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Eastby Sanatorium: Part One – Why was there a need for a TB Sanatorium at Eastby?
As you go up Eastby Bank towards Black Park, Halton Heights and Barden Tower, you pass by Felside Grange and Fell House Apartments, located on the hill side overlooking the valley below. If you have wondered why these buildings are in such an isolated place, the answer is that this was originally a sanatorium (plural: sanatoria), that is, an isolation hospital specifically built to provide the “fresh-air treatment” for tuberculosis patients. Eastby Sanatorium was built by the Poor Law Guardians of Bradford, and was considered radical in that it was first in the country to be entirely established and supported out of public funds for the benefit of the poor. Previously sanatorium treatment was only offered by charities or for fee-paying patients. All that remains now (the building on the left) of the original sanatorium is what was the administration building. (The house on the right is a recent construction.)
This is the first of several articles on Eastby Sanatorium, and begins with an explanation of the sanatorium movement.
Extent of TB:
Tuberculosis or T.B. (the most common form, affecting the lungs, was also known as ‘pulmonary tuberculosis, ‘consumption’ or ‘phthisis’) was extremely widespread in Victorian and Edwardian Britain, and indeed across the world. In just a single decade, from 1881 to 1890, 589,000 people died of this disease – that was equivalent to over 11% of all deaths in England and Wales.[1] In the Registrar-General’s statistics for England and Wales, it was recorded that in 1853 the death rate from phthisis was 3,050 per million; by 1905 this had fallen to 1,125 deaths per million. The disease was more fatal in men than women, and more widespread (by up to 40%) in urban areas.
Nevertheless, even at the start of the 20th Century the death rate was still far too high. ‘Cause of death’ tables published in a Bradford newspaper in 1901, revealed that T.B. was the second most common killer disease in the Bradford district, after heart disease. Before the late 19th Century it was usually fatal, killing 80% of patients within a period of 5 to 15 years. During the Boer Wars (1899-1902) the rejection of a large proportion of army recruits, due to them being diagnosed with T.B., caused panic among social commentators and politicians of the day, perceiving the disease as a threat to the very existence of the Empire:
“Lord Rosebery’s words once more ring in our ears: – ‘In the slums and rookeries of our great cities an imperial race cannot be reared.’ … The future of the Empire depends on the way we tackle this mighty mischief.’ “ [2]
Causes and Symptoms: The wide variety of the forms of T.B. meant diagnosis was often confused, especially before it was discovered that the cause was bacterial infection. The disease could be chronic or acute (also known as ‘miliary’ T.B.) , intermittent or persistent. The most commonly recognised form was pulmonary T.B., or phthisis, which attacked the lungs. But there were many other forms such as those which attacked the skin – covering the body with ulcerous nodules – the blood, kidneys, spine, bones and joints (common in children), or the digestive system, causing excruciating pain.
Symptoms would also vary from one patient to another. Signs of the disease could include pale, translucent skin – but sometimes with a localised pink flushing of the cheeks on the face, loss of appetite, weight loss, a constantly running nose, a coarse or hacking cough, fever, the spitting of blood, wheezing, and drenching night sweats. One form, scrofula or ‘Kings Evil’, affected the neck glands.
The medical profession were aware that the infection was carried by sneezing, and coughing, carried in droplets through the air. They were not aware at this time that many people were asymptomatic – that is, carrying and transmitting the disease while not displaying any symptoms. Probably only 10% of infected people actually displayed symptoms. Most forms were slow in their progress, and did not cause obvious physical disfigurement until the final stages. Add to this the common confusion with other wasting illnesses, and the extent of the disease was persistently underestimated.
Until the mid-19th Century the popular romantic ideal of the ‘beautiful death’ did not help – the poet Keats famously hoped he would die of consumption, and for many Victorians it was a ‘good death’ in that it gave an ethereal appearance to the dying, and also gave the sufferer time to contemplate their life and prepare their soul for the afterlife, while quietly and solemnly slipping away – the preceding period of painful coughing and messy spewing of sputum would be forgotten in this romantic portrayal.
