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clear gif

A FORGOTTEN ERA

A tale about a young boy who had tuberculosis
in the days before the NHS

By Tom Frew

Foreword:

In todays era of personal drug usage, alcoholism, intolerance, mindless behaviour and depression affecting so many, with no understanding of past urban poverty and disease-ridden environments they can thank whichever Deity they pray to that they do not suffer the indignities impressed upon past generations.

And so!

Challenged to recall life before the National Health Service in the UK presented no challenge whatsoever. The real challenge would be where to stop detailing the personal aspects of how it was as seen through the eyes of a very sick child. 

The advancement of medicine and control of infectious diseases since the introduction of antibiotics in the early 1940s is well documented In a similar manner there are voluminous documentation and expanding numbers of thesis spanning all forms of causative effects and treatments thereof. Prior to those years before antibiotics the population in general depended on good luck, fresh air, rest and solitude in various sanatoria. Few if any working class could enjoy the care and attention of the famed Switzerland clinics; indeed such a possibility was so far fetched as to be ridiculous. 

Much more rarely is there documented pre-health service history as seen through the eyes of the actual patient suffering from one form or other of the debilitating scourge tuberculosis prior to the introduction of antibiotics and the curative methodologies employed. It is so easy for present day generations to be aware of recorded history identifying mans inhumanity to man and yet to be completely unaware or forgetful of how their present day life has become protected against disease that struck so many of us down a little over a half a century or so ago. 

When asked to provide some personal day to day events and an insight to how matters were in Scotland before the NHS is to recall some very painful physically and indeed mentally distressing events inflicted upon a mere child commencing at 8 years of age. Such was the trauma of the era circa 1937 through 1942 that day-to-day events are never to be forgotten; to this day they are indelibly imprinted in ones memory banks. Indeed between the trauma of disease and the Second World War that was raging at the time, all of which compounded making life more miserable through the eyes of a child.  

Where to start then on how one eight-year-old child fought and survived the most serious of bone infections, combined pyogenic osteomyelitis and tuberculosis. Even more mystifying from where or how did a well nourished and much loved sole child fall victim to this scourge? Before proceeding let the reader beware that tuberculosis, antibiotics or not, is still rampant in many parts of the world and to this time in the 21 century claims many millions of lives annually! 

As a child there was never any attempt made to identify the source of the infection or perhaps it was a case of not being clinically demonstrable, although some analysis of the events prior to incarceration in a sanatorium would create a likely hypothesis of how it came about. In 1937 I was infected via an outbreak of scarlet fever at school and was placed in a local hospital for tubercular patients. The recall of men on each side of my bed coughing sputum and blood in to containers was an earth shattering experience for a very sick and lonely homesick child. The use of common utensils free of sterilisation, air borne germs and unwashed staff hands made it a mockery by todays hygienic standards. Hence in gambling parlance the dice were loaded in favour of serious infection. By no means is the writer today overlooking the additional possibility of bovine infection.  

Control of bovine tuberculosis in Scotland during the late 1930s was highly questionable at best. Few today will remember that many farms delivered milk direct from the farm and housewives bought their milk at the roadside. There was no thought of refrigeration or pasteurisation. Pasteur developed pasteurisation process in the mid-19th century but the implementation of the process and lack of refrigeration is another story altogether. To explain to the reader the actual pasteurisation process subjects liquid or food to a mild heat treatment for a specified time to eliminate the bacilli is based on the resisting capacities of the deadly Mycobacterium tuberculosis found in milk producing cattle. 

In the 1930s Scotland was not alone in this by any means but the TB infection rate among children in central Scotland living in urban poverty and overcrowded disease ridden conditions was so rife, to the extent that the authorities were forced to created specific centres to house long-term hospitalisation of infected children. Many like Mearnskirk Hospital [Newton Mearns] could contain upwards of 500 children so the readers can judge for themself the severity of the widespread disease in the city of Glasgow and satellite towns. However this particular disease knows no boundaries nor was anyone in any circumstances free from the possibility of infection.

