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Bargaining for Life: A Social History of Tuberculosis, 1876-1938
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Barbara Bates. 435 pages. Philadelphia: University of Pennsylvania Press; 1992. $19.95 (paper), $45.95 (cloth).
Dr. Barbara Bates is probably best known to health professionals as the author of a best-selling textbook on physical examination. What they may not know, and will shortly discover, is that she is also a talented historian. This richly textured, beautifully written history examines tuberculosis in Pennsylvania over a period of seven decades. Bates has expertly used a unique and untouched source, the letters and papers of Dr. Lawrence Flick, a Philadelphia physician whose career spanned the late nineteenth and early twentieth centuries. These records provide the basis for a detailed, revealing look at a prominent doctor's views on the diagnosis and treatment of tuberculosis and contain candid testimony by persons who contracted the disease and by the nurses who cared for them.
Dr. Flick entered practice in 1880 and soon achieved national recognition as a medical crusader against tuberculosis. Between 1895 and 1903, he founded the Free Hospital for Poor Consumptives, the White Haven Sanitorium, and the Henry Phipps Institute. Bates meticulously captures the life of residents in these new institutions. The structure and details of arrangements varied according to race and class, but as Bates convincingly shows, the treatment of tuberculosis was subject to negotiation. Persons afflicted with the disease, whether wealthy or poor, white or black, bargained with their caretakers about specifics. Patients resisted unpalatable diets, did not always follow stipulations for work or exercise, and often preferred to live at home with their families.
The author shows a keen appreciation for both the medical and social context of her subject. She has overlooked no relevant secondary source. Her writing has poignancy and literary flair, although long quotations occasionally impede the flow of the narrative. The book is well organized, displays nicely selected photographs, and has an excellent index. The discerning reader must ultimately decide whether the Pennsylvania experience with tuberculosis reflected the nation as a whole. Certainly, the broad perspective of this study adequately compensates for its limited geographic focus. It is the finest overall historical treatment of tuberculosis available and deserves to be read by historian and non-historian alike.
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