Often associated in the 18th and 19th Centuries with sensitive and creative people, this romantic view was reinforced by the deaths of a number of prominent artistic and creative people – The Brontes (Anne, Emily and Branwell; possibly also Charlotte), J.W. Turner, R.L. Stevenson, Chopin, Louis Braille, Florence Nightingale, Robert Burns, Elizabeth Barrett Browning, Doc Holliday (in the American West), John Ruskin,– the list is extensive and continued into the 20th Century with well-known people such as Alexander Graham Bell, Anton Chekov, Maxim Gorky, Stravinsky, W.C. Fields, Nelson Mandela, Vivien Leigh, George Orwell, D.H. Lawrence and many others – and Keats got his wish too.
Among the reasons for the gradual fall in the spread of T.B. during the late 19th and early 20th Centuries were better living conditions, the regulation of food quality, better access to fresh food, the pasteurisation of milk, better public sanitation and slum clearance, yet in the 1920s it was still a major killer.
In fact, it was overwhelmingly a disease of the poor. Although it could be exacerbated by a sedentary lifestyle, restrictive fashions such as tight corsetry, and by constant hunching of the body over a desk or needlework, the disease thrived most in damp, overcrowded housing, where there were poor sanitary conditions, putrid air caused by industrial smoke, pollution, and malnutrition. The widespread and unregulated adulteration of food, often with poisonous additives, the infection of milk and meat with bovine TB, and the lack of access to fresh food in the cities, further weakened the resistance of the poor to T.B., as indeed to many other diseases.
The development of the Sanatorium movement
Despite the growing awareness of the need for early treatment, until 1903 there was very little provision for those T.B. patients who were unable to afford to pay for treatment. Hospitals often refused admittance to patients they regarded as incurable, although workhouses might take them in. There were charities that set up sanatoria for minimal fees or free-of-charge, but places were very limited, and they struggled to find funds.
Nevertheless, the wealthy had a number of options, as sanatoria opened up all over the world. The movement had begun in Boston in 1857 when Harriet Ryan Albee opened a clinic, the Channing Home, in the basement of a church, for destitute, chronically ill women, mostly suffering from T.B. The first sanatorium specifically built and devoted entirely to T.B. patients was set up in 1859 in Silesia, but the most famous institution was Dr Walther’s sanatorium established in 1888 at Nordach, in the Black Forest, Germany.
The regime of care here was adopted worldwide as the most effective system for T.B. hospitals (known as sanatoria) across Europe, America, South Africa and Australia. In reality the success rate was variable, and difficult to assess, since much depended upon the climate in which the sanatorium was situated, and the stage of the disease at which each patient was admitted.
The Nordach method was based on the principles of pure air, plenty of good food, constant monitoring of body temperature, plenty of rest, and supervision of a qualified doctor. As long as they were kept away from smoke, dust, and ‘excitement’ (which in some places extended to the reading of novels!), it was not considered important to keep the patient warm and dry – indeed this was actively discouraged. The early sanatoria, especially those in Europe, were often more like luxury hotels and spas than hospitals. Patients at such sanatoria could usually enjoy gentle recreation, expensive cuisine, beautiful garden surroundings in which to relax, and activities such as golf, swimming, and dinner dances. However, the regimes tended to be stricter and more rigid in the cheaper institutions set up for the middle classes, and even more so in those run by charities for the poor. The one principle that all institutions adopted to its full extent was that of the ‘open-air’ treatment – exposure of the patient to as much fresh air as possible.
The first to be established in Ireland was opened in 1896 at Newcastle, County Wicklow, by Miss Florence Wynne. (Interestingly, in Britain, women doctors were at the forefront of the sanatorium movement).
Although the disease was declining, the average death rate from T.B. in Britain was still about 60,000 by the early 20th Century. Yet by this time, provided it was caught in its early stages it was treatable, and sanatoria were highly effective in such instances. By the end of the 19th Century it was widely accepted that the Nordach model or ‘open-air treatment’ was effective in the early stages, although not in more advanced cases.
