The White Plague

The mothers of my childhood friends paid special attention to me, and I never understood why. I was dimly aware that something about me made them pat my shoulder and murmur sympathetically or, on the other hand, quite as inscrutably, bar me from their homes and keep their children from visiting me. Grown-up behavior was difficult to fathom, and I did not question it.

I never connected it with the fact that my mother suffered from tuberculosis.

It was not until I was grown and my mother was gone that I came to understand the dread the very word “tuberculosis” engendered in people’s minds in the late nineteen twenties and early thirties. I came myself to fear it, the natural result of years of anxious looks and repeated warnings to wash my hands, stand back, avoid infection. “Do you think I have it yet?” I once asked my older brother, who replied coldly, “I don’t know. It’s like water wearing away a stone.”

As late as 1875 tuberculosis was still the leading killer in America, and even when I was a child about eighty-six people per hundred thousand were still dying of the disease. Worse, nobody really knew how it was contracted or how it could be cured. The TB patient— and sometimes the patient’s family—was shunned in much the same way that a leprosy victim would have been shunned. Oddly, the bacilli of the two diseases look remarkably alike.

But as a child in the upstate New York town of Rome, I knew nothing of all this. Be it ever so odd, a child’s particular world is to him the norm, and I saw nothing I remarkable about ours. The Russells next door went to church on special days. Down at the corner, they f couldn’t come out to play till the dishes were washed. Different houses, different rules.

I took the way of life in our house for granted. My mother had suffered a lung hemorrhage when I was very small and had gone away to live in a sanitarium at Saranac Lake in the Adirondacks. She came home about 1930, almost a stranger to me, improved but far from cured, and our household rearranged itself around her.

My father built a special wing on the house for my mother’s homecoming—a big separate bedroom and bath and a sleeping porch. My older brother, who had had a spot on his lung that had been pronounced arrested, slept as a precautionary measure on a second sleeping porch, often with an inch or two of upstate New York snow on top of his blankets. A trained nurse came to live with us, and Nettie, the Irish second maid, was instructed to keep my mother’s silver separate, to tie a string around each piece, and to wash them in a separate dishpan. I was severely enjoined never to put a morsel of food in my mouth without surgically scrubbing my hands first.

My mother was allowed to come downstairs only once a day. I was brought to visit her in her room or on her porch as she lay in her cure chair, a specially built combination couch and chair which was supposed to encourage the correct position for maximum healing. She spent her days lying in it, reading omnivorously. She seemed to me very beautiful and was very thin, somewhere around 95 pounds. I was told to keep as far away as possible.

Evenings she presided over the dinner table, wearing elegant gowns and smoking cigarettes through a long cigarette holder like the women in the pictures of John Held, Jr. I remember people coming in to play cards, the rattle of ice in the cocktail shaker, laughter. I was put to bed early, but sometimes I saw her being carried upstairs after it was over.

Afternoons she and I rested for two hours. Rest was considered the shield against TB, and I was incarcerated daily from two to four in my room while the neighbor children stood beneath my window inquiring how much longer I would have to lie in bed and elaborately shushing each other. A great deal of faith was also placed in milk. Huge quantities were urged on us children, and a glass was forever on the way upstairs to Mother’s room.

My mother’s new wing angled out from my bedroom and I could hear her coughing in the morning, something she always did in private. It was a deep, terrifying cough, and I found it hard to think of it coming from my mother. Later, when I paid my morning call on her, I would see the cardboard box on the table beside her. She coughed into the box, not only so that a potential source of infection could be burned, but so that occasionally a sputum sample could be sent to her doctor in Saranac for analysis.

Mother’s doctor was Lawrason Brown, who from 1901 to 1912 had been head of the Trudeau Sanitarium in Saranac. Trudeau was world famous as a semicharitable cure hospital—a patient paid fifteen dollars a week in 1937—but it was staffed by famous New York doctors, most of whom had come to Saranac for their own health. When not working at Trudeau, they had enormously lucrative and fashionable private practices. Dr. Brown’s name was spoken in hushed tones in our house. Young as I was, I sensed the awe with which the nurse rolled his name on her tongue.

Years after my mother’s death, in the Adirondack Room of the Saranac Lake Library I found a copy of Dr. Brown’s Rules for Recovery From Pulmonary TB , a layman’s handbook of treatment. It was published about the time my mother wearied of the sanitarium and came home to live, and in this book, when it was too late to matter, I found the key to some of the things that troubled me about my mother.

The nervous system is damaged by TB, wrote Dr. Brown; and I am transported back across the years to our dinner table where my mother sat, her cheeks flushed with the fever, toying with her food and drumming her slim fingers on the mahogany of the table. From my seat beside her, I heard the cutting edge in her voice as she spoke to my father. But he never answered back. Was he told that he must expect my witty and beautiful mother to be irritable?

