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 OUP CORRECTED PROOF – FINAL, 07/17/2015, SPi

C O N TA G I O U S C O M M U N I T I E S
OUP CORRECTED PROOF – FINAL, 07/17/2015, SPi
 OUP CORRECTED PROOF – FINAL, 07/17/2015, SPi

Contagious Communities
Medicine, Migration, and the NHS in
Post-War Britain

RO B E RTA B I V I N S

3
OUP CORRECTED PROOF – FINAL, 07/17/2015, SPi

3
Great Clarendon Street, Oxford, OX2 6DP,
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© Roberta Bivins 2015
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First Edition published in 2015
Impression: 1
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OUP CORRECTED PROOF – FINAL, 07/17/2015, SPi

To Lisa
OUP CORRECTED PROOF – FINAL, 07/17/2015, SPi
 OUP CORRECTED PROOF – FINAL, 07/17/2015, SPi

Acknowledgements
Like all histories, this book was shaped not just by the historical moment in
which it was written, but by conversations, questions, and ideas shared with me
over the course of its lengthy gestation. I first thought about the questions raised
here at the end of a postdoctoral appointment at the Centre for the History of
Science, Technology and Medicine in Manchester. My colleagues there, and espe-
cially the late John Pickstone, helped me transform a barrage of questions into a
workable research agenda. In Manchester, too, I met the first of many generous
and supportive NHS colleagues; without the early input of Stephen Tomlinson,
Verna Angus Davis, and Rafeya Rahman, this might have been a different and
much poorer response to the rich complexity of the British medical response to
migration and ethnicity.
From Manchester, I moved to the University of Houston, where the intellec-
tual diversity of a large and thriving history department exposed me to new
tools and agendas in the field. Conversations with Richard Blackett, Martin
Melosi, and Joe Pratt in particular enriched my approach to the contexts—
transatlantic, urban, and economic—in which migrants encountered new health
care systems. I am grateful, too, for the hospitality of Robert Palmer; the friendship
and collegiality of Xiaoping Cong, Susan Kellogg, Karin Klieman, Karl Ittman,
and Eric Walther; and the warmth of Lorena Lopez, Donna Butler, Gloria Ned,
and Daphne Pitre.
The support of the Wellcome Trust has shaped and transformed my career and
the field in which I work. A Wellcome University Award, gained under the aus-
pices of Cardiff University and with the enthusiastic support and institutional
input of Keir Waddington, allowed me the time I needed to immerse myself in a
new field of scholarship and to luxuriate in new archives. At this early stage,
Scott Newton kindly rescued me from near-total ignorance of the British polit-
ical economy, and reminded me of the great variety of actors operating in the
modern state. An invaluable interlocutor from the beginning, Bill Jones con-
tinues to i­mmeasurably enrich my understandings of migration as both a global
and a local process, and one in which migrants’ contact zones play crucial roles
both at home and abroad.
Moving to the Department of History and Centre for the History of Medicine at
the University of Warwick, I continued in my profligacy and fell yet deeper in debt.
Without the support, prodding, and critical readings provided by David Arnold,
Rebecca Earle, Margot Finn, Hilary Marland, and Mathew Thomson, in par-
ticular, this book might never have been completed, and certainly would have been
less coherent. Maria Luddy, both as a friend and a Head of Department, was gen-
erous in her support, as were CHM colleagues Angela Davis, David Hardiman,
and Claudia Stein. I learned at least as much about the NHS from working with
OUP CORRECTED PROOF – FINAL, 07/17/2015, SPi

viii Acknowledgements

Martin Moore and Jane Hand as I taught them. Jane’s research opened my eyes to
the visual riches of health education, and without Martin’s incisive comments,
these chapters would be both longer and muddier.
In the wider community, Alison Bashford and Warwick Anderson have been
inspirations as well as generous readers and interlocutors. Mark Jackson, Harriet
Ritvo, and Allan Brandt have shaped my approach not just to this book but to
the history of medicine as a discipline. John Welshman, David F. Smith, Adrian
Wilson, and Nadav Davidovitch have all kindly shared work and ideas with me at
crucial moments in my research and writing. I have also benefited enormously
from the comments and questions of audiences at Birmingham, Leeds (both HPS
and Centre for Medical Humanities), LSHTM, Oxford Brookes, and at the annual
meetings of the American Association for the History of Medicine, the Society for
the Social History of Medicine, and the Association for Medical Humanities. Hilary
Marland and Catherine Cox gave me the perfect forum and pool of discussants in
which to explore the intersections of migration and medicine at their University
College Dublin conference on health, illness and ethnicity. Kat Foxhall asked me
to think about rickets in new ways when she invited me to her workshop on illness
histories at King’s College London. And I cannot thank Volker Roelcke and Sascha
Topp enough for their workshop on the medical selection of economic migrants at
the University of Giessen. The papers and participants they brought together gave
me new insight into my own work at a vital moment. I am grateful to Kamila
Hawthorne, Bernadette Modell, David Weatherall, members of the NHS Research
and Development Forum, members and participants at IDEA Collaboration
meetings, and many other medical professionals for sharing their experiences of
research and clinical practice with me.
Producing a work of this kind required me to develop new skills, a sometimes
painful process with which I again received considerable help. Archivists at the
National Archives in Kew, Manchester’s Central Library Archives and Local
Studies Unit, the Modern Record Centre at Warwick, and of course, the Well-
come Library gave me essential support and flawless service. Lynn Wright at
Warwick’s University Library has miraculously expanded the digital and print
resources available for my research and teaching despite ever-tighter library
budgets, and Helen Ford of the Modern Records Centre has been an endlessly
creative force for archival good.
A clutch of articles preceded or were pruned out of this volume; to the anonymous
readers and patient editors of The Bulletin for the History of Medicine, Immigrants
and Minorities, Social History of Medicine, and Medical Humanities, I am very grateful:
you helped me to frame and shape the wider arguments I present here. While none
of these articles are reproduced as chapters, some heavily modified sections appear,
for which I thank the journals in question. Thanks are due as well to the Punch
Archives and the National Archives for allowing me to reproduce the images
printed here. Claudia Castaneda’s close reading and many suggestions helped me
excavate arguments from a superabundance of evidence. Sue Ferry, too, was a won-
derful reader, and raised essential questions that had somehow escaped me. My
editors at Oxford University Press, Robert Faber and Cathryn Steele, and three
 OUP CORRECTED PROOF – FINAL, 07/17/2015, SPi

Acknowledgements ix

challenging and encouraging anonymous readers, helped me to significantly

­improve this book in its final stages. Elissa Connor’s meticulous copy-editing
smoothed rough edges and rescued the reader from the many irritations of incon-
sistency. All errors, of course, are mine alone.
A wide and inadequately rewarded group of friends endured this book with
remarkable patience and good humour: Julie (and the Ku clan who kindly shared
her with me), Bill and Val, Christoph and Helen, John and Toni, Kate and Ben,
Claire and Julia, Kevin: I cannot promise not to do this again. Family members too
have suffered both my absence and my abstracted or disputatious presence; to
Linda, Nick, Zach, and Abigail Gioppo, Joan Belsham, and Peggy and Nick Sr.,
I am especially grateful. Rachel and Jereme, thank you for providing the proof
of Southern hospitality and charm. And finally, there are no words to describe the
contributions made to this book, to my continued scholarship, and to my happi-
ness by Lisa Belsham.
OUP CORRECTED PROOF – FINAL, 07/17/2015, SPi
 OUP CORRECTED PROOF – FINAL, 07/17/2015, SPi

Contents

List of Illustrations xiii

List of Abbreviations xv

Introduction: Medicine, Migration, and the Afterimage of Empire 1

I . T U B E RC U L O S I S I N B L A C K A N D W H I T E :
M E D I C I N E , M I G R AT I O N , A N D R A C E I N
‘ O P E N D O O R ’ B R I TA I N
1. Suspicions and ‘Susceptibility’: The Tuberculous Migrant 1948–1955 23
2. Contained but not Controlled: Public Discontents, International
Implications 62

I I . ‘AT O N C E A P E R I L TO T H E P O P U L AT I O N ’ :
I M M I G R AT I O N , I D E N T I T Y, A N D ‘ C O N T RO L’
3. Smallpox, ‘Social Threats’, and Citizenship, 1961–1966 115
4. ‘Slummy Foreign Germs’: Medical Control and ‘Race Relations’,
1962–1971 168

I I I . C H RO N I C A L LY E T H N I C : T H E L I M I T S O F
I N T E G R AT I O N I N T H E M O L E C U L A R A G E
5. Ethnicity, Activism, and ‘Race Relations’: From ‘Asian Rickets’
to Asian Resistance, 1963–1983 233
6. Genetically Ethnic? Genes, ‘Race’, and Health in Thatcher’s Britain 304
Conclusion: Contagious Communities and Imperial Afterimages 368

Bibliography 377
Index 395
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List of Illustrations

4.1 Things Should be Better for Him; No One Can Say He’s Not British 207
5.1 The Seven Rules of Health 279
5.2 Eat Wisely, Feel Lively 280
5.3 Your Child Needs Vitamin D 289
5.4 Using the National Health Service 290
6.1 You’re Swamping Us 357
C.1 Our World Renowned Social Services 370
C.2 Deep Seated Prejudices 371
OUP CORRECTED PROOF – FINAL, 07/17/2015, SPi
 OUP CORRECTED PROOF – FINAL, 07/17/2015, SPi

List of Abbreviations
AMC Association of Municipal Corporations
AMO Area Medical Officer
BAME Black, Asian, and Minority Ethnic
BMA British Medical Association
BMJ British Medical Journal
BNF British Nutrition Foundation
BPA British Paediatric Association
CCA County Councils Association
CHC Community Health Council
CIA Commonwealth Immigrants Act
CIB Commonwealth Immigrants Bill
CMO Chief Medical Officer
COMA Committee on Medical Aspects of Food Policy
CRC Community Relations Commission
CRE Commission for Racial Equality
CRO Commonwealth Relations Office
DCMO Deputy Chief Medical Officer
DHSS Department of Health and Social Services
FAO United Nations Food and Agriculture Organisation
GP General Practitioner (in the NHS)
HEC Health Education Council
HSSJ Health and Social Service Journal
ISRs International Sanitary Regulations
JAMA Journal of the American Medical Association
LCC London County Council
LHA Local Health Authority
LSHTM London School of Hygiene and Tropical Medicine
MAFF Ministry of Agriculture, Fisheries and Food
MAPG Merseyside Area Profile Group
MOH Medical Officer of Health (pl. MOsH)
MP Member of Parliament
MRC Medical Research Council
NACNE National Advisory Committee on Nutritional Education
NBTS National Blood Transfusion Service
NHS National Health Service
NSCACA National Sickle Cell Anaemia Control Act (USA)
OSCAR Organisation for Sickle Cell Anaemia Research
PKU Phenylketonuria
PMO Principal Medical Officer
RDCA Rural District Councils Association
SAMO Senior Administrative Medical Officer
SAP Serum alkaline phosphatase
SCA Sickle cell anaemia
OUP CORRECTED PROOF – FINAL, 07/17/2015, SPi

xvi List of Abbreviations

SHHD Scottish Home and Health Department
SMAC Standing Medical Advisory Committee
STAC Standing Advisory Committee on Tuberculosis
UDCA Urban District Councils Association
UKTS United Kingdom Thalassaemia Society
UN United Nations
WHO World Health Organization
 OUP CORRECTED PROOF – FINAL, 07/17/2015, SPi

Introduction
Medicine, Migration, and the Afterimage of Empire

‘Well it’s not two countries you know, it’s one country . . . we are part of India and
part of British soil as well.’ With these words, thrice-migrant Londoner Maghar
Singh Hunjan neatly encapsulated a fundamental characteristic of the post-
imperial period: the world that empire made persisted long after its formal demise,
shaping the identities, actions, and beliefs of its subjects. Countries and cultures
bound together by imperial ties of trade and migration were not readily disentan-
gled. Moreover, the habitudes formed by empire, like its institutions, endured not
only in former colonies, but in the once and future imperial metropoles. Hunjan
was born into the Raj, recruited to East Africa, displaced to independent India and
finally settled in East London. For him, the expansive contact zones created by
empire seamlessly merged geography and culture, constituting from ‘India’ and
‘Britain’ one country—a country to which he and others like him were ‘belongers’
by right. Borders defined by history and community trumped those prescribed by
cartography and political citizenship whether rooted in jus soli or jus sanguis (birth
or blood).
Other boundaries proved less easily transcended, including those mapped on
and through the body itself. Rather than language, politics, or economics, it was
the limits of bodily adaptability that finally tied Hunjan to Britain rather than
India: ‘my body [is] used to the English weather . . . and my lifestyle is here. I don’t
think I will be going back and settle because medication there doesn’t fit to
the people living in this country for more than 30 years.’1 Thus, through his years
of residence, Hunjan had—perhaps inadvertently—become a brown-skinned
Englishman in ways unimagined by nineteenth-century imperialists: not in his
‘opinions’ but in his experience of embodiment.2 Contagious Communities will
­explore the impacts on British medicine of the ‘unimagined communities’ founded
by Hunjan and his fellow migrants on British soil, and of a global context in which
Karachi, Kingston, and New Delhi served as metropoles to an English periphery,
just as much as the reverse.