A Conference of Poor Law Guardians from across Yorkshire, held in Halifax in 1899, was dedicated to the subject of tuberculosis: They were told the damp and cold English climate did not undermine the principles of the Nordach model. What really mattered was isolation, and close medical supervision. The main concern of the Poor Law Guardians however, was that they would be expected to provide sanatoria without any support from municipal authorities. The Bradford Guardians declared that they were already considering providing a specialist sanatorium for pauper consumptives, and had visited private institutions in Cheddar, Somerset, and in the Cotswolds, with a view to gathering useful information. Dr Munro, also from Bradford, added that over-large hospitals should be avoided – sanatoriums should be kept small – with no more than 80 patients – in order to minimise the spread of infection.
Despite cost fears, the Conference voted in favour of a resolution that pauper consumptives should not be treated within workhouse infirmaries, but rather in specialist isolation hospitals. Nevertheless, Bradford was the only Poor Law Union to seriously consider putting this into practice by setting up and running their own sanatorium. [3] Even so, Eastby Sanatorium would probably never have been built in the first place if Sir Francis Powell, had not fought long and hard against the objections of the Local Government Board. [4] The patronage of King Edward VII for a sanitorium in Sussex (which took in fee-paying patients and some sent by charities) had prompted great public interest. But local authorities were still proving reluctant to be at the forefront of hospital provision, usually for financial reasons. There were still lingering Victorian beliefs that self-help and self-discipline on the part of the poor was as important as hospital provision, or that charitable provision was the most effective solution. Innumerable conferences were held all over the country where charities such as the ‘National Association for the Prevention of Consumption and other forms of Tuberculosis’ declared the problem was too great and they needed support from local authorities and Poor Law Unions, while also having to pester the public and wealthy benefactors for funds. It was not until the Boer War (1899-1902) proved that army recruitment was seriously hampered due to the poor state of health of the working classes, that the authorities – local and national – recognised more needed to be done at an official level.
King Edward VII, who took a great interest in the subject, was patron of The British Congress on Tuberculosis held in London, in July 1901, which attracted speakers from all over the world and was attended by 2,500 people. Dr. Koch, who in the 1880s had discovered the bacteria which caused T.B., was simultaneously lauded and criticised for what were considered his revolutionary views on the spread of, and treatment of T.B. His view that dairy products and meat infected by bovine forms of the disease could not harm humans were widely thrashed and indeed have since been proved false. But his other ideas on bacterial causes, and the spread of infection through droplets in the air from sneezing and coughing, and prevention through isolation and public health measures, were increasingly being acknowledged. He urged that it was essential to abolish the conditions in which it thrived. Overcrowded dwellings had to be eliminated. Since advanced cases were incurable he saw little point in providing expensive sanatorium treatment for them. Instead, they should be accommodated in special wings of existing hospitals, as was the common practice in England, where they would not infect the general population. The sanatorium was suitable only for early stages of the disease, and must go hand-in-hand with public health education. [5]
…”he [Koch] paid England the compliment of pre-eminence in the founding of such institutions, and attributed the diminution of consumption in this country largely to such provision. It is, by the way, to the honour of the Bradford Guardians that they are the first Poor Law authority to apply for permission to establish a consumption sanatorium… “ [6]
Indeed in 1901 provision for the poor who suffered from tuberculosis was lamentably limited. Most hospitals refused such cases, and fees at private sanatoria were beyond their means. Most were left to be cared for by their families at home, the very environment which had nurtured the disease in the first place. Local authorities proved stubbornly reluctant to establish sanatoria – but the ‘Bradford Union Sanatorium for Consumptives at Eastby’ was of increasing interest as an example to follow.
