1. By the late nineteenth century, the infectious nature of TB had generated debate for years in the United States and Europe. Despite the discovery of the pathogen responsible for consumption, deeply rooted beliefs regarding “hereditary consumption” (transmittal of the disease from parent to child) prevailed. This belief gained traction as whole families succumbed to the disease. Lawrence Flick effectively argued, however, that consumption was indeed contagious and fully discussed the differences between heredity and predisposition in his journal article, Contagiousness of Phthisis (Tubercular Pulmonitis) Transactions of the Medical Society of the State of Pennsylvania. 1888 June;20:164–82.Anticontagionists denied that consumption was spread between individuals — rather, they claimed that the disease was acquired when persons of a certain genetic predisposition came into contact with “miasmas” emanating from decaying garbage. For more on anticontagionists see Lerner Barron H New York City’s Tuberculosis Control Efforts: The Historical Limitations of the ‘War on Consumption,’ American Journal of Public Health. 1993 May;83(5):758–66. [PubMed]
2. Lawrence F. Flick, Henry Phipps Institute Fifth Annual Report (Philadelphia, 1909) (hereafter HPI Annual Report). In his annual Clinical and Sociological Report, Flick explains the natural course of TB: “An individual inhales the dust carrying tubercle bacilli which is then implanted in the bronchial lymphatic glands or in the glands of the upper respiratory tract. The disease lies dormant in these glands or else slowly progresses during a period of years, until finally in the grown-up individual, under the stress and the vicissitudes of life and under the demands of labor and deprivation, the bacilli having gotten into the lungs or some other tissue by way of the lymphatic’s or the circulation, it breaks out full force” (21).
3. Brandt Lilian Social Aspects of Tuberculosis. Annals of the American Academy of Political and Social Science. 1903 May;21:65.Brandt concluded that social conditions such as physical environment, poor ventilation, and lack of sanitation contributed the prevalence of TB.
4. Newman Bernard J. Preventing Tuberculosis in Pennsylvania. Philadelphia: The Society; 1914. “The Relationship of Housing to Tuberculosis,” in Pennsylvania Society for the Prevention of Tuberculosis; p. 39.
5. Brandt, “Social Aspects of Tuberculosis,” 65. According to Brandt, physical predisposition to TB was not merely a function of heredity, but was also attributed to the “attendant evils of poverty, such as ignorance and carelessness, … all of which produce a physical condition predisposed to disease” (67).
6. City of Philadelphia Bureau of Health. Annual Report of the Director of the Department of Public Safety and Bureau of Health. Philadelphia: 1901. In 1901, consumption caused 2,845 deaths. Due to the high death rates, “consumption of the lung” was placed on the list of reportable diseases on 12 March 1901. Physicians were then required to contact the Bureau of Health to report all cases of consumption.
7. Landis Henry RM A Report of the Tuberculosis Problem and the Negro. Philadelphia: Henry Phipps Institute; 1923. p. 10a., Table 7. Landis used the U.S. Mortality Statistics for 1920, which demonstrate that Philadelphia’s TB was higher than that in any other region of Pennsylvania. It was also noted that not all cities shared Philadelphia’s high mortality. Detroit, St. Louis, and Newark all reported death rates under 100 per 100,000 compared to Philadelphia’s 137.3 per 100,000. Rates increased in the city in general and blacks specifically between 1916 and 1919 due to the combined effects of influenza, World War I, and increased occupational hazards.
8. Bureau of Health Annual Report. 1901. p. 80.
9. Mossell Sadie T. A Study of the Negro Tuberculosis Problem in Philadelphia. Philadelphia: Henry Phipps Institute; 1923. McBride David. The Henry Phipps Institute, 1903–1937: Pioneering Tuberculosis Work with an Urban Minority. Bulletin of the History of Medicine. 1987;61:78–97. [PubMed]McBride David. From TB to AIDS: Epidemics Among Urban Blacks Since 1900. New York: New York University Press; 1989. Bates Barbara. Bargaining for Life: A Social History of Tuberculosis, 1876–1938. Philadelphia: University of Pennsylvania Press; 1992. P.S. I Am … Colored; pp. 288–310.
