TB's influence on Scottish architecture for World TB Day

By Margaret Campbell, MPhil

Submitted by SarahManavis on 23-03-2017 11:56:06

When walking down Bank Street from the Lawn Market to The Mound in Edinburgh, I often glance up at No 13. Situated on the corner, the first floor flat in this building, with its panoramic view of Princes Street and the Firth of Forth, holds a significant place in the role that Scotland played in the search of a cure for one of the major health scourges prior to the mid-20th century.

On the wall, an impressive blue plaque indicates that not only is this the location of the first tuberculosis dispensary in the world, but also where the prevention, identification and treatment of the disease, The Edinburgh Scheme, was established by one of the great pioneer chest physicians, Dr (later Sir) Robert Philip in 1887.

At that time, there was no known cure and until the late 1940s with the introduction of antibiotics, Mass X-Ray procedure and in the early 1950s, the Edinburgh Method, a multi-drug regime as, developed by Sir John Crofton, then Professor of Respiratory Diseases and Tuberculosis at the University of Edinburgh. However by the 1970s, tuberculosis was not defeated as a more virulent and persistent strain of multi-drug resistant strain emerged.

Yet all vestiges that tuberculosis had on architecture has vanished. Only a revolving summerhouse in a suburban garden, 1930s balconied flats or the sad shells of abandoned sanatoriums for which no use can be found, remain.

However, disposable paper cups, paper tissues and recliner chairs are permanent reminders of the personal needs of ‘tuberculars’.

 

Revolving summerhouse - Ballindalloch, Moray (2016)
Archive photograph, City Hospital Edinburgh - for open-air treatment for tuberculosis (c 1900)
Balconies Napier House Edinburgh (1937)

This architectural feature, while unsuitable for northern European (and Scottish) climate, was adopted by Modern Movement architects (eg Le Corbusier) to express image of healthy living but functionally was also used by occupants with ‘weak chests’ ie tuberculosis.

In the mid-nineteenth century, many tuberculosis physicians advocated specific treatment regimes. One such was the Nordrach Method with Glen o’Dee Sanatorium in Banchory, the only example in Scotland.

Glen o’Dee Sanatorium, Banchory
Glen o’Dee Sanatorium, Banchory (c1900)

The Nordrach Method regime, as practised at Glen o’Dee, was established in the Black Forest, Germany by Dr. Otto Walther in the mid nineteenth century. It was an extreme Frei-luft kur regime where patients were treated in the open-air until their fever subsided. When in 1899, after Dr David Lawson (fromDeeside) with a group of Scottish physicians visited Germany to see this method, Banchory was recommended as the most desirable place in Scotland to build this type of sanatorium. Climatic conditions at Nordrach-on-Dee, (its original name) were ideal, with a dry sunny climate, the beneficial vapours from the pine trees that surrounded the site and over 2.5% ozone in the air. 

“It is essential for patients to spend the whole of their time in pure air. In order that they may do this with a maximum of comfort, the buildings have been specially designed. All bedrooms face south, and are heated by steam pipes, lighted by electricity, and fitted with hot and cold water supply; the floors being covered with a material which readily ensures absolute cleanliness…”

However, it was a sanatorium for patients who could afford such ‘spartan luxury’ unlike Philip’s Dispensary in Bank Street. Here patients were classified into three categories: advanced cases, early onset, and cured patients but who required further rest to avoid a recurrence of the disease.  Advanced cases were sent to the City Hospital where in 1906, 50 beds had been made available. Revolving shelters similar to the ‘summerhouses’ were also provided. Early onset cases were sent to the Victoria Hospital for Consumption which was opened in 1894 (now the Royal Victoria Hospital). Here patients could rest, be exposed to sunlight and fresh air and maybe, arrest the progress of the disease. RVH also had shelters in the grounds where patients could spend the day, or for those out-patients, who had to work during the day, occupy at night.

The third part of Philip’s ‘Edinburgh Scheme’ were the colonies. This was an innovative development where light outdoor work, such as growing vegetables and tending to farm animals (poultry, pigs and cows) in an environment where recovering and cured TB patients could continue improve their health. So often, this was not possible in the overcrowded urban home environment in which the patient had initially contracted the disease. At Southfield Colony Hospital (1902) and Polton Farm Colony (1910), once it was realised that TB could be transmitted through milk, Philip introduced TT-testing as well as the official notification of the disease and use of the BCG vaccine.

However for patients who could not afford to be treated in either type of sanatorium, open-air living on an access-way in a tenement or a wooden board across a sink by an open window had to suffice; not quite the sophisticated Modern Movement balconies as at Napier House.

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