Tuberculosis–otherwise known as the White Plague or Pott’s disease–was an inevitable ticket to death in Europe during the 1650s; the combination of a dense population and and abysmal sanitary conditions served as a breeding ground for the illness. Evading the illness became the number one goal in the seventeenth, eighteenth and nineteenth centuries, and that fear of an early death vis-a-vis high fever and coughing up blood incentivized the Children’s Preventorium – “residential institutions for children,” as Cynthia Connolly defines it. These Preventoria were the early building blocks to rising above a society encumbered by fear of tuberculosis.
Given the societal conditions that allowed for the propagation of tuberculosis, the Children’s Preventorium, according to Connolly, “rescued” lower class children from the poor sanitary conditions in which they lived and fortressed them with “[blended] features of a hospital, sanatorium, and school, while endeavoring to imbue its patients with the values of an idealized middle-class life home” (Connolly 2). The method by which these children were secluded from the disease can be considered almost a reverse quarantine; but, instead of isolating the sick from society, the Preventorium isolated the healthy (a considerably smaller percentage of society) from the rest of the world, guaranteeing their safety and preventing an early, gruesome death. And–once again– we see in Connolly’s study that tuberculosis proliferated throughout the continent as a result of high population and poor living conditions. So, in a way, Connolly’s study echoes a common historical problem: a failure to recognize the relationship between illness and living conditions.
Similar to Connolly’s study, which centers on a particular group of people (children), J. Madison Taylor’s study focuses on the effect of tuberculosis on the African American community in the United States. His opening statement, “A rich man may get along with poor health and not suffer for essentials of life,” functions as the thesis statement for his article and paragons the recurring dilemma in our discussion of tuberculosis (160). In a way, he conflates poverty with color, and contends that “in order that the African American shall survive or even to maintain a fair measure of health, it is imperative that he shall keep out of the big cities and live in the open countries (162); thus suggesting that poor living conditions perpetuate the horrific disease. In addition to this argument, Taylor examines the traits of an African or African-American that make him or her more susceptible to the disease, such as “leaky skin” or the “wide nostril.” Taylor argues that is it necessary that the black population adapt to these weaknesses and learn how to cope with them to survive as a race. Despite Taylor’s discussion of narcotic drugs, it is striking that his implication of poor living conditions and disease parallels nearly every study we’ve examined thus far in this semester.
With that, I pose a question: Is the government entirely to blame for the proliferation of diseases such as tuberculosis? Certainly, they oversee the department of health, whose responsibility it is to ensure our safety; but, in the annals of American history, we see the department of health continually falling short of its duties to keep the population safe and the country’s citizens consequently falling victims to tragic deaths. (I realize that the United States isn’t the only country we’re examining, but for the sake of narrowing down conversation a bit, I’m gearing this question specifically toward the U.S.)
Time and again, our weekly readings seem to show how environmental and population factors seem to be key causations for the spread and culmination of odious disease. This week’s readings centered on Tuberculosis and interesting views of its prevalence as a deadly disease. Going through the readings especially, Connolly’s, reminded me of the readings about Cholera. As both Alex and Safanah mentioned, the number one priority was avoiding Tuberculosis, this was similar to the Cholera epidemic.
I noticed some similarities when it came to the population’s reaction regarding these diseases. When the Cholera epidemic was rampant, many people seemed to believe that sinners, and drug users were the one’s who were only afflicted with disease. People thought that God was trying to rid the earth of all sinful people. Yet, Cholera did not discriminate in this way but in more of an environmental sense.
Similarly to Cholera, it was believed that Tuberculosis was a discriminating agent. Many physicians seemed to believe that Tuberculosis was afflicting people who were African Americans. According to Boyle, many educated people believed that African Americans become more afflicted with the deadly disease because of their promiscuous behavior as a result of emancipation. According to the reading, many people seemed to find a “link” between genetics of African Americans and their susceptibility to Tuberculosis. Many people chided African Americans for their poor health as the sole reason yet “ They made little mention of the hostile social and racial climate in which the former slaves found themselves.” A disturbing point about the spread of Tuberculosis was the reaction of the upper white class. This class offered programs to “help” African Americans as a way to make sure white people do not become afflicted with the disease. This points out a very divisive approach to solving an epidemic.
