As shown in our previous bloghome visits were not possible for all Tuberculosis patients in the community, and the medical officer therefore looked to sanatoria as a means to both help sufferers and prevent its spread. Sanatoria began as open air resorts for wealthy patients in late nineteenth century Europe, usually located in mountains or spa areas. The idea spread and many were created for different types of clientele, religious groups, companies and even trade unions. However they were run, sanatoria were usually in the countryside, and the presence of pine trees was thought to bring benefit. Covered verandas protected patients from the elements when outdoors, or French windows allowed patients to enjoy fresh air inside. Firm adherence to rules, hygiene, feeding-up, and an increase in movement and work were thought to both improve the patient and prepare their return to health.
The Stannington files have revealed that children were admitted from or to a range of 58 hospitals and sanatoria, as far away as Great Ormond Street. The files show Stannington in the context of the wider tuberculosis movement in the UK and even abroad, as during WWII there were Stannington patients who were refugees and evacuees, who had attended sanatoria and hospitals much further afield. Here we will examine Stannington’s connection with some of the local sanatoria.
A map showing the location of the sanatoria mentioned in the patient files in relation to Stannington Sanatorium.
Barrasford, Northumberland.
Situated on the moors north of Hexham, Barrasford shared much of its history with Stannington. It was funded by the raising of a public subscription, helped by a large donation from an individual, in this case William Watson-Armstrong (later Baron
When the PCHA created Stannington Sanatorium in a bid to combat Tuberculosis (TB) they were not alone in the fight against the disease. In 1906, the year before Stannington Sanatorium opened, the National Association for the Prevention of Consumption highlighted to local authorities that deaths from the disease of 60,000 people each year in England and Wales were preventable if they acted.
Northumberland County Council acted by urging district councils to notify them of cases of disease, punish spitting, appoint health visitors for sufferers and their families, and place strict controls on dairies. However they put great emphasis on the district councils to improve the major problem of sub-standard housing. As one County Medical Officer put it ‘Tuberculosis is a housing disease’.
A pamphlet from 1849 titled Report to the General Board of Health on a Preliminary Inquiry into the sewerage, drainage [etc…] of the borough of Morpeth and the village of Bedlington by Robert Rawlinson (NRO 2164) shows just how bad this could be. Rawlinson described the collier’s cottages of the area, where a flagstoned 14ft square room served as living room and bedroom for a large family, with a small bedroom in the roof space ‘open to the slates’. Other houses like the above in Morpeth, had a 16ft by 15ft bedroom in which 8 people slept. Worse however were the overcrowded lodging houses. He quotes the Town Clerk’s account of them, where beds were occupied by ‘as many as can possibly lie upon them’. When these were full others would sleep on the floor in rows. The Town Clerk added ‘nothing but an actual visit can convey anything like a just impression of the state of the atmosphere… what then must it be like for those who sleep there for hours?’ This description shows an atmosphere in which TB could easily spread, where the occupants of the lodging houses (often labourers moving between work) could then spread it at the next lodging house they came to.
However if you think this only happened in the mid-nineteenth century, think again. Dr Allison, who worked for many years at Stannington, described the inside of a house he had visited in 1905:
Dr. Allison’s story from the Yorkshire Post, 14th September 1905
In the five years leading up to 1914 it was calculated 92 people for every 100,000 in the county died of consumption. This was more than Scarlet fever, Diphtheria, Enteric fever, Measles, and Whooping cough combined, as these diseases together killed 70 people in every 100,000 (NRO 3897/4, 1914, p.26). Notification of cases became compulsory, and the County Medical Officer was under a lot of pressure when asked to assist TB sufferers, and so a full time post was created for a Tuberculosis officer from January 1914. Tuberculosis dispensaries with the TB officer and nurse were established in densely populated areas (NRO 3897/4, 1914, p.25). During the 1920s one in every ten deaths in Northumberland was caused by TB, and the County Council used around 75% of their health expenditure to tackle the disease.
Tables from NRO 3897 showing the condition in 1922 of adults and children treated in 1914 for different stages of TB.
