Tuberculosis Flashcards
Bynum (2012), image of consumption, early 19th C
seen in new ways
- fashionable
- youthful faces, bright eyes, red cheek spots, alabaster skin. Conscious fashion statement was imitated among the trend-setting Romantic
- refined victims, selected ostensibly by virtue of their youth and beauty, endowed - biting tragedy.
- consumptive poet or other creative artist crystallized from its earlier incarnation
- Nerves seen as so finely wrought in these individs that they cld easily become overwrought, using up a lifetime’s store of energy
- necessary balance between human affliction and the production of art in its highest forms
- Consumptive end = increasingly glamourised
Bynum (2012), Keats
seemed to embody the long-held association between consumption and genius
Keats’ consumption was at the long end of the ‘acute phthisis’ spectrum.
Keats had foolishly exhausted himself wandering in the oft wet and cold Scottish countryside
After the publication of his long poem Endymion in May 1818, several reviews were a shock to the system.
Brother’s death
Girlfriend troubles - Fanny Brawn
Went to Italy Sept 1820
mid-December 1820 after Keats had ‘vomited near two cupfuls of blood’, Clark immediately let ‘about 8 ounces ofblood from the Arm: it was black and thick in the extreme
The next day the same occurred
Bynum (2012), chronic consumption
A ‘chronic’ case could last for several years.
But because doctors (and patients) were so reluctant to admit that it was consumption it was often only the final phase of a much longer illness that was regarded as consumption proper
Bynum (2012), TB and heredity
Contemps understood Keatses to share an inherited predisposition
Medical opinion firmly supported the notion that ‘mental depression operating on a constitution already predisposed to, or labouring under tubercular disease’ accelerated ‘the evil’
Bynum (2012), James Clark, Keats’ doctor
wrote up his experiences as Medical Notes on Climate, Diseases, Hospitals and Medical Schools in France, Italy, and Switzerland (1820).
in the cold, blood sent inward from extremities to internal organ, which became congested, increasing the disease there
- where pulmonary consumption had advanced and suppuration taken place in the tubercle in the lungs, the patient ought to stay at home
- strict regime over num of yrs cld cure tb
- Following Laennec, he regarded tubercles in the lung as both consumption’s ‘essential character and immediate cause’. The tubercles were the result of a ‘morbid condition of the whole system’ because of a hereditary disposition
Evidence that the body was trying to counteract its plethoric condition and calm an agitated circulation was to e found in the tendency to
haemoptysis. The symptomatic remedy therefore was to quieten the system by altering diet, using medication, inducing rest, and perhaps prophylactic bloodletting.
Bynum (2012), females of higher classes in partic danger of consumption
- floating fabrics of the Romantic age fashionable; didn’t provide much warmth
- excessive exposure to the sun shunned bc brown skin = sign of lower classes
- white skin, red cheeks and red lips, fashionable since medieval period, reached new heights of desirability early 19th C - combined with other aspects similar to consumption’s visible effects, such as wilting demeanour, lightness of form, pretended exhaustion
- girls sent to boarding schools, confined without sufficient exercise in the strengthening fresh air
- sedentary occupations e.g. embroidery
- mid-19th C, corset back in fashion, stretching down over hip. Chest couldn’t properly expand - not prevented active physical exercise
- cult of invalidism, supported by burgeoning industry of care
Bynum (2012), cold-water hydropathy
underpinned by the belief that the body’s inability to withstand the effects of being chilled was a leading cause of the inflammation that either gave rise to tubercles or excited these deposits to suppurate. Strengthening to resist the effects of cold by a course of frigid bathing was akin to an inoculation for smallpox.
Dr Gully - hydropathy establshment in Malvern
Bynum (2012), consumptive heroine
Female consumptives who conducted themselves with dignity during their illness and death were seen as providing valuable examples of religious piety
Tubercular lives and deaths were often recounted by fam mems
Caroline Leakey (1827-81), the author and philanthropist, memorialized her sister Sophia's death in 1858 in an Evangelical magazine. - after being tempted by the devil in the days leading up to her death, Sophia's faith triumphed: 'Her face was as if it had been the face of an angel.