They are all gone now who could have told me, but I think my mother improved for a time and then relapsed, a very common story for TB in those days. After she had been home a few weeks, I was sent away to school, and in summer to camp. When I came home for a brief visit, the nurse had disappeared. Letters from my parents came postmarked Nassau and other palm-lined cruise ports of call. Mother must have lived a reasonably normal life for a time, conserving her energy for the things that mattered to her, drinking her milk and taking her rest, checking her temperature twice a day. She measured her life out in judicious pieces, choosing carefully, snipping a few spent roses in the garden, being driven on a morning round of errands behind the chauffeur. A cautious life, keeping out of the sun and always observing Dr. Brown’s dictum, “Never stand when you can sit. Never sit when you can lie.”

In the old photograph album I look for pictures of her as a girl, and she is, surprisingly to me, well rounded with curves and smiling radiantly. I do not connect this plump, pretty woman in the sailor suit and Gibson girl hat with the thin, nervous mother of my childhood.

Little by little I put together the pieces of the puzzle, the fragments from people who knew her at the time, the things my father told me later. She had a persistent cough, a cold which hung on. She was always dieting. She sat in hot baths and drank lemon juice. The local doctor pronounced the cough of no importance, but as she stood beside her bed one day the blood welled up in her throat. My father was a successful lumber merchant. He took her to Saranac, installed her in the Santanoni, the fashionable apartment hotel named after the nearby mountain range, and went home to a half life to raise us children alone.

What was her life like during those seven years she spent in Saranac, when Edward Livingston Trudeau was living and the frigid village was an international mecca for people seeking pulmonary cures? What was it like to be young and recently married and be sent to take the cure when coffins were rolling out every night, under cover of darkness.

Saranac is just another Adirondack village today, but there are some who still remember when passing motorists held handkerchiefs to their noses and exceeded the speed law to minimize exposure to the disease. So many TB patients thronged into the town that from two to four in the afternoon, the official rest period, the sound of a dropped tire jack would re-echo from one end of the town to another. Spitting on the street carried a twenty-five-dollar fine, a penalty rigorously enforced.

My mother went to Saranac in the twenties, when its reputation, because of Dr. Trudeau, was at its zenith. Until the summer of 1875, when Trudeau discovered he had TB and came to die in the woods he had always loved, Saranac was a village of a single schoolhouse, a sawmill, and a small hotel for guides and lumbermen. The clerk at the only store doubled as the telegraph operator.

Trudeau, on his arrival, was so wasted with fever that the man who carried him to his room remarked, “Why, doctor, you don’t weigh no more than a dried lambskin.” But the next day they fixed him a bed of balsam boughs in a guideboat, laid his gun across the center seat, and loaded him in to go hunting. Miraculously, slowly, his health improved and he gained weight. Returning to his practice, he attributed his recovery to the pure, cold mountain air and stayed on to found a sanitarium for other TB sufferers.

Word of the effects of the climate spread through medical circles, and many of Trudeau’s New York colleagues joined him. In 1889, Little Red, the tiny nucleus of Trudeau Sanitarium for the Treatment of Pulmonary Disease, was dedicated, the culmination of a dream which had been shaping in Trudeau’s mind since he first knew he would not, after all, die at Saranac.

Today it is almost impossible for us to understand what it meant in Trudeau’s day—and indeed on into the mid-forties—to be diagnosed as tubercular. Tuberculosis was a death knell, the end of a normal life and the beginning of months or years of enforced idleness, banishment, and hopelessness. TB meant a sanitarium and one might as well be exiled from life itself.

“Sanatorium,” wrote Betty MacDonald in The Plague and I , describing the moment in the forties when the chest specialist diagnosed her own case, “I knew what that meant. I had seen Margaret Sullavan in Three Comrades and I had read The Magic Mountain . Sanatoriums were places in the Swiss Alps where people went to die. Not only that, but everyone I’d ever heard of who had had tuberculosis had died.”

Today the discovery of a tubercular lesion on the lung usually means nothing more inconvenient than a year or more’s course of a combination of drugs, probably isoniazid, rifampin, and ethambutol. While taking this, the patient in most cases will not even break the normal stride of his life. Though TB is still a leading cause of death in the Third World, in America the discovery of streptomycin in 1944 triggered the end of the disease as a major killer. In 1974, with a population of more than 200,000,000, there were only 3,513 deaths from TB in the United States. Until 1933 it was not required in all states to report the tubercular death figures, but Anthony Lowell, in his book Tuberculosis , estimates that in 1930, among a population of about 120,000,000, the disease killed 88,000 Americans.

