This wasn’t a very well-written book, with rather poor use of language, and characters who were all such caricatures that I was half-expecting someone to pipe up “Ooh, Matron”. However, it did make a few interesting points about the early years of the NHS, and the treatment of TB at that time. The idea was that several working-class stereotypes – a Cockney wide boy, his garishly-dressed twin sister and a brash American soldier – had been sent for treatment at what had previously been a private sanatorium, alongside a posh bluestocking, an eccentric aristocrat and various others, under the supervision of a busty nurse and a repressed art teacher. All the women were after the brash American, and someone nearly died after being injected in the backside with stolen drugs. As you do! The idea of a novel set in a sanatorium, at this point in history when the NHS had just been established and penicillin was just becoming available, was good, but it just wasn’t very well-executed. However, the author made some points that were genuinely thought-provoking.
I think the point of the book was meant to be that all these characters from different backgrounds bonded due to their shared experience of life in the sanatorium, but it just wasn’t convincing, because they were all so caricatured. That’s a shame, because it was a good idea. But it did bring out some interesting issues.
One was the never-ending problem of cost within the NHS. Much of the plot revolved around the fact that antibiotics to treat TB were now available, but that the funding just wasn’t there to provide them for everyone. How often do we hear heartbreaking stories of someone being denied lifesaving treatment because the money isn’t there? That’s not a criticism of any political party: money does not grow on trees. It’s just the eternal problem of there not being enough money to go round, and of the desperation of knowing that there’s something out there that could save the life of you or one of your loved ones, but that you/they can’t have it. The idea that the characters would steal the drugs and then half-kill one of their own by, with the best of intentions, injecting her with it without medical supervision sounds far-fetched, but it was actually one of the better-written parts of the book.
Then there was the suggestion that it was not generally expected that the middle classes, let alone the upper classes, would use the NHS. Again, this is a complex political and ethical issue, but the suggestion in the book was that it was only expected that the NHS would need to fund treatment for those who had been unable to pay for it previously This is a very controversial area, and the idea that the NHS for everyone is so deeply ingrained in our culture that it seems quite shocking now. But, in the late 1940s, the NHS was a new idea.
When I was a kid, there was a stigma about wearing NHS glasses, as opposed to wearing nice (and we’re talking ’80s “nice”, so think Deirdre Barlow!) frames that you had to pay for. It’s that idea, applied to the NHS as a whole. And let’s not forget that we’re still seeing people having to give up their homes and life savings to pay care home fees, whereas those without any assets get their fees paid by the state. So, whilst I don’t agree with the idea at all, I can see where the expectation might have come from, and why that might have made it difficult to forecast how much money would be needed – and this was long before medical advances brought about the sort of complex and highly expensive treatments available now.
And, on a different note, an interesting point was made about attitudes towards vaccination. This isn’t the anti-vaxxer stuff we get now, with some people thinking that vaccinations can have dangerous side-effects: it’s something different. When I was at school, everyone got vaccinated against TB, unless they were naturally immune. They don’t now. When the book was set, the vaccine was only just being rolled out in the UK: it seems to have been in use nationwide by 1953. TB was still rampant at the time, so you’d think people would have been ecstatic that a vaccination had become available, yet some people disapproved on the grounds that, according to them, it was giving people a free pass to lead an unhealthy lifestyle. We’re talking about the predecessors of the sort of sanctimonious people who say that anyone who’s overweight should be denied hospital treatment, or say that you should exercise every day with no thought to how people who are at work and have housework to do are supposed to find the time to do so. The book only mentions the idea in passing, rather than making it part of the plot, but it gives quotes from newspapers, and tells the reader a lot about the social attitudes of the time.
The whole idea of the sanatorium tells the reader a lot about the attitudes of the time. What medical professionals say, goes. Apart from one patient, whom it turns out hasn’t actually got TB but can’t cope with life outside an institution – her story would have been a lot more interesting than the story we actually got -, most of them, certainly those being treated on the NHS, are there against their will. They include young children who’ve been taken away from their parents, and parents who’ve been separated from their own children. Again, this is a challenging issue. They’re there for their own good: they’re not going to magically recover if they stay at home. And, TB being highly contagious, their being there is protecting their families and friends from infection. But it’s the you-will-obey-the-great-doctors attitude that really jars with modern sensibilities. OK, this is pretty mild compared to the horror stories from Spain and Argentina about babies being taken away and parents being told that they’d died, but, again, it says a lot about the mindset of a time that’s really pretty recent.
The medical details are worth reading too – from deflating lungs to leaving people sat out on balconies in freezing cold weather. TB was so rife for so long, and doctors tried so hard to find effective treatments for it … and then penicillin was discovered rather by accident. If only someone could, accidentally or otherwise, stumble across equally effective treatments for cancer and dementia.
It was a great idea for a book, but the characterisation was poor, and the use of language was poor as well. I’m fine with bits of Yiddish being thrown in all over the place, but some readers aren’t going to be familiar with the words; and the use of English just wasn’t very good – much of the narrative was written in the style of an ineloquent person speaking, and I found that very annoying. Save it for the dialogue! The book’s been widely praised by critics, so maybe I’m missing something, but I thought it could have been a lot better. And I would quite like to meet the author: I think we must know some people in common, and I love the fact that she says she grew up reading Lorna Hill’s ballet books. Her interviews are great. I just wasn’t so impressed with the book!