Tuberculosis: A biosocial study of admissions to a children's sanatorium (1936–1954) in Stannington, Northumberland, England
Introduction
The impact of tuberculosis (TB) on our human population has had a very long history, and remains with us today in both developed and developing countries, including England [1], [2]. Although today treatment is very much more advanced and effective for many, in the more distant past care and treatment of people who were victims of this infectious disease were generally poorly developed [3]. They consisted of regimes based on disease concepts at the time. For example, an illness believed to occur because of an imbalance of the four humours in the Graeco-Roman and later periods, meaning that draining away one of those humours, blood, would likely help. These treatments were used mainly because, firstly, there was a lack of understanding of the nature of the infection and how it was transmitted and, secondly, effective treatment with chemotherapy had to wait until the 1940s and 1950s.
However, one aspect of care that was initiated was placing people with TB in sanatoria. There may have been sanatoria founded earlier than the majority, but the real concept originated in 1840 in England (George Bodington, Sutton Coldfield). Edward Livingston Trudeau was his counterpart in the United States, and founded the sanatorium movement there [4]. Early sanatoria, initially in the 19th century AD, were for admitting people with TB (meaning “to heal”, as opposed to “sanatorium” meaning “concerned with health”). Britain, along with other countries across the world opened many sanatoria, usually in rural environments, at high altitude, or next to the sea where the air quality was good. They were institutions where people with TB were admitted for rest, a good diet, fresh air, graduated exercise and treatment, although they were not universally accepted in the battle against TB. Indeed, Evans suggested that ‘there is no scientifically acceptable evidence that it reduced the toll of the disease’ [5]. However, a more healthy environment, and segregation of patients, must have had some impact on the decline of the infection, and they were certainly the key focus for “treatment” in the late 19th century [5]. Nevertheless, personal experiences suggest that life in a sanatorium was challenging, and because patients were estranged from their families and friends, life could be miserable [6], [7], [8], [9]. By the 1950s sanatoria as places for the care of people with TB declined in use because of the development of a vaccine and antibiotics for treatment.
By 1919 there were 97 sanatoria in England plus isolation hospitals and voluntary institutions for TB treatment [10], and by 1935 the Ministry of Health records in England and Wales 550 sanatoria and other institutions for segregating and treating people with TB documented in England and Wales by the Ministry of Health; 174 were opened specifically for children [10]. In Northumberland, north-east England, two of the four sanatoria operating in the early 20th century were for children with TB: the Philipson Children's Sanatorium at Stannington, and the Sanderson Home for Crippled Children, Gosforth [10]. The focus of this study is on Stannington, lying 12 miles north of Newcastle-upon-Tyne (Figure 1), not far from the coast and in a rural environment. It functioned between 1907 and 1953. It was the first sanatorium opened for children in England [10]. At its maximum development it had 312 beds and catered for children with all types of TB from pulmonary to skeletal. When it closed its doors as a sanatorium in 1953, it continued as a convalescent home for children.
Using archival records of the children admitted, the aims of this study were to consider the biosocial profile of the children admitted to Stannington, and to explore how the following were reflected in those admitted and how they were treated:
- •
the origin of the children (rural or urban),
- •
their socio-economic status (rich or poor)
- •
the pre- and post-antibiotic eras (1937–1943 and 1944–1953)
- •
the pre- and post-World War II periods
- •
the implementation of the National Health Service (NHS) in 1948
- •
the presence of bone and joint TB
The urban or rural nature and socioeconomic status of people admitted were explored because it was hypothesised that poorer urban children would have been more predisposed to TB. It was further hypothesised that the introduction of antibiotics as a treatment at Stanington in 1946 affected the types of TB from which the admitted children suffered, and their length of stay at the sanatorium. It was further suggested that when fathers began returning from WWII, and were likely in an immune-compromised state and more likely to contract TB, they could have become the main TB contact for their children (rather than their mothers). Finally, the numbers and backgrounds of children admitted to the sanatorium may have changed once the National Health Service had been established. Prior to the NHS there were barriers to access to care and treatment, inadequate quality of care, inefficiency in provision of care (e.g. long waiting lists), and inequality in health care provision (e.g. urban/rural and north-south divides) [11]. Following formation of the NHS, care and treatment was free at the point of use so there was no financial barrier, and it was a comprehensive and equitable service. Interestingly, in spite of the NHS, today many of these problem remain.
