Tuberculosis Flashcards

Question

Berry, classical definition of luxury

Answer 1

creator of effeminacy. Plato considered it threat to virility bc indulgent lifestyle not conducive to male strength and power

Answer 2

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

Answer 3

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

Answer 4

oft acted as blanket term in 19th C for occupational emphysema, lung cancer, and other pulmonary disorders which were unrecognised at the time

Answer 5

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

Answer 6

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

Answer 7

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

Answer 8

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

Answer 9

TB = powerful leveller of class

Answer 10

= nervous complaints - hypochondria, hysteria, melancholia the bourgeois nervous body was ‘highly responsive to cultural conditions’ and therefore a perfect vehicle for social criticism

Answer 11

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

Answer 12

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

Answer 13

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

Answer 14

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.

Answer 15

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

Answer 16

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

Answer 17

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

Answer 18

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

Answer 19

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

Answer 20

Clearly, outbreaks of infectious disease are ‘social events’ as well as natural phenomena.

Answer 21

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,

Answer 22

based on exclusion relies on ability to perceive borders

Answer 23

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

Answer 24

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)

Answer 25

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.

Answer 26

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.

Answer 27

idea that the | phthisic body is consumed from within by its passions

Answer 28

idea that the | phthisic body is consumed from within by its passions

Answer 29

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.

Answer 30

not in medical terms (medicine had little to offer anyway), but in popular terms, first as romantic redemption, then as reflection of societal ills

Answer 31

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

Answer 32

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

Answer 33

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.

Answer 34

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

Answer 35

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.

Answer 36

(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

Answer 37

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

Answer 38

Only rarely in the period before Koch's | discovery was the disease portrayed realistically in artistic works.

Answer 39

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.

Answer 40

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

Answer 41

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.

Answer 42

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.

Answer 43

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.

Answer 44

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

Answer 45

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

Answer 46

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'

Answer 47

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

Answer 48

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

Answer 49

grudgingly approved for limited use in the UK in 1949

Answer 50

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

Answer 51

halving of English and Welsh TB mortality rates since 1948

Answer 52

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.

Answer 53

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’

Answer 54

‘tuberculosis had lost its news value’. | so low was morbidity and mortality in the general population

Answer 55

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’

Answer 56

TB Aliens fill our clinics quarter of all new patients at one chest clinic were recently arrived ‘aliens’.

Answer 57

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 other reasonable civilised country has taken that step’

Answer 58

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.

Answer 59

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

Answer 60

‘it is not always realized how mentally and socially backward some of our fellow citizens are’. (Here, Simmonds was talking about Britain’s indigenous ‘underclass’)

Answer 61

‘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’

Answer 62

renounced biological race sensitivity to dangers of 'racialism'

Answer 63

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

Answer 64

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 the Lancet’s editors shared with Lancet correspondents 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

Answer 65

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

Answer 66

(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'

Answer 67

'colour' operated as a moderator of risk, distorting what had been a clear focus on immunological and environmental factors unlike their Irish counterparts, ‘coloured’ migrants imposed no measurable burden on the NHS—but were nonetheless suspect although the evidence before the LCC Health Committee most clearly implicated Irish migrants while largely exonerating ‘coloured’ migrant groups, the LCC Health Committee advocated an approach focused on the latter and combining elements of exclusion with those of assimilation. Colour, rather than contagiousness, drove responses on the ground.

Answer 68

in context of seeking a new niche for its health promotion and disease prevention endeavours that the NAPT discovered colonial migrants as a population in need of expertise no longer equally vital to a healthier indigenous population. Pressed by the Secretary of State for the Colonies for the data upon which their claims were founded—and particularly for evidence of unusual rates of tuberculosis among colonial migrants—the delegates were forced to admit that they had no such proof. Their certainty that West Indian migrants were vectors and victims of infection again demonstrates the enduring power of the association between immigrants and contagion, colonials and ‘diseases of civilization’.

Answer 69

attempts by Birmingham’s Mass Miniature Radiography (MMR) ‘to attract the coloured population’ had failed specifically ‘because the people who were aimed at were scared off by the publicity that was undertaken’ Such reports reinforced historic assumptions that migrants (Irish and West Indian alike) represented a particularly intractable and uncooperative population.

Answer 70

expressing his Council’s dismay at an ‘influx of coloured immigrants' ‘coloured immigrants naturally gravitate on first arrival to “colonies” of their kind and remain there until they find employment and more permanent accommodation.’

Answer 71

Amy Fairchild, among others, has seen this usage as literally equating the migrants to the germs they were assumed to carry and spread language of ‘colonies’ also suggests a much more topical and contentious analogy, and one that I believe operated far more powerfully and directly. In this era of decolonization, independence struggles, and the decline of imperial identities and loyalties, to describe immigrant communities composed of recent arrivals from Britain’s former empire as ‘colonies’ was to assert that the colonized had themselves become colonizers.

Answer 72

Migrants did not require special measures or provisions, since their problems could be safely subsumed into health planning and policy making for the general public. assumption that assimilation would naturally eliminate the ‘problem’ of immigrant tuberculosis seemingly applied only to Irish migrants—perhaps because only this group was seen as capable of it. Certainly, it did not stop Ministry staff from pursuing special inquiries about the prevalence of TB among the West Indian migrant population

Answer 73

In notes for internal (ministry) consumption, Dr Prideaux concluded that the ‘prominence’ given to this tiny handful of Indian and Pakistani cases by local chest clinic staff related more intimately to the region’s still significant TB waiting lists, than to any actual threat.123

Answer 74

while Smethwick received more Indian and Pakistani migrants than most other areas, not only were their TB figures low, but such local experiences could not reasonably become the basis for nation-wide generalizations. reminded Osborne that any control of Commonwealth immigration required new legislation on citizenship, and as such was not within the Ministry’s remit. Nor was the ‘comparatively small public health problem’ a reasonable basis for such radical legislation

Answer 75

the 'susceptible immigrant' spreading confidence of tuberculosis specialists that the bulk of tuberculous migrants—largely Irish but also African and possibly West Indian—were epidemiologically naïve, tuberculin-negative rural youngsters, infected in Britain’s teeming industrial cities this understanding of the disease marked certain ethnic populations as medically fragile, ill-suited to life in Britain, underdeveloped or even ‘uncivilized’—but it did render them no longer ‘suspect’

Answer 76

arguments that migrants were immunologically ‘innocent’ would gradually become limited to the Irish other migrants, while equally ‘invisible’ to border control due to their shared imperial identity, were increasingly rendered both medically and politically visible as tuberculosis ‘suspects’.

