Living in the Shadow of Death: Tuberculosis and the Social Experience of Illness in American History / Edition 1

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Overview

For more than 150 years, until well into the twentieth century, tuberculosis was the dreaded scourge that AIDS is for us today. Based on the diaries and letters of hundreds of individuals over five generations, Living in the Shadow of Death is the first book to present an intimate and evocative portrait of what it was like for patients as well as families and communities to struggle against this dreaded disease. "Consumption", as it used to be called, is one of the oldest known diseases. But it wasn't until the beginning of the nineteenth century that it became pervasive and feared in the United States, the cause of one out of every five deaths. Consumption crossed all boundaries of geography and social class. How did people afflicted with the disease deal with their fate? How did their families? What did it mean for the community when consumption affected almost every family and every town? Sheila M. Rothman documents a fascinating story. Each generation had its own special view of the origins, transmission, and therapy for the disease, definitions that reflected not only medical knowledge but views on gender obligations, religious beliefs, and community responsibilities. In general, Rothman points out, tenacity and resolve, not passivity or resignation, marked people's response to illness and to their physicians. Convinced that the outdoor life was better for their health, young men with tuberculosis in the nineteenth century interrupted their college studies and careers to go to sea or to settle in the West, in the process shaping communities in Colorado, Arizona, and California. Women, anticipating the worst, raised their children to be welcomed as orphans in other people's homes.In the twentieth century, both men and women entered sanatoriums, sacrificing autonomy for the prospect of a cure. Poignant as biography, illuminating as social history, this book reminds us that ours is not the first generation to cope with the death of the young or with

This book contains no illustrations.

