TUBERCULOSIS: THEN AND NOW

By: Kennedy Barrow

Edited by: Glenn T. Johnston

I. A fictional introduction to tuberculosis as it might have appeared in 1800s Baltimore.

The paper boy looked gaunt and pale, but he persevered, his raspy voice cracking as he shouted, “Consumption sweeps through the ships of America—the ‘king’s evil’ has struck”!

Many people walked their way through the soiled and grimy cobblestone streets, the smell of a city inhabited by the unwashed penetrating through their many layers of clothing and assaulting their nostrils. A man stumbled out of a bar, squatted, and relieved himself in a puddle on the street. He smiled at passersby, revealing his blackened teeth; his clothes stained and tattered, and his beard matted around the mouth with dried blood. A passing coachman sneered as his buggy splashed through the puddle, spattering the stinking secretions onto the bearded man and those behind him. A small girl in a pink dress wiped droplets from her arm, shook her hand, and then brushed the moisture from her brow. She walked through the streets toward the Baltimore seaport market.

At the market, a fisherman coughed into his hands, tired from a his time on the Bay. He picked up a fish from the catch box on his ship and brought it to the roofed vendor cart to sell. His closest friend, still below deck, felt ill and exhausted; he had picked up a cough on the coast. The fisherman thought that the cold had gotten him in its grasp as well. He had tried to convince his friend working below deck to see a physician on the mainland, but the man had profusely refused. Deathly terrified of blood, he could not bear it if he had to be let by a physician or barber taking a knife to his wrist, draining his life into a cup. He had insisted that he was stronger than the imbalanced humors in his body, speaking through flushed cheeks and retching coughs.

The fisherman wiped his brow of the sweat formed from Baltimore’s humid summer heat. He loaded the rest of this morning’s catch onto the cart for sale. Hastily prepared, an array of fresh blue crabs, filleted rockfish, perch, flounder, and shucked oysters spread across the salt-soaked, blood-stained wood. His callused hands grasped the smooth wooden handles, and he let out one last cough into his shoulder before hoisting the cart onto its wheels. He glanced toward the ship’s hatch and made his way down the ramp into the port’s marketplace. The crowds were already bustling, the surrounding factories booming—an industrial cacophony. “Fresh fish and crab!” the fisherman howled as he parked near sailors selling foreign herbs and spices.

People from all walks of life swarmed toward him, gathering in line. Cooks and maids from wealthy houses gathered ingredients, while recently immigrated Irish and German folk searched for cheap food, and free African American locals restocked their supplies. Fellow sailors shook his hand and inquired how this morning’s catch had fared as they stole a quick oyster snack. He recalled the cough his mate had caught, and suddenly those who had heard stilled. They looked at him quizzically, knowing the “king’s evil” had been making its rounds, rapping on doors across the city.

The fisherman felt the fear from all their eyes, but he didn’t know why. His only connections for his time away fishing were his mate and the sea. This was his first day back ashore in weeks. His mate usually handled the market. He attempted to stifle a cough, but its claws dug into his throat. He had no choice but to submit, using his hands to shield the crowd. As he convulsed, the crowd dispersed, scrubbing their hands against their pants and skirts, whispering prayers to the Lord.

After the fisherman finished gathering his wits about him, he looked up from his cupped hands and caught the last of his crowd scattering to their respective corners of the city. His hands slick, he wiped them dry on his shoulder sleeve, focusing on how much of his catch he had left and the money he had made. A tug on his pant leg pulled him back to attention. A smiling girl in a stained pink dress met his gaze. Her smile faltered for a moment, but when she spotted the last handful of crabs still on the cart, she jutted out her hand filled with coins. He took her payment, shook her hand, and gave her the tray with the last blue crab. Before she took the tray, she pointed to the stain blooming on his shirt. He looked down and licked his lips, a metallic taste coating his tongue. A darkening red patch had spread across the fibers of his white cotton shirt. His heart thundered like the chisel that would be carving his name into a gravestone weeks later.

The fisherman had caught tuberculosis in the 1840s and continued the spread to locals and travelling sailors by a contaminated gesture. A stroke of bad luck. A death sentence caught by being born in a period without antibiotics, proper hygiene systems, and underdeveloped microbiological knowledge.

II. Tuberculosis in Maryland

The first effective treatment for tuberculosis wasn’t discovered until Selman Waksman wrote his name on his assistant's findings, one hundred years later. His assistant's name was Albert Schatz, at this time he was a World War II veteran coming home dragging his feet from a back injury he sustained in the field. He was one of Waksman most trusted team members, that’s why he was welcomed back with open arms with his new state of mind. A microbiologist witnessing the strife and disease of war. Men with orifices open and weeping with pus from bullet wounds, protruding shrapnel, or skin burnt away. Leaving the scent of humid breath, infection, and charred meat in his nostrils.

