Saving Sickly Children: The Tuberculosis Preventorium in American Life, 1909-1970

Chapter 2: Tuberculosis: A Children’s Disease

Phthisis in the adult is but the last verse of the song, the first verse of which was sung to the infant at its cradle. —Emil von Behring1 Until the turn of the twentieth century, many Americans believed in the idea of a “golden age” of immunity from tuberculosis for children, especially for those between the ages of five and fifteen years. The little available demographic data appeared to support this assumption. In most locations, children did die much less frequently than older adolescents and adults. In 1900, for example, the tuberculosis death rate for children in the United States between the ages of five and nine years was 2.2 per 1,000, lower than for any age group excepting those over eighty years old. In contrast, the death rate for those between ages twenty-five and twenty-nine was 153.7 per 1,000. Although infants experienced higher mortality rates than older children (18.3 per 1,000), it was lower than that of adults.2 A succession of scientists in the early 1900s strongly challenged the childhood immunity assumption. In a finding that shocked many seasoned experts, autopsy examinations in children found that between 40 and 55 percent of those youngsters who died from causes unrelated to TB had been 26 Chapter 2 Tuberculosis A Children’s Disease Tuberculosis 27 infected with the tubercle bacillus.3 At the same time, Emil von Behring, a disciple of Koch who just a few years earlier introduced antiserum therapy for diphtheria, another infectious disease that killed thousands of children, published findings suggesting that a reactivation of the tubercle bacillus acquired in childhood resulted in tuberculosis in later life. Theorizing that some kind of a trigger stimulated symptoms in people already exposed to TB, he concluded: “Phthisis in the adult is but the last verse of the song, the first verse of which was sung to the infant at its cradle.”4 Other scientists, including Luther Emmett Holt, the well-known pediatrician at New York’s prestigious Babies’ Hospital, quickly verified Behring’s 1903 findings and seconded the idea that seemingly well children harbored the tubercle bacillus.5 Stunned, child-savers struggled to address this new challenge. Because of its size and urban poverty, reformers knew that New York City provided particularly rich soil for TB, just as it did for many other infectious diseases. Despite a half century of reform efforts, at least two hundred thousand rooms in Manhattan’s tenements still lacked a window as required by law. Many others had no indoor toilets, the only option for residents being the poorly maintained outhouses behind the buildings. Epidemics of diphtheria, measles , whooping cough, and smallpox regularly swept entire streets of dank, densely populated dwellings.6 When Dr. S. Josephine Baker, medical inspector for New York’s Department of Public Health, first began visiting families in the city’s notorious “Hell’s Kitchen” section in the late 1890s, she became overwhelmed by the social pathology she encountered and its effect on babies and young children: “I . . . met drunk after drunk, filthy mother after filthy mother and dying baby after dying baby.”7 Because not all tenements had running water, mothers had few opportunities to bathe themselves or their children. Moreover, despite a growing municipal public health infrastructure, it was not uncommon in the first decade of the twentieth century to find dead horses, mules, pigs, and cows decaying on New York City streets as children played around them. Even the construction of the subway, a technological innovation that later reduced urban crowding by allowing the city to expand, first created a public health nightmare. During its 1902 construction, workers frequently broke sewage lines and allowed the contents to flow freely into the excavation, which only encouraged city residents to use the construction areas as garbage bins.8 Child-savers publicized the fact that thousands of New York City youngsters died annually from drinking impure milk and water, and eating contaminated food.9 Using words and photographs, Jacob Riis, a New York City 28 Saving Sickly Children police reporter turned photojournalist and social reformer, vividly described the infant mortality problem in his book How the Other Half Lives: “Seventytwo dead babies were picked up on the streets last year. Some of them doubtless were put out by very poor parents to save funeral expenses.”10 Many poor people bought their food from unrefrigerated pushcarts that lined streets and...