Consumptive Capitalism

Professor Sara Silverstein is someone to whom I listen on issues of health and history. This essay helps us to situate the present American health drama in the history of health care, and thereby to see much more clearly what we face. It draws from her forthcoming book For Your Health and Ours: An Eastern European History of Global Health. Professor Silverstein is currently at work on her next book, provisionally entitled Corporal Capitalism.

Consumptive Capitalism, by Sara Silverstein

Until very recently, tuberculosis was common, expensive, and lethal in the United States. It defined the lives and brought the deaths of many of the people who created our world. We have forgotten about all this because antibiotics, public health, and improved living conditions have largely erased the disease.

The current administration’s health policy rests on nostalgia rather than knowledge. It romanticizes a harsh past, a time when few and desperate choices were available to Americans. Because all that was available then was hope, many suffered for the profit of the wellness industry of the day. A few portraits of life with the disease can help us to imagine, and perhaps to prevent, a return to such profiteering.

In the cold central European winter of 1904, a young Polish political thinker called Kazimierz Kelles-Krauz visited a sanatorium in the Tyrol to treat his tuberculosis. He had been sick for a year and this was his second visit to the mountains. The sanatorium had a routine: resting and eating, taking the air and taking exercise. He would also try creams, compresses, and injections. He would go home after two months, still sick, only to enter another sanatorium in the summer.

Treatments in sanatoria gave him hope. But they were expensive and he and his wife struggled to afford them. His family was poor, but generally made ends meet until his illness. There was no cure for tuberculosis. The medical advice of the time was to dedicate yourself to building your general constitution. An entire industry, centered on the sanatorium, grew up around the tubercular patient’s expensive efforts to recover.

Franz Kafka also spent years chasing hope in sanatoria. At a low point in 1921, he described the sanatorium as a place where “the torture goes on for years, with pauses for effect so that it will not go too quickly, and – the unique element – the victim himself is compelled ...