Hostname: page-component-745bb68f8f-l4dxg Total loading time: 0 Render date: 2025-01-07T16:40:27.192Z Has data issue: false hasContentIssue false
  • English
  • Français

Seek and Hide: Public Health Departments and Persons with Tuberculosis, 1890–1940

Published online by Cambridge University Press:  01 January 2021

Sheila M. Rothman
Get access Rights & Permissions [Opens in a new window]

Extract

In 1882 Koch discovered the tubercle bacillus and transformed both the medical and the social history of tuberculosis and the experiences of those who contracted it. For the first time, the absence or presence of the bacillus made it possible to define, in Koch’s terms, “the boundaries of the diseases to be understood as tuberculosis.” And for the first time the sick became subject to oversight and discrimination.

Prior to Koch’s discovery, tuberculosis, or as it was then called, consumption, was considered a hereditary and non-contagious disease, albeit a very deadly and persistent one. Over the first half of the nineteenth century, it was responsible for one out of every five deaths. It crossed all boundaries of geography, social class, age, and sex affecting residents in rural as well as urban areas, the prosperous as well as the poor, the young even more notably than the old, females more often than males. Physicians assumed a familial predisposition existed (as in the case of insanity); following the precepts of humoral medicine, they postulated that the disease originated in “irritations” whose sources were to be found in the interaction of an inherited constitution with a particular lifestyle and environment.

Type
Article
Information
Journal of Law, Medicine & Ethics , Volume 21 , Issue 3-4 , Fall Winter 1993 , pp. 289 - 295
Copyright
Copyright © American Society of Law, Medicine and Ethics 1993

