Julius Roth on Negotiating release from a TB sanitorium

Updated version of the post in jimsresearchnotes on Julius Roth Timetables 26 June 2012. Many dead links had to be replaced or abandoned.

Tuberculosis used to be a scourge of poverty and was widespread during the era of laissez-faire especially coinciding with rapid urbanisation, slums and overcrowding. The TB mass vaccinations of older children put a stop to this in industrialised countries, at least for a while. Images of tuberculosis vaccination can be viewed in any image browser (the above link is to google images). It was, as I remember it, painful and took a long time to heal, leaving a permanent scar.

In most of Asia as well as in Sub-Saharan Africa it remains an important cause of death. The problem is made more acute by the multi-drug resistance, resulting in pandemic scares. For an overview see Tuberculosis in China.

The winter of 2010/11 was far too cold to sit out on the porch. But this winter I felt I really needed to get some fresh air. The permafrost started early in the autumn of 2011, and made harder by lingered well into May. This made it difficult to go for even short walks in the fresh clear air we enjoy here.

So last month, May  I was still not able to take even a 10 minute walk and felt my life-energies fading. June was only marginally easier, partly due to record cold, the all-time record set already in mid-june). Kerstin suggested that I should try to sit out in the sun whenever its warm enough, on the somewhat more sheltered porch if necessary, well-wrapped up and a blanket over my knees. She explained that this is something that is done in all elderly care where the patient has an oedema that affects breathing, and the benefits of clear air to getting a better night’s sleep.

This rang a bell and after some searching through my files of Symbolic Interactionist papers I found two article photocopies on a book I had read in the mid-1960s by Julius Roth.

Julius Alfred Roth Timetables: structuring the passage of time in hospital treatment and other careers (Bobbs-Merrill, 1963) is a classic where “cure” was a matter of negotiation, with inmates/patients etc. often longing to get back to their families and lives, or just to have a secret smoke. There was even a brand of fags in England called Woodbines, popularly nicknamed (in the spirit of appropriately gallows humour) as coffin nails. The website Goodbye to coffin nails shows this connection, and reminds us that it was not so long ago when smoking was allowed everwhere. The Woodbines brand name was later permanently withdrawn by the Bristol-based  tobacco importer and cigarette manufacturer W.D. and H. O. Wills.

Tuberculosis provided considerable opportunities for negotiation, for the patient to obtain early release from a sanatorium.

Julius Roth used his own experiences as a form of participant observation. The earliest article I have been able to identify predates the book, being the chapter by Julius Alfred Roth (1924-2002) “The Treatment of Tuberculosis as a Bargaining Process” in Arnold M. Rose (ed) Human Behavior and Social Processes: an interactionist approach (Routledge, 1962 Ch. 30, pp. 575-588).

There is also a much later article: Julius A. Roth “Staff-inmate bargaining tactics in long-term treatment institutions” Sociology of Health and Illness (July 1984 Vol. 6 No. 2 pp. 111-131) that looks at different kinds of institutions. I was hoping to buy the original book secondhand, but, being as rare as hen’s teeth, very few examples are available and all at exorbitant prices.

Edward Livingstone Trudeau was a pioneer of fresh mountain air treatment. The link to the above, shows a picture of rows of beds on a verandah of the sanitorium he founded in the Adirondacks. It is winter and the snow lies deep. The patients lie in beds well-covered in quilts and blankets against the freezing cold air. In some of the images the track along which the beds could be moved provided flexibility in the spacing of beds (you can see these, too, if you examine some of the other old photographs, for example on google images searching for sanatorium). A good diet and a positive attitude were also important.

There remains the risk of TB returning as the inoculated generation is replaced by those without protection, while the discovery of penicillin and its widespread use in combination with the increase in poverty and globalisation, new waves of refugees – even in Fortress EU – increase the risk of new resistant strains of TB spreading. India and China seem to be entering an era of exploding numbers of TB cases.

I will end this with a personal observation. When I was a child I was quite sickly and once I was taken to the isolation hospital in Dog Lane, Brentfield. I can’t remember what illness I had, it could have been whooping cough, meningitis or croup, or even for a tonsillectomy. This website, http://ezitis.myzen.co.uk/neasden.html, describes it in general terms.

I remember it quite clearly. It had a glass wall to the outside, so the patient could be seen by visitors without them even entering the building. They could wave and smile, but that was about it. I spent a Christmas there, probably in the late 1940s. Not much fun, but an experience I have never forgotten. Here is a quote from the above link:

“In 1948 it joined the NHS.  A newly refurbished theatre block opened in 1949 with 16 beds for tonsillectomy patients.

“By 1953 the Hospital had 128 beds for patients with acute infectious diseases, mainly food poisoning (salmonella, typhoid and dysentery), whooping cough, diphtheria and croup.  About 60% of its patients were children.  Twenty beds were for TB patients, but smallpox patients were not admitted.”

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