Many historians, including myself, have told the story of New York City’s Sea View Hospital, a tuberculosis sanatorium that operated from 1913 to 1961. But only now, with the publication of Maria Smilios’s new book, The Black Angels: The Untold Story of the Nurses Who Helped Cure Tuberculosis, is a crucial part of Sea View’s history being told: the role of Black nurses in staffing an underfunded, overcrowded hospital and likely helping to save hundreds, perhaps thousands, of lives.
So why has this story been hidden for so long? Unfortunately, for decades, the contributions of Black figures to the history of medicine have too often been ignored or purposely marginalized. But now, in the wake of the 2020 murder of George Floyd and the renewed examination of pervasive racism in American society more broadly, scholars, authors and commentators have looked more closely at how racism has also permeated medicine and health care.
In addition to racism, there is another reason the story of the Black Angels has not previously been told: the lack of documentation. As Smilios writes, when she first met with Virginia Allen, the last surviving Black Angel, and asked about written archival materials, Allen told her “There were none.” But then Allen told her: “I’ll tell you what I know, and then give you the names of people who can tell you more.” How good a job does Smilios do in telling this crucial, but hidden, story?
The Black Angels is a great read for no other reason than that it retells the engrossing history of tuberculosis control in the United States from a fresh perspective. Many books, including my own, have explored this area, but readers new to the subject are likely to be fascinated. At the turn of the twentieth century, tuberculosis, also known as “consumption” and nicknamed the “Captain of all men of death,” was the leading cause of mortality in many American cities. It was a brutal infection that affected all parts of the body but mostly the lungs, where it ate away at the tissue. Victims grew progressively short of breath, coughing up blood and choking as they wasted away.
The predominant treatment of tuberculosis was bed rest, which was believed to help lungs to heal. By the 1930s, a series of medical procedures that collapsed the affected lung, such as artificial pneumothorax (injection of air into the pleural space surrounding the lungs) and thoracoplasty (surgical removal of part of the ribcage), had joined the repertoire. But without antibiotics, there was no cure. Health officials often sent patients away to sanatoriums, tuberculosis hospitals that provided these treatments and also segregated potentially infectious patients from the general population. Roughly a third of patients died. But many of these “lungers” who eventually recovered remained hospitalized for years.
Some sanatoriums, such as those in New York’s Adirondack region with its supposedly salubrious fresh air, catered to wealthy patients. But Sea View did not. A municipal hospital in Staten Island, the outermost of New York City’s five boroughs, Sea View was chronically underfunded and overcrowded. It was also understaffed, particularly when it came to nurses. By the end of the 1920s, its white nursing staff began to quit. Smilios gives several reasons, such as the long commute to Staten Island and the twelve-hour days, but the main explanation was tuberculosis itself. Working in what Staten Island residents derisively termed a “pest house” meant constant exposure to a deadly and frightening disease.
In the early 1930s, it looked as if Sea View would have to close. But there was one possible repository of nurses: Black women from the South who were nurses or wanted to become nurses. “The call went out,” Smilios recounts. “Advertisements appeared in Black newspapers and on church bulletin boards.”(11) A Georgia nurse named Edna Sutton learned about Sea View through word of mouth from one of her former teachers. Historians have written extensively about the “Great Migration” of Southern Black individuals in the mid-twentieth century, and Smilios does an excellent job of adding Black nurses to this story.
For the next three decades, Black nurses like Sutton became the backbone of Sea View and informally became known as the “Black Angels.” Smilios estimates there were hundreds of Black nurses at Sea View, and they comprised the vast majority of the nursing staff after 1929. In addition to Sutton, Smilios tells the compelling stories of several other Sea View nurses from this era.
Sutton was thrilled with her job, which paid $720 a year and far exceeded what she could have accomplished in Georgia. But merely being in the north did not mitigate the racism she had always experienced. For one thing, the remaining white nurses earned $1,100 annually. Neither Sutton nor her Black colleagues got promotions, even when a further exodus of white nurses to private-duty careers meant the remaining Black Angels often had to work consecutive double shifts.
