Neglect, Ambition, Bad Fortune, and the Early Years of Blood Transfusion

Today we have a guest post written by one of our project volunteers, Ella St John-McAlister.

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Reading Alfred’s case file left me with the impression that he had been a bright and ambitious boy. He came into the care of The Children’s Society (then known as The Waifs and Strays Society) in 1916. Unlike the subjects of most case files I come across (I am researching children’s illnesses and their medical history) he was a healthy boy. This was in spite of Alfred’s father having passed away when Alfred was five years old and his mother being jailed twice for neglecting her children – although the nature and extent of her “immoral life” is unclear.

We know little about Alfred’s life before he entered The Children’s Society except that he had six brothers and sisters, one of whom was the illegitimate child of a “sergeant who was called to France and killed”. It was for neglecting this child that Alfred’s mother was first jailed in 1916. We also know that all of Alfred’s brothers and sisters were in the workhouse: a desperate, destitute sanctuary for those who were unable to support themselves. Something of Alfred’s character comes across in the application form submitted to The Children’s Society, where it states that Alfred played truant despite being “quick and sharp”.

Alfred was admitted into The Children’s Society’s care at the age of eight in 1916, and at the age of 14 he applied for an apprenticeship on a Navy training ship called the Arethusa, indicating a desire to travel and a willingness to “obey his [the Commander’s] and [his successors’] lawful commands”.

Alfred’s acceptance letter from the Arethusa Navy Training ship, 1922 (case number 20702)

The fact that he was allowed to join the ship indicates that he must have been at a certain level of health because there were strict requirements on the height and health of those who joined:

Age: 13½-15   Height: At least 4ft. 8 in. (without boots.)
Age: Over 15   Height: At least 4ft. 10½in. (ditto.)

Once on board a typical daily menu aboard the Arethusa might have looked something like this:

  • 1lb soft bread
  • 8oz biscuit
  • 7oz fresh meat
  • 8oz potatoes
  • 3/4oz cocoa
  • 1/8oz tea
  • 2/3oz sugar

A pretty meagre and dour menu by today’s standards. After he joined the Arethusa Alfred vanishes from view. Sadly, it is a letter from Alfred’s mother reporting his death in 1926 at the age 18 that enables us to piece together an idea of his last years.

A letter from Alfred’s mother informing The Children’s Society of his death, 1926 (case number 20702)

A letter from Alfred’s mother informing The Children’s Society of his death, 1926 (case number 20702)

Dear Sir,

I feel I must write to tell you the sad news of
my poor boy, Albert [middle initial, surname], he went out to America 2 ½
yrs. ago. I was Expecting him home last Easter, I received
news a fortnight ago to-day to say he met with an accident
on Jan 11th and died Jan 19th it is a terrible shock to me,
I shall never, never get over it, he had an operation and
transfusion of blood, but they could not save him.

When the snow was about, he was in a sled coasting
down a steep hill, when the sled struck a stick, causing it
to swerve into the gutter seriously injuring him, they took
him to St. Vincent’s Hospital, West New Brighton, he was
provided with a private room and two trained nurses, at the
expence [sic] of the New York Telephone Coy. [Company] where he had been
employed only two months, previous to that, he
served 12 months in the U.S Army, so ten of his soldier
friends acted as ball [sic] bearers and firing squad over his
grave, he put his age on 3 years, by letters I have had his
friends were surprised at his correct age, he was a fine
fellow. The British Society and his firm gave him a good
burial, plenty of flowers, in fact, he was far better
treated than he would have been in England, I hope you don’t
mind me writing, but I felt I must.

I don’t know what I shall do without him, he
was always a man in his ways, I would not mind so much if
I could have seen him the last of him, or if I only I could see
his grave.

I hope this will find Matron quite well,

I am,

Yours Truly,

(Sgd. [Signed]) Alice [middle initial, surname]

It is a sad ending to what looked as if it could have been a very promising future, but this letter also holds some fascinating information. The reference to a blood transfusion is the first instance we have found of this procedure in The Children’s Society’s case files. The technology behind the procedure for extracting, storing, and transfusing blood was still developing at the time Alfred received his transfusion.

