Tuberculosis – A Forgotten Pandemic?

Origins

Barrasford Sanatorium

Constant coughing? High temperature? Flu-like symptoms? Night sweats? Fatigue? Looking pasty and washed out? A case of coronavirus? No. This is the year 1925. The “Spanish flu” pandemic of 1919-1920 has passed and you are living cheek by jowl with your family in a Newcastle terrace of houses.

What you have got is pulmonary tuberculosis, TB for short, the “white plague” as it is often called, owing to the paleness of the patients. It is also called the “Captain of all these men of death” because it has been spreading death and despair around the world for hundreds of years.

It was good that many people were naturally immune because there was no reliable vaccine and a cure was over 20 years away. Penicillin would have no effect. The benefits of streptomycin had not yet been discovered and the associated drugs not yet developed. Streptomycin would be hailed as a “magic bullet” but TB would be a tricky bacterium to tackle because it mutates so easily.

The disease spreads easily through the air in droplets and infects others in close proximity, including children, without discrimination. Particularly susceptible are people who live in poor or overcrowded housing, or have a poor diet, or have pre-existing respiratory difficulties, often from smoking or breathing polluted air. But the rich are equally at risk because TB is a true pandemic.

Isolation was the only way of limiting the spread of TB and in 1912 it became a notifiable disease. Treatment for a favoured few took a step forward with the development of the TB sanatorium. In 1907, two sanatoria opened in Northumberland, one for children at Stannington and the other at Barrasford for adults.

High on the fells above Gunnerton, Barrasford sanatorium catered for adult men and women and accommodation for nursing and ancillary staff was built within the grounds owing to its isolated location. Nursing TB patients was not particularly attractive to the aspiring nurse and there were constant difficulties in recruiting and keeping staff. Kathy James (1931-2001) described her life at the Sanatorium before she married Gordon James in 1952. Her father was Simpson Hope, one of the two gardeners, who lived on site and grew vegetables for the patients. “We would see the patients walking around but we as children were not allowed to go near to them. When I was eighteen, I worked in the dining room of the Sanatorium and for a while I was in the laundry. All the staff had to be in tiptop health. We all used to have medical tests and injections. We were not allowed to go near the patients, if we lost weight. We were not allowed to take any food off the patients unless it was a sweet that was wrapped – and then we said that we would eat it later. We had to stay in the Nurses’ Home. It was a ruling of the hospital that we were not allowed to live at home. The bottom half of the Nurses’ Home was used as the sitting room for the sisters and nurses, though the matron had a flat on the right. The nurses and the sisters had rooms on the second floor and members of the domestic staff were at the top. All the nurses and domestic staff lived in. We had to be in by 10 o’clock. If we wanted to go to a dance at Colwell or Barrasford, we had to get permission to be out late and the night nurse would have to come over from the main building to let us in – just like a night porter!”

Barrasford and Stannington were surrounded by woods where patients could walk. Not that many had the strength to walk the carefully measured and monitored distances because of their general weakness from persistent coughing and recovery could take months or years. As patients gradually gained strength during their stay, which was generally six months, they might be encouraged to help in the kitchen garden as sanatoria were intended be “colonies” that were self-contained and self-sufficient. Costs had to be kept low. All this was in the days before the National Health Service.

There was no cure for TB, no antibiotics and no drugs until the development of a powerful antibiotic called streptomycin, originally found in the soil, and powerful enough to kill anything from microbes to men. The doses had to be right. Many otherwise hopeless cases were treated as guinea pigs in the 1940s, some with success, others not. Much of this was done under the supervision of Selman Waksman, a Ukrainian-born Jewish-American inventor, and microbiologist, whose research into decomposition of organisms that live in the soil led to the discovery of streptomycin and several other antibiotics. He was responsible for the eradication of arguably the world’s oldest, most persistent and debilitating diseases.

Though anyone could catch it, the poor caught it more easily than the rich because their constrained lifestyle could not produce an immune system that was strong enough to fight disease, especially TB.

Treatment consisted of several regimes. None killed the TB bacterium directly but all aimed at restraining the development of the disease and building up the strength of the body so that it could deploy its own immune system to fight the disease. Many TB sufferers were unhealthy owing to poverty, poor diet and unhealthy, cramped housing. The first priority, therefore, was as much fresh air and wholesome food as the patient could tolerate. Next came the promotion of good health, such as the treatment of skin diseases. Injections of various kinds, notably those containing gold compounds, were given to increase the strength of the body. Finally came more invasive surgery, such as the deliberate collapse of a weakened lung (artificial pneumothorax) to give it a chance to recuperate.

Fresh air, the nearest thing to pure oxygen, was part of the treatment and patients would be placed near open windows, whatever the weather, or in wooden shelters in the grounds. Indeed, those patients on the elevated fells above Barrasford enjoyed a quality of air that they had never experienced in the industrial towns. Some were cured completely, or at least until they returned to their cramped living conditions; others never made a full recovery and others inevitably died. It was just the way it was. TB was a pandemic and claimed around 60,000 lives a year in the British Isles. The rich could escape it by “self-distancing” in social contacts or “self-isolating” in housing; the poor did not have the choice. To secure a place in a sanatorium was a major triumph and offered at least the hope of a cure. Sanatoria on the continent were big business and catered for a wealthy clientele who would frequent such health resorts and spas in their thousands.

The American Way: Fresh Air, Country Living, Healthy Lifestyle!