Customer Reviews

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

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"[T]uberculosis was the leading cause of death in the United States throughout the nineteenth century and well into the twentieth. From 1800 to 1870 tuberculosis was responsible for one out of every five deaths. Paying little attention to geography, social class, or age, it struck rich and poor, young and old, and urban and rural residents." These statistics in Rothman's introduction are tragic enough. The narratives that follow are even sadder.

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.

As Rothman, ruefully notes in her book there have been studies of medicine from the perspective of the doctor and from the perspective of the disease but not from the perspective of the patient.

Thus, Dr. Rothman sets out to do "a history of patienthood" and how being a patient changed over the course of time with respect to one single disease, TB or Consumption.

The problem is that her original sources are diaries, mainly of women but not exclusively. That by and of itself limits her subjects overwhelmingly to upper crust and educated NE families by and large. Overwhelmingly these are the well-off, relatively speaking. Theretofore, all of Rothman's democratic impulses are naturally very limited. The whole thrust of thesis is thus quite silly. This is not a history truly of patienthood, but of patienthood of the wealthy - of a small well-to-do segment of society.

What was it truly like to a patient with TB among the indigent and the poor? Rothman cannot really say for these people kept no diaries and if they did they were certainly not preserved a hundred and fifty years later in some library archives waiting for her to come find them.

Rothman gives us only the narrowest slice of what it means to be a patient.

Furthermore, this is a telling of history through anecdote. So she takes one, two, maybe 3 dozen diaries and summarizes what the people say in them. Who cares! To say these 3 dozen people are a representative sample (even among the upper crust educated elite of society) is downright silly.

It would be like someone reading 3 dozen blogs today on the net and saying they have a general sense of what society was thinking of the Iraq war. Who actually spends their time writing a blog? What is the motivation of those who write the blog? By definition, they are the people with extreme views, angry, disenchanted, frustrated, opinionated jerks. Represenative of nothing.

And this all leaves out the fact that we still have no clue as to biased selection of diaries that Rothman chose, potentially only using the one's that made her point (or only quoting passages from the diaries that support her thesis).

This is not history. This is not fact-telling. This is historical fiction writing.

If you want to understand disease read the work of Robert Fogel, Nobel Prize winning cliometrician. If you want to read historical fiction, go read Barbara Tuchman or Leon Uris.

This is just bad fiction with labored dense writing posing as history.