Artificial and perhaps reflected the desires of the onlooker rather than the reality of the patient
Sophia’s own account more realistically referred to the real world concerns of having the strength only to sleep or cough
Bynum (2012), Verdi’s Violetta, La traviata:
- typifies the notion that the predisposition to consumption was not only hereditary, but could be induced by bad living.
- broadens the visibility of suffering from consumption beyond the artistic and social elite, even if this comes at the price of blaming the victim. While the poor might have little choice about the way they lived and worked they were frequently condemned for it.
Violetta lives at the extreme. Hedonism regarded as only cure for disease she suffers until Alfredo’s redemptive love offer a different solution.
The dangerous and debauching city, Paris, is briefly swapped for the purported bucolic health of the countryside. Violetta appears to be in better health
She follows Alfredo back to Paris where his father persuades her that she must renounce him for the good of their family name.
Her rapidly advancing disease is now admitted and she is given a prognosis of only hours to live at the opening of the final act. The news brings Alfredo back for a reconciliation and the opera heads towards its climax
The opera’s subsequent success in the final decades of the 19th century glamorized the female consumptive death and exposed the disease to a growing public scrutiny. While genius and beauty might be the marks of the disease among the middle and upper classes, and offer a spectacle in the case of Violetta, when it affected the masses, consumption became rather more distasteful.
Bynum (2012), bohemian lifestyle
those who pursued brought disease and death upon themselves
Bynum (2012), consumption late 19th C
The realities of the sallow complexion, furred tongue, and fetid breath came to the fore. Many came to regard with distrust prematurely aged faces and painfully thin bodies, wracked by ugly coughing. By definition almost everything in the life of the urban poor contradicted the precaution for those of a consumptive disposition or whose relatives fell victim to the disease
Bynum (2012), advice for those with consumptive constitutions, 19th C
avoid sedentary occupations, especially in confined and obscure places, a residence in large town and cities, or in low humid and cold situations, unwholesome or improper diet, imperfect clothing, abuse of liquo
Bynum (2012), middle third of the 19th century
consumption gained a heightened visibility though poetry, art, literature, and the stage. By the century’ end a new leading public enemy had been formulated. This owed much to the discovery of the causative organism of what gradually became known as tuberculosis-the tubercle bacillus.
Byrne (2011), 1840s
the ‘hungry forties’
lndustrialisation, urbanisation and the population explosion combined to produce overcrowded housing, inadequate food, contaminated water and unhealthy factory conditions, namely perfect breeding conditions for infectious illness.
Byrne (2011), tuberculosis’ persistence
did not respond to intervention e.g. sanitary improvements
endured long past 19th C as signifier of industrialisation
Byrne (2011), TB and capitalism
TB created a population of unproductive invalids who were physically unable to partake in the workings of capitalist society and were thus a further burden on an already struggling community
Byrne (2011), phthisis as cultural metaphor for economic progress
TB’s gradual wasting and using up of the body’s resources of flesh and strength clearly made it a perfect signifier for the dangers of excess and consumerism on the body politic
(trade deficit)
George Cheyne, 1733, The English Malady
phthisis, cancer and gout = direct consequence of over-indulgence in the upper classes
Such a view of consumption persisted throughout 19th C
Byrne (2011), 19th C docs and consumption
19th-C med thinking accepted it as consequence of industrialisation in general and factory system in particular
Dr John Murray - 1830 - believed that consumption = ‘excess, and the ideal creation of luxuries, which consume our vitals and destroys us
Some physicians recommended nourishing and plentiful diet, others warned against rich/ animal food and strict rules about necessity of skipping lunch if breakfasted late to avoid overindulgence
Byrne (2011), consumption and civilisation
After turn of 20th C - Latham and Garland - TB as ‘direct product of civilisation… the disease does not exist in uncivilised countries’
Consumption seemingly being constructed as price soc has to pay for economic and social progression and development
Disease = as much the product of the capitalist system as threat to it
Soc = agent of own destruction
Dickens, Dombey and Son (Byrne’s account)
moral fable of consumer soc in which progress of capitalism disrupted by the consumptive illness which kills the heir to the fam firm
Consumption = appripriate disease for Dickens’s purposes bc widely believed to afflict valuable, beloved children like Paul Dombey
Dombey (owner of mercantile firm)supplies commodities for ppl and is thus held responsible by Dick for social and moral consequences of consumer capitalism
Policing of hlth of Polly Toodle - potential wet nurse for Paul - by Dombey
Fears of cross-class contamination
Plot as resistence to accepted view of proletariat as pathologised
Any illness in the book is of bourgeois rather than lower-class origin
Toodles = essence of hlth
Marx – progeny essential to progress of capitalism.