1 Maghar Singh Hunjan, interviewed by Irna Imran on 26 March 1998 ‘London Voices’ http://www.
museumoflondon.org.uk/archive/londonsvoices/web/interview.asp?pid=19#i1051 (accessed 30 January
2012) and used with the permission of the Museum of London.
2 Macaulay famously argued for the creation in India of ‘a class of persons Indian in blood and
colour, but English in tastes, in opinions, in morals and in intellect’ as ‘interpreters between us and the
millions whom we govern.’ Thomas Babington Macaulay, ‘Minute of 2 February 1835 on Indian Edu-
cation’, G. M. Young, Macaulay, Prose and Poetry (Cambridge MA: Harvard University Press, 1957),
721–4, 729.
OUP CORRECTED PROOF – FINAL, 07/17/2015, SPi

2 Contagious Communities

Physical traits and bodily practices also came to define some post-war migrants
in the eyes of their British hosts. In particular, British attention focused on and
often conflated the bodily signs of ‘race’ with those of ill health and cultural diffe-
rence. The Irish, European Voluntary Workers, and especially the ‘dark strangers’
coming to Britain from her former tropical colonies were assumed to imperil the
integrity both of individual British bodies and of Britain’s body politic.3 The latter,
in particular, were suspect. In the eyes of the general public and in the rhetoric of
many politicians and medical professionals, such ‘New Commonwealth’ migrants
imported certain diseases; were especially vulnerable to others; and endangered,
by their visible, ineradicable difference (albeit from a white British norm that
was only ever imaginary), the social whole on which the post-war consensus and
Welfare State alike were built. Crucially, they were perceived and represented as
burdening the already-prized National Health Service (NHS) and undermining
the important but fragile health gains it had generated for the majority popula-
tion. Still worse, the diseases with which New Commonwealth migrants became
most firmly associated—tuberculosis (TB), smallpox, rickets—threatened British
claims of modernity: once eradicated or at least in steep decline, all were resurgent
among Britain’s newcomers (or so the papers said).
This book explores the ways in which British post-war policies on migration were
(and were not) medicalized. It considers how migrants themselves were perceived
through their relationships—both metaphorical and material—with British medi-
cine, health, and disease. Finally, it assesses the impact of post-colonial migration
on British medical research and culture. In short, through close analysis of political
and press discourse, and medical and health policy making, Contagious Communi-
ties begins to integrate the history of the post-war medical state with debates on
immigration and race relations, tracing the ways in which British identity and the
NHS became intertwined as the British nation became ‘multicultural’.
In focusing on the limits, dangers, and distinctiveness of migrants’ physical
bodies and cultures of embodiment—their diets, hygiene, dress, and behaviours—
post-war Britain continued a pattern of responses to immigration already well-
established in the immigrant-receiving nations of North America, Australia, and
New Zealand. Studies of medicine and migration past and present have highlighted
the deep suspicion in which migrants were held, and the extent to which this suspi-
cion was grounded on and rationalized by fears of contagion, threats to hygienic
protections, racial degeneracy, and imported ‘burdens of disease’. The literature is
rich in accounts of what Howard Markel and Alexandra Minna Stern have called
‘the foreignness of germs’. While much of this work has explored immigration to
the USA, Australia, and Canada, shorter accounts have tackled a wide range of
global sites.4 Recent work, too, has highlighted the centrality of infectious disease

3 I take this descriptor from Sheila Patterson, Dark Strangers: A Sociological Study of the Absorption
of a Recent West Indian Migrant Group in Brixton, South London (London: Tavistock Publications,
1963). See also Chris Waters, ‘ “Dark Strangers” in Our Midst: Discourses of Race and Nation in
Britain, 1947–1963’, Journal of British Studies, 36 (1997), 207–38.
4 For instance, Howard Markel and Alexandra Minna Stern, ‘The Foreignness of Germs: The Per-
sistent Association of Immigrants and Disease in American Society’, The Milbank Quarterly, 80 (2002),
 OUP CORRECTED PROOF – FINAL, 07/17/2015, SPi

Medicine, Migration, and the Afterimage of Empire 3

to the histories of nationalism, colonialism, internationalism, and development—

as well as contemporary ideas of globalism.5 Most of this research has focused on
the first modern era of mass migration (by sea), beginning in the wake of the Irish
famine and ending as the traditional immigrant-receiving nations adopted
­restrictive legislation, exclusionary or assimilative border controls, and quarantine
regimes in the early decades of the twentieth century. Across nations and migrant
groups, this literature demonstrates the ways in which portrayals of migrants as
vectors of disease (and madness) provided a ‘scientific alibi’ for discrimination and
anti-immigrationism.6 A handful of studies, including Markel and Stern’s essay,
Alison Bashford’s work on Australia, and Nayan Shah’s influential study of San
Francisco’s Chinese community have confirmed the persistence of such links
­between migration and contamination up to the mid-century. Historians have
written far less about the relationship between health, disease, and perceptions of
migration and migrants in the second half of the twentieth century, especially in
the UK.7 While some British scholars (particularly of empire) examining the

757–88. For a small sample of case studies and examples: Emily Abel, Tuberculosis and the Politics of
Exclusion: A History of Public Health and Migration to Los Angeles (London: Rutgers University Press,
2007); Alison Bashford, Imperial Hygiene: A Critical History of Colonialism, Nationalism and Public
Health (Basingstoke: Palgrave Macmillan, 2003); Amy Fairchild, Science at the Borders: Immigrant
Medical Inspection and the Shaping of the Modern Industrial Labor Force (Baltimore: Johns Hopkins
University Press, 2003); Alan Kraut, Silent Travelers: Germs, Genes and the Immigrant Menace (London:
Johns Hopkins University Press, 1994); Eithne Luibheid, Entry Denied: Controlling Sexuality at the
Border (London: University of Minnesota Press, 2002); Laura Madokoro, ‘ “Slotting” Chinese Fam-
ilies and Refugees, 1947–1967’, Canadian Historical Review, 93 (2011), 25–56; Howard Markel,
Quarantine! East European Jewish Immigrants and the New York City Epidemics of 1892 (London: Johns
Hopkins University Press, 1997); Lara Marks and Michael Worboys (eds), Migrants, Minorities and
Health: Historical and Contemporary Studies (London: Routledge, 1997); Nayan Shah, Contagious Div-
ides: Epidemics and Race in San Francisco’s Chinatown (Berkeley: University of California Press, 2001);
Barrington Walker (ed.), The History of Immigration and Racism in Canada (Toronto: Canadian Scholar’s
Press, 2008). For reflections in relation to contemporary concerns: Charles T. Adeyanju and Nicole
Neverson, ‘ “There Will Be a Next Time”: Media Discourse about an “Apocalyptic” Vision of Immi-
gration, Racial Diversity, and Health Risks’, Canadian Ethnic Studies, 39 (2007), 79–105; Nick King,
‘Security, Disease, Commerce: Ideologies of Post-Colonial Global Health’, Social Studies of Science 32
(2002), 763–89; Nancy Tomes, ‘Public Health Then and Now: The Making of a Germ Panic, Then
and Now’, American Journal of Public Health, 90 (2000), 191–8.
5 Alison Bashford, ‘ “The Age of Universal Contagion”: History, Disease and Globalization’, in
Alison Bashford (ed.), Medicine at the Border: Disease, Globalization and Security, 1850 to the Present
(Basingstoke: Palgrave, 2006), 1–17 at 1. Sunil Amrith, Decolonizing International Health: India and
Southeast Asia, 1930–65 (Basingstoke: Palgrave Macmillan, 2006).
6 Shah, Contagious Divides, 161; see also Krista Maglen, ‘Importing Trachoma: The Introduction
into Britain of American Ideas of an “Immigrant Disease”, 1892–1906’, Immigrants & Minorities, 23
(2005), 80–99; on migrant mental health, see Alison Bashford, ‘Insanity and Immigration Restric-
tion’, in Catherine Cox and Hilary Marland (eds), Migration, Health and Ethnicity in the Modern
World (Basingstoke: Palgrave Macmillan, 2013), 14–35; Catherine Cox, Hilary Marland, and Sarah
York, ‘Itineraries and Experiences of Insanity: Irish Migration and the Management of Mental Illness
in Nineteenth Century Lancashire’, in Cox and Marland, Migration, Health and Ethnicity, 36–60;
Angela McCarthy and Catherine Coleborne (eds), Migration, Ethnicity and Mental Health, Inter-
national Perspectives, 1840–2012 (London: Routledge, 2012).
7 Note, however, David Feldman, ‘Migrants, Immigrants and Welfare from the Old Poor Law to the
Welfare State’, Transactions of the Royal Historical Society, Sixth Series, 13 (2003), 79–104 at 96–104;
Joanna Herbert, Negotiating Boundaries in the City: Migration, Ethnicity and Gender in Britain (Aldershot:
Ashgate, 2008); Anne MacClellan, ‘Victim or Vector? Tubercular Irish Nurses in England 1930–1960,’
in Cox and Marland, Migration, Health and Ethnicity, 104–25; and John Welshman (see n. 8). See also
OUP CORRECTED PROOF – FINAL, 07/17/2015, SPi

4 Contagious Communities

post-war period have noted the rhetorical fusion of race with abiding anxieties
about degeneracy, dirt, and disease, only John Welshman has focused on race and
immigration through a medical lens.8 Contagious Communities will bridge this gap,
asking how the ideas and ideals of the post-war Welfare State have played out in
terms of political and practical responses to the key challenges of racialized migra-
tion and medicalized embodiment.
In some cases, mass migration had direct and immediate implications for British
public health and medical research. As subsequent chapters will illustrate, many
migrant groups, both ‘white’ and ‘black’, experienced higher rates of tuberculosis
than the majority population. Some were also strongly associated with the import-
ation of smallpox—one of the few ‘imported’ illnesses that produced any direct
impact on the health of the indigenous British public. Other migrant groups and
their descendants experienced distinctive patterns of nutritional deficit; and only
with the settlement of certain communities did once-rare genetic conditions become
relevant and accessible to UK-based practitioners and researchers. However, the
challenges faced by migrants and the society into which they entered were also
often described and configured in medical terms, the presence of obvious social
and economic roots notwithstanding. Consequently, efforts to restrict immigra-
tion were often rhetorically linked to claims about migrant pathogenicity, despite
considerable evidence that most immigrants were hale and that enclavism limited
the circulation of any ‘imported’ disease. Similarly, responses to tuberculosis among
migrants focused on screening, surveillance, and medical interventions, rather
than improving appalling living conditions and low socioeconomic status. Nutri-
tional disorders, too, might be linked to poverty or inadequate access to necessary
amenities—but were consistently investigated in relation to biological differences
or distinctive cultural practices.
Responses to the association between migrants and infectious diseases were also
shaped by another crucial problem: national responses to migration and to the mi-
grants themselves took place in an intensely international context, shaped both by
Cold War politics and by increasingly global scrutiny of what the British termed
‘race relations’. Yet as Alison Bashford has pointed out, persistent conflations of ‘race’
and ‘contagion’ notwithstanding, epidemiological data throughout the post-war
period also confirmed marked differences in health between the populations of the

John Eade, ‘The Power of the Experts: the Plurality of Beliefs and Practices Concerning Health and
Illness among Bangladeshis in Contemporary Tower Hamlets, London’, in Marks and Worboys,
Migrants, Minorities and Health, 250–71.
8 John Welshman, ‘Importation, Deprivation, and Susceptibility: Tuberculosis Narratives in Post-
war Britain’, in Flurin Condrau and Michael Worboys (eds), Tuberculosis Then and Now: Perspectives
on the History of an Infectious Disease (London: McGill-Queen’s University Press, 2010), 123–47; John
Welshman, ‘Compulsion, Localism, and Pragmatism: The Micro-Politics of Tuberculosis Screening in
the United Kingdom, 1950–1965’, Social History of Medicine, 19 (2006), 295–312; John Welshman,
‘Tuberculosis, “Race”, and Migration, 1950–70’, Medical Historian: Bulletin of Liverpool Medical
History Society, 15 (2003–04), 36–53; John Welshman, ‘Tuberculosis and Ethnicity in England and
Wales, 1950–70’, Sociology of Health & Illness, 26 (2000), 858–82; Ian Convery, John Welshman, and
Alison Bashford, ‘Where is the Border? Screening for Tuberculosis in the United Kingdom and Australia,
1950–2000’, in Bashford, Medicine at the Border, 97–115.
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Medicine, Migration, and the Afterimage of Empire 5

global South, and those of the global North.9 Contagion followed the perceived
global ‘colour line’: rates of infectious disease were (and remain) markedly higher
in the regions from which racialized migrants came than in the areas to which they
migrated. In political terms, this fact was sometimes convenient, but it was also
awkward. As this volume will argue, the prominence of race discourse in the Cold
War struggle for ‘hearts and minds’ in the non-aligned developing world made
even epidemiologically-based port and public health measures politically sensitive
if they affected solely or even predominantly non-white populations. In the specif-
ically British context of decolonization, they were also perceived as threatening to
the Commonwealth on which many of Britain’s post-war claims to international
influence were based.10 Such concerns have implications, too, for the writing
of history; while it is imperative to recognize the material, epidemiological, and
­environmental constraints and conditions under which all parties operated, it is
equally essential to avoid reinforcing the abiding association between immigration
and infection, and to recognize the generally good health in which most migrants
arrive at their destinations.