10. It is worth noting that there is an ongoing debate regarding what factors contributed to the decrease in TB rates. While some historians argue that improved housing conditions, water filtration, and other environmental changes decreased disease rates, others attribute the decline to the success of the antituberculosis campaign. In the 1916 Bureau of Health Annual Report, diminishing rates of TB were attributed to several factors, including increased health education of the lay public with an emphasis on how the disease was spread (by means of sputum) and how the disease can be destroyed; early diagnosis and immediate reporting of cases; and isolation and segregation of advanced consumptives. Last, decreased rates were attributed to the gradual establishing of “immunity against the disease” (279).
11. Bureau of Health Annual Report. 1918.
12. First Annual Message of Mayor John E. Reyburn. Philadelphia: 1908. p. 96.
13. U.S. Department of Commerce, Bureau of the Census. Negro Population in the United States, 1790–1915. Vol. 68. Washington, DC: GPO; 1918. pp. 350–51.. It is also worth noting that while TB death rates were elevated in blacks, they were also elevated in some, though not all, European immigrants. Irish-born immigrants’ TB rates were among those elevated in the early twentieth century, but trended downward rapidly as the decades progressed. While experiencing some elevation in TB mortality rates, European immigrant death rates were never as high as for blacks and dropped more quickly. When considering mortality rates it was then and is now common practice to compare disease rates between racial and ethnic groups. While I make no specific attempt to make such comparisons, it is worth noting that a review of vital statistical records compiled by the Bureau of Health for 1900–1920 included comparative breakdowns of TB death rates by race and ethnicity. Categories such as “people of color” and “nativity” were used as broad taxonomic categories. The breakdown by race and ethnicity is helpful for stratifying disease, but it has limitations due to inconsistencies in the use of categories. For instance, a review of death rates due to TB in 1900–1918 shows that the term “people of color” generally referred to blacks except for in 1915, when “Chinese” were also grouped under this heading. It remains unclear why this change occurred in this singular year, given that every year before and after 1915 put Chinese under the subheading “nativity.” Furthermore, when considering mortality rates that compared “colored” and “whites,” it is not clear from the tables whether foreign-born whites were considered in the “white” mortality values.
14. Though death rates fell for both groups between 1908 and 1913, the rate for blacks reveals a remarkable 51 percent decline. Several plausible reasons may explain this drop. Blacks newly arrived in the city may have had low resistance. Some scholars have argued that, unlike native whites, some of whom had lived in the city for nearly a century, blacks may have been more susceptible to the disease once exposed to white society. As large numbers of black migrants arrived in Philadelphia after the Civil War, the high TB mortality at the opening of the twentieth century may reflect more recently infected blacks, whose rates were higher initially after arriving to the city, then fell off due to the natural progression (and the progressive development of resistance) of the disease. For further explanations for fluctuations in TB mortality in Philadelphia across racial and ethnic groups, see Landis A Report of the Tuberculosis Problem and the Negro.
15. Bates, “P.S. I Am … Colored.”
16. Fuller William D. The Negro Migrant in Philadelphia” (1924), Negro Migrant Study, 1923, Housing Association of the Delaware Valley, Records, 1923–1924, 5 folders and oversize worksheets, URB 31; Sadie T. Mossell, “The Standard of Living Among One Hundred Negro Migrant Families in Philadelphia. Annals of the American Academy of Political and Social Science. 1921 November;98:173–218.
17. National Tuberculosis Association. Report of the Committee on Tuberculosis Among Negroes: A Five-Year Study and What It Has Accomplished. New York: The Association; 1937. p. 24.. See also Du Bois WEB The Philadelphia Negro: A Social Study. Philadelphia: University of Pennsylvania Press; 1899. pp. 147–63.