The first recorded, successful attempts at blood transfusions happened in the 1600s, although these experiments used animals. Even in the late 1800s blood transfusions were shunned by medical professionals and considered extremely risky. In fact, in Britain in the early 20th century, surgery textbooks referred to blood transfusions as a quaint relic of medical history. If only they had known! However, just as the idea of blood transfusions was being cast aside, the discovery of different blood types was made. The medical and surgical needs brought on by World War I also acted as a catalyst for the idea of blood transfusions gaining respectability within the medical field.

Click here for more information about blood transfusions (including an interesting image) from The Science Museum.

What makes Alfred’s story so exciting is that in 1926 when he received his blood transfusion, the first hospital blood bank in the United States had not even been established. Whilst blood was donated voluntarily in Britain from the early 1920s onwards, donors were being paid up to $100 for a pint of blood in the U.S., meaning Alfred’s procedure could have been quite a costly one.

Although Alfred’s case file is fairly slender, it contains useful information on what it was like to be a child at that time and a child under The Children’s Society’s care, and also on an important medical advance, one many of us might take for granted today.

Artificial sunlight and sunshine suits

Today’s photos might look a little like something out of a vintage science-fiction film, but they are, in fact, pictures of real early-20th Century medical treatments. These treatments were carried out in some of children’s homes that were run by The Children’s Society (then known as the Waifs and Strays Society) and they both involve light.

You may have heard that exposure to sunlight helps our bodies to synthesise vitamin D, and that a lack of vitamin D can lead to rickets. It’s perhaps not surprising, then, that the children’s homes which carried out this light therapy were ones that looked after children with orthopaedic problems.

As well as cases of rickets, The Children’s Society’s orthopaedic homes often looked after children who were suffering from tubercular diseases of the bones and joints. Light therapy could be used to treat these diseases too, as light kills the tuberculosis bacteria.

The most obvious way to carry out light therapy is to expose the patient to sunlight, as in the photo below from 1927.

Photo of children in sunshine suits at St Nicholas' Home, Pyrford, Surrey, taken from the annual report for the Children's Union, 1927

These children at St Nicholas’ and St Martin’s Orthopaedic Hospital and Special School in Pyrford, Surrey, are wearing what the caption calls ‘sunshine suits’. To me these suits look rather like a pair of swimming shorts or underpants (and baggy ones at that!) It would seem that the aim was for the children to wear minimal clothing so that as much of their skin as possible could be exposed to the sunlight while they played outside.

However, as the British weather means that sunlight can’t be relied upon at all times, some of the homes also carried out artificial light therapy using electric lights.

Photo of girls undergoing artificial light therapy at Halliwick School for Girls, Winchmore Hill, London, taken from the school's annual report, 1937

In the above photo from 1937 we see girls at Halliwick School in Winchmore Hill, London, undergoing this ‘artificial sunlight’ treatment. The girls are sitting so that the skin on their backs is exposed to the electric light, while they are wearing goggles to protect their eyes.

From these photos and from others that I’ve come across in the archives, it seems that light therapy, be it natural or artificial, was a very popular treatment in The Children’s Society’s orthopaedic homes during the early-20th Century. When was this treatment first used and how successful was it for the patients? We won’t know without further research. Anyone interested? Please contact us (Hidden-Lives-Revealed@childrenssociety.org.uk) if you are, or if you’d like to use the archive for any other research projects.

For more information about light therapy see the following articles from:
The Wellcome Trust
The Science Museum

Sea air and tuberculosis (TB beside the seaside)

Today we have a guest post written by one of our project volunteers, George Cooban.

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It’s the time of year when lots of us go to the seaside. The case files tell us that many of the children in the care of The Children’s Society in the late-19th and early-20th centuries also visited the coast. But, unlike today, it was often for medical reasons, rather than a holiday.

Previous posts on this blog have highlighted cases where various health conditions led to children spending time by the sea. The coastal convalescent homes run by The Children’s Society at Hurstpierpoint and Broadstairs, established to facilitate the care of sick children sent there, have also been researched in detail. However, I was keen to find out what the case files can tell us about the thinking behind this formerly commonplace practice.

Photograph of matron, staff and children outside 'Coronation Cottage', St David's Home, Broadstairs, Kent, c1912

Tuberculosis features very prominently in the case files, and the medical rationale behind the way it was dealt with is often quite clearly recorded. Therefore I decided to focus on cases relating to this condition in this blog post.

