Spotlight
Library of Congress/Science Photo Library
Television A constant chorus of coughs
Published Online March 24, 2015 http://dx.doi.org/10.1016/ S2213-2600(15)00098-3 The Forgotten Plague Directed by Chana Gazit. PBS, 2015. For the movie website see http://www.pbs.org/wgbh/ americanexperience/films/ plague/
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“I think I know something of the feelings of the man at the bar who is told he is to be hanged on a given date, for in those days pulmonary consumption was considered an absolutely fatal disease. I pulled myself together—escaped from the office, after thanking the doctor for his examination. When I got outside, I felt stunned. It seemed to me the world had suddenly grown dark. The sun was shining, and the street was filled with the rush and noise of traffic but to me the world had lost every vestige of brightness. I had consumption—that most fatal of diseases! Had I not seen all its horrors in my brother’s case? It meant death and I had never thought of death before! Was I ready to die? How could I tell my wife whom I had just left in unconscious happiness with the little baby in our new house?” An Autobiography, Edward Livingston Trudeau (1915).
John Bunyan called consumption the “captain of all these men of death”. Half of those who contracted the disease died within 5 years. By the dawn of the 19th century, it had put an end to one in seven human lives. Consumption cut across social classes—everyone was vulnerable. It bred uncertainty. Parents fretted over how their children would fare without them—they taught them how to behave should they ever become orphans living in another family’s home. In the early 1880s, Robert Koch would identify the causative agent, Mycobacterium tuberculosis. But removing the executioner’s hood does not always make him less deadly. It would take another 60 years or so before the advent of streptomycin and the subsequent combination treatments. New York physician Edward Trudeau was diagnosed with consumption in 1873. He was 24 years old. In Europe, germ theory was taking form but it would still be another couple of decades before consumption became widely known as tuberculosis, the shift in nomenclature a powerful recognition of the burgeoning understanding. In the meantime, regardless of what was happening in Old World laboratories, Edward Trudeau had been given a death sentence. The story is taken up by PBS’s slender documentary The Forgotten Plague, a deft tale of the sanatorium movement driven by Trudeau and the way in which tuberculosis shaped modern America. Interviews with tuberculosis survivors, and an abundance of photographs and expert opinion, flesh out the account. It begins in the Adirondack Mountains in up-state New York. In line with the prevailing wisdom of the time, Trudeau repaired to the remote
and snowy wilds of Saranac Lake after his diagnosis. His experience of nursing his brother had not quickened him with hope—James Trudeau died soon after he had been diagnosed with consumption, despite Edward’s tireless ministrations. But things took a happy turn. “The open air life has a wonderful effect on my health”, commented Trudeau. He put on 15 lbs. Alongside Trudeau’s story, the film traces the settlements that sprang up in the American west, peopled by unwell migrants hoping that the change of climate would cure them. Pasadena, for example, began as a colony for consumptive patients. The incipient cities of Denver, Albuquerque, and Los Angeles soon abounded in tuberculosis. Patients from all over the USA were drawn by campaigns such as that run by Charles Willard in Los Angeles, which all but established the west as a kind of secular Lourdes. Willard had hoped that only the rich would make the journey, but the promise that the dry air and temperate climate held remedies sovereign against consumption attracted thousands of the stricken poor. Los Angeles resounded with a “constant chorus of coughs” sighed one peeved resident. Tent cities began to spring up, as communities attempted to debar coughing migrants from entering. After learning of Koch’s work and the European sanatorium movement, and heartened by his own response to the bracing outdoor air, Trudeau established the Adirondack Cottage Sanatorium. He had a different vision to the cities on the other side of the continent. Trudeau wanted his sanatorium to be open to the poor. Taking the air was considered crucial, regardless of temperature. A sprawling network of similar establishments across America soon housed thousands of patients. By 1900, the Adirondack facility contained 22 buildings, a church, and a research laboratory. Trudeau had struggled to replicate Koch’s experiment— maintaining his rudimentary facilities at 37°C proved particularly tricky. But eventually he had managed to isolate the distinctive rod shaped bacillus—from his own ravaged lungs. “And my rose-coloured dreams of achievement and professional success in New York. They were all shattered now, and in their place only exile and the inevitable end remained”, lamented Trudeau on his diagnosis. Not quite—he did not die until 1916, one of the great pioneers of public health.
