Living in the Shadow of Death: Tuberculosis and the Social Experience of Illness in American History

Tuberculosis -- once the cause of as many as one in five deaths in the U.S. -- crossed all boundaries of class and gender, but the methods of treatment for men and women differed radically. While men were encouraged to go out to sea or to the open country, women were expected to stay at home, surrounded by family, to anticipate a lingering death. Several women, however, chose rather to head for the drier climates of the West and build new lives on their own. But with the discovery of the tubercle bacillus in 1882 and the establishment of sanatoriums, both men and women were relegated to lives of seclusion, sacrificing autonomy for the prospect of a cure.

In Living in the Shadow of Death Sheila Rothman presents the story of tuberculosis from the perspective of those who suffered, and in doing so helps us to understand the human side of the disease -- and to cope with its resurgence. The letters, diaries, and journals piece together what it was like to experience tuberculosis, and eloquently reveal the tenacity and resolve with which people faced it.

"A fascinating and powerful book... compelling reading. Tuberculosis was a disease, now reemerging, that killed more Americans, young or old, rich or poor, than any other disease, until well into the twentieth century. It shaped our culture, determined careers, blighted lives. Rothman writes beautifully and with great sensitivity about the human condition. The book will, I believe, become a classic in the field." -- David E. Rodgers, Cornell Medical College

Consumption -- as it was known at the time -- was thought to be either inherited or the result of a sedentary life. (The communicable tubercle bacillus wasn't discovered until 1882.) Doctors focused on a three-pronged cure for their male patients of means: daily exercise, a good diet, and travel to a better climate. On the other hand, female patients were told to handle their domestic duties as best as possible and to get assistance from single female family members who could move in temporarily. Invalids and their families eventually dealt with the inevitable outcome and prepared for death. In the twentieth century, patients were sent off to sanatoriums. Chances are good that someone in your ancestry was affected. At the very least, they knew people who were.

This book is revealing because it is written from the patient's viewpoint and with the individuals in mind. Letters and diaries of consumptives show that people commiserated with fellow sufferers and exchanged news of symptoms and possible curative measures. The focus of the story-telling is thus very personal rather than medical. It makes for compelling reading.

"Living in the Shadow of Death" is mandatory reading for anyone interested in life in the United States in the 1800s and early 1900s. Genealogists and academic researchers in the humanities (especially literature and history) should put this title on their to-read list. "The good old days" really weren't.
July 07, 2004