Antonio Stella, M.D., Tuberculosis and the Italians in the United States, New York City

In spite of the traditional renown of Italy as the paradise of Europe and one of the most healthful countries on earth, notwithstanding the fact that she really yields less victims annually to consumption than any other nation on the continent under similar demographic conditions, it is an undoubted fact, and a truth sadly brought daily to the attention of physicians, social workers, and others in a position to know, that tuberculosis is very prevalent among the Italians emigrated to these shores.

To have an idea of the alarming frequency of consumption among Italians, especially in the large cities of the Union, one must not look for exact information to the records of the local boards of health and the registry of vital statistics; they are, for the very reason of the mobility of the Italian emigration, very fallacious, and show a low figure; but one must follow the Italian population as it moves in the tenement districts; study them closely in their daily struggle for air and space; see them in the daytime crowded in sweat-shops and factories; at night heaped together in dark windowless rooms; then visit the hospitals and dispensaries; and finally watch the outgoing steamships, and count the wan emaciated forms, with glistening eyes and racking cough, that return to their native land with a hope of recuperating health, but ofttimes only to find a quicker death.

This desire and tendency on the part of all Italians, whether rich or poor, to go back to their homes as soon as informed that they are affected with phthisis, is the chief cause of the discrepancy between the actual high number of consumptives existing among the Italians in the United States and the official low figures of the various health boards.

In fact, in a recent table of the New York Health Department as to the mortality from consumption among the different nationalities between, the ages of fifteen and forty-five years, we find that the Italians occupy only the tenth place in the list, losing but 149.9 per 10,000 population, as against 548.4 and 428.0 lost, respectively, by the negroes and the Irish, who lead the way. On the contrary, Italians come second in the table, where the mortality is considered below the fifteenth year of life (children generally being allowed to die here) ; and the same high percentage would certainly be found for the adult generation, were the statistics arranged

not according to the death-rate, but according to the infection-rate, which is simply appalling.

From some tenements in Elizabeth and Mulberry street, there have been as many as twelve and fifteen cases of consumption reported to the Board of Health since 1894. But how many were never reported? How many went back to Italy? How many moved away to other districts?

My personal experience with some of the houses in that particular neighborhood is that the average has been not less than thirty or forty cases of infection for each tenement yearly, the element of house-infection being so great. I remember some rear houses in Elizabeth street, and one in Mott street, now torn down, through the operations of the new tenement law, that yielded as many as twenty-five cases in the course of a year to my personal knowledge alone.

And how could it be otherwise? When we consider the infectious character of tuberculosis on the one side, and

the overcrowded and filthy conditions of some tenements on the other, where a population of men, women and children is herded together at the rate of eight and ten in every three rooms (in some "flats" on Elizabeth street this number can often be doubled), a population, besides, made up chiefly of agriculturists, fresh yet from the sunny hills and green valleys of Tuscany and Sicily, abruptly thrown into unnatural abodes and dark sweat-shops -- a population, at that, overworked, underfed, poorly clad, curbed with all the worries and anxieties of the morrow, and only free, thank God! -- from the worst ally of consumption -- alcoholism -- where could the Koch bacillus find victims more prepared, where a soil more fertile than among such surroundings?

We know now-a-days that the penetration of a pathogenic germ into our system is not sufficient to cause a disease. It must find our body in a state of temporary paralysis of all its natural defenses, to be able to give rise to certain morbid processes, the evolution of which constitutes a disease.

No one will deny that the integrity of our respiratory organs depends chiefly on the quantity and quality of air we breathe. Every individual in normal condition should have at least 35 cubic meters of air as it is reckoned for hospitals, and the air we breathe in should not contain more than one per cent of all the expired air (Rubner). In many tenements, on account of the overcrowding, the quantity of air left for each person is reduced to three or four cubic meters, and the expired air in the sleeping-rooms represents one-half or one-sixth of all the air available. We can well say, then, that the atmosphere of those places is largely made up of the emanations from the bodies of the various persons living together.

What deleterious effect on the lungs and on the system in general the sojourn and sleep in these rooms must have, is beyond all calculation. The haematosis and oxygenation are first affected, and then appears that train of obscure and insidious symptoms (persistent anaemia, progressive fatigue, emaciation, etc.), which represent the ante-tubercular stage, and actually prepare the ground for the bacillary invasion.

Those that feel this change most keenly, and fall victims to tuberculosis with marked rapidity, are not the second generation of immigrants, as generally believed, but the very first arrivals, especially those coming from the rural districts of Italy, unaccustomed yet to the poisoned atmosphere of city life.