‘great failure’ of D&S = inevitable result of breakdown of patriarchal inheritance caused by the death of little Paul from TB
Illness – TB – offers means of resisting time in life
Slow, gradual progression of consumption renders it as much a way of life as way of death
Paul Dombey - Physical manifestation of his disease
Suggests he has been spiritually removed from normal time span of childhood growth – described as looking like terrible little being in fairy tales, at 150/200 yrs of age
Spiritually he is old.
His tubercular decline presented as triumph over society’s attempts to assimilate him into capitalist world. Paul - ‘I had rather be a child’
Assoc between the disease and water
TB useful literary means of countering the terrestrial, materialistic world of capitalism, w its crude dependence on the corporeal – TB breaks down flesh into water and air
TB actually rife amongst urban poor – not depicted in novel
Paul’s schooling central to his decline:
Repd in part of plot that delas w the Bllimbers’ establishment, which prides itself on production of the capitalists of the future, by strictly enforcing bourgeois ethics of application and industry amongst its pupils
Disastrous effects
Dombey after death of first wife. Austere. Vision of masculinity. Miss Tox – His presence! His dignity!
After purchases Edith, gives himself up to luxury. House rebuilt as shrine to trade, wealth and display – life of opulence sets Domb on path to illness, suffering and financial ruin
Byrne (2011), 19th C artistic circles
hlth was undesirable bc it was the normal state of common beings entrenched in their bodies, and this was not the expected position of the true genius
Unhealthy were thus bc they considered their bodies of less importance than their minds and abilities and treated them as such
Porter, lifestyle changes
lifestyle changes casued by Eng’s economic success in 18th C were frequently far from healthy
Not only new trade itself that was pathogenic, but also affluence that accompanied that trade
Byrne (2011), education
Newfound preoccupation with education of children, preocc w child’s future and standing in society – Adolescents allowed to loaf around reading, less hard labour
Sedentary academic routine contribd to decreased immunity
Berry, classical definition of luxury
creator of effeminacy.
Plato considered it threat to virility bc indulgent lifestyle not conducive to male strength and power
Byrne (2011), consumption and syphilis
Syphilis - Soc’s illicit appetites produced disease w far-reaching and damaging effects
Link w consumption = clear
Paul Dombey’s resemblance to syphilitic child – aged appearance classic sign of congenital syphilis
Gaskell, North and South
North and South offers alternative ‘form’ of consumption to that repd in Dombey and Son – w-c version of the disease
Bessy Higgins’ consumption directly caused by her work in the poorly ventilated cotton factories
Likely but avoidable consequence of industrial production, rendered inevitable by nature of the capitalist system which encourages greed of manufacturers
Bessy believes disease caused by inhalation of dust and fibre at factory, rather than infection
B’s transformation from labourer and breadwinner into invalid who is financial burden
Makes it necess for her younger sister to go out to work
Potentially perpetuates cycle of illness and poverty that dogs the lower classes in the novel
B – spiritualised and even intellectualised by her removal from hlth B more ‘ladylike’ Sense here of TB as upper-class illness, bringing traces of nobility even to its poorest sufferers
B treated differently from other invalids specifically bc her ‘disease is consumption’ so she won’t want commodities usually deemed appropriate for invalids
W/in symbolic world of the novel, TB sufferers cannot be assisted or comforted by luxury gods, for as victims of capitalism, any interaction w symbols of conspicuous consumerism must do more harm than good
Bessy’s consumption of sweet pastries in attempt to ‘sweeten’ an otherwise drab existence
B not entirely innocent victim – her illness signals she is at once a suffering martyr and an agent of self-inflicted contagion, her consumption the product of a society she has helped create
Byrne (2011), consumption broad definition
oft acted as blanket term in 19th C for occupational emphysema, lung cancer, and other pulmonary disorders which were unrecognised at the time
Byrne (2011), TB and trade
belief at this period that the consumption of ‘tropical produce’ e.g. sugar was an import cause of phthisis
TB well known to seek out those w low immunity from any class, and the commonest cause of this lack of resistance was inadequate diet
imported tropical foods e.g. sugar
were widely used by the w-c’s bc they acted as appetite suppressors
made a not insignificant contribution to the nutritional deprivation of the masses, and thus to the endemic existence of TB
Sussman, colonial trade
English consumption habits – has ident the importation of ‘sugar and other drug foods’ – tobacco, tea, coffee, opium – as responsible for a national decline in nutrition values
Byrne (2011) TB, from luxury or deprivation?
