Extraordinary tale of the beginning of the end of tuberculosis

Review: Vivien Horler

The Black Angels – The untold story of the nurses who helped cure tuberculosis, by Maria Smilios (Virago)

During World War II my aunt, who was a munitions worker in her early 20s in Cornwall, contracted tuberculosis.

She was sent to a sanatorium where she and several other women shared a three-walled ward – the fourth wall was open to the elements, all year round.

Bed rest, fresh air and good food – as good as was available in wartime Britain – was the treatment, and after two years she was pronounced cured.

Her fiancé had not hung around, so her engagement was over, and she had lost two years of her 20s, but compared with the horrors described in The Black Angels, it would seem she got off lightly.

TB is still a dread disease and the battle against it is far from over.  HIV has exacerbated the problem, because it is said as many as half the SA population has been infected with TB, but healthy immune systems keep it in check. When immunity is compromised however, such as by HIV, the TB microbes are free to make the patient desperately ill.

WHO figures showed around 540 000 people died of TB in SA in 2022, a figure which outpaces HIV deaths.

In the years before antibiotic treatments a diagnosis of consumption, as it was known for many years, was usually a death sentence. According to The Black Angels, TB killed 5.6million people in the US alone in the first half of the 20th century.

You could get TB of the lung, brain, blood, bone, kidney, tongue, skin and genitals. Ghastly treatments were prescribed, from medications including antifreeze to debilitating surgeries that removed half a patient’s ribs.

The Black Angels is a massive project, which took the author eight years to research and write. It deals with TB, racism in the American medical profession, and activism against it, the desperate battle to find a cure, and also tells the personal stories of some of the nurses who were on the frontline against a disease for which there was no cure.

One horrific line struck me, and will resonate with all of us who lived through Covid: “A single sneeze blasted 40 000 infected droplets 27ft into the air at a 100 miles an hour, and a cough sent out 3 000 of them.”

In early 1929, white nurses began quitting Sea View, a sprawling municipal TB sanatorium on New York’s Staten Island which had thousands of patients. The nurses cited the long shifts, the commute from Manhattan, and of course the mental and physical toll taken by working among terribly sick and sometimes deranged patients.

At the same time many properly trained black nurses were battling to find jobs. They were not allowed to join the all-white American Nurses Association, and were barred from working in many hospitals (and from many training facilities).  Sea View provided a chance.

The work was hard and dangerous, but it meant a job, a salary, and a chance to do what the nurses had signed up for.

The book focuses on the life of one nurse, Edna Sutton, who left Savannah, Georgia, to find a job in New York around 1929. She had heard that Sea View, was recruiting “colored” nurses, providing a salary, housing and free training.

But other nurses are also highlighted, including Virginia Allen, Edna’s niece, who joined her aunt at Sea View and was still living at the decommissioned Sea View nurse’s home at the age of 90 when she was interviewed by author Maria Smilios.

The struggle by black nurses to be recognised is a major theme in this book, along with the effect of the ravages of TB on thousands of patients. But also there is the detail of the efforts around the world to find a medical cure, and the key role played by the staff – and patients – of Sea View in the studies of various drug regimes.

The discovery of the cheap-to-make isoniazid changed everything.

Researchers needed a variety of patients for their studies – old and young, male and female, sick and not so sick, which Sea View could provide in numbers – and the desperate patients readily agreed to be part of the work. They had little to lose.

Nurses and the doctors at Sea View meticulously recorded the doses, the protocols, and the patients’ reactions.

The first doses of isoniazid were administered in June 1951, and by early 1952 patients began to get better, were eventually discharged, and Sea View became a series of empty pavilions.

One of the key doctors in the Sea View study, Edward R Robitzek, looked at what he and other staff had achieved with satisfaction. “He could celebrate how Sea View, the under-resourced municipal hospital on an isolated hilltop, had helped bring the world a cure; how his patients, their bodies so often dismissed for lack of privilege, had enabled a remedy. And how the Black nurses, long rejected as inferior professionals, had proved America wrong.”

The achievements at SeaView were not the end of the fight against TV, as we know, but marked perhaps the beginning of the end. This is a magisterial and magnificent work.



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