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Respiratory Diseases

Respiratory diseases were an increasingly common and serious concern for an increasingly industrial, urban France in the 19th century. Some, like tuberculosis and influenza, were contagious and spread easily in crowded urban environments; others, like emphysema and "black lung" (then called melanosis and now called coal workers' pneumoconiosis), were caused by airborne irritants. New diagnostic methods and instruments resulted in more precise diagnosis of respiratory diseases; the inventor of the stethoscope, Rene Laënnec, used his device to diagnose respiratory diseases by breath sounds, distinguishing tuberculosis from pneumonia, asthma, bronchitis, and other common ailments with different prognoses.1

Tuberculosis (TB) was—and remains—one of the deadliest human diseases.2 Although urbanites were clearly more susceptible than their rural countrymen, doctors in the early 19th century disagreed about what caused TB, variously attributing it to miasma, heredity, syphilis, poverty, depression, and other factors.3 In 1882, the year Robert Koch isolated the causative bacillus, it was estimated that one out of seven deaths worldwide was caused by TB.4 With the identification of TB as an infectious disease came radical new practices for containing its spread. Patients were treated in isolated sanatoria, architecturally designed to maximize access to natural light and salubrious air.5 Despite calls by some prominent French doctors for the mandatory quarantine of those diagnosed with TB, institutionalization was usually voluntary, and many could not afford it.6 In 1891, France established a national anti-tuberculosis league dedicated to making treatment in sanatoria accessible to the working class.7 Pediatrician Jacques-Joseph Grancher founded an influential charity in 1902, under whose auspices thousands of Parisian children were removed from household where TB was present and placed with foster families in the countryside; the 'Grancher system' was not compulsory, but the social pressure to comply was enormous.8 The BCG (Bacillus Calmette-Guérin) tuberculosis vaccine, named for its developers Albert Calmette and Camille Guérin, was first tested on humans in 1921 and is still used to vaccinate vulnerable children today.9

Notes

  1. Roguin, "Rene Theophile Hyacinthe Laënnec," 233-4; Meiklejohn, "History of Lung Diseases of Coal Miners," 128; Davies, "Living with asthma in 19th-century France," 2.
  2. See CDC, "Tuberculosis (TB)" and WHO, "Tuberculosis."
  3. Barnes, The Making of a Social Disease, 23-27.
  4. Bynum, Spitting Blood, 110. It should be noted that this statistic says more about how dangerous Koch and his peers believed TB was than about its actual prevalence. 
  5. Bynum, Spitting Blood, 128-9, 138-145.
  6. Barnes, Social Disease, 104-112.
  7. Bynum, Spitting Blood, 132.
  8. Bynum, Spitting Blood, 166-7; Dormandy, The White Death, 303-307.
  9. Kanabus, "Information about Tuberculosis."
  10. Opinel and Gachelin, "French 19th century contributions," 173-4.
  11. See Cohen, "The agony of nasal polyps," 1311-13 for a published case study. 

Bibliography

  • Barnes, David S. The Making of a Social Disease: Tuberculosis in Nineteenth-Century France. Berkeley: University of Califorrnia Press, 1995. http://ark.cdlib.org/ark:/13030/ft8t1nb5rp/.
  • Bynum, Helen. Spitting Blood: the History of Tuberculosis. Oxford University Press, 2012.
  • Centers for Disease Control and Prevention (CDC). "Tuberculosis (TB)." Updated 22 March 2018. Accessed 4 June 2018. https://www.cdc.gov/tb/statistics/default.htm.
  • Cohen, J. "The agony of nasal polyps and the terror of their removal 200 years ago: one surgeon's description." Laryngoscope 108.9 (1998): 1311-1313. DOI: 10.1097/00005537-199809000-00009.
  • Davies, Helen M. "Living with asthma in 19th-century France: The doctor, Armand Trousseau, and the patient Emile Pereire." Journal of Medical Biography (2018). DOI:10.1177/0967772017741763
  • Dormandy, Thomas. The White Death: a History of Tuberculosis. London: Hambledon and London, 2001.
  • Kanabus, Annabel. "Information about Tuberculosis." TBFacts.org. Global Health Education (GHE), 2011. Accessed 4 June 2018. https://www.tbfacts.org/bcg/.
  • Meiklejohn, Andrew. "History of Lung Diseases of Coal Miners in Great Britain, Part I: 1800-1875." British Journal of Industrial Medicine 8 (1951): 127-137.
  • Opinel, Annick and Gabriel Gachelin. "French 19th century contributions to the development of treatments for diphtheria." Journal of the Royal Society of Medicine 104.4 (2011): 173-178.
  • Roguin, Ariel. "Rene Theophile Hyacinthe Laënnec (1781-1826): The Man Behind the Stethoscope." Clinical Medicine & Research 4.3 (2006): 230-235.
  • World Health Organization (WHO). "Tuberculosis." Updated 16 February 2018. Accessed 4 June 2018. http://www.who.int/news-room/fact-sheets/detail/tuberculosis.