Tuberculosis Research Paper
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Sample Research Paper on Tuberculosis Infection and Socioeconomic Status
Tuberculosis (TB) became the malady of the impoverished. The socio-economically disadvantaged urban poor were the most vulnerable. The social position of the poor, rather a lack thereof, led to infection. Within the scope of this research, we will elaborate on Tuberculosis and how the infection was effected by the social and economic status in the 19th century.
“During the entire nineteenth century, the scourge of tuberculosis was widely felt and widely feared through the impoverished urban population.” (F.B. Smith, 1988) Tuberculosis has an ancient history, and in its dominant respiratory form, which primarily affects those in the prime of life, has had an incalculable effect on human societies and individual destinies. It is an infectious disease, although this was not accepted in the United States until the end of the nineteenth century.
Tuberculosis is a chronic infectious disease which may manifest itself in different forms: as respiratory (pulmonary) tuberculosis (also known as phthisis, or consumption), scrofula, lupus, tuberculosis of the bones and joints, or tubercular meningitis. In addition to being chronic (the period from the active manifestation of the disease to its termination in death lasts for years rather than weeks or months), it is a cruelly debilitating disease with a most complex etiology. (L. Bryder, 1988)
It is caused by the bacillus Mycobacterium tuberculosis, discovered by Robert Koch in 1882, but there are five types of tuberculosis affecting different animal types, of which only two, the human and bovine, cause disease in man. The human type was by far the most common source of disease in this period, although contemporaries believed until 1901 that tuberculosis of bovine origin was more common, and that the disease was increasing rapidly among the bovine population.
In fact human tuberculosis was responsible for around 98 per cent of all cases of pulmonary tuberculosis, and for some 70 per cent of non-pulmonary cases; bovine tuberculosis, which is transmitted primarily in infected milk and is associated more particularly with the disease in infants and children, was responsible for the rest.( T. Dormandy, 1999)
Human tuberculosis is spread by droplet infection, in the fine saliva spray expelled when speaking, coughing, or sneezing. Three routes of transmission for the bacillus have been described: dried, as dust particles; in moist droplets; or as droplet nuclei, formed when the liquid content of small droplets has evaporated quickly, leaving dried ‘droplet nuclei’ so small that they remain suspended in the air for a considerable time. (L. Bryder, 1988)
The relative importance of these three routes is uncertain, although most authorities agree that infection is generally airborne. The risk of infection is clearly related to the duration and intensity of the individual exposure to the bacillus. Although a small percentage of cases are particularly infectious, tuberculosis is not in general a highly infectious disease; it is principally where people are crowded together in poorly ventilated conditions that the risk of infection from active cases is great. (F.B. Smith, 1988)
Infection with tuberculosis is not, however, synomyous with the development of active disease. Most infected individuals successfully overcome infection, and remain unaware of their encounter with Mycobacterium tuberculosis, although healed lesions in the lungs bear witness to the encounter.
“In the 19th century some 90 per cent of United States’ population was estimated to have been infected with tuberculosis at some time, although only 1 per cent of these developed active disease.” (T. Dormandy, 1999) The factors which lead to disease, whether by activation of existing infection or by re-infection, are known to include personal and domestic hygiene, diet, overcrowding, occupational exposure to infection, environmental exposure to agents liable to cause lung damage, and the effects of previous infectious-disease episodes.
In seeking to explain the decline of tuberculosis, structural factors such as fertility and migration may be added to these social determinants of mortality. The balance of these factors in determining the overall pattern of, and regional variations in, tuberculosis mortality is unclear.
Economic conditions, as much as social, plainly play a crucial part in the equation, but within this generalization the respective roles of housing and diet remain debateable. In general terms, the reasons for the decline of tuberculosis have been well defined: better nutrition, housing, nurture, lessening of fatigue, smaller family size, acting synergistically in varying permutations through time and place hold the answer.
The problem of respiratory tuberculosis dominated the nineteenth-century preventive approach to the disease. In seeking to understand the decline of the disease, however, an issue of outstanding importance is the reliability of recorded mortality figures.
While the effects of the spread of hygienic nursing and reformed attitudes towards ventilation must be largely speculative, and the problems of domestic cleanliness and fresh air which underlay them were not class-specific, they were none the less closely associated with a major preventive, essentially class specific, problem: overcrowding.
In terms of tuberculosis etiology, both domestic overcrowding and housing density are significant. In neither respect did conditions in the United States improve significantly during this period, and the fall in tuberculosis mortality occurred notwithstanding. None the less, the effects of overcrowding on the distribution of the disease within the cities were marked. Allowing for the hospital factor, the distribution of heaviest tuberculosis mortality changed little in the United States from the 1860s to the 1890s.
Levels of domestic overcrowding, the presence of hospitals treating the disease, and also the occupations of the residential population all affected tuberculosis mortality-rates in different parishes. Many large cities had their mortality swollen by the presence of numerous common lodging houses within their boundaries. These were frequented by the poorest of the poor, the tramps and the homeless, and were recognized as the last alternative to the workhouse for those with incurable maladies; consumption always prevailed ‘to an extreme extent’ in districts where such houses were common. (F.B. Smith, 1988)
“The poverty factor affected individual cities death-rates quite specifically.” (M. Teller, 1985) In the first place, tuberculous families tended to drift downwards in the social scale, into poorer localities, and often eventually into the workhouse. In the 1890s preventive officers battling with the same problem were often inclined to return to the theory of the epidemic streets: “Every physician has noticed that Tuberculosis repeatedly appears in certain houses”, and that this pattern could often be related to the house itself, rather than to any one family. (B. Bates, 1996)
Public Health’s virtual definition of Tuberculosis as a disease of poverty in 1900 may be seen as an early manifestation of what later became a more public campaign to strengthen the preventive case by associating the disease primarily with poverty. It has recently been suggested that the declining death-rates from tuberculosis in the later nineteenth-century threw into relief the association of the disease with poverty–with overcrowding and poor diet–that led in the twentieth century to its being defined as a disease of poverty.
