Responding to Outbreaks of Multidrug-Resistant Tuberculosis
Even before Robert Koch identified the tubercle bacillus in 1882, many in the scientific and medical communities were convinced that tuberculosis (TB) was an airborne infectious disease and that only isolation of those with active pulmonary disease would decrease transmission of the disease to others. Although the sanatorium movement corresponded to secular trends of decreasing TB incidence in North America and Western Europe, the degree to which isolation practices contributed to the decline ofTB in industrialized countries is still debated (1-4). It is clear, however, that the identification and isolation of all those with active disease was a burdensome and costly strategy ofTB control; its impact on families was often devastating.*
*Bates (4) offers myriad examples of patients troubled by families' want for income or food as a result of caring for sick relatives. She cited Mabel Jacques, of the Visiting Nurse Society of Philadelphia, who described the effects of institutionalization on families: "What effect does the sending of a tuberculous patient to an institution have on the family ... In nine cases out of ten it means eventually the breaking up of the family." Children, wrote Jacques, "become unruly, probably live on the streets and are generally neglected; the father loses heart and interest and either places them in an institution or allows them to go utterly to the bad."