Farewell To The East End

throughout Europe and America, crowded into factories and workshops, cold, half-starved men, women and children laboured for twelve or more hours a day in enclosed, foetid conditions and returned at night to tenement dwellings the sanitary conditions of which were beyond our imaginings. Infection would have passed with rampant speed from one sad individual to another, made more livid and virulent by the physical debility of the victim, caused by overwork and malnutrition.
    In previous centuries all over Europe, child labour was the norm. From 1750 onwards, in industrial Europe, children were confined in closed, ill-ventilated rooms, working up to twelve hours a day. The Royal Commission on Child Labour in Manufacture of 1843 described children of seven and eight years as … ‘stunted in growth, pale and sickly; the diseases most prevalent are disorders of the nutritive system, curvature of the spine, deformity of the limbs, and diseases of the lungs, ending in consumption’. The number of deaths from tuberculosis amongst these children may not even have been recorded. They were child paupers, frequently gleaned from workhouses, unwanted, unprotected, endlessly expendable.
    In the enclosed workhouses of Britain, where inmates were confined and not allowed out, contagion would have been a continuous fact of life. The only record I have been able to find of the incidence of tuberculosis in a workhouse was from one in Kent, where in 1884 it was recorded that all of the seventy-eight boy inmates suffered from tuberculosis, and that amongst ninety-four girls only three could be found who were not infected. It has not been recorded how many of these workhouse children died, but many would have. Undoubtedly the worse the living conditions, the worse the effects of the tuberculosis bacillus. In the Jewish ghetto of Vienna, at the height of the epidemic, it was recorded that 100 per cent of the dwellers were affected, of whom 20 per cent died. The rich Viennese were terrified to go anywhere near the area.
    For the poor, consumption was not the romantic image of pale, wasting youth. It was not the occasion to lie in bed for months on end, writing long, sad poems. It did not lead to extended travel abroad. No, indeed; for the labouring poor consumption was the great killer, the breeder of destitution, the father of orphaned children.
    While the highest mortality from tuberculosis occurred in young adults, children also died. In the graveyard of Burton on the Welsh Borders, where my father and grandparents are buried, can be found the tragic memorial to ten children from one family who died between the ages of six months and twelve years from ‘wasting consumption’. The composer Gustav Mahler was one of fourteen children, seven of whom died of tuberculosis. The Masterton family, whose tragic story I tell, were not the only ones with such a history. In the tenements of Poplar lived the parents of six children, all of whom, I was told, had died of consumption. The prevalent sadness of the parents is, to this day, alive in my memory.
    Contagion – the possibility of the spread of disease from one person to another by some unseen agent, but especially by breath – was not part of medical thinking at the time. Consumption was considered to be an hereditary malformation of the lungs, and the fact that so many families were consumptive lent weight to this theory. Strangely, the equally observable fact that, inside closed religious orders, where monks and nuns were not related, up to 100 per cent could be found to be infected, did not prompt physicians to pursue another line of thought.
    However, in 1722 an English physician, Benjamin Marten, published a paper postulating that ‘a species of animalculae, or wonderfully minute living creatures, capable of subsisting in our bodies, may be fretting and gnawing at the vessels of the lungs’. The idea was considered so preposterous that the medical thinkers of the time refused to believe it. Had Marten’s hypothesis been accepted, and proper isolation and decontamination procedures been adopted, the Great White Plague of Europe might never have occurred.
    In 1882, the German scientist Robert Koch, in a home-made laboratory, isolated the tuberculous bacillus for the first time and demonstrated by animal experiments that the bacillus was responsible for the disease that had baffled generations of researchers and medical thinkers. He also demonstrated that the bacillus could cross