The second in our series of posts on some of the surgical procedures carried out at Stannington focuses on the use of curettage and a skin graft to treat tuberculous skin infections.
Patient 84/37 was male and aged 13 ½ when he was admitted to Stannington on 16th December 1938 diagnosed with TB of other organs and an old ankylosed ankle joint. He had previously been in the sanatorium from June 1936 to July 1938 suffering from TB of the right ankle which had healed but since his discharge in July 1938 he had developed a tuberculous skin infection on his right ankle overlaying the original tuberculous focus. This sort of infection might be referred to today as scrofuloderma where there is a direct extension of the tuberculous disease from underlying structures, such as the bone, to the skin. A report on his condition on admittance reads as follows:
‘Large sinus R ankle, healed, but skin lower part reddened & thin & scabbed. Healed sinus R knee & 3 healed on thigh and 1 on leg. Mobility good’
Radiographs taken of his right ankle during his second stay in the sanatorium show the tuberculous ankle to be healed and therefore not causing medical staff any great concern. Figure 1 is a radiograph taken in1939 for which the report reads, ‘no bone lesion in the right foot’, and figure 2 was taken in 1940 with the report stating that there are ‘bony ankyloses of ankle joint’.
Throughout his stay comments in his case file reveal the scar on his ankle to be thin, unsound and broken down. Given that at this time there were no antibiotics available to treat this skin infection a commonly used minor surgical procedure was opted for. On 9th August 1940 curettage was performed on an area on the lateral side of the right ankle with a Thiersch skin graft. Curettage simply refers to the removal of the infected tissue using a surgical tool called a curette. A Thiersch skin graft is a split-thickness graft that can be quite thin and involves the removal of the epidermis and part of the dermis from a donor site elsewhere on the patient’s body, which can then be placed in narrow strips over the wound. By November of 1940 it was noted that the skin graft had taken well, was soundly healed, and that there was good movement of the foot at the 1st metatarsal joint. He was discharged quiescent on 19th November 1940 with the procedure having been a success.
Sources:
B. Kumar and S. Dogra, ‘Cutaneous Tuberculosis’, in Skin Infecitons: Diagnoisis and Treatment, Edited by J. C. Hall and B. J. Hall (Cambridge: Cambridge University Press, 2009)
L. Teot, P. E. Banwell, & U. E. Ziegler, Surgery in Wounds, (Berlin: Springer-Verlag, 2004)
We touched upon the problems of infected milk supplies in a previous posting on abdominal TB and we’ll focus on the issue in more detail here. Mycobacterium bovis is the pathogen responsible for the development of TB in cattle, which is commonly referred to as bovine TB. The consumption of milk from cows infected with bovine TB and in turn the ingestion of mycobacterium bovis can lead to an individual developing TB. This was for many years a very common cause of TB in humans and remains so in countries that do not routinely pasteurise milk. Pasteurisation involves the heating of the milk in such a way as to kill off any bacteria that might be present, and through its use the spread of bovine TB to humans has nearly been eradicated in the UK.
The 1875 Public Health Act made it compulsory for local authorities to appoint a Medical Officer of Health (MoH) who produced an annual report detailing any health and sanitary issues in the district as well as giving a wealth of statistical information related to birth and death rates, population, infectious diseases and causes of death. The MoH for Northumberland makes regular reports on the situation in the county regarding tuberculosis including comments on the causes of abdominal tuberculosis and efforts made to prevent its spread. In the 1906 report he states:
“That about 30 per cent of the milch cows in England are tuberculous, and that consequently infants and persons suffering dangerous illness are in many cases being fed milk containing the organisms of tuberculosis” [NRO 3897/3, 1906 p.21]
The problem of infected animal products is clearly recognised by medical and sanitary officials early on in the 20th century but little is done to tackle the situation head on and so abdominal tuberculosis continues to be a significant problem. Three years later in 1909 the MoH expresses his frustration at the situation and lack of power to change it:
“The elimination of tuberculosis from dairy herds is a matter of great difficulty since, at present, no assistance is given, by the state, to the farmer who, for the benefit of the general public as well as for his own advantage, may wish to obtain a herd free from this disease.” [NRO 3897/3, 1909 p.33]
It is not until the 1940s that significant steps were taken to introduce tuberculin tested milk and encourage pasteurization.
“The eradication of tuberculosis from our milk supplies is a matter of greatest importance to us all, and it is encouraging to note the marked increase in the production of milk from tuberculin tested cows. 45% of all the milk produced in the County was from such herds, and it is known that in 1948 the proportion had risen to more than 50%.” [NRO 4081/1, 1947 p.8]
HOSP/STAN/11/1/51 Boys at work on the farm
Milk supplies were something given great consideration by those responsible for the establishment of Stannington Sanatorium from the outset. In 1905, two years before the official opening of the sanatorium, a farm colony was established on the site to take in young boys and provide them with training. It was from here that the sanatorium was able to receive a safe supply of milk from tuberculin tested cows. Tuberculin testing is another method used in preventing the spread of bovine TB whereby the cows were tested to see whether they carried mycobacterium bovis rather than treating the milk itself. This method was used quite commonly early on before the onset of widespread pasteurisation and would have been essential to the recovery of many of the patients and in preventing any of them acquiring any further infection. As time goes on, and tuberculin testing and pasteurisation is implemented more widely across the county, it is notable when looking at the patient files that instances of abdominal TB decrease particularly as we enter the 1950s.
