Social and Political Contexts of Tuberculosis Prevention and Treatment

Tuberculosis has its roots deep in ancient history and has grown to be notorious for its high mortality rates and excruciating symptoms. It has taken centuries of scientific advancements to determine the bacterial origin of this disease and its contagious characteristics. It was not until relatively recently, in the twentieth century, that a vaccine for tuberculosis was developed. Until that time, large urban cities struggled with methods of prevention, control, and treatment of the contagion. The social and political contexts provided for us by these readings allow us to fully appreciate the repercussions of tuberculosis outbreaks.

A few of the readings, particularly Connolly and Freudenberg, focus specifically on tuberculosis in New York City. In New York City, the first line of action was prevention of disease through adoption of aseptic techniques, such as pasteurization developed by French scientist Louis Pasteur, a policy spearheaded by reformer Nathan Straus (Connolly). This was just one of the many things American policymakers would pick up from the Europeans. Before John Seely Ward, board member of the Association of Improving Conditions of the Poor, learned about European sanitoriums, New York City’s public health enforcement required the compliance of parents in order to treat children. Meanwhile, in France in the 1880s and 1890s, legislation was enacted allowing the state to take custody of children in impoverished, immoral, or abusive households (Connolly). Though this policy seems like an encroachment of the state on individual affairs, the government believed that “the stakes were too high” to risk (Rothman). In France, and also Germany, children with tuberculosis left their homes for sanitoriums, where they were extensively cared for by nurses, consistently well-fed, and provided with adequate fresh air that doctors believed aided in their recovery. Here we again see miasma theory being supported, and not without reason. Sanitoriums worked wonders. Not only were children cured, but they enjoyed being with each other, no longer feeling alone or shunned because of their medical condition (Rothman). Connolly provides us with stories of miraculous recoveries that inspired Ward to emulate his own version of a sanitorium, “Sea Breeze”, in New York City. Sea Breeze received tremendous support from elites and the general public, both a cause and an effect of its continual success. There was always a waitlist of hopeful patients requesting beds at Sea Breeze. Many were financially supported by the “Christmas Seal” fundraising program, an idea adapted from a Danish postmaster (Connolly). The United States Public Health system repeatedly borrowed from European ideas and wisely selected polices and programs with proven positive results.

Reading about tuberculosis, we again encounter the recurring theme of social status as a factor of disease prevalence. When the economy experienced a dip in 1975, the financial crisis had profound effects on the public health sector. Cities and states cut funding to health programs, and the skyrocketing percentages of tuberculosis patients reflect the impact of these changes (Freudenberg). The poor no longer had access to health care services and became even more susceptible to tuberculosis. Interestingly, not only did socioeconomic status impact susceptibility, but race also played a measurable role. Achard and Boyle both noted that Black Americans were more likely to develop tuberculosis even though, during times of slavery, they appeared to be resistant. Boyle disturbingly refers to this as “the white man’s burden”. He goes on to say that it is due to “shiftlessness, ignorance, and poverty” and can only be treated by “disciplinary training of his physical, mental, and moral powers.” He seems to imply that their freedom contributed towards their sickness, with outrageous conclusions that have no basis in science or research. Tuberculosis itself also became a discriminating agent; diagnosed patients would have difficulty seeking employment (Rothman).  In essence, even cured patients, and the rest of New York City, were affected by tuberculosis for life. The tragic contagion was a learning process and a milestone in the development of the city’s Public Health department which, coupled with scientific advancements, culminated into successful decrease in tuberculosis rates today.