The achievement of that definition was more deliberate, and more politically motivated, than is generally apparent, although it sprang from a recognition of the realities of the social distribution of the disease. If preventive programmes for Tuberculosis were to have a chance of success without disrupting the fabric of society, then the well-to-do classes’ frantic fear of infection–’indiscriminating, even to absurdity’–must be diffused, and the stigma of infection relieved.
The preventive authorities sought to achieve this by emphasis on transmission through dust, but also by stressing the connection of the disease with poor hygiene and poverty. Notification, sputum tests, disinfection, and associated preventive paraphernalia could be disassociated from the better classes by judicious propaganda. (F.B. Smith, 1988)
For the poor, the basic barrier to well-being is the lack of resources or goods and services needed to carry out permissible, meaningful, and instrumental activities. Thus, part of the problem lies in the social psychology of materialism. In a materialist society, certain goods and services are essential to the performance of membership activities. These commodities are not provided without specific restraints. (T. Dormandy, 1999)
As societies move from primitive to technological stages, the living out of prescribed identities requires more material objects and services as a starting point for personal development. The starting line of the perpetual relay race is determined by a person’s access to and control over such goods and services.
If one is to define the good society as one in which people have the lifeexperiences they need to regard themselves as members, then we can examine the goal of equality against our standards of justice. (B. Bates, 1996) If people think they are what they know they should be and know they are generally accepted as such, then we presumably have what Rainwater believes to be a good society.
A study of comparative communities and collectivities shows that people can regard themselves as having a valid place in society without having equality of position and status. Many societies are highly egalitarian in the distribution of resources but are still highly stratified. The key to a content society is not necessarily equal status.
A content society could be one in which individuals simply have a valid membership and a secure sense of place. Therefore, one way of abolishing poverty (in addition to providing adequate subsistence and the like) would be, to make the poor content with their lot by convincing them that their status has meaning and purpose within the overall design of the society and that there are validated activities for which one does not need mainstream resources. (B. Bates, 1996)
This goal, however, would be impossible in a society that positions people principally by their relationship to the economy. A society’s effective development of industrial capabilities requires considerable openness, fluid mobility of labor, and open competition. Definitions of self and others are also highly related to the degree of command over resources. (L. Bryder, 1988)
Conventional notions to the contrary, there is little solid empirical research to specify the extent and mechanisms by which low-income and badly designed welfare structures affect family stability and health. Traditionally, people have used situational theory or cultural theory to explain lower class behavior. A synthesis of the two theories is formulated by conceding that a lower class culture exists, although with a different set of values, beliefs, knowledge, and life-coping techniques. (M. Teller, 1985)
This configuration is adaptive to the socioeconomic marginality. The culture of poverty perspective is lacking because it does not take into account this adaptive nature. The situational perspective is faulty in that it fails to consider that the socioeconomic position does affect individuals’ development and their techniques for controlling their environments. (R. &. J. Dubos, 1952)
Lower class values are not the only complex of culture that has an impact on the poverty populations. The residual poor, the working poor, the marginal middle class, and others generally agree on what constitutes the good life. They hold many conventional virtues in common, and these relate to the desirability of stable monogamous marriages, the legitimacy of children, and intact families. (M. Teller, 1985) There is a large difference between concepts of virtue and behavioral practices. The more economically marginal a group is to the mainstream of the stable working class, the more lower class adaptations the group develops.
“The economic and epidemiological conditions of urban compared to rural places continued to have a bearing on the risk of death from Tuberculosis in the 19th century.” (B. Bates, 1996) The historical analysis of such differentials offers several pointers to the way in which the debate might be advanced.
First, the focus of attention clearly needs to be mortality in childhood, which appears to be highly sensitive to differences in population density. It is important as well to distinguish between deaths in infancy and early childhood and to realize that an excess of the latter may be found especially in urban centers and at times before the medical control of childhood infectious diseases became possible.
Second, although it is convenient to categorize environments as either urban or rural, in reality there was in the past, at least in the United States, a mortality continuum. Certainly the average life chances, measured by life expectancy at birth, were as much as 1.5 times better in the countryside than in the larger towns, but this does not mean that the former was invariably healthier. What changed the situation in the United States during nineteenth century was rapid urbanization: the redistribution of people from the relatively good to the bad locations in terms of health environments.
The long debate on urban –rural mortality differentials has not been brought to a successful conclusion, but the signs of greater cultural awareness and analytical sophistication are encouraging. In particular, it is critical that the crude depiction of an urban graveyard effect be replaced by a far more contingent account that is sensitive to the diversity of health environments that may be associated with the clustering of populations in high-density areas.
1.F.B. Smith The Retreat of Tuberculosis, 1850-1950. New York: Harper Collins, 1988.
2.T. Dormandy The White Death: A History of TB. London: Sage, 1999.
3.B. Bates Bargaining for Life: A Social History of Tuberculosis, 1876-1938. Oxford: Oxford University Press, 1992.
4. L. Bryder Below the Magic Mountain: A Social History of Tuberculosis in 19th- century. London: Sage, 1988.
5. M. Teller The Tuberculosis Moment. New York: Rutledge, 1985.
6. C. Gradmann ‘Robert Koch and the pressures of scientific research: tuberculosis and tuberculin’, Med Hist 45 (2001).
7. R. &. J. Dubos The White Plague: Tuberculosis, Man and Society. New York: Harper Perennial, 1952.