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TB scare recalls unhealthy past

Josephine Gardiner looks back at the dark days of childhood illnesses and finds there is still no room for complacency

The news that 198 children have tested positive for tuberculosis in Ponteland, an affluent Northumberland village, is a chilling reminder that the diseases we assumed were safely confined to the past are not extinct.

Frank Dobson, the health minister, last week warned against complacency about disease when he launched the Government's Green Paper on health.

While the biggest achievement of the NHS, founded 50 years ago, must be the massive reduction in infant mortality and the general increase in life expectancy, Mr Dobson warned that "successive surveys have shown that over the past 20 years the gap between the rich and poor has been growing".

In the 1970s there was no difference between rates of heart disease in social classes one and five. Now, men in class five are three times more likely to have heart disease.

Surveys have also shown up alarming differences in life expectancy between children born in the comfortable home counties and those in the inner cities.

The foundations of the NHS were laid in William Beveridge's report in 1942, in which he famously recommended a joint attack on the related evils of Want, Disease, Ignorance, Squalor and Idleness. Beveridge's report, and its enactment in Aneurin Bevan's 1948 legislation, marked a sea change in attitudes to poverty and illness. Before this, the feeling remained that poverty was at least in part the fault of the individual and its relief must include an element of punishment - the workhouse. Beveridge brought in the concepts of dignity, rights and services.

Fifty years later, there are plenty of people willing to turn back the clock. The historian Correlli Barnett wrote in the Times a few weeks ago that Beveridge's dream had "turned to the dank reality of a segregated, subliterate, unhealthy and institutionalised underclass hanging on the nipple of state maternalism . . . " The 19th century tends to be associated with Dickensian images of extreme childhood suffering and poverty. But the latter part of the century also saw a growing concern about children's health, culminating with the Gladstone government's introduction of school boards in 1870. The dawn of the 20th century saw the realisation that the teacher's task might be easier if pupils were not half-starved, verminous and rickety.

In London in 1902, Dr James Kerr, one of the first school medical officers, told of children in slum schools who had "heads encrusted with scabs, exudation and lice". Other evils included ringworm and chronic malnutrition.

A 1907 Education Act established a school medical service, though its effects were limited - parents could not afford a doctor - so many of the diseases uncovered by inspection went untreated. The school medical service was resisted by doctors, who resented state encroachment on to their territory, and the introduction of school meals in 1906 drew howls of protest from those who believed it would lead feckless parents into a dangerous dependency on the state.

Nevertheless, by the 1930s, much had been achieved, although the gains were uneven, depending on which local authority area you lived in.

In 1911 the first "open air" school for children with the dreaded "consumption" (TB of the lungs) opened. These attempted to restore the children's health with a regime of rest, wholesome food and fresh air. They became redundant with the availability of penicillin in the 1940s. Evidence of improving health can be seen in figures for deaths under five in Edinburgh. In 1863, 80 children died of diphtheria; by 1913 this was down to 22, and by 1946 there was only one death. Figures for pneumonia over the same years were 318, 120 and 5.

Conscripts recruited in 1939 were found to be fitter than their counterparts in 1914, but the evacuation of city children to the country in World War 2 still exposed glaring inequalities and deprivation.

Rationing, however, brought a huge improvement in the health of the poorest children. For the first time, they had access to a balanced, if boring, diet, supplemented with vitamins, milk and orange juice.

The NHS Executive has published a resource pack for schools, Your NHS - A Force for Health, including a 40-minute video. It is available free from Hobsons Academic Relations on 01487 823546.

AILMENTS OF HISTORY

Polio, TB, diphtheria, pneumonia, scarlet fever, measles, whooping cough, typhoid fever, cholera, smallpox, starvation, ringworm, impetigo, body lice, rickets, scurvy, dysentery, boils and chilblains.

MODERN PROBLEMS

Cancers, meningitis, leukaemia, asthma, HIV, allergies, obesity, anorexia, mental illness (childhood depression, behavioural problems), malnutrition, addiction (drugs, alcohol, smoking), head lice, food poisoning, traffic accidents.

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