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The White Plague in the City of Angels

Caroline Luce, Author
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Public Health Response - Containing the Contagion, ca. 1900

Dr. Robert Koch’s discovery that tuberculosis was caused by a communicable infection of tubercle bacilli unleashed a massive public health campaign to end the epidemic in the late 19th and early 20th centuries. These efforts took two primary forms: one focused on containing the spread of the contagion throughout society and another focused on developing ways to slow or stop the spread of the infection in the body. In both cases, efforts to contain the disease required exerting absolute control over the behavior and the bodies of those afflicted.

Progressive Era reformers focused the bulk of their efforts on containing the spread of the disease, particularly in the densely populated, working-class neighborhoods of industrial cities in the eastern United States. Advocates of public health waged massive educational campaigns to raise public awareness of the disease’s contagious nature and offered tips for how to prevent the disease from spreading. They advocated for new legislation to require that both milk and water were properly sterilized and to impose regulations on food safety so that the disease could not be spread through contaminated food. Some called for the abolition of child labor, believing such hard labor early in life increased the chances of infection, and for the elimination of crowded sweatshops where workers could infect one another. Public health advocates in the early 20th century also concentrated their efforts on improving the living conditions of the poor, calling on municipal governments to provide safer, cleaner housing, and public bathhouses, playgrounds and parks.

In these campaigns against contagion, anxieties about racial and cultural purity blended with public health concerns. Although tuberculosis had once been prevalent across the socio-economic spectrum, by the turn of the twentieth century, the disease was concentrated primarily among the urban poor, many of whom were immigrants. Fears of disease and contagion combined with prevailing racist and xenophobic attitudes towards the new arrivals, prompting some to argue that dirty, un-educated, disease-ridden immigrants threatened to infect the rest of society. The educational campaigns of public health advocates coincided with more broad-based Progressive-era efforts to reform the domestic behavior of immigrants – their habits of cleanliness, table manners, eating, and nutrition – to reflect “American” norms. In settlement houses and missions throughout the country, these Progressive reformers sought to solve the social problems of industrial cities, including the epidemic of tuberculosis, by changing the behavior of immigrants.

Perhaps not surprisingly, the most aggressive public health campaigns following Koch’s discovery was launched in the place where the vast majority of America’s new immigrants arrived: New York City. In 1893, the city council of NYC began requiring doctors to register those they had diagnosed with the disease so that carriers could be identified and educated. Inspectors would then visit the afflicted and teach them how to deal with sputum, treat the disease and prevent spreading it to other family members. New York’s Public Health Department later developed mechanisms to remove those identified as having contracted the disease from their homes and to isolate them in public hospitals so that they could not infect others. Public health officials in New York believed that containing the spread of the contagion required exerting immense authority and regulation over the lives of those infected.
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