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  • "Must We All Die?" Alaska's Enduring Struggle with Tuberculosis
  • Leonard G. Wilson
Robert Fortuine . "Must We All Die?" Alaska's Enduring Struggle with Tuberculosis. Fairbanks: University of Alaska Press, 2005. xxx + 264 pp. Ill. $39.95 (1-889963-69-0).

Tuberculosis appears to have been present in Alaska since the first humans came across the Bering Strait, but in the nineteenth and early twentieth centuries it became intensely epidemic among the Eskimos and Indians. Antituberculosis efforts had by 1950 greatly reduced the incidence of the disease throughout the United States and Canada, but that campaign, as Robert Fortuine shows with painful clarity, left Alaskan natives untouched. Although as early as 1889 Territorial Governor Lyman E. Knapp had urged the need for a special hospital for tuberculosis patients, and his successors repeated such recommendations, little was done. In 1925 a former military hospital near Tanana was opened for tuberculosis patients but served also as a general hospital. In 1931 a thirty-bed annex was added to the small Juneau Native Hospital, and these became the only beds reserved for tuberculosis patients in the whole Alaska Territory.

Little more was done in the territory until the close of World War II. In 1944 the Alaska Health Department fitted out an army surplus vessel as a floating clinic, and during the summer of 1945 its workers visited communities in southeast Alaska, taking chest X rays; in 1946 it was replaced by a larger surplus vessel capable of cruising among the Aleutian Islands and to northern Alaska. In 1949 the Health Department added two more barges, one adapted for work among the Aleutians, the other for the Yukon River. The vessels' staffs performed thousands of tuberculin tests and X-ray examinations along the coasts and rivers of Alaska. In 1952 severe cuts in federal funds forced their withdrawal from service, but their work had revealed the dimensions of tuberculosis in Alaska.

Meanwhile, in 1945 several tuberculosis sanatoria were opened in former army and naval facilities, but their total capacity of about five hundred beds remained inadequate to the problem. In 1947 a team of physicians sent to Alaska by the American Medical Association urged that the territory needed at least a thousand beds for tuberculosis patients. In 1954 a second medical team, led by former surgeon-general Thomas Parran, found that tuberculosis mortality among Alaskan natives was thirty times greater than in the United States. More than 65 percent of Alaskan Eskimos and Indians gave a positive tuberculin reaction.

In 1953 a new four-hundred-bed Native Hospital was opened at Anchorage with three hundred beds intended for tuberculosis patients. The following year Alaskan authorities also arranged to send several hundred patients to tuberculosis sanatoria at Seattle. Meanwhile in the native villages of Alaska, public health nurses began to administer antituberculosis drugs to patients awaiting hospitalization. Gradually their work shifted to the care of patients after hospitalization. Through tuberculin tests of children and X-ray and sputum tests of adults, the nurses also sought out hidden cases of active tuberculosis. Fortuine pays deserved tribute to these nurses, who traveled to remote villages, enduring harsh conditions. The campaign, applying knowledge gained during a half-century of antituberculosis work, was spectacularly successful: by 1960 tuberculosis mortality among Alaskan [End Page 387] natives, which ten years before had been 672 per 100,000, had dropped below 26 per 100,000; by 1970, Alaska recorded no deaths from tuberculosis. Nevertheless, Fortuine emphasizes that Alaskans cannot be complacent: with a reservoir of latent infection, small tuberculosis epidemics continue to break out sporadically in the villages, frequently arising from a single individual.

Fortuine's account of the historically brief, but successful, antituberculosis struggle in Alaska is topical rather than chronological. As he moves from topic to topic, going backward and forward in time, historical developments are sometimes difficult to follow. Yet he demonstrates vividly that tuberculosis continued to wreak havoc among Alaskan natives until an organized medical campaign treated the victims and removed the sources of infection.

Leonard G. Wilson
University of Minnesota, Minneapolis (emeritus)