The White Plague: Tuberculosis in Early America
From asses’ milk, shorter dresses, and elephant urine to antibiotics
Doctor Edward Trudeau was born in New York City to a family of physicians. During his late teens, his elder brother James contracted tuberculosis (TB) and Edward took care of him until his death three months later. Trudeau later graduated as a physician from Columbia, and would subsequently lose his first two children, Charlotte, in her teens, and Edward, Jr., in his twenties, to TB. Dr. Trudeau himself was diagnosed with the dreaded TB in 1873.
The symptoms of “consumption”, as it was called up until the 1800s, included a painful, hard “graveyard cough” with blood, fever, chills, weakness, and sweats. The disease wasted the body and left victims with pale skin and melancholy spirits. It is no wonder it was known as the white plague”.
Even though the mortality rates were generally around one percent, in places such as outdoor Army tent hospitals, or on ships at sea with poor quality air, food, and water, the deathrates were higher. Consumption was a slow, horrible illness and a terrible way to die. Eventually, after a long, slow degenerative wasting, the victim’s fever spiked and he would choke to death on his own blood. In colonial America, large numbers were incapacitated and died from the disease. Famous people who fell to tuberculosis include England’s King Edward VI, Pochahontas, John Keats, Robert Louis Stevenson, George Orwell, and Franz Kafka to name a few.
Following conventional thinking of the times, Trudeau’s physician and friends urged a change of climate and he went to live in the Adirondack Mountains of New York as a treatment for the disease. After spending time every day outdoors in the “cold air” he subsequently regained his health. In 1876 he moved his family to Saranac Lake, N.Y. to devote himself to researching and treating the highly infectious disease.
The Most Common Killer in Colonial America
During the 1700s this highly contagious disease infected large numbers of people and killed as many as 66 percent of its victims within five years of diagnosis. And it was especially prevalent in overcrowded conditions where there was malnutrition. It also killed people of lesser socioeconomic means and people of color at disproportionately higher rates than white people in the 1800s. In fact, it killed as many as a quarter of those living in poorer conditions.
Consumption was arguably the most common killer of adults in colonial America, accounting for more than 25 percent of the deaths in New York City alone, between 1810 and 1815. Although the disease was sometimes initially confused with pneumonia, the symptoms were more clear-cut than a range of other febrile afflictions affecting colonials, but unfortunately, in most cases successful intervention was elusive.
The disease was suspected to be contagious as early as 1546 when Girolamo Tracastoro wrote that bedsheets and clothing of victims could contain “contagious particles”. In 1720, a British physician named Benjamin Marten suspected that tuberculosis could be caused by “minute living creatures” and that coming into contact with a victim could pass the disease to healthy individuals. But American doctors in the 18th century still did not believe it was contagious. Since it had a higher prevalence in more disadvantaged people, some physicians associated consumption with hereditary traits. But the wheels of medical research continued to turn over time.
Breakthroughs From Stethoscopes to Bacterium
One major breakthrough in the practice of general medicine came in 1816. René Théophile Hyacinthe Laennec, whose mother died of TB, became a renowned French physician and medical researcher. He observed a female patient with heart disease. It was common practice for a physician to rest his ear on a patient’s chest to listen to the lungs and heart. Laennec rolled his lab papers into a tube and used it to listen to the patient’s heart. The tube saved Laennec the embarrassment of laying his head on a female patent’s chest and he noted that the sound was more distinct as well. Soon, Laennec’s primitive wood-carved listening tube to diagnose lung diseases and heart ailments quickly led to more sophisticated stethoscopes that amplified sound into the ears. Who knows how many practitioners’ lives the stethoscope has saved by reducing the infectious disease risk between doctors and their patients?
In the year 1834, German pathologist Johann Schonlein named the disease tuberculosis, after post-mortem autopsies on victims revealed clusters of tubercles, or lesions, especially on the lungs and sometimes throughout the body. Often the lesions resembled millet seeds, hence it was described as miliary tuberculosis.