TB at once a disease of luxury and consumerism and of deprivation
Attractive imported gods were essentially superfluous to hlth but consumed as if necessities
Byrne (2011), gender
female consumptives symbolically complicit in own illness bc of age-old ident between femaleness and consumerism
If women largely responsible for consumerism, they are also producers of its ills, namely TB
Byrne (2011), class
TB = powerful leveller of class
Logan, diseases of wealth
= nervous complaints - hypochondria, hysteria, melancholia
the bourgeois nervous body was ‘highly responsive to cultural conditions’ and therefore a perfect vehicle for social criticism
Bell, Brown, Faire (2006), 2001 TB outbreak
at Crown Hills Community College in Leicester - 3 pupils in same tutor group diagnosed. 19 later found to have active TB
number increased to 26
yr after human genome project, linked to optimistic discourse and a confidence that this scientific breakthrough marked the dawn of a new therapeutic age
TB outbreak assoc w sense of return of disease of the past
Bell, Brown, Faire (2006), TB at beginning of twentieth century
major cause of premature death in Britain
no longer understood as the poetic disease of an earlier Romantic age but as a disease of poverty, overcrowding, undernourishment and insanitary living conditions
Bell, Brown, Faire (2006), TB resurgence
despite the lowest ever recordings of the disease in 1987, since the early 1990s many of Britain’s cities have seen a resurgence in tuberculosis
Bell, Brown, Faire (2006), Leicester
one of the UK’s most diverse cities
From the 1950s onwards, the city attracted immigrants from the Punjab, Gujarat and Pakistan
In the 1960s and 1970s the by then significant South Asian population was augmented by the arrival of more than 20 000 displaced East African families.
Bell, Brown, Faire (2006), role of local media, Leicester TB outbreak
Leicester Mercury acted both as an important source of information and as a potentially soothing influence.
emerged as a site through which health experts sought to communicate directly with the public
dialogue was led by specialists in communicable diseases
Published under the headline, ‘How battle against ‘‘white death’’ was won’, a story linked tuberculosis to the poor living conditions associated with the city’s Victorian slums
Secondly, tuberculosis was identified as a disease that affected many ordinary families in the city. As such, the story served as a reminder that it was not an ‘exotic’ disease, brought in from outside
allusion to the role of the city’s South Asian population in the outbreak was quickly rebutted by Dr Philip Monk, a consultant in communicable disease control, who remarked that it was ‘wild speculation’
Leicester Mercury played a crucial role. It did not seek to establish blame for the outbreak. Early links between tuberculosis and the mobility of the city’s South Asian population were largely ignored
Bell, Brown, Faire (2006), wider context of Leicester TB outbreak
occurred during an age of anxious urbanism, a key feature of which is the fear that increased global connectivity brings with it considerable dangers to health
Bell, Brown, Faire (2006), role of hlth professionals
over 140 000 letters were sent to parents throughout Leicestershire.