Answer 77

operated as the representative body for a range of different clinical organizations and societies interested in the problem of tuberculosis. April 1956, the JTC issued a highly critical ‘Report on Immigrants and Tuberculosis’, roundly rebuking the Ministry of Health for what it claimed were efforts to minimize ‘the full extent of the menace of tuberculosis infection imported by immigrants’. 'ignorance', deliberate efforts to ‘escape supervision’ and ‘evade treatment or medical observation’ Forced to acknowledge the significant impact of Irish immigration on Britain’s continued excess of TB morbidity, the JTC’s investigators nonetheless concluded that ‘West Indians, Colonial and other Commonwealth workers’ were an ‘even more formidable menace’ Their anxieties, like those of other groups, were based (p.67) almost entirely on suppositions. Chief among them was the unfounded claim that the rates of TB incidence among migrants would reflect the national statistics of their countries of origin abundant evidence that after arrival here their hygiene and living habits are unsatisfactory. This and particularly the overcrowding, greatly facilitates the spread of infection 'public health menace' JTC only ever interested in a model of immigrants as disease importers, tainting and threatening indigenous health. ‘Infectious migrants’ made political sense and offered new traction to a professional body rapidly losing its relevance.

Answer 78

Irish were at least marginally preferred to their West Indian counterparts preference probably derived from the by-now widely-shared conviction that the Irish were ‘susceptible’ victims rather than tubercular ‘suspects’

Answer 79

motion expressing ‘alarm’ at the continued influx of immigrants ‘suffering from communicable diseases’, especially tuberculosis at its July annual meeting H. D. Chalke of the BMA’s Council noted West Indians posed distinctive dangers, rooted in ignorance 1958, it was actively campaigning for much tighter medical surveillance of migrants. Drive for exclusionary external or port hlth controls

Answer 80

Hungarians were legally subject to border control, medical examination, and exclusion on medical grounds. However, they were excused from these restrictions as refugees from Soviet oppression. They were offered screening in their places of residence and work, and when few initially took up those offers, interpreters were called upon to fully explain the purpose of the examinations

Answer 81

no effort to explain process of TB screening to them rather, it was accepted as, to all intents and purposes, a fixed aspect of their TB pathogenicity, and a mark of their status as part of the ‘underclass’ to which they were analogically linked by their racial identities. West Indians and South Asians, presumed to be unassimilable medically says later - presumably as English speakers, they—like the Irish—were expected to draw this knowledge from the existing publicity materials, tailored to the UK’s majority populations

Answer 82

As in the first half of the decade, proponents of control in the late 1950s eagerly sought medical evidence that such migrants produced negative health impacts

Answer 83

In part, Britain was still structured as a ‘global economic unit’ with significant business interests and populations spread throughout its former colonies. Moreover, and perhaps more urgently, the nation’s global political status drew strongly on the transnational ties and sway it had developed as an empire, and sought to maintain through the Commonwealth. Britain’s claim to geopolitical significance leaned heavily on its much-vaunted influence in the politically sensitive regions of Africa and South Asia.

Answer 84

number of in-patient cases of TB cut by almost half since 1953 Ministry chose to assemble those results into eight quasi-geographical, but also racially inflected categories highest rates of incidence, and the largest numbers of immigrant cases were found in the group from the Indian subcontinent had Europe been considered as a single category (that is, had the Hungarians not been considered as a separate group) it would have produced a significantly larger group of affected migrant Thus the way in which the survey data were categorized, tabulated, and displayed minimized rates of infection in the only statutorily controllable group 'race' was implicit in analysis and conceptualization of these data

Answer 85

‘a significant proportion’ of its members described a high incidence of TB amongst specifically rural Irish migrants. Leeds and Smethwick reported high rates of TB among their European migrant populations, while Bradford and Smethwick stated that Indian and Pakistani workers too had rates which were ‘relatively very high’. In the absence of elevated TB rates, West Indians were charged with high rates of venereal disease. In the absence of statistics on which to firmly base their claims and proposals, the report’s authors stated that their conclusions were founded on the existence of such controls elsewhere, and, in another remark clearly informed by eugenics —‘the protection of the community on genetic grounds from a lowering of standards by the introduction of elements who are diseased or of poor physique or mentality. fearful and possessive discourse of its exploitation by ‘medical tourists’ was already emerging, hand in hand with redefinitions of British identity and ‘belonging

Answer 86

motion supporting a reconsideration of the unrestricted access to Britain enjoyed by all British subjects. claimed that he had been forced to raise the issue precisely because unrestricted immigration was causing racial prejudice to flourish, due to the ‘serious problems’ that arose in its wake. First among these were ‘difficulties to our health authorities’. MP James Lindsay - Multi-racial countries have a colour problem

Answer 87

'What also worries our people, especially in Bradford and in other towns where Pakistanis are congregating, is the poor health of these immigrants and the belief that many of them are carriers of contagious and infectious diseases.’

Answer 88

Growing numbers of tuberculosis sufferers among those already occupying very poor housing, for example, posed genuine problems for local Tuberculosis Care Committees, run as charitable enterprises.