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Editorial Reviews

From The Critics
Reviewer: David Y. Rosenzweig, MD (Medical College of Wisconsin)
Description: This book narrates the impact of tuberculosis, the leading cause of morbidity and death in this country from 1800 to 1940, from the standpoint of those sick and otherwise affected, not from the view of the medical profession.
Purpose: The description of disease from the patient's view is unusual and rather unique in nonfiction, though fictional works, especially on tuberculosis, are well known (The Magic Mountain, La Boheme, La Traviata, etc.). Those with the disease were called invalids and faced a chronic, uncertain, and often fatal course. They coped by travel, the climatologic cure, first to tropical islands, later to the southwest and Colorado. They put meaning in their professional lives often by becoming missionaries or abolitionists. These avenues were open only to men of means, however. Women and the poor had no such options. By 1890 the cause and contagiousness of tuberculosis became known, the invalids became patients, and the stigma and disruption of lives by prolonged sanitarium confinement, where the sick and dying were concentrated, became the norm. The historical account is comprehensive, although somewhat repetitious. This saga is relevant to today's world. Not only has interest in tuberculosis reawakened, but the modern scourge of AIDS, a chronic illness profoundly affecting younger adults, shows important parallels.
Audience: Medical and social historians and tuberculosis health workers will benefit from this work. A more general audience should also include health care planners physicians primarily managing chronic diseases and those that are touched by the AIDS epidemic.
Features: The book is written as a series of individual narratives divided roughly by the eras covered as 1800-1850, the invalid experience; 1850-1890, health seekers in the West; 1890-1940, the patient and the sanitarium.
Assessment: This is an unusual and valuable account of the impact of an important disease on individuals and society with historical and modern applicability. It has a place in medical libraries and in libraries of those individuals noted above.
David Y. Rosenzweig
This book narrates the impact of tuberculosis, the leading cause of morbidity and death in this country from 1800 to 1940, from the standpoint of those sick and otherwise affected, not from the view of the medical profession. The description of disease from the patient's view is unusual and rather unique in nonfiction, though fictional works, especially on tuberculosis, are well known (The Magic Mountain, La Boheme, La Traviata, etc.). Those with the disease were called invalids and faced a chronic, uncertain, and often fatal course. They coped by travel, the climatologic cure, first to tropical islands, later to the southwest and Colorado. They put meaning in their professional lives often by becoming missionaries or abolitionists. These avenues were open only to men of means, however. Women and the poor had no such options. By 1890 the cause and contagiousness of tuberculosis became known, the invalids became patients, and the stigma and disruption of lives by prolonged sanitarium confinement, where the sick and dying were concentrated, became the norm. The historical account is comprehensive, although somewhat repetitious. This saga is relevant to today's world. Not only has interest in tuberculosis reawakened, but the modern scourge of AIDS, a chronic illness profoundly affecting younger adults, shows important parallels. Medical and social historians and tuberculosis health workers will benefit from this work. A more general audience should also include health care planners physicians primarily managing chronic diseases and those that are touched by the AIDS epidemic. The book is written as a series of individual narratives divided roughly by the eras covered as 1800-1850, theinvalid experience; 1850-1890, health seekers in the West; 1890-1940, the patient and the sanitarium. This is an unusual and valuable account of the impact of an important disease on individuals and society with historical and modern applicability. It has a place in medical libraries and in libraries of those individuals noted above.
Publishers Weekly - Publisher's Weekly
Rothman's involving social history of tuberculosis is built around patients' own narratives reconstructed from diaries, letters and memoirs. For example, we meet Deborah Fiske (1806-1844), a deeply religious Massachusetts teacher who submitted to God's will even as she desperately tried to prepare her two daughters for their future as orphans; she also joined a support group of tubercular women who read medical texts and pooled their knowledge. Testimonies by patients confined to sanatoriums seethe with shame and anger at being stigmatized. Other health-seekers migrated westward from the 1840s to the 1920s, lured by physicians in California or Colorado touting their region as a curative Eden. In an alarming epilogue, Rothman, a scholar at Columbia's College of Physicians and Surgeons, notes that TB is again becoming a scourge with new strains proving resistant to drugs. Illustrated. First serial to Mirabella. (Feb.)
Library Journal
While Frank Ryan's The Forgotten Plague ( LJ 5/1/93) described the history of the search for a cure of tuberculosis, Rothman, a scholar at Columbia University's College of Physicians and Surgeons, recounts here the experiences of TB patients through 150 years of American medicine. As death rates soared in the early 19th century, men were frequently urged to abandon their in-door pursuits and travel to more salubrious climates. Women, however, were encouraged to carry on with daily responsibilities, to endure debilitating pregnancies, and to meet death with Christian fortitude. The latter 19th century saw entire communites, such as Colorado Springs, organized for invalids seeking new lives in more congenial climates. Following the discovery of the TB bacteria, minimizing contagion became the focus of public health, and hospitals became far more structured and confining institutions. Rothman has uncovered compelling original sources that she enhances with sensitive analysis. Her evenhandedness is ultimately frustrating, however, as she neglects to explore the implicit ethical conflict between early accounts of extended families ravaged by contagious disease and the later narratives of bored and rebellious infectious patients forcibly confined by public health authorities. Recommended, with reservation, for academic and larger public libraries.-- Kathy Arsenault, Univ. of South Florida-St. Petersburg Lib.
Booknews
For more than 150 years, until well into the 20th century, tuberculosis was the dreaded scourge that AIDS is for us today. Drawing on the diaries and letters of hundreds of individuals over five generations, Rothman presents an intimate portrait of what it was like for patients, families, and communities. Annotation c. Book News, Inc., Portland, OR (booknews.com)
William Beatty
Rothman intends a major outcome of her study of tubercular Americans' own accounts of their experiences to be the realization that sufferers from any dreadful disease should be viewed as individuals, not as a group. Her consideration of some 100 patient accounts according to three historical periods leads, however, to generalization. In the early nineteenth century, she demonstrates, men went on sea voyages to recover, whereas women, relying on the support of religion, friends, and relatives, tried to keep up their families and homes. Late-nineteenth-century sufferers went West and, often at the urging of physicians who had cured themselves likewise, pursued active outdoor lives. In the twentieth century, following the lead of sanatorium impresario Edward Livingston Trudeau, the tubercular flocked to sanatoriums, boardinghouses, and state and local institutions at which life was much more constrained and rest was emphasized. Throughout, Rothman smoothly blends the personal flavors of the patients' stories into the appropriate medical, scientific, and cultural contexts of the larger historical narrative. Hers is a readable, informative, and well-documented effort.

3 Stars from Doody
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Product Details

  • ISBN-13: 9780465030026
  • Publisher: Basic Books
  • Publication date: 2/1/1994
  • Edition number: 1
  • Pages: 319

Meet the Author

Sheila M. Rothman is Research Scholar at Columbia College of Physicians and Surgeons and Director of the Program on Human Rights and Medicine. She is author of Women's Proper Place.

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Table of Contents

Acknowledgments
Introduction 1
Pt. I The Invalid Experience: New England Men, 1810-60
1 The Dreaded Disease 13
2 Manhood and Invalidism 26
3 The Pursuit of Health 45
4 Body and Soul 57
Pt. II The Female Invalid: The Narrative of Deborah Vinal Fiske, 1806-44
5 Coming of Age 77
6 Domestic Duties 89
7 Deborah and Her Doctors 105
8 Intensive Care 116
Pt. III Health Seekers in the West, 1840-90
9 Come West and Live 131
10 The Physician as Living Proof 148
11 The Western Narrative 161
Pt. IV Becoming a Patient, 1882-1940
12 A Disease of the Masses 179
13 Confining for Cure 194
14 In the Shadow of the Sanatorium 211
15 The Sanatorium Narrative 226
Epilogue 247
Appendix 253
Notes 259
Index 305
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