tuberculosis

Killer in the community – the County Council’s approach to Tuberculosis

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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 patient was 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.

 

 

From Stannington to South Africa and other stories – the role of the Boards of Guardians

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Before the NHS supported children at Stannington Sanatorium there were a few sources of finance for patients who could not fund their own places. We have already covered a little of the practice of donations for memorial cots in our online exhibition. From 1929 the Northumberland County Council’s Public Assistance Committee supported places for children from the county, with other councils doing likewise. However what about the children who went to Stannington before 1929?

Before the Committee was created those on low incomes were supported by the Poor Law Boards. They ran the workhouses, provided out-relief to those on low incomes, housed the orphans of the parish, and financially supported the ‘lunatics’ of the parish in the County Asylum (see our recent post). There were ten Poor law unions in Northumberland; Alnwick, Belford, Bellingham, Berwick, Castle Ward (for the Ponteland area), Glendale (for the Wooler area), Haltwhistle, Hexham, Morpeth and Rothbury. We decided to look through our poor law records for children who were supported at Stannington by the Board of Guardians, who dealt with the welfare of individuals, for Hexham Union.

Though Stannington Sanatorium had been open since 1907 the first mention we find in the records isn’t until 1910, when in the minute books we have an explanation of how the system worked:

Box 1

As the Board of Guardians were not charged for the Stannington patients we do not know how many of the children were sent, but we have a few cases where their return is mentioned.

Box 2 Box 3

Though we do not know what became of Janet, the Guardian’s minute book (GHE/20) shows by 1930 Catherine was at the Convent of Notre Dame, Southwark, London. The Sisters of Notre Dame de Namur ran, and continue to run, numerous schools and pupil teacher centres like Southwark across Britain. It is possible that Catherine was training as a pupil teacher, a five year apprenticeship in which girls received lessons as well as teaching younger girls (if you would like to learn more the Sisters have a very informative website). The Guardians sent Catherine £14 11s 9d in National Savings Certificates they had held for her, which were to be kept by her Sister Superior until she turned 21.

Photograph of the Phillipson Farm Colony boys and their manager from the Stannington Sanatorium brochure HOSP/STAN/9/1/1
Photograph of the Philipson Farm Colony boys and their manager from the Stannington Sanatorium brochure HOSP/STAN/9/1/1

However patients at the Sanatorium were not the only children that the Board financed at Stannington. The Philipson Farm Colony was used as a training facility to prepare boys to go into agricultural jobs. The first we see to be sent from Hexham is an orphaned boy, 14 years 5 months old, called William Young.

We first hear of William’s story in a letter in February 1911 to the PCHA, in which the guardians ask for a place at the Philipson Farm Colony for William. Further letters show this was granted, the Guardians agreed to pay six shillings in maintenance for him, and he was to be sent on the 11th March or the 1st of April. The 1911 census, taken on the 2nd April, shows he was a farm labourer, one of many boys in their late teens and early twenties present at the colony, and was born in Brampton, Cumberland. Sadly we have been unable to discover which of the many William Youngs born in the area he might have been.

The Farm Manager at this time was John Atkin, who had leased the farm since 1900 and was in charge of the boys at the colony from its opening in 1905. An article written by John in the Rotary Wheel magazine of August 1918 describes his endeavour to produce the most from the land in as diverse a way as possible, advocating a mixture of crops, livestock and poultry. William would therefore have learned many different aspects of farming at the Philipson Farm Colony.

In March 1913 the Guardians began to debate his next step, likely at the request of the PCHA or Farm Colony, and on the 4th April they had agreed for William to go to Canada. At the time emigration to the British colonies was encouraged, and it was a common thing that boys from the colony would make a new life there using their farming skills. The Guardians requested reassurance of William’s willingness to go and the suitability of the place he would be sent to. It seems this place fell through, and another letter on the 20th of September announced that the Board agreed to his being sent to Australia. However by the 18th of October the plan had again changed to South Africa. He was sent money for clothing, and we know from later correspondence he departed the next day. It seems however William did not enjoy his time there – he wrote to his sister in Hexham, and the letters were passed on to the Guardians and the Farm Colony for them to look at. A letter dated the 29th May 1914 writes to the PCHA that the Boarding Out Committee had decided:

Box 4

John Nicholas Hall was another boy sent to the Philipson Farm Colony by the Hexham Board of Guardians. A letter on the 26th June 1912 shows they had considered John emigrating to Canada with William, however he went to the Farm Colony instead, again at the same rate of 6/- weekly. All we know from his time there is a brief mention in the minute books. On the 29th April 1913 we find:

