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Health and Disease
Contents
Health and Disease
> Childbirth in the late 19th
Century > Cholera
> Marasmus and Scrofula > Hydrocephalus
> Byssinosis > Typhus
Fever > Typhoid Fever > Polio
> Infant Mortality > Combating
Epidemics at the Turn of the Century > Tuberculosis
Tuberculosis
In the nineteenth century, tuberculosis, also
known as consumption, phthisis, and the 'White Plague' was the
leading cause of mortality and one of the American people's greatest
fears. The reason for its height of contagion at that time was
likely due to the Industrial Revolution when a mass migration
of people moved to cities where they worked in dark, unsanitary
factories and lived in crowded housing conditions. After the turn
of the century the death rate from tuberculosis steadily declined
due to improved environmental conditions and the rise of preventive
medicine. In the United States these health gains were made with
better water and milk supplies (in 1910 purification/chlorination
of water was introduced and in 1912 milk was pasteurized), the
rapid growth of the sanatorium movement (the first of which began
in 1885 at Saranac Lake) and laws against spitting in public (the
first anti-spitting notices were put up in street cars in New
York in 1891). Measures were made by the city of New York to improve
living conditions, especially in crowded conditions on the Lower
East Side. The most important of these was the Tenement Housing
Law of 1901 which required building alterations for adequate lighting,
ventilation, water supply, and proper sanitary equipment.
In New York City, the death rate from tuberculosis in 1812 was
as high as 697 per hundred thousand. By 1912, one century later,
the death rate from tuberculosis was approximately 215 per hundred
thousand. Between 1910 and 1920 tuberculosis slipped from the
second leading cause of death in New York City to the third. In
1918 the number of registered cases of pulmonary tuberculosis
totaled approximately 50,000 out of a population of approximately
5.5 million people. In the borough of Manhattan in 1918 a recorded
4,987 people out of a population of 2.3 million died of tuberculosis.
In the public mind, tuberculosis was known as a "Jewish disease",
yet statistically Jews had a lower mortality rate than gentiles.
Throughout the nineteenth and twentieth centuries the highest
rate of death from pulmonary tuberculosis was among Irish and
Scandinavians and the lowest among the Jews. Anti-semitic views
of Jewish immigrants as being unclean and diseased fostered this
thinking. Tuberculosis was also associated with the clothing industry
(it was sometimes referred to as "tailor's disease"), presumably
as a result of an unhealthy environment in the crowed work shops
which nurtured consumption. Perhaps because Jews were chiefly
engaged in the manufacturing of clothing, the concept of the Jewish
tubercular tailor grew.
What is Tuberculosis?
Tuberculosis is a contagious disease that is contracted by breathing
in or swallowing the tubercle bacillus germ. The germ, once ingested,
causes swelling and damage of the lungs and can lead to death.
The disease has an indefinite incubation period and can be very
slow to progress. Many people can be exposed to tuberculosis and
not exhibit any symptoms. There are many strains of the disease
such as tuberculosis meningitis, bovine tuberculosis and tuberculosis
of the intestines, but pulmonary tuberculosis is the most prevalent.
Contacting tuberculosis requires intimate exposure such as using
the same drinking cup, eating utensils, or towel. It can attack
anyone at any age, from children to adults, rich or poor. Although
everyone is susceptible to tuberculosis, someone with a lower
resistance to the disease is more likely to contract it. Infants
and young adults, however, seem to be the most susceptible to
TB. Those who die of tuberculosis are typically between the ages
of 35 and 45. Abraham Rogarshevsky was 47 when he died of TB.
The Causes of
Tuberculosis
Pulmonary TB, its most familiar form, is caused by a tube-shaped
bacterium that is spread from victims coughing into the air or
onto food. Before milk pasteurization in the late 19th century,
TB was often passed through contaminated milk. Treatment for the
disease consisted of removal to a sanatorium or to another open-air
space, bed-rest, and opium to relieve the pain of lung hemorrhage,
characteristic of last stages of the disease. There was no cure
for TB until after World War II, when antibiotics were introduced.
However, TB strains resistant to antibiotics continue to plague
New Yorkers and third-world peoples even today.
Bad environment favors tuberculosis. Sunlight kills the tubercle
germs. In dark, crowded urban centers, tubercle bacilli can live
and thrive for days. People crowded into tenements, subject to
stress and without adequate food and clothing, are more liable
to develop tuberculosis. A patient with the disease is not necessarily
sickly and frail but can be heavy and in robust health. A person
in poor health, however, when exposed to the tubercle bacilli
germs, is more likely to succumb. Exhaustion, chilling, malnutrition,
or stress tends to weaken natural defenses.
Garment workers like Abraham Rogarshevsky, who was a presser,
frequently worked in a crowded, small shop located in a tenement
apartment. Pressing, when done by a hand iron, required great
physical exertion (this demanded the lifting of a large iron that
was heated on a stove or furnace and applied directly to the goods).
Also, the presser would tend to work longer hours because their
work was not intimately connected with the other workers (e.g.
cutters, basters, finishers) so they could continue their work
after the others had left the shop. Since his body was subject
to strain and potentially a lack of sleep, he had a low resistance
to the disease. It is also possible Abraham contracted tuberculosis
before coming to America, and the disease had a long incubation
period before it was noticeable and eventually debilitating.