Answer 89

By October, the Ministry of Health received a letter and petition of sixty-one signatures which had been sent to a Stoke Newington MP: Stoke Newington was becoming a coloured area ‘owing to the uncleanly way of life of most of the coloured immigrants’ riots were ‘after all … mainly a reflection of the growing impatience of thousands of people who are not prepared to see their country flooded by immigrants, which is quite a natural thing, after trying to build up a decent standard of living after the last war.

Answer 90

Nottingham Council of Social Service, People and Work formed a study group in the spring of 1959 to explore welfare issues affecting the local West Indian community (some 3,000 people). The study group included a number of West Indian men and women their report recognized the emergence since the early 1950s of a competent leadership from within the West Indian community authors noted not only the very low rates of TB among West Indians, but also reported ‘West Indian members of the group told us of the extreme dread of tuberculosis (p.96) in the West Indies, how people with a cough might be avoided as though they were lepers, and of the personal measures adopted to prevent the spread of infection e.g. never drinking out of the same cup as another person.’ The group’s medical member suggested that ‘minor ailments seemed to distress coloured patients acutely’ and caused them to attend surgery repeatedly until cured Overall, the report concluded that its immigrant communities were healthy and were assimilating to British life; the two were very clearly seen as directly related for example, the adoption of ‘English food habits’—articulated as a source of individual and community health.

Answer 91

writing to local colleagues, he categorized all South Asian immigrants in Birmingham as likely ‘foci of infection’. Bivins - From being potential tuberculosis sufferers, these migrants had become the disease itself

Answer 92

West Indians, having been brought up in a Christian and British atmosphere, are most anxious to assert their equal dignity with the English and strongly resent being treated as social inferiors. … The Pakistanis on the other hand mostly speak very little English and are of Moslem religion and have no desire whatever to fit into English society... Having no sense of dignity, they do not mind taking the most menial jobs and they are reported to be good hard workers.

Answer 93

Only as it became increasingly clear that some form of immigration control for Commonwealth immigrants was on the horizon

Answer 94

Together, these transformed perceptions of tuberculosis (especially among migrants), creating at one stroke a proud achievement, a prized resource, and a nation of possessive stakeholders In the wake of the NHS, immigrants to Britain came to experience in a highly amplified form the scrutiny and suspicion that all migrants have faced at the hands of states, societies, and communities anxious to preserve resources for ‘belongers’ and those who might one day ‘belong’.

Answer 95

feared or accepted the newcomers in proportion to their willingness to assimilate to what were seen as ‘British’ norms

Answer 96

Only for the West Indians in the middle years of the decade: no amount of medical evidence eradicated their putative and politically expedient ‘suspect’ status until large scale South Asian migration replaced migration from the Caribbean as the apex ‘threat’ to British bodies, and body politic

Answer 97

if historians must reject simple racism as a model for the relationship between tuberculosis incidence and immigration rhetoric, it is important to acknowledge the rise of a new essentialism in medical thinking Rooted in the emergence and ascendance of genetic understandings of individuals and populations suggestive that over the course of this period, some clinicians and public health workers reshaped rejected notions of ‘racial susceptibilty’ to argue for hereditary transmissible factors deriving not from race but from variability in immunological environments. Like the explicitly racial models which preceded them, these rendered some immigrant bodies (especially the Irish but also Africans) distinctively and invariably susceptible to tuberculosis in Britain.

Answer 98

switch from physiological to ontological models of disease

Answer 99

Significant continuities in the med understanding of consumption bc of diff responses across med and because the dominant seed and soil metaphor allowed constitutional notion to be refashioned in terms of the vulnerability of the human 'soil' and then immunities.

Answer 100

Significant continuities in the med understanding of consumption bc of diff responses across med and because the dominant seed and soil metaphor allowed constitutional notion to be refashioned in terms of the vulnerability of the human 'soil' and then immunities. Atmpts by MOsH to add consumption to their responsibilities were half-hearted and had not succeeded by 1900

Answer 101

resulted from manner in which the germ practices Koch develd were used as the basis for creating the discipline of bacteriology Before introduction of Koch's ideas and methods, sci and tech of germs had been uncertain, in large part due to the lack of standard procedures After, devel of standardised methods etc Powerful images that were seen down microscopes and on culture plates, plus their wide dissemination, meant that there was tremendous interest in emulating Koch's work Advice on bacterial microscopy and culturing was rapidly added to med and pathology textbooks New 1882 edition of Bristowe's Theory and Practice of Med contained appendix on bacterial techniques Anticipated adoption of bacteriological methods into general and hospital practice did not happen Once novelty of seeing the microbial world first-hand had gone, practical value of the new bacteriological skills to ordinary practitioners seemed meagre Courses slow to start up - first formal course started at King's College, 1886

Answer 102

largest single recorded cause of death in Br in the 19th C and wrought an annual death toll of over 50,000 in Eng and Wales throughout he 1870s Further 20,000 ppl died annually of nonrespiratory forms of tubercular diseases e.g. scrofula, tabes mesenterica and tubercular joints 200,000 active cases of pulmonary consumption at any one time 1/40 adults between ages of 20 and 60 was sufferer at any one time

Answer 103

Consumption = popular term for the disease but docs preferred 'phthisis'

Answer 104

Culturally consumptives and their fams carried stigma of inherited 'taint', w connotations of weakness and undesirable qualities By last 1/4 of the century the earlier romantic associations with genius and heightened sensibilities had been replaced by links w debility and degeneration

Answer 105

Incidence of the disease highest amongst the poor - living conditions and lifestyle lower quality, allowing diathesis to express itself

