SHIRLETT SANATORIUM

by Victoria Cox

The ‘Association for the Prevention of Consumption and other forms of Tuberculosis in the County of Shropshire and the Hundred of Maelor’ was founded in 1911 to establish a sanatorium in the County, to educate the public about the means of spreading tuberculosis and its prevention, to influence public bodies to exercise their powers to prevent tuberculosis, and to take `any other measures which may be practicable for the prevention of.... tuberculosis' [i].

Reasons for building the sanatorium

In the 1900s in Shropshire, lung tuberculosis caused more deaths than all the other infectious diseases, with over 120 deaths from the disease per year.[ii] In 1907 there was only one institution in Shropshire that would accept tuberculosis patients, with general hospitals specifically excluding such cases because of the contagious nature of the diseases.[iii] With tuberculosis diagnosis rates and death rates increasing quickly, something had to be done and without a cure, sanatoria seemed the next best solution. The problem was heightened when the returning soldiers from the Great War brought an influx of tuberculosis. The Shropshire tuberculosis death rate was higher in 1918 than at any other time since 1906 and Shirlett was running at full capacity.[iv]

Tuberculosis affected every part of the consumptive's life, if that person was the breadwinner for their family, they faced high costs associated with long-term treatment, and in many cases the loss of further income due to the death of the patient. In Shropshire, the financial cost through loss of earnings because of tuberculosis was assessed in the investigation into the need for a sanatorium in the county. With an average annual loss of £34,766 in Shropshire through tuberculosis related deaths, building a sanatorium was a good investment because it could help return people to good health and therefore to work.

The financing of the sanatorium

The County Council awarded three-fifths of the costs of building the sanatorium, which were not to exceed £90 per bed. This limited it to basic wood construction that could house 20 to 40 inmates in cheaply constructed wooden shelters costing between £6 and £8 per couch, with toilets, a kitchen and administration offices in a more solidly built central block. [v]

In 1916 the County Council provided £2731 1 s I0d compared to the £656 13s 6d provided by public subscriptions, and £55 7s 2d from patient's contributions. But this was not enough so economies had to be made. Shirlett was practically self-sufficient. In 1916 all the fruit and vegetables the sanatorium used were grown on site except potatoes, and the report for that year announced plans to grow them in future to save money. These efforts continued until the sanatorium closed. The report also refers to the installation of a water softening plant in 1916, which reduced costs in a variety of areas including negating the need for the boiler to be cleaned every 3 months, and also the savings made in soap and washing powder.[vi]

In 1931 Shropshire County Council was asked to adjust its contributions from 5/6 of each patient's maintenance costs to 11/12 because the sanatorium had a debt of £2,020 2s 8d, showing that it was unable to support itself.[vii] , The situation was unchanged by 1939 and fears had mounted that patients would have to be sent home because the sanatorium could not find the extra 1/6 of the care costs.[viii] From 1st January 1939 the council contributed 11/12 of the care costs.[ix] The National Health Service Act of 1946 provided funds to prevent, diagnose and treat illness free of charge so that the type and amount of treatment was no longer related to income or insurance contributions.[x]  For the first time in history, everyone was entitled to free health care.

The reaction to tuberculosis

The social implications of tuberculosis were huge; people with the disease were often ostracised by their friends and families. The public knew that the success rate of sanatorium cure was low and therefore employees with backgrounds of tuberculosis were a great risk to potential employers because they would be less likely to stay at work or be as productive as fellow employees. It was not uncommon for ex-patients to stay on as groundsmen or even as nurses because they could not or would not find work outside the `safety' of the sanatorium. Shirlett had at least two nurses who had been treated there and then worked there when they recovered.[xi] Even the staff of sanatoria were treated with some suspicion, with family and friends unable to understand why they would want to work there.

Methods of treatment and their success

Shirlett prescribed bed rest, but forbade patients to lie in sunshine, underlining this rule by constructing the shelters so that they faced north. One patient recalled that she had been confined to bed for the first six months of her stay in the sanatorium. The doors to the wards were never closed which allowed fresh air to circulate. The memory of coldness experienced at the sanatorium was particularly evident in one patient's account of his stay.[xii] Local residents even recalling seeing patients in beds covered with snow. [xiii]

The 1917 report included a table on the increase and decrease of patient's weights during their stay at the sanatorium. Of the 159 patients that were treated at the sanatorium during 1916, 137 experienced a weight increase, 12, a weight decrease and the remaining 10 were not weighed.[xiv] This suggests that weight was an important indication of the success of the treatment being given in the sanatorium. The report of 1935 referred to in the Wellington Journal mentions that `nothing but the best English meat ... and Grade "A" T.T. milk' was supplied. This also indicates the desire to use good food as treatment for the patients.[xv]