 So it came to pass that within a few months of recovering from scarlet fever that in early 1938 (age 9),  I was obviously in a distressed condition with an ever-swelling left knee joint. The medical direction of the time was to exercise the knee as much as possible to the extent that the child could no longer walk without extreme pain! A really questionable medical diagnosis! The inevitable followed of course by being bedridden for many months at home before a conclusion was reached on the medical approach to resolve the condition. 

It is with great sadness to recall a barely turned nine year old, an only child at that being taken from his mothers arms and placed in a sanatorium isolation environment many miles away from his parents. As a child there was no possible conception of what lay ahead, not only in trauma but a realisation of the devastation caused to my parents. They full well knew my absence was going to be long term but were never prepared nor could be they for the years ahead. Perhaps more comment on the parents later. 

Meanwhile arriving at the sanatorium by ambulance, being was carried in to the isolation ward, which essentially consisted of separate glass cubicles was frightening. Stripped naked and harshly rubbed down with a cloth, gowned then placed in a bed was the introduction to what was to come. I recall being left on my own as the sole occupant of the isolation facility, fed when necessary and at night was left in a dark environment until the dawn. Night after night weeping copiously for his home, his parents and loving environment taken away through necessity until exhausted sleep would come. There was nothing uncaring or deliberate about the treatment that was just how the process was in the late 1930s. 

Finally after many weeks the day came when I was declared FFI [Free from infection relatively!] the main fight still had to come. There was no need for transporting by stretcher out to waiting ambulance; the attendant [Bill Brown?] lifted me up into his arms and carried me out to the ambulance for transportation to the No.8 ward. The pain of the knee joint bending after weeks of immobility was excruciating and trying desperately to support the leg by holding the ankle alas was but a portend of many painful occasions in the years ahead. The words to Mr Brown to this day 60+ odd years later are as fresh now as then. Mr my knee is awfy painful . in the dialect of the area.   

Arriving at Pavilion No.8 that was to be the childs home for the better part of the next four years was another devastating impression. In a small three-bed ward it contained Wee Hughie a grossly disfigured pigeon-chested boy with totally wasted lower limbs and another boy called Howie, neither of whom survived. Nevertheless, being out of isolation meant that at long last being reunited with my parents if only for one hour Wednesday and Sunday afternoons. I recall my fathers tears and his mothers distress at the environment. One can only wonder so many years later what went through their minds. I suspect they believed they had lost a son! 

 While the limb degeneration continued I without realising began to accept that this was now home and the life encapsulated within the Pavilion was becoming the norm. This probably started some six months or so after admittance to the hospital as ones mind reacted to the circumstances and environment within which one was ensnared. Ward Sisters and nurses became surrogate mothers with a breast to weep upon when everything got too much. Such wonderful caring individuals that makes a nurse the salt of the earth!   

With hindsight it was obvious that financial restraints limited the patient care to the absolute medical necessities only. A hospital of 500 children was doomed to have absolutely no educational facilities whatsoever. The consequence of this was that dependent on patient recovery time and returning to normal, life for all too many would be faced with little more than primary school education if at all that. Surely many were too ill to conceive of study but a large proportion of patients could have been taken care off somehow but one must assume the lack of finance plus WW2 also an inhibiting factor. It must be emphasised that 100% subsidising of these huge sanatoriums was a costly business for local authorities so little blame can be put upon them for establishing priorities and hence education fell by the wayside.

[Paradoxically a handicraft teacher visited the wards teaching those able, to sew, knit, make tea cosies, beaded cork mats and the like. It was readily apparent that those able to do handicraft work were quite capable of educational instruction but alas!]