So, when Waksman was assigned by Mayo Clinic in 1943 to find a solution, tasked him to isolate himself with the disease that had been terrorizing the world for centuries to potentially find a cure, he did it. The soil sample he found contained an antibiotic specimen called streptomycin that successfully killed the bacteria that causes tuberculosis, Mycobacterium tuberculosis and gram-negative bacteria. This discovery was monumental. Schatz worked tirelessly to revolutionize the medical world to improve public health. He revealed his extraordinary findings with his mentor. The man he’s looked up to since he was a budding microbiologist, and Waksman with hands shaking took his colleague’s findings with his eyes glued to the positive death zone around M. tuberculosis. Waksman presented the findings to the Mayo Clinic that same year. He received the Nobel Peace Prize. He collected the royalties. He was the face of the miracle drug that was saving patients around the nation.

Albert Schatz was shadowed by his idol’s stride toward scientific fame, he held no riches and no credit. The man who worked tirelessly, seemingly praying and hoping that just maybe with his discovery he could rid the smell of decay from his memory. That he could hopefully secure a future where his children could poke fun at his limp and he wouldn’t feel so bad because they don’t need to worry about how their lungs would destroy themselves from the inside out.

After the first successful treatment of very late stage extrapulmonary tuberculosis was treated in 1944, the miracle antibiotic was spread through America. Maryland hospitals, like the white-only Eudowood Sanatorium, later named “Hospital for Consumptives of Maryland”, that was opened in 1896 and run solely by volunteers were eternally grateful to afford the new effective antibiotic treatment. The management methods consisted of spacing out infected patients, keeping windows open to bring the healthy air in, and nurses tried their best to remove bloodied rags and sheets when soiled.

While the Henryton Tuberculosis Sanatorium built in 1922, only accepted African American beds who had come to Maryland for refuge. Freed black communities in the late 1860s flocked to the northern states after the chains that businessmen put them in were finally broken. Hate ran like wildfire through the south and spread like consumption’s bloody cough, but in the deep corners, love thrived. Hope lit paths like lanterns on dark trails, leading people home. A place they once only knew from faces, now placed into their hands. Opportunities to grow, evolve, and love freely. How naive can one be to think if we were created through love, then wouldn’t we lead life with it?

Yet their wards were dark and cold, they were clumped and clinging together for support. They were told of the antibiotic, but words have never been an effective cure. Hope can only survive so long on words. They were told to walk and keep the air they breathed fresh, but most couldn’t inhale without choking on a piece of lung.

Other “African-American only” facilities included the House of Reformation and Instruction for Colored Children where Black children were taken under the guise of a juvenile detention center that was opened by a wealthy businessman, Enoch Pratt in 1877. He employed a former Civil War general, Oliver O. Howard, to supervise the boys. Prior to this, Howard had been in charge of the US Freedmen’s Bureau. The mission of the House of Reformation was to address the systemic racism in the prison system. African American children were tried and sent to prison with adults because the local juvenile detention center was for white boys only. Black children were punished like adults. Using targeted raids and arrests, the Maryland state prisons filled their cells with Black men who were forced into prison labor. Grueling work in brickyards where they made the materials needed for building homes and businesses into which they, as convicted felons, would never be welcomed in. The prison’s budget was based on prisoners’ production. It was a system in which guards beat and shoved them into dark isolation cells for days on end.

In comparison to what awaited them in prison, the idea of the House of Reformation and Instruction for Colored Children seemed like a refuge for these young men charged with petty theft and “uncooperativeness”. The General’s style of reformation could be interpreted as another source of cheap child labor. For decades, young men would be put to work at the surrounding farms, making shoes and other goods to sell at local markets. Accounts tell of how using their nimble fingers they tailored clothes even as they pricked their fingers or injured their hands with tools as they made shoes. Others were ordered to clean the kitchen and other facilities with water and harsh detergents. Made with lye, they irritated the children’s skin causing them to crack and split. They were educated in the middle of the day to a level of functional literacy. Underfunded, the lessons taught numbers and letters-- just enough to collect payments and read signs for errands. Their reading only included approved literature that glorified the birth of the country their ancestors had been abducted to. Under conditions like these, it is not hard to see that their malleable minds far from being challenged and educated were, instead, intellectually starved and broken.

Illness and disease ran rampant throughout the close quarters of the building. Tuberculosis was one of many causes of death that can be found in the archives of what would be later called “Maryland’s Hell Hole,” however tuberculosis was not always the actual cause. In 1934, after Aubrey Brunson was shot for not getting in the food line, authorities discovered from the testimonies of other boys living there that some boys reported as “missing” were most likely beaten to death, died of illnesses due to neglect, or were murdered. The State of Maryland took control in 1937.

