Disease, Class and Social change : Tuberculosis in Folkestone and Sandgate 1880-1930

• Main Author: Arnold, Marc
• Published: University of Kent 2011
• Subjects: 942.239081
• Online Access: http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.587563

This thesis considers the interaction of the cultural and the medical through tracing shifts in the understanding and treatment of pulmonary tuberculosis between 1880 and 1930. As a disease recognised as occurring to a disproportionate extent amongst the working classes tuberculosis provides a focus for historical debates concerning the relative effects of infection, heredity and economic deprivation on the health of the public. The identification of its causes and the implementation of measures for its prevention, it is argued, were particularly influenced by prevailing social concerns and cultural assumptions regarding the morality and constitutional fitness of the working classes. In order to examine these interactions between cultural perspective and the construction and deployment of medical knowledge a local study of the elite English coastal health resorts of Folkestone and Sandgate has been selected as the focal point of this research. This examination of "tuberculosis and class in Folkestone and Sandgate reveals the social and ideological interests of local entrepreneurs, charitable and government agencies and Poor Law and public health officials. This research concludes that historical accounts of the English medical profession's focus on the infectivity of tuberculosis from the late nineteenth century are oversimplistic. A pervasive eugenic consciousness, together with political and economic expediency, were at least as significant in leading to the public sanatorium treatment of the working classes. The inability of urban workhouses to cope with destitute consumptives together with the growing financial burden : :::imposed on Boards of Guardians and Friendly Societies were also factors that led to provision for the tubercular under the National Insurance Act of 1911. From the 1890s many public health experts had argued that tuberculosis was largely a disease of poverty that could most efficiently be eradicated through social reform, in particular by addressing problems of poor housing and overcrowding. The 1911 National Insurance Act, however, focused mainly on the isolation and hygienic education of working class consumptives. Not until a change of approach by public health experts, particularly sanatorium doctors and Medical Officers of Health, in the mid-1920s towards strengthening the immune system of the tubercular did an emphasis on social reform, and improvements to housing, emerge as a public health priority.