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

Koch, Robert, “The Aetiology of Tuberculosis,” The American Review of Tuberculosis (25) March, 1932, pp. 299, 306, 311. This is a translation of the paper that Koch read at the Berlin Physiological Society on March 24, 1882.Google Scholar
Physicians themselves often noted these facts. “Fully one-half the deaths from consumption,” wrote James Clark, “occur between the twentieth and fortieth years…. Mortality is about its maximum at thirty.” (Quoted in Sweetser, William, Treatise on Consumption (Boston: T. H. Carter, 1836), p. 45. Sweetser also noted that females were more prone to consumption than males, (Ibid, p. 43).Google Scholar
For an analysis of nineteenth century American medical practices see Warner, John Harley, The Therapeutic Perspective: Medical Practice, Knowledge and Identity in Nineteenth-Century America, 1820–1855 (Cambridge, Harvard University Press, 1986). For specific treatments physicians used see Sweeter, A Treatise on Consumption p. 82, 172.Google Scholar
Drolet, Godias J., Lowell, Anthony M., A Half Century's Progress Against Tuberculosis in New York City 1900–1950 (New York: New York Tuberculosis and Health Association, 1952) pp.iii, li-liv, quotes Billings, . See also Billings, John S., Vital Statistics of New York City and Brooklyn Covering a Period of Six Years Ending May 31, 1890 (Washington D.C.: U.S. Census Office, 1894).Google Scholar
Even among immigrants there were not uniform mortality statistics. Apparently Jews, even those who lived in the most crowded tenement districts, had lower mortality rates than other groups. Fishberg, Maurice, “The Relative Infrequency of Tuberculosis Among the Jews,” American Medicine (2) 1901 pp. 695–8. Historians have interpreted this disparity. Dwork, Deborah, “Health Conditions of Immigrant Jews on the Lower East Side of New York: 1880–1914,” Medical History (25) 1981 pp. 1-40.Google Scholar
Knopf, Adolphus, Tuberculosis as a Disease of the Masses and How to Combat It (fourth edition, New York: Fred P. Flori, 1907) p. 16.Google Scholar
Id. at 43–45, 83–86. For an overview of this medical social alliance see Teller, Michael E., The Tuberculosis Movement: A Public Health Campaign in the Progressive Era (New York: Greenwood Press, 1988).Google Scholar
See Smith, Theobald, “Public Health Laboratories,” Boston Medical and Surgical Journal, 143 (November 15, 1900): 491–493.CrossRefGoogle Scholar
Charles V. Chapin, “Dirt, Disease and the Health Officer,” in Gorham, Frederic P., ed., Papers of Charles V. Chapin, M.D. (New York: The Commonwealth Fund, 1934) pp. 22–23.Google Scholar
On transmission see Charles V. Chapin, “The Principles of Epidemiology,” in Gorham, , Papers, p. 184.Google Scholar
Welch, William H., “What May Be Expected from More Effective Application of Preventive Measures Against Tuberculosis,” an address delivered in Albany N.Y. January 27, 1908, reprinted in Welch, William H., Papers and Addresses, edited by Burket, Walter C. (Baltimore: Johns Hopkins Press, 1920) p. 632.Google Scholar
Charity Organization Society, A Handbook on the Prevention of Tuberculosis (New York: Charity Organization Society, 1903) p. 98.Google Scholar
Billings, John S. Jr., “The Registration and Sanitary Supervision of Pulmonary Tuberculosis in New York City,” New York City Department of Health, Monograph Series 1 1912 p. 57.Google Scholar
New York City Department of Health, Annual Report, 1894 p. 95.Google Scholar
On tactics the tubercular poor used to avoid detection see Biggs, Hermann M. and Huddleston, John Henry, “The Sanitary Supervision of Tuberculosis as Practiced by the New York City Board of Health,” The American Journal of Medical Sciences, (109) pp. 25–26.Google Scholar
New York City Department of Health, Annual Report, 1895 p. 96.Google Scholar
The law contained precise instructions for disinfection which became more stringent over time. At first landlords had ten days, later 48 hours. The costs were to be borne by the landlord. New York City Department of Health Annual Report 1894 p. 97. See also National Association for the Study and Prevention of Tuberculosis, Technical Series, A Manual of Tuberculosis Legislation 8 (1926): 37.Google Scholar
Biggs, Hermann, “To Rob Consumption of its Terrors,” The Forum, 16 (February, 1894): 767.Google Scholar
Winslow, C.E.A., The Life of Hermann Biggs (Philadelphia: Lea and Febiger, 1929) p. 158.Google Scholar
Chapin, Charles V., “Pleasures and Hopes of the Health Officer,” in Gorham, , Papers, p.6, supra note 9.Google Scholar
For detail see Winslow, Biggs, supra note 19, pp. 131-152. Public health officials defined tuberculosis as a communicable disease. “No reasonable sanitary officer,” Biggs maintained, “would expect to put in force regulations requiring notification of tuberculosis, with the same conditions and in the same way that a similar one with regard to small pox would be enforced” (151). For a fascinating analysis of the way Biggs's professional motivations shaped the battle see Fox, Daniel M., “Social Policy and City Politics: Tuberculosis Reporting in New York, 1889–1900,” Bulletin of the History of Medicine, 49 (1975): 169–195.Google Scholar