‘ C O L O U R ’ , ‘ R A C E ’, A N D ‘ E T H N I C I T Y ’ :
TERMS AND TERRAINS

Conceptions of race as biological have been central to models of identity and

belonging throughout the western world in the twentieth century, as in the nine-
teenth. They played a very visible role in shaping immigration policy in the USA
and in Britain’s colonies (and later, dominions).11 The intentional or accidental
conflation of race and health in the construction and application of border medical
controls was (and remains) common among migrant-selecting nations.12 In Britain,

9 Alison Bashford, ‘The Great White Plague Turns Alien: Tuberculosis and Immigration in Australia,
1901–2001’, in Condrau and Worboys, Tuberculosis Then and Now, 100–22 at 115–17.
10 See also Nick King, ‘Immigration, Race and Geographies of Difference in the Tuberculosis
Pandemic’, in Matthew Gandy and Alimuddin Zumla (eds), Return of the White Plague: Global Poverty
and the New Tuberculosis (London: Verso Press, 2003), 39–54. On Britain and the Commonwealth, see
Chapters 1–2, and Jim Tomlinson, ‘The Empire/Commonwealth in British Economic Thinking and
Policy’, in Andrew Thompson (ed.), Britain’s Experience of Empire in the Twentieth Century (Oxford:
Oxford University Press, 2011), 211–50 at 220–33.
11 In addition to the studies of migration already listed, see Warwick Anderson, The Cultivation
of Whiteness: Science, Health, and Racial Destiny in Australia (Durham, NC: Duke University Press,
2006); Warwick Anderson, Colonial Pathologies: American Tropical Medicine, Race, and Hygiene in the
Philippines (Durham, NC: Duke University Press, 2006); Natalia Molina ‘ “In a Race All Their Own”:
The Quest to Make Mexicans Ineligible for U.S. Citizenship’, Pacific Historical Review, 79 (2010),
167–201; Alexandra Minna Stern, ‘Buildings, Boundaries, and Blood: Medicalization and Nation-
Building on the U.S.–Mexico Border, 1910–1930’, The Hispanic American Historical Review, 79
(1999), 41–81.
12 See nn. 6–9, and Renisa Mawani, ‘Screening out Diseased Bodies: Immigration, Mandatory
HIV Testing and the Making of a Healthy Canada’ in Bashford, Medicine at the Border, 136–58;
Renisa Mawani, ‘ “The Island of the Unclean”: Race, Colonialism and “Chinese Leprosy” in
British Columbia, 1891–1924’, Journal of Law, Social Justice and Global Development, 1 (2003),
1–21.
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6 Contagious Communities

both Jewish and Irish migrants were at times racialized and medicalized, alongside
more obvious (to us) targets including the Chinese and the many ethnic groups
together designated ‘lascar seamen’.13
Here, I argue that in mid- and late twentieth-century Britain, too, interactions
between health status and racial identity have influenced debates about in-migration.
Eventually, a stable dichotomy became established, associating health with European
or ‘Old Commonwealth’ origins, and illness and contagion with origins in the
tropical world. However, this binarism emerged only gradually from a far less dis-
tinct picture in which class, occupation, and gender played equally important roles
in shaping perceptions of migrants’ place in the hierarchies of health and risk.14
Professional and policy responses to New Commonwealth immigrants and Hun-
garian refugees in the 1950s, and to British Cypriot and Black British communities
in the 1970s and early 1980s reveal the changing perceptions and effects of such
intersectionality over time, and in relation to international developments including
the Cold War and the US civil rights movement.
As immigrants marked out by ‘racial’ characteristics became residents, then citizens,
and finally the pioneering settlers of established multi-generational communi-
ties, simple elisions of race and disease were further complicated by questions of
acculturation and ‘assimilability’.15 In this context, the emergence of ‘ethnicity’
as the language of choice for health professionals and policy makers from the late
1960s to the present was not just a reflection of inter- and post-war anxieties
about racism and the appearance of racism—although it was certainly boosted
by them.16 It also reflected emerging doubts about the plasticity of ‘culture’ and
in particular the cultural practices that shape and constrain embodiment: mat-
ters of diet, dress, hygiene, physical activity, reproductivity. Thus, following the
lines that Megan Vaughan and Peter Wade have delineated for colonial South
Africa and colonial and contemporary Latin America respectively, post-war British
descriptions and assumptions about ‘race’ were tied to and infused with conceptions

13 See for a masterful but concise summary of a rapidly expanding literature, Laura Tabili, ‘A
Homogenous Society: Britain’s Internal “Others”, 1800–Present’, in Catherine Hall and Sonya Rose
(eds), At Home with the Empire: Metropolitan Culture and the Imperial World (Cambridge: Cambridge
University Press, 2006), 53–76; also Feldman, ‘Migrants, Immigrants and Welfare’; Marjory Harper
and Stephen Constantine, Migration and Empire (Oxford: Oxford University Press, 2010), especially
Chapter 7; Colin Holmes, John Bull’s Island: Immigration and British Society (Basingstoke: Macmillan,
1988); Andrew Thompson, ‘Afterword: The Imprint of Empire’ in Thompson, Britain’s Experience of
Empire, 330–45; Rozina Visram, Asians in Britain: 400 Year of History (London: Pluto Press, 2002),
especially Chapters 7–9; Waters, ‘ “Dark Strangers” in Our Midst’.
14 See Lousie Ryan and Wendy Webster (eds), Gendering Migration: Masculinity, Femininity and
Ethnicity in Post-war Britain (Aldershot: Ashgate, 2008); Wendy Webster, Imagining Home: Gender,
‘Race’ and National Identity (London: UCL Press, 1998).
15 Gavin Schaffer, Racial Science and British Society, 1930–62 (Basingstoke: Palgrave Macmillan,
2008). Schaffer has recently argued that models and understandings of ‘race’ became increasingly the
domain of the social rather than the biological science in the years after 1950—a flow which Lundy
Braun argues is now, once again, reversing as molecular genetics becomes a dominant explanatory
mode. See Lundy Braun, ‘Race, Ethnicity, and Health: Can Genetics Explain Disparities?’, Perspectives
in Biology and Medicine, 45 (Spring 2002), 159–74.
16 David Kelleher, ‘A Defence of the Uses of the Terms “Ethnicity” and “Culture” ’, in David Kelleher
and S. M. Hillier, Researching Cultural Differences in Health (Abingdon: Taylor & Francis Routledge,
2002), 69–90.
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Medicine, Migration, and the Afterimage of Empire 7

of ‘culture’ and ‘civilisation’.17 In this, they followed the established precedents of

colonial medicine.
‘Race’ in the wake of the Second World War and during the Cold War was a
hotly contested and politically sensitive term and concept, indelibly marked by the
horrors of the Holocaust. A previous generation of scholarship, both in the sci-
ences and the humanities, argued that the notion of fixed biological race was, if
not eliminated, at least in sharp decline in the post-war period.18 However, more
recent work in the history and social studies of science, medicine, and technology
has explored the degree to which ‘race’ persisted as a valued category in biomedical
research (and indeed the wider culture).19 Certainly ‘race’—or ‘colour’, as it was also
commonly termed between 1948 and the mid-1960s—remained (and remains) a
key variable and interpretive category in medical research, practice, and public
health. In the medical and scientific literature analysed here, explicitly racial ter-
minology was often replaced by the language of ‘populations’ and ‘ethnic groups’.
Nonetheless, the presumed existence of distinctive and identifiable biological
groups broadly recognizable by the old racialized traits of skin colour, hair colour
and texture, and a shifting but familiar palette of other biological and tempera-
mental characteristics survived. And as a plethora of scholars have argued, they
are once again in the ascendant as markers of identity and as viable biomedical
categories, particularly through the new discourses of genomics on one hand and
‘personalised medicine’ on the other.20 Thus professional and political responses to
the racialized genetic conditions sickle cell anaemia and thalassaemia from the late
1960s onwards prefigure and resonate strongly with David Skinner’s cautionary
assessment of contemporary ‘biologism’ in contemporary discussions of race.21
Forging a language through which to discuss different concepts of race, and the
different groups to whom those concepts were applied is a significant challenge for
any scholar writing about the late twentieth century. Like ‘race’ itself, and like the
terminology used to designate particular human populations, the terms with which
communities and individuals choose to identify are fluid and highly emotive. They

17 Megan Vaughan, Curing Their Ills: Colonial Power and African Illness, (Palo Alto, CA: Stanford
University Press, 1991), especially Chapter Two; Peter Wade, ‘The Presence and Absence of Race’,
Patterns of Prejudice, 44 (2010), 43–60.
18 See Elazar Barkan, The Retreat of Scientific Racism: Changing Concepts of Race in Britain and the
United States Between the World Wars (Cambridge: Cambridge University Press, 1992); Richard King,
Race, Culture and the Intellectuals, 1940–1970 (Baltimore: Johns Hopkins University Press, 2004);
Nancy Stepan, The Idea of Race in Science: Great Britain 1800–1960, (London: Macmillan, 1982).
19 E.g. Braun, ‘Race, Ethnicity and Health’; Marek Kohn, The Race Gallery: the Return of Racial
Science (London: Jonathan Cape, 1995); Jennifer Reardon, Race to the Finish: Identity and Governance
in an Age of Genomics (Princeton: Princeton University Press, 2004); Shaffer, Racial Science and British
Society; William Tucker, The Funding of Scientific Racism: Wickliffe Draper and the Pioneer Fund
(Urbana: University of Illinois Press, 2002).
20 Brian Beaton has usefully reviewed a growing literature in ‘Racial Science Now: Histories of
Race and Science in the Age of Personalised Medicine’, Public Historian, 29 (2007), 157–62; see also
Troy Duster, ‘The Medicalisation of Race’, Lancet (2007), 702–4; Elizabeth Phillips, Adebola
Odunlami, and Vence Bonham, ‘Mixed Race: Understanding Difference in the Genome Era’, Social
Forces, 86 (2007), 795–820.
21 David Skinner, ‘Racialized Futures: Biologism and the Changing Politics of Identity’, Social
Studies of Science, 36 (2006), 459–88.
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8 Contagious Communities

vary in different national and regional cultures, and particularly over time. Thus
in a volume like this one, traversing decades punctuated by the landmarks of sig-
nificant change in attitudes towards personal, group, and national identity, a wide
variety of terms necessarily appear. At different moments between the late 1940s
and the early 1990s, racialized migrants were homogenized as ‘coloured’, ‘Negro’,
and ‘black’. They and their descendants were called ‘immigrants’, ‘New Common-
wealth immigrants’, and later ‘Black British’. Less generically, from the late 1950s,
many migrant groups were differentiated by their (assumed) global regions of
origin. At this point, categories like ‘West Indian’, ‘Asian’, ‘African’, and less
commonly ‘Mediterranean’ were seen by the naming classes—politicians, policy
makers, media commentators, and medical professionals—as more accurately rep-
resentative of the differences between such large and internally fragmented groups.
This approach ignored the extent to which intra-imperial labour (free, indentured,
and forced) mobility had already dispersed and intermingled its subject popula-
tions.22 National origins too came into use, as the evident importance of differen-
tiating between Indians and Pakistanis (in particular, due to the political and
nationalist sensitivities of both nations), or for example, Jamaicans and Bajans
became better known. The major immigration crises triggered in the late 1960s
and early 1970s by the ‘Africanization’ policies of the newly established states
of Kenya and Uganda also introduced the term ‘East African Asians’ or simply
‘­African Asians’ to describe these exiled communities. Today, abbreviations like
BAME (Black, Asian, and minority ethnic) attempt to acknowledge the diversity
of these populations while capturing certain shared aspects of their experiences in
the UK. All of these actors’ terms will appear here. All were deeply imbued with
assumptions about the race of the groups so identified, and thus represent to a
greater or lesser degree the twinned phenomena of racialization and ‘othering’.
None can be accepted as neutral or merely factual. My goal here is to recognize and
assess attitudes towards populations and individuals who were considered, between
1948 and 1991, to be physically, medically or culturally distinctive migrants to
Britain, without reifying the assumptions which underpinned them. On the other
hand, to avoid a distracting blizzard of punctuation, I will only set off such con-
temporary designations—like the term ‘race’ itself—where necessary for clarity,
rather than to indicate at each occasion that the categories and relationships they
denote remain are contested, contingent, and far from transparent. In particular,
while I will use the terms ‘South Asian’ and West Indian’ where my sources do not
allow greater precision, I recognize that these are artificial categories, and do not
necessarily reflect the self-defined or experienced identities of the diverse popula-
tions subsumed under them for the sake of administrative convenience.23
22 See Harper and Constantine, Migration and Empire, Chapter 6 for an introduction to this topic;
Clare Anderson, Biographies of Colonialism in the Indian Ocean, 1790–1920 (Cambridge: Cambridge
University Press, 2012) offers a more detailed perspective, often through the eyes of those subject to
penal transportation.
23 Indeed many migrants have described their ‘discovery’ of a shared West Indian or ‘Asian’ identity
only after arriving in the UK. See Webster, ‘The Empire Comes Home’, 149–50; David Ellis, ‘ “The
Produce of More than One Country”: Race, Identity and Discourse in Post-Windrush Britain’, Journal
of Narrative Theory (JNT), 31 (2001), 214–32.
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Medicine, Migration, and the Afterimage of Empire 9

The ways in which three other migrant groups were identified is also worth brief
consideration under this heading. European migrants and refugees, who play only
a small part in my story despite their prominence in the immediate post-war
period, were commonly labelled ‘European Voluntary Workers’ (EVWs). Alterna-
tively, they were identified by their nationalities, and occasionally as ‘refugees’, a
term which was also favoured in relation to Hungarians fleeing from the collapse
of the Revolution of 1956. Nationals of Eire, like the residents of the UK ‘Home
Nation’ Northern Ireland, were usually identified simply as ‘Irish’. When a distinc-
tion between these two populations was required, formal documents and those
produced by the state for public consumption might use the term ‘nationals of
Eire’; more casually, ‘Southern Irish’ was the norm. Finally, in the 1960s and 1970s,
migrants from Britain’s Mediterranean territories Malta and Cyprus presented a
particular linguistic challenge: sometimes they were classed as ‘white’, sometimes
as ‘Mediterranean’ and sometimes as ‘coloured’. In recognition of their ambivalent
racial status, they too were usually identified by their nationalities.
It was the post-war disciplines of sociology and anthropology that pioneered,
tested, (and usually discarded) these terms first. In The Afterlife of Empire, Jordanna
Bailkin has ably explored the ‘ “birth” of the immigrant in social science’ and the
‘psy’ disciplines.24 As Bailkin has shown, this ‘migrant’, perhaps especially in
Britain, was forged in the embers of imperial and pre-war (often eugenically influ-
enced) physical anthropology, and then defined and captured by psychiatry, psych-
ology, psychoanalysis, sociology, and social anthropology. The state and the media
alike recirculated what became increasingly doom-laden visions of post-war migra-
tion; so too did the general medical profession. Medical experts, in contrast, often
refined or rejected some aspects of social scientific research, while embedding
others in the many assumptions which all too often served to replace consultation
with migrants themselves.