Children of course can be particularly adaptable to circumstances and as each month passed a gulf was being created detaching me from my parents. This is not to say that the one hour bi-weekly visitation were any less important, just that home sickness and longing to be doing the things that normal children do were no longer so important. Friendships developed with other young ones and a form of camaraderie were created based on mutual if unrecognised understanding.

Many months passed slowly but so surely as the insidious disease began the unrelenting, necrotizing and destruction of bone, cartilage and soft tissue of the knee. Tunnelling sinuses would commence their journey to the skin surface leaving open weeping abscesses. Strangely, they would worry me less than the constant need for aspiration of pockets of pus. Being held down whilst doctors drained off fluid with syringes, would be an extremely painful and unpleasant process. Syringe needles would clog up, doctors perspiring through tension and knowledge of the additional pain inflicted made every draining session in the years to come the substance of nightmares.

One form of medical intervention was that the foot of the childs bed was elevated by some 61cm  [24] a considerable margin, so life was taking another deviation for what could only be described as worsening. Eating was difficult enough lying at such an angle but the need for personal requirements was something else. Can the reader imagine lying flat at a steep angle and using a bedpan to defecate? I suspect not! Again of course many children lived like this permanently especially those children who were tied to spinal carriages for years on end. One lived with constant reflux.

An image never erased was the day that a Dr Dale surgeon and assistant superintendent of the sanatorium and others arrived to review and make a decision on the acute condition of the knee that was placing my life in jeopardy. In retrospect the sheer insensitivity of the open discussion and listening to every word was astonishing. It is hard to believe to this day some 60 odd years later that Dr Dale ring barked the leg with his pen and said we will amputate here! There was no lack of understanding what this meant but how could his Dad let them do such a daft thing! Out of the mouths of babes does such innocence flow! How else was I to ride my bike when I returned home?

On the following Sunday my mother who was now pregnant was asked to meet with the doctor. One tearful lady returned having been made aware that amputation was imminent. As a child I remember making every effort to console mother by telling her I knew why she was crying but she should not worry since Dad would see to it. How could a child understand such devastating news being given to a parent?

At last my guardian angel that had been missing in his life at this junction decided to come and sit on his shoulder!!

Few have not heard of the evacuation of the British Army from Dunkirk in France during WW2. Strange as it may sound it was this historical event that came in one way to save me from having a leg amputated. Why so? Very simple really, the amount of wounded soldiers put the operation on the back burner due to operating theatres being overloaded with incoming from the Dunkirk beaches.

Meantime Sister Ross said to a staff nurse we are not going to allow this leg to go and for the next few weeks the legs was constantly immersed in a leg bath with some solution to help cleanse the putrefying flesh. One must imagine that this was a last ditch attempt any which way one would look at it. Nevertheless, after the third week the infection started to retreat and from there on the knee slowly but surely commenced the healing process. It did not happen overnight, huge open abscesses had to close; the largest one being 80mm by 50mm but the road to recovery seemed assured. As a child and the adult that I became owe much to that caring ward Sister and her staff such a debt could never be repaid.

More than one full year would pass with the child still on the elevated bed always with his leg in traction. Traction consisted of adhesive tape on the leg with attached weights hung over a pulley, despite that of course the childs leg growth could not equal the other one and some shortening was inevitable but not too serious fortunately. Walking again was still a long way off

Life in the sanatorium contained many aspects; there were some happy moments, despite all since children are basically pretty resilient. Conversely there were many things to so fear of in a childs mind. Firstly unjustly being petrified of Dr Dale, an exceptionally heavy set individual with an extremely swarthy complexion. Then among the more horrific was the frequent withdrawal of fluid from the stomach. [For what reason I wonder?]  Some nurses being slightly heavier handed ramming a rubber tube down the gullet caused terrible retching with the net result that the tube frequently ended up on the bed somewhere. That was one of the less popular exercises and more repulsive moments! Always done before breakfast please note!

