Living in the shadow of death

For more than 150 years, until well into the twentieth century, tuberculosis was the dreaded scourge that AIDS is for us today. Based on the diaries and letters of hundreds of individuals over five generations, Living in the Shadow of Death is the first book to present an intimate and evocative portrait of what it was like for patients as well as families and communities to struggle against this dreaded disease.

"Consumption," as it used to be called, is one of the oldest known diseases. But it wasn't until the beginning of the nineteenth century that it became pervasive and feared in the United States, the cause of one out of every five deaths. Consumption crossed all boundaries of geography and social class. How did people afflicted with the disease deal with their fate? How did their families? What did it mean for the community when consumption affected almost every family and every town?

Sheila M. Rothman documents a fascinating story. Each generation had its own special view of the origins, transmission, and therapy for the disease, definitions that reflected not only medical knowledge but views on gender obligations, religious beliefs, and community responsibilities. In general, Rothman points out, tenacity and resolve, not passivity or resignation, marked people's response to illness and to their physicians.

Convinced that the outdoor life was better for their health, young men with tuberculosis in the nineteenth century interrupted their college studies and careers to go to sea or to settle in the West, in the process shaping communities in Colorado, Arizona, and California. Women, anticipating the worst, raised their children to be welcomed as orphans in other people's homes. In the twentieth century, both men and women entered sanatoriums, sacrificing autonomy for the prospect of a cure.

Poignant as biography, illuminating as social history, this book reminds us that ours is not the first generation to cope with the death of the young or with the stigma of disease and the proper limits of medical authority. In an era when a deadly contagious disease once again casts its shadow over individual lives and communities, Living in the Shadow of Death gives us a new sense of our own past as it equips us to comprehend the present.