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One thing we notice when examining many of these case files is that seaside convalescent homes were viewed as a means of preventing tuberculosis. (So not all the children who stayed at them were, strictly speaking, convalescent). This is illustrated by reports such as this one, dated 19 June 1910.

“There is a delicate girl aged 13, May [surname], who has been [at the Leamington Home for Girls] for many years, but has to be sent annually to the sea for her health. She probably has a tendency to tuberculosis, but no disease has developed owing to care. She now looks well having just returned from the sea. As she is now at a critical growing and developing age, it would be desirable to move her if possible to Felixstowe before winter for the next two or three years before she goes out. Leamington is relaxing and she needs bracing sea air.”

Another case file contains a medical certificate, written on 7 June 1905, which states that a child, a seven year old girl named Dorothy, has “a tendency towards consumption [tuberculosis]” and recommends moving her to the coast. Later correspondence says that she was treated with a special diet including new laid eggs.

Terms like “delicate” and “a tendency to tuberculosis” appear regularly in the case files. The health of the children referred to in this way was not good, but there is evidence to suggest that sending them to the seaside was seen as a preventative measure, stopping the development of more serious problems.

Several case files, such as those quoted above, give the impression that “sea air” was seen as healthy. But a letter from another case file provides a bit more detail. Dated 3 December 1913, it reports on the condition of a 13 year old girl, Annie, who was staying at St. David’s convalescent home in Broadstairs, Kent:

Letter reporting on the condition of Annie, who was staying at St. David’s convalescent home in Broadstairs, Kent, 3 December 1913 (Case number 13819)

Dec. 3rd. 1913.

Dear Sir – I am sorry to
inform you that
Annie [Surname]
has been examined by the
doctor today & he asks me
to write at once to you so
that she may be removed
to a sanitorium [sic] as early
as possible.

Owing to high winds & rain
I was obliged to remove her
bed indoors a fortnight
ago, & since then she has
gone down rapidly &

Dr. Brightman considers
it unsafe for her to be
in a room with other children
owing to her Tubercular
condition.

We have no proper place
for out of door patients
in the winter.

I am very sorry indeed
she is such a nice, willing
& gentle child.

Yours faithfully
Elsie Philip-Smith

The most surprising thing about this letter is the time of year it was written. It is implied that the only suitable place to treat tuberculosis patients is outdoors, even in winter. Open-air treatment for conditions including tuberculosis was fairly common a century ago. By arranging beds out in the open, as can be seen in the picture from The Children’s Society’s St Martin’s Home in Pyrford below, patients would be exposed to lots of air.

The open-air ward at St Martin’s Home, Pyrford, Surrey, 1928

From the letter about Annie we discover that open-air treatment was practiced all year-round. The need for weather which allowed it to take place is also evident. It can be said, in fact, that the weather conditions were of greater importance than how close the patients were to the sea. This is certainly suggested by a letter from another case file. A doctor writing in 1909 advises that a girl “threatened with phthisis [tuberculosis]… would be much benefited by removal to a warmer & more equable climate in the South of England.” Since the girl was living at that time in the St Barnabas’ Home For Girls, New Brighton, Cheshire – a place right by the sea – we can say that sea air on its own was not seen as especially important for health.

The prioritisation of fresh air, together with an “equable climate”, features in medical writing from the time. An article in the British Medical Journal from July 1898, for example, advises that an open-air sanatorium for tuberculosis sufferers should be situated “where the prevailing breezes sweep over the sea, or over moorland, or, better still, where these two conditions are associated, and fresh, pure air comes from all quarters of the compass.”

Similar thinking appears in another case file. A doctor’s report from 1927 on a 16 year old boy, Leslie, who had been working at The Children’s Society’s head office in London, states that he is “obviously predisposed to tuberculosis, especially as he works in London”, and recommends for him “an outdoor occupation, preferably in the country or at sea, as this will probably prevent any active tuberculosis developing”. The Society helped Leslie find work as a steward on the SS Baltic. This was quite different to the career previously envisaged for him: earlier correspondence highlights Leslie’s aptitude for draughtsmanship.