Answer 106

His = the dominant med account of consumption in 1860s Laennec had defined consumption as one of a num of tubercular afflictions that were recognisable postmortem by presence of small swellings or nodules, in which grey-yellow masses were deposited (tubercules) and which over time became enclosed in hardened (caseous) deposits observation that tubercules had common structure led him to regard all tubercular diseases as unitary Nodules were seemingly formed as existing tissues and organs were broken down and 'consumed', e.g. producing cavities in the lungs

Answer 107

Tubercules = nonspecific and secondary - poss result of any tissue becoming inflamed What became known as the 'German school' regarded tuberculosis as one possible result of inflammation, not a new growth of a specific nature Supported by Green leading Br authority on consumption pathology 1870s

Answer 108

Villemin claimed that tuberculous lesions could be produced by the inoculation of tuberculous tissue into susceptible animals In late 1860s and early 1870s hardly anyone interpd Villemin's work to suggest tubercular diseases were ordinarily contagious

Answer 109

assoc w William Budd - in 1867, pointed to similarities between consumption and a disease like typhoid fever Also personal experiences of disease spreading in fams Almost all comments by clinicians on Budd's proposition were dismissive (e.g. Richard Cotton)

Answer 110

some clinicians argued that consumption was not a disease at all, but 'a mere mode of dying', and that all medicine could do was 'prolong a life naturally drawing to its close' (most docs more optimistic)

Answer 111

Set out best forms of restorative, antiinflammatory treatment - good diet, cod-liver oil, exercise, pure atmosphere and bathing Stimulant, phlogistic or 'sthenic treatments, aided by climate hygiene and med Drugs used largely to manage symptoms, esp cough and expectoration No formula - everything depended on judgement of the doctor Separate line of therapy was used of specific antiinflammatory and antiseptic treatments Principally these involved inhalations

Answer 112

1870s - high Alps, sea voyages, distant deserts became more fashionable than the resorts of the Mediterranean No consensus on why climate might help Practical reason for move away from Mediterranean resorts - hostility shown to consumptives by local ppl - in Southern Europe, strong belief consumption was contageous

Answer 113

one extreme - 'revolutionary' the other - many pathologists maintained that the 'virus' had been expected and that it could be easily adapted to prevailing doctrines Existence of bacillus itself seems not to have been an issue Import question was whether it was a cause, concomitant or consequence of the disease Green - poor general health, or the predisposing effects of another chest disease had to have made the lungs 'open' to infection Docs cld accept the tubercle bacillus as just another factor in the pathogenesis of this most variable and capricious of med afflictions

Answer 114

- tubercle hereditary - phthisis not easily communicable man to man - Inoculation experiments on animals do not allow conclusions to be drawn as to their causal agency in man

Answer 115

contagion If disease = contagion, perhaps no longer a med problem but instead one for sanitary authorities and MOsH

Answer 116

By end of yr, 1078 replies of which 62% said 'no' to if observed any cases in which Phthisis appeared to be communicated, and 24% siad yes - 14% undecided or equivocal

Answer 117

subject of tubercular phthisis as regards diagnosis, prognosis and treament, exactly where was before

Answer 118

therapeutic consequences of germ theory v limited

Answer 119

way in which it was used to persuade docs and public tb was curable, or cld be 'arrested' Preventing seed, and strengthening soil through hardening lungs Most common view - body actively 'resisted' infection Suggestion body's ability to localise infection depended on directing physiological energy climate therapy persisted. Talked about less in terms of overall environment, more about specific properties of air - high altitude brought low temps that wld kill bacilli in the air, low atmospheric pressure that wld deepen breathing etc

Answer 120

white blood cells sought out and ingested invading microorganisms used in new explanations of tb Physician now pictured Tubercle bacilli in a Darwinian struggle for existence against the cells of the body, or had a militaristic vision of invading germs and bodily defences (however, persistence of other theories/ models, e.g. poison and antidote)

Answer 121

Campaign by MOsH and other pub hlth officials against meat and milk contaminated w tubercular matter, which began in late 1870s, was given new impetus by identification of the Tubercle bacillus in 1882, tho as import were the International Med Congresses in 1881 and 1884, and the International Veterinary Congress in 1883 - Br practits learned of ambitious continental plans to control and eradicate bovine TB

Answer 122

Koch's authority damaged in 1890s by failure of his much-hyped Tuberculin cure Despite shattered hopes and expectations, Koch and bacteriology more generally emerged relatively unscathed from the episode

Answer 123

Many approaches to treatment for pulmonary tb in early 1890s Successful treatment = match selection of these to the individ patients Treatment of choice = 'rest and a change of air' In terms of bacillary theory, the intention was to achieve a 'strengthening of the resisting powers of the tissue ' and to reduce further infection with bacilli Clinicians' optimism boosted by further evd the disease was curable antiseptic treatments - little efficacy

Answer 124

Tuberculin skin tests of the general population revealed infection rates to be a high as ninety percent amongst adults in some cities for most ppl most of the time, balance was in favour of human soil resisting tb seed persistence of perceived role of hereditary predisposition/ acquired strength through hygienic living

Answer 125

number of doctors brought the treatment down from the mountain and downmarket Downplayed value of air Instead promoted virtues of life in forests in the open air and of the systematic application of hygienic rules main model which Brit docs mimicked was was Otto Walther's sanatorium at Nordrach in the Black Forest Regime had 4 main elements - open air, overfeeding, rest w some controlled exercise, strict discipline Return to holistic therapies and reaction against bacteriology and leb med?

Answer 126

estabd November 1898 w combined ideals that consumption both 'curable and preventable' three areas: - public education on prevention - removing threat to human of bovine tb - promote establishment of sanatoria, esp for working class

Answer 127

theories of immunity that developed after 1890 were not widely applied to tuberculosis. Its pathology was not easy to accommodate with metaphor of attack and defence, at least not the rapid pace of modern warfare, though notions of seiges and 'hundred year war ' would have been more appropriate.

