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Bulletin of the History of Medicine 74.4 (2000) 735-772



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The White Plague Goes to College: Tuberculosis Prevention Programs in Colleges and Universities, 1920-1960

Heather Munro Prescott


During the 1930s, the National Tuberculosis Association (NTA) began a nationwide program to detect and prevent tuberculosis in college and university students--spurred partly by the discovery of surprisingly high rates of infection among this age group. According to numerous studies conducted during the 1920s and early 1930s, the rate of infection as determined by tuberculin skin tests was as high as 50 or 60 percent among undergraduates in colleges and universities in the northeastern United States, and as high as 80 percent among students in the southwest. Infection rates were even higher among medical and nursing students, with some schools reporting that it was not unusual for the entire graduating class to test positive for tuberculosis. 1 These statistics were especially alarming because among the population at large TB was declining, and because it was a disease usually associated with poverty. 2 [End Page 735] Although it was well understood at this point that the majority of those who tested positive never developed the disease, the discovery of high infection rates in a relatively privileged population prompted an aggressive campaign by the NTA and the American Student Health Association (ASHA) to educate students about the dangers of tuberculosis, and to institute prevention programs at the nation's colleges and universities. 3

At first glance, the history of TB prevention programs for students appears to be a relatively minor chapter in the history of this disease. College students were a small portion of the population, representing less than 7 percent of young adults in the 1920s and 1930s. These programs in colleges and universities are never mentioned in histories of the NTA, suggesting that they were not major activities. 4 Nevertheless, an examination of their history can make a contribution toward our understanding of the history of this disease in the interwar period, an era that has not been as thoroughly covered by historians as have other periods. Most histories of tuberculosis have tended to focus on the nineteenth and early twentieth centuries, and have given less thorough attention to the years after the First World War. 5 Georgina Feldberg, Barron Lerner, and Katherine Ott have described the history of the control of this disease in the postantibiotic era and have begun to fill in details for the period between 1920 and 1945. As Lerner observes, the waning of progressivism and the increasing conservatism of the 1920s was reflected in tuberculosis policies. According to Lerner, during the 1920s and 1930s the emphasis of the tuberculosis prevention programs of the NTA and its local affiliates shifted away from what were perceived to be unworthy populations, and "increasingly emphasized educational programs and demonstration projects" aimed primarily at "socially viable" persons-- [End Page 736] that is, those who were most likely to be cured and become productive citizens. 6 Drawing on Lerner's hypothesis, I will show that the NTA's programs in colleges and universities reflected and reinforced beliefs about the social importance of the nation's young people, especially white males.

My study will also contribute to our understanding of the history of college health. Most writings on this subject have been commemorative histories of the ASHA or of particular individuals. Although useful, these works do not link developments in college health with larger trends in the history of medicine or in American history. 7 Historians have begun to explore the history of college health but, as with tuberculosis, the focus has been on the nineteenth and early twentieth centuries, and more specifically, on the "sex in education" controversy that attempted to demonstrate the negative affect of higher education on women's health. 8 There has been comparatively little historical scholarship on the twentieth century, nor has there been much systematic work on how concepts of health and disease shaped the experiences of college men. 9

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