Talha Khan Burki
www.thelancet.com/respiratory Vol 3 June 2015
Library of Congress/Science Photo Library
Television A constant chorus of coughs
Published Online March 24, 2015 http://dx.doi.org/10.1016/ S2213-2600(15)00098-3 The Forgotten Plague Directed by Chana Gazit. PBS, 2015. For the movie website see http://www.pbs.org/wgbh/ americanexperience/films/ plague/
434
“I think I know something of the feelings of the man at the bar who is told he is to be hanged on a given date, for in those days pulmonary consumption was considered an absolutely fatal disease. I pulled myself together—escaped from the office, after thanking the doctor for his examination. When I got outside, I felt stunned. It seemed to me the world had suddenly grown dark. The sun was shining, and the street was filled with the rush and noise of traffic but to me the world had lost every vestige of brightness. I had consumption—that most fatal of diseases! Had I not seen all its horrors in my brother’s case? It meant death and I had never thought of death before! Was I ready to die? How could I tell my wife whom I had just left in unconscious happiness with the little baby in our new house?” An Autobiography, Edward Livingston Trudeau (1915).
John Bunyan called consumption the “captain of all these men of death”. Half of those who contracted the disease died within 5 years. By the dawn of the 19th century, it had put an end to one in seven human lives. Consumption cut across social classes—everyone was vulnerable. It bred uncertainty. Parents fretted over how their children would fare without them—they taught them how to behave should they ever become orphans living in another family’s home. In the early 1880s, Robert Koch would identify the causative agent, Mycobacterium tuberculosis. But removing the executioner’s hood does not always make him less deadly. It would take another 60 years or so before the advent of streptomycin and the subsequent combination treatments. New York physician Edward Trudeau was diagnosed with consumption in 1873. He was 24 years old. In Europe, germ theory was taking form but it would still be another couple of decades before consumption became widely known as tuberculosis, the shift in nomenclature a powerful recognition of the burgeoning understanding. In the meantime, regardless of what was happening in Old World laboratories, Edward Trudeau had been given a death sentence. The story is taken up by PBS’s slender documentary The Forgotten Plague, a deft tale of the sanatorium movement driven by Trudeau and the way in which tuberculosis shaped modern America. Interviews with tuberculosis survivors, and an abundance of photographs and expert opinion, flesh out the account. It begins in the Adirondack Mountains in up-state New York. In line with the prevailing wisdom of the time, Trudeau repaired to the remote
and snowy wilds of Saranac Lake after his diagnosis. His experience of nursing his brother had not quickened him with hope—James Trudeau died soon after he had been diagnosed with consumption, despite Edward’s tireless ministrations. But things took a happy turn. “The open air life has a wonderful effect on my health”, commented Trudeau. He put on 15 lbs. Alongside Trudeau’s story, the film traces the settlements that sprang up in the American west, peopled by unwell migrants hoping that the change of climate would cure them. Pasadena, for example, began as a colony for consumptive patients. The incipient cities of Denver, Albuquerque, and Los Angeles soon abounded in tuberculosis. Patients from all over the USA were drawn by campaigns such as that run by Charles Willard in Los Angeles, which all but established the west as a kind of secular Lourdes. Willard had hoped that only the rich would make the journey, but the promise that the dry air and temperate climate held remedies sovereign against consumption attracted thousands of the stricken poor. Los Angeles resounded with a “constant chorus of coughs” sighed one peeved resident. Tent cities began to spring up, as communities attempted to debar coughing migrants from entering. After learning of Koch’s work and the European sanatorium movement, and heartened by his own response to the bracing outdoor air, Trudeau established the Adirondack Cottage Sanatorium. He had a different vision to the cities on the other side of the continent. Trudeau wanted his sanatorium to be open to the poor. Taking the air was considered crucial, regardless of temperature. A sprawling network of similar establishments across America soon housed thousands of patients. By 1900, the Adirondack facility contained 22 buildings, a church, and a research laboratory. Trudeau had struggled to replicate Koch’s experiment— maintaining his rudimentary facilities at 37°C proved particularly tricky. But eventually he had managed to isolate the distinctive rod shaped bacillus—from his own ravaged lungs. “And my rose-coloured dreams of achievement and professional success in New York. They were all shattered now, and in their place only exile and the inevitable end remained”, lamented Trudeau on his diagnosis. Not quite—he did not die until 1916, one of the great pioneers of public health.
Talha Khan Burki
www.thelancet.com/respiratory Vol 3 June 2015
