In any historic survey of tuberculosis (TB) in the South, two things stand out. First, until about the 1920s it was one of the region’s leading causes of death, mostly brought on by slow destruction of the lungs. Second, it killed—and was allowed to kill—African Americans three times more often than whites. In 1900 in South Carolina it claimed the lives of 219 blacks per every 100,000 of population, while the white rate was just above 70.
While its immediate cause was the germ Mycobacterium tuberculosis, contributing factors were multiple and generally the same for both races, though all affected blacks much more severely. Malnutrition was one, for the long absence of key vitamins lessened the body’s ability to resist infection. But infection’s greatest spur was overcrowding: in close quarters one active case could infect many. The culprit, epidemiologists would discover, was the dried remains of bacteria-laden droplets called “droplet nuclei.” Sprayed into the air as a fine mist by cough or sneeze, droplet nuclei could hang in the air for long periods—even after the infected source had departed—and were small enough to be inhaled into terminal air passages where TB could begin. The one predisposing cause unique to blacks was their lack of historic experience with TB. Exposed to it on first encountering whites, usually in New World slave societies, blacks as late as the twentieth century had not had time to acquire whites’ immunity level.
A final factor, bearing on both races but putting blacks at special disadvantage during segregation, was insufficient medical care and treatment. Until chemotherapy emerged in the late 1940s, the one fairly sure—if slow—cure for TB was the sanatorium, which offered not medicine but bed rest on open-air porches. Blacks, however, had no access to them until the 1920s, many years after white care began; and even when sanatoriums were built for blacks, they were woefully inadequate. South Carolina was typical: the white facility opened in 1916; blacks had none until 1921, and they had to raise much of its funding themselves. Moreover, the state’s blacks had only a fraction of needed beds. The standard was one for every TB death. In 1934, 844 blacks died, but their sanatorium accommodated only 148 patients. The hospital for whites met the standard.
Although TB continued to be a problem for blacks until the 1960s, increased federal funding after 1945 for added beds and TB control (which searched out victims and got them into treatment) helped blacks disproportionately. Then in the 1950s improved chemotherapy offered a sure and speedy cure without hospitalization. Once black pressure and civil rights law ended medical segregation in the 1960s, blacks gained equal access to such therapy. By 1970 all those factors, plus rising income, finally brought blacks’ TB under control. In 1945 their mortality in South Carolina was 56 cases per 100,000; twenty years later it was just over 6. Though that was still three times the rate for whites, in the interval blacks’ progress had slightly surpassed whites’, and their long struggle against TB was over.
Beardsley, Edward H. A History of Neglect: Health Care for Blacks and Mill Workers in the Twentieth-Century South. Knoxville: University of Tennessee Press, 1987.
Lerner, Gerda. “Early Community Work of Black Club Women.” Journal of Negro History 59 (April 1974): 158–67.
Scheele, Leonard A. “The Health Status and Health Education of Negroes in the United States.” Journal of Negro Education 18 (summer 1949): 200–208.
Wyngaardan, James, Lloyd Smith, and J. Claude Bennett, eds. Cecil Textbook of Medicine. 19th ed. Philadelphia: W. B. Saunders, 1992.