The Council felt provision of sanatoria was vital, providing uninsured patients with 10 beds at the private Barrasford Sanatorium, 9 at Stannington Sanatorium, and housed insured patients at other sanatoria as well. However many patients shortened their stay and returned to work to keep a wage. Likewise many tried to avoid going to see doctors in the early stages of TB as they feared taking time off work. The Medical Officer’s report for 1922 noted that many were coming to see the Tuberculosis Officer at the dispensary in the late stages of the disease. Above are tables showing what condition patients who applied for treatment for TB in 1914 were by 1922, and many had worsened or relapsed.
The Medical Officer also feared that once the patients had left the sanatorium, without further help the disease would return. The Stannington Sanatorium patient files echo this reluctance to return their patients to poor living accommodation. The majority of files give us some idea of the living arrangements in each child’s home, who the family members were and whether they had had TB. Below is part of a letter written in 1953 between Dr Miller and the Whickham Chest Clinic, in which he describes a patient’s home conditions:
The patient was kept at Stannington longer than medically necessary because of this. Another patientwas only discharged when their family moved into a council house. Though the longer treatment received by the children at Stannington Sanatorium gave patients a much better recovery rate, improved home conditions were seen as essential to their long term improvement.
In 1944 the TB After-care Sub-committee was formed from the Public Health and Housing Committee. The central committee met quarterly, and worked with local sub-committees and an almoner to look after patients discharged from the sanatoria and new patients in the community. The county was divided up into 12 of these sub-comittees based on the then existing dispensary areas: Wallsend; Gosforth and Longbenton; Whitley and Monkseaton; Seaton Valley; Blyth; Ashington; Morpeth; Bedlington; Newburn; Hexham; Alnwick; and Berwick (CC/CMS/PROPTBA/1). Cases were referred to sub-committees by the Tuberculosis officer through the dispensary or local health visitor. Patients’ needs were assessed after a visit by the committee members, who would provide additional medical treatment such as nursing, free milk, extra food, training for employment, and financial assistance such as with rent. They also helped families move to better accommodation, provided travel expenses for patients and their families, clothing, shoes, and importantly, bedding ‘to enable patients and contacts to sleep apart and thus prevent the spread of infection’ (CC/CMS/PROPTBA/1). They provided equipment, from beds to back supports and bedpans, sputum mugs and even deckchairs. Gifts of drinking chocolate, tinned fruit, and magazines also went through the sub-committees. As at Stannington occupational therapy was important (see our previous blog post) with after-care patients crafting everything from embroidery to fishing flies, leatherwork, and even cabinets.
An important function was to refer patients for help with different organisations too, such as the British Legion, Ministry of labour, and the Poor Children’s Holiday Association. A patient assisted by the committee to become a shorthand typist was provided with holiday travel expenses by the ‘BBC Children’s fund for Cripples’, likely describing a forerunner of BBC Children in Need. The County Council paid the PCHA to board out children from homes with a Tuberculosis case, and many of these children likely went to Stannington.
There are several references to individual cases, including one lady:
During the Second World War mobile mass radiography became a huge boon to diagnosing the disease, with factories and workplaces often used as bases, and later mobile vans with their own generator operated in the community. They were used across the world and even reached Alaska by dog-sled. The County Council paid a shilling to the Newcastle local authority for each Northumberland case x-rayed with their machine. The County Council knew they would require an adaptable and economic mobile unit, but first used Newcastle Corporation’s unit at Ashington Colliery, where radiographs were taken from the 30th April 1947 (CC/CMS/PROPTB/2). By September that year 3,642 had attended in Ashington, with 23 referred to the Dispensary, and 1,780 attended the unit at Blyth, with 25 referred for treatment. Though the disease is by no means eradicated, improved housing conditions, the TB Vaccination, and early diagnosis with mass radiography made such a dramatic impact on the disease that sanatoria like Stannington were converted to other uses.
References:
Bynum, H., (2012) Spitting Blood: a history of Tuberculosis. Oxford: OUP
Taylor, J., (1988) England’s border county: a history of Northumberland county Council.