Prevention
from Spreading to Others
Because sunlight kills the tuberculosis germ, a tubercular's room
should get as much exposure to sunlight as possible. The floor
should be without carpets so the germs can not settle in the fibers.
Scrubbing with soap and water best cleans the room. A boiling
temperature kills the germs in a few minutes so boiling water
should be used to disinfect dishes and clothing. Tuberculosis
sufferers should not swallow what was coughed up but rather use
a spittoon or a cup to expectorate in (not on the sidewalk). Ideally
this cup should be half filled with strong lye water or carbolic
acid. When the patient coughs or sneezes he or she should use
a handkerchief to protect against the spread of germs and to wipe
the lips. The cups (or spittoons) and mouth cloths should be burnt
after use. The patient's hands and face must be washed intermittently
with a separate towel and soap. Food should be consumed in separate
dishes and should be washed (and scalded) separately from the
dishes belonging to other family members. Ideally the tubercular
should sleep alone and wear neither a beard nor mustache.
Living in such close quarters and having his family nurse him,
presumably Abraham's entire family was exposed to the disease.
In fact, in 1924 Abraham's son Morris was diagnosed with tuberculosis
and left for a sanatorium.
Ideal living conditions for Abraham's health were hardly attainable
as a result of poverty. Due to the cramped conditions, he could
not have been kept in exclusive quarters and as an Orthodox Jewish
man, Abraham would not shave his beard completely, but he kept
it clipped.
Symptoms
Early symptoms of tuberculosis include a loss of weight and strength,
rapid heartbeat, a sense of fatigue on slight exertion, a loss
of appetite or indigestion, slight pains in the chest, and hoarseness
in the throat or cough. Later symptoms indicating advancement
of the disease include bloody sputum, a hacking cough, chills,
night sweats, emaciation, paleness, copious expectoration, and
the inability to work.
According to his death certificate, Abraham consulted Dr. Louis
Freedman two years prior to his death. The advanced symptoms of
tuberculosis are most easily identified while the earlier ones
usually need a physician's close observation and frequent periodical
examination. Since doctors were not visited regularly and since
the family was poor, it is unlikely that a doctor would have been
called in the earlier stages of the illness. Although he was considered
in the advanced stages of the illness, it still took two years
for the disease to progress and for his lung tissue to damage
severely in which time Abraham presumably continued his work.
Treatment
No medicine could cure tuberculosis. Only fresh air, rest and
good nourishment could help the tubercular. Good ventilation in
the home, both physical and mental rest, milk and eggs were all
essential components in the treatment of a tuberculosis patient.
The sanatorium could not cure tuberculosis, but it provided treatment
and a comfortable place for voluntary segregation. Here the patient
was given rest, fresh air and nutritious food to help him or her
to recover while the public was protected from the infection.
In many instances, landsmanschaftn, or fraternal organizations
would have sent members with tuberculosis to sanatoriums. Abraham
did not go to a sanatorium. Staying amongst people who spoke the
same language, wanting to avoid breaking up the family by sending
the breadwinner to an institution, and being happy and comfortable
at home with family and friends were all influences that may have
prevented his leaving.
The back room is set up as Abraham's sick room. Since fresh air
and ventilation would have been the best "medicine", the front
room, the only room with windows that opened outside, would have
provided more of it and should have been his "sick room". However,
since the rest of the family needed to remain active, they may
have occupied the bigger front room instead. To maximize Abraham's
fresh air intake, he may have slept up on the roof or out the
fire escape since the number of germs, the quantity of dust, and
the air temperature all decreased with elevation above the street
while the movement of the air increased.
Many immigrants used bankes or cupping cups to supposedly rid
the body of ailments. Again, much like the doctor's placebos,
cupping cups were considered an effective method for patients
while they did little to ameliorate their condition. This method,
which involved heating the inside of the cup to draw out the oxygen
and adhering it to the skin which, theoretically drew the "disease"
to the skin's surface, was generally used for influenza and pneumonia.
But since it was a cultural "home remedy" used to cure coughs
and poor appetites as well as a myriad of other aliments, Abraham
may have had his chest cupped.
Tuberculosis Today
Today tuberculosis is considered a curable disease, as there are
many antibiotics used to treat it and advanced systems for detecting
it in its earliest stages. However, recently in the United States
tuberculosis has made a resurgence. In 1994, more than 25,000
people in this county contracted the disease and about 3,000 of
these people live in New York City. Factors owing to this increase
include the HIV infection and the emergence of multi-drug resistance.
Tuberculosis
Timeline
1873-Use of sanatoriums to help treat tuberculosis (consumption)
begins
1882-Robert Koch identifies the tubercle bacillus (disease now
named tuberculosis)
1901-Open air hospitals used in treatment, greatly reduce the
spread of the disease and death rates among victims.
1907-Dr. van Pirquet invents the skin test for diagnosis of tuberculosis,
which is still used today.
1955 (check date)- Erythromycin (which exact antibiotic?) discovered.
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