Tuberculosis and race in Britain and its empire, 1900–50

The history of tuberculosis in twentieth-century America or Germany could not be written without considering race. However, historians of the disease in Britain have largely ignored the issue and have only considered this great ‘ social disease’ in terms of class, occupation, urbanisation and welfare policy. ¹ Race was to the fore in the United States for obvious reasons: the differential incidence of tuberculosis among immigrants from Europe, the exceptionally high mortality rates among Native Americans and fears about the rising toll among African Americans after 1870. ² In Germany, the disease was spoken of as a ‘racial poison’. ³ Yet British work and campaigning with tuberculosis was not completely insulated from race. The country had its own ‘races’ and immigrants, and was at the centre of an empire of many ‘peoples’, among whom the incidence of tuberculosis rose rapidly in this century. In this chapter, I argue that discussion of the relationship between tuberculosis and race was integral to the changing epidemiological and pathological understanding of the disease in Britain and its colonies. I focus on the dominant discourse developed by doctors in Britain and Africa, and only briefly mention the different patterns of ideas current in Australasia, India and the West Indies. Indeed, it was the alliances of medical specialists, rather than national or physical geographies, which defined the relevant communities. In general, colonial medical officers interested in tuberculosis found a more receptive audience in metropolitan medicine than they did among their peers, who were preoccupied with tropical diseases. ⁴ In an earlier article, Mark Harrison and I discussed how tuberculosis in Africa and India was constructed as a ‘disease of civilisation’; here I focus on race and explore in detail ideas of ‘racial immunity’ and ‘primitive tuberculosis’ . ⁵