Abstract

Homelessness has existed in America since colonial times, and the attitudes, analyses and solutions offered through the succeeding centuries have evolved far less radically than recent media attention might suggest. From the building of the first poorhouse in Boston in 1664, to the conversion of massive armories into latter day poorhouses in New York City in the 1980s, our society has had ambivalent feelings towards the poor and the homeless. The outbreak and progression of tuberculosis in such settings—a seeming mystery at best, a reality denied at worst—reflects both society’s ambivalence towards this population, as well as a misguided belief that modern medicine can be viewed in the abstract as curative and divorced from the social context to which all disease is inextricably bound. Unless and until these beliefs are addressed and altered, TB among the homeless will continue unabated.