The task of preparing and feeding 500 children displaced through 9 Pavilions must have created a logistical nightmare. With all honesty so often the food was found repulsive and being forced to eat it has to the extent in my future life certain foods could never be tolerated. Half a century and more later as an adult the mere thought of porridge and sago churns the stomach. 

An incident involving the child, when WW2 was threatening was the debate among the children who ranged in age up to 16 years old as to the likelihood outbreak of hostilities. A 10-year-old child with one penny in his purse accepted a bet from a much older boy betting against war happening. Losing that penny was a drastic event to say the least and even more so by not understanding how could anyone want war! Consequently as an adult he would never ever gamble again. Perhaps a worthwhile loss? 

The outbreak of WW2 of course led to windows being taped and blacked out at night, and for those able the nightly transposition from being in bed to sleeping below the bed was considered a bomb shelter! At night all the beds in the larger wards where wheeled into the middle of the ward side by side in two columns. Some children of course were immobile due to being on spinal carriages or on elevated beds like myself. Those children below beds slept on mattresses on the floor. This was all considered great fun and broke through the barrier of boredom. The additional stress on the nursing staff must have been something else. 

The nearest to being directly in the firing line of war was around March 1941 when the German planes were flying overhead on their way to destroying the Glasgow_Clydebank area and adjacent docklands. The drone of the engines kept us awake and very quiet, quite frankly scared to death. In retrospect the layout of this particular sanatorium must have resembled an army barracks from the air, however it was the unfortunate 30,000 people left homeless in Clydebank that bore the brunt of several nights bombing in succession. The people killed were considerable.

The next wartime escapade was when the German Rudolf Hess flew his Messerschmitt 110 plane to Scotland and parachuted quite near to the hospital. Children who can be cruel to each other manifested it in the older boys informing those bed-ridden that the German paratroopers had landed and those who could not walk were to be shot immediately. It required my Dad on the next visiting day to convince me that it was only one man and not paratroopers. Still and all it was an anxious few days!!

Personal hygiene was not exactly too high on the list of sanatorium priorities. Patients were not allowed out of bed regardless of condition, unless they were ambulatory and preparing to go home. Many weeks would intervene between being provided a bed bath which essentially was a rub down with a facecloth at best. An amusing incident but not at the time for the child now nearly 12 years of age was being washed by Staff Nurse Cleary. While washing the childs private components an erection of the penis had the nurse smiling and a child with a red face!! Of course the smile and knowing look was a simple recognition by a woman that the child was turning into a man. The word must have got out because from theyre on in the recipient of the bed bath got to do his own thing!!! 

The spirit of the incarcerated children should be admired. During that era with war raging one of the local newspapers in Glasgow had a project called: Jocks Box where donations should be sent to the newspaper for them to somehow provide additional benefits for the serving members of the forces. The children of Pavilion 8 endeavoured to sell their handiwork items [via parents] and donate the proceeds to Jocks Box. There was great pride for the children to see their Pavilion 8 in print and somehow doing their bit for the war effort. It was even more so when the wounded soldiers dressed in hospital blues would wave to the children bedded down for the day on the ward verandas 

 Then there was Molly the lass who cleaned and buffed the ward wooden floors with a large section of material covered wood with a long hinged handle. Molly a lovely red head of tremendous energy and physical fitness manually polishing the floors day in day out kept the boys enthralled with details of her nights at the jiggin [dancing] and other nightly events in Glasgow. You have to remember there was no TV, radio or newspapers available in the wards so everything was word of mouth no doubt with exaggeration along the way.

 It was a fact of course that all religious bodies steered well clear of imparting their beliefs to what can only be described as a captive audience. Upon refection it was patently obvious that religious teaching of all denominations and tuberculosis was such that the twain were never to meet. It was preferable that the application of a Nelsons Eye was prescribed for these forgotten children.