18. Landis A Report of the Tuberculosis Problem and the Negro.
19. Bureau of Health Annual Report (1918), 343. While the mortality figures surrounding TB are helpful for capturing trends, the contextual background is equally important, and useful for those interested in “unpacking” the numbers. First, when considering the accuracy of available TB mortality rates during the early twentieth century, the reliability of TB reporting should be considered. A law adding TB to the list of reportable diseases was passed in 1901, but not formally put into practice until 1906. Thus mortality rates for TB before 1906 may have been influenced by underreporting in all groups (actual rates may have been higher).
20. Landis A Report of the Tuberculosis Problem and the Negro. p. 12.Flick HPI Annual Report. 1906. Work of the Year; p. 19.Differences in TB mortality between socioeconomic class and occupational groups are discussed in Flick HPI Annual Report. 1909. Clinical and Sociological Report; p. 31.
21. Flick HPI Annual Report. 1906. Work of the Year; p. 19.Though few discussions in the primary sources discuss class differences in TB mortality rates, it is made clear that class distinctions existed and that it may be assumed that members of less affluent classes likely succumbed to the disease at higher rates.
22. National Tuberculosis Association. Report of the Committee on Tuberculosis. p. 6.
23. For further readings on early twentieth-century intellectual thoughts on heredity and race, see Ross Edward A The Causes of Race Superiority. Annals of the American Academy of Political and Social Science. 1901 July;18:67–89.Thomas William I The Mind of Woman and the Lower Races. American Journal of Sociology. 1907 January;12(4):435–69.
24. See also Grandy CR Inherited Immunity in Tuberculosis. American Review of Tuberculosis. 1926 April;13(373):78.Carter HG Pulmonary Tuberculosis Among Negroes. American Review of Tuberculosis. 1923 January;6:1002–7.Grandy CR The Control of Tuberculosis in the Negro. Virginia Medical Monthly. 1927 December;54:566–71.Note that a similar debate was occurring regarding the high rate of TB in the Irish as compared to the English. Early twentieth-century writers continued to regard the Irish as a separate and inferior racial group, and as such, more inclined to develop TB.
25. Bushnell George EA. A Study in the Epidemiology of Tuberculosis, with Special Reference to Tuberculosis of the Tropics and of the Negro Race. New York: William Wood; 1920. p. 221.
26. National Tuberculosis Association. Report of the Committee on Tuberculosis. p. 21.
27. McCain PP. Tuberculosis Among Negroes in the United States. American Review of Tuberculosis. 1937 January;35:25–35.
28. McBride David. Integrating the City of Medicine: Blacks in Philadelphia Healthcare, 1910–1965. Philadelphia: Temple University Press; 1989.
29. Mossell A Study of The Negro Tuberculosis Problem. p. 18.Mossell found that blacks could receive care for TB at Philadelphia General Hospital at Thirty-Fourth and Pine Streets, Rush Hospital and Clinic at Thirty-Third Street and Lancaster Avenue, Jefferson Chest at 238 Pine Street, State Clinic no. 21 at 1724 Cherry Street, State Clinic no. 107 at Frankford Avenue and Palmer Streets, and the Henry Phipps Institute at Seventh and Lombard Streets.
30. Ibid. Philadelphia General Hospital’s large number of black patients was likely due to its open admission policy, which did not bar them. It was also large and had 300 beds devoted to TB patients. Despite its size it was frequently overcrowded and accommodations were lacking. Several of the other facilities mentioned had limited bed availability on their inpatient wards.
31. Landis A Report of the Tuberculosis Problem and the Negro. p. 3.Landis noted a lack of hospital beds at the two black hospitals, Douglass Memorial Hospital and Mercy Hospital, and attributed this to lack of funds. See also Bates Barbara Bargaining for Life: A Social History of Tuberculosis, 1876–1938. Philadelphia: University of Pennsylvania Press; 1992. p. 220.
