ABSTRACT
This chapter reviews the Thomas McKeown moment, the social paradigm in medicine associated with it, and its place in the narrative of tuberculosis control in the twentieth century. The focus shifts to the elaboration of a series of laboratory tests for tuberculosis, the forging of a diagnostic tool kit as part of the unfolding bacterial aetiology, the use of x-rays and molecular diagnostics. McKeown wanted to know whether doctor-led scientific medicine, public health interventions focusing on the transmission of infectious diseases, or other factors were responsible for the sustained growth of Britain's population from the 1770s. McKeown's weighing of the relative merits of social and technological disease paradigms can also be read as part of today's much subtler and more comprehensive social determinants of health movement. In the wake of the declaration of tuberculosis's global emergency in 1993, systematic reviews of the DOTS programme revealed the limitations of the recommended diagnostic tests.
