Fighting Fit: the wartime battle for Britain’s health

“We’re on Number 12 platform at Waterloo Station, one of the ten big metropolitan stations that are engaged today (1 September 1939) on the evacuation of London’s schoolchildren,” reads the BBC’s radio announcer to the sound of puffing steam engines. “The train’s in and the children are just arriving…coming along in their school groups, with a banner in front saying what school they are…the tiny tots in front, leading up to the bigger ones…and here comes a high school, more like 14, 15 and 16. They’re being evacuated, too.”

Evacuees from Bristol to Devon, 1940. Image credit: Imperial War Museum, © IWM (D 2593).

The evacuation—the movement of nearly 1.5 million children out of bombing-targeted cities—produced some of the most enduring images of World War II. Think about the evacuation and these are the pictures you remember: railway platforms full of little children, with little suitcases, both child and case with a buff paper luggage label tied on so as not to get lost en route to the countryside. A picture of great pathos, yes, but this influx of children to the countryside could have proved more deadly than a German invasion. Health authorities in the rural reception areas where the children would be billeted were extremely worried about what the children were bringing with them. Not in those little suitcases, but in those little bodies…

I first become interested in wartime public health when I wrote an article for the Wellcome Trust/Guardian Science Writing Prize. That article was about the secret scientific study that influenced rationing. That short taster peaked my curiosity. While wartime public health was hugely important to the war effort, very little had been written about it; there were magnificent records on the period held in public institutions, including the Wellcome Library; and there were great stories of inventiveness, scientific creativity—and occasional villainy—to be told. That first article grew into a chapter and the chapter into a book, published July 2016: ‘Fighting Fit: the wartime battle for Britain’s health‘.

Cover of Fighting Fit. Image credit: Laura Dawes,

One of the chapters of ‘Fighting Fit’ is about the evacuation and the medical wager it represented. Most people know about the one side of the wager: evacuating children to the countryside would get them out of the way of bombs dropped on cities and would reduce casualties. But it was the other side of the wager that startled me. The Wellcome Library’s copy of the ‘Medical Officer‘ was useful to me in investigating this. (This is the journal of the local authorities’ Medical Officers of Health, who would be responsible for the health of children evacuated into their areas.)

As the journal explained, the evacuation “carries with it a definite danger of serious disturbance of the epidemiological balance of the districts into which these town dwellers are introduced…It seems almost inevitable that severe epidemics will be generated in the reception areas.” Evacuating children from the microbial and viral soup of the cities to the comparatively virgin countryside could have disastrous consequences. Diphtheria, scarlet fever and polio had all been particularly prevalent in cities the previous year…and outbreaks of those diseases tended to occur in the autumn, just when city children were heading to those railways platforms, suitcases in hand.

It seems almost inevitable that severe epidemics will be generated in the reception areas.

That was the wager: setting the surety of deaths from bombs against the possibility of deaths from diseases. While the Ministry of Defence worried about German invasion, health authorities quietly prepared for germ invasion.

Did the wager pay off? Yes and no. The evacuation of city children did produce outbreaks in rural areas, but the background rate of disease for those years was remarkably, fortuitously low. This meant the overall level of illness was not particularly pronounced. The fact that city schools had been closed for the week before the evacuation may have helped keep disease circulation in check. Possibly also ‘double-shift’ schooling (where local classes and evacuated classes followed each other in the classroom) reduced mingling and the chance of cross-infection. And a delightfully long, mild autumn that allowed children to be turfed outside to play rather than being cooped up and coughing on each other may have helped as well. Hygeia—the goddess of health and sanitation—certainly smiled on Britain.