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"THE GREAT WHITE PLAGUE"—TUBERCULOSIS BEFORE THE AGE OF ANTIBIOTICS

A Chronic Infectious Disease

Pulmonary tuberculosis—also known as consumption, phthisis, or the "great white plague"—was still an insidious, chronic presence in the 1930s. The disease is caused by a tubercle bacillus, or germ, contained in the sputum coughed up by patients with tuberculosis of the lungs, and it is spread from sick to well individuals by close personal contact. After the discovery of the bacillus in 1882, doctors and the public hoped that a means could be found to kill it within the body or to immunize the individual from its threats, but this did not exist in the 1930s. In 1930 the tuberculosis mortality rate was seventy per one hundred thousand population per year. It took more lives than any other contagious disease. In 1936 the U.S. Bureau of the Census estimated that one out of every twenty-one deaths was due to tuberculosis. Its greatest toll was in young people between the ages of fifteen to forty-five, and it affected proportionately more women than men.

Treatment

Although deaths from tuberculosis were still high, mortality rates had declined from the two hundred tuberculosis deaths per one hundred thousand population per year in 1900. Several factors contributed to this steady decline, including the public concern raised by individuals and organizations such as the National Tuberculosis Association. By 1930 scientists better understood how the disease was spread; earlier diagnosis by means of X-ray machines and tuberculin tests prevented the more serious forms of the disease; the testing and elimination of tubercular cows and the pasteurization of milk eliminated the infection in children from cows' milk; and more-widespread institutional care in private sanatoriums and state and municipal TB hospitals provided both quarantine and better medical supervision. Treatment still consisted primarily of rest, a well-balanced diet rich in vitamins and minerals, an "abundance of fresh air and moderate amounts of sunlight," or even surgery to collapse the diseased lung for treatment or to remove the diseased part of the lung.

Christmas Seals

In most European countries the government funded health and welfare programs to combat tuberculosis, but in the United States both the federal and the state governments were slow to become involved. Consequently, lay associations such as the American Red Cross and the National Tuberculosis Association funded most of the tuberculosis programs. The best-known fund-raiser was the brightly colored little stamps called Christmas seals, which cost only a penny. The bright red double-barred cross that was the insignia of antituberculosis work throughout the world identified them, and they were used as decorations on mail and packages.

A New X-Ray Machine

With fears of a spread of tuberculosis from the poverty of the Depression, one of the few advances against the disease made in the 1930s was the movement for X-raying schoolchildren. The use of X rays in the diagnosis of TB was nothing new in itself, but the novelty in 1933 lay in a new weapon—a machine capable of taking X rays of the lung at the rate of four X rays a minute. The high speed and precision of the new machines made it possible to examine large numbers of schoolchildren in a very short time. They lined up near the machine, and one by one they stepped up and were "shot" at the rate of 150 or more an hour. The new, portable equipment lowered the price of X-ray diagnosis and improved treatment possibilities. The X-ray exam could spot early lesions in the lungs. In its earliest stages, before the victim was even aware of its presence, tuberculosis cure was comparatively easy and sure. In the later stages it was much more difficult. Public health officials hoped that with periodic X-ray exams of all children and adolescents, cases could be found and treated, eventually wiping out tuberculosis. By 1938 the tuberculosis death rate had been reduced to 56 per 100,000 population per year. Yet the greatest twentieth-century innovation in the treatment of tuberculosis, Selman Waksman's chemo-therapeutic agent streptomycin, was a decade away.