A S S I M I L AT I O N , I N T E G R AT I O N , A N D
‘ H YG I E N I C C I T I Z E N S H I P ’

Soon after their arrival in Britain’s cities, many migrants encountered another facet
of responses to their presence: efforts aimed at their assimilation, integration, and
later, under the remit of ‘multiculturalism’ a more limited—but still normative—
agenda of incorporation into a fluid but supposedly singular ‘national culture’.25

24 Jordanna Bailkin, The Afterlife of Empire (Berkeley: University of California Press, 2012), 18. See
Chapter 1; ‘psy’ is defined at 33.
25 On ‘multiculturalism’ in Europe, see Riva Kastoryano, ‘Negotiations beyond Borders: States and
Immigrants in Postcolonial Europe’, Journal of Interdisciplinary History, 41 (2010), 79–95. Kastoryano
also explores the emerging phenomenon of ‘transnationalism’: ‘A transnational organization allows
immigrant populations to escape national policies. But transnational networks linking the country of
origin to the country of residence and promoting participation in both locations also challenge the
single allegiance required by membership in a nation’s political community. Transnationalism has led
to an institutional expression of multiple belonging, in which a country of origin becomes a source of
identity; a country of residence, a source of right; and the transnational space, a site of political action’
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10 Contagious Communities

Underpinning each of these responsive modes were prescriptive models of British

embodiment. Just as Shah has illustrated in relation to mid-century San Francisco’s
Chinese Americans, in Britain under the Welfare State, medical and public health
services were recruited as primary mediators, interpreters, and indeed potential level-
lers of bodily difference.26 Linking these medicalized responses to immigrant bodies
and practices of embodiment is the idea of ‘hygienic citizenship’, carefully explored
by Warwick Anderson, Alison Bashford, and others.27 Much of this work has been
situated in colonial contexts rather than in the metropoles; however, as Fairchild,
Shah, and Stern have documented, migrants too have been expected to earn their
places through conformity to the dominant culture’s hygienic expectations. Such ex-
pectations and pressures intensified in Britain, where the migrants themselves were
identified with an unwelcome domestication of colonialism’s ‘civilizing mission’, just
as empire itself was receding. For (New) Commonwealth migrants to Britain in the
second half of the twentieth century, compliance with medical surveillance measures
and the adoption of certain practices of self- or family surveillance were added to
earlier models of hygiene that incorporated everything from toilet habits to compli-
ance with domestic standards not just of cleanliness but of ‘tidiness’—the mainten-
ance of the cosmetic appearance of shared and even private amenities. Untoward
sights, unwanted sounds, and unfamiliar smells—repeatedly, the smell of curry—
could trump even the most meticulous conformity to community ideals (certainly
not norms) of personal hygiene, as illustrated for example, by a noisy discourse of
complaint about cooking odours, loud parties, and backyard litter.28
In interpreting British responses to the medical impacts of postcolonial immi-
gration, gender and age, as well as race and ethnicity, are important variables. Thus
while both male and female migrants from the New Commonwealth were con-
strued as posing threats both to individual British bodies, and to the body politic,
the nature of those threats was very different. Male South Asian and especially
Pakistani migrants were closely associated with infection—single male workers
were blamed both for spreading TB within their own, and smallpox to the majority
community. On the other hand, as migrants became settlers, public and policy
responses positioned female migrants as threatening the body politic through their
uncontrolled fertility and their failed maternity, as represented both by genetic and
nutritional disorders among their children. Female Pakistani and Indian migrants
were also seen as a vector of incomplete modernity, and blamed for reproducing
foreign and anti-modern behaviours among their children.

(at 95). On ‘national culture’ see David A. Hollinger, ‘National Culture and Communities of Des-
cent’, Reviews in American History, 26 (1998), 312–28; Tariq Modood, Multicultural Politics: Racism,
Ethnicity and Muslims in Britain (Minneaopolis: University of Minnesota Press, 2005).
26 Shah, Contagious Divides, Chapters 4, 8, and 9. See also Bailkin, Afterlife of Empire, on the
Welfare State itself.
27 See Anderson, Colonial Pathologies 180–207; Bashford, Imperial Hygiene, 79–80.
28 Shah shows the deep history of this trope of disgust at the unfamiliar smells of ‘exotic’ foodstuffs,
which was expressed just as explicitly by those missionizing Chinatown in the early twentieth century.
Shah, Contagious Divides, 116–18. On curry see Elizabeth Buettner, ‘ “Going for an Indian”: South
Asian Restaurants and the Limits of Multiculturalism in Britain’, Journal of Modern History, 80 (2008),
865–901.
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Medicine, Migration, and the Afterimage of Empire 11

Geography too played a role: the story of postcolonial migration and medicine
in this period is principally English and urban, since it was to London and England’s
largest industrial conurbations that most migrants moved. Scottish r­ esponses to
immigration, building on a different tradition of public health as well as the
smaller scale of the inward movement, leaned towards active intervention, a
difference that would eventually produce professional tensions and policy dif-
ferences within the wider British response.29 Wales and Northern Ireland attracted
comparatively small numbers of New Commonwealth migrants from the 1950s
through the early 1990s. The migrants themselves came from a wide range of
backgrounds, climates, and settings; their (often presumed) urban or rural origins
in particular affected how they were perceived, and the type of threats attributed to
their presence.

M E D I C I N E A N D M I G R AT I O N I N
THE POST- COLONIAL ERA

For post-imperial Britain, migration became empire’s enduring afterimage, simul-

taneously inverting and perpetuating the assumptions of colonialism, and in the
process destabilizing understandings of Britishness itself.30 This was no less true for
medicine than for other hegemonic cultural endeavours—indeed, it may have
been even more true: parts of the medical civil service in particular were awash
with a returning professional diaspora, dislodged by the end of empire.31 Yet the
post-colonial history of migration to the UK is still a minor, if a growing literature,
in the wider fields both of late twentieth-century history, and of migration and
ethnicity studies. It is overshadowed by the expansive body of scholarship addressing
the USA on one hand and nineteenth-century immigration, on the other. Those
histories which do consider post-war migration to Britain have until recently
largely ignored the period’s rich discourse linking migration and disease, dismissing
29 On the distinctive and often more interventionist approach in Scotland, see Roger Davidson, ‘A
Scourge to be Firmly Gripped’: The Campaign for VD Controls in Interwar Scotland’, Social History
of Medicine, 6 (1993), 213–35; Martin Gorsky, ‘ “Threshold of a New Era”: The Development of an
Integrated Hospital System in Northeast Scotland, 1900–39’, Social History of Medicine, 17 (2004),
247–67; Morrice McCrae, The National Health Service in Scotland: Origins and Ideals, 1900–1950
(East Linton: Tuckwell Press, 2003); David F. Smith and Malcolm Nicholson, ‘Chemical Physiology
Versus Biochemistry, the Clinic Versus the Laboratory: The Glaswegian Opposition to Edward
Mellanby’s Theory of Rickets’, Proceedings of the Royal College of Physicians of Edinburgh, 19 (1989),
51–60; Charles Webster, The Health Services Since the War, Vols I and II (HMSO, London,
1988–96).
30 For wider discussion, see Bill Schwarz, The White Man’s World (Oxford: Oxford University Press,
2011); Thompson, Britain’s Experience of Empire; Webster, Englishness and Empire; Webster, Imagining
Home.
31 Little has been written on the effects of this returning group in medicine or in other fields;
­Anthony Kirk-Greene, ‘Decolonization: The Ultimate Diaspora’, Journal of Contemporary History, 36
(2001), 131–51, has done important preliminary work documenting the postcolonial second careers
of returning civil servants. Bill Schwarz hints at the political impacts of such returnees in White Man’s
World. I have also written briefly about this subject in Roberta Bivins, ‘Coming “Home” to (Post)
Colonial Medicine: Treating Tropical Bodies in Post-War Britain’, Social History of Medicine, 26
(2013), 1–20.
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12 Contagious Communities

the widely expressed contemporary concerns with these topics as mainly rhetorical.
Instead, authors have focused intently on expressions and experiences of racism;
changing models of citizenship in the wake of imperial decline and decolonization;
and cultural responses to the migrants and the emergence of a ‘multiracial’ Britain.32
In contrast, Contagious Communities focuses specifically on discourse, policies, and
practices that represented and responded to migrant bodies as pathological, patho-
genic, or vulnerable.
I argue that the history of postcolonial migration in Britain—the inward
movement of population from Britain’s colonies, former colonies, and New
Commonwealth—is intricately intertwined with ideas and experiences of health
and disease, and with the history of the NHS and public health in the post-war
Welfare State. Medical and political responses to the migrants reflected the deeply
embedded traditions and attitudes—about race, ‘civilization’, and health—of colo-
nial medicine. At the same time, they were shaped by a vision of national modernity
expressed through a medical state, which was both universally accessible and uni-
versally participatory. In other words, the post-war consensus predicated health(care)
as both the marker and the earned reward of active citizenship.
It is only a striking coincidence that the arrival of the Empire Windrush and
its 492 Jamaican passengers—popularly construed as launching the era of mass
Commonwealth in-migration and multicultural Britain—preceded the NHS
Appointed Day by less than a month. Yet, taken together, these events neatly bring
into conjunction the ‘push’ and ‘pull’ factors of the era’s mass migrations, its key
actors, and a crucial site both of their agency and their disempowerment, the NHS.
Certainly, there was nothing coincidental at all in a pattern of immigration legislation
tailored around, among other economic factors, the Service’s manifest dependency
on colonial and post-colonial labour recruitment. The advent of the NHS, with its
promise of free access to a complete medical service, released a tidal wave of pent-
up medical need, and shone a spotlight on the complete inadequacy of existing
systems to meet that need. By the early 1950s, it was clear that the NHS was
stretched to the limit under its formidable burden of antiquated and bombed-out
hospital stock, and inadequate supplies of increasingly high-tech professional
equipment. But the greatest challenge lay in Britain’s limited facilities for training

