Tuberculosis, called “consumption,” by doctor Richard
Morton or “phthisis,” (Greek term for pulmonary tuberculosis) or the “white
plague,” was the cause of many casualties in industrialized countries during
the nineteenth and
early twentieth centuries. By the
late nineteenth century, approximately seventy to ninety percent of the urban
populations of Europe and North America were infected with the TB bacillus, and
about eighty percent of those individuals who developed active tuberculosis
died of it.1 Tuberculosis’s
surveillance and maintenance of public health during the nineteenth and
twentieth centuries has certainly evolved since its initial findings. In this
essay, I’ll identify what tuberculosis was considered in the nineteenth century,
its changes by the twentieth century and what it is considered today.

In the seventeenth
century, phthisis was believed to be genetic. However, by the nineteenth
century, Tuberculosis was thought to be a
hereditary, constitutional disease rather than a contagious one. By the end of
the nineteenth century, when infection rates in some cities were thought by
public health officials to be nearly a hundred percent tuberculosis was also
considered to be a sign of poverty or an inevitable outcome of the process of
industrial civilization. About forty percent of working-class deaths in cities
were from tuberculosis.2

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Koch’s identification of the tuberculosis bacillus in 1882 helped to convince members of the medical
and public–health communities that the disease was contagious. He was able to prove that a bacterium caused
tuberculosis. In 1890, Koch announced his discovery of tuberculin.
Additionally, he thought tuberculin could be used as a cure for tuberculosis.

According to Koch, Tuberculosis was firstly a
bacterium disease. Its bacterial pathogen was specifically, Mycobacterium
Tuberculosis. He was able to identify that first, it required high levels of
oxygen. Second, cell walls protection made resistance to treatment more
prevalent. Third, he pointed out how there was slow and deliberate cell growth.
Fourth, because of the human’s waxy cell wall, it made us immune to
antibacterial medication. And lastly, that the disease would spread by exposure
to mucous droplets by infected host.3

Preventing the spread of tuberculosis became the
motivation for some of the first large-scale public health crusades.
After Koch’s identification
of the bacillus, the quest for a cure grew rapidly. Despite eager exposure Koch’s
tuberculin treatment, announced in 1890, proved mostly useless and sometimes harmful
though it did turn out to be helpful in diagnosing the disease.

In efforts to combat
tuberculosis, the sanatoria movement came along around 1880, was a strive to
cure tuberculosis naturally and to prevent its spread by moving patients into
quiet, isolated environments, where the air was pure and freely circulating.
Major sanatoria included some in Davos, Switzerland, and Saranac Lake, New
York. At a sanatorium, rest in
the open air was of paramount importance, and special houses, porches, and
cabins were built to allow easy access to the outdoors. The sanatorium model was
adapted for use in urban environments, and dispensaries, free public clinics for the poor,
also advised patients using the sanatorium model.4

Nearly a century
ago, public health
official Hibbert Hill wrote a sugestive book, The New Public Health.
In it he sought to point out the underlying changes that had taken over the
medical field. The “essential change” he characterized briefly: “The old public
health was concerned with the environment; the new is concerned with the
individual. The old sought the sources of infectious disease in the
surroundings of man; the new finds them in man himself.”5

For Hill, to improve the
health of the nation, one had to begin changing behavior a single person at a
time. The field had to abandon environmental solutions by introducing pure
water, sewage systems, street cleaning and begin focusing on training people
how to live cleaner, more healthful lives. Bacteriology held out hope for
“efficient” public health. The logic behind sanitarians’ ideas ultimately led
to radical reformation of the environment (e.g., tearing down filthy,
air-deprived slums, improving the infrastructures of entire neighborhoods),
whereas education and control of the actions of the infected individual merely
required a focus on the rebel few. Treating a few thousand victims of disease
was, in his analysis, far cheaper, he estimated “one seven-hundredth the
magnitude” than improving housing for millions.6

Important to note is the fact that, although the movement
could and often did focus on the moral characteristics of those who contracted
the disease, it was nonetheless partnered with social and labor reformers
seeking to transform housing and work conditions for city dwellers at the turn
of the century.7

In closing, I’d like to highlight the fact that
over time, mortality rates began declining in the late 19th century throughout
Europe and the United States. Whether sanitary measures, sanatoria, improved
nutrition, or larger epidemiological factors unrelated to human intervention
were the cause of this decline remains undecided. 8