may mean that rates of incidence in the 1930s were actually higher than reported.

      Early diagnosis significantly improved the chance of recovery. The information-aware Bermondsey Public Health Department produced a film for their travelling cinemas, Consumption, in 1932 which illustrated how ‘a consumptive, by placing himself under medical treatment and obeying simple rules of hygiene, can live an ordinary life for many years, without fear or risk to himself or those with whom he comes into contact’. Dr Salter himself played the doctor the patient consults after coughing blood into his handkerchief. He is seen sending the young man to a local authority sanatorium where he gradually gets better and is taught a new trade. On his return home he declines to kiss his wife since he is still contagious, and she makes up a bed for him in a shed in the backyard — provided free of charge by the council.

      One way that people might receive treatment was to be admitted to Papworth Village Settlement, near Cambridge, founded by Dr (later Sir) Pendrill Varrier-Jones in 1917 along the lines of Ebenezer Howard’s ‘garden city’ of Letchworth, where, as he explained in an article in 1931, if a tuberculosis patient was found to be ‘suffering from extensive and permanent damage he would be able to live and work permanently in a village settlement with his family. The whole tuberculosis problem would be revolutionised. Those who thought they had tuberculosis would present themselves at a very early stage … and the success rate in treatment would be revolutionised’ — not that Varrier-Jones believed that tuberculosis could be cured: treatment was a life sentence.

      By 1938 Papworth, which was infused with the same spirit of experimentation (‘studying the mechanisms of resistance’) and holistic treatment as the Pioneer Health Centre in Peckham — ‘We are dealing with persons, not cases,’ Varrier-Jones was fond of saying — offered a hospital and a sanatorium consisting of open-air shelters with canvas flaps constructed in Papworth’s carpentry workshops for which patients were issued with waterproof blankets to keep off the snow: glasses of water holding false teeth froze solid by the beds. A population of a thousand, including 360 children, lived in the 142 semi-detached cottages to which patients were able to move as they grew stronger, with a verandah and a garden, but no ornaments or wallpaper allowed, as these harboured germs, the windows permanently open. They ate a rich diet that included eggs, milk, porridge and cocoa, and were able to make use of communal facilities such as a swimming pool, join clubs for tennis, cricket, athletics and book reading, and to go to the cinema or pub on site. Since ‘not everyone is fitted for a life in Utopia’, the emphasis was on self-discipline externally policed. Patients lived under a strict paternalistic regime that censored entertainments they laid on themselves and the films they were allowed to watch, and leave passes were rigorously controlled. There was a psychiatric clinic to counsel the despairing.

      As well as families, Papworth admitted single men from 1927 and single women (most of them former domestic servants) from 1929, their hostels sited some distance from each other, with ‘a tumulus heaped up’ between them to help maintain segregation. However, several inter-patient marriages did take place, and on such occasions Dr Varrier-Jones would present the happy couple with an engraved glass vase.

      Varrier-Jones had hoped that the settlement would become financially self-sufficient through farming and market gardening — and in any case he thought it essential that those that could, should work, or they would soon ‘“throw up the sponge” if they were treated as permanent invalids’. However, the income thus generated turned out to be too little, so he set up a factory turning out travel goods and furniture. Patients were also employed in signwriting, printing, boot repairing and jewellery making, plus some horticulture and poultry farming. By 1930 Papworth’s turnover was £85,000, and by 1937 this had increased to over £130,000, with a number of Cambridge colleges purchasing pieces of the well-made furniture.

      The incidence and treatment of tuberculosis provides something of a metaphor for a nexus of 1930s attitudes. The clean, sweeping design of tuberculosis hospitals, sanatoria and health centres that rejected Victorian and Edwardian decoration — curtain rails with heavy plush curtains, flocked wallpaper, cornices and curlicues that might harbour dust and therefore bacilli — the fervent belief in the health-giving properties of fresh air, ‘aerotherapy’ as it was sometimes known, and sunlight, and therefore the use of glass, wipeable venetian blinds, open-air balconies, the curved buildings looking like great ocean liners, such as the expanded Benenden sanatorium, or Harefield hospital, built in Middlesex in 1938 in the shape of an aeroplane floating in the verdant countryside. The Finsbury Health Centre had been explicitly designed to catch the changing angle of the sun, and the interior murals by Gordon Cullen urged ‘Fresh Air Night and Day’ and ‘Live Outside as Much as You Can’.

      Flexible interiors were also part of the ethos: Peckham Health Centre had moveable glass partitions which meant that almost whatever they were doing, its members could be observed by the experts like goldfish in a bowl. Such buildings united zealous democratic (and usually socialist) reformist urges with modernist architectural forms that let light into what were formerly dark and hierarchical spaces. Above all there was the debate about what ‘caused’ tuberculosis. Was it hereditary — the Leicester Schools’ Medical Officer was of the opinion that parents with tuberculosis should be prevented from having more children (How? Celibacy? Segregation? Sterilisation?), and the city’s Medical Officer of Health made sure that patients were handed a leaflet when they left the sanatorium advising them not to marry or have children. Was it unhealthy living conditions or an inadequate diet that was responsible? Did poverty cause tuberculosis? Or was it that tuberculosis caused poverty (through lack of earnings)? Could an individual take charge of his or her own medical destiny by clean living, or were environmental factors beyond individual agency responsible?

      Average life expectancy was increasing: by 1930 it was 58.7 years for men and 62.9 for women, whereas in 1900 it had been 48.5 for men and 52.4 for women, and infant morality was slowly falling. But this was only part of the story. Relief at the decline in the incidence of infectious diseases (such as tuberculosis) overlooked indicators of poor health such as anaemia, debility and undernutrition, and failed to differentiate between different parts of the country. In fact the death rate was rising: between 1930 and 1931 it increased from sixty per thousand to sixty-six, and in the depressed areas of Lancashire, Teesside, South Wales and Scotland the picture was bleak, with the death СКАЧАТЬ