One example out of hundreds was Matthew Bloe. He was one of six boys reported to have died of tuberculosis in 1877. He was struck with a hatchet in the back by his teacher. When questioned, his teacher admitted that he had “been playing” with Bloe. His body was never given a proper autopsy because his postmortem report had no mention of bodily injury. He was then buried. Another 20 years later, in 1893, the winter months were cold; Charles Salisbury and John Hall developed frostbite from working outside without shoes. They were locked in cells, cold and dark with a thin blanket in the corner until they had to be hospitalized. Their legs were amputated; only John Hall survived. Records show that Charles Salisbury died from blood poisoning, no other causes or factors.

In 1972, Troy Bailey, the state delegate at the time, found the secret cemetery in an overgrown forest area of Prince George County, Maryland and the estimated 230 boys that were buried in marked and unmarked graves. The headstones he found belonged to William Jones who died at 17, Anthony Johnson who died at 11, and Ashbury Brown who died at 15. They were surrounded by depressions suggesting other gravestones had been there, but they were removed or stolen by locals. He found others marked by just a simple cinder block. This wasn’t further addressed by authorities until September of 2025 by Governor Wes Moore.

Reforms come from taking accountability, from seeing evil and addressing it. It was evil that throughout the 1800s into the early 1930s “night doctors” from Maryland universities and medical schools would take cadavers from facilities like the House of Reformation, state prisons, and shelters. This led many authorities to believe that the records recovered from these places were underreported or falsely reported many causes of death. African Americans who were already sick and struggling were segregated and placed in squalor in these places. People were left to die for supply and demand, and they had nowhere else to go.

Many of the problems from our past continue into the present. Public health statistics repeatedly support an understanding that poor communities are our most vulnerable populations. Members of our homeless population become ill and can’t afford medical care. This skews our public health reporting system because they can initially spread illness unnoticed from person to person, thus creating a delayed response. For example, in Johnson County, Kansas there was a serious outbreak of tuberculosis that was reported in 2024. The factor that sounded the alarm for the local health department that they needed to get a hold on the situation was that a 4-month-old baby had contracted an active tuberculosis infection. She was being raised in an extremely poor household in a very dense urban area.

Contemporary microbial sciences show the specialized bacillus M. tuberculosis, that Schatz worked with so long ago, embeds itself into the microscopic holes of the lungs that expel oxygen into the bloodstream. It hides inside the flesh, a rattlesnake waiting for the right moment to strike. Once conditions reach optimum, one cell becomes two, causing the holes to expand. Two turns into four, then eight, and sixteen with no regard for the flesh tearing around them. These microscopic holes become long-growing lesions, oozing blood into the airway. Breathing becomes a challenge as the lungs fill with their own ichor, the patient coughs until their throat is raw trying to expel the rising liquid. As the coughing persists, the bloody sputum contains pieces of the patient’s own lung.

Once the lungs are covered in small white pox from the immune system’s attempt to fight the infection and cavernous lesions, it spreads. M. tuberculosis travels through the lymph nodes and the blood stream, hijacking the patient’s immune system, rendering it useless. Even as the patients’ fever spikes to critical levels, thousands of snake-like invaders find other orifices to abide in around the body. This includes the kidneys after swallowing, bones infected by the blood stream, and the sinuses connected to lymph nodes. Once the bacterium reaches the sinuses, it very easily travels to the brain, leading to Tuberculosis meningitis. The patient becomes a shell of who they were; their soul trapped in a body already decomposing.

Even in modern times, with the usage of antibiotics, a patient’s recovery is not always guaranteed. Treatments used in hospitals take months with several different rounds of antibiotics that attack M. tuberculosis by stripping away its outside layers until the last round unravels its DNA. This process is long, painful, and expensive.

One may think they’re lucky to be born into a time long after the discovery of antibiotics, however overuse of what was once a miracle drug has made hospitals breeding grounds for mutated strains of infections. Bacteria are living organisms that evolve. They have the ability to develop and pass on genes that can protect themselves against enemies like antibiotics. Additionally, bacteria, like M. tuberculosis, divide and reproduce in minutes. This allows these genes to transmit during treatment. Thus, the death sentence of catching the disease in the 1840s has shifted to the danger in 2025 of the medicine used to treat tuberculosis being ineffective due to its ability to evolve.

Globally, in 2023, 8.2 million cases were reported by the World Health Organization. The United States began its departure out of the World Health Organization in January 2024. Data show that the United States has recently seen a rising resurgence of tuberculosis in 2024 and 2025 with outbreaks in Kansas, South Carolina, Maine, and Washington state. That reverses the trend of seeing it in decline since 2011.

He coughed. He and the girl shook hands. It passed to a new generation. All it takes is an infected gesture.