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

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Living in the Shadow of Death

Tuberculosis and the Social Experience of Illness in American History

Book Outline:

Part I

The Invalid Experience: New England Men, 1810-1860

I . The Dreaded Disease

A. Origin in Greece

B. Consumption America's Deadliest Disease

1. "The Great White Plague"

2. Disease takes one out of five deaths

C. Disease of the Chest

a. Confusion and hysteria

b. Early medicine

D. One in seven to one in four die

E. The countries earliest and most prominent epidemic

II. Manhood and Invalidism

A. Disease spreads through early colonies

B. Starting from a cold and ending in death

C. Disease host

D. No protection form disease

E. Disease prevention myths

F. A deadly medical practice

III. The Pursuit of Health

A. When one contracts consumption a whole family dies

B. Medicine from New England to America

C. Climate and consumption

D. Life span with the disease

E. Consumption quarantine

F. The Southwest frontier

G. Journey through Texas

IV. Body and Soul

A. Spiritual guides

B. Medicine Man

C. Overcoming through religion

D. Calvinism Vs. Christianity

E. "Pilgrims Progress"

F. Augusta Cheever

G. The Panoplist

H. Reverend David Brainerd

I. Cherokee Indians

J. Amos Augustas Phelps

Part II

The Female Invalid: The Narrative of Deborah Vinal Fisk, 1806-1844

V. Coming of Age

A. Understanding consumption

B. Examining death records

C. Deborah Vinal Fisk

D. Marshfield and Newburyport

E. Massachusetts general hospital

F. Venerability in age

G. "The Big Winter"

VI. Domestic Duties

A. Motherhood

B. Family social life

C. Boston recorder

D. Youth's companion

E. Proper business

F. Martha Hooker

G. Home and health

H. The downcast

VII. Deborah and Her Doctors

A. Women with consumption and their physicians

B. Dr. John Collins Warren

C. Controversial medicine

D. Parturition, rapid progress to death

E. Neurological effects

F. Chronic Bronchitis

G. Boston Medical Journal

VIII. Intensive Care

A. During dying

B. Fear and panic

C. Coughing blood

D. Passive virtues

E. Healing methods

F. "Fruit of the Tree of Life"

G. First Congregational Church

Part III

Health Seekers in the West, 1840-1890

IX. Come West and Live

A. A worldwide epidemic

B. The scourge of consumption

C. Commerce of Prairies

D. Problems in the West

E. Rheumatism

F. Native Americans

G. Lake Tahoe

H. Daniel Drake

I. Systematic Treaties

X. The Physician as Living Proof

A. "Health Seekers'

B. Dr. Samuel Edwin Solly

C. "Come West and Live"

D. Mineral water and climate

E. Rocky Mountain health resort

F. Journal of the American Medical Association

G. "American Climatological Association" (ACA)

H. Dr. James Trudeau

XI. The Western Narrative

A. Sea Voyage

B. Western Boosters

C. George Weeks

D. San Bernardino Mountains

E. Doctor and Patient

F. West Indies

G. Social Norms

H. Consumption, the threat of early death

I. Newport Rhode Island

Part IV

Becoming a Patient, 1882-1940

XII. A Disease of the Masses

A. Century of dishonor

B. Harriet Beecher Stown

C. Robert Koch

D. 1882, Tubercle Bacterium Identified

E. A medical revolution

F. Tuberculosis vs. Pneumonia

G. A new scientific terminology

H. A parasitic disease

I. Prescriptions gain new stature

J. Dr. S. Adolphus Knopf

K. A biological crusade

L. Understanding bacteria in relation to disease

XIII. Confining for Cure

A. Combating a disease of the masses

B. Tenement House Commission Report of 1900

C. Targeting the immigrant communities

D. Instruction on the spread of disease

E. New York City's new policies on immigrants

F. Registration of all tuberculosis cases

G. Weeding out the disease

H. Phythisiophobia

I. Bacteriology

J. A cure

K. The City vs. The Country

XIV. In the Shadow of the Sanatorium

A. Informing the public

B. X ray

C. Robert Ferguson

D. Heeling and Wealth

E. Suicide, a way out

F. "The Cure Cottage"

XV. The Sanatorium Narrative

A. "The Magic Mountain"

B. The use of wine

C. Adirondack Cottage Sanitarium

D. McClintock

E. The Fluoroscope

F. A national health policy

G. The end of the beginning

H. Tuberculosis through social change

I. TB shapes history

J. TB in the 21st century

Book Review:

Living in the Shadow of Death

Tuberculosis and the Social Experience of Illness in American History

The book Living in the Shadow of Death chronicles the medical and societal treatment of tuberculosis in the United States from the perspective of individuals who suffered from the disease. The author includes illness narratives derived from letters and diaries of the afflicted; her analysis spans the period in American history from the nineteenth through the first half of the twentieth century.

The book is divided into four sections. Part I, "The Invalid Experience: New England Men, 1810-60" and Part II, "The Female Invalid: The Narrative of Deborah Vinal Fiske, 1806-44" reveal an interesting contrast in the medical/societal treatment of tubercular men and women, and the resulting differences in their lives as "consumptives." Whereas men were expected to seek a cure by embarking on sea voyages and other travel, women remained at home and sought to control the disease by adjustments in domestic life. For men this meant major disruption and even change of career along with a sometimes exhilarating change of scene; for women it meant relentless anxiety and elaborate coping strategies.

Part III, "Health Seekers in the West, 1840-90" describes the role of cure-seekers in the westward migration and demonstrates how the culture of the time, an optimistic faith in nature and in the economic promise of the newly settled western territories, was reflected in the treatment regimen for tuberculosis. Interestingly, much of the promotional effort to bring "consumptives" west was initiated by physicians who were themselves tubercular.

The final section, "Becoming a Patient, 1882-1940," moves into the modern era with the discovery of the tubercle bacillus, public health measures, and the illness narratives of people who were confined in sanatoriums. Rothman points out that this period marked a transition away from the patient's ability to understand and determine his/her treatment to one more like the current one in which the medical establishment is the authoritarian "expert."

Commentary Rothman's book is interesting for several reasons. In providing a historical overview of chronic illness and infectious disease from the patient's perspective it demonstrates the wide ranging response of human beings to the experience of life-threatening and chronic disease, as well as of the role played by societal expectations and custom in determining both experience and outcome.

The patient narratives are particularly powerful; perhaps most striking is the nineteenth century voice of Deborah Fiske, who spent a great deal of time and effort to prepare her children for the future, in anticipation of her inevitable (but at the time indeterminate) death. Acceptance of the inevitable and the planning for it are in striking contrast to modern concepts of restoration of health as a right, to be obtained by heroic and costly medical interventions if necessary.

Also poignant are the narratives of those who sought cures in or were relegated to the sanatorium. Stigma, exclusion, and the experience of institutionalization as both imprisonment and release from responsibility are all relevant to the human issues in present-day discussions of health policy.


Rothman, Sheila M. Living in the Shadow of Death: Tuberculosis and the Social Experience of Illness in American History. Basic Books: New York City, New York, 1994.

Reading, Danielle. March 2005. Online. Internet. Available FTP:

Dormandy, Thomas. The White Death: A History of Tuberculosis. Hambledon: London, 2001.

Reading, Danielle. March 2005. Online. Internet. Available FTP:

Cole, Stewart T. Tuberculosis And The Tubercle Bacillus. American Society Microbiology: New York City, New York, 2004.

Reading, Danielle. March 2005. Online. Internet. Available FTP: