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 rate in the early 1930s as high as it had been before the First World War. Infant mortality rates rose, and not just in the depressed areas. There were marked differences between classes: in Lancashire and Cheshire the number of childhood deaths varied from around thirty-one per thousand among the well-off to ninety-three in the poorest class. Deaths in childbirth were 2.6 per thousand in the South of England, but 5.2 in the North and 4.4 in Wales. Surveys indicated that 80 per cent of children in the mining areas of County Durham and the poorest areas of London showed signs of early rickets, which was put down to both poor diet and lack of sunshine under the smoke-laden industrial skies (hence the preoccupation with sunlight of the health centres); modern estimates suggest that between a quarter and a half of all children living in areas of economic depression survived on a diet that was inadequate to maintain normal growth and health.
The charge that there was a connection between ill health and government policies was consistently contested during the Depression. Again tuberculosis provides an exemplary study, with the Chief Medical Officer of Health, Sir George Newman, attributing the rise in deaths from the disease in the industrial areas of South Wales (from 131 per 100,000 in young men aged fifteen to twenty-five in 1921–25 to 197 per 100,000 in 1930–32, and for young women from 185 to 268 in the same period) to ‘geographical features of coalmining districts’, by which he meant the lack of sunlight in the deep valleys in which the villages were located. He also allowed social factors, such as ‘the tendency to crowd into small rooms and halls, some lack of playfields and facilities for open-air recreation, sometimes an unsuitable diet and the tendency to conceal the presence of tuberculosis’, while for the mortally afflicted young women it was a question of ‘migration to domestic service’ and not returning home until the disease was in its terminal stage. Nonsense, a member of the Committee against Malnutrition riposted: ‘There is no evidence that the valleys are deeper and narrower today than formerly, and migration to service does not account for the increase in male mortality.’
Although the Ministry of Health declined to draw a correlation between poverty and the disease, citing ‘a complex interaction of a considerable number of factors’, those on the ground had no such doubts. A former MoH for Cardiff was unequivocal: ‘Poverty has long been recognised as a prime factor in the causation of tuberculosis, principally through its effect on nutrition,’ he wrote in 1933. A tuberculosis officer for Lancashire, asked to conduct a survey in Durham, concluded that ‘The principal means by which poverty is found to cause tuberculosis are the overcrowding and undernourishment which are the chief distinguishing features between the poor and not poor families [some 3,000] studied,’ and considered the link between tuberculosis and undernourishment to be more significant than that between tuberculosis and overcrowding.
In Jarrow, the death rate from tuberculosis was higher in 1930 than it had been before the turn of the century, at a time when rates across the rest of the country were falling by 50 per cent. The fact that there were fewer cases of spinal, bone and joint tuberculosis in Jarrow than might have been expected could be put down to the fact that fewer of the people who lived there were able to afford fresh milk. (In the 1930s almost 30 per cent of non-pulmonary tuberculosis deaths and 2 per cent of the pulmonary strain were caused by tubercular cows’ milk or infected meat: in 1931 a thousand children under fifteen died of tuberculosis of bovine origin, and many more were crippled, but by the end of the end of the decade still less than 50 per cent of milk was pasteurised.) ‘There is no mystery about the high tuberculosis rate of Jarrow,’ flatly asserted ‘Red Ellen’ Wilkinson, the Labour MP for the town (so named by virtue of both her politics and her flame-coloured hair), scourge of the National Government’s policies towards the unemployed. It was not caused by the supposed facts that ‘“the women do not know how to cook … The Irish have a racial susceptibility to tuberculosis … The families are too large … The geographical formations are unfavourable” … all of which reasons have been put forward by various medical authorities’. Rather, it was caused by the vicious cycle of ‘bad housing, underfeeding, low wages for any work that is going, household incomes cut to the limit by public assistance, or Means Test or whatever is the cutting machine of the time … these mean disease and premature death’.
But still there were those who preferred to see tuberculosis as an individual responsibility, a sickness of advanced civilisation, when the simple life in the fresh air had been abandoned in favour of irregular hours, too little exercise, the stress of modern life, even ‘the thoughtless misuse of leisure time’. All of which were ills that could be rectified by a stiff dose of self-help, rather than costly programmes of social welfare.
As the number of unemployed inexorably mounted month on month to over three million by 1931, politicians, economists, scientists, writers and commentators investigated, pronounced, theorised, constituted themselves into committees and wrote reports, and gathered together to lunch and dine, all in an effort to find reasons for and solutions to Britain’s economic and social problems. In October, November and December that year the BBC invited a selection of prominent public figures to ruminate in front of a microphone on ‘What I would do with the world’. Out of ten speakers, three advocated eugenics.
Lord D’Abernon, a former Ambassador to Berlin and then Chairman of the Medical Research Council, suggested that ‘A wise dictator would devote his attention in the first years of his dictatorship to measures calculated to improve the human race,’ since ‘By excessive latitude given to the weak-minded, by imposing burdens in the shape of taxation on the hard-working to help out the improvidence of the inefficient and less capable, we are doing for the human race exactly what every intelligent breeder avoids in the animal world: we are stimulating breeding from the weak, the inefficient, and the unsound.’ Sir Basil Blackett, a director of the Bank of England, agreed that he would ensure that ‘we make ourselves and the human race better fitted intellectually and physically to use the scientific knowledge which the twentieth century places so freely at man’s disposal’. His programme would make the study of eugenics ‘a compulsory item in the training