Tuberculosis Prevention

By: Gabriel Hernandez

Tuberculosis was “a scourge wiping out thousands of lives during the Romantic, Victorian, and Modernist periods.” For example, in London in March 1860 there were 171 deaths related to phthisis or pulmonary consumption in a span of one week (Boev, 2012). In order to prevent tuberculosis during the middle 19th to early 20th century, England’s parliament issued a series of public health regulations concerning both the public’s actions and environmental hazards that could increase the chances of causing but, especially spreading the disease.

There were many different ideas on how tuberculosis and its related diseases were caused during the 19th and early 20th century. Since not a lot was known about tuberculosis in middle of the 19th century, there were different ideas on how it was caused and how it could be prevented. One idea that remained dominant was that tuberculosis was caused by filthy living conditions in cities thus believed it could be prevented by improving sanitary conditions. For example, in 1850, John Simon, Medical Officer of Health for the City of London argued that chronic diseases such as consumption and epidemic deaths from them could be prevented with sanitary legislation. Simon included such measures as improving public sewage draining, house drainage, water supply and dwelling conditions. Another MOH stated that the only way that consumption could be prevented was through breathing plenty of fresh air, which was not easily accessible in most cities, especially London.

After the discovery that tuberculosis could be spread from one human or animal to another and that tuberculosis was caused by a bacterium called Mycobacterium, different measures were taken to prevent Tuberculosis. A report in 1899 from the Hackney district of London recognized how people with consumption of the lungs coughed up large amounts of phlegm that contained microbes of tubercle, and that this was the main way that tuberculosis is spread from person to person. Knowing this, cities began implementing new practices during the 20th century that could prevent tuberculosis such as “the display of cautionary notices with a view of checking the dangerous and disgusting practice of spitting.” In addition, railway companies became increasingly more involved in protecting the public from getting infected by adopting a strict method of cleaning their railway carriages. For example, the Great Eastern Railway of the east district of London had to disinfect and sweep four times daily and have spitting notices that were strategically placed and visually appealing. Other stations even had vacuum cleaners that would be used daily to reduce the amount of filth in the carriages.

Once the Royal Commission came out with an interim report in 1904 stating that bovine tuberculosis was the same as human tuberculosis, many regulations and inspections were imposed on meat and dairy products. This lead to the creation of the Milk and Dairies bill in 1909 that would require the inspection of cattle, milk and its storage units to prevent the sale of tuberculosis milk and thus preventing tuberculosis from spreading. Although this bill never passed, similar ones were passed in later years. For example, in 1925 Britain passed the “Public Health (prevention of tuberculosis) Regulations.” It stated that any persons:

who are aware that they are suffering from tuberculosis of the respiratory tract may not enter upon any employment or occupation in connection with a dairy which would involve the milking of cows, the treatment of milk or the handling.

Oates, 1930

In addition, if a local authority believes that someone is suffering from tuberculosis and is working in an environment handling dairy then they may notice him to leave his employment occupation (Oates, 1930).

Other measures regarding isolation and quarantine to prevent the spread of tuberculosis were also advised. For instance, in 1937 the MOH of Walthamstow recommended that all infected patients be re-housed and separated from everybody. They were told it was best if they had a separate bed and bedroom to prevent spreading the disease. Towards the middle of the 20th century sanatoriums were created for this purpose. Tuberculosis patients were to have a place where they could get “fresh air and exercise, diet, and graduated labor” since the idea of open-air treatments was still common (Oppenheimer, 1998). Other forms of tuberculosis prevention were preventive programs that were sponsored by anti-tuberculosis organizations that educated the public on how the disease was transmitted and developed to help prevent its transmission. People were also encouraged to get frequent checkups if they were infected (Johnston, 1993).

The development of the bacillus Calmette-Guerin vaccine, also known as the Tuberculous or B.C.G vaccine, greatly helped prevent the number of newly occurring tuberculosis cases and deaths in the 20th century. Likewise, the Medical Research Council of Britain found out that vaccinations were indeed helpful in preventing tuberculosis in adolescents if they had received the vaccine as a child. This led to extensive recordings and testing of all children in secondary schools to try and eliminate tuberculosis cases and prevent it from spreading to other vulnerable children. They believed that if all children were vaccinated then that would eventually lead to the eradication of the disease.

Overall, because of these prevention implementations on many areas of the public’s life and vaccinations, tuberculosis cases were significantly lowered in the later 20th century. In the year 1866, London had an average of 469 deaths from tubercular cases. However, by 1932 there was as few as 14 tubercular related deaths reported. Almost all cases were eradicated or contained towards the end of the 20th century.

This is an example of a pile of treatises regarding tuberculosis that could have been found during the early 20th century. It shows an articles about how it can spread, be prevented and how it can be fatal.

Bibliography

Boev, Hristo. “Dickens’s Consumptive Urbanity: Consumption (Tuberculosis) through the Prism of Sensibility.” Dickens’s Consumptive Urbanity: Consumption (Tuberculosis) through the Prism of Sensibility. Ovidius University, October 28, 2012. .

Collingridge, Wm. City of London 1904

Collingridge, Wm. City of London 1909

Johnston, William. “Tuberculosis.” Chapter. In The Cambridge World History of Human Disease, edited by Kenneth F. Kiple, 1059–68. Cambridge: Cambridge University Press, 1993.

Letheby, H. City of London 1866

Oates, Geoffrey Eugene. Paddington 1929

Oppenheimer, Gerald M., and A. L. Fairchild. 1998. “Public Health Nihilism vs Pragmatism : History, Politics and the Control of Tuberculosis.” American Journal of Public Health 88 (7): 1105–17.

Pearce, Samuel. Bethnal Green 1860

Powell, A. T. W. Walthamstow 1937

Powell, A. T. W. Walthamstow 1955

Simon, John. City of London 1850

Warry, King. Hackney 1899

Willoughby, Mason. City of London 1932