Farewell To The East End

from man to animals and vice versa, thus proving that milk from tuberculous cows could infect human beings, especially children.
    From that time onwards, massive public health programmes were ordered in all European countries and in America. The public were instructed in the facts of infection and contagion, which were completely new concepts for them to grasp. The strange and novel process of sterilisation had to be taught. Limiting the spread of infection was the order of the day, and this continued for nearly eighty years.
    Pasteurisation of milk was started in the 1920s. This was nearly forty years after Koch had demonstrated the cross-infection from animals to humans, but even then a great many people would not believe it and refused to buy pasteurised milk. TB testing of cattle was at first voluntary for farmers, but became obligatory in the 1930s. In the 1920s large notices saying ‘SPITTING PROHIBITED’ were displayed in all public buildings, meeting places, and on public transport – and these notices were still displayed in the 1950s and ’60s. All pubs and private bars, such as those in golf and tennis clubs, had a spittoon in the bar.
    Consumptives were removed from the workplace; even the idle rich were no longer free to wander around the South of France infecting others; they had to be treated in isolated sanatoria. Medical and nursing staff were specialists. Strict barrier nursing of TB patients was undertaken, and TB nurses did not enter general hospitals. A consumptive parent was removed from his or her children. A consumptive child was removed from school. Due to these measures tuberculosis, which had terrorised Europe, began to lose its grip.

    The possibility of vaccination was considered. Vaccination against infectious disease was first developed in 1796 by Edward Jenner, who had observed the link between cow-pox and human smallpox. In the 1880s, when Robert Koch discovered the tuberculous bacillus, he held out great hopes that a vaccine could be prepared from dead tuberculous bacilli. This should have gone well, but, in the early use of the treatment, tragedy struck. A batch of the vaccine had been improperly prepared, and living bacilli were injected into a large group of children, all of whom contracted tuberculosis, and many of whom died. This disaster halted the use of a vaccine for over sixty years, and a safe and effective treatment had to wait until the 1950s, when the BCG (Bacillus-Calmette-Guerin) strain became available for the prevention of tuberculosis.
    But a vaccine is preventative, not curative for those already infected. In the first half of the twentieth century many curative drugs were developed and used. In the 1930s sulphanilamide was tried; in the 1940s para-animo-salicylic acid; in the 1950s streptomycin was the first of the antibiotics to be introduced, and this one saved millions of lives.
    X-rays were invented as long ago as 1895, and could determine the extent of the disease. Surgery was attempted, and by the 1930s was relatively well advanced, from removal of a whole lung to removal of one or more diseased lobes of the lungs. Thoracoplasty and artificial pneumo-thorax, aimed at resting the lungs, was attempted in the 1890s and developed throughout the early part of the twentieth century.
    But it was the public health programmes carried out over eighty years that were chiefly responsible for success, and by the end of the 1960s tuberculosis was no longer a major cause of death in European countries and America.

    We, the favoured few of the twenty-first century, do not, cannot know the dreadful impact that tuberculosis had in days gone by. Let us be thankful for the advance in medical knowledge, and let us strive to extend it worldwide. 12

THE MASTER

    And there she lulled me asleep
And there I dreamed – Ah! Woe betide! –
The latest dream I ever dreamt
On the cold hill side.
‘La Belle Dame Sans Merci’, by John Keats

    They were having tea in Lyon’s Corner House in The Strand. They usually met there. Mrs Masterton liked the atmosphere. Refined, she called it. It was their usual afternoon out, once a month. Mrs Masterton poured the tea.
    ‘They tell me your father’s ill,’ she said abruptly.
    ‘Dad? Ill? I didn’t know.’
    ‘I heard it from our milkman, whose brother is a cab driver. Cabbies get to know everything. He said the Master of the Master’s Arms in Poplar is ill. That’s all I know.’
    ‘What’s wrong?’
    ‘I don’t