Disease, Class and Social Change

This social and medical history of tuberculosis during the late Victorian, Edwardian and inter-war periods assesses the shifting inter-relation of medical, political and social forces in determining responses to this devastating disease. The previously unexamined history of the beginnings of open-ai [...]
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This social and medical history of tuberculosis during the late Victorian, Edwardian and inter-war periods assesses the shifting inter-relation of medical, political and social forces in determining responses to this devastating disease. The previously unexamined history of the beginnings of open-air treatment for the poor and destitute in English coastal resorts demonstrates how contrasting meanings were assigned to the disease along lines of class. It also permits an analysis of the effects of scientific ideas, in particular social evolution and germ theory, on attitudes to poverty and chronic disease. In Folkestone and Sandgate these conflicting perceptions of the disease were highlighted in a clash of interests between reformist public health officials in overcrowded London boroughs and a provincial plutocracy with a vested interest in maintaining the status quo in an elite health resort. This local controversy precipitated calls for state treatment of the disease and throws light on the ways in which doctors, politicians and other social commentators, including historians, have tended to frame the issue of tuberculosis according to their own political perspectives and values.Medical attitudes to tuberculosis varied between viewing it as a disease of poverty that could most efficiently be eradicated through addressing problems of poor housing and overcrowding to a focus on the isolation and sterilisation of those deemed to possess an hereditary taint. Heroic accounts of the impact of bacteriology on the development of public health in England in the early twentieth century have often been simplistic and misleading. A pervasive eugenic consciousness and the growth of workers' mutual aid societies as public health providers were also significant factors leading to state provision for the tubercular under the National Insurance Act of 1911. Although concerns over the dangers of infection from tuberculosis were prevalent from 1898, after World War I a movement away from a focus on infection is evident and a more holistic approach emerged that emphasised strengthening the immune system of the tubercular through improvements to diet and housing. Conflicts between an infection model of tuberculosis and a focus on social reform still characterise approaches to tuberculosis treatment today.