Walther’s German sanatorium in Nordach in the Black Forest, ‘an abode for Spartans’ 1,500 feet above sea level and ‘exposed to every wind’, the model for so many dilute British establishments with names such as Nordach-upon-Mendip and Nordach-on-Dee. They were governed by strict rules — visitors one Saturday afternoon a month was not unusual — with a regime regulated by bells which included rest, a great deal of food (though not always of the highest quality), some outdoor exercise whatever the weather, and indoor crafts such as wood whittling, raffia work, crocheting and painting, and absolutely no sharing of cutlery or crockery. Spitting, a not uncommon habit in the 1930s, was forbidden, since sputum was know to be a carrier of the tubercle bacillus.
Belinda Banham, who had trained as a nurse at St Thomas’s Hospital in London, wrote that the treatment provided to tubercular patients in the 1930s by the Royal Sea Bathing Hospital in Margate (founded in 1791 as the Royal Sea Bathing Infirmary for Scrofula)
consisted, for the main part, in exposure to the elements … each ward gave onto two verandahs, one on either side. The verandahs were equipped with shutters which were never to be closed in the day, and at night only with the permission of the night sister. Permission was rarely granted, even when the snow was falling, as it was thought contrary to the patients’ interest. Cloaks were allowed to nurses only in moving to and from the wards. Strength and stamina were essential to survival … It is difficult today to conceive of the patience and heroism of patients occupying those beds. The length of stay was indeterminate and never less than six months. With tuberculosis of the spine … two or three years was common … with patients often immobilised for two years or more … Efforts were made to protect nurses from contracting tuberculosis, mainly by means of an ample diet … nonetheless, several nursing colleagues did acquire the disease and two died in my time there.
When Dr W.A. Murray arrived at Glenafton Sanatorium in Ayrshire in 1934, he found chilblains ‘prevalent among staff and patients’, which was hardly surprising since the wards had no heating and the icy Scottish wind blew in round the ill-fitting windows, raising the linoleum from the floors in waves ‘which made a ward round something like a trip on a roller coaster. Rain also came through the windows to such an extent that a patient with some skill as a cartoonist’ depicted the doctor ‘doing his rounds in thigh boots while a patient sailed a toy boat round his bed!’
Fresh air was also recommended for supposedly susceptible children who might be ‘pre-tubercular’ (though some were actually suffering from malnutrition), and could be removed from their infectious homes during the ‘delicate years of growth’. By 1937 there were ninety-six open-air day schools in England, catering for 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