As on previous occasions, people were advised to call NHS Direct if they were concerned. The response was overwhelming. According to reports in the Leicester Mercury, the number of calls to NHS Direct had doubled since the outbreak
ongoing dialogue between health professionals and the general public. Its purpose was to be both informative and reassuring
consultant with the Public Health Laboratory Service told the BBC, ‘We have always had tuberculosis in this country
Bell, Brown, Faire (2006), role of national press, Leicester TB outbreak
93 stories Feb-May 2001
simplistic and deterministic representation of the tuberculosis outbreak
outbreak in Leicester occurred at a time of heightened concern over the threat of emerging and re-emerging infectious diseases
key feature of national newspaper coverage of the TB outbreak was the suggestion that the global mobility of Leicester’s South Asian population acted to connect the city with a region in which tuberculosis was endemic
Daily Mail - ‘much of the increase in TB can be put down to the movement of people.’
belief immigration was to blame
Daily Telegraph revealed that the school had a ‘large number of pupils of Asian origin’
concern that the global tuberculosis epidemic, especially in its multi-drug-resistant form, was a threat to the health of the nation. As an article published by The Guardian’s health editor suggested, ‘increasing numbers of multi drug-resistant TB (MDRTB) cases will arrive in the UK’.
In its first report on the outbreak, The Times carried the headline, ‘Rise of disease has links to the Empire.
Transformation of Britain from a ‘tightly knit, static community to a component in a highly mobile global world’ made outbreaks such as that in Leicester inevitable because of its position within this post-imperial network.
alternative expert voices to those managing the outbreak locally were employed to justify the scalar narratives appearing in the national newspaper media, e.g. Daniels, Daily Mail
heterogeneity of immigrant population ignored
By locating the origins of the tuberculosis outbreak in the Indian subcontinent and by identifying tuberculosis as a disease of nineteenth-century Britain, (590) the reporting implied that Leicester’s South Asian population linked this city in the present with a disease of the past.
static and fixed view of national identity and national borders in which connections to the outside signified an ever-present threat
March 2001 report by public health experts at the Public Health Laboratory Service, in collaboration with the British Thoracic Society and the Department of Health
Rates of tuberculosis remained high in all ethnic minority populations: for example, among people from the Indian subcontinent.
it was 121 per 100 000. By contrast, among the country’s white population the tuberculosis rate was 4.4 per 100 000
Bell, Brown, Faire (2006), the social
Clearly, outbreaks of infectious disease are ‘social events’ as well as natural phenomena.
Nicholas King, public hlth
important feature of public health practice in Western industrialized nations is a concern with borders and territoriality.
‘global’ processes are argued to have ‘local’ consequences,
Laura Otis, membrane model of identity
based on exclusion
relies on ability to perceive borders
Bell, Brown, Faire (2006), post-imperial world
As Europeans expanded their borders, the cultures, peoples and diseases they embraced began diffusing through permeable membranes back towards their imperial cell bodies.
In the words of Donna Haraway, the colonized (the invaded) were perceived as the invader
Bell, Brown, Faire (2006), better postcolonial approaches
represented by genetic model, and in particular the metaphor of DNA
identification in 1953 of the interweaving strands of DNA molecules in an intricate double helix structure, is suggestive of the dynamic and fluid qualities of nation and identity
recognition that human variability arises from interactions between genes and the environment
way of identifying fluidity without resorting to the negativity that surrounds it (as in membrane model)
Morens (2002), Robert Louis Stevenson
escaped to Davos, to rugged sea-swept Speyside, and to sunny Marseille
All the while, he worked on the great books we still read all over the world, Treasure Island, Kidnapped—novels of escape.
Surviving a succession of hemorrhages, Stevenson
climbed hills and sailed oceans, following the medical advice of his time.
1891, Stevenson
escaped to Upolu
The doctors said it was a stroke that felled him in December 1894.
Shelley, Elegy on the Death of John Keats
a pale flower by some
sad maiden cherished,/And fed with true-love tears, instead of dew/The bloom, whose petals nipped before they blew/Died on the promise of the fruit, is waste;/The broken lily lies—the storm is overpast.
Morens (2002), central metaphor of consumption in 19th C
idea that the
phthisic body is consumed from within by its passions
Morens (2002), central metaphor of consumption in 19th C
idea that the
phthisic body is consumed from within by its passions
Morens (2002), spes phthisica
condition believed peculiar to consumptives in which physical wasting led to euphoric flowering of the passionate and creative aspects of the soul.