Winslow, supra note 19, p. 139.CrossRefGoogle Scholar
Devine, Edward, “A Working Program,” Transactions of the National Association for the Study and Prevention of Tuberculosis 1 (1905): 53.Google Scholar
Winslow, , Supra note 19, pp. 144, 146. For an analysis of the composition of the city's medical profession in the city and its response to compulsory reporting see Fox, “Social Policy and City Politics,” supra note 21, pp. 169-195. For another view see Starr, Paul, The Social Transformation of American Medicine (New York: Basic Books, 1983) p. 187.Google Scholar
On the penalties contracting the disease imposed see Teller, , The Tuberculosis Movement, pp. 77–78; 109-110.Google Scholar
See Pottenger, F.M., “Is Another Chapter in Phthisiophobia About to be Written,” California State Journal of Medicine 1 (1903): 81–84.Google Scholar
Winslow, supra note 19, p. 178.Google Scholar
For a discussion of legislation on involuntary confinement, see National Tuberculosis Association, A Manual of Tuberculosis Legislation Technical Series, New York: 1928 p. 38. Billings, John S., “Discussion,” Transactions of the Third Meeting of the National Association for the Study and Prevention of Tuberculosis (1906) p. 52.Google Scholar
Rhode Island State Commission on Tuberculosis, Report on Hospitals for Advanced Cases (Providence, Rhode Island, 1911), pp. 34–36.Google Scholar
Tobey, James A., Public Health Law (New York: The Commonwealth Fund, third edition 1947) p. 152.Google Scholar
Ingraham, Charles Wilson, “Control of Tuberculosis from a Strictly Medico-Legal Standpoint,” Journal of the American Medical Association, 28 September, 1896 p. 694. Welch, William, “Address,” Transactions of the Fifth Meeting of National Association for the Study and Prevention of Disease 1909 p. 36.Google Scholar
Conley, Walter H., “Detention of Consumptives in a City Hospital,” Journal of the Outdoor Life, 11 (1914): 104.Google Scholar
Wilson, Robert J., “Difficulties Encountered by Hospital Authorities in Detaining Homeless Consumptives,” Journal of the Outdoor Life, 11 (1914): 102.Google Scholar
Id. at 103. To improve discipline, Wilson advocated a form of medical parole.Google Scholar
Committee on Hospitals for Advanced Cases of Tuberculosis, “Report,” Transactions of the Ninth Annual Meeting of the National Association for the Study and Prevention of Tuberculosis 1913 p. 54–66.Google Scholar
On the difficulties of gaining the compliance of New York City physicians see Billings, , “Registration,” supra note 13, p. 86. For a discussion of physician compliance see Teller, , The Tuberculosis Movement, supra note 7, at 72–3.Google Scholar
Billings, , Supra note 13, p. 14–17.Google Scholar
Huddleston, Biggs, “The Sanitary Supervision of Tuberculosis,” p. 25–26.Google Scholar
Case #27, Dr.Ziselman, M. to Dr.Spivak, Charles, Beck Memorial Archives, Jewish Consumptive Relief Society Collection, University of Denver.Google Scholar
Sweet, Ernest, “The Interstate Migration of Tuberculous Persons,” U.S. Public Health Reports, 30 (April 16, 1915): 1149.Google Scholar
Hall, Sharlot M., “The Burden of the Southwest,” Outwest, 28 (January, 1908): 9.Google Scholar
Ross, Will, I Wanted to Live, Wisconsin Anti-Tuberculosis Association, (Milwaukee, Wisconsin: Anti-Tuberculosis Association, 1953) p. 51.Google Scholar
Webb, Gerald B., Powell, Desmond S., Henry Sewall, Physiologist and Physician (Baltimore: Johns Hopkins Press, 1946) p. 276.Google Scholar
Galbreath, Thomas, Chasing the Cure in Colorado (Denver: published by the author, 1909) p. 29.Google Scholar
For a detailed description of life in these colonies see Carrington, Paul M., “Economic Housing of Consumptives with Especial Reference to the Southwest,” Transactions of the Sixth International Congress on Tuberculosis (1908): 1042–1050.Google Scholar
Hall, Dick, “Ointment of Love: Oliver E. Comstock and Tucson's Tent City,” Journal of Arizona History, (Summer, 1978): 112.Google Scholar
Ibid.Google Scholar
McClintock, Marshall, We Take to Bed (New York: Jonathan Cape and Harrison Smith, 1931) p. 45.Google Scholar
Lowry, Iva Marie, Second Landing (Philadelphia: Dorrance and Company, 1974) p. 53.Google Scholar
Drolet, Godias J., Porter, Donald E., Why do Patients in Tuberculosis Hospitals Leave Against Medical Advice (New York: New York Tuberculosis and Health Association, 1949).CrossRefGoogle Scholar
For a detailed account of the experiences of the sick in the sanatorium see Rothman, Sheila M., Living in the Shadow of Death: Tuberculosis and the Social Experience of Illness in American History (New York: Basic Books, 1994).Google Scholar