32 As well as historical depictions of British racism and racialism, both popular and political, there
are many first-hand accounts. Colin Holmes, John Bull’s Island: Immigration and British Society,
1871–1971 (London: Macmillan, 1988) is a strong general introduction. Herbert, Negotiating Bound-
aries in the City offers an accessible entry point and extensive bibliography of the growing literature
exploring the Asian experience in Britain, as well as an innovative attempt to assess the origins of
white working class racism. Mary Chamberlain, Family Love in the Caribbean: Migration and the
Anglo Caribbean Experience (New Brunswick: Transaction Publishers, 2006) and Karen Fog Olwig,
Caribbean Journeys: An Ethnography of Migration and Home in Three Family Networks (Durham, NC:
Duke University Press, 2007) do similar work with Caribbean examples. On race and citizenship, see
the sharply contrasting accounts of Kathleen Paul, Whitewashing Britain: Race and Citizenship in the
Postwar Era (Ithaca: Cornell University Press, 1997); and Randall Hansen, Citizenship and Immigra-
tion in Post-War Britain: The Institutional Origins of a Multicultural Nation (Oxford: Oxford University
Press, 2000). Hall and Rose, At Home with Empire; Thompson, Britain’s Experience of Empire; and
Webster, Englishness and Empire all present valuable starting points for examining the impact of immi-
gration on British culture.
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Medicine, Migration, and the Afterimage of Empire 13

healthcare staff of all descriptions, from specialist consultants to general practi-

tioners to nurses, medical social workers and health visitors. As all sides recognized,
Aneurin Bevan’s promises could be redeemed only if NHS access to professional
and skilled migrant labour continued unimpeded. Moreover, in a period of
near-full employment, the intimate, dirty, and low-paid work supporting the
edifice and practices of modern medicine—cleaners, carers, and manual workers—
could not attract indigenous British labour. Unskilled, or de-skilled labour too
was essential.33
Paradoxically, however, migration was simultaneously imagined as a threat to
the very institutions in which so many migrants provided essential services. I will
argue here that in the minds of many Britons, the NHS represented more than a
national commitment to health equity, more than a safety net against the bitterly
remembered unfairness of the pre-war period. Its success, and the parallel achieve-
ments of public health services and campaigns, in reducing unnecessary and pre-
mature mortality and alleviating morbidity across the entire British population was
a prized symbol of Britain’s national status and modernity. The decline of tubercu-
losis among the indigenous British population was an especially cherished sign of
progress—and one seen as particularly threatened by immigration. Local, regional,
and national governments in Britain and global bodies like the United Nations
(UN) and the World Health Organisation (WHO) were united in assuming that
migrants from the less developed nations of the New Commonwealth would
­impose greater health costs and risks, particularly of infectious disease on developed
host nations. Moreover, they expected the migrants to be less willing or able to comply
with the demands of modern public health. Politicians, the public, and many in
the medical profession volubly attributed a range of imported infections, bodily
vulnerabilities, and moral or hygienic failures to the migrants. Thus pathologized,
33 As well as Charles Webster’s magisterial (political) History of the Health Services since the War,
the history of the NHS has been detailed in numerous accounts. The three most widely available are
Rudolph Klein, The New Politics of the NHS, 6th edn (Milton Keynes: Radcliffe Publishing, 2010);
Geoffrey Rivett, From Cradle to Grave: Fifty Years of the NHS (London: Kings Fund Publishing, 1998)
(and his regularly updated website http://www.nhshistory.net) and Charles Webster, The National
Health Service: A Political History, 2nd rev edn (Oxford: Oxford University Press, 2002). Both Rosemary
Stevens and Martin Gorsky have reviewed this expansive and disputatious literature, with slightly different
results: see Rosemary Stevens, ‘Fifty Years of the British National Health Service: Mixed Messages,
Diverse Interpretations’, Bulletin of the History of Medicine, 74 (2000), 806–11; Martin Gorsky, ‘The
British National Health Service 1948–2008: A Review of the Historiography’, Social History of Medi-
cine, 21 (2008), 437–60 Although richly attested in the pages of Hansards, and in the records of the
Ministry of Health, accounts of migrants’ contributions to the NHS are thinner on the ground; for
doctors, see Aneez Esmail, ‘Asian Doctors in the NHS: Service and Betrayal’, British Journal of General
Practice, 57 (2007), 827–31; Christopher Kyriakides and Satnam Virdee, ‘Migrant Labour, Racism
and the British National Health Service’, Ethnicity and Health, 8 (2003), 283–305; Parvati Raghuram,
Joanna Bornat, and Leroi Henry, ‘The Co-marking of Aged Bodies and Migrant Bodies: Migrant
Workers’ Contributions to Geriatric Medicine’ in Julia Twigg, Carol Wolkowitz, Rachel Cohen, and
Sarah Nettleton (eds), Body Work in Health and Social Care: Critical Themes New Agendas (Oxford:
Blackwell, 2011), 147–61; David Smith, Overseas Doctors in the National Health Service (London:
Policy Studies Institute, 1980). For nurses, see Louise Ryan, ‘Who do you Think you are? Irish Nurses
Encountering Ethnicity and Constructing Identity in Britain’, Ethnic and Racial Studies, 30 (2007),
416–38; Linda Ali, West Indian Nurses and the National Health Service in Britain 1950–1968 (PhD
thesis, University of York, 2001) In contrast, see Jessica Howell, ‘Nursing Empire: Travel Letters from
Africa and the Caribbean’, Studies in Travel Writing, 17 (2013), 62–77.
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14 Contagious Communities

their presence was constructed as endangering both the health improvements

British ‘natives’ had earned through their wartime efforts, and Britain’s already
­fragile standing among the world’s leading nations.
Approaches to the intersections of medicine and migration in the context of
mid- and late twentieth-century Britain have largely focused either on imported,
often exotic, ‘burdens of disease’ or on racially-linked domestic (or border-crossing)
‘health inequalities’.34 While these dominant tropes remain central to this volume
as well, it also highlights the much greater diversity of lenses through which the
medical impacts of migration were interpreted by medical professionals, politicians,
civil servants, the press, and the general public. Migrants and the multi-generational
communities they nucleated in Britain were understood as cancers, as ‘colonies’—
both political and bacterial—and as resources, particularly for leading-edge medical
research and the mundane servicing of the NHS. At the same time, they were, as
one medical author put it in 1965, the ‘intravenous radioactive isotope, showing
up blockages and points of strain in our society’—a role which they certainly serve
in this volume.35
In no small part, this diversity of conceptions reflects the increasing variety of
medical models through which migrants’ bodies, capacities, and needs could be
read. The ‘medical gaze’, eugenics, and microbiology—the biomedical tools which
dominated efforts to identify, contain, and control the ‘immigrant menace’ from
the late nineteenth through the early twentieth centuries—remained important.
But these approaches were joined by epidemiology, biochemistry, and molecular
genetics. To capture this shift, and the ways in which new and established modes
of interpreting immigrant embodiment interacted in late twentieth-century Britain,
Contagious Communities explores reactions to post-war immigration through a series
of different diseases and conditions, all associated closely with particular migrant
and ethnic groups.
Two of these are classic ‘port health’ diseases, contagious and readily commu-
nicable. Once the archetypal ‘disease of civilization’, devastatingly exported from
industrial cities to tropical colonies, tuberculosis became the model ‘immigrant’
illness in this period.36 Familiar enough to be fearsome, tuberculosis was—after
massive wartime public health efforts and with the discovery of antibiotics—
seemingly on the verge of eradication among the majority community. Yet this

34 See Waquar I. U. Ahmad (ed.), ‘Race’ and Health in Contemporary Britain (Buckingham: Open
University Press, 1993); Raj Bhopal, ‘Research Agenda for Tackling Inequalities Related to Migration
and Ethnicity in Europe’, Journal of Public Health, 34 (2012), 167–73; Hannah Bradby and James
Nazroo, ‘Health, Ethnicity and Race’, in William Cockerham (ed.), The New Blackwell Companion to
Medical Sociology (Malden, Oxford: Wiley-Blackwell, 2010), 113–29; Convery, Welshman, and
Bashford, ‘Where is the Border?’; Jenny Donovan, ‘Ethnicity and Health: A Research Review’, Social
Science & Medicine, 19 (1984), 663–70; Jenny Donovan, We Don’t Buy Sickness, It Just Comes: Health,
Illness and Health Care in the Lives of Black People in England (Aldershot: Gower, 1986); Chris Smaje,
Health, ‘Race’ and Ethnicity: Making Sense of the Evidence (London: King’s Fund, 1995); Evan Smith
and Marinella Marmo, Race, Gender and the Body in British Immigration Control: Subject to Examin-
ation (Basingstoke: Palgrave Macmillan, 2014).
35 ‘Immigration’, Lancet (18 December 1965), 1286.
36 Mark Harrison, Michael Worboys, ‘A Disease of Civilisation: Tuberculosis in Britain, Africa and
India, 1900–1939’, in Marks and Worboys, Migrants, Minorities and Health, 93–124.
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Medicine, Migration, and the Afterimage of Empire 15

highly transmissible disease was undeniably common among Britain’s migrants.

As the sole public health threat which could convincingly be attributed to immi-
gration, tuberculosis attracted the lion’s share of medical, political, and public
attention from 1948 through to the end of the 1960s. Smallpox, meanwhile, was
already officially extinct in Britain despite regular importations from empire
throughout the inter-war and war years. Nonetheless, it too came to have particular
resonance in relation to the immigration debates, demonstrating the dangerously
permeable boundaries between national policy and geopolitics, as well as between
endemic and disease-free territories.
While tuberculosis and smallpox posed real, if often exaggerated risks to the
British public, other diseases commonly linked to immigration physically affected
only the migrants themselves. The bone-softening disorder rickets (in adults,
osteomalacia) was, like tuberculosis and smallpox, once common in Britain—so
common that it was long called the ‘English disease’. Eliminated among the indi-
genous poor by direct and forceful state intervention during the Second World
War, rickets was transmuted, by politics and by science, from a marker of poverty
into an imported ‘tropical’ disease in the 1960s and ’70s. If introduced infections
seemed to threaten individual British bodies, the return of rickets among South
Asian immigrants and their children endangered the body politic, signifying failed
assimilation and imperilled national modernity. It therefore drew unprecedented
medical attention to the newcomers’ diets, dress, and daily lives. Yet responses to
rickets also demonstrate the impact of wider societal shifts as ‘migrants’ became
‘ethnic minorities’, and as ‘race relations’ gradually reshaped official attitudes to-
wards both racial discrimination and health disparities. Policy responses were
profoundly influenced by the nutritional expertise of returning colonial medical
workers. At the same time, this non-contagious chronic condition provided research
opportunities on biochemistry’s leading edge, thus creating links between elite bio-
medicine and the under-served poor of Britain’s inner cities.
Finally, the volume closes with the racialized ‘immigrant’ body on the cusp of
the genomic revolution, when the presence in domestic populations of sickle
cell anaemia and thalassaemia—genetic disorders of the blood—became a vital
resource in Britain’s battle for international scientific standing. The final case
study explores the impact of molecular genetics on medical responses to migrant
and ethnic minority groups who were assumed to be genetically distinctive, and
on medical policy making in the shadow of ‘race’. The 1949 discovery that sickle
cell anaemia could be directly linked to a specific genetic miscoding put an
under-studied, under-funded, and, in the UK, initially uncommon genetic dis-
ease at the forefront of biomedical science. Researchers rapidly discovered that
the deadly heritable condition thalassaemia also resulted from genetic coding
errors affecting the manufacture of the haemoglobin molecule. Like rickets, the
haemoglobinopathies sickle cell and thalassaemia suddenly attracted intense
clinical and scientific attention. And like rickets, this medical attention brought
media and political scrutiny in its wake. Crucially, Britain’s ‘immigrant’ commu-
nities were again positioned as a valuable resource in the battle to maintain the
nation’s biomedical leadership.
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16 Contagious Communities

In Part One of Contagious Communities, responses to TB among migrants to the

UK offer a window on understandings of immigration in the last years of imperial
identity and ‘open door’ migration policies. In the nineteenth and early twentieth-
century metropolitan centres of empire, TB was a disease of poverty, and particularly
of the industrial and urban poor. Hard to diagnose in port health settings, and
endemic across Europe and North America, TB (like venereal disease) was specif-
ically excluded from control under the International Sanitary Regulations. In
the settler-colony nations (for example, Canada, Australia, New Zealand, and the
USA), separate legislation brought it under remit of border health controls and
rendered it an excludable disease by the first decade of the twentieth century, despite
difficulties in obtaining a swift and reliable diagnosis.37 However, in Edwardian
Britain, with less immigration and a more laissez-faire attitude towards border con-
trol (driven by a commitment to the free movement of trade), migrants were only
one more vulnerable population at great risk of tuberculosis. Moreover, it was well-
recognized that many contracted tuberculosis only after arrival in the urban slums
of their host countries. Representations of TB as a specific ‘disease of immigration’
thus only began to appear after the Second World War.
Chapter 1 covers the period from the 1948 British Nationality Act—which expli-
citly defined a shared Citizenship of the United Kingdom and Colonies, enveloping
equally the populations of the British archipelago, the established nations that
emerged from Britain’s white settler colonies, and the new and aspiring nations of
the tropical empire—to the mid-1950s. It explores the medicalization of migration
in the absence of race, through a close examination of medical and political responses
to tuberculous European and Irish migrants. The high incidence of tuberculosis
among these populations provoked public and professional calls for health checks
and a variety of interventions. However, the emergence of a specialist discourse of
‘susceptibility’ rendered their illness innocent; moreover, their labour was essential
to reconstructing Britain—and in the case of the infectious Irish, they were ‘kith
and kin’. In the absence of either medical or bureaucratic consensus, this combin-
ation was sufficient to short-circuit demands for immigration controls.
Chapter 2 tracks the shift from a weakly medicalized to an increasingly racialized—
and politicized—response as rising numbers of West Indian and South Asian eco-
nomic migrants attracted public, political, and medical attention from which
European Cold War refugees were tellingly exempt. By the end of the decade,
momentum was building for a post-imperial and more exclusive British identity,
and with it a far more rigorous regime of entry controls. Lay, professional, and
political interest in the ‘susceptible migrant’ was replaced by moral panic about

37 While it was possible to identity tubercule bacilli in sputum, not all clinically diagnosed individ-
uals produced sputum samples containing the bacilli; tuberculin testing, by contrast, might identify as
tubercular individuals with no clinical signs (those who had been exposed to TB but had successfully
resisted infection were just as liable to a positive result as those in whom early or latent disease per-
sisted). See Fairchild, Science at the Borders, 161–72 for an interesting analysis of the US case, in which the
role of medical debates foreshadows their importance in post-war Britain. Barron Lerner, among others
has discussed the difficulty of establishing a TB diagnosis (even after radiographic analysis became
possible). See Barron Lerner, ‘The Perils of “X-Ray Vision”: How Radiographic Images have Historic-
ally Influenced Perception’, Perspectives in Biology and Medicine 36, (1992), 382–97 at 389.
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Medicine, Migration, and the Afterimage of Empire 17