Among those -- and they are the large majority – who seek work in factories and shops, instead of pursuing their natural occupations in the open air, the stigmata of progressive physiological deterioration and general low vitality are most apparent. Six months of life in the tenements are sufficient to turn the sturdy youth from Calabria, the brawny fisherman, of Sicily, the robust women from Abruzzi and Basilicata, into the pale, flabby, undersized creatures we see, dragging along the streets of New York and Chicago, such a painful contrast to the native population! Six months more of this gradual deterioration, and the soil for the bacillus tuberculosis is amply prepared.

For the Italians, though, besides the abrupt passage from rural to urban life, and the unsanitary housing accommodations, which stand among the foremost influences responsible for the spread of tuberculosis among them, another potent factor must be mentioned, and this refers to certain trades and occupations, that are especially favored by our countrymen, and which may well be called phthisiogenic, on account of the important role they play in the development of tuberculosis.

Suffice it here to mention the rag-sorters, sweepers, bootblacks, hotel cleaners, continually exposed to the inhalation of dust contaminated with dried tubercular sputum; the plasterers, marble and stone cutters, cigar makers, printers, pressmen, upholsterers, cabinet makers, barbers, tailors, brass and glass workers, who all stand near the head of the list in the mortality front consumption, and among whom we find thousands of our Italian immigrants.

In many of those occupations, besides the direct irritation to the bronchial mucous membrane from the inhalation of dust, the work itself requires a sitting position (cigar makers, tailors), in which the chest is bent forward, and thus prevents the expansion of the lungs, and directly interferes with the proper aeration of the pulmonary apices.

Still worse is the condition where the sweat-shop system flourishes at home, either as extra work, done late in the night, by young men and women already exhausted by ten hours of work in a crowded factory, or as a regular practice, by poor housewives, desirous of adding to their husbands' earnings.

Words can hardly describe the pathetic misery of these Italian women, compelled to sew two or three dozen of pants for forty cents, using up their last spark of energy to make life better, when in fact they only accomplish their self-destruction. For their health is usually already drained by a too-productive maternity and periods of prolonged lactation; they live on a deficient, if not actually insufficient, diet; they sleep in dark, damp holes, without sunshine and light, and have already had enough to exhaust them, with the raising of a large family and the strain, of hard housework.

This practice explains in a measure the somewhat higher death-rate from phthisis of Italian women than men, especially among Sicilians, and the fact that we often find among them consumption in the quick form, that is, miliary tuberculosis of the sub-acute or the very acute type, which, rather than a clinical rarity, is of quite common occurrence in this class of patients.

And this high susceptibility is not due to any inherent lack of vitality in the race. The Italians otherwise show the most wonderful elements of resistance and recuperation, as may be seen in the favorable manner they react to surgical operations, extreme temperatures, and all sorts of trials. Nor is it dependent upon any individual hereditary predisposition, for while the younger generation, emigrated to America, die rapidly, their parents at home live to a surprising old age. Their rapid fall is due solely to an ensemble of deleterious causes, acting simultaneously, steadily and forcibly on their constitution, and in a manner so complete, that the fertilization of the ubiquitous Koch bacillus must result of necessity.

The pulmonary form, however, while by far the most prevalent, is not the only manifestation of tuberculosis among the Italians in the United States. Tuberculosis is of the peritoneum and intestines, of the bones and glands, is seen very frequently among adults, in contrast with the common experience elsewhere that it is chiefly prevalent in early life; in the same way you will hear from physicians of large hospital practice, that many obscure conditions in the pelvis and adnexa, in the brain, kidney and other internal organs, occurring among Italians, prove at the pathological investigation to be tubercular, when everything else would have pointed to a different cause.

In view of these facts and the present state of our emigration, we must then consider the prevalence of tuberculosis among Italians as a function of their special economic and social conditions in their new environment, and if any remedies can be expected in the future to stop the spread of the scourge among them, they must be found in the betterment of those conditions and a thorough change of their present aspirations.

The statistics show that the higher we move up in the social scale, the lower the mortality from consumption; or as Gebhard puts it, "the death-rate from tuberculosis among the various classes, in large cities, is in inverse ratio to their individual income." This inequality of fortune in our modern society plays really the most important role in the spread of tuberculosis, and as long as present conditions prevail, we shall always find tuberculosis to be "the disease of the masses" par excellence, and the inseparable ally of poverty.

Now every one knows that the Italians in this country represent almost exclusively the working class, and in some quarters the very poor class. To raise them to a higher social level, economically speaking a matter of slow evolution, implies a problem of such magnitude and such distant realization at the present, that we can only hint at it in passing by, and leave the social workers and economists the full discussion of it.