"Well, Diary, I'll introduce myself. My name is Evelyn, I'm 16 years old. I have tuberculosis and at the present time am in the Ray Brook Sanitorium trying to get cured. You must keep my secrets well for I'll tell you things I want none to know."
When Evelyn Bellak began her diary on January 1, 1918, she had no idea how long she would be staying at her new home, the New York State Sanatorium at Ray Brook, not far from Saranac Lake. Like everyone else confined there, Evelyn had contracted a disease that in half a century had killed tens of millions of people, young and old, rich and poor, throughout America and the world. Sometimes called the "White Plague" or the "People's Plague," tuberculosis reached epidemic proportions in the 1870s and '80s. It was all the more frightening because not much was known about it then. What caused it? How did it spread? How did you treat it? How did you cure it? But by 1918, at least three of those questions had been answered. Evelyn was one of the luckier ones.
Tuberculosis is not a new disease - signs of it have turned up in Egyptian skeletons from 3700 BC. Like the moon, tuberculosis epidemics have waxed and waned over the centuries. At the end of the nineteenth century, one out of seven people world-wide lay dying of tuberculosis. In Europe, particularly, it was thought to be an affliction of the upper classes, and to die of it was both romantic and spiritual. A wasting disease, as the flesh was consumed and the victim withered away, his spirit slowly emerged, radiant, no doubt, due to the fever he was running.
In reality, to have consumption, as it was often called, in any of its stages was not at all pleasant. A person would start coughing, at first intermittently, then constantly, coughing up phlegm, or blood streaked sputum, until he hemorrhaged and coughed up pure blood. His lungs were actually dissolving. He would develop a daily fever, tire easily and lose weight. Often he would experience chest pain as the pleura (membranes) around the lungs were affected. If untreated, tuberculosis could spread to other parts of his body, to the bloodstream, the intestines or the bones and joints. Eventually, he died, from lack of food and water, by drowning in his own body fluids, or losing a vital organ to the disease.
Many treatments for tuberculosis were tried over time. Rest, living underground, and drinking fresh milk - woman's, camel's, ass's, goat's - were prescribed by Greek authorities. Some advised inactivity, some exercise, especially horseback riding; others advocated sea air, mountain air, cold air, warm air or sunlight. One folk remedy called for eating a wolf's liver boiled in wine. Arsenic, creosote, gold and copper salts were all prescribed for consumptives. But while some managed to recover, countless others continued to die.
Then, in the nineteenth century, great advances in science were made. In France, chemist Louis Pasteur successfully identified bacteria under a microscope, validating the germ theory of disease. In 1872, a German bacteriologist named Robert Koch isolated a curved or rod-shaped plant which was active as long as it had oxygen. This Koch described as the tubercle bacillus and identified it as the cause of pulomary consumption. Furthermore, the bacillus, which multiplied rapidly in dark, moist places and could survive several hours in sunlight, was airborne - it could be carried from person to person by coughing or sneezing. Tuberculosis was known to be contagious before Koch's discovery, but here was proof of it. A cure for the disease was still decades away, but understanding what caused it and how it was spread, gave doctors and health officials new ways to fight it.
In America, tuberculosis became identified with the poor, especially those living crowded together in cities where air and water were tainted, ventilation poor, buildings neglected by landlords, and living conditions generally unsanitary. Thousands of immigrants who had poured into American cities in the 1880s and `90s, only made conditions worse. A scene in a Cincinnati neighborhood made for an anti-tuberculosis film in 1913 reads:
A Sunday view of a court in this neighborhood. Filth and garbage from end to end. The stench is awful. Note the little girls carrying babies in their arms over piles of rotten garbage. Nearly all the property around this court belongs to one man.
No longer regarded as a mystery or a refined ailment of the rich, it was clear that tuberculosis thrived in a poor environment. It was a social disease. This was a call to arms for public health officials. Not only did poverty foster tuberculosis, but some thought that the poor were responsible for the very conditions that were making them sick. All they needed to do was to improve their standard of living. The great crusade against tuberculosis was slow to get started, however. Many doctors in America in the last quarter of the nineteenth century did not acknowledge the new advances in medicine in Europe. Not many were trained in experimental sciences such as bacteriology and pathology. Only a few physicians believed in "germs." They still treated tubercular patients in the same way, by wrapping them in bedclothes, shutting the windows and closing them in a dark room, often with other sufferers who shared the same air and eating utensils.
