In the film Alfie, which is set in London in the 1960s, the title character (played by Michael Caine) goes for a routine chest X-ray and is discovered to have a lung infection which is implied to be tuberculosis. He’s sent for convalescent treatment in the English countryside for six months. The film is explicit that the British National Health Service is providing the care.
How realistic is the treatment for tuberculosis described in the film for this time period and place? I know from other threads here and from reading old novels (Anna Karenina, for example) that it was common for tuberculosis patients with the wherewithal to relocate to warmer, drier climes to recuperate. But this was before the discovery of antibiotics and before universal health care. Would someone like Alfie really have been sent to a convalescent home for six months on the government’s dime in the 1960s? Couldn’t he have been treated locally in London?
In the early 60’s ear Call the Midwives one of the nuns midwifing in East End London is found to have TB and is sent to the countryside to a sanitarium to recover. Her recovery is tracked with X rays and when cured about 6-8 months later she returns to London.
Isoniazid was in standard use for TB treatment before the early 1960s. Ethambutol was added by the early 1960’s too. Streptomycin had been used in the 40’s but TB had become resistant to it quite quickly.
Dr. QtM, your post made me curious re: what pharmaceutical treatment the Call the Midwife character would have received in addition to sequestering herself in a rest home in the country. Here’s what I could find:
…Dr. Turner makes a reference to the “triple treatment” for tuberculosis. This therapy was developed in 1952; it consists of streptomycin, para-aminosalicylic acid and isoniazid…
The series at this point was pulled from the memoirs of one of the nurse midwives, so I’m guessing it was accurate about treatment for TB in London in the early 60s. Of course, not all East End dwellers would have had the wherewithal to decamp to the countryside. Sister Bernadette was an Anglican nun in addition to being a nurse, her order provided for excellent care for her, probably out of reach for most, if not all, of her East End patients. I hoping they could somehow have gotten their hands on the oral triple drug treatment.
Well, Alfie is shown getting some sort of injection in the convalescent home, so maybe this was was one the drugs you mentioned. But was it advisable back then for him to get this treatment in the countryside instead of in London?
The NHS began in 1948, just about when the memoirs begin, so may of the East Enders could access medicines, I hope. There were many, many immigrants, war refuges and transient seamen in the East End (Poplar), how many of them could use the NHS I do not know.
I’ll wait for a UK Doper to answer this question historically. In the memoirs, very few disabilities/work injuries appear to have provided subsistence wages. It appeared that institutional care for the long term could be found for a child born with special needs but that care didn’t occur in the East End community.
I can’t find any proof online, but it really doesn’t seem that unlikely that someone could have been allowed to stay at a sanatorium for six months for TB. My uncle spent at least a few months in one in the 60s and it was definitely not being paid by him or our our family.
For poorer people the main issue would have been loss of wages. Disability and unemployment benefits (for disability it was then called “income support”), did exist but wouldn’t usually have paid enough to actually support the family, if the person was the breadwinner. Alfie only supported himself (as did my uncle), so that wouldn’t have been an issue.
The transient seamen might have had issues accessing NHS treatment, but communicable diseases like TB might well have been different - can’t say for sure. I can say for certain that the others would have been covered, because the NHS from its founding has been open to any UK resident, not just British citizens.
The antibiotics would cure the infection, but the disease damages the lungs so the patient needs time to recover. Mountain air was prescribed for patients even before antibiotics.
As an exemplar, baseball player Rico Carty developed tuberculosis in spring training in 1968 and missed the entire season.
Even now, treatment for an active TB infection takes 6-9 months. And the person has to isolate for at least a few weeks until they no longer pose a threat of infecting others.
para -Aminosalicylic acid, discovered in 1945, when combined with streptomycin was found to greatly reduce the occurrence of drug resistance.
Clean air Therapy whether out in the country, in the desert, or even deep in caves (as was tried in Mammoth Cave, KY) was not really helpful other than getting these patients out of smoggy, coal burning cities and villages. though they had to use fire for illumination in the caves, so that really didn’t help.
