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resources to municipal hospitals, improving the conditions and pay of nurses and other medical staff, providing outpatient facilities at most hospitals for the surrounding community and ridding hospitals of any Poor Law connotations, since ‘every possible suggestion of charity, subservience, and general second rateness must be banished’. Instead London’s citizens should regard ‘the municipal hospitals as their own [since they had] every right to use them and expect the best from them’. But although the reform of London’s health provision was of considerable interest to other authorities, even Somerville Hastings, chairman of the LCC Hospital and Medical Services Committee, recognised that it was unlikely to be fully possible ‘within the limits of existing legislation’.

      As well as inadequate hospital provision, the range of remedies doctors could provide was still very limited: during their brief consultation patients would be given a handful of pills, which might come in a range of colours but would in fact probably all be aspirins, though bottles of dilute mixtures of powerful drugs such as kaolin and morphine were also dispensed. A Welsh doctor provided his miner patients with a tincture of chloroform and morphine, effectively an addictive drug, for their chronic chest conditions. Many general practitioners had few aids to diagnosis, a stethoscope, thermometer, ear syringe and maybe a speculum being fairly standard, sterilising instruments was a dispensable luxury, and doctors had to pay for laboratory tests themselves — and therefore tended not to take advantage of new techniques and treatments that were being developed during the 1930s. A Welsh doctor who prescribed little but ‘black liquorice’ for his miner patients’ pneumoconiosis was regarded as a cut above other practitioners in the town, since he had a machine that enabled him to take a patient’s blood pressure.

      Aware of their limited therapeutic arsenal, doctors essentially bought time by dispensing medicine, hoping that an illness would turn out to be self-limiting and would disappear, while patients appeared to be satisfied if they left the surgery clutching a bottle of medicine (private patients would have their bottle wrapped in white paper and sealed with sealing wax and usually delivered by the doctor’s errand boy on a bicycle after evening surgery) or, less frequently, a box of pills, for which they had paid two or three pence. Aspirin powder for pain relief had been available since the turn of the century, and a tablet form had been patented in 1914, insulin injections to control diabetes had been introduced in the 1920s, followed by kidney dialysis, radium treatment for cancers, skin grafts and blood transfusions. Salvarsan was effective as a cure for syphilis and pernicious anaemia could now be treated with iron injections (rather than raw liver sandwiches, as previously), while the significance of vitamins began to be appreciated, leading to new therapies using vitamins C and D in cases of scurvy and rickets.

      However, there were few things in the medicine cupboard in Eileen Whiteing’s home ‘apart from fruit salts, cough mixture, plus iodine for cuts … and we certainly did not include [the commonplace aspirin] in our home remedies, having to endure headaches and other pains until they went away of their own accord … cod liver oil and “Virol” were favourite remedies for winter ailments … and in the case of nerves or depression, a strong iron tonic would be prescribed, with the advice to “pull yourself together”.’

      Diphtheria in children, an infection resulting in the throat thickening and the danger of suffocation, was one of the spectres hovering over the inter-war years, with some 50,000 cases every year. Two thousand children died each year from diphtheria and whooping cough until effective vaccines began to be used towards the end of the decade. Eileen Whiteing recalled that when she and her sister caught ‘the dreaded diphtheria … Mother refused to let us go away to hospital, so a trained nurse was engaged at great expense, and, between the two of them, plus the resident maid, we were nursed safely through the long weeks of fever. Disinfected sheets had to be hung over the bedroom doors, all visitors had to wear white coats and face masks, and the whole house had to be fumigated by the local health officers at the end of the isolation period … People were endlessly kind … since illness was quite a serious event then: I remember hearing the news in hushed tones that straw had been spread over the road outside the house of one of my friends while he lay desperately fighting for his life with double pneumonia in order that the noise of passing traffic should not disturb him until what was known as the “crisis” was past’ and the patient’s dangerously high temperature either fell, or he or she died of exhaustion or heart failure, since in the absence of any effective medication, all the doctor could do was visit several times a day, wait and watch.

      It was not until 1935–36 that real advances in medical treatment were possible with the manufacture of sulphonamides, anti-bacterial drugs effective for the treatment of a range of serious illnesses including streptococcal and meningococcal infections, the ‘miracle drug’ of those pre-penicillin years.

      Tuberculosis was another killer disease that awaited its antidote: in the first decade of the twentieth century it was responsible for one death in every eight, and although that figure was steadily declining by the 1930s, there were still some 30,000 deaths a year from respiratory tuberculosis, and it continued to be seen as a deadly and frightening disease, freighted with social stigma. George Orwell, the most pungent chronicler of the mid-century, who had first contracted TB in 1938, died from its effects in January 1950, aged forty-six. In 1925 the typical tuberculosis dispensary was described by the Chief Medical Officer of the Ministry of Health as ‘an outpatient department, stocked with drugs that are mainly placebos, or an annexe of an office for the compilation of statistics’, and not much had changed a decade later. Although tuberculosis could be managed to an extent, and a diagnosis was no longer an automatic death sentence, there was no effective treatment until BCG (Bacille Calmette-Guérin) vaccine, after fraught years of trials and considerable resistance from the medical profession, started to be used extensively in Britain in the 1950s. Until then treatment consisted either of radical surgery — usually collapsing a lung, an operation performed on the principle of putting the diseased portion of the body to rest so it could combat disease with its own resources — or exposure to fresh air, on much the same principle of encouraging the recuperative power of nature, since there was not much else on offer.

      The notion that sunshine and fresh air helped TB sufferers (and sufferers from other medical conditions) had been popular since the late nineteenth century, and those who could afford it might take the Train Bleu to the South of France or head for the bracing air of the Swiss Alps. The first British sanatorium for the open-air treatment of tuberculosis opened in Edinburgh in 1894, and others followed in Glasgow, Renfrewshire and Frimley in Surrey; they soon spread throughout the country, including one funded by the Post Office Workers’ Union in Benenden in Kent. Some were for the well-off (though the rich usually chose Menton or Davos), many were funded by philanthropists (although, despite its romantic, artistic connotations, TB was regarded primarily as a disease of the poor, and did not attract the same level of donations or research funding as, say, cancer, despite the fact that even at the end of the Second World War it accounted for more deaths between fifteen and twenty-four years of age in Britain than any other condition). Ireland had one of the worst death rates from TB in the world, and although it had been falling since the turn of the century, it started to rise again in 1937, in stark contrast with the rest of the United Kingdom and Europe, due mainly to poverty and a lack of specialist services such as x-ray machines, which barely existed outside Dublin. Faced with the helplessness of the medical profession, those afflicted turned to folk remedies, desperately trusting in the efficacy of a daily dose of linseed oil mixed with honey, swallowing raw eggs or paraffin oil, goats’ milk or dandelion-leaf sandwiches, or positioning themselves in the street outside the Belfast gasworks, since fumes from the vats were reputed to clear the lungs.

      Since tuberculosis was ‘the principal social disease of our time’ in the view of Britain’s Chief Medical Officer of Health, with implications for the whole community, the government, in conjunction with local authorities, funded a network of sanatoria (sometimes using old Poor Law infirmaries for the purpose) for free treatment, and aftercare to be provided by tuberculosis dispensaries. If possible the sanatoria were in isolated locations, since statistics showed that tuberculosis was more prevalent in urban areas than rural, and TB was regarded with such suspicion that any proposal to build a sanatorium invariably met with stiff local opposition. (Indeed, local authorities could obtain a court order for a person suffering from pulmonary tuberculosis to be forcibly removed from their home,

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