The prosaic human, it was said, became poetic as the body expired from consumption, genius bursting forth from the fevered combustion of ordinary talent, the body burning so that the creative soul could be released. Keats’ great poetic output during his last year was considered a direct consequence of consumption.
Morens (2002), how was consumption viewed 19th C?
not in medical terms (medicine had little to offer anyway), but in popular terms, first as romantic redemption, then as reflection of societal ills
Morens (2002), opera
perhaps provides the most powerful examples of romantic redemption through tuberculosis. The pallor and wasting, the burning sunken eyes, the perspiration-anointed
skin—all hallmarks of the disease—came to represent haunted feminine beauty, romantic passion, and fevered sexuality, notions reinforced by the excess of consumption deaths in young women
Morens (2002), La traviata
translation - the lost one
In taking her life, consumption also serves as a vehicle for atonement. Violetta dies redeemed in the eyes of Alfredo and his father
1881, Les contes d’Hoffman (Morens’ account)
exhibits an important
shift in thinking about consumption
Antonia is treated by the charlatan physician
Dr. Miracle. Satirizes med impotence
links Antonia’s consumption to her mother’s. Heredity as a possible cause of consumption (a popular concept before Koch’s discovery) appealed to the opera’s audience because it absolved the patient from guilt or shame.
Morens (2002), 19th C shift in relationship between med and TB
At the time of Keats’ death, in 1821, little could be done to treat phthisis; the physician’s role was in prognosis. By 1881, the “medicalization” of consumption was in full swing, with diets, nostrums, regimens, and activity lists
Morens (2002), end of the 19th C
By 1896, the cause of consumption had been discovered. Tuberculosis or TB (as the disease was now becoming known to everyone) had also been definitively linked to poverty and industrial blight, child labor, and sweatshops. A contagious disease and shameful indicator of class, it was no longer easily romanticized in conventional artistic terms. Public health efforts to isolate the infected and control their behavior were everywhere.
Puccini, La bohème, 1896 (Morens’ account)
(the bohemian life)
features characters new to opera, street artists living with poverty and disease.
seamstress portrayed as a fevered beauty whose allure is
heightened by physical decline
in the winter cold, Mimì is reconciled with Rodolfo
and dies beside him. In one of opera’s most enduring scenes, there is no attempt at metaphorical understanding. Mimì dies
literally. No one is saved, no one is redeemed, and no larger point is made. Opera and tuberculosis have entered a new era, recognizable today, in which tragedy is seen as experiencing loss but is not necessarily understood in an artistic or philosophical sense.
blames society for this
Hugo’s Les misérables (1862), Morens’ account
hounded protagonist (Jean Valjean) finds redemption in the adoption of a child of a dying woman (Fantine) who had been forced by poverty into prostitution.
Fantine’s death from consumption is portrayed as a consequence of social ills
Morens (2002), impact of Koch’s discovery on artistic portrayals of TB
Only rarely in the period before Koch’s
discovery was the disease portrayed realistically in artistic works.
Morens (2002), Romantic Era of Consumption
1821-81
At the beginning of this period, the stethoscope was invented and used to diagnose phthisis, and statistics were compiled by population-oriented proto-epidemiologists (e.g., Louis-François Benoiston de Châteauneuf) and by clinical proto-epidemiologists (e.g., Pierre-Charles-Alexandre Louis). In the 1820s, contagion was beginning to coalesce into a modern concept, although it was not imagined in chronic conditions like phthisis.
Morens (2002), Discovery of Mycobacterium tuberculosis
1882-1952
romantic notions about tuberculosis were replaced by scientific ideas and products: vaccines and therapies, rest cures, tonics, pneumonectomies, lobectomies, thoracoplasties, “artificial” pneumothoracies, phrenic nerve crushings, plombage, pneumatic cabinet treatments, and antiseptic injections into the pleural spaces.
science and medicine
were unapologetically prosaic
Morens (2002), impact of TB on Western society after Koch’s discovery
tranformative
Tuberculosis patients were excluded from many occupations. Married patients had to sleep in separate beds from uninfected spouses and were counseled to avoid sex and especially to not have children
Public health nurses visited
door to door, sanatoria were built by the hundreds, and hospitals added tuberculosis wings. Cold water hydrotherapy, alcohol massages, and brisk rubdowns with coarse towels were prescribed.