In the 1880s the legendary German physician and microbiologist Robert Koch would find the disease was caused by the infection of a bacterium that he isolated, known as Mycobacterium tuberculosis. TB continued to kill as many as one in seven Americans during the prosperous 1800s.
But it wasn’t until 1899, when Carl Flügge, who was working with tuberculosis, malaria, and other infectious diseases, developed the droplet theory of infection. He demonstrated that even in quiet conversation, minute droplets are sprayed in the air. At that time, masks were simply a roller gauze strip covering the mouth. Since then, masks have prevented microbes from being passed from one airway to another. But early remedies for victims of the white plague persisted for centuries.
Asses’ Milk, Wolf Livers, and Elephant Urine Treatments
Cases of consumption are recorded as far back as several thousand years in ancient times. During the age of Hippocrates, victims were offered exercise, sea voyages for fresh air, plentiful good food including, asses’ milk, human breast milk, wolf livers, and elephant urine as remedies.
Dr. William Buchan offered a similar panoply of consumption treatments in his 1772 book, Domestic Medicine:
“ASSES milk ought to be drank, if possible, in its natural warmth, and in the quantity of half an English pint at a time… COWS milk is most readily obtained of any; and tho’ it be not so easily digested as that of asses or mares, it may be rendered lighter, by adding to it an equal quantity of barley water, or allowing it to stand for some hours, and afterwards taking off the cream. If it should, notwith|standing, lie heavy on the stomach, a table spoonful of rum or brandy, and a bit of loaf-sugar, may be put into half an English pint… IN a populous town in England, where consumptions are very common, I have frequently seen consumptive pa|tients, who had been sent to the country with orders to ride, and live upon milk and vegetables, return in a few months quite plump, and free of any complaint. This, in|deed, was not always the case, especially when the disease was hereditary, or far advanced; but it was the only me|thod in which success was to be expected; where it failed, I never knew medicine succeed… IN the first stage of a consumption, the cough may some|times be appeased by bleeding; and expectoration promoted by the following medicines. Take fresh squills, gum am|moniac, and powdered cardamum seeds, of each a quarter of an ounce; beat them together in a mortar, and if the mass proves too hard for pills, a little of any kind of syrup may be added to it. This may be formed into pills of a moderate size, and four or five of them taken twice or thrice a-day, according as the patient’s stomach will bear them.”
Shorter Dresses And Wearing Bells to Fight TB
German sanatorium doctors particularly valued the open-air rest treatments, where the emphasis was put on remaining outdoors in all weather conditions combined with a rich diet. Not soon after Dr. Trudeau became infected he started the first sanatorium in the United States.
Treatment became a cottage industry with the opening of sanitoriums such as the Trudeau Center in Saranac Lake, New York, the Cragmor in Colorado Springs, and the National Jewish Hospital For Consumptives in Denver.
TB victims flocked to Colorado in large numbers seeking sunshine and clean, dry air, and not everyone could afford sanitoriums, although the National Jewish Hospital offered free treatment. Many of the newcomers had no money and homelessness became a problem in Colorado. As concern over contagions emerged, victims were required to wear bells around their necks, spitting was outlawed and women were encouraged to wear shorter dresses, ostensibly to discourage stirring up dust from the roads.
The Trudeau Center treated thousands of well-to-do and underprivileged people afflicted with the disease. The sanatorium consisted of homes, over 50 buildings, a large main building, many patient and staff cottages, an infirmary, a workshop, a library, a laundry, a chapel, community rooms, and its own post office. But the age of the TB sanitoriums would soon come to an end.
In 1956 the Madras Experiment was carried out in India comparing treatment benefits in a sanitorium with treatment at home. After a five-year follow up the results showed that there were no significant differences between the two groups. This experiment marked the end of the sanitoriums with most of them closing or shifting to research or other services. National Jewish Health and the Trudeau Center still do research today. Eventually, antibiotics prevailed as the best treatment for TB, notwithstanding complications such as mutating bacilli and immune deficiency disorders.