Trudeau made Saranac internationally famous and brought specialists there who made its reputation as glittering as that of any of the cure centers in Switzerland. Every train arriving in Saranac poured more TB victims into the village, anxious to try the wonderful mountain air and regain their shattered health. It was a village with one industry, a mecca for the dying, a source of new hope for many who had heard of the famous doctor’s own miraculous cure. The local residents, hastily ducting off their spare bedrooms and stocking up on sputum cups and thermometers, rejoiced. The mountain air was their natural heritage, and their cash registers were jingling.

But not everyone was pleased. The Adirondacks were also attracting summer visitors—healthy ones—in ever increasing numbers, moneyed city folk bent on escaping the heat amid some of the most beautiful scenery America offers. The Lake Placid Club and Saranac Inn, in spite of their uneasy coexistence with the tubercular community, had become fashionable northern resorts with a large, chic July and August clientele. They feared the consumptive as the International Exposition in Paris feared smallpox.

At the desk of both resorts discreet signs announced that no TB patients would be admitted. My family violated that rule repeatedly, and I suppose others must have done so, too. But we did it nervously. I can remember sitting with my brother in the back seat of my father’s car wending its way up the impressive Santanoni driveway to take my mother out to dinner. She would emerge flushed with pleasure at the prospect of the outing, wearing her tiny pointed shoes and, in winter, her squirrel coat, and we would drive the ten miles to Placid, round Mirror Lake, and pause briefly, out of sight of the club, while my mother coughed. TB patients were told to resist coughing as much as possible, but it made my mother feel better to have done it just before stepping into the premises where she was forbidden. The management knew a tubercular cough when they heard it, and we feared to take a chance.

Already in its fifth edition in 1931, Dr. Brown’s book reflects the bits and pieces of knowledge with which the doctors labored to cure their patients. Robert Koch, in 1882, had identified the TB bacillus; but no one had discovered a way to deal with it. All the early specialists could do was attempt to strengthen the body’s natural defenses through rest, nourishing food, and what they believed to be the greatest remedy of all for sick lungs, the fresh mountain air.

“The current popular belief in Saranac Lake,” writes Dr. Brown, “is that one hour of driving is worth two of sitting on a porch.” The climate was all important, total immersion in it essential. The cold was an amulet. “Properly clad persons can be quite comfortable sitting outdoors even at 20 and 30 below,” wrote Dr. Brown encouragingly. An ex-patient at Trudeau told me he often found himself covered with frost when he was rolled in for breakfast after a night on the sanitarium porch.

Even the cough remedies sound strange to present-day ears. Dr. Brown recommended against coughing, but advised those who must do it to take very slow, full breaths, or put a little slippery elm or common table salt on the tongue. TB patients rarely coughed in public. They were early taught to control it and avoid it when possible. It was bad for sick lungs and bad for disease control. The germs remained suspended more than an hour in the air; everyone in Saranac knew that. Old-timers say every sleeping car departing from Saranac was fumigated and each rented room vacated was, by law, disinfected.

Open air, rest, and food. Each TB patient was urged to try to become ten pounds overweight. Six or eight hours a day in “God’s open, fresh air, with good ventilation at all times” was advised. The colder the air, the better, and it was a popular belief that one winter in Saranac was worth two summers.

Dr. Brown mentions a special Klondike method of wrapping the blankets about the patient in the cure chair, and The Journal of the Outdoor Life , the magazine he founded in 1904 for the TB patient, is full of photos of consumptives wearing earmuffs and mittens as they turn the pages of their books. Some patients, wrapped to the gunwales otherwise, bared their chests to the cold, believing the air would work more marvels if it did not have to penetrate clothing. The value of the cold climate to the health seeker was buttressed by doctors who reminded their patients that Greece and Rome were conquered by healthy invaders reared in a cold, northern climate.

The TB patient who did not have fever, whose afternoon temperature reading showed no elevation, could do what he liked as long as it was mostly outdoors and he rested in the afternoon. TB patients without fever went on winter picnics, sleigh rides, bobsleds, forming the special, close friendships that expatriates form when marooned together in island outposts. At Trudeau, I am told, the constant, haunting presence of death drove many patients to plunge into sexual affairs with other patients and particularly with the nurses, who were apparently drawn to the consumptives with their aura of fatalism. For many patients, these relationships were the only close human contact they had. Families frequently brought their tubercular members to Trudeau and never returned. Ranged in tiers, two to a porch, the Trudeau patients took informal roll call daily, calling to the tiers above and below, out of sight, to check that the departing coffins the night before had not contained a friend.