Patients’ bed linens were changed daily and were boiled and laundered separately
Japanese “paper handkerchiefs” became popular, leading eventually to the modern “facial tissue.” Tuberculous women had to forego corsets and brassieres in favor of loose-fitting clothes
Compulsory registration, immigration bans, and even interstate travel restrictions were debated.
Babies were no longer allowed to play on the floor, and mothers were told not to kiss children on the mouth. Some churches abandoned the “common” communion cup. “TB” and “x-ray” became household words
Long “trailing” dresses went out of fashion because they dragged on
the ground and picked up potentially infectious dust.
Morens (2002), TB in Modern Times
1952-2002
late 1940s and early 1950s, trucks cycled through neighborhoods to administer chest x-rays, and schools provided “tine tests.
Ppl spoke in a slight hush when they mentioned “TB.”
The 1950s represented the cusp of a new era in which drug treatment would end tuberculosis visibility in industrialized countries.
modern tuberculosis era began around 1952 with antituberculosis chemotherapy, but more die of the disease today than in the 19th century.
Morens (2002), TB global/ class shift
in 1891, when Stevenson had
escaped to Upolu, tuberculosis was still a disease of wealthy industrial nations.
Now, more than a century later, tuberculosis has escaped to the places where its victims once sought refuge, the one-time
colonies of Western nations.
The disease destroys the poor and underprivileged as it once destroyed the wealthy—95% of cases and 98% of deaths occur in the developing world.
Bivins (2015), TB persistence
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
Bivins (2015), fears of migration
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.
mounting evidence of racial bias in popular and political responses to immigration undermined cherished British myths of national tolerance, and its status as a model for its ‘multicultural’ empire
Bivins (2015), post-war migration
labour shortages. In response, public and private bodies actively recruited both skilled and unskilled labour, initially from Europe’s refugee camps
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’
1848 British Nationality Act
all Commonwealth, colonial, and Irish citizens were entitled to free entry and right of abode in Britain, their imperial ‘home’.
Thus invisible to border controls
Bivins (2015), post-war British identity
rooted in welcome improvements in the health and life-spans of indigenous Britons, and especially their reduced morbidity from preventable diseases, including tuberculosis.
By the mid-twentieth century, tuberculosis was a disease in decline in Britain, as in much of the industrialized world.
from the perspective of a public and a wider medical profession that genuinely expected the total eradication of tuberculosis from Britain in the immediate post-war period, even twenty-five imported cases of a contagious disease could seem a worryingly large number
Bivins (2015), BCG vaccine
grudgingly approved for limited use in the UK in 1949
Bivins (2015), shifting approaches to TB control 20th C
National Association for the Prevention of Tuberculosis (NAPT), described high-quality nutrition and housing as the best tools of TB prevention.
TB = social disease
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
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
CMO annual report on the hlth of the nation, 1953
halving of English and Welsh TB mortality rates since 1948
Bivins (2015), shifting cultural conceptions of TB 20th C
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.
Times leader 1950
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’
President of the Society of Medical Officers of Health, late 1957
‘tuberculosis had lost its news value’.
so low was morbidity and mortality in the general population
1951Timesarticle (Bivins’ account)
sympathetic towards the EVW groups in particular, and confirmed that ‘all were given a careful medical examination’. Overall, the article’s tone was positive; EVWs and West Indians, despite ‘occasional disputes over the relative dignities of British citizenship and a white skin’ were settling into British life well.
Explicitly for this paper and its mainstream middle-class audience, this meant ‘assimilation’
Daily Herald, 1953
TB Aliens fill our clinics
quarter of all new patients at one chest clinic were recently arrived ‘aliens’.