Answer 128

Intriguing that the disease which is oft said to have been most changed by reductionist, laboratory-based, med science in the 1880s should at the turn of the century be fought by a holistic therapy based on methods that anticipte scientific management rather than modern sci med Labs, X-rays and other symbols of sci med were oft part of the sanatorium package, but its core was the enhancement of the healing powers of naturE

Answer 129

The notion that different races had differing immunities to disease is long-standing 'Racial immunity' as a term emerged after 1900 as a synthesis of ideas of race, evolutionary theories and immunology Within twentieth-century medicine the term 'race' was used quite loosely, referring both to groups with shared physical/biological characteristics and to groups defined by social/cultural differences the environmental, cultural and behavioural factors that were believed to determine the incidence of the disease were thought to interact with the biology of individuals and groups, and perhaps inheritance

Answer 130

developed in the 1930s by S. Lyle Cummins People in 'primitive societies' were supposed only to produce 'primitive' responses to tuberculosis in two senses: rudimentary immune responses that failed to combat infection and the complete absence of any preventive health measures. such ideas gave medical and scientific authority to the construction of non-European peoples as biologically and culturally inferior

Answer 131

disease in decline as effective immunity developed in individuals and populations, while hygienic practices prevented infection and allowed controlled tubercularisation.

Answer 132

'virgin soil' theory TB resistance = inherited article on the disease among Egyptian and Sudanese troops He observed that in their 'natural' conditions the primitive Sudanese were not exposed to the disease so there was no selection pressure from the Tubercle bacerium

Answer 133

paper to the Society of Tropical Medicine and Hygiene TB resistance = acquired primitive peoples, like new-born children everywhere, were nonimmune until able to develop immunity after exposure to the disease drew on current aetiological ideas in Britain, and reports on ethnic and racial differences in North America. In making tuberculosis a 'disease of civilisation', he was in part following the dominant idea that tuberculosis was a 'social disease', but adding a new immunological dimension. also referred to the American literature on tuberculosis. Singled out Polish Jews, whose tuberculosis mortality rate was only 170 per 100,000 despite living in very crowded conditions - inner-city areas. Their ethnic advantage, which allowed them to escape the influences of occupation and socio-economic class, explained by their long experience of urban living (cultural not racial advantage) But, the ways that cultural variables (such as dietary choices) supposedly worked with immunological and evolutionary mechanisms (say, by giving greater physiological strength) made the biological and social dimensions of Jewishness constitutive of each other. The Irish were the opposite of everything Jewish C also drew from experience of Royal Army Medical Corps anti-typhoid inoculation programme (position held for 3 yrs) - Observations from across Europe had long shown that up to 90 per cent of adults had healed or arrested tubercular lesions, whereas less than 10 per cent ever showed clinical signs of the disease. On this model, the full-blown disease only occurred when high levels of the bacilli overwhelmed the immunity that had built up, and in those individuals who, for whatever reason, had not developed effective immunity

Answer 134

1. sanitary reform had improved urban and working environments, while industrialisation had produced higher standards of living. 2. better understanding of the causes of tuberculosis had allowed infection to be reduced and treatments to be improved Put another way, tuberculosis may have been a 'disease of civilisation' but the answer to the problem was more not less civilisation

Answer 135

tubercularisation. He maintained that European populations were now exposed to low levels of infection in increasingly hygienic conditions tubercularisation was a form of natural immunisation, where individuals had to be diseased in order to be healthy.

Answer 136

- those, mostly in public health medicine, who focused almost exclusively on the 'seed' and wanted tuberculosis categorised as a contagious or 'catching' disease, so that it could be controlled by notification, isolation, disinfection and hygienic education - those, mostly clinicians, who continued to use a modified version of the older notion that the disease arose from an inherited tubercular diathesis or acquired vulnerability

Answer 137

any idea of inherited or racial susceptibility was considered a minor factor. The rapid fall in mortality in the previous half-century was thought to have been simply too rapid for inheritance or natural selection to have played a large part

Answer 138

Black physicians argued that differences in mortality levels within the white population were great as between races

Answer 139

imperial powers in Africa and elsewhere should slow down the 'civilising mission' and ensure that it not move ahead of the tubercularisation process Such views assumed and gave naturalistic authority to social evolutionary models which suggested that Africans had childlike bodies as well as minds.

Answer 140

distinction between the acclimatisation of an individual, which he saw as acquired immunity, and the racial immunity that was 'deeply fixed in the blood' Cobbett's views signalled a growing tendency from the mid-1920s to reassert the role of inherited racial factors in susceptibility to tuberculosis. Practically this represented no more than a change of emphasis, as the major focus in aetiological thinking and preventive schemes remained on social and cultural factors.

Answer 141

Cobbett was impressed by new evidence from pathological anatomists which showed that tuberculosis in 'civilised races' was chronic and localised in the lungs, while in the 'primitive and dark races' it tended to be acute and generalised. extensive surveys of autopsies in the United States, the majority of which showed that tuberculosis in black Americans tended to affect the lymph nodes and was more generalised than among whites

Answer 142

From the mid-1920s Lyle Cummins also began to argue there was an inherited racial element in immunity to tuberculosis He told the Annual Conference of the NAPT in 1928 that this racial factor depended on 'not an inherited resistance or an inherited susceptibility, but on an inherited faculty to develop resistance when brought into contact with infection' Cummins' change of mind coincided with his involvement with the Tuberculosis Research Committee (TRC) in South Africa and the three visits he made to Africa after 1926. high number of deaths in the very early months of employment suggested many migrant workers already had the disease when they arrived and that mine conditions merely 'reawakened' or accelerated prior infections.

