The controversy triggered by Sir Brian May’s recent documentary on badgers and bovine tuberculosis (TB) might seem just for farmers and animal rights campaigners but, as Chris Holme reflects, it also continues a largely forgotten legacy of catastrophic failure in public health which claimed the lives of tens of thousands of British children and left many more maimed or disabled. They died from drinking infected milk.

The twentieth century started on a wave of optimism.

Robert Koch had identified the human form of TB in 1882. Different strains of the bacillus were later found in other species, including cattle.

Then in 1901 Koch announced that humans could not catch bovine TB.

Others took issue with him, including Harold Stiles, surgeon to the Royal Hospital for Sick Children in Edinburgh.

He was the successor to Joe Bell, Conan Doyle’s inspiration for Sherlock Holmes, and also  seemed to inherit some of the detective’s skills.

Stiles knew the full horror TB could inflict on children – gnawing away at the spine and joints. It formed a large part of his caseload to excise or repair bones, samples of which were retained. Two of his assistants studied them and identified bovine TB as the principal cause.

Stiles bemoaned the huge resources being invested in sanatoria to treat human TB, where there was treatment but no cure, yet very little for bovine TB which was eminently preventable through eradicating it in cattle – or at the very least, ensuring infants and young children only drank treated milk.

He noted that other European cities like Vienna had no such problems since milk was boiled before consumption.

Edinburgh had just one vet to inspect all byres in the city and milk brought in from the country. Dairy keepers were left to dispose of diseased cows, and “unfortunately a considerable proportion of these animals find their way to England, where they must … continue to propagate this disease.”

“The question is one of national importance and the sooner it is faced the better,” Stiles declared in 1911.

Legislation was introduced but, as he had feared, it failed to address this key issue. It also set the pattern for Parliamentary dithering over ensuing decades.

Stiles was meticulous in his analysis and also looked abroad for best practice. This contrasted with the blinkered arrogance which characterised British thinking.

Denmark and other Scandinavian countries embarked on long term programmes aimed at eradicating bovine TB. Perhaps surprisingly, however, it was the USA which led the way. Some states had already begun testing and slaughtering infected cattle, and from 1917 federal funding was provided to extend this to every state.

It was a hugely complex and expensive undertaking but by 1940 the American effort was judged to be a success on economic grounds alone– aside from the huge gain in public health.

Several attempts were made in Britian to build a consensus for a concerted approach but each foundered on factionalism and heavily polarised arguments. There was a range of scientific “evidence” to select for any opinion.

DH Lawrence, a victim of TB , was openly scornful of his treatment by “scientific doctors.”

Successive governments delayed, dithered, and ducked out from dealing with the issue. It was always too difficult to resolve, or even implement Stiles’s basic rule to keep children safe from raw milk.

A Milk Marketing Board was established to promote the nutritional value of milk and help the dairy industry. But bulk supplies, even in free school milk, still contained bovine TB.

Instead of pasteurisation, a graded system of TT (tuberculin tested) milk was introduced. This had limited impact, not least because it was expensive.

Untreated milk remained the staple for the poor.

By 1931 bovine TB was still killing one thousand children in England and Wales and leaving many more  maimed. The total number of child deaths in the UK from 1900 to 1960, when new drugs and pasteurisation became the norm, is difficult to calculate, but 60,000 would seem a reasonable starting estimate.

The BCG vaccine, derived from an attenuated strain of bovine TB, was used widely in Europe. Opposition in Britain was led by the influential Sir Robert Philip, professor of tuberculosis at Edinburgh University, through the National Association for the Prevention of Tuberculosis.

It took Britain nearly 30 years to adopt it – prompted, in part, by the deaths of young nurses coming to work in sanatoria from country areas with no natural immunity.

Scotland banned the sale of raw cows’ milk in 1983 and since 2009 has been officially designated free from bovine TB. There are still a small number of cases and strict controls remain in place.

Badgers bad?

History will probably judge the mass culling of 230,000 badgers in England and Wales to have been policy running down another rabbit hole, or more accurately, a badger sett.

Brian May’s film at least gave the public an insight into the terrible impact of the disease on farming families. There is no doubt that cattle can pick up TB from badger excreta, but this is only one risk of many.

The new Labour government has announced a “refreshed” policy to consider wider issues which still leave large areas of England and Wales at high risk.

It is also dealing with more recent scandals such as Grenfell and infected blood products which have echoes of the bovine TB failures.

Dither, delay, and deny live on. This might even seem Kafkaesque.

Reflecting on his own pulmonary and laryngeal TB, which killed him in 1924, Franz Kafka wrote : “I am willing to believe that tuberculosis will be controlled; every disease will ultimately be controlled. It is the same with wars – each one will come to its end, but none ever stops.

“Tuberculosis no more has its origins in the lungs than, for example, the World War had its cause in the ultimatum. There is only a single disease, no more, and medicine blindly chases down this one disease as though hunting a beast in endless forests.”

Chris Holme is a former Reuters Foundation fellow in medical journalism.

Brian May’s documentary is available on the BBC iPlayer.

 

Read more by Chris Holme: TB and the Edinburgh physician; Plain speaking and the NHS conversation; Scotland’s first chief scientist; Dr Finlay and the making of the NHS;