32. Mossell A Study of The Negro Tuberculosis Problem.
33. Historian Barbara Bates attributes the prohibition of admitting blacks to private sanatoriums to open prejudice and the desire of white patients to limit social interaction with blacks. This was the case at White Haven Sanatorium, which enacted a policy prohibiting blacks in December 1914. In the early twentieth century, White Haven was among the institutions that accepted black patients, but white patients were angered when forced to share the same space as blacks and sent letters of protest and threats. The board of directors capitulated to the demands of white patients who threatened to leave. The fear of reprisal from private patients was of particular concern to proprietors who relied on these patients as their primary means for reimbursement for services. For more see Bates Bargaining for Life. :294–95. 323.
34. Hunter John E. Tuberculosis in the Negro: Causes and Treatment. In: Gamble Vanessa N., editor. Germs Have No Color Lines. Blacks and American Medicine 1900–1940. New York: Garland Publishing; 1989. pp. 12–19. quote on p. 18.
35. Landis A Report of the Tuberculosis Problem and the Negro. p. 1.See also HPI Annual Report (1909), 10, 19. In his Clinical and Sociologic Report, Flick notes the low percentage of blacks treated at the institute from its beginning. During its first five years the percentage of black patients was low: in 1904, blacks represented 6.63 percent of HPI patients; in 1905, 5.65 percent; in 1906, 5.96 percent, in 1907, 9.83 percent; and in 1908, 7.68 percent. Blacks held nearly the highest rates of single visits with no return follow-up compared to other racial/ethnic groups.
36. Who’s Who in America. 1903. p. 1856.; news clipping, “$5,000 Is Phipps Gift to University of Pennsylvania for Tuberculosis Fight,” December 1909. Born in Philadelphia on 27 September 1839, son of an immigrant English shoemaker, Phipps moved to Allegheny City, close to Pittsburgh, in 1845. As a young boy, Phipps made the acquaintance of the Carnegie family, forming in particular a friendship with Carnegie sons Andrew and Tom. The boyhood friendship between Henry and Andrew turned into a profitable business partnership in the iron forge and manufacturing industry. In 1901, after four decades, Phipps sold his business interests to the United States Steel Corporation, netting $100 million. In his early sixties, Phipps increasingly focused his attention on humanitarian efforts.
37. Bates Bargaining for Life. pp. 99–100.Pennsylvania Society for the Prevention of Tuberculosis. Preventing Tuberculosis in Pennsylvania. Philadelphia: The Society; 1914. p. 55.. The Pennsylvania Society for the Prevention of Tuberculosis was one of the first organizations in the United States to mount an organized campaign against TB. One of Flick’s early endeavors began with the founding of Rush Hospital for Consumption and Allied Diseases. The hospital opened in 1891 and accepted its first patients in 1892.
38. Gazette. 5 March, 1926. The Phipps Gift., University of Pennsylvania Archives Information Files Collection ( UPF 8.51), Folder Henry Phipps Institute; news clipping, “Dedication of the Phipps Institute,” December 1909. The HPI takeover was completed with the continued annual support of $50,000 per year from Phipps.
39. News clipping, “Dedication of the Phipps Institute.”
40. News clipping, “$5,000 Is Phipps Gift.”
41. Bates Bargaining for Life. p. 101.
42. HPI Annual Report. 1904:4–5.
43. Ibid., 6. The early annual reports of the institute do not explicitly provide the racial makeup of its nursing staff. It may be surmised with a great deal of certainty that these nurses were white, since as indicated in subsequent Phipps records, the first black nurse, Elizabeth Tyler, is hired in 1914.
