The White Plague

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“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.