Contagion and Confinement: Controlling Tuberculosis Along the Skid Road - Tapa dura

"Lerner presents a fascinating and well-written history of a critical public policy issue. His lucid review of the detention of tuberculosis patients reveals the perils of well-intentioned social reform, and is particularly relevant in today's context of emerging and re-emerging infectious diseases." -- Thomas R. Frieden, M.D., M.P.H., Supervisory Medical Officer, Centers for Disease Control and Prevention, Former Director, Tuberculosis Control, New York City Department of Health

Most historians of tuberculosis have focused on the sanatorium era of the early twentieth century, losing interest in the disease with the discovery of curative antibiotics in the 1940s. In Contagion and Confinement, Barron H. Lerner offers the first in-depth look at the history of tuberculosis control in the antibiotic era, providing a vital account of this neglected chapter in the history of the disease. He argues that the new antibiotic drugs, rather than being a simple panacea, actually highlighted the complex social problems that continued to predispose people to tuberculosis and interfere with its treatment.

The most controversial strategy used by American health officers to control tuberculosis was forcible detention. Since 1903, Lerner notes, health departments have locked up tuberculosis patients whose behavior presented a public health threat. Using Seattle's Firland Sanatorium as a case study, he focuses on the surprisingly recent use of detention between 1950 and 1970. Although Firland planned to use confinement only as a last resort, Lerner explains, the facility detained nearly 2,000 patients, most of them alcoholics from Seattle's famous "Skid Road." In retrospect, it is clear that Firland staff members overused detention. But Lerner also finds that they worked hard to improve the lives of the alcoholic patients society had forgotten.

Given the resurgence of tuberculosis and the renewed use of detention in the 1990s, Contagion and Confinement raises issues that are both timely and controversial. Although modern public health officials are duly concerned with civil liberties, they still have great authority to detain tuberculosis patients who do not take their antibiotics. Recent studies show that such persons are most likely to be homeless, HIV-positive, or drug users. Society is still struggling, Lerner concludes, to balance public health concerns with respect for patients.