Racism also infused local and national organizations. In New York, the Department of Hospitals only allowed Black nurses to work at four of its twenty-six facilities. When pushed to integrate the other hospitals, the commissioner chillingly admitted why he favored keeping Sea View mostly Black. “In twenty years,” he stated in 1934, “we won’t have a colored problem in the United States of America because they’ll all be dead of tuberculosis.” (104) Meanwhile, the American Nursing Association—like the American Medical Association—forbade Black members, leading to the formation of the National Association of Colored Graduate Nurses which, as Smilios reports, eventually helped many of Sea View’s Black nurses assume leadership positions.
Smilios has done a terrific job of rescuing largely forgotten historical figures and correcting incomplete and at times misleading historical accounts. Many authors have written about Sea View, particularly the famous 1951 trial of isoniazid, a new antibiotic that was so effective that previously moribund patients could suddenly get out of bed, walk, and even dance. But as Smilios notes, the isoniazid trial could not have been carried out successfully without the nurses’ knowledge of “how the disease ebbed and flowed, how it cloyed, then let go.” (319) That these were Black nurses who worked under terrible conditions with jobs that white nurses were able to decline should now be central to the history of tuberculosis.
Books like The Black Angels thus do a great service in telling forgotten stories about race and forcing us to explore why they were forgotten. Smilios conducted copious interviews with Allen’s connections, including former Sea View patients and children of the Black Angels, and unearthed an enormous number of newspaper clippings, photographs, and family memorabilia that fleshes out her narrative.
But, like other recent works in the history of medicine, Smilios, in trying to create a convincing and moving narrative, takes liberties with actual facts and events. For example, in telling the story of Edna Sutton and the other nurses, Smilios describes specific actions and activities of her subjects. Of one day in 1938, she writes: “Edna stopped a moment to look at the wildflowers that danced and swayed in the summer breeze” (168). Describing an operation on a patient named Elke, Smilios states that ”Edna took Elke’s hand and pushed down on her inner wrist and detected a pulse so slight it felt like a tiny vibrating cord” (74). Sutton, however, left no documentation that could confirm what Smilios has said. Similarly, while Smilios did not invent the term “Black Angels,” she uses it uncritically throughout the book. Although the women who risked their lives to treat tuberculosis patients were surely impressive, the book’s hagiographic tone ironically resembles that of earlier biographies of white male physicians that justifiably have come under fire for their uncritical portrayal of their subjects.
Smilios is well aware of the liberties she is taking and carefully explains that her invented scenes are recreated from “oral reports” of individuals who knew the book’s figures, corroborated by written materials when possible. They are thus a facsimile of what may have happened. These caveats raise fundamental issues not only in the history of medicine but history more broadly. How can we tell the histories of forgotten individuals – often people of color but also white women – whose “inferior” status in society made it unlikely that they left behind concrete documentation?
Historians are only beginning to generate answers to this question. But it is clear that books like The Black Angels, while perhaps making certain readers uncomfortable, nevertheless make previously invisible history visible. And for that, we should be grateful.
- Ayah Nuriddin, Graham Mooney and Alexander I. R. White, “Reckoning with Histories of Medical Racism and Violence in the USA,” Lancet 396, no. 10256 (October 3, 2020): 949–51. https://doi.org/10.1016/S0140-6736(20)32032-8. ↑
- Mark Caldwell, The Last Crusade: The War on Consumption, 1862–1954 (Atheneum, 1988); David McBride, From TB to AIDS: Epidemics among Urban Blacks since 1900 (State University of New York Press, 1991); Barron H. Lerner, Contagion and Confinement: Controlling Tuberculosis along the Skid Road (Johns Hopkins University Press, 1996); Katherine Ott, Fevered Lives: Tuberculosis in American Culture since 1870 (Harvard University Press, 1996); Thomas Dormandy, The White Death: A History of Tuberculosis (New York University Press, 2000). ↑
- On the history of Black nurses, see Darlene Clark Hine, Black Women in White: Racial Conflict and Cooperation in the Nursing Profession, 1890–1950 (Indiana University Press, 1989); Hafeeza Anchrum, “A New Era in the Fight for Nursing Civil Rights: Mercy-Douglass Hospital School of Nursing,” PhD dissertation, University of Pennsylvania, 2022. ↑
- See, for example, J. C. Hallman, Say Anarcha: A Young Woman, a Devious Surgeon, and the Harrowing Birth of Modern Women’s Health (Henry Holt, 2023). ↑