This case, like the others, shows the impact contemporary medical opinion had on the lives of children who had tuberculosis or were at risk of contracting it. Nowadays the condition can be treated with antibiotics. But a century ago the dangers were much greater, and the response was often to move children long distances for the good of their health, even if they were only considered susceptible to tuberculosis.

At a time when urban air pollution in Britain was severe, sea air was valued for its quality. However, simply being by the coast was not essential: the objective was fresh air. But the convalescent homes established on the coast did offer other benefits besides sea air. The staff were better trained to look after children with health problems. There were opportunities for the children to get exercise, which may have been limited in more urban homes. There is also evidence in some case files that children were given more or better food to build them up while they were staying in the convalescent homes. Finally, a modern study has suggested that there may be health benefits to be gained from living on the coast, but they are psychological ones, and not related to the air there. The case files show that, in the absence of today’s more effective treatments, a proactive approach to tuberculosis was taken, and this surely saved many lives.

Want to find out more?
Click here to read another blog post on sea air and health, featuring a case where the avoidance of sea air was recommended.

Historic articles from the British Medical Journal discussing open-air treatment of tubercular cases can be found here: http://www.bmj.com/archive

What medicines do you remember?

In previous posts, I’ve mentioned treatments and medicines that aren’t so commonly used any more although they were very popular in their time. If you can remember any of these, or would like to tell us about any other common medicines or treatments that you can remember, please let us know in the comments section below.

M&B 693

In the post about influenzal colds in 1940, the medical book notes that the children were treated with 693 tablets.

693 was a name for an antibiotic medicine called sulphapyridine. It was produced by the firm May and Baker and so was often also known as M&B.

The drug was first discovered in 1937. In tests it was found to be an effective treatment for pneumonia and it was also used to treat other infections such as sore throats and gonorrhoea. In fact, it became so popular that it was widely used during the Second World War and May and Baker had trouble keeping up with wartime demand for the drug.

Famously, Winston Churchill was successfully treated with M&B when he was suffering from pneumonia in 1943 which he contracted shortly after attending the Teheran conference that finalised the strategy for the war against Nazi Germany.

693 was later superseded by penicillin and other antibiotics.

Cod liver oil

In the post about tuberculosis in the early 1900s, we find that when John was ill, but before the cause of his illness was known, he was treated with cod liver oil.

Cod liver oil contains vitamin A and vitamin D and it is still used today as a supplement to help with joint problems. In the past it was regularly given to children; this was to help prevent rickets, which was very common in the early-20th Century.

Presumably, as in the case of John, it was also seen as a cure-all that could help to relieve someone’s symptoms when they were ill.

Port wine and brandy

Another treatment mentioned in the post about tuberculosis in the early 1900s is the use of port wine and brandy. When John entered a convalescent home with tuberculosis, he was prescribed port wine, brandy and a generous diet to help build up his strength.

Alcohol has been used as a medical treatment for a long time and spirits such as brandy were popular in the late-19th and early-20th Centuries. They were often used as cardiac stimulants that were thought to increase blood pressure, but some doctors used them as treatments for a whole variety of diseases.

One of the uses of brandy and other spirits was as a supposed aid to digestion and metabolism. They were often prescribed in the diets of people convalescing from illnesses and it is probably for this reason that they were prescribed for John.

Fresh air

In a number of cases we see that children convalescing from illnesses were sent out to homes in the countryside or on the coast. Several of The Children’s Society’s children’s homes were built on the coast for this reason, such as St David’s Convalescent Home in Broadstairs, Kent and St Agnes’ Convalescent Home at Pevensey Bay, Sussex.

Photograph from a leaflet advertising the Children’s Union, showing boys on the beach at St Agnes’ Convalescent Home, Pevensey Bay, Sussex, c1936

Leaving the big cities was thought to aid recovery although, interestingly, a number of children’s homes in London took in children with illnesses too. This was because a stay in London meant that the child would be able to attend hospital for treatment. Often they would be sent to London for a brief period of time and then go out to the countryside once the hospital treatment was complete.

What do you remember?

Do you remember any of the treatments I’ve mentioned here? Please tell me in the comments. It would be interesting to find out how popular they really were.

And that’s not all. I’d love to hear about other treatments and medicines that you remember. I’m sure my list is just the tip of the iceberg!