H.L. Mencken

Baltimore Evening Sun/February 8, 1911

Stamping Out Tuberculosis

“Give me $50,000,000 and 10 years’ time,” said an enthusiastic young doctor the other day, “and I’ll make tuberculosis as rare in Maryland as yellow fever.” The gentleman was both too modest and too bold. Not $50,000,000, nor even $10,000,000 would be needed to segregate and guard all the consumptives within the state’s boundaries, and not ten years, nor even eight, would be required to kill or cure them. But it would take many times $50,000,000 and much longer than 10 years to erect a wall around Maryland high enough and stout enough to bar out the touring consumptives of other states. 

In brief, it will be difficult, if not downright impossible, to stamp out the great infections absolutely until the Federal Government takes charge of the work and health laws are made national in scope. Of what use is it for one state to war upon tuberculosis if a neighboring state permits it to rage unchecked? There is constant communication between state and state. The Marylander infected elsewhere comes home to die. Until the national government takes charge of the campaign, or all the states, without a single exception, agree upon a plan of operations and carry it out with equal intelligence and ardor, tuberculosis will continue to take a heavy toll every year.

Smallpox And Yellow Fever

But we have got rid of yellow fever and smallpox. Why not of tuberculosis and typhoid? The cases, unluckily, are not alike. Yellow fever and smallpox are diseases which strike so swiftly and so dramatically that even the most stupid person is quickly filled with fear of them. It is not difficult, under such circumstances, to enforce strict quarantines and to segregate all patients. If yellow fever appeared in Baltimore tomorrow, every patient would be rushed to the quarantine hospital immediately, and no one, save, perhaps, the patients themselves, would make objection. The thing is done as a matter of course whenever a case of smallpox bobs up. 

But tuberculosis and typhoid, being slower in their workings, strike less terror to the popular mind, and so it is more difficult to combat them. If the officers of the local Health Department essayed to drag consumptives and typhoid patients to quarantine, there would be a wall of protest from the ignorant and sentimental, and that wall would be so loud that it would have to be heeded. A state law requiring such segregation could never be enforced. But a national law, it is probable, could be enforced. 

And why? Simply because national laws happen to be made that way. They have the great weight and authority of the government behind them. Their enforcement is in the hands of men who are, as a rule, detached and unsentimental. It is not possible for each separate community to interpret them and modify them as it pleases. They are universal in their application; no man escapes them; the consent of distant and unprejudiced persons is necessary before they may be amended or set aside. A national law is a whole law, a state law is half a law, a city or county law is one-eighth of a law. 

The State and the Consumptive

Our present state laws are making fair progress, against tuberculosis, but they would make vastly more progress if they were a bit more drastic and were enforced a bit more thoroughly. Nine-tenths of them provide for the free treatment of any citizen afflicted with consumption. The theory here is that it is profitable for the state to convert ill and dependent citizens into well and self-supporting ones, and the duty of the state to protect healthy citizens against infection. But the state gives without receiving. No duty, in brief, is laid upon the consumptive. He may, if he has sense, accept the treatment offered and get well. But he also may, if he is an ignoramus, refuse the treatment and drag his way to the grave, a burden and a menace to all about him. 

So long as such ignorant persons are permitted to go at large there will be tuberculosis in the land. What are we to do about them? Educate them? That seems to be the favorite plan of the moment. But will it ever be possible to educate them? Isn’t it a fact that a certain number of human beings in every hundred, say 25 or 30, are utterly and incurably resistant to instruction? How long would our present immunity to smallpox last if we depended upon educating the sort of folk who have that disease? Not long, I am convinced. As a matter of fact, even lawmakers are aware of it and so we do not try to educate smallpox patients, but drag them out by the heels and carry them to some place where they can do no harm. 

Three-fourths of all the cases of tuberculosis in Maryland today show a history, it is probable, of infection through ignorance and carelessness. Among the negroes it is rare, indeed, to find a consumptive who makes any intelligent effort to protect those who must come in contact with him. Among the lower orders of whites the same thing is observed. The ignorant consumptive insists to the last upon his constitutional right to live where and how he pleases, to spit wherever he pleases, to infect whomsoever he pleases. Until that right has been taken away from him, as similar rights have been taken away from the victims of smallpox and yellow fever, tuberculosis will remain a great plague. 

Let me quote a paragraph from the annual report of the Elizabeth McCormick Open-Air School in Chicago—a school founded for the purpose of combating tuberculosis among the children of the poor. The paragraph tells the story of little Frances O, aged 13 years, one of the pupils: 

Frances is one of 13 children who lived in a little frame cottage directly back of the stockyard, where the odor was nauseating. Her father died one year ago of tuberculosis. The visiting nurse had never been able to induce him to take the slightest precautions. He expectorated in the sink and on the floor, and forbade say one of the family to open a window. The only outside air which this household of 15 got at night came through a broken window-glass which they were too poor to replace. 

The Cost of Ignorance

This filthy wretch died, but his ignorance lives after him. Little Frances has tuberculosis at 13. She is growing up broken and inefficient. Until death comes to her relief charity will have to help her to keep alive. Her mother, too, has tuberculosis. No doubt half a dozen of the other children are also infected. What will the family cost the community before it disappears? Perhaps $10,000; perhaps, in the long run, $100,000. And all because one ignorant man exercised his constitutional right to pollute the world.