Shirlett used `graduated labour' to strengthen their patients for work. In 1917 there were `light gangs' who chopped off and stacked small branches and `heavy gangs' who sawed off and stacked the large branches of trees which had fallen in a storm in 1916. The construction of a shed for the water softening plant was done using patient's labour, thus saving the sanatorium £46.[xvi] The report of 1917 includes a table which assesses the working capacity of the patients that were discharged in 1916, recording patients as `unimpaired', `impaired' and 'incapacitated'.[xvii]

The 1930s saw an increase in operations to alleviate the suffering of not too far advanced cases. Thoracic surgery required surgeons, which involved patients from Shirlett going to Wolverhampton and Yardley Green hospitals for operations. Tuberculosis physicians were able to carry out minor operations such as `artificial pneumothorax' and `pneumoperitoneum' in the sanatorium.[xviii] In 1943 mass national radiography schemes were introduced to discover early tuberculosis cases after fears of a recurrence of World War One levels of consumption mounted in the 1930s.[xix] Even with the extra bed provision of that year, the average number in residence at Shirlett in 1935 had been 99.27% of the possible number.[xx] In the 1942, Shropshire County Council considered buying x-ray equipment to diagnose and treat tuberculosis at the sanatorium, but decided that £2000 was too much in wartime.[xxi] However, by the end of the 1940s, the sanatorium had x-ray facilities on site.

The nature of institutionalisation in the sanatorium

At Shirlett, as in most hospitals and sanatoria at the time, wards were single sex, with patients only being allowed to fraternise at meal times and in Church.[xxii] However, there was some abuse of the rules, and ex-patients have hinted that it was not uncommon for couples to meet in the undergrowth of the grounds of the sanatorium. There was also an incidence of a couple being found in bed by the nursing staff. The offending couple were sent to different institutions to prevent a repeat performance.[xxiii] There were also incidences of local residents courting patients from the sanatorium. Locals recall going up to the sanatorium to meet patients who were being treated there. This was done in secrecy from their parents who would have been horrified if they had found out because of the risk of catching tuberculosis.[xxiv] Those who were not confined to bed rest at Shirlett were given relative freedom to do as they pleased in the grounds. There were instances of patients visiting a nearby public house more as a stunt against the rules than for any other reason.[xxv] Alcohol was forbidden at Shirlett, but the grounds are littered with old beer bottles which were presumably smuggled into the sanatorium by friends and relatives of the patients, suggesting that institutionalisation was not as strong as the staff would have liked.[xxvi]

Recreation at the Sanatorium

Shirlett was not all rules and no fun. Christmas was a time of special generosity. This is recorded in a newspaper article from 1917, `Afterwards festivities were held, each patient receiving a useful and handsome present... After tea an enjoyable concert was held... The large dining-hall was tastefully decorated, some of the designs being unique and distinctive.[xxvii] This indicates the community feeling at the sanatorium with all concerned pulling together to make Christmas as enjoyable as possible. Even in the late 1940s under the NHS, the Matron still used her `comfort fund' to buy Christmas presents for the staff and patients. A member of staff recalled being overwhelmed by the amount of presents she received as a member of staff from the sanatorium.[xxviii] The quote also shows the wide range of activities available to the patients, including playing musical instruments, and producing decorations for the festivities. Patients normally read, backed horses through the shop, knitted, did needlework, worked leather, played dominoes, and listened to a hospital radio station which was transmitted from Shrewsbury.[xxix] For the children there was a small school which was run by a local teacher.[xxx]

THE FEMALE HUTS - SHIRLETT SANATORIUM

One must remember that sanatoria were only the tip of the iceberg when it came to dealing with tuberculosis. The disease was so prolific in Britain that there could never have been enough beds provided to cater for the consumptive population that Britain became lumbered with. Sanatoria were built as a reaction to the disease that was sweeping the country. The fear that tuberculosis brought with it was founded on the lack of ability to treat it with medicine. Sanatoria, and the lifestyle that they offered gave hope to a destitute nation of sufferers, albeit to a limited number. The success of the sanatoria system has been heavily debated, with some describing it as an expensive failure and others criticising it more generously, saying that they helped to inform the country about the disease, and therefore help prevent it. The methods used to cure patients were limited. A good diet, pleasant conditions and graduated labour were really the only treatment that sanatoria could provide before the use of Chemotherapy and inoculations in the 1950s. There is much debate over the success of these `treatments' but it probably is safe to suggest that the change of scenery and improved living conditions did help a lot of people recover from their ailments on a temporary basis. However, on their return home, the effects were often lost and patients were potentially in a worse situation than when they were admitted to the sanatorium.

THE FEMALE HUTS - SHIRLETT SANATORIUM