Answer 143

Many doctors thought that he relied on a false analogy with acute infectious diseases, like scarlet fever

Answer 144

In 1930 Cummins said that '{h]e found himself increasingly sympathetic to the view that there existed differences in racial susceptibility. After some generations of intense endemicity, no appreciable evidence of increased resistance was found in some races interesting that co my knowledge Cummins never offered. a racial account of tuberculosis in Wales By 1935 Cummins was writing that 'native races' lacked 'toughness' and would only develop resistance to infection on a historical timescale.

Answer 145

Without a figure like Cummins co disseminate information and connect with metropolitan discourses, the experience of the disease in the rest of the Empire did not have the same impact in Britain as African studies.

Answer 146

the 'fact' (from pathology if not immunology) that there were degrees of inborn racial resistance was incorporated into the major ruberculosis textbooks racial theory of tuberculosis had gone against the wider trend in the biological sciences to question the validity of 'race' as a scientific category in the interwar yrs

Answer 147

While tuberculosis specialises on the Britain-Africa-America triangle were referring increasingly to inherited racial differences, they still regarded environmental factors as more potent determinants of morbidity and mortality 1940s - Nazis - wider political scene mitigated against stressing racial susceptibilities. Docs wary of stressing anything that might sound eugenic Besides, the idea of a genetic factor that might take many generations to mitigate did not fit with the temper of the times. The introduction of streptomycin and then combined antibiotic therapy gave anti-tuberculosis programmes new impetus and optimism. The control of tuberculosis was one of the earliest priorities of the World Health Organisation. environmental factors were always primary in policy and practical measures. However, this should not divert us from the conclusion that 'virgin soil' and racial theories of tuberculosis were influential both in Britain and its empire

Answer 148

pathologists suggested that differences in the response of tissues to disease revealed genetic differences, whereas those found in immune systems did not. latter was seen as interacting with the external world and to be more labile, whereas tissues were internal and fixed both theories sustained notions of racial difference, albeit on different and shifting ground

Answer 149

global tuberculosis mortality has been on a steep upward curve since the 1950s (indeed, in 1993 the Organisation had declared the disease a 'global emergency) two epidemic waves: the first, which was concentrated in northern, industrialised countries, peaked around 1900 and went into decline before a second wave, concentrated in southern, Third World countries, picked up in the 1950s

Answer 150

Contrasts were mainly drawn between 'civilised' and 'primitive' societies- the latter, mostly in Africa, were seen as comparable to Britain in Roman time

Answer 151

dominant version of 'virgin soil' theory tressed acquired immunity, so that the social history and contemporary conditions of a population were felt to be more important than their innate biology That said, distinctions between acquired and inherited immunity were often blurred

Answer 152

tb = 'the price paid for civilisation'

Answer 153

had undermined the idea of distinct racial susceptibilities and pathologies

Answer 154

tuberculisation was not the result of civilisation as such, but was a feature of 'faulty ' civilisation that ignored the 'law of health' and had not balanced social and economic changes with 'necessary safeguard '

Answer 155

like Cummins, there were many colonialists and medical experts who felt a sense of responsibility for the fact that 'primitive' peoples had been exposed too rapidly to the rigour of higher levels of 'civilisation In the African context, it was social diseases like tuberculosis, syphilis and leprosy that were the diseases of civilisation in the first half of this century not those we now place in this category -cancer, heart disease and diabetes.

Answer 156

In no part of the territory I visited could the Natives be regarded as virgin soil.

Answer 157

reframing of tuberculosis in Africa as an endemic disease, made worse by the social and economic dislocation of imperialism, resonated with the wider picture of colonial health and welfare that developed in the 1930s Economic recession, colonial indebtedness, emergent nationalism, a los of self-confidence in the 'civilising mis ion' and the ideal of the 'dual mandate' combined to create what contemporaries called the 'colonial problem'

Answer 158

By the end of the 1930s, however, little or nothing had been done in most colonies with regard to tuberculosis and other non-tropical diseases. At the Empire Conference on the Care and After-Care of the Tuberculous in 1937 many speaker from African colonies admitted frankly that they had no idea of the extent of the disease in their territory

Answer 159

Tuberculosis was 'discovered' by Europeans in India only in the 1840 , but there was never a strong belief that Indians were 'virgin oil' in the same way that African had been widely believed that it inhabitant enjoyed a partial immunity to the disease According to Ewart, this immunity wa not an innate 'racial ' characteristic, but the result of healthy living apparently greater incidence of tuberculosis among Indian women recorded by public health visitors provided new ammunition for their assaults on the purdah system and on the institution of child marriage Increasing tuberculosis infection among Indian , and other colonial people , became an index of the limitation of colonial rule and wa viewed with concern by Briti h doctor and indigenous critics alike. The extensive provisions envisaged by reform-minded doctors were incompatible with both the financial position of colonial governments and (sometime ) the feeling and priorities of the indigenous population, a the unpopularity of tuberculosis sanatoria among Indians demonstrates. civilisation was constituted not only in terms of social and environmental condition , but also in terms of the level of the welfare and protection offered to subjects of the British Empire.

Answer 160

Contemporaries certainly saw the ri ing incidence of the disease a a consequence of the activities of expatriate colonialists, but their responsibility lay not in importing infection but in spreading disease-making conditions. spread of this disease was said by British and colonial medical experts to be double-edged; they anticipated high mortality in the short and medium term, but in the long term it was likely to be beneficial as a fully tuberculised society was one with great resistance to infection and to fatal tubercular disease

Answer 161

Overall, the problem of colonial tuberculosis was seen as directly analogous to the problem in Europe and North America - in other words, it was a 'social disease'. A large part of the explanation for this is that there was a single, Empire-wide, if not international, community of tuberculosis experts concerned with this disease and its control.