In honour of World Tuberculosis Day, we have a guest blog from Rebecca Cessford. Rebecca is a PhD researcher with the AHRC funded Heritage Consortium based at the Universities of Hull and Bradford. She will be using the Stannington Sanatorium Collection to study tuberculosis in the past using the archaeology of human remains and medical history. Here she tells us about her research and the role of the Stannington Collection in it.
When we think of tuberculosis (TB), images are conjured of a romantic disease causing a bloody cough, a pale complexion and weight-loss, the romanticised disease of the 19th century. What we do not think of is TB roaming the streets today. But tuberculosis is still a great threat, with over a million people dying of the disease each year and over 6,500 new cases declared in the UK during 2014. With increasing multidrug resistant strains of tuberculosis, is it possible to look back at a time before antibiotic drug therapy to better understand the future of this global emergency?
Early Discovery, Early Recovery 1929. Image from the National Library of Medicine, USA
Tuberculosis is a disease that extends as far back as the Neolithic period in Europe, with the earliest case reported in England coming from Dorset dating to the Iron Age. However, our ability to identify tuberculosis in skeletal remains from archaeological contexts is difficult. Firstly, tuberculosis of the bones and joints only affects 3-5% of all cases. Secondly, bone can only react to disease in a limited number of ways with many diseases causing similar bony destruction and remodelling. There are also problems identifying tuberculosis in the remains of children, due mainly to the under-representation of children in the archaeological record.
The most characteristic feature of tuberculosis in the skeleton is Pott’s Spine, an angular deformity in the mid to lower spinal column caused by the collapse of one or more vertebral bodies. The presence of this deformity has, for many years, been the only way of diagnosing tuberculosis in human remains with any certainty, despite the fact that any bone in the body can be affected. Advances in ancient DNA and biomolecular studies in archaeology mean tuberculosis can be tested for, even in the absence of any physical pathologies. However, these destructive and costly procedures are not without their limitations, still leaving much reliance on routine macroscopic observations (seen with the naked eye) of dry bone remains.
Pott’s Spine – characteristic collapse of the vertebral bodies causing an angular deformity of the spine due to tuberculosis. Image from University of Durham.
My research aims to look at the potential for using pre-antibiotic clinical radiographs (x- rays) as an aid to the macroscopic identification of tuberculosis in human remains, focussing specifically on infants and children. To do this, I intend to undertake a thorough examination of all the radiographs demonstrating skeletal tuberculosis to look at variations in progression of disease over time; the outcomes of healing on bones and the distribution of tuberculosis across the body where more than one bone was involved. In addition to this I will look at the corresponding medical file for each set of radiographs drawing on details outlined in the medical notes and x-ray reports to add to my own observations from the radiographs for an informed review of the underlying processes to bone and soft tissue being observed. It is hoped that the compilation of this data will provide a more detailed understanding of the processes involved in advancing tuberculous infection with comparative examples from pre-antibiotic radiographs. This strives to increase the ability to diagnose tuberculosis in archaeological remains even in the absence of Pott’s Spine.
Tuberculosis of the Knee: HOSP-STAN-07-01-02-91_09Tuberculosis of the Spine – HOSP-STAN-07-01-02-1662-22Tuberculosis affecting the finger bones: HOSP-STAN-07-01-02-641_07
By studying the patterns of tuberculosis in the past we are better informed when it comes to dealing with the disease in the present and in the future. To be able to offer an evidence-based and informed approach to tackling tuberculosis we need better criteria for diagnosing it macroscopically in archaeological human remains, to get a more encompassing view of the various manifestations associated with it. The outcomes of my research will aim to act as an aid to the identification and study of tuberculosis in children in relation to archaeological remains further identifying the worth of pre-antibiotic medical records.
The Stannington Collection is a unique resource for studying this long standing infectious disease in children from the early to mid-20th century, many of which are still alive today living with the memories and/or side effects of the disease. I would also like to take this opportunity to thank the former patients of Stannington Sanatorium who expressed support for academic research to be undertaken on the collection during the first phase of the Stannington Sanatorium Project; their support makes research all the more worthwhile.