Box 5

These examples give us a little insight into the arrivals at Stannington Sanatorium and the Philipson Farm Colony in their early years, but also into the end of the Poor Law Unions. Though perhaps not the most caring of organisations (such as their reference to Catherine as ‘it’!) the Poor Law Boards sought to find a home and training for a future career for all the children that came to them. They also made sure that children who were unwell were cared for, including within their own institutions. However William’s case also makes us wonder about the stories of the children associated with Stannington and the Farm Colony. We know many other boys from the Farm Colony also emigrated and it is possible this was under the ‘Home Children’ scheme. The scheme started in the 19th century and led to the emigration of many thousands of children from the United Kingdom to Australia, Canada, New Zealand and South Africa.  Until relatively recently it has been difficult to find information about these children, but now records have become more accessible via national initiatives. The websites of The National Archives of the UK, Australia, Canada and New Zealand provide useful advice about researching child migration. Sadly there is nothing for South Africa yet, but hopefully we will be able to learn what became of William with further research.

Opening up the patient files and our new Flickr collection

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We our happy to now announce at just past our halfway point in our repackaging and digitisation project of the 1944-1966 patient files we are launching a new collection of Flickr sets of some of the files. Our hope in this is that we can showcase some of the types of documents for those wishing to study the files.

We hold the patient files covering the period 1937 to 1966. The first files are pre-printed sheets, which were sorted and bound into books after the patient’s discharge. These give the medical and family history of the patient, the tests done, temperature charts and diagrams of the front and back of the torso to record observations on the chest. Additional sheets of temperature charts and diagrams could be pasted in once the first sets were used. The project’s first phase looked a lot at these and there is much about them in previous posts. We have chosen one as an example, which you can see here. In 1943 the staff transitioned to using files, which were also filed by the date of discharge until 1946.

first page in the discharge book for HOSP/STAN/07/01/01/476
The first page in the discharge book for patient HOSP/STAN/07/01/01/476

We don’t find the same documents within each file, but wanted to show a range of what we commonly find, and have divided these into what we have described as ‘core’ and ‘non-core’. The core documents give an overview of each case and are appended to our online catalogue, available to search here. Non-core documents include temperature charts, correspondence and less common documents; these cannot be viewed via our catalogue. Our new Flickr page will give a glimpse of how the whole files and their associated radiographs look.

However, choosing which files to use has been difficult, as the cases and the contents of the files themselves are so varied. We have chosen two files from each of the three types of disease identified by the patient files – pulmonary (in a blue file), bones and joints (in a green file) and cases of Tuberculosis where tissues were affected (in a pink file). For each type we have shown an earlier case, around 1946-1948, and another from after the introduction of streptomycin and similar antibiotics at Stannington, around 1949-1953. After 1953 we have fewer radiographs, and we wanted to ensure these were included too. Each file has been redacted to remove the names and personal details of each patient, leaving details of treatment, condition and other aspects of their stay at Stannington. We have left out long runs of temperature charts, superfluous backs of documents, and included only a few of the radiographs where they are taken repeatedly over months and years. However we can always be contacted by emailing archives@northumberland.gov.uk if you have any further questions.

Rather than taking you through each file here when they can be explored fully on Flickr, we will look instead at some of the types of documents that are included in the files. We have divided the non-core documents into those we commonly find which are present in some combination in most files, and those we find less regularly, even rarely, in some of the files.

Treatment card from file HOSP/STAN/07/01/01/2654, showing stars indicating all three antibiotics were used.
Treatment card from file HOSP/STAN/07/01/01/2654, showing stars indicating all three antibiotics were used.

Core documents:

  • The file – gives the patient’s name, address, date of birth, sex, age, local authority, religion, admission and discharge dates, whether notification was given before or after admission, when immunised for diphtheria, if permission was given for dental treatment and anaesthetic, diagnosis and result of treatment. On the inside of the file was recorded the patient’s family history, results of tests, sputum reports, other pathological reports and X-ray reports (which were later recorded on the X-ray card).
  • Patient history – a short summary of the patient’s family history and general condition on arrival, followed by details of their progress at Stannington, often quite similar to the treatment card.
  • Treatment card – written up by the doctors with changes in condition and treatment. Like the above image, later examples are often quite colourful, with streptomycin and other drugs written in red and a different coloured star given to show which drug a patient was given, as shown in the above example. Red stars were for streptomycin, blue for para-aminosalicylic acid (PAS) and green for isonicotinic acid hydrazide (INH). The three were often used together, forming an effective combination treatment.
  • Discharge report – written summary of the patient’s progress while at Stannington, and their condition on discharge. A copy would often be sent to their local doctor, clinic or the hospital that referred the patient to Stannington.
  • X-ray card – listing dates, serial numbers, locations and settings of X-rays.
Bacteriological report from file HOSP/STAN/07/01/012654, showing the results of a sputum test.
Bacteriological report from file HOSP/STAN/07/01/012654, showing the results of a sputum test.