Sources:
ALLISON, T. M. (1908) Children’s Sanatorium, Stannington, Northumberland, British Journal of Tuberculosis, 2 (3), p.204
SCHOFIELD, P. F. (1985) Abdominal Tuberculosis, Gut, 26 (12), pp.1275-1278
NORTHUMBERLAND ARCHIVES: NRO 03897, Northumberland County Council: County Medical Officer of Health Reports, 1893-1935
NORTHUMBERLAND ARCHIVES: NRO 04081, Northumberland Health Authority: Records, 1942-1970
Writing from the front to his sister in Berwick on March 7, Private William Storey, 2nd Northumberland Fusiliers, says:
The platoon to which I was attached was holding a small detached trench in a field away from the remainder of the company. We had been in the trench 24 hours, and we only had three bottles of water between about 30 men, so when night came the officer in charge sent six of us out for some water. We had to cross an open field, go through a small wood, and across another open field before we could reach the company, at the end of whose trench ran a small brook.
We got the water all right, but as we got back near the wood again the Germans started sending star-shells up, so we had to lie down. When we thought they had finished we got up again, and just as I got on my feet I got hit on the inside of my right thigh. The bullet hit a button on my great coat. It knocked the top off the button, but I send you the other half as a curio. If it had not hit the button it would have hit me in the stomach, so I was very lucky.
Advert for Campbell & Sons Tailors, The Berwick Advertiser 19th March 1915
Military Recreation Rooms Opened in Berwick
Opening Ceremony Performed by The Sheriff
Large numbers of soldiers, representative of the different regiments stationed in the town; together with a good number of the general public, assembled to witness the opening ceremony of the new Recreation Rooms for the Military in Hide Hill, in the premises recently occupied by Messrs Walter Wilson, Ltd, on Monday night.
The spacious rooms of the building have been excellently fitted out and will prove of inestimable use to the troops stationed here. The front room on the ground floor has been partitioned off into two departments, and is to be used as a writing room. Tables are plentifully scattered around the rooms, and all facilities for writing are provided. A letter box has been erected where letters, etc. can be posted, and this will be cleared at suitable hours.
At the rear is another large hall, which is to be used as a reading and smoking room. This will also be used as a concert hall, and here a piano has been installed. The wants of the inner man are provided on the first floor upstairs, where an excellent refreshment bar has been installed. The games room is found in the third storey, and judging by the way it was patronised on the opening night, it will be well made use of.
14 Hide Hill, seen here as Hardy & Co in 1959 , was converted into Military Recreation Rooms in 1915. Ref: BRO 1250/117
THANKS TO THE OWNER
The opening ceremony was held in the Concert Hall, which was filled to overflowing. The Mayor (Mr Thomas Wilson) presided, and he was supported by the Sheriff (Mr E. W. Stiles) and Colonel Peterkin, 10th Royal Scots. Other officers of the 10th Royal Scots present were:- Major Dudgeon, Captain Forbes, Captain Laing, Lieutenant Wolfe, Lieutenant McLeod, and Sergeant-Major Dawes.
The proceedings opened with the singing of the National Anthem.
The Mayor-Before asking the Sheriff to formally open this club room, I wish to publicly acknowledge our debt of gratitude to the owner of these buildings, who has given them at very small rental, and has made it possible for us to have such a splendid place with the accommodation there is. (Applause). Unfortunately, through illness, he is unable to be present, but I I am sure we all trust he will be restored to health and strength to come here and see what has been done through his kindness, not only to you but to the committee in making it possible to give you this accommodation. I have much pleasure in calling upon the Sheriff to open the club rooms. (Applause).
THE OPENING CEREMONY
The Sheriff said-Mr Mayor, Colonel Peterkin and gentlemen, may I in the first place, on creation of the Committee responsible for the creation of this recreation resort, offer to every member of His Majesty’s Forces a most hearty welcome on their first visit to these premises. (Loud applause). So long as you are in our midst the Committee earnestly hope you will take every advantage possible of these rooms. It is intended to keep the rooms open every evening. Including Sunday, from 6 o’clock to 9.45. The Ladies Committee has kindly arranged to entirely take charge of the refreshment department, and they will carry out their duties every evening from eight o’clock until closing time, and there you can obtain refreshments for a very reasonable charge. I think you will prefer to pay something for it and it has been communicated that you would. We hope therefore, that you will make some little acknowledgement towards the expenses of maintaining the establishment. (Applause). I hope you will be able to make good use of these premises which the Committee have at considerable difficulty put into the excellent condition as we see them now, and I hope before you leave the town they will have been of material help to you in you hours of leisure. It is intended to hold concerts occasionally, and I trust the different regiments in the town will take one night each to be responsible for a concert, and the town’s people will also do their best to provide a concert in their turn. (Applause). I have much pleasure in declaring these premises open and support the debt of gratitude we owe to the donors of the premises. (Applause).
Colonel Peterkin, in making a few remarks, said;-Mr Mayor, Mr Sheriff and gentlemen-I do not think it is easy for me to properly and adequately express the debt of gratitude the whole of the regiment feel they owe to the people of Berwick….
….All this kindness, I am afraid, that we are having here is very bad training for the trenches. (Laughter). However, it is best to wait until trouble comes before meeting half way, and I do not think we can acknowledge these kindnesses better than making use of these spacious rooms. (Applause). I ask you to give a hearty vote of thanks to the Committee and to the Mayor and Sheriff who are the moving factors in this movement. (Applause).
A smoking concert was afterwards held, when an excellent programme was submitted. In the course of the evening the soldiers were the guests of the Ladies Committee, and refreshments were provided free.
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