As soon as he knew, Frank Pollitt, soon as he knew she'd got it, he gave her up. She was heart-broken. She'd been going with him three years, but he never came round again, when he heard she'd got TB. (Angela Hewins, Mary, after the Queen [Oxford, 1986] When Linda Bryder's story starts, Robert Koch had already demonstrated the pathogenicity of the tubercle bacillus in 1882. But for at least fifty years afterward, the germ theory was by no means generally accepted. The public health scene had beer, dominated by the fear of the great epidemics which had taken their fearful toll over the previous centuries. No-one really knew how or why they had spread. In introducing Section 16 of the National Insurance Act (1911), which provided for free institutional treatment for all sufferers from tuberculosis, Lloyd George pointed out that the disease was responsible for 75,000 deaths per annum in England and Wales, and, 'in his view, if a plague wiped out 75,000 people and then returned to do the same the following year, all the resources of the country would be placed at the disposal of science to crush it', (p. 37) The message that now came from the doctors was that tuberculosis was infectious and it had earned its popular title of 'the great white plague'. The health education programme was the corner-stone of the anti-tuberculous campaign. The communicability of the disease was stressed and the means to avoid it was seen to be avoidance of exposure. So the sufferer came to be regarded 'as a leper' by family, friends and employers and not surprisingly by himself. Sanatoria were seen as risks to the surrounding communities, rather like leper colonies. They evoked complaints about diminished property values from their neighbours. It was small wonder that the individual response was that of Frank Porritt in his rejection of Mary Hewin's sister. (p. 201) Although there was no specifically efficacious therapy, it did not lessen an insistent demand for the doctors 'to do something' about it. The result was a reliance on the historically acceptable approach of treatment by regimen and the importance of airs, waters and places. This produced the concept of the 'open air' principle in favourable climates. Hence the title taken from Thomas Mann's novel, set in a fashionable sanatorium in the Swiss Alps. The disease had romantic overtones, and was by no means confined to the indigent poor. The British sanatoria developed a graded form of rest and work which earned itself the title of 'the pickaxe cure for consumptives'. On some inverted logic from the evidently wasting nature of the disease, Sir James Kingston Fowler and R. J. Godlee pronounced in 1898, 'If he can grow fat he need have little fear that the disease is making progress'. This led to what became known as 'high-feeding', with resultant vomiting, nausea and other abdominal discomforts. The Dartmoor Sanatorium comfortingly advertised in 1903, 'Patients not made to eat more than they can digest' (p. 54). Medical opinion very gradually came to doubt the value of sanatoria. Figures were produced to show that of all the people who had received sanatorium treatment during 1914, approximately 80 per cent were dead by 1920. In 1921, Sir James was asking whether this costly failure ought not to be abandoned, (p. 69)
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