The Role of Public Health in Tackling TB in Dundee

At Dundee Heritage Trust, we are fortunate to be supported by a dedicated team of volunteers; who generously donated 1200 hours of their time to Verdant Works Museum and Discovery Point in 2023 alone!

For many, their time is spent greeting visitors at our five star attractions, whether beginning tours, demonstrating inspiring machinery or bringing stories to life. Others assist in dictation, research, illustration and more.

Alison joined our Dundee Heritage Trust volunteer team in 2023, following a call out. A retired GP, Alison played a key role in researching Dundee’s connection with tuberculosis (TB) as part of our latest exhibition, ‘Tackling TB: Dundee Scientists Fighting the Killer Cough’, produced in collaboration with WCAIR at the University of Dundee. Through this blog post, Alison shares her findings and delves into the role of public health in the 20th century in Dundee.

(Read the original edit of this blog post here: https://dundeeheritagetrust.wordpress.com/2024/02/08/role-of-public-health-in-tackling-tb-in-dundee/)

“In January 2023, after seeing an advert on social media for a volunteer open day at Verdant Works, I went along and met Dundee Heritage Trust’s Education and Community Officer, April and volunteer John. Both were extremely welcoming, and I was really impressed by John’s knowledge of Dundee, which he conveyed in a very jovial way. I then was mentored by Ian and Richard for a few more sessions before going ‘solo’ as a guide in Verdant Works Museum every Wednesday.

“Like nearly every Dundonian, I had family members that were associated with the jute industry. My maternal grandfather worked in Lansdowne Mill in Calcutta, India from 1905 – 1937 and my paternal great grandfather and great, great grandfather were jute merchants in Blackness area in the 19^th century.

“The above quote might be a familiar message from Covid, but is actually taken from the patient information leaflet written by Dr. Templeman, Dundee Medical Officer for Health (MOH), and handed out to afflicted tuberculosis households in the city by health visitors in the early 1900s.

“In the 19^th century, many infectious diseases were rife – driven by poor housing and sanitation, poverty and a lack of understanding of (or treatment for) the ailments. All these areas would need addressed to combat any rampant disease, including tuberculosis. I therefore decided to research the role of Public Health in fighting TB in Dundee in the past; looking at the statistics, planning and the thinking, of the time.”

“In the 19^th century, many infectious diseases were rife – driven by poor housing and sanitation, poverty and a lack of understanding of (or treatment for) the ailments. All these areas would need addressed to combat any rampant disease, including tuberculosis. I therefore decided to research the role of Public Health in fighting TB in Dundee in the past; looking at the statistics, planning and the thinking, of the time.

“I found that after several cholera epidemics during the 19th century, legislation was passed in Dundee which vastly contributed to the decrease in TB and other infectious diseases. The Dundee Police and Improvement Acts of 1850 and 1871 encompassed, not only public order, but also sanitation; public health; housing; and street and urban development. These improvements in housing, sewerage and sanitation – including a new water supply from Lintrathen Loch in 1875 – are reflected in the start of the decline of TB and displayed in a graph within the Tackling TB Exhibition at Verdant Works.

“The death rate from pulmonary TB in Dundee went from nearly 3/1000 in 1880 down to less than 1/1000 by 1925 (MOH report 1925).

“The Public Health Scotland Act (1867) allowed the local authority to appoint a Medical Officer of Health. Dr. Pirie, Dr. Anderson and Dr. Templeman were early appointees, dealing with local medical planning and provision. Once Koch identified in 1882 that tuberculosis was a disease spread through the tubercle bacterium, organisation regarding dealing with TB cases really took off.”

“Dispensaries – or clinics – were set up to triage patients with TB. The worst cases were sent to hospital, with milder cases sent to a sanatorium to (hopefully) regain strength with a good diet and to fight off the disease in quiet surroundings with lots of fresh air. In Dundee, ‘new’ Dundee Royal Infirmary was opened in 1855 and Kings Cross Hospital in 1889 – the former actually being used increasingly for TB cases, such that it became known as the ‘place to die’, if you had TB. Sidlaw Sanatorium was opened at Auchterhouse in 1903. The charge was £2 2s a week and you were admitted if you could pay that. If not, then the local committee considered your case to see whether admission would be allowed! Ashludie Hospital opened in 1916 which was fortunate as, after WW1 and WW2, cases of TB increased considerably.”

“In the early 1900s, voluntary notification of the disease was introduced, with personal sputum flasks issued rather than spitting on the floor or into a communal spittoon. Households with infected patients were cleaned and disinfected. Health Visitors were dispatched to affected homes and provided advice and information regarding disease and infant feeding. In the 1903 MOH report, the Dundee Health Visitor reports on 11,000 home visits to 1 or 2 roomed homes;

‘The kitchen area was generally clean. Otherwise, there was dirty sputum giving off an offensive odour and 2 -3 pails of filth in the room. Our aim is to teach women the virtues of cleanliness, thrift, decency and good ventilation’.

“This gives a succinct summary of how grim life was at home for the working poor, such as millworkers, at the time.

“However, the educational messages did have an impact, especially regarding feeding of children and infants. Dr Templeman’s advice leaflet reads: “All milk, more especially that which is to be given to children, should first of all be boiled. No consumptive mother should suckle her child”. The incidence of non-pulmonary TB in children declined, as did the infant death rate.

“In the 1920 MOH report, Chief TB Officer, Dr Hunter states; ‘One of the most important functions of the Dispensary is the education of the patients and families. The mere medical treatment of the ailment is a minor function’

“In October 1947, Kings Cross Hospital became one of the five Scottish treatment centres allotted sufficient Streptomycin to treat four patients with a 3 month course. The first antibiotic treatment against TB. Screening programmes such as mass radiography and BCG vaccination in Dundee were started in the 1950s.

“Even with new discoveries and advances in medical treatment, the mainstay of controlling infectious disease remains the same throughout the centuries – cleanliness, fresh air and reducing contagion spread.”