‘suspect’ disease carriers exploiting ‘loop-holes’ in Britain’s epidemiological de-

fences. In a foretaste of things to come, public attention was tightly focused
on ‘coloured’ migrants as vectors of tuberculosis contagion, despite considerable
evidence that such populations contributed a negligible volume of new infec-
tion. Yet in terms of immigration policy and public health practice, the decade
was a stable one. Tuberculosis provided a node at which expert and popular anx-
ieties converged. While this intersection of interests attracted growing political
and medial traffic, Whitehall resistance both to medicalization and to control
remained intact.
In Part Two, Contagious Communities moves into the era both of immigration
control—the closing of Britain’s ‘open door’—and the implementation of ‘race
relations’ legislation. Chapter 3 captures the moment when Britain definitively
ceased to be ‘home’ for its extended imperial family. It sifts the circumstances
under which Britain passed the 1962 Commonwealth Immigrants Act, and delin-
eates an unexpected role for smallpox in lowering bureaucratic and expert resistance
to politicizing migrant health or medicalizing calls for immigration restriction.
Late in 1961, the Conservative government introduced legislation to restrict
immigration from the Commonwealth. Weeks later, amongst a flood of migrants
anxious to forestall their exclusion, five Pakistani migrants brought smallpox to
Britain. The disease outbreaks which followed smouldered through the spring
of 1962, as the Commonwealth Immigrants Act was debated and finally enacted
in Parliament. These imported smallpox outbreaks renewed by far the oldest
and institutionally most established medical vision of immigration, one which
portrayed migrants as vectors of epidemic disease. This is the model of population
movement which had initially terrified Europe (and the nations which received
her migrants), and against which the International Sanitary Regulations stood
as a bulwark.
Smallpox itself, like tuberculosis, was a familiar if frightening presence on
Britain’s medical stage. Although the disease was no longer endemic, the UK had
experienced numerous outbreaks in interwar period and in the aftermath of the
Second World War. Tourists, businessmen, service personnel, colonial officers, and
foreign students had all imported smallpox, inadvertently spreading it among
family members and strangers alike, often along the corridors of Britain’s dense
transport network. For half a century, the close net of British public health surveil-
lance had reliably ensured the rapid identification of smallpox cases, and ring-fence
vaccination of their contacts. Thus although Britain was especially vulnerable to
such recurrences because of its colonial ties and poor rates of smallpox vaccination,
its population had every reason to remain calm in the face of the 1961–62 recur-
rence. However, despite the many similarities between the 1961–62 outbreak and
those which had immediately preceded it, the British media and politicians por-
trayed the event as novel and unprecedented. It is no coincidence that this ‘smallpox
invasion’, occurring at a crucial junction in Britain’s post-colonial history, provoked
media frenzy unmatched by responses to similar outbreaks in the immediately
post-war era. Chapter 3 will explore this concatenation, and its enduring effects on the
immigration debates, public perceptions, and the medical surveillance of migrants.
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18 Contagious Communities

Through the same lens, it exposes the impact of an increasingly global media on
discourses of race, disease and ‘belonging’.
After this epidemic interlude, Chapter 4 returns to the tubercular migrant, now
strongly racialized and subject to potentially exclusionary border health controls.
How did the new vistas of surveillance and control created by the 1962 Common-
wealth Immigrants Act affect medical and political responses to immigration from
the postcolonial world? In fact, despite empowering legislation and heightened
attention to migrants as vectors of infection, Britain’s apparently medicalized bor-
ders remained stubbornly porous to migrants and mycobacteria alike. While the
nation’s immigration policy was increasingly restrictive, its immigration practices
were another matter. Constrained by economics and hamstrung by resistance
elsewhere in Whitehall, the Ministry of Health remained focused on internal and
integrative, rather than external and exclusionary health surveillance of the new-
comers. Here too, I will begin to address the political twinning of immigration
restriction and ‘race relations’ legislation. What effects did laws against racial dis-
crimination have on the provision of health and social services to migrants and
ethnic minority communities, and how did an increasingly restrictive immigration
regime affect social and political responses to the medical needs of these groups?
Despite the rising incidence of tuberculosis among settled migrants, rates among
the majority population continued to plummet (simultaneously revealing the limi-
tations of 1965’s toothless Race Relations Act). By 1968, when Britain shockingly
excluded Kenyan Asian passport holders, popular racism had replaced tuberculosis
as the iconic imported ‘disease’ of immigration.
The examples of smallpox and tuberculosis illustrate the persistence of the trad-
itional association between immigration and communicable disease, and the
durability of medical responses focused on the surveillance, identification, and
control of potentially contagious individuals. The significant role played by these
diseases in debates over immigration control and the nature of ‘belonging’ in Britain
indicates their impact on post-war responses to migrants and the communities
they established. However, the years between 1948 and 1991 also saw significant
changes both in patterns of immigration, and in dominant medical paradigms of
disease causation. The ongoing epidemiological transition—the decline of acute
infectious diseases, and the corresponding emergence of chronic, inherited or
lifestyle-linked morbidity and mortality—brought into prominence a new set of
healthcare priorities, and medical research questions. As tuberculosis lost its grip
on the public imagination and its potency in political debate, wider changes acted
to bring new ‘immigrant’ diseases to the fore.
Part Three of Contagious Communities focuses on nutritional and genetic condi-
tions. Each chapter examines the impact of new medical models of disease and
new patterns of morbidity on public, political, and medical responses to immigra-
tion and ethnicity. Moreover, these chapters will unpick the increasingly complex
nexus of relationships between racial politics, patients, communities, and the med-
ical professions in the context of race relations legislation, major NHS reforms,
and rising patient and community health activism. They examine the changing
valence of ‘race’ in medicine and society during and after the advent of race relations
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Medicine, Migration, and the Afterimage of Empire 19

legislation in the late 1960s and ’70s. How does—and how should—the modern
state engage with culturally distinctive communities who also apparently share cer-
tain heritable traits and susceptibilities? Responses to ‘Asian rickets’ and the genetic
haemoglobinopathies illuminate aspects of a biomedical present dominated by
molecular understandings of disease and risk, but also by ever-louder state calls for
individual responsibility on one hand, and increasingly vociferous patient and
community activism on the other. Thus, these chapters document the transform-
ation of Britain’s West Indian and South Asian communities from scrutinized ‘immi-
grants’ to domestic political actors.
Chapter 5 explores the childhood deficiency disease rickets (and its adult form
osteomalacia), and the perspective it offers on ‘race’, assimilationism, and commu-
nity agency—as well as the persistence of ‘colonial’ medicine. Questions of nutrition
and diet were high on the healthcare agenda in post-war Britain, buoyed by the
government’s generally successful management of the tightly rationed wartime
food supply in accordance with nutritional science, and by enduring practices of
welfare feeding linked to maternal and child health. Nutritional deficit diseases
like rickets, once a familiar feature of Britain’s epidemiological landscape, had like
TB all but disappeared from the indigenous population, to the not inconsiderable
gratification of medical professionals, health policy makers, and the public alike.
Their absence revealed an underlying stratum of complex inherited metabolic dis-
orders, and a new clinical and biochemical frontier: the opportunity to unravel the
mysteries of normal metabolism. It is at this critical juncture that the interests of
Britain’s elite biochemical research community and its growing immigrant and
ethnic minority communities coincided: by the 1960s, rickets, like TB before it,
was making an ominous but useful reappearance in the bodies of children born to
Britain’s new ethnically Asian populations.
At the same time, nutritional policy was increasingly being shaped by a cadre
of professionals whose skills had been honed in Britain’s tropical colonies. Their
responses to nutritional deficiency in Britain projected those experiences and
sensibilities onto a population that must have looked hauntingly familiar, if unex-
pectedly close to home. Thus while elite biochemists and general practitioners alike
called for a return to the direct interventions that had eradicated rickets during the
war, those making central policy assumed that such responses would be culturally
unacceptable (as well as economically unpalatable). Instead they sponsored health
education intended to teach ‘Asians’ how to adapt to British climes and norms. Yet
as racism was itself increasingly pathologized in the 1970s, the tentative ‘race rela-
tions’ discourse of the mid-1960s gained new force. New actors interpreted the ill
health of Britain’s racialized minorities as an indicator of failings in the Welfare State.
By the mid- 1970s, the persistence of what had become ‘Asian rickets’ prompted
shocked commentary in the media and some sectors of the medical press. When
Margaret Thatcher’s Conservative government took power, such criticism finally
provoked a response from the medical state. Framed by neoliberal ideologies of
self-help and utterly resistant both to direct interventions and to any hint of bio-
logical distinctiveness, the 1981 ‘Stop Rickets’ campaign mixed old-fashioned
assimilationism with a new drive to actively engage and medically integrate affected
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20 Contagious Communities

communities. It thus offers a unique perspective on ‘race’ and racialization at the

intersection of race relations and molecular biology.
In Chapter 6, sickle cell anaemia and thalassaemia offer another route through
this dangerous intersection, and another perspective on the international commu-
nities, both lay and professional who populate it. While racial politics and poor
access to healthcare poisoned relations between US researchers and the affected
African–American population, Britain’s old imperial connections provided British
clinical and research geneticists with a treasure trove of baseline data. Its newly di-
verse domestic populations and universally accessible National Health Service
offered ample and in one case enthusiastic ‘clinical material’. Preoccupied with
contagious disease throughout the 1960s, government authorities initially ignored
growing medical concern about genetic conditions. However, if the medical state
declined to intervene, British medical elites increasingly saw and seized an oppor-
tunity to gain a competitive edge in its battle for international standing, especially
in comparison to the USA. At the same time, affected individuals, families, and
communities sought new ways to navigate Britain’s medical systems. This case
study explores the use of racial politics as leverage against entrenched resistance to
targeting resources specifically towards ‘minority’ needs. Here, too, I consider the
role of genetics in the revival of ‘race’ as a biological entity in medicine and society,
tracking evolving professional and political interpretations of race through the
optic of genetic disease.
Drawing together the evidence of all five case studies, the Conclusion reflects
on British strategies for responding to immigration and diversity, as well as their
medical sequelae. My interest in this volume is not specifically with what has been
described as the ‘racialization’ of British immigration policy, although of course,
the rewriting of British citizenship in the post-war and post-imperial period is an
important element of my story. The historical record comprehensively demonstrates
that ‘race’—and especially fears about Britain becoming a multiracial nation—
played a central, but by no means a solo role in the post-war reformation of British
citizenship and identity. Instead, this book asks how and why medical actors, pol-
icies, expertise, and assumptions became entangled in this process. It documents
tensions between views of science as authoritative and forces that made it politic-
ally weak; and tensions between the urge of the medical state to intervene and its
desire to avoid the twin traps of politicization and racialization. And it seeks to
demonstrate the ways in which the balance between these tensions shifted along
with attitudes towards race. In short, Contagious Communities explores complex
British responses to the medical—and the diversely medicalized—challenges posed
by the post-war increase in racial and cultural diversity. Its case studies expose both
changes and continuities in popular and medical understandings of ‘race’, and
reveal the roles played by such conceptions in biomedical, political, and institu-
tional interpretations of migrant and ethnic health and illness.
 OUP CORRECTED PROOF – FINAL, 07/17/2015, SPi

PA RT I
T U B E RC U L O S I S I N B L A C K
AND WHITE: MEDICINE,
M I G R AT I O N , A N D R A C E I N
‘ O P E N D O O R ’ B R I TA I N

Tuberculosis was a quotidian fact of daily life in Britain in the early years of the
National Health Service (NHS), just as it had been since the first decades of the
twentieth century. So familiar that two letters (TB) sufficed to designate it in al-
most any context, tuberculosis remained endemic across the British Isles, as well
as Europe and much of North America. Contemporary Britons witnessed its symp-
toms and knew the rigours of its treatment; a half-century of campaigning, in-
tensified during the Second World War, rendered many equally well-aware of the
means by which the disease could be prevented. However, its familiarity in no way
erased the stigma experienced by TB sufferers, nor obscured its still-heavy death
toll in the mid-twentieth century. In the immediate post-war period, TB re-
mained Britain’s most deadly contagious disease. As a ‘disease of civilization’—a
term rooted in the realization that tuberculosis endemicity followed in the wake
of exploration and empire—its presence was naturalized as an inevitable feature
of urban industrial life, and even a portable marker of modernity.1 So how did
this endemic British disease become, in the final third of the twentieth century,
the archetypal ‘immigrant problem’ and ‘imported illness’?
In 1950s Britain, TB prompted two narratives that impinged on each other
without ever being fully integrated. For most of the population, in most of the
UK, the story was one of declining mortality, morbidity, and visibility. Tubercu-
losis became a disease of old men and ‘problem families’. These changes played
out slowly in Scotland, Wales, and Northern Ireland, more quickly in England’s
prosperous suburban south. Rural agricultural communities (and urban consumers)
also experienced the transformation of milk and meat production as tuberculosis
was eliminated from the national herd. This story of decline was, of course, one of
mass miniature radiography, screening campaigns, antibiotics, and for some, the