Perhaps a link between Tuberculosis and AIDS can be drawn as well. During the first years of the AIDS pandemic, the disease has been called “God’s scourge” against homosexuals and intravenous drug-users. This description antagonized many people, who clung to the idea that only gays and drug-users should be afraid of this deadly ailment. These same people felt superior to the victims of AIDS and broadly advocated life-style changes for gays and cessation of drug-use for the addicts to ebb the advances of AIDS.
However, as we all know, AIDS slowly became a non-discriminatory disease. The myth that AIDS attacked only gays and drug-users was proven untrue soon after the pandemic started. As cases of heterosexuals being diagnosed with HIV virus surfaced, a sense of disbelief swept in, forcing many people to rethink their view and comprehension of AIDS.
Ultimately, I find it very interesting to see patterns repeat throughout history. It is fascinating to notice how a multiple populations living in different centuries react to similar rampant outbreaks. It seems that fear, ignorance, and intolerance of certain classes seem to fuel an unwarranted reaction to a potentially deadly problem at hand.
I agree with both David and Alex on the idea of public health symptoms correlating with social status. In these readings, we learn that tuberculosis was not only a serious sickness, but it was also used to separate the population just as cholera and typhoid fever did. In the cases of cholera and typhoid fever, many of the poor population were affected by these infections and they entered a “self-fulfilling prophecy” by not having enough money to move upward into better conditions. By being poor, they remained in bad conditions and increased their risk of contracting the disease.
In the Rothman reading, we learn that tuberculosis was used to separate the poor from the wealthy. Much of the poor immigrant population died due to the disease and they were looked down upon as spreading the disease. As the contagion theory evolves through this time period, we also learn that it was used to create a health stigma that drove fear into the population and separated the classes further.
This same reasoning resonated in the Gamble reading where the black population was discriminated against because of their susceptibility to tuberculosis. I really liked David’s connection to the AIDS epidemic in the 80s and 90s where the African American and homosexual communities were targeted as being the causes of HIV. That same issue stuck with me while reading this article as many blamed race on tuberculosis, but chose not to focus on the environments that African Americans lived in.
To answer Alex’s question, I think the government has some blame on the topic of the proliferation of disease. During each of the diseases we’ve learned, the government has not adopted a strong measure of preventative care and has instead opted to act only when an epidemic strikes. This creates the problem of a disease spreading, but the government cannot do much until technology advances and allows for the study of diseases and the creation of vaccines and other preventative measures.
I really like how Alex described the Preventoriums as “reverse quarantines.” Connolly mentions that children would play on the streets, around and about dead carcasses of animals. The environment, once again, proves to be the perfect setting for an epidemic to unfold. And even so, nurses and the wealthy would overlook these conditions and blame the poor, as they have done time after time.
Overall, I think the main reason people like to believe that a disease only attacks a certain group of individuals is because they are afraid. When the cholera epidemic first broke out, people in the United States rationalized that they would not be targets of the disease because they were more “free” than other nations. As David has pointed out, more than a hundred years later people still lean toward this means of justifying their immunity to a disease.
That being said, it was nice to see one person step up and try to revert this belief that the poor are more susceptible to disease. Ward’s actions have led to this movement of educating the poor and the young as the best way to prevent the spread of disease, which can still be seen in our society today.
Alex posed a very good question. Is the government to blame when it comes to epidemics? In “The Impact of New York City’s 1975 Fiscal Crisis on the Tuberculosis, HIV, Homicide and Syndemic”, this very issue is explored. The trouble started when there was a high number of TB, HIV and homicide cases and NYC did not respond as efficiently as they could have. In 1975, New York City was going through a financial crisis and in order to balance the budget, many public services were cut, including large cuts to the Department of Health. This led to the shutting down of chest clinics, which were responsible for screening and diagnosing for tuberculosis. The general downfall of the economy led to a lower standard of living due to the fact that so many people lost their jobs. Those who could afford to left the city, which may explain the discrepancy in rates of TB in those in the upper classes versus those of those in the lower classes. I believe that those in the lower classes occupied more cramped spaces, did not live on a well balanced diet and did not have a good enough education to understand how to avoid the spread of opportunistic infections so they contracted TB much more easily than their richer counterparts. Those who were discharged from hospitals did not come to their follow up appointments and things got worse when some people had a drug-resistant form of TB.
