Tuberculosis as Disease and Politics in Germany, 1871-1961
Political structures, ideology, and science interact to shape public health policy in a way that is complex and still poorly understood. The German experience in the 20th century creates a unique historical opportunity for studying this interplay. This study examines the development and variation of tuberculosis control measures under the Kaiser Reich, during the Weimar Republic, in the era of Nazism, and in the post-1945 occupation zones and subsequent German states. This dissertation examines major milestones in scientific understanding, medical practice, public health policy, legislation, and regulation related to tuberculosis control under successive German states and governments will help to clarify their interaction. In the course of this turbulent German century, profound changes occurred in the scientific understanding of tuberculosis. Tuberculosis had reached epidemic proportions in Germany in the wake of the industrial revolution, spurring considerable research into its origins, treatment, and the conditions of its spread. Robert Koch's 1882 discovery of the tuberculosis bacillus launched a period of progress in diagnosis and treatment that coincided with increased political interest in public health more generally. Only with the discovery of streptomycin in 1945 did medical science begin to develop the first effective drug therapies and struggled with questions of how to integrate these into existing treatment and prevention paradigms. Here, a comparison between the East and West German experience proves particularly helpful in exploring the importance of ideology, politics, medical knowledge, as well as institutional and professional interests. Ultimately, through the case study of tuberculosis treatment and control, this dissertation examines how the interaction between various German states' ideologies, their medical traditions, and their scientific knowledge shaped Germany's public health policies and practices.