Commonly occurring Non-core documents:

  • Medical report to institution (from local authority or other source) – a short report of a patient’s condition before coming to Stannington. Pre-NHS (and for a short while afterwards) local authorities would ‘sponsor’ a bed for a patient from their area, and the appearance of the form differs depending on the area.
  • Permissions and medical history form – this appears in the late 1940s and alters very little over the years. It asks parents and guardians to give details of childhood illnesses, immunisations and permission for dental treatment and anaesthetic. We also find permissions slips for specific operations, vaguely for ‘an operation’, and other instances, such as day trips.
  • Bacteriological reports – reports from a bacteriological laboratory showing the results of tests from samples, for example samples of pus being checked for tubercle bacilli. These change through time and are found in two types, a small sheet that would be stuck to the file, document or separate sheet of paper, or a longer thin sheet. In earliest files these may be pathologist’s reports.
  • Dental card – showing condition of teeth and any treatment during the patient’s time at Stannington. Also sometimes optical or dermatological cards and check-ups.
  • Correspondence with other hospitals and doctors – from before admission, during their stay and after the patient’s discharge from the Sanatorium. Communication from before a child entered Stannington usually arranged their admission. During their stay correspondence may have arranged a transfer for procedures at another hospital. Any correspondence after a child left Stannington was often with local authorities or the doctor or clinic providing follow up care.
  • Temperature charts – most patients had their temperature taken twice a day throughout their stay and recorded on a chart, and bowel movements noted. On occasions a 4 hourly chart was used when a child was suffering from a high temperature.
  • Correspondence with parents and family – includes letters arranging visits and interviews with doctors about the patient’s condition, and the child’s discharge home. These letters sometimes give an insight into home and family conditions.
  • Out patients review reports – after discharge some patients, usually orthopaedic cases, might be reviewed to monitor progress, often on a three monthly or six monthly basis until the disease was quiescent.
Permissions slip for 'any operation necessary' from file HOSP/STAN/07/01/01/2558.
Permissions slip for ‘any operation necessary’ from file HOSP/STAN/07/01/01/2558.

Some of the other non-core documents that we sometimes find:

  • Transfer documentation, notes and charts from other hospitals – often enclosed in the file that was used at the other hospital.
  • Things written or drawn by the children – very occasionally the patients seem to have got a hold of their file and written or drawn on them. On other occasions little drawings or letters have ended up in the file. As can be seen in the Flickr set, the patient in file HOSP/STAN/07/01/01/2697 was an amateur fortune teller!
  • Newspaper cuttings – of stories about patients may later be put in the files, such as when patients later married etc.
  • Permissions forms – in addition to the general Permissions and medical form given on arrival we also find permissions slips for specific operations, vaguely for ‘an operation’ like the example above, and other instances, such as day trips.
  • Removal without medical consent slip – signed by a parent on removing their child from the sanatorium, either pre-typed or handwritten.
  • Sputum charts – recorded the amount and colour of sputum produced on each day, and found in the latter end of the period our files cover. These long thin coloured graphs could almost be works of art.
  • Artificial pneumothorax card – like an X-ray card, showing when an artificial pneumothorax was performed. This procedure collapses a lung, allowing it to rest and heal.
  • Drug charts – occasionally we see charts detailing the time and date drugs like streptomycin and PAS were given.
  • Diabetic charts – though these are a drug chart in that they record insulin intake, they also record sugar and keytones present in urine.
  • Diet menus and instructions – for some patients with specific requirements we might find a typewritten sheet giving instructions of what the patient should and shouldn’t eat, or menus for a diet.

We are hoping that making some of the patient files accessible will give an idea of the contents of the collection as a whole. The collection has great potential for academic study of the radiographs and treatments that were used during a time of great development in treating tuberculosis, but also gives a valuable insight into the life of a sanatorium and its patients, and the perception of tuberculosis in wider society. You can view the whole Flickr collection here, and search the online catalogue here through our website. We hope you find the files as interesting as we do, and that they give a little insight into life at the sanatorium.

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