At the same time, HIV was being spread through the use of contaminated needles and New York, in an attempt to combat increasing citizen addiction rates, focused all its resources on methadone programs and not the underlying drug treatment system. Methadone did not work with cocaine addiction, which soon became a different vector to spread the retrovirus. In addition, the cuts to the Department of Health led to a lack of health educators, which prevented effective communication on prevention methods. This article clearly explains how the government has just as much of a responsibility in trying to prevent widespread disease as the residents of an area do and how the lack of proper planning can lead to epidemics that spiral out of control.
I really like Michelle’s statement that educating the poor and the young is the best way to prevent the spread of disease. I think this is a valid response to Alex’s question of whether or not the government and the department of health were fulfilling their duties to the citizens. I believe that for progress to be made in the battle against epidemics, the public must be informed and everyone must be on the same page. The problem with this is that public health was still in a state of disarray. Multiple theories were being juggled around, such as miasma theory and contagion theory. With this split in public health, it was extremely difficult to come to a consensus on how these epidemics spread and how the government should relay that information to the citizens.
It is interesting to see the schism between the wikipedia article and the Gamble reading. According to Gamble, the high incidence of tuberculosis in blacks essentially posed a threat to the health of whites. This fear is almost common place amongst the general population, where the poor and lower classes were feared because they posed the threat of spreading a disease to the more wealthy and upper classes. In the wikipedia article however, tuberculosis was known to be the “disease of artists,” and representative of “spiritual purity and temporal wealth.” These two views juxtapose each other, where we see in one case the disease is feared and the poor and blacks are discriminated, and the other case we see the disease being a noble disease to die from amongst artists. The romantic side of tuberculosis viewed the disease this way because “the slow progression of the disease allowed for a ‘good death’ as sufferers could arrange their affairs.”
Once again the miasmatic theory of disease causation was held to such a high regard, specifically through speculation that open air from the countryside mitigated the symptoms of tuberculosis (Conolly 2).
Non-relatedly, I was disturbed at the “childhood immunity” theory many Americans believed in the nineteenth century. Basically, it was thought that children between the ages of five and fifteen years old did not contract TB. Holders of that belief cited poorly done research as proof, which apparently showed that the rate at which children from the particular age group died from tuberculosis was disproportionally smaller than the rates of death from TB of adults and older children (Conolly 26). Of course, that theory was later debunked, albeit in a gruesome way: in a series of autopsies of children, it was found that as much as 55% of the children who allegedly died from causes other than TB actually had traces of tubercle bacillus in their bodies (Conolly 27). Talk about hard science.
Although personal hygiene and compliance is important to public health, the government is to blame if no effort is made to address the issue. A recurring theme is the proliferation of disease and poor health conditions among the poor. As seen with this week’s readings, tuberculosis (TB) seemed to target socioeconomic status or race.
According to the Connolly reading, privately funded “preventatoriums” meant to “rescue” lower class children from poor sanitary conditions were popular in the early 1900’s. Education, and public health infrastructure was expanded during this time period to help combat tuberculosis. According to the Freudenberg article on the tuberculosis crisis in New York, TB rates began to rise in 1978, which was around the time that the number of poor people in New York City increased. The article states that budget cuts that closed health centers, chest clinics, and the city TB hospital led to poor control of TB.
Public health is a function that only the government can effectively carry out. History has shown that if the government makes no effort to promote public health and instead makes cuts to public health infrastructure, then the governed will inevitably fall to disease and disaster.
In this week’s readings we again see the connection between health and socio-economic status. The poor living in crowded cities were more susceptible to tuberculosis and were blamed for the spreading of the disease. As Alex mentioned, a “reverse quarantine” was used to isolate the lower class children from the unsanitary conditions in which they lived. This small select group was protected from tuberculosis, while those still living in the crowded areas outside of the preventorium became ill. As Safanah said, it is interesting to see not only social status, but race playing a role in the spread of disease. I also found it to be a bit racist. Like Michelle said, people were afraid and needed someone to blame. Often instead of authorities taking action, they ignore the situation (like we saw in the previous week’s readings about the Great Stink), or choose a group to blame.
