If you wanted to strike fear into the heart of the average New Havener circa 1870, you need only have uttered the word. The disease took the lives of at least 190 citizens that year—mostly people who’d been “in the pride and vigor of life,” according to one of the city’s earliest Board of Health reports, issued in 1876—making it the city’s #1 killer, responsible for nearly 15% of all deaths in New Haven. Some years, its share approached 20%.
Now we call it tuberculosis. In ancient Greece it was called “phthisis” (from phthinein—“to waste away”). In Enlightenment-era Europe, it was called “white plague.” A victim might start with pain in the chest and a characteristically nasty cough expelling material from the lungs. That might progress to fever, chill spells and chronic malaise, with pallor to match, loss of appetite and, for many, death. Tuberculosis killed Andrew Jackson; Doc Holliday; George Orwell; Eleanor Roosevelt. It could come and go for years, and even after recovery could weaken the constitution enough for some other malady to finish the job.
In 1870s New Haven, improvements in sanitation and hygiene were the chief concerns of the city’s burgeoning public health elite, who sought to stem the tide of what they’d come to believe were preventable infectious diseases: cholera, pneumonia, typhoid fever and, of course, consumption. The 1876 Board of Health report lamented the city’s many “tenement houses, in which exist an utter disregard for all sanitary requirements,” expressing concerns about “thorough ventilation,” “the storing of… offensive and polluting material” and “the drainage about dwellings.”
The city and its populace were slow on the uptake, and the young Board of Health was limited in its charter, which it also lamented: “A general sanitary inspection of the City should be started at once. But by the ruling of [city] counsel we are powerless to incur any expense for such a purpose.” The board further needled the governing class, pointing out that “proper hygienic measures on the part of those in authority, as have been so often urged by this Board,” would have prevented a surge of disease-related infant deaths preceding the report’s release.
Yet it would take about fifty years for the city to make serious progress with tuberculosis. In the meantime, a patient exhibiting symptoms might have found himself in an isolated “sanatorium” in the country, where the ability to infect others would presumably be limited, or in the Ellen M. Gifford Ward for the Incurables at New Haven Hospital (located at Congress Avenue and Cedar Street, pictured above on a postcard circa 1905). The New Haven Dispensary, an impressively progressive clinic opened in 1871, provided free care and medicine to the city’s poorest consumption sufferers.
By the 1920s, that evocative word “consumption” was largely dropped in favor of the clinical “tuberculosis,” and New Haven finally started to get a grip on the problem. According to the Health Survey of New Haven (1928), a collaborative report headed by Yale professor and public health pioneer Charles-Edward Amory Winslow, the disease caused an average of 203 deaths annually between 1905 and 1919. Then, from 1920 to 1924, that figure was nearly halved, to 118. This was in part the result of better patient care, achieved through modest municipal investments in a new city clinic and in the local chapter of the Visiting Nurse Association, which attended to sufferers of various afflictions in their own homes (and still does today). Another factor was a concurrent increase in the practice of pasteurizing cow’s milk, which in its raw state posed a special tuberculosis risk for kids.
During 1925 and 1926, the average number of yearly deaths attributed to the disease dropped even further to 84, coinciding with a pivotal study of New Haven administered by Harold Archibald Pattison, the head of the National Tuberculosis Association. Winslow’s survey noted Pattison’s major recommendations: the appointment of a “full-time Director of Tuberculosis” for the city as well as a “centralization” of the city’s nursing and clinic activities. This time the city listened and, “with promptness and vision,” enacted the suggested reforms; meanwhile, an additional state-of-the-art hospital opened in town. The report summed it up this way: “New Haven has now a coordinated central control, a coordinated clinic service, a coordinated nursing service and hospital and sanatorium facilities probably unequalled in any city of the United States…”
These changes led to greater knowledge-sharing and -accumulation among medical professionals, and it gave the city’s residents a clear and less stigmatized path to take in the case of suspected infection. The disease was caught in its earlier stages more frequently, improving patient recovery odds, limiting the risk of long-term health effects and reducing the chances that any given victim would unknowingly spread it around.
By 1950, New Haven had tuberculosis on the run. According to the annual report of the Department of Health that year, the disease’s death rate had dropped from 187.9 per 100,000 residents in the year 1900 to just 18.2 in 1950, ranking eighth among the city’s leading causes of death. There were just 30 fatalities that year from tuberculosis, and its pediatric incidence had been completely eradicated. It still got a lengthy section in that city health report, but by the time the 1970 version rolled out, it got just a couple short paragraphs and a small line graph showing a death rate indistinguishable from zero. In the 2000 report, it got a single bullet point all the way at the back, registering 11 confirmed diagnoses on the year, no deaths indicated.
It’s not like we don’t have health issues to worry about in New Haven circa 2014, but hey, at least we’ve got that tuberculosis thing handled.
Written by Dan Mims. Image, provided courtesy of Colin Caplan and Magrisso Forte, depicts the Ellen M. Gifford Ward for the Incurables at New Haven Hospital circa 1905.