Contagion and Confinement

Historians of tuberculosis have generally focused on the sanatorium era of the late 19th and early 20th centuries, losing interest in the disease with the discovery of curative antibiotics in the 1940s. But the author of this work argues that the availability of drugs actually highlighted the complex social problems that predisposed people to tuberculosis and interfered with its treatment. Lerner offers an in-depth look at the history of tuberculosis control in the USA after 1945 and at the issue of forcible detention of non-compliant tuberculosis patients. Since 1903, Lerner notes, health departments have locked up tuberculosis patients whose uncooperative behaviour 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's policy during this period was to use confinement only as a last resort, Lerner explains, the facility detained nearly 2000 patients, most of them alcoholics from Seattle's famous "Skid Row". Given the resurgence of tuberculosis and the renewed use of detention in the 1990s, the text raises issues which are still controversial. Although modern day 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 protection of the public's health with the rights of patients.