Pulmonary therapy to clear secretions and open up plugged airways could help some too. As did giving decent nutrition to try to help the patient fight off the disease.
But the real key was stopping the progress of the infection.
I’ve only treated 1 case of actual TB disease in my career; it was successful. Treating Latent TB infection (non-active, not contagious, not health threatening) is something I’ve done many times in folks who were at risk for converting into TB disease.
TB infected not just the lungs, but could infect and cause horrors in every organ system in the body. It was known as “The Great Pretender” (along with syphilis) because it could manifest looking like so many other diseases, depending on how and where it was active. TB of the brain, spleen, abdomen, pelvis, kidneys, bones, skin, etc.
Not only that, but streptomycin also wreaks havoc on the 8th cranial nerve, with deafness, often permanent, being the most common side effect. Dihydrostreptomycin isn’t as brutal, but it’s still no fun to take. I’ve only seen that drug dispensed once, when I lived in an area that had a higher than background incidence of active TB.
Amikacin is also used for TB nowadays, and it too often causes hearing loss.
Back in the early to mid 20s Dashiell Hammett had tuberculosis and was moved back and forth from his family to an apartment by himself in San Francisco as they intermittently thought it might be contagious. It strained the marriage so that it failed. It was on the government dime because he’d contracted the disease when he was serving in the army during WWI so it was administered by whatever the VA was called back then.
I took a Dashiell Hammett walking tour and there were quite a number of residences. One of them, 891 Post St. was where he was living when he wrote The Maltese Falcon and might be where Sam Spade was living – the view out the window matches what Spade saw when Wilmer was lurking in the vicinity.
FWIW, although a sanitorium on the coast sounds luxurious, and in the 60s the coastal towns were still sort of fashionable, it’s because the charities that owned them prior to the NHS had generally moved their sanitoriums to the countryside or coast even before the NHS was founded. Even back then they could get an awful lot more bang for their buck outside London, and the pollution in London was even worse then than now, the WWII changed things again. Orphanages and almhouses had almost all moved out of London too.
So when the NHS needed to send a Londoner to a sanitorium, it almost always wouldn’t have been in London, but it wasn’t because it was a treat for Londoners, it would have been because there probably wasn’t anywhere in London for them to go to.
Being treated on the government’s dime is the very definition of the NHS - if the treatment involves being in a convalescent home in the countryside for six months, then of course the NHS will cover it.
But this was precisely the question—whether moving out of the city was considered an essential treatment back then. (Of course the NHS doesn’t and never did pay for treatments not considered necessary.) I think others have since established that sanatoria stays were indeed typical, that no sanatoria would have been located in London, and that in any event the air quality in London may have been too poor at the time.
In this way it’s no different from any other treatment on the NHS - if your doctors think you need to be treated at a certain specialist hospital, that’s where they’ll send you.
FWIW my father had a recurrence of TB in 1959, and he was certainly sent down to a sanatorium of some sort in the countryside. I was only a child at the time, so don’t know whether this was NHS or (possibly) paid for privately by generous employers, but it wouldn’t be at all surprising if it had been on the NHS.
Likewise I assume (but don’t know) that his employers continued to pay his salary. AFAIK, government/statutory sick pay only covered short-term illness). National Assistance (as it was then known,later “Supplementary Benefit”) would have been if you were put out of work altogether, I believe, and because it was means-tested still carried a bit of a stigma for someone of my father’s generation and background. If his employers were that generous, they got their money’s worth, since he went back to working for them for the next 15 years or so).
The only major disruption, from my child’s point of view, was that I got the BCG vaccination, whereas it was usually only given to older teenagers. That, my parents giving up smoking - and a couple of scarves my father wove in his occupational therapy class (I still have them).
And - not that movies are necessarily accurate social history - there’s the 1962 movie Twice Round the Daffodils: clearly it’s taken as a given that the NHS had sanatoria in the country,