Shadows in the Valley: A Cultural History of Illness, Death, and Loss in New England, 1840-1916

Chapter 5: Dutiful Daughters, Pallid Young Women

84 5 dutiful daughterS, Pallid young women More [illnesses] occur from pulmonary consumption than from any other cause. —Stephen West Williams, “Medical and Physical Topography of Deerfield, Massachusetts” (1836) “Consumption, that great destroyer of human health and human life, takes the first rank as an agent of death; and as such, we deem it proper to analyze moreparticularlythecircumstancesunderwhichitoperates.Anyfactsregarding a disease that destroys one-seventh to one-fourth of all that die, cannot but be interesting.” So wrote Lemuel Shattuck, who had earlier lost his own fathertoconsumption,inhisReportof theSanitaryCommissionof Massachusetts in 1850.1 Throughout the nineteenth century consumption—a large proportion of which was pulmonary tuberculosis—was a major killer in the United States and Europe. In the latter half of the century it was the leading cause of death for both sexes, although more girls and women died of it each year than did boys and men.2 Observers early on established that consumption, unlike dysentery and scarletfever,showedlittleevidenceof seasonalityandfluctuatedlessfromyear to year than did the epidemic diseases.3 In city and country it was a constant, daily reminder of chronic illness and of the mortal self. And although it was well known that death from consumption could take one at any age, people were beginning to understand that a particular segment of the population in New England, as elsewhere, was unusually vulnerable: adolescents and young adults, especially young women—people normally considered to be in the “prime of life.” Shattuckwentontoobserve,amongthevitalstatisticshewasabletogather forMassachusetts,thatfortheyears1845–48almostthreetimesasmanyyoung women between fifteen and twenty died of consumption than did men of the same age group, and for those twenty to thirty, the rate was twice that of men. Parents were losing their precious, dutiful daughters. Vital statisticians, Dutiful Daughters, Pallid Young Women 85 physicians, sanitarians, and health reformers would repeat similar statistics for most of the second half of the nineteenth century, in Britain as well as the United States. It came to be recognized that the strenuous work of girls and young women, compounded by their greater tendency to be cooped up indoors with a lack of fresh air, contributed to their vulnerability.4 In earlier chapters the experiences of infant diarrheas and childhood fevers wasobservedprimarilythroughtheeyesof parentsandotheradultsinauthority . The story of consumption in the 1870s and 1880s, however, offers voices from the afflicted themselves. Moreover, in this story the state begins to play a larger role in measuring and managing disease and health. The arena in which citizens of rural New England experienced their ills was slowly becoming enlarged, encompassing their urban neighbors and institutions of the state. In the medical establishment, too, important transitions were taking place. With the work of scientists such as Louis Pasteur in France and Robert Koch in Germany, the third quarter of the nineteenth century saw the germ theory of diseasegaincoherenceandsomefamiliarityamongdoctorsandlaypersons.5 The country doctor in Franklin County could begin to envision the infectious agents that somehow caused many of the zymotic class of diseases. In 1882 Koch isolated and identified the cause of consumption: the tubercle bacillus, a typeof bacteriumnowassignedtothegenus Mycobacterium.Bythemid-1880s an occasional country doctor might even have possessed his own microscope and been able to observe the characteristic shape of tubercle bacilli in the expectorations of his patients. Today we tend to regard consumption as an antiquated term for pulmonary tuberculosis, and indeed, it often was in the nineteenth century as well. But whatwascalledconsumptionthenwasnotnecessarilyasingledisease.Doctors applied the term to any number of wasting diseases, including what we now knowastuberculosis.Sometimestheyusedthetermphthisis(pronouncedtisis orteesis)asasynonymforawastingconsumptionorforpulmonarysymptoms. Scrofulareferredtosymptomsof thelymphaticsystemnowgenerallythought to be caused by tubercle bacilli, and these could be combined with pulmonary symptoms.OnlyafterKochisolatedthebacillusandphysiciansbecamefamiliar with microscopic diagnosis was the term tuberculosis assigned a more objective and constrained meaning.6 Nevertheless, consumption, whether clinical or metaphorical, provides a useful disease category in examining the deaths of young women in the Connecticut River valley during the second half of the nineteenth century. Two archetypes dominated nineteenth-century portrayals of consumptive patients:thepallid,emaciated,yetluminousyoungwomanandthedebauched, morally weak, constitutionally defective working-class person, more likely Illustration for William Cullen Bryant, “Consumption” (1824). From Poems (1876). Courtesy of Katherine Ott. Dutiful Daughters, Pallid Young Women 87 an immigrant.7 The latter was often marked male, although working-class “girls” could share this stereotype. Similarly, affluent young men, particularly those deemed artistic or intellectual, could occupy the romanticized image of the middle- or upper-class consumptive. Perceptions of the underlying causes of the disease, its course, and even its outcome could be...