The fear was always present, spoken or unspoken. The sound of the ice wagon was particularly dreaded. Especially at Trudeau, where the patients often arrived with advanced cases, the last-ditch measure was a block of ice on the chest to slow the hemorrhage and compress the lungs. Twenty pounds of sand were sometimes used the same way. Either could mean that there would be a gap in the line when the beds were next pushed out on the porch.

At the Santanoni, the realities of the disease were more veiled than at Trudeau, but I never heard my mother speak of her life there. I remember little of that period except the long drive up the hill and the little smocked dresses I took home after nearly every visit. My mother made these dresses during her rest hours.

Recently I went back to Saranac and from the bottom of that hill looked once more up at the Santanoni. It had been gutted by fire and stood deserted but still proud, like a grand dame down on her luck, its windows blackened with smoke and its top two stories gone. I walked up the drive in search of a piece of my mother’s life and found the new owner puttying the broken windows.

He had been a small boy who came frequently to the kitchen door for a pastry treat in the twenties, and he remembered vividly the Santanoni in its full flower. It was very grand, he told me, shaking his head. Such a kitchen. Every day his father sold the chef fresh fish caught in the lake. The hotel’s quartered oak floors became legendary and it had one of the first hydraulic elevators in the country; the patients who rode it were most elegantly dressed. They were forever having cocktail parties and smoking, like my mother, from long, slim holders. Those in the top floors brought their own private nurses.

The list of the tuberculars he remembered who had lived at the Santanoni could have been cribbed from an International Who’s Who . Manuel Quezon, the President of the Philippines, brought his retinue to the town and established a government in absentia at the nearby Hotel Saranac; Christy Mathewson, the ballplayer; Hope Lange, the movie star; Rosalind Russell’s adopted daughter; the wife of the chef of the New York Ritz, Louis Diat; much later Dean Acheson’s daughter, Mrs. William Bundy.

In the offices of the Adirondack Daily Enterprise next day I found the account of the fire and the obituary of the Santanoni. It was designed by William Scopes, a well-known architect who had come to Saranac from New York to take the cure himself. From the moment it was completed in 1914, a long list of patients sought apartments there. It boasted the latest in cure accommodations, with one and sometimes two sleeping porches for every room and beds on wheels that could be rolled out onto them. Two regular nurses were in constant attendance, and the doctors who called daily were the aristocracy of the profession. Dr. Brown’s name was there and so were those of Drs. Francis Trudeau, Senior and Junior.

One of Saranac’s most elegant social events was the marriage in 1946 of June Serrelas of the Don Q rum fortune to a fellow Santanoni patient. It took place at St. Bernard’s Church at the end of the block, and the red carpet ran all the way across the street to the Hotel Saranac in the next block, where the reception was held. For the occasion, the Serrelas family presented the church with a new $10,000 organ to play the wedding march.

From the day Dr. Trudeau recovered his health, Saranac attracted a long procession of famous people. Robert Louis Stevenson spent the winter of 1887 here in a rambling cottage atop a hill, believing himself tubercular, though there is doubt about this now. In a letter to Henry James he wrote: “You should see the cows butt against the walls in the early morning while they feed; you should also see our back log when the thermometer goes (as it does go) away away below zero till it can be seen no more by the eye of man. Not the thermometer, which is still perfectly visible, but the mercury, which curls up into the bulb like a hibernating bear.”

Celebrities who had tuberculosis continued to come over the years to live in the brown-shingled houses on Park Avenue or in the many private health sanitariums—Harry Houdini’s brother, Legs Diamond’s brother. Mrs. Francis Trudeau, daughter-in-law of the founder of Trudeau, says she played bridge regularly in 1914 with Dutch Queen Wilhelmina, the head of the Bank of France, whose name escapes her, and a curator from Buckingham Palace.

Many came and stayed awhile, and went back where they came from too soon. TB sufferers were particularly prone to remission and recurrence. My mother did not really get well. At some time when I was away at school, she underwent the operation common at the time for lung collapse. Air is induced into the thoracic cavity to collapse the lung, sometimes permanently, with the removal of several ribs occasionally included. The theory was that a lung not working was a lung with time to heal. One could tell at a glance in the streets of Saranac which patients had submitted to surgery by the dropped shoulder and the slight chest concavity. One doctor invented an overshoulder bag of shot worn inside the clothing to combat the lopsided appearance of his postoperative patients.

My mother did not improve with the operation. She lived on for a while, swallowing in vain the cream soups and Hollandaise sauce that Dr. Brown hoped would increase her weight. In 1937, a telephone call brought me to her deathbed, little more than six years before the discovery of the drugs that would have saved her.

“I couldn’t help her,” said my heartbroken father, taking my hand in his. I told him he had managed to extend her life for seventeen years.

It comforted him then. I wonder now whether what he did for her made any difference at all.