Answer 162

The epidemiology and pathology of tuberculosis helped construct and reinforce the importance of cultural rather that racial (biological) differences The 'virgin soil' theory, with its emphasis on acquired immunity, did not impute any significant influence to racial differences racial = third or fourth order factors, after social and environmental conditions, and exposure

Answer 163

before 1940 colonial ruler and medical services failed to act on the warnings given by Cummin and later by local agencies. - Indian and colonial medical services (and indigenous peoples) had other disease-control priorities and programmes - being framed a a disease of civilisation meant that tuberculosis was a problem to be settled in historical time, not by immediate medical or sanitary intervention

Answer 164

Tuberculosis can still be regarded as a disease of civilisation, though this can no longer be solely linked with urban, industrial societies; there is now more of a case to be made for its linkage to poverty and social inequalities, both nationally and internationally.

Answer 165

published a masterly analysis of the data and also offigures obtained from parish registers and public dispensary returns. He found that the absolute and relative mortality from consumption had increased in many parts of the country since 1700

Answer 166

After 1700 novelists allude to symptoms and effects more often and descriptions of the pale heroine languishing in a decline are not hard to find, but usually the writers avoided the dreaded word 'consumption' Victorian song writers also liked them. It is only in the past few decades, as the stigma has slowly disappeared, that tuberculosis has been named with any frequence; nowadays no details are spared of the early symptoms, the rigours of sanatorium treatment, and the dramatic episode of the sudden haemoptysis

Answer 167

The decline associated with the emotional disturbances of an unhappy love affair was a popular theme with Victorian novelists like the Brontes and Jane Austen, who were themselves tuberculous Helen Burns in jane Eyre (I847) who died of semi-starvation and neglected colds; and 'the vanished bloom and wasted flesh' in Shirley (I849), also written by Charlotte Bronte, about her sister

Answer 168

epidemic occurred in the fleet blockading Brest in I809 Unsatisfactory, overcrowded quarters, were conducive to contact infection (mentioning tb in early 19th C as infectious, tho wasn't understood as such

Answer 169

seem to have written with a hectic urgency The characteristic urge to produce, and produce at speed, whether due to toxaemia and pyrexia, or the fear that the tide is fast ebbing, was shown by Stevenson, when, extremely ill and bedridden at Bournemouth, he wrote Dr. Jekyll and Mr. Hyde in three days.

Answer 170

e.g. Brontes, Keats, Chekhov

Answer 171

Poverty was the usual accompaniment of early years in the literary and artistic fields and this and an unsettled way of life favoured a lowering of resistance at a time when none could avoid infection. Sometimes drugs and alcohol were superimposed on the toxins of the tubercle bacillus. (trying to explain origins of tb using today's understanding - retrospective diagnosis)

Answer 172

Models often chosen by the Great Masters for their beauty, languor and appealing sadness of expression, were often in the sickness of tuberculosis Botticelli, in his Venus and other paintings, idealized Simonetta the Florentine beauty, who died tragically in 1475 at the age of sixteen. pre-Raphaelite painters of the mid-nineteenth century e.g. Rossetti, Ruskin - depicted pale, distraught young women, with sad and tired faces

Answer 173

Spinoza. His sickly constitution forced him to devote the whole of his life to study. (using TB to explain successes etc - looking for disease's impact on hist through retrospective diagnosis)

Answer 174

A delicate constitution in early life, not rare in those who later became famous, restricts physical activities, giving a preference for the study to the playing field, with ample time for contemplation and scholarship. A feeling of physical inferiority may guide the thoughts down the pathways of reform or embittered revolt; a vein of gloom and melancholy running through the writings of certain of the poets is symptomatic

Answer 175

Tuberculosis, a chronic complaint, has been with the world for a long time The historical record would have been even more meagre had it been restricted to medical treatises; fortunately, it can be supplemented by biography and contemporary literature: portraits, too, may help fill in the gaps, and even cave pictures and figures on pottery have something to offer. Evidence of spinal caries in Neolithic skeletons and Egyptian mummies has confirmed the antiquity of the disease

Answer 176

Edward VI, who died in 1553, had a visible and swift decline and a violent cough which nothing would relieve. His death was attributed to 'quack nostrums on a consumptive frame'. Northumberland acquired great influence over the ailing boy, to name Lady Jane Grey to succeed him. Had Edward not died, England would have been saved the bloodshed of Mary's reign.

Answer 177

immigration has more than once brought fresh sources of infection to this country

Answer 178

distressing situations of yesterday and the happier state of affairs today

Answer 179

sufferers from tuberculosis or syphilis, for example, once touched by the illness, were cursed for the rest of their lives: the illness and its symptoms, abating and recurring, good days and bad days, came to define their biographies —a feature that recent analysts have described as characteristic of the modern chronic illness experience.

Answer 180

While it is often assumed that tuberculosis and consumption were identical, consumption, I argue, did not disappear when tuberculosis was conquered. some of consumption's cultural meanings transferred to other chronic illnesses in the twentieth century. Some wasting illnesses that would have been identified as forms of consumption a generation or two earlier were transformed by medical innovations in the twentieth century

Answer 181

much of what was described as consumption in old medical writings was not pulmonary tuberculosis. Until the late nineteenth century, when a patient was seen to waste away slowly and seemingly inevitably, the diagnosis was usually consumption. a ‘refined disease’, ‘in which the mind triumphs over the body’

Answer 182

Rather than being synonymous with tuberculosis—a diagnosis that presupposes the identification of tuberculous lesions in post-mortem examinations and, following Robert Koch (1843–1910), the demonstrable presence of a specific bacillus— consumption was associated with the clinical picture of patients deteriorating, sometimes rapidly, sometimes over years. Consumption was the endpoint of much chronic illness Wasting diseases whose final stages were often characterized as consumption included also scurvy, scrofula, and various forms of cancer. Conditions such as asthma or dropsy were also linked to consumption Consumption, thus, was not a distinct disease entity, but rather, being consumptive was a personal quality

Answer 183

shaped the dominant female beauty ideal of the time—ethereal, thin, pale, with a red flush on the cheeks, as depicted in many pre-Raphaelite paintings

Answer 184

Victorian London ‘If one roams the streets a little in the early morning, when the multitudes are on their way to work, one is amazed at the number of persons who look wholly or half consumptive.'

