By Dr Charles Dulles – 20 Q&As – Unbekoming Summary

Unbekoming

Jun 08, 2025

In 1897, Dr. Charles Winslow Dulles, a seasoned physician at Philadelphia’s Rush Hospital for Consumption, challenged the prevailing narrative that tuberculosis—then known as consumption—was a contagious bacterial infection requiring draconian public health measures. His paper, summarized here, drew on clinical observations, statistics, and historical precedents to argue that consumption did not spread readily from person to person, despite alarmist claims by newspapers and overzealous Boards of Health. At Brompton Hospital in London, only four of 500 staff contracted the disease despite constant exposure. In Colorado Springs, a hub for consumptive visitors, only twenty local cases emerged over two decades. Mortality rates had been declining since 1853, long before contagion-based interventions. Dulles dismissed animal experiments injecting tubercle bacilli into “weak and unresisting” guinea pigs as artificial, a view echoed in The Truth About Contagion, which credits sanitation improvements for disease declines. His call for practical precautions, like sputum disposal, clashed with germ theory dogma that labeled bacteria as the cause, when they are “firefighters” responding to disease, not starting it—a flaw also seen in Whooping Cough (Pertussis), where bacteria are blamed despite weak contagion evidence.

This tension resonates in modern contexts, notably for me in the badger-to-cow tuberculosis narrative depicted in Clarkson’s Farm that I have been recently watching and enjoying. The show, while compelling, uncritically accepts, and promotes, the contagiousness of bovine tuberculosis, alleging badgers transmit it to cows, forcing farmers to cull herds and face financial ruin—an assault on private wealth and economic “warfare” based on the germ theory fraud. There is clearly a deeper agenda: badgers, granted more rights than landowners, reflect how animal conservation becomes a tool against sovereign property rights, a subtle form of “oligarchy’s way of control without ownership.” This aligns with Beyond Contagion, which critiques how contagion fears justified excessive controls, alienating patients and disrupting communities, much as farmers face restrictions based on questionable science. Dulles’ rejection of extreme measures, like the “frantic” destruction of patients’ belongings in 17th-century Naples, parallels this modern overreach, suggesting fear trumps evidence.

The badger story’s second prong—an attack on private wealth—further illuminates Dulles’ prescience. In Clarkson’s Farm, farmers cannot sell the asymptomatic “infected” cows once tested “positive,” or buy new ones to replace them, or preserve the value of the remaining cows. Dulles noted that doctors misreported consumption as pneumonia to evade stigma and insurance penalties. This manipulation inflates disease fears to justify control, whether over 19th-century patients or 21st-century farmers. Like the pertussis narrative in Whooping Cough (Pertussis), TB’s bacterial “firefighters” are scapegoated, ignoring nutrition, hygiene, and living conditions. Dulles’ advocacy for rational precautions over “spasmodic and violent measures” offers a framework for questioning such policies, as The Truth About Contagion shows TB declined with sanitation, not isolation. It is but another manufactured crisis to pressure farmers. This introduction sets the stage for Dulles’ summary, inviting readers to interrogate contagion myths and their socio-economic impacts, from 1897 hospital wards to modern farmlands, with a critical eye on who benefits from fear.

With thanks to Dr Charles Dulles1.

 

Consumption Not Contagious

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`Analogy

 

Imagine a small coastal town where authorities suddenly announce that swimming at the local beach causes drowning at alarming rates. Signs are posted, newspapers publish frightening warnings, and some officials propose banning beach access entirely. However, a lifeguard who has worked at the beach for decades observes something curious: out of thousands of swimmers he's watched daily, year after year, virtually none have drowned despite no special precautions beyond basic swimming safety.

The lifeguard investigates other beaches and finds the same pattern—almost no drownings among regular swimmers. Meanwhile, swimming instructors, who spend their entire careers in the water with others, rarely drown themselves. The lifeguard discovers drowning rates have actually been declining steadily for years, even before the warnings began. Upon closer examination, he finds the scary statistics are flawed—many "drownings" were actually heart attacks near water or happened in dangerous offshore areas, not at supervised beaches. The lifeguard concludes that while water deserves respect and basic precautions (like learning to swim and avoiding dangerous conditions), the beach itself isn't inherently dangerous, and closing it would needlessly deprive people of its benefits. Swimming isn't contagious, and neither, in the practical sense, is consumption.