At the Annual Yorkshire Poor Law Conference, held at Bradford in 1905, the delegates visited Eastby, where they were read an ‘instructive paper’ by Dr David Goyder of the Bradford Board of Guardians on “Poor Law and the Treatment of Consumption”. He confirmed the disease was not hereditary but bacterial, and that it thrived in crowded dwellings, stale air, bad food, malnutrition, ‘intemperate habits’ and insanitary conditions. The common habit of spitting was also widely blamed for spreading the disease. The conference were privileged to be given a talk by Dr Koch, who had famously discovered the bacteria in the 1880s. He urged municipal authorities deal with slums, take more proactive steps in detecting cases, impose compulsory public notification of outbreaks of tuberculosis so that patients could be isolated and quickly removed to sanatoria. As proof of the efficacy of the sanatorium treatment, he proceeded to read out a number of letters from grateful former patients from Eastby, which he praised as a fine example to other Poor Law Boards. On returning to Bradford for afternoon tea, the delegates were afterwards entertained (curiously to a modern viewpoint) with a ‘smoking concert’.[7]
Resistance to public funding
Naturally, charitable societies, poor law guardians and local municipal authorities were assured that the expensive treatment found in fee-paying sanatoria was not required – or even desirable – for the poorer patients. After all, it was often argued, once they were recovered, non-fee paying patients would have to return to work and their humble lives, so it would do no good to spoil them during their time in a sanatorium. As the sanatoria movement spread, cost-cutting led to a dilution of the basic principles of the Nordach model, to the point where it was often regarded as no longer effective.
A typical attitude was expressed in a letter to the Leeds Mercury newspaper (1 June 1900) from Mr. Sicklemore, of Ilkley. He criticised the rapid spread of sanatoria where the Nordach model was only partially followed, without due regard to the finer, but what he regarded as the essential, elements of the regime. Many, he pointed out, failed to provide proper qualified medical supervision, relying instead simply on open-air rest and generous helpings of food. He emphasised that a strict daily routine was required under doctor’s orders. Nevertheless, he argued, paupers should be given the plainest of food, rather than “food that would do credit to a first class London hotel”.
Typical examples of the interplay between charitable organisations and local authorities were plentiful. For example, the Leeds Tuberculosis Committee was established in 1900 as the result of a series of experimental cottage hospitals across Wharfedale. Their aim was to establish an open-air treatment sanatorium for the poor, relying on voluntary donations from benefactors.[8] They also raised funds through social events such as concerts. This charity’s success in raising funds prompted the chairman of the Leeds City Corporation to smugly declare there was no need for the municipal authorities to step in and provide special hospitals for pauper T.B. sufferers.[9] Meanwhile, the National Association for the Prevention of Consumption were pleading for the Local Government Board to offer such facilities through local authorities.[10] Most local authorities however preferred to focus on regulating adulterated food supplies, which spread bovine forms of the disease, and were gradually realising they could play a role in improving public sanitation and workers’ housing. Thus, in 1900, a conference held in Wakefield, bringing together various local authorities from across the West Riding, spent much of its time debating regulation of the milk supply, as well as the provision of public sanatoria. The delegates were told that in 1890, 2,304 people had died from phthisis in the West Riding; that figure had dropped to 1,865 in 1899, thought largely due to improved public sanitation and housing measures. It was agreed this was still far too high a number. While local authorities were obliged by law to provide isolation hospitals for specific infectious diseases, such as smallpox and diphtheria, they were not obliged to do so for tuberculosis, which was not even a publicly notifiable disease at this time. There was general agreement that sanatoria were needed for the poor, that these needed to be small in scale, and that serious or advanced cases needed to be kept separate from patients in the early stages. The conference was warned by the Chairman, that local councils were over-dependent upon private and charitable institutions, and they must step up to make proper provision for the poor. The conference, not yet ready to accept such a burden, simply voted to set up a deputation to discuss the issue with the Local Government Board.[11]