1 Mark Harrison and Michael Worboys, ‘A Disease of Civilisation: Tuberculosis in Britain, Africa
and India, 1900–1939’, in Lara Marks and Michael Worboys (eds), Migrants, Minorities and Health:
Historical and Contemporary Studies (London: Routledge, 1997), 93–124.
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22 Contagious Communities

Bacillus Calmette–Guérin (BCG) vaccine; but also of gradually-emptying tuber-

culosis sanatoria and wards—and of reconstruction, re-housing, and improving
nutrition. The eradication of tuberculosis, so confidently predicted as the
decade began, proved to be a fairytale, but for many thousands of infected
Britons, there was certainly a much happier ending than even the most opti-
mistic experts would have predicted a decade earlier.
The second tuberculosis narrative, and the one which will preoccupy the next
two chapters, was told in more sombre tones by and to medical experts, general
practitioners, public health workers, politicians, municipal authorities, and the
residents of Britain’s devastated inner cities. This story was one of progress re-
tarded, health undermined, and modernity spoiled by newcomers who never quite
‘belonged’, whose motives in coming to Britain were inherently suspect, and who
were often perceived to exploit what many indigenous Britons felt they (alone) had
earned through the privations and sacrifices of the Second World War: the benefits
and protections of the Welfare State. The exact objects of local suspicion changed
over the course of the decade. European refugees and migrant workers, then Irish
immigrants, later the West Indians, and finally Indian and Pakistani migrants all in
their turn assumed the leading role in this tuberculosis discourse.
This repeated re-framing and re-direction of popular, political, and professional
attention was based in part on rates of migration and the visibility of different mi-
grant groups. It also reflected shifting medical models of tuberculosis epidemi-
ology, and changes in the practices and organization of public health. As we will
see, the publication of official and semi-official data on the incidence of TB among
different populations in 1953, 1957, and 1960 had significant effects. Alterations
in the wider—sometimes much wider—context, too, were crucial: in Whitehall
and Westminster, on hospital corridors, and in the streets, attitudes towards dif-
ferent migrant groups responded to the availability of housing and employment;
cultural perceptions of the in-comers themselves; current events in Britain (for
example, the Coronation and the Notting Hill riots); and Cold War geopolitics
(marked here by the failed Hungarian uprising and subsequent refugee crisis, as
well as delicate negotiations with non-aligned India and Pakistan).
In this Part’s first chapter, I sketch the relationship between tuberculosis and
immigration from the early years of the National Health Service to the mid-1950s.
At the beginning of this period, immigrants were ‘discovered’ to be the immuno-
logically naïve victims of a more sophisticated bacteriological environment. By its
end, discussions of the tuberculous migrant were becoming increasingly entangled
with assumptions about ‘colour’ and ‘race’. The second chapter examines the varying
responses made to different groups of ‘suspect’ migrants as ‘imported’ disease be-
came ammunition in a social and political battle over the definition of Britain’s na-
tional and international identity. Yet despite the marked interpretive shifts which
these chapters will document, close scrutiny reveals a period during which health
and immigration policy were relatively stable. If senior figures in Whitehall and
Westminster looked ahead with foreboding, they certainly showed little inclination
to reveal or act on their fears. This Part therefore explores the intersections between
public, political, and expert understandings of ‘immigrant tuberculosis’ just before
those discourses gained operational definition and force.
 OUP CORRECTED PROOF – FINAL, 07/17/2015, SPi

1
Suspicions and ‘Susceptibility’
The Tuberculous Migrant 1948–1955

Relatively little scholarly work has been done on the rhetoric and practices surrounding
tuberculosis in post-war Britain. In general, authors addressing tuberculosis in this
period have been preoccupied by a set of transformational technologies and their
effects: specifically, mass miniature radiography, tuberculin-based diagnostic testing,
Bacillus Calmette-Guérin (BCG) vaccination, antibiotic chemotherapies, and the
closure or repurposing of TB sanatoria, chest clinics, and other public health insti-
tutions previously dedicated to this demoted ‘captain of the men of death’.1 Like
many medical practitioners both at the time and since, historians have been cap-
tivated by the astonishing decline of TB in the developed world, rather than its

1 Tuberculosis has been the subject of extensive historical investigation, resulting in a rich scholarly
literature. The classic study is René Dubos and Jean Dubos, The White Plague: Tuberculosis, Man and
Society (Boston: Little, Brown and Co., 1953). Thomas McKeown, The Modern Rise of Population
(London: Edward Arnold, 1976) used tuberculosis as a key example illustrating his argument that
improved standards of living, rather than medical interventions, had prompted the demographic tran-
sition. However, national histories of tuberculosis have rarely extended detailed analyses into the
post-war period (1950, in particular, has become a favoured terminus): e.g. Lynda Bryder, Below the
Magic Mountain: A Social History of Tuberculosis in Twentieth Century Britain (Oxford: Clarendon
Press, 1988); Greta Jones, ‘Captain of all these Men of Death’: The History of Tuberculosis in Nineteenth
and Twentieth Century Ireland (Amsterdam: Rodopi, 2001); William Johnston, The Modern Epidemic:
A History of Tuberculosis in Japan (Cambridge, MA: Harvard University Press, 1995); Katherine
McCuiag, The Weariness, the Fever and the Fret: the Campaign against Tuberculosis in Canada 1900–1950
(Montreal: McGill-Queen’s University Press, 1999); Katherine Ott, Fevered Lives: Tuberculosis in
American Culture since 1870 (Cambridge, MA: Harvard University Press, 1996); F.B. Smith, The Retreat
of Tuberculosis, 1850–1950 (London: Croom Helm, 1988); Michael E. Teller, The Tuberculosis Move-
ment: A Public Health Campaign in the Progressive Era (Westport, CT: Greenwood Press, 1988). In the
last decade, scholarly articles have broached the post-war period to address international health efforts
(often in conjunction with the new technologies) and campaigns targeting particular marginalized
groups: e.g. Niels Brimnes, ‘Vikings against Tuberculosis: The International Tuberculosis Campaign
in India, 1948–1951’, Bulletin of the History of Medicine, 81 (2007), 407–30; Laurie Meijer Drees,
‘The Nanaimo and Charles Camsell Indian Hospitals: First Nations’ Narratives of Health Care, 1945
to 1965’, Histoire sociale/Social History, 43 (2010), 165–91; David S. Jones, ‘The Health Care Experi-
ments at Many Farms: The Navajo, Tuberculosis, and the Limits of Modern Medicine, 1952–1962’,
Bulletin of the History of Medicine, 76 (2002), 749–90; Barron Lerner, Contagion and Confinement:
Controlling Tuberculosis along Skid Row (Baltimore: Johns Hopkins University Press, 1998), and the
essays in Flurin Condrau and Michael Worboys (eds), Tuberculosis Then and Now: Perspectives on the
History of an Infection Disease (London: McGill-Queen’s University Press, 2010). Other recent work
has examined late twentieth and twenty-first century TB in conjunction with AIDS/HIV and the
emergence of multiple drug resist strains: e.g. Richard Coker, From Chaos to Coercion: Detention and
the Control of Tuberculosis (New York: St. Martin’s Press, 2000). Helen Bynum, Spitting Blood: The
History of Tuberculosis (Oxford: Oxford University Press, 2012) likewise offers a quick sketch of the
post-war period, but her focus is largely international.
OUP CORRECTED PROOF – FINAL, 07/17/2015, SPi

24 Contagious Communities

persistence. Yet tuberculosis did persist, even under the new dispensation of ‘commu-
nitarian medicine’ exemplified by the NHS.2 Its near-disappearance from Britain’s
majority population only rendered more visible—and more threatening—those
marginal groups among whom TB had not been conquered. Britain’s immigrants
fell exactly into this category.
In post-war Britain, medical practitioners, politicians, and the public alike
believed that uncontrolled migration could only expand the shrinking TB ‘infector
pool’ of hygienically and medically intransigent individuals, thus perpetuating the
disease. Worse, while the continued prevalence of a curable infectious disease
threatened British claims to medical modernity and burdened the NHS, mounting
evidence of racial bias in popular and political responses to immigration under-
mined cherished British myths of national tolerance, and its status as a model for
its ‘multicultural’ empire. The apparent stasis of official responses to ‘immigrant
tuberculosis’ in the 1950s camouflages a finely-balanced struggle between those
(mainly politicians and medical professionals) eager to medicalize the political
problem of immigration, and those (principally within the Ministry of Health)
who adamantly resisted such a change. But what was the status quo ante: in what
contexts and on what platforms were assumptions and arguments about infectious
immigrants built? In the succeeding sections, I will delineate the social and eco-
nomic context, and assess the positions towards immigrant tuberculosis taken—
and largely held—by politicians, civil servants, medical specialists, and the press
between 1948 and 1955.
In Britain, the period of post-war reconstruction was marked by full employment
and labour shortages. In response, public and private bodies actively recruited both
skilled and unskilled labour, initially from Europe’s refugee camps (European
Volunteer Workers, or EVWs).3 Economic conditions simultaneously escalated

2 John Pickstone, ‘Production, Community and Consumption: the Political Economy of Twentieth-­
Century Medicine’, in Roger Cooter and John Pickstone (eds), Companion to Medicine in the Twentieth
Century (London: Routledge, 2003), 1–20 at 3.
3 It is worth noting that these programmes routinely excluded Europe’s surviving Jewish popu-
lations, ironically on the grounds that their presence might stimulate British anti-semitism (and
subtextually, that they were neither racially compatible with the English nor physically suited to the
jobs available). See Wendy Webster, ‘The Empire Comes Home: Commonwealth Migration to
Britain’, in Andrew Thompson (ed.), Britain’s Experience of Empire in the Twentieth Century (Oxford:
Oxford University Press, 2012), 122–60, at 140–1; Gavin Schaffer, Racial Science and British Society,
1930–1962 (Basingstoke: Palgrave Macmillan, 2007), 107–14. For further analysis of European migrant
groups, see Kathy Burrell, Moving Stories: Narratives of Nation and Migration among Europeans in
Post-war Britain (Aldershot: Ashgate, 2006); Tony Kushner, ‘Anti-semitism and Austerity: the August
1947 Riots in Britain’, in Panikos Panayi (ed.), Racial Violence in Britain in the Nineteenth and Twentieth
Centuries (London: Leicester University Press, 1996); Tony Kushner, We Europeans? Mass Observation,
‘Race’ and British Identity in the Twentieth Century (Aldershot: Ashgate, 2004); Louise Ryan and
Wendy Webster (eds), Gendering Migration: Masculinity, Femininity, and Ethnicity in Post-War Britain
(Aldershot: Ashgate, 2008). Those Jews who were admitted were chosen for and encouraged to maintain
‘invisibility’—which may in part explain the compete silence of these files about health and disease
among ethnically or religiously Jewish migrants. See Claudia Curio, ‘“Invisible” Children: The Selec-
tion and Integration Strategies of Relief Organizations’, Shofar: An Interdisciplinary Journal of Jewish
Studies, 23 (2004), 41–56, and Tony Kushner and Katharine Knox, Refugees in an Age of Genocide:
Global, National and Local Perspectives during the Twentieth Century (London: Frank Cass, 1999),
126–216.
 OUP CORRECTED PROOF – FINAL, 07/17/2015, SPi

The Tuberculous Migrant 1948–1955 25

the familiar cycle of migration and return which had long characterized migration
from the Irish republic to the UK. The employment boom—combined with new
restrictions imposed by the 1952 McCarran-Walter Act on would-be Caribbean
migrants to the USA and political turmoil in the Indian subcontinent—also
prompted the first wave of mass migration to the UK from Britain’s ‘New
Commonwealth’.4 Invisible to border controls under the 1948 British Nationality
Act, all Commonwealth, colonial, and Irish citizens were entitled to free entry and
right of abode in Britain, their imperial ‘home’. Whatever their ethnicity or national
origins, such migrants’ ready access to the ‘mother country’ and their entitlement
to its tax-funded welfare and health services provoked controversy. As this chapter
will demonstrate, generic anxieties about the distribution of public resources were
gradually amplified by tensions around ‘colour’ and by fears that the arrival and
settlement of racialized groups would spoil Britain’s nascent post-imperial identity
as a progressive, egalitarian, and modern nation—still world leading, if no longer
ruling a global empire.