The feat by parents to visit twice a week, year in and year out in all weathers by public transport must have been an unimaginable and monumental strain. The comment to my mother that she was getting awfully fat had little recognition of a two-hour journey each way by public transport, per visit and in her 9 month of pregnancy emphasised her love for the child. The medical advice to reduce the childs mothers depression over her son illness was to have another child, was probably exceptionally good advice. They must have taken the advice to heart because by the time I returned home two sisters were waiting on me. 

Compared with current day visiting hours it is shameful to think back to those days when regardless of the time of arrival the one hour visiting time was cast in bronze. All too often parents travelling by public transport in the winter had to deal with the vagaries created by the conditions. Many was the time when the childs parent arrived close to the 4pm deadline but still got bundled out by the nurse ringing the handheld bell. The frustration for those visiting under these conditions is today hard to imagine. Was it necessary to be so pedantic? All in all for those myriad of parents who travelled great distances and at a financial cost most could hardly afford, year in and year out, one can only hope that their progeny by some means rewarded them by succeeding in their endeavours in the years to come. Alas the fear must be that children so bereft of education would only succeed in life by their wit alone. 

So came the day when it was announced that I was going to be allowed to walk again, albeit never to walk again as a normal person. After years of no movement and essentially a destroyed knee joint the child was to be left with an ankylosis which essentially in laymans terms is an abnormal adhesion and rigidity of the bones. Hence the knee joint was never to bend again! Never mind the big day came when the splint maker arrived to measure the child up for his supporting calliper. The brand new boots were desecrated by a hole being drilled through the heel for the tube section insert to support the calliper. Indignation indeed. 

Finally the great day in late 1941 when with the calliper fitted it was time to stand up. Learning to walk again at nearly 13 years of age where balance and movement were uncoordinated was a mind blowing exercise in humility. Determination to walk without nurses holding me up soon overcame such human frailty. The happiest moment for many years for the child and parents alike was the Sunday I walked out of the Pavilion to meet them. His mothers tears would have floated the Queen Mary!!! Dad just could not speak for his happiness. 

So the saga of Mearnskirk Hospital that had been home for the better part of four years was drawing to a close. The physical and mental scars would never leave through childhood and subsequent adulthood. It would be a further two years and more before the calliper would be consigned to the scrap heap. Overall it would have taken nearly seven years from a childs life, I would never know the joy of living again without a physical handicap albeit I knew even at early age I was going to achieve my own personal objectives in the life ahead. 

Returning home of course to find two wee sisters was a bit of a shock after being a sole child. The age gap would prove not so much to be difficult but more that as children not growing up together there were not so many things in common to share. Although the teenager probably gave them a hard time now and again I always loved them very much. It is with a lot of regret that my life as an adult has been on the opposite side of the world but I still feel very close to them regardless of the tyranny of distance. 

The road to recovery and success started grievously! Simple fact of life was that to place a 14 year old in a primary class was akin to Gullivers Travels. That soon changed and then the indignity of being placed in special class for retarded children did little for my self-esteem. I mean no offence to those unfortunate children who suffered intellectual handicap. When asked how or who taught me to read the answer was relatively simple, I taught himself from comic books and the like brought into the hospital by the parents. That was the first step in a long road to an Engineering Diploma [no time for a degree] and the thousands of hours spent in the local Carnegie Library devouring every imaginable reading material. To this day 60+ years on I still resent bitterly the dialogue of one maths teacher who gave me a hard time with no comprehension of where I was coming from at that time. Despite an extensive library of my own now I still fondle with great care my first book purchased, with hard saved pocket money The Concise Oxford Dictionary. It travelled the world accompanied by its owner. 

And so these many years later through the journey of life, I have paused to reflect on my life, it happiness, the trials and tribulations, losing a loved one, remarriage, a business career that made me a millionaire all of which started with a very turbulent beginning all those years ago. I have tried to contain my tale to what life was like without antibiotics but I felt that to identify the cause and effect of before and after tubercular infection was too far reaching to ignore.

 If the reader got this far you are to be congratulated.

 

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