Answer 185

invention of stethoscope laid foundation of the modern ontological understanding of tuberculosis as a disease entity, the specific form of consumption that is associated with tubercles in the lung What defined the disease in the classificatory system promoted by Laennec and his followers was no longer a (potentially infinite) set of symptoms that the physician considered in the context of the patient's biography, but finite number of specific disease markers in the body felt bodily sensations of the patient and the patient's recounted story of them, would increasingly lose their primacy and power

Answer 186

TB widely ident as essentially an urban diseases, esp tragic bc cuts off young in prime climaxed around mid-19th C, accounting for up to 1/4 of all urban deaths in north-western Europea nd eastern US seaboard, esp those of young adults Leading TB docs e.g. Beddoes explicitly blamed the menacing curse of the disease upon the effete and aetiolated hot-house life-styles cultivated by the beau monde

Answer 187

for as long as its cause was not understood and the ministrations of docs remained so ineffective, TB thought to be an insidious, implacable theft of a life. Now it's cancer's turn

Answer 188

when TB = death sentence, common to conceal the ident of their disease from tuberculars and from their children after they died

Answer 189

disease of one organ, lungs. Not just bc pulmonary = most common form. Also bc myths about TB do not fit the brain, larynx and other sites where the tubercle bacillus can also settle, but do have close fit w traditional imagery (breath, life) assoc w the lungs disease of extreme contrasts - white pallor and red flush, hyperactivity alternating w languidness Coughing, recovers breath, then coughs again Makes the body transparent - rich in visible symptoms thought to produce spells of euphoria, increased appetite. Having TB imagined to be aphrodisiac, and to confer extraordinary powers of seduction Many symptoms deceptive - rosy cheeks look like sign of hlth but come from fever TB is disintegration, disease of liquids - body turning to phlegm and finally blood - and of air, of the need for better air person is consumed by ardor- burned up. disease of passion - caused by too much passion. Ravages of sexual frustration deficient in vitality, life force TB = disease of time, speeds up life, highlights and spiritualizes it Like all rly successful metaphors, TB metaphor rich enough to provide for two contradictory applications - death of someone e.g. child thought too 'good to be sexual. Also a way of describing sexual feelings Above all, was a way of affirming the value of being more conscious, complex psychologically. Health becomes banal, even vulgar

Answer 190

oft imagined of disease of poverty TB was one index of being genteel, delicate, sensitive later 19th C, however much TB blamed on poverty and insalubrious surroundings, it was still thought that a certain inner disposition needed to contract it

Answer 191

for over a hundred years, TB remained the preferred way of giving death a meaning - an edifying, refined disease 19th-C lit stocked w descriptions of almost symptomless, unfrightened, beatific deaths from TB, partic of young ppl, such as little Eva in Uncle Tom's Cabin The Romantics moralized death in new way - TB death etherialized the personality, expanded consciousness aestheticization of death - Thoreau, who had TB, wrote in 1852 - 'death and disease are oft beautiful, like... the hectic glow of consumption

Answer 192

mid-18th C Oliver Goldsmith, She stoops to conquer (1773) - Mrs Hardcastle of her spoiled son - am I to blame? too sickly to do any good. He's consumptive. Afraid of his lungs

Answer 193

all the evd indicates that the cult of TB was not simply invention of romantic poets but a widespread attitude became staple of nineteenth-c manners: - rude to eat heartily - glamorous to look sickly - TB-influenced idea of the body was new model for aristocratic looks - at moment when aristocracy stops being matter of power and starts being mainly a matter of image

Answer 194

I cough continually! But for a wonder, far form making me look ugly, this gives me an air of languor that is v becoming

Answer 195

melancholy character - or the tubercular - was a superior one: sensitive, creative, a being apark TB as model of bohemian life - TB sufferer = dropout, wanderer in endless search of healthy place illness exacerbates consciousness however much the disease was dreaded, TB always had pathos. someone w TB considered quintessentially vulnerable and full of self-destructive whims

Answer 196

this consumption is a disease partic fond of ppl who write such good verses as you have done

Answer 197

did so by validating so many possibly subversive longings and turning them into cultural pieces although here was a certain reaction against the Romantic cult of the disease in the second half of the last century, TB retained most of its romantic attribute - sign of superior nature, as a becoming frailty Still the sensitive young artists's disease in O'Neill's Long Day's Journey into Night to die of TB still mysterious and (often) edifying

Answer 198

split up and parceled out to two diseases: - insanity - notion of sufferer as hectic, reckless creature of passionate extremes. This is current vehicle of our secular myth of self-transcendence - cancer - the agonies that can't be romanticized

Answer 199

- isolates one from community - mysterious diseases of individuals - cld strike anyone - TB frightening - not only as contagion but as seemingly arbitrary, uncommunicable 'taint' - inherited, and revealed something singular about the person afflicted - TB as failure of will or an overintensity - assoc w pollution - Florence Nightingale thought it was 'induced by the foul air of houses'

Answer 200

notion that disease fits the patient's character, as punishment fits the sinner, was replaced by notion that it expresses character disease as vehicle of excess feeling

Answer 201

w the modern diseases, (once TB, now cancer), the romantic idea that the disease expresses the character is invariably extended to assert that character causes disease one is responsible for one's disease

Answer 202

TB caused by hereditary disposition, unfavourable climate, sedentary indoor life, defective ventilation, deficiency of life and 'depressing emotions'

Answer 203

polemical. used to propose new, critical standards of individual health and express dissatisfaction w society increased over 19th Century

Tuberculosis Flashcards

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