‘ K E E P A N E Y E O N YO U R C H E S T ’: T U B E RC U L O S I S
A N D T H E M A J O R I T Y P O P U L AT I O N , 1 9 4 8 – 1 9 5 8

One aspect of post-war British identity was rooted in welcome improvements in

the health and life-spans of indigenous Britons, and especially their reduced mor-
bidity from preventable diseases, including tuberculosis. By the mid-twentieth
century, tuberculosis was a disease in decline in Britain, as in much of the industri-
alized world. Building on the sometimes polemical work of an earlier generation of
historians interested in the causes for this decline (theories have focused variously
on improved nutrition, better housing stock, public health campaigns, and a
variety of medical interventions), scholars including Anne Hardy have explored
perceptions of the disease and its decline, and have studied organized efforts to
sustain the plummeting trend in tuberculosis incidence in the middle years of the
twentieth century.5 The massive demand for labour created by the Second World
War prompted major changes in state responses to tuberculosis, with the advent of
social support systems including allowances, rehabilitation services, and a rapid
increase in hospital beds for tuberculosis patients.6 In the war’s aftermath and with
the arrival of the National Health Service, popular and professional attention
began to focus on the possibility of eliminating the disease altogether. A 1949
Times lead article, for example, excoriated British ‘backwardness’ for allowing an
estimated 400 people a week in England and Wales to die of TB. Why, it asked,

4 The term ‘New Commonwealth’ came to refer to all of the emerging nations and remaining
colonial territories of Britain’s disintegrating empire except the old Dominions of Australia, Canada,
and New Zealand (and for some, white South Africa).
5 Anne Hardy, ‘Reframing Disease: Changing Perceptions of Tuberculosis in England and Wales,
1938–70’, Historical Research, 76 (2003), 535–56.
6 Linda Bryder, Below the Magic Mountain, 227; John Welshman, Municipal Medicine: Public
Health in Twentieth Century Britain (Oxford: Peter Lang, 2000), 149–57.
OUP CORRECTED PROOF – FINAL, 07/17/2015, SPi

26 Contagious Communities

were doctors not emulating Britain’s veterinarians, already committed to using all
available technologies to eradicate tuberculosis in the national herd? New tech-
nologies and treatments could, the editors claimed, eliminate TB as ‘a national
ailment’, if only they were applied. The article despaired of ‘experts quibbling over
statistics’, a reference to the drawn-out process by which the BCG vaccine was
grudgingly approved for limited use in the UK in 1949. Echoing an article in
the esteemed Lancet medical journal, the editors demanded more active Ministry
of Health leadership, and condemned ‘[c]omplacency and lack of enthusiasm’.7
In the weeks following this editorial exhortation, the Times published a series of
letters from chest physicians, anti-TB campaigners, other medical practitioners,
and members of the public. Each letter supported the Times’ position and demanded
further action, often comparing Britain unfavourably to other nations and decrying
the economic and human costs of failures in prevention, detection, and cure. The
solutions proposed by these correspondents, concerned with TB among Britain’s
majority population, clearly endorsed the broad approach to population health
associated with social medicine, rather than the narrower biomedical methodolo-
gies linked to an emerging model of health as a matter of individual risk and
responsibility. They called for ‘continuously improving nutritional and general social
standards’ and, like the National Association for the Prevention of Tuberculosis
(NAPT), described high-quality nutrition and housing as the best tools of TB
prevention.8 TB among indigenous Britons was, for these experts, a social disease,
and one to be eradicated not just through new technologies, but through raising
living standards for all.
Responding to such demands, medical and public health authorities were drawn
into eradication efforts. However, this work was constrained by Britain’s straitened
finances. As the re-housing and slum clearance essential to social medicine stalled,
TB control strategies were instead shaped around—perhaps even driven by—the
advent of new technologies and drugs. These in turn promoted approaches rooted
in medical surveillance and medicalized intervention rather than social uplift and
regeneration. Mass miniature radiography (MMR) facilitated a series of popular
campaigns (now tied to rebuilding Britain, as they had previously been to the war
effort) to identify affected individuals in the working population. Members of the
public were encouraged to take personal responsibility for the surveillance of their
own health as a part of modern citizenship. ‘Keep an eye on your chest’, the NAPT
exhorted the British public, ‘Have you visited an X-ray unit yet?’9 By 1953, fifty-three
MMR units had x-rayed twelve million Britons. In schools too, state-authorized
medical surveillance targeted TB, and BCG vaccination was finally approved for
school leavers after the conclusion of Medical Research Council trials in 1953.10

7 ‘Tuberculosis’, Times (26 September 1949), 5.

8 Frederick Heaf and F. J. Bentley, ‘Tuberculosis in Britain Disturbing Figures’, Times (30 Sep-
tember 1949), 5; See also Ivy Portland, Robert A. Young, and Harley Williams, ‘The Control of Tu-
berculosis: Requisites of The Campaign’, Times (21 October 1949), 5.
9 Wellcome Library EPH533:4, ‘Keep an Eye on Your Chest’ (London: National Association for
the Prevention of Tuberculosis), c.1950s.
10 For contemporary comment, see ‘B.C.G. Vaccination’, Times (9 November 1953), 9.
 OUP CORRECTED PROOF – FINAL, 07/17/2015, SPi

The Tuberculous Migrant 1948–1955 27

Such efforts produced impressive results. In his 1953 annual report on the health
of the nation, Britain’s Chief Medical Officer was able to announce the halving of
English and Welsh TB mortality rates since 1948.11
As Hardy has demonstrated, anti-tuberculosis campaigns were inventive and
highly publicized (highlighting another, more gradual change in the medical cul-
ture of the post-war period, as professionals became more outward-looking and
willing to directly engage the public).12 For instance, a 1957–58 campaign in
Glasgow, Britain’s most tuberculous city, began with a six-month publicity drive,
opened with a parade and fireworks, and ended (having x-rayed 87 per cent of
the city’s population) with thanksgiving services around the city. MMR units and
contact tracing extended that net of surveillance even further. The discovery of
chemotherapies capable of rendering patients swiftly non-contagious, and then
curing their disease acted as the carrot to counterbalance the stick of continuing—
perhaps even growing—fear and stigma around the disease.13 Still associated with
poverty, TB had over the course of the century also become a disease of non-­
compliance, supposedly perpetuated by irresponsible individuals and populations,
at significant cost to their families, communities, and the state. Among native
Britons, TB clung on only among a handful of economically marginal groups:
young children and old men. While tuberculosis work had never been high status,
it rapidly became the ‘Cinderella of clinical medicine’.14 Repeatedly, the national
papers noted the scarcity of trained TB nurses, and the difficulty of attracting any
nurses to such a difficult, poorly paid, dangerous, and low status career.15 Nursing
and other staff shortages in turn kept sanatorium beds empty, despite continuing
demand for their services.16 Likewise, in a period when academic chairs of medicine
were emerging as badges of status for emerging medical specialties and research
areas, the Times lamented that there was no professorial chair for tuberculosis
anywhere in England.17 Thus, in Britain’s medical schools, the subject was often
poorly taught by non-specialists.
Coverage of tuberculosis in the mainstream press between 1948 and the mid-
1950s offers an excellent barometer of its changing national status. Mortality rates
in the early years of the NHS remained high in England and Wales—nearly 22,000
died from the disease in 1948—but specialists reported that the urgency with
11 ‘Trends in the Nation’s Health’, Times (11 December 1953), 9.
12 Anne Hardy, ‘Reframing Disease’, 540. On the medical profession and the public, see Virginia
Berridge, ‘Medicine and the Public: The 1962 Report of the Royal College of Physicians and the New
Public Health’, Bulletin of the History of Medicine, 81 (2007), 286–311.
13 Anne Hardy, ‘Reframing Disease’, 541.
14 F. Knights, ‘Tuberculosis In Britain Teaching Hospitals’ Facilities’, Times (7 February 1950), 7;
Brian Thompson, ‘Tuberculosis In Britain Long Waiting Lists For Treatment’, Times (10 February
1950), 7. See also Charles Webster, The Health Services since the War. Volume I. Problems of Health Care.
The National Health Service before 1957 (London: HMSO, 1988), 7–8, 321–5.
15 E.g. F. J. Bentley, ‘Tuberculosis in Britain: Disturbing Figures’, Times (30 September 1949), 5;
Portland et al., ‘Requisites of the Campaign’; ‘Tuberculosis’, Times (18 January 1950), 5; Frederick
Heaf, ‘Tuberculosis In Britain: “Three Lines of Attack” ’, Times (20 January 1950), 5; F. A. H. Simmonds,
‘Tuberculosis in Britain: Nurses’ Conditions of Service’, Times (30 January 1950), 5.
16 H. Senior Fothergill, ‘Tuberculosis in Britain’, Times (10 October 1949), 5.
17 Thompson, ‘Long Waiting Lists For Treatment’. See also Helen K. Valier, ‘The Politics of Scientific
Medicine in Manchester’ (PhD dissertation: University of Manchester, 2002).
OUP CORRECTED PROOF – FINAL, 07/17/2015, SPi

28 Contagious Communities

which tuberculosis had been addressed during the war had been lost.18 In 1950, a
Times leader lambasted the government, decrying the extraordinary fact that 400
Britons a week were still dying from the disease, and accusing the Ministry of
Health of ‘a certain complacency’.19 The paper’s editors pointedly questioned
whether the Ministry of Health was ‘strong enough for its task’ and whether it was
being prevented from ‘getting things done’. As the politics of tuberculosis became
entangled with the politics of immigration and border control after 1950, such
questions would become ever more pertinent. Nonetheless, by the late 1950s,
­tuberculosis morbidity and mortality in the general population was so low as to be
no longer newsworthy; even the miracle cures of the early 1950s became mundane.
By late 1957, the President of the Society of Medical Officers of Health observed
that ‘tuberculosis had lost its news value’.20
Even in the immediately post-war period though, high rates of mortality and
morbidity notwithstanding, members of the public, public health officers, and
many chest specialists already saw TB as principally of historical interest.21 In the
Ministry of Health, civil servants joked about the likely future of the MMR units
in this world of effective chemotherapy and declining rates of incidence. Encour-
aging their efforts to ‘clean up tuberculosis’ was, one claimed, ‘[r]ather like goading
the Gadarene swine to go ever faster in their mad rush downhill to self-destruction!’
Their demise, he enthused, was ‘imminent’.22 Many in the UK also took consider-
able pride in what they saw as a collective and personal achievement, and in the
National Health Service and allied public health services which made such remarkable
strides possible for all. At the same time, however, tuberculosis experts cautioned
that the ‘residual pool of infection’ (the diminishing ranks of contagious TB suf-
ferers) was becoming more and more dangerous to the rest of the population.23
The indigenous UK populations who were least at risk of infection were becoming
ever more susceptible to it as both ‘herd immunity’ (acquired through childhood
exposure to TB) and preventive health measures simultaneously declined. Together,
these two factors may help to explain the gradual revival of media, public, and
medical interest in tuberculosis, in conjunction with what many saw as a novel and
unwelcome source of contagion: immigrants.

I M P O RT I N G L A B O U R , I M P O RT I N G D I S E A S E : E A R LY
R E S P O N S E S TO T H E I N F E C T I O U S I M M I G R A N T

In Britain, as elsewhere, immigrants were historically regarded as potential carriers

of disease. However, unlike the USA and the ‘Old Commonwealth’, Britain only

18 ‘Tuberculosis Death Rate: Complacency Unjustified’, Times (7 July 1949), 2.

19 ‘Tuberculosis’, Times (18 January 1950), 5.
20 ‘Problems of Tuberculosis Control’, Public Health, 71 (April 1957–March 1958), 426–30.
21 Anne Hardy, ‘Reframing Disease’, 554.
22 TNA MH55/2275 Daniel Thomson to Michael Reed, 29 October 1955.
23 Fredrick Heaf, ‘The New Epidemiology of Tuberculosis’, Medical Officer cii (1959), 71–5 at 72,
quoted in Anne Hardy, ‘Reframing Disease’, 552.
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 Transcriber’s Note
You will note in the Table of Contents, that the pagination of
the original text begins with ‘1’ for each of the two Parts. Page
references in these notes below refers to each Part by prefixing
‘1.’ or ‘2.’.
Errors deemed most likely to be the printer’s have been
corrected, and are noted here. The references are to the part,
page and line in the original.
1.44.21 Really, Madame d’Ambresac[,/.] Replaced.
1.102.22 from the window[ of] a country Added.
house
1.135.29 by the sumpt[u]ous curtains Inserted.
1.155.32 would never venture[.] Restored.
1.157.31 the thought of Mme. de Added.
Guermantes[.]
1.185.21 if-I[-]tell-you-a-thing Inserted.
1.194.25 were barely distinguish[i/a]ble Replaced.
1.209.15 discern[a/i]ble at most Replaced.
1.210.19 she’ll perhaps [h/b]e afraid Replaced.
1.213.17 a woman desir[i]ous of earning Removed.
1.290.28 [“]Whenever there’s a famous Added.
man
1.311.7 [“]After all, one never does know Added.
1.313.16 to explain it to him.[”] Added.
1.321.8 [“]if they’re all like Gilbert Added.
1.351.7 [“]But I’ve found out Removed.
1.358.27 [‘/“]Damn it, these fellows will see Replaced.
1.381.32 by exposing his strat[e/a]gem. Replaced.
1.393.7 that intermittent familiar[it]y Inserted.
396.22 his [“/‘]haggart[”/’]) of a mother Replaced.
1.418.21 rashes, asthma, ep[l]ilepsy, a Inserted.
terror
1.425.24 I said to him: ‘Y[’] mustn’t let go Added.

2.18.4 with a hot needle.[”] Added.

2.40.6 which he had[ had] left ajar. Removed.
2.70.28 the temptation to kiss you.[”] Added.
2.82.24 has been tra[n]smitted Inserted.
2.138.4 plent[l]y plenty of foreigners Inserted.
2.220.14 on the afternoon of[ of] “Teaser Removed.
Augustus”.
2.250.7 with the s[ta/at]isfaction which he Transposed.
derived
2.174.20 r[yh/hy]thm of precise and noble Transposed.
movements
2.290.10 all go quite smooth[l]y. Inserted.
2.282.17 of their conversation, Transposed.
[oc/co]mments which
2.331.5 Feuilles d’A[n/u]tomne Inverted.
2.348.12 regard[n/l]ess of any want Replaced.
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