Tuberculosis Dispensaries

By Juliet Agadagba

From the early 1900s to about the mid 1960s, tuberculosis was an ever present threat in London, England. Overcrowding and poor sanitary conditions were the two main catalysts that increased the spread of TB (tuberculosis) and therefore, the number of cases reported. Surges of TB cases were mostly found in poor, underdeveloped areas of the city. Due to the enormous number of people living at or below the poverty line, overcrowding in London was especially common. At times, there were as much as ten people living in one 450 square foot house. Also, most houses of this size were shanties that often harbored holed ceilings, molded ceilings, broken windows, cracked walls, collapsing floors etc. All of these lacerates made for easy access for mycobacterium tuberculosis–the microorganism that causes TB–to enter in and spread. Each part of London had its own protocols for how it contained the spread of TB. As can be expected, these protocols changed as the  knowledge of TB , hygiene, proper sanitation expanded. Bermondsey and Wandsworth are two burroughs that adjusted TB treatment techniques and methods as new information about TB rose over the years.

Bermondsey Health Centre, Grange Road
By Henry Tansley, Borough Architect, 1936. Bermondsey was a pioneer in health provision. This originally included “infant welfare and ante-natal clinics, rooms for radiotherapy and diathermy (heat treatment using high-frequency electrical current), a foot clinic and a solarium and dispensary for sufferers of TB”. (municipaldreams).
  © Copyright Stephen Richards and licensed for reuse under this Creative Commons Licence.

In 1921, Bermondsey’s TB dispensary and solarium were beginning to lose track of their TB patients. At this time, there was an influx of documented TB recoveries, un-confirmed TB patients, and TB moralities that it became difficult to keep track of it all.  Evidence of this issue was clearly stated in the Report of sanitary condition of the Borough of Bermondsey for the year 1927,

…it had developed somewhat on the lines of an ordinary out-patients’ department of a hospital, where, besides tuberculosis all sorts of cases were treated, and the patients were given very large doses of medicine.

Patients received more medication than what was prescribed to them because of patient record disorganization. To help resolve this issue, the Tuberculosis Dispensary of Bermondsey appointed a new assistant TB officer, Dr. D.M. Connan in 1927. His job was to sift through

…7,000 cases eliminating patients who had died, were not suffering from tuberculosis, had left the district, for various reasons either were not or should not be under care of the Dispensary.”

Bermondsey 1927

From his promptness to re-organize, it can be inferred that Dr. D.M. Connan understood that the only dispensary in the Borough of Bermondsey would suffer if patient records were not in order. Moreover, he understood that mixing records for different diseases increased the likelihood of wrong drug administration and or drug over dosage which could increase mortality rates. For this reason Dr. D.M Connan decided to

take non-TB cases off the medical records, remove death cases from the live register, make all cases appointment only, and strict limitations on drugs.

Bermondsey 1927

Similar changes in the dispensary systems at Wandsworth were implemented in order to provide the best healthcare possible to TB patients of all socioeconomic statuses. About every other Friday afternoon, the Tuberculosis Dispensary Committee of Wandsworth would meet to discuss current issues plaguing TB patients and how to best manage and or deal with those issues.

The Committee meets at 79, East Hill, on alternate Friday afternoons at 2:30pm. The goal of the committee is to improve the social and economic conditions of patients suffering from Tuberculosis.[3]

Wandsworth 1928

To accomplish its goal, the committee made a list of things that they needed to augment or incorporate in order to better serve their TB patients. These commodities included but were not limited to,

…the provision of extra nourishment, extra bed accommodations, open air shelters, removal of patient to friends and relatives in the country, care for children when the mother or housewife was absent, and financial assistance for patients and their families.”

Wandsworth 1928

It was apparent that this committee was forthcoming in putting the needs of their patients and their families before anything else. The extent of their caring abilities was attributed to the neighborhood charity groups within the communities. These groups helped the Care Committee

investigate the financial circumstances of families in order to determine what sum could be contributed for treatment by the family and what sum the dispensary could cover.

Wandsworth 1928

Basically, the committee decided that they would meet the patients who could not afford treatment half way. As a result, many low socioeconomic TB patients were able to receive the treatment they needed. In 1928, after the investigation, the committee

assessed and collected the contribution of 369 patient cases (adults and children) and noted that they had received 867 pounds.

Wandsworth 1928

Once again, this incident was another great example of the lengths the Care Committee went to in order to insure that the majority of their TB patients attained the treatments they needed without worrying about the bills. Wandsworth was not the only borough that went the extra mile to insure the health and wellness of their communities.

mage result for london slums 19th century
Photo Credit: Content Provider(s): Wellcome Library The original uploader was Report of the Medical Officer of Health for Beckenham.

MOH Reports

Beddington and Wallington 1954

Bermondsey 1927

Bermondsey 1931

Bermondsey 1926

Wandsworth 1928

Beckenham 1938

Beckenham 1939

Beckenham 1964

Beckenham 1908

Secondary sources

Boev, Hristo, “Dickens’s Consumptive Urbanity: Consumption (Tuberculosis) through the Prism of Sensibility

Grad, Roni. “Cod and the Consumptive: A Brief History of Cod-Liver Oil in the Treatment of Pulmonary Tuberculosis.” Pharmacy in History 46, no. 3 (2004): 106-20.

Johnston, William. “Tuberculosis.” Chapter. In The Cambridge World History of Human Disease, edited by Kenneth F. Kiple, 1059–68. Cambridge: Cambridge University Press, 1993.