The objective of this study was to understand the differential impact of TB on males and females, according to:
- •
different age groups
- •
the types of TB suffered
- •
socioeconomic background
There had been no previous research on the medical records at Stannington.
Section snippets
Materials and methods
Ethical approval was acquired from Northumberland Medical Ethics Committee, via Dr Nicol Black, Communicable Disease Control Unit, Newcastle General Hospital. While it is believed that there are almost 8000 extant medical files for Stannington, due to time restraints, only 1987 files dating from 1936 to 1954 and archived at the Northumberland Record Office at Morpeth, Northumberland were available for access (c.25% of the potential total); strict anonymity was followed during the research. The
Results
Results showed that more females (1018 or 54%) than males (879 or 46%) were admitted between 1936 and 1954 (Table 1, Table 2), and this was statistically significant (0.001%). Age at admission was between one and 16 years, with six, nine and 13 years being the peaks for male admissions, and 13 years for females (i.e. being the groups with the highest frequency of admissions: >9%). Most children admitted were from poor urban environments (86.6%, 1642), and specifically nearby Newcastle and
Discussion
Stannington sanatorium was opened by the Newcastle Poor Children's Holiday Association and Rescue Agency in 1907. It catered only for children with TB. Of those admitted to Stannington between 1936 and 1954, there were more females; this correlates with many other studies [13], although rates are higher in males today after the age of 30 years.
Most children admitted were poor urban dwellers; this correlates with TB as being a disease of poverty today. Treatment of those admitted included rest
Conclusions
This study contributes to understanding the burden of TB for children in early 20th century Northumberland. Unfortunately, there are no comparative data available from any other children's sanatorium of this period for this study to explore whether the admissions were unique to Stannington. The objectives of this study, to understand the differential impact of TB on males and females, according to different age groups, the types of TB suffered, and socioeconomic background, was achieved. While
Acknowledgements
Northumberland Records Office, Morpeth, the Northumberland Health Authority's Local Research Ethics Committee, Dr Nicol Black, and the Institute for Bioarchaeology for funding part of this research. This paper is based on the second author's PhD.
References (15)
Global tuberculosis report
(2013)Tuberculosis in the UK
(2013)- et al.
The Bioarchaeology of tuberculosis. A global view on a reemerging disease
(2003) Fifty years at the Trudeau sanatorium: an historical sketch in honor of its birthday
(1935)Historical background
The plague and I
(1997)Below the Magic Mountain: a social history of tuberculosis in Twentieth-Century Britain
(1988)
Cited by (9)
The palaeopathology of industry, a perspective from Britain
2023, International Journal of PaleopathologyThe greatest health problem of the Middle Ages? Estimating the burden of disease in medieval England
2021, International Journal of PaleopathologyTuberculosis, COVID-19 and hospital admission: Consensus on pros and cons based on a review of the evidence
2021, PulmonologyCitation Excerpt :At the time of sanatoria and during the pre-antibiotic era17,18 admission was used as an ‘isolation’ intervention to reduce Mycobacterium tuberculosis transmission within the community and as support measure to ensure rest, optimal nutrition and eventually to perform pneumothorax after Carlo Forlanini’s discovery in 1907.19 In addition, in children severe extra-pulmonary TB and social circumstances likely contributed to hospitalization.20 Over time, hospital admission was considered ideal to better monitor the initial phase of anti-TB treatment and eventually drug adverse events, and, in some countries, to ensure adequate adherence to the prescribed regimen.21,22
Bacterial infections
2019, Ortner's Identification of Pathological Conditions in Human Skeletal RemainsAn Historiography of Twentieth-Century Women's Missionary Nursing Through the Lives of Two Sisters: Doing the Lord's Work in Kenya and South India
2023, An Historiography of Twentieth-Century Women's Missionary Nursing through the Lives of Two Sisters: Doing the Lord's Work in Kenya and South IndiaAlloparenting adolescents: Evaluating the social and biological impacts of leprosy on young people in Saxo-Norman England (9th to 12th centuries AD) through cross-disciplinary models of care
2021, The Family in Past Perspective: An Interdisciplinary Exploration of Familial Relationships Through Time
- 1
Tel.: +1 450 973 5317.