44. Ibid., 8.
45. Ibid., 12.
46. Ibid., 12.
47. Landis, A Report of the Tuberculosis Problem and the Negro, Table 1, “Analysis of Negro Patients Within Present District, in Attendance at Phipps Institute Tuberculosis Clinic in 1903, 1906, 1913, 1922, by Diagnosis, Prognosis, and Result.”
48. Ibid., Table 3, “Analysis of White Patients Living Within Present District, in Attendence at Phipps Institute Tuberculosis Clinic in 1903, 1908, 1913, 1922, by Diagnosis, Prognosis, and Result.”
49. Ibid., Table 9, “Attendance at Five Tuberculosis Clinics in Philadelphia in 1921, Showing the Number and Percent of White and Negro Patients Examined and the Number of Negro Patients Diagnosed.”
50. Ibid., Table 3.
52. Whittier Centre Annual Report. Philadelphia: 1914. p. 4.
53. Starr Centre Association. Untitled Pamphlet. Philadelphia: 1907. , Barbara Bates Center for the Study of the History of Nursing, Starr Centre Collection, Box 9, Folder 105.
54. Whittier Centre Executive Board Meeting Minutes, 1913.
55. Whittier Centre Annual Report. 1914. p. 5.
56. “Who’s Who, 1924–25 American Men of Science,” University of Pennsylvania Archives, Information Files Collection (UPF 8.51) Folder Henry Phipps Institute; Bates, “P.S. I Am … Colored,” 296.
57. Whittier Centre Annual Report. 1914. pp. 3–4.
58. Whittier Centre Annual Report. 1915.
60. Whittier Centre Executive Board Meeting Minutes, 1913.
61. Pitts Mosely Marie O Satisfied to Carry the Bag: Three Black Community Health Nurses; Contributions to Health Care Reform, 1900–1937. Nursing-History Review. 1996;4:65–82. [PubMed]Elizabeth Tyler’s career as a public health nurse did not end in Philadelphia. In 1921 she left the HPI to take a position in Delaware for the State Health and Welfare Commission. Later she held positions in Newark and Essex County, New Jersey, for the New Jersey Tuberculosis and Essex County Tuberculosis leagues, respectively. In each position Tyler maintained her community outreach efforts for education and disease prevention. In the current examination of Tyler’s public health activities, I attempt to layer her nursing work alongside those of civically active community residents and thereby recontextualize her health promotion success within the larger scope of community-building initiatives already perculating in local black communities.
62. Whittier Centre Annual Report. 1914. p. 4.
64. Ibid., 6. The total number of visits for each family is not provided.
65. Ibid., 4.
67. Ibid., 7.
68. Whittier Centre Annual Report. 1916. p. 6.
69. Whittier Center Annual Report (1915), 5. In my examination, I saw no evidence of forcible removal of patients from their homes. Tyler could only encourage patients to go to hospitals or sanatoriums for treatment; ultimately black patients had the right to refuse.
70. Ibid., 6.
71. Whittier Centre Annual Report. 1916. p. 6.
72. Whittier Centre Annual Report. 1915. p. 6.
73. Whittier Centre Annual Report. 1916. p. 2.
74. Whittier Centre Annual Report. 1915. p. 6.
75. Philadelphia Colored Business Dictionary. Philadelphia: 1913. p. 81.
76. Minton Russel F. The History of Mercy-Douglas Hospital. Journal of the National Medical Association. 1957;43(3):153–59. [PMC free article] [PubMed]
77. Ibid., 154.
78. Whittier Centre Annual Report. 1924. p. 13.
79. This new clinic was established based on the Whittier Centre–sponsored research conducted by Sadie Mossell under the supervision of Landis. Mossell’s study indicated the need for increased treatment facilities due to persistently high rates of Mossell TB A Study of The Negro Tuberculosis Problem
80. Whittier Centre Annual Report. 1924. pp. 13–14.
81. Whittier Centre Annual Report. 1915. p. 6.. The names of the churches are not provided.
82. Whittier Centre Annual Report. 1919. p. 11.