The Context of “John M’Neil”

The last post outlined that “The Story of John M’Neil” can now be viewed at the British Film Institute website. In this post, I have set out the context of the 1911 film.

TB was the biggest cause of death in the UK.

Tuberculosis was a major problem in Britain at the time. For instance, the table above [1]  shows deaths from various causes in 1907; deaths from phthisis and other forms of tuberculosis were responsible for over 11 percent of deaths from all causes in the U.K. The word “phthisis”, not in common usage today, is the wasting or atrophy of the body caused by tuberculosis of the lungs. In addition to the death toll, TB disabled 150,000 people each year.

TB was associated with poverty.

When TB struck the breadwinner, whole families would be thrown into destitution. It was, according to Dr Sutherland, “the direct cause of one eleventh of the pauperism in England and Wales, a charge upon the state of one million sterling per annum.” [1]

The connection between TB and poverty complicated the problem. A great burden was placed on welfare agencies. Many workers who had the disease in its early stages did not want to seek treatment in case the interruption meant that they would not get their job back. While in theory patients could be treated in an infirmary (called a “voluntary hospital” in Scotland), in practice these institutions were reluctant to expose their other patients to TB. While many victims of the disease spent their final days in the poorhouse hospital, many did not seek treatment there because of the social stigma associated with the poor house.

TB affected the poor around three times more than the wealthier classes, which fed into the then-fashionable Social Darwinist and Eugenic ideologies (of which more later).

TB was a medical and social problem.

Dr (later “Sir”) Robert Philip devised what became known as the “Edinburgh System” to cure, care and prevent the disease. A system was essential, because if one person were to remain outside the system they would continue to infect the others. The Edinburgh system was build around the Anti-Tuberculosis Dispensary. Other institutions in the system were the:

• Sanatorium for Indigent Curable Cases;
• Hospital for Advanced Cases;
• Farm Colony for Convalescents;
• Open-air School.

These were accompanied by administrative measures, such as notification of the disease and assistance to workers and their families. All of these elements had to work in harmony in order for the campaign against tuberculosis to work. The system enabled the medical and social aspects of the problem to be addressed.

In his obituary, Dr Sutherland was described as Dr Philip’s “Grand Vizier”, implementing many of Philip’s schemes in innovative ways. The Story of John M’Neil is evidence of this.

TB was an infectious disease.

The film starts with this message:

Before you see the picture it is necessary for all to realise that not only is tuberculosis CURABLE in its earlier stages, but above all it is PREVENTABLE.

This might appear to us to be a statement of the obvious, but in 1911 this was a controversial thing to say. Many (including the medical and scientific establishments) believed that TB was an hereditary affliction: caused by germs true, but the susceptibility to it was inherited.

Mainstream eugenists regarded the M’Neil family as “racially diseased”.[2] The cure was not treatment: this was a waste of time because while it might alleviate the suffering of the patient, he or she would still pass on their defective genes. Karl Pearson, Professor of Eugenics at London University argued that a better way to cure TB was to breed out the tuberculous. Sir James Barr, at one point the President of the British Medical Association even argued that “the elimination of the tubercle bacillus is not worth aiming at. It forms a rough, but on the whole very serviceable check, on the survival and propagation of the unfit.”

Dr Sutherland knew that TB was primarily an infectious disease and he published his evidence in the British Medical Journal in 1912.

In the 1930s Dr Sutherland wrote with more that a little frustration at meeting patients who persisted in the belief that the disease was hereditary. In Laws of Life (1936), he wrote:

Here is one of the saddest cases I have ever known.

A young man, who had been gassed in the war, was in receipt of a pension from the Ministry of Pensions. His disability was labelled pulmonary tuberculosis, but like hundreds of men so labelled he was not suffering from tuberculosis. His disability was fibrosis of the lungs, due to gassing. This was confirmed by radiogram. When I told him there was no evidence of tubercle he was crestfallen. I explained that this would not affect his pension for fibrosis, and that he would enjoy his pension much longer than if the original diagnosis had been correct.

“This is terrible,” he exclaimed, and then he told me. Engaged to be married, he had been reading eugenic literature, and did not wish to transmit tubercle to his children. He went to a surgeon, who, without any corroboration of the diagnosis, performed a vasectomy. It was only a slight operation, but one that could never be undone. Even if the man had had tubercle, there was no reason why it should have been transmitted to his children.

Brief synopsis of the film.

The opening scene of the film shows a “tuberculosis nest”, a tenement block in Scotland similar to many of its kind all over Britain. The next scene is the M’Neil family who suffer to varying degrees from consumption (tuberculosis in the lungs). The rest of the film shows how medical intervention leads to treatment and cure of the disease in its sufferers and to ensure it does not recur.

Intent of the film and target audiences.

In order to give the film as much reach as possible, copies were produced in the in the 35 mm format suitable for projection in cinemas. Only 22 minutes long, the film was aimed at mass audiences who regularly flocked to the relatively new and hugely popular form of entertainment, the cinema.

The film provides a hopeful message that TB could be prevented, treated and cured. The inhabitants of tenement blocks, the so-called “tuberculosis nests” would see that there was practical and humane treatment which would not put them in the poor house.

The film was also a way to portray the vectors of the disease. In the opening scene, several of the courses of infection are portrayed such as stirring up dust, drinking out of the same vessel, spitting, coughing over food and cutlery, and so on. In this way it could be used to educate people.

Finally the film depicted the various parts of the Edinburgh System, how it is applied to patients, the different treatments for the different stages of the disease, and the supporting activities (such as the cleaning of the apartment). This would be used to brief medical personnel unfamiliar with the system.

Mark Sutherland, Curator, hallidaysutherland.com

Post Script

This dramatised account of the experiences of a Scottish family devastated by tuberculosis is believed to be the first British health education film.

The film offers practical guidance as as well as a message of hope and was widely shown across Britain, usually accompanied by a lecture.

The filmmaker, Halliday Gibson Sutherland, was a British doctor and author. He researched and wrote widely about tuberculosis and in the year he made the film he founded a tuberculosis clinic and an open-air school for children—like the one featured in this film – in the bandstand of Regent’s Park, London.