Clara's Rib and Clare Hall 1953-54

  

Clare Hall Hospital:
Resident physicians' quarters, staff dining room, patients' library, shop, etc. I lived in the room behind the 3rd window from the left on the 2nd floor, June 1953-February 1954






Anne Raina's book Clara's Rib, about her sister Clara's tuberculosis and its treatment in the Royal Ottawa Hospital, our local TB sanatorium, in the 1940s and 50s, reminded me of my experience at Clare Hall Hospital, Hertfordshire, in 1953-54. Clare Hall was a tuberculosis sanatorium with about 400 beds, near St Albans on the north west outskirts of London. Most of the patients were 'London Irish' - immigrants from impoverished Irish backgrounds who came to London in search of work and succumbed to tuberculosis. The worst cases were bed bound - like Paddy, the man Wendy described in her memoir "The Smile" - but half or more of the patients were up and about, in the sanatorium for active treatment and to keep them segregated  and minimize the risk of transmitting TB to others. Active treatment in the 1950s consisted of chemotherapy with streptomycin, para-amino-salycylic acid (PAS) and isoniazid, and collapsing the lungs with TB cavities by injecting air into the pleural or peritoneal space. In the worse cases, segments of ribs were surgically excised to permanently collapse lung cavities in the hope that this would help to cure the lesions in the lungs. At Clare Hall, three thoracic surgeons and their teams performed this operation on up to a dozen patients a week. As senior resident physician, I spent five mornings a week in a small dark room inspecting the status of lungs under a fluoroscope screen and injecting air into pleural and peritoneal spaces to induce and maintain artificial pneumothorax and pneumoperitoneum, a less drastic temporary way to collapse diseased lungs so they would heal more quickly. It sometimes worked. Beyond these measures treatment consisted of rest, fresh air, a good diet. Most patients stayed at Clare Hall for many months, often for several years. It was a self-contained community, 2-3 miles from the nearest village, South Mimms, and from St Albans. The West End of London with its theatres, book shops and other attractions, was about an hour and a half away by bus and tube.

Thomas Mann's masterpiece The Magic Mountain describes the life of the patients and staff of a tuberculosis sanatorium in the Swiss Alps. I could have written a novel about the lives of the patients and staff at Clare Hall if I had the talent and insight to do so. The staff nurses included the customary quota of compassionate angels, incompetent dolts, drug addicts and cold-blooded sadists. The patients were more interesting. They were predominantly young and in many cases tuberculosis had done nothing to reduce their libido. Men and women were segregated as far as humanly possible - male and female wards were at opposite ends of the compound, separated by treatment rooms, operating suites and the administration building - but it wasn't feasible to keep ambulatory patients apart in places like the library, dining hall, cafeteria, or the spacious grounds. During my 10 months at Clare Hall, I flushed amorous couples from behind library book shelves, a gazebo in the garden, and a corner where the treatment block and administration offices adjoined.  A pretty young Irish lass not yet 20 had a near-lethal unintended pregnancy that had to be aborted to save her life. She would never say who the father was but we suspected a dashing cad in his late 30s who boasted about his numerous conquests.

We didn't know it then but tuberculosis which had been a ubiquitous festering illness throughout history was about to melt away for a generation or more in affluent, well-fed industrial societies. It has remained a serious public health problem in low income countries and has come back in an ominous drug resistant form in rich nations. But TB sanatoriums and the teams of dedicated physicians, thoracic surgeons and other therapists had become obsolete by the 1970s, the surgeons saved from irrelevance by lung cancer, the physicians by other diseases due to tobacco addiction. As for me, I'd almost forgotten the Clare Hall episode of my life until Clara's Rib reminded me.