12-point summary

 

1. Central argument against contagion theory: Dr. Dulles firmly rejected that consumption (tuberculosis) was contagious in the ordinary sense and questioned whether it was infectious to any meaningful degree. He criticized overzealous medical professionals and Boards of Health for making exaggerated claims in newspapers that alarmed the public unnecessarily, noting that no "conservative and dignified medical body" had recommended compulsory notification of consumption cases.

2. Evidence from consumption hospitals: Multiple hospitals for consumptives showed minimal transmission to staff despite constant exposure. At Brompton Hospital in London, among approximately 500 staff members (including doctors, nurses, and other personnel), only four had contracted the disease. Similar findings came from Victoria Park Hospital, Rush Hospital in Philadelphia, and New York's consumption hospital, all showing virtually no cases among attendants despite years of close contact with patients.

3. Limitations of animal experiments: Dulles argued that experiments on animals provided weak evidence for human transmission. He noted that inoculation studies used "animals of weak and unresisting constitution" under artificial conditions "most favorable to the destruction of their health and life." Unlike laboratory animals being injected with tuberculosis material, humans typically encounter any infectious material through intact skin or mucous surfaces, after filtering through nasal passages in the case of airborne exposure.

4. Evidence from dust studies: Research repeatedly failed to demonstrate significant infection risk from dust in consumption settings. Kirchner found tubercle bacilli in dust from rooms occupied by consumptives in only one instance of many searches. More dramatically, Drs. Heron and Chaplin conducted 100 inoculation experiments with dust from uncleaned areas of Brompton Hospital, producing tuberculosis in guinea pigs only twice, demonstrating "dust possessed but little infective power."

5. Paper mill worker studies: Mr. Clifford Beale's investigation of paper mill workers who were constantly exposed to dust from potentially infected rags showed no increased tuberculosis rates. Despite working in environments with "an enormous amount of dust suspended in the air" at the age when tuberculosis was most easily acquired, and with no attempts to disinfect materials, workers did not show the frequent tuberculosis cases that contagion theory would predict.

6. Health resort experiences: Evidence from tuberculosis health resorts showed no increased disease rates among local populations despite large numbers of consumptive visitors. At Colorado Springs, Dr. Solly reported only twenty local cases in twenty years despite consumptives freely mingling in all public settings without isolation. Similarly, at Davos-Platz in Switzerland, where approximately 1,000 of 1,500 winter visitors had consumption, Dr. Wagner observed no cases of person-to-person transmission.

7. Medical consensus against contagion: The Cambridge Medical Society surveyed its members regarding the communicability of phthisis, with thirty-four of thirty-eight respondents reporting no observed transmission. This aligned with Dr. Ransome's statement that "the universal testimony of physicians of these institutions is that no such conveyance of the disease can be traced in any such institution," and his observation that consumption wards were potentially "the safest places" for susceptible persons.

8. Declining consumption rates: Mortality statistics showed consumption had been steadily decreasing for decades prior to contagion theory and related preventive measures. Dr. Samuel Abbott documented "the comparatively even reduction of the mortality from consumption in Massachusetts in forty years, from 1853 to 1893," decreasing from forty-two to twenty-three per ten thousand population, long before any systematic prevention efforts based on contagion theories.

9. Statistical reporting issues: Dulles identified significant problems with consumption statistics that complicated analysis. Some apparent reductions resulted from changing geographical boundaries in data collection, but more importantly, doctors were increasingly reporting consumption under alternative diagnoses (pneumonia, bronchitis, congestion) to avoid stigma and restrictions, particularly when insurance policies wouldn't pay benefits for consumption deaths.

10. Academic versus popular infectiousness: Dulles endorsed Dr. Russell of Glasgow's nuanced distinction: "In the academic sense it is infectious; in the popular sense it is not." This acknowledged that under certain artificial conditions, transmission might occur, while maintaining that in normal social contexts, the disease did not spread as truly contagious diseases would, thereby justifying a more measured approach to prevention.

11. Reasonable precautions endorsed: Rather than extreme isolation measures, Dulles advocated practical precautions focused on proper handling of sputum. He praised the French Society for the Prevention of Pulmonary Phthisis for stating that a consumptive "is not in the least dangerous by contact or proximity" and that one could "chat with him for hours, live with him for years" without risk if sputum was properly collected and destroyed before drying.

12. Historical perspective on extreme measures: Dulles referenced historical attempts to control consumption in Naples and Rome from two hundred years earlier, where authorities sacrificed patients' clothing and furniture, scraped walls, and tore down woodwork in sickrooms. He presented these as ineffective overreactions comparable to contemporary alarmism, arguing that current extreme measures were similarly "unnecessary and useless" based on both historical experience and contemporary evidence.

20 Questions and Answers