Dr Horace Joules, a prominent chest physician and anti-tuberculosis campaigner
For reasons I cannot understand the Ministry refuses to screen the aliens—I could understand it if it were a Ministry of Disease instead of a Ministry of Health. Every otherreasonable civilised country has taken that step’
Bivins (2015), role of Ministry of Health
Health was comparatively weak in Whitehall. It lacked Cabinet level representation
If the Ministry of Health was minded to require ‘X-ray photographs and radiologists reports’ certifying freedom from tuberculosis, the more powerful Home Office and Ministry of Labour were having none of it.
Both departments clearly felt that any additional layers of control or surveillance might disrupt the vital flow of labour
specialists envisioned the problem of immigrant disease very differently from their non-expert medical colleagues.
Similarly, the effects of mass migration viewed from a national perspective differed sharply from experiences of the same phenomena in the local areas most directly affected.
The Ministry of Health consistently privileged expert opinions and national perspectives over local and generalist concerns.
Government policy, as late as November 1961, remained that compulsory medical examination was neither necessary nor practical.
Central Health Services Council, 1953 survey
exonerated immigrants (taken as a generic whole across the entire country) from the charge of disproportionate TB morbidity, and showed that few imported their disease.
its own expert advisors from the Standing Advisory Committee on Tuberculosis reviewed the country-wide figures and asserted that tubercular immigrants posed no ‘menace’ to the nation’s health
CHSC focused on the more dramatic data produced in a single part of Greater London (the immigrant-rich North West Metropolitan Hospital Region) and urged the Minister of Health to introduce radiographic examinations for all would-be immigrants
F. A. H. Simmonds, 1953 presidential address to the British Tuberculosis Association
‘it is not always realized how mentally and socially backward some of our fellow citizens are’.
(Here, Simmonds was talking aboutBritain’s indigenous ‘underclass’)
Simmons, 1954 and later
‘susceptible individuals’—those whose natural immunological defences had never successfully met the challenge of exposure to tuberculosis.
ngoing threat to the nation’s recovery, and the eventual eradication of tuberculosis from Britain came from abroad
did not argue that the migrants brought disease to Britain’s shores. Rather they were themselves victims of the familiar ‘problem individual’ (the chronic infective), and of their own poor housing and inadequate diets.
undershot with an already outdated acceptance of ‘racial susceptibility’
Bivins (2015), post-war med and race
renounced biological race
sensitivity to dangers of ‘racialism’
1954 article in Tubercle, the journal of the British Tuberculosis Association
Tubercle, the journal of the British Tuberculosis Association
Macdonald and Hess found that the Irish were indeed considerably more susceptible to TB. However, closer scrutiny also established that the Irish group fell primarily into the most vulnerable young adult age group, and that virtually all came from rural Ireland, where rates of exposure to tuberculosis were unusually low
Only six of the 104 Irish patients had been diagnosed with TB before arriving in Britain
Clearly, the nineteenth- and early twentieth-century assumption of infectious immigrants, carrying their burden of contagion with them from squalid homes had not disappeared in the mid-twentieth century; however, at least for the Irish, this stereotype did not hold.
confirmed importance of susceptibility
Irish susceptibility—and by extension, that of other rural migrants—resulted from TB’s ‘epidemiological phase of development’ in their country of origin and not from ‘an inborn racial defect’.
Assertion that migrants were in fact the victims of tainted British slums
Lancet’s stance on the medicalization of border controls
Lancet’s stance on the medicalization of border controls
can’t refuse entry to those who fought on our side during the war and later found own countries barred to them
In calling for BCG vaccination while rejecting radiographic examination at the borders, it reflected the clinical state-of-the art.
Yet theLancet’s editors shared withLancetcorrespondents the conviction that some health checks were necessary, if only to prevent Britain from becoming the destination of last resort for tuberculous would-be migrants facing rejection elsewhere
Bivins (2015), majority of medical commentators
supported greater surveillance of immigrants, both before their departure from their countries of origin and after their arrival in Britain
expressed supported greater surveillance of immigrants, both before their departure from their countries of origin and after their arrival in Britain
Times late 1954, Norman MacDonald
(based on no discernible evd)
‘the entry of coloured people whose acquaintance with tuberculosis is comparatively recent into cities where there is a greatly increased risk of exposure to infection … is apt to lead to an accelerated rate of breakdown’