Similar reluctance was found elsewhere. A typical example was in Nottingham, where in 1901 the city council declared its sympathy for attempts by voluntary groups to check the spread of TB; “But when it is proposed to use the ratepayers’ money for the object, it is necessary to act cautiously and not rush to some precipitate decision.” They were not willing to deploy public rates for such a venture, There was also the argument that in funding one charity, such as the Nottinghamshire Sanatorium for Consumptives, would encourage a tidal wave of demands from other charities. It was noted that there was no free open-air specialist sanatoria for the poor, although admittedly some poor law authorities were currently considering various options, and Bradford had even committed itself to building one soon. But like the majority of authorities, Nottingham preferred to continue paying subscriptions to private and charitable institutions to reserve a specified number of beds for pauper patients. Nottingham City Council also mooted the idea, which was increasingly popular in some quarters, of treating patients at home, supported by health visitors and a health education programme. Despite the fact that the home may have been the cause of the disease, many local authorities felt confident that health education and visits by health workers could ensure the patients followed a self-disciplined lifestyle which could cure them. As part of such a solution there were recommendations that the patient could be isolated in their own bedroom, or in a shed in the garden, provided the windows were kept open all the time, and family members kept interaction with them to a minimum. In conclusion, the City Council implied that it would wait to see if the public would be generous in their support of the fundraising and that only if necessary they might consider – provided “the expenditure is moderate” – to “look with sympathetic consideration“ into financially supporting existing sanatoria.[12]
Similarly, and in the same month, the York Branch of the National Association for the Prevention of Consumption appealed to the local authorities to help out in the building of a sanatorium for the poor of York and the North and East Riding of Yorkshire. Again there was general agreement that this terrible disease needed to be eradicated as it “threatened to undermine the health and stability of a very large portion of the manhood of the nation”, and that the open-air treatment appeared to be the most successful form of tackling it. But the resolution was to encourage charities to actually provide the sanatorium. Over the previous couple of years benefactors across the North Riding had paid a subscription to support sending a few patients to the North London Hospital for Consumption at Hampstead in London. Dr. Ramsay (Vice-President of the Association’s York branch), in seeking sponsorship from wealthy benefactors to build a hospital near York, assured the meeting that any sanatorium they erected would be “to assist some deserving persons“ and it would not be “absolutely a charity”.[13]
In the meantime, the general public, many of whom had no access to qualified medical professionals, let alone a place in a sanatorium, were dependent upon ‘cures’ such as that offered in an advertisement in the Craven Herald (21 April, 1822):
“Life to the Dying: … The Great Remedy for Consumption, &c. Toulson’s Life Restorer, the most speedy and permanent Cure for Consumption, all Diseases of the Lungs, Coughs, Cold, and Degeneration of Natural Power. Millions of valuable lives may be saved from these fearful Diseases by the re-animating properties of Toulson’s Life Restorer.”
Decline of the Sanatorium Movement
The B.C.G. vaccination against T.B. emerged in 1921 in France, although it was not widely used until the late 1930s, by which time antibiotics were becoming a more viable alternative, leading to a dramatic decline of the disease from the 1950s. More recently new resistant strains and vaccination refusal have led to a concerning re-emergence of T.B in Britain. Worldwide it is fast becoming a very serious issue again, especially in Africa, Asia and Russia.
Article notes
[1] Leeds Mercury, 4 Nov 1903.
[2] Bradford Daily Telegraph, 25 July 1901
[3] Yorkshire Post and Leeds Intelligencer, 13 May 1899.
[4] Formed in 1871, the Board was a central government body responsible for local government and public health; it was replaced in 1919 by the Ministry of Health. Sir Francis Sharp Powell (1877-1911) had previously been an M.P. for Wigan, for Cambridge, and The Northern Division of the West Riding of Yorkshire; He was a member of the Royal Commission on Sanitation, and in 1904-05 became President of the Royal Statistical Society. He was made a freeman of the city of Bradford in 1902.
[5] Bradford Observer, 23 July 1901 / 24 July
[6] Bradford Daily Telegraph, 25 July 1901
[7] Leeds Mercury, 20 September 1905
[8] Wharfedale & Airedale Observer, 16 March 1900
[9] Leeds Mercury, 17 September 1900
[10] Grantham Journal, 20 October 1900
[11] Yorkshire Post and Leeds Intelligencer, 17 November 1900
[12] Nottingham Journal, 5 March 1901
[13] Leeds Mercury, 28 March 1901
Part two will explore the establishment and early years of the Sanatorium at Eastby.
Jane Lunnon – EwE Historical Research Group, March 2024
Categories: All, History Posts
