Tuberculosis on Skid Row

X-ray bus on Skid Row (1955; photo: Philip Taylor)

The above picture was taken by Phil Taylor around 1955. It is a mobile chest x-ray setup… state of the art medical technology for that time, I’m supposing. It was part of an outreach program that sought to x-ray homeless men on Skid Row in Philadelphia. This medical end of it was run by the Philadelphia Tuberculosis and Health Association, and the social service part was done by the Friends Neighborhood Guild (FNG). In particular, the FNG part was largely Philip Spencer, a caseworker who was particularly dogged in bringing the men in to be x-rayed and then, if the x-ray indicated TB, then Spencer would have look to track down their whereabouts and persuade them to go for treatment. Taylor followed Spencer around with a camera, and got some fascinating shots still tells stories of places and situations that Spencer’s work got them into.

I have struck up a friendship with Phil Taylor in recent months; at age 91 he is remarkably sharp. He has been an amateur photographer since before his short-lived partnership with Spencer, and his accomplishments here have been written up elsewhere. He remains passionate about this TB project, as they found astronomical rates of TB among those tested on Skid Row and, as hard as they tried, no media outlet would cover this story as the national disgrace and public health menace that Taylor, Spencer and others on the project felt it was. He sees my interest in this as a last hope to get the story the attention it deserves.

This is indeed a story that fascinates me, though what I do with it remains to be seen. I have been getting deeper into Skid Row with the eventual aim of looking at this story. Indeed, TB and homelessness have a long history together, one that continues to the present. I personally can attest to this intersection, as I spent six months on a prophylactic regimen of Isoniazid in my early twenties after a PPD skin test I took came back positive. I never came down with TB, but I was exposed to it from my work in San Antonio (TX) homeless shelters. Every so often I need to get a chest x-ray to show that I am not infected.

Accompanying my interest in this is my relative ignorance on things TB. I feel there is a story here, though how well my story will ultimately line up with Taylor’s vision is uncertain. It’s a bit like going on a road trip, with the destination being “west” and a faith that this will become clearer as I continue to drive.

As an introductory leg of this trip, I just finished Barbara Bates’s book Bargaining for Life: A Social History of Tuberculosis, 1876-1938. She looks at the establishment of TB care largely through the correspondence of Lawrence Flick, one of the seminal forces in establishing medical and convalescent care for people with TB in the late 19th and early 20th centuries. It is fortunate (to me) that Flick was based in Philadelphia, although the time period covered is earlier than the time period that I am looking at. Nonetheless, it provides invaluable background information to tuberculosis care in Pennsylvania.

I read this book selectively, skimming over the parts that dealt with patient and physician accounts of day to day details of care, and was more interested in what types of care, and especially residential care, were provided. To my surprise, the book chronicles the proliferation first of private sanitariums, and then of a state network of public sanitariums. As such, this was similar to the institutional systems for mental health treatment and corrections, such as was chronicled in Rothman’s The Discovery of the Asylum. But Rothman never even mentioned TB. The same themes resonate in the TB sanitariums as in psychiatric hospitals: huge public expense, overrated cure rates, and an ever-growing demand for care.

In my work on homelessness, the role and function of institutions in shaping this problem has been a recurring topic. And here pops up an instance of this that I was not aware of. By the time of the chest x-ray bus, medications such as isoniazid and streptomycin were already being used to treat TB, but most of the homeless men would still be sent to a sanitarium. The details of this should be fascinating, and that is where I will ultimately return to. 1955 seems to be at the cusp of a decline in institutional care and this may be a window into that process. Alternately, this may fit in a more general narrative of how we have handled TB among the homeless. I feel like I’m on to something here, but in a vague way. I need to keep driving to get a clearer beat on my destination, and I have a long way to go.

Next up is Barron Lerner’s book Contagion and Confinement: Controlling Tuberculosis along the Skid Road. It looks to be essentially the same topic, but in Seattle. I’m sure I will write about