This week’s readings discussed the Great White Plague, that exhibited the familiar connections between health, poor living conditions, and specific groups of people.
Those who could not afford better living conditions were required to live in unsanitary crowded cities where the transmittance of disease was much more probable. These people were often looked down upon by the rich folks who, of course, had a much lower susceptibility to the disease. Instead of being grateful for their health and helping victims, they rationalized the victims’ contraction of the disease as a punishment for their “filthy” habits, similar to the cholera epidemic, and blamed the helpless for the spreading of the disease. Similarly, others blamed blacks for the proliferation of the disease.
It seems to me that after learning of a deadly disease that is rapidly spreading and the fact that they have no defenses against this invisible killer, people get angry and blame the group whom they see as inferior. Their actions do not cure the disease or prevent its spread, but at least they can gear that anger towards a scapegoat. If only fear of a proliferating fatal disease was used as a motivator for change rather than placing guilt.
-Chhada Nathan Kabariti
Alex ended his post, with a truly thought provoking question, “Is the government entirely to blame for the proliferation of diseases such as tuberculosis?” When addressing issues of public health and the spread of disease, it is not uncommon to study the etiology of diseases or even environmental factors impacting disease. However, not enough attention is focused on the role of the government in these devastating epidemics. Because the government has such available power and resources, and for the most part has the ability to reach almost every person within it’s borders, it definitely plays a significant role in the spread or more importantly the control of disease. Nonetheless, disease is a naturally occurring incident, and has a much bigger role in the life cycles within biological systems. Consequently, even large and powerful institutions such as the government can only do so much in regards to the proliferation of diseases such as tuberculosis.
While the government can and definitely should offer people preventative care to help combat the spread of disease as Michelle said, one of the most important things that can be done is educating the poor and young about proper health, preventative care, and disease prevention and control. For example, during the 19th century, tuberculosis became romanticized by popular culture. It was dubbed the “White Plague” and was even acknowledged to be a romantic disease at the time. The disease even “began to represent spiritual purity and temporal wealth.” (Wikipedia, History of Tuberculosis) Furthermore, it was believed that tuberculosis was a “good death” since those who suffered endured a slow progress of disease which gave them ample opportunity to arrange their own affairs. This ideation about the “White Plague” even caused women to purposely make their faces look paler in order to look like they were ill with consumption because that pale, pure even sickly look was what was considered beautiful. (Wikipedia, History of Tuberculosis)
It is this kind of delusional ideation that the government should have worked to prevent with proper education. Without the scientific advancements that would come later on in time, there was not much that the government could to do help treat those infected. However, as it was evident that tuberculosis was an infectious disease, the government should have taken it upon itself to provide basic education to the masses of health measures we now acknowledge as common sense.
The government did try to separate the healthy children from the rest of society by creating these “preventoriums.” (Saving Sickly Children, page 2) However, this was not enough, the government should have encouraged more programs promoting separation between the ill and healthy in order to manage the spread of the disease. The idea of separating the healthy and the sick to help safeguard those who had yet to fall ill, should also have been part of education programs since that was not often though of when people lived in dirty over-crowded living conditions.
In conclusion, the government cannot create programs to save everyone. It cannot prevent disease from occurring or even contain it entirely. However, the power of education should not be taken so lightly. If people understand the proper protocols in order to keep themselves and their families healthy, a lot can definitely be achieved in terms of controlling these contagious diseases before they become epidemics that can wipe out millions.
Once again we see the connections between disease, race, and socio-economic status. Tuberculosis was one of the most fearsome and threatening diseases of the nineteenth century, and as both Michelle and Teressa have said, people were terrified of catching it. However, what those people have failed to see is that it isn’t race or class that causes disease. The poor were blamed for the spread of tuberculosis. However, it is because of the squalid conditions they lived and primitive hygiene habits they practiced that made them so susceptible to the disease. Ignoring the disease and not doing anything to find the root of the problem was usually the path chosen by health officials at that time. However, education is the best solution to effectively curtailing the spread of a disease.