The meanings of diseases change over time, probably none more so than tuberculosis. An ancient human complaint, tuberculosis or ‘consumption’ by the nineteenth century was associated with the romantic and fatally flawed artist. In 1882 German researcher Robert Koch identified the bacteria (Mycobacterium tuberculosis) that caused the disease,but it would be more than 60 years before the development of antimicrobials for effective treatment. In the meantime, medical experts tried to explain why, if a bacterium caused the disease, some people got sick and others did not. They turned to a useful analogy of ‘seed and soil’ to explain why some, such as the working class poor and certain ethnicities (‘races’), seemed particularly prone. Certainly the bacteria, the ‘seed’, caused infection, they argued, but a receptive ‘soil’ or a hereditary disposition was also necessary before the disease developed. Eugenicists believed that this vulnerability to tuberculosis should be added to the list of ‘defects’ that could be passed on to the next generation.
Today tuberculosis is understood as an infectious disease spread through droplet infection by coughing or sneezing. It most commonly affects the lungs but can involve almost any organ of the body. Symptoms include fatigue, lethargy, fever, and weight loss that progress to chest pain, coughing up of sputum and blood, and shortness of breath. But until the disease reaches an advanced stage, many experience only mild respiratory symptoms similar to the common cold. Unlike other infectious diseases, tuberculosis is acutely environmental-specific. Whether the disease develops once a person becomes infected depends on a number of factors, the most important of which are living conditions (including overcrowding), quality of nutrition, and general health.
History of Treatment Well before Koch’s 1882 identification of the tubercle bacillus, and before active measures such as public sanatorium treatment, tuberculosis death rates had been steadily falling in Europe and North America. The reasons for decline are not altogether clear, but it is apparent that a greater emphasis on personal hygiene, greater levels of prosperity generally, and social reform movements for safer workplaces and improved sanitation and housing all had an impact. So, by the early 20th century when active anti-tuberculosis campaigns emerged in Canada, the disease was already in decline, at least among the more comfortable classes. On this shifting ground, tuberculosis became increasingly associated with the poor and the many social problems that seemed to breed in their homes or lurk in their families.
Tuberculosis and Degeneration Fears of national degeneration in the World War One era fed the eugenics cause. Progressive middle-class reformers, active in many campaigns aimed at improving Canadian society, associated tuberculosis with the prohibition movement by drawing links between alcoholism and a disposition to tuberculosis both in drunkards and their children. The same moral degeneracy that led to drunkenness and venereal disease predisposed one to tuberculosis, or perhaps it was the other way around. In any case, reformers linked tuberculosis with degeneracy generally, providing a broader public health foundation for the eugenics movement.
Tuberculosis and Eugenics Anti-tuberculosis reformers understood that, though tuberculosis itself was not inherited, people could be predisposed to the disease as a result of inherited traits – both racial and individual. Historian Katherine McCuaig notes that anti-tuberculosis workers warned that for genetic reasons, tuberculous people should never marry. They would merely produce feeble, miserable children who would have no vitality and be easy prey to the disease. In fact, reformers asserted, tuberculosis might even be an indirect cause of feeble-mindedness or insanity.
In some American states in the late 19th century tuberculosis was added to the eugenic defects that could disqualify couples from marrying. Historian Katherine Ott explains that physicians who supported eugenic theory counseled patients not to marry if there was history of tuberculosis in their families. They advised tubercular women who were already married to avoid pregnancy lest they produce defective offspring. In the early twentieth century eugenicists suggested that couples planning to marry be required to obtain physical certificates attesting to the absence of a variety of conditions in their family histories, including feeble-mindedness, tuberculosis, drunkenness, epilepsy and insanity. Still others mentioned the possibility of sterilizing consumptives.
Eugenics in Canada As historian Angus McLaren notes, in 1919 WL Lochhead, a Canadian professor of botany, made the case for a eugenic approach to the problems of the day: “Many defects such as feeble-mindedness, epilepsy, deaf-mutism, and disposition to tuberculosis and other diseases are undoubtedly inherited, and to put no hindrance to the breeding of the unfit and degenerate persons exposes our country to the gravest risk of regression, especially when it is recognized that the population is being largely recruited from inferior stocks.”
In 1924 the United Farm Women of Alberta pushed to have debarred from entry into Canada “the feeble-minded, epileptic, tubercular, dumb, blind, illiterate, criminal and anarchistic.” The future of the country relied on breeding “good stock”, but equally it depended on not importing “bad stock;” diseased and sickly immigrants would weaken the population further. Though unsuccessful at controlling immigration, eugenicists provided seemingly scientific rationales for existing racial and class prejudices. Sanatorium Cure.
We can never know how many tuberculosis sufferers took to heart the eugenics message and remained single or childless. But by the interwar period, anti-tuberculosis efforts shifted from a focus on the social problems that gave rise to the disease to state-supported treatment. Enlisting the aid of municipal and provincial governments, the voluntary anti-tuberculosis associations provided tax-supported sanatorium treatment for those who could not afford a lengthy hospital stay. The expedient of isolating patients in sanatoria likely helped reduce the disease’s spread, and it certainly allayed fears, though the treatment consisted of little more than bed rest and a rich diet. The ‘rest cure’ was later augmented with risky and disfiguring chest surgery.
The Modern Disease After 1944, with the development of the antibiotic streptomycin and later para-aminosalicylic acid (PAS), and by 1952, isoniazid (INH), tuberculosis became manageable if not curable. The Canadian Tuberculosis Association’s 1977 celebratory history, The Miracle of the Empty Beds, praises the efforts of lay people and doctors in conquering the disease. That celebration was premature. Tuberculosis remains one of the world’s deadliest communicable diseases. In 2013, an estimated 9 million people developed the disease and 1.5 million died. In Canada, it continues to stalk the desperately poor, the homeless, and those whose immune systems are compromised by HIV/AIDS, while drug-resistant strains of tuberculosis have emerged.
Feldberg, Georgina. Disease and Class: Tuberculosis and the Shaping of Modern North American Society. New Jersey: Rutgers University Press, 1995
Koch R. Die Atiologic der Tuberkulose. Berliner Klinische Wochenschrift. 1882
McCuaig, Katherine. The Weariness, the Fever, and the Fret: The Campaign against Tuberculosis in Canada, 1900-1950. Montreal and Kingston: McGill-Queen’s University Press, 1999
McLaren, Angus. Our Own Master Race: Eugenics in Canada, 1885-1945. Toronto: McClelland and Stewart, 1990
Ott, Katherine. Fevered Lives: Tuberculosis in American Culture since 1870. Cambridge: Harvard University Press, 1996
Pearson, Karl. A First Study of the Statistics of Pulmonary Tuberculosis, and Tuberculosis, Heredity, and Environment. London: Dulau & Co. 1907
Wilson, Philip. “Confronting ‘Hereditary’ Disease”, Journal of Medical Humanities 27 (2006): 19.