David McCullough Library E-book Box Set

by David McCullough

  Black coffee may have been the Roosevelts’ “trump card,” as Mittie said, but Teedie was also made to swallow ipecac and smoke cigars. The purpose of the cigar was to subject the child to what, in essence, was a dose of nicotine poisoning. “In those who have not established a tolerance to tobacco,” explained Henry Hyde Salter, “its use is soon followed by a well-known condition of collapse, much resembling seasickness—vertigo, loss of power in the limbs, a sense of deadly faintness, cold sweat, inability to speak or think, nausea, vomiting.”

  The moment such a condition could be induced, he said, “the asthma ceases as if by a charm.”

  The picture of such loving parents as Mittie and Theodore inflicting punishment of this kind seems almost inconceivable. But they did, which, if nothing else, is a measure of the extremes to which a mother and a father will go to avoid a bad attack. Also, violent vomiting very often works, just as Salter said. It can in fact avert an attack and is still resorted to in certain situations. And black coffee, it happens, was also a sound choice; caffeine, a stimulant, is closely akin to theophylline, among those drugs used most frequently to treat present-day asthmatics.

  The sensation of an acute asthmatic attack is that of being strangled or suffocated, only infinitely more complex. The whole body responds. When Victorians used the words “fit” or “seizure” they were close to the mark. The trouble is not just in the lungs. The central nervous system is involved, the endocrine system, both sides of the brain, possibly the stem of the brain as well. The agony is total, unlike that, say, of smashing a finger in a door, where the pain is concentrated at one point. And the largest part of the agony is psychological—inexpressible terror, panic.

  “Witches in my chest” is an expression sometimes used by children, while most adult asthmatics find it impossible to give words to what they experience during an attack. A feeling like drowning is frequently mentioned—slow drowning—but not even that quite suits. In the words of one asthmatic, “If I were drowning I would know I was drowning and I was going to die and that wouldn’t be so bad. Asthma is just plain terrifying. . . . You may die . . . but your fear is you won’t.”

  Many asthmatics cannot bring themselves to talk about their illness, largely, it would seem, for fear that the mere thought of an attack might bring one on. Ten-year-old Teedie, for all that he was capable of including in his diary about the contents of museums or the events of a day, writes nothing of the feelings he experienced when “very sick” or having “a miserable night.” In later years he would remain equally reticent—very uncharacteristically reticent—saying only that as a child he had been “wretched,” “suffered much” from asthma and that “nobody seemed to think I would live.”

  For reasons that are still imperfectly understood, the attacks come nearly always at night, usually about three or four in the morning. Asthma is a disease of the night, which, for a small, impressionable child, can contribute greatly to its terrors. The onset may be sudden or gradual. The first stage is a tightening of the chest and a dry, hacking cough. Breathing becomes labored and shallow. The child starts to pant for air (”asthma” in Greek means panting). A high-pitched wheeze begins. The child has to sit up. If he tries to speak at all, it is in short, desperate bursts. Soon he is unable to speak or move, except with the utmost difficulty. He is battling for breath, tugging, straining, elbows planted on his knees, shoulders hunched high, his head thrown back, eyes popping. Fiercely as he pulls and gulps for air, what he gets is never enough. A distance runner near the point of collapse knows much the same agony, except he also knows he can quit running if he chooses. The asthmatic has no such choice, and there is no telling how long the agony will go on.

  “I sat up for 4 successive hours and Papa made me smoke a cigar,” reads the entry describing an attack the night of the crossing to Trieste.

  “Poor little Teedie is sick again . . .” reads part of a letter written by Bamie from Munich,

  it was coming on all day yesterday, but in the evening he seemed a little better so Father went out—before his return, however, Teedie had a very bad attack. Mother and I were very much worried about the poor little fellow and at last Mother gave him a strong cup of coffee, which failed as he could not sleep but sat in the parlor to have stories of when Mother was a little girl told to him.

  At another point in the diary, he writes that he was rubbed so hard on the chest “that the blood came out.” By whom he does not say.

  The cause of the horrendous difficulty in breathing is a swelling of the bronchial tubes which lead to the lungs, specifically the branchlike extensions of the bronchial tree. The normal involuntary muscular action of these airways is not functioning as it should. The bronchial tubes are filling with mucus. They are in spasm, no longer dilating (contracting and releasing) properly; they narrow and close down. Hyperventilation occurs, as less and less air is pulled into the lungs. The feeling, it has been said, is of taking in mere spoonfuls of air, these reaching only the top of the lungs, “and you know that no more is going to penetrate, that everything under that has turned to lead, and you’re depending on that little tablespoon as fast as you can get it.” Back and chest muscles are put to tremendous strain. The heart is pounding. The child coughs and perspires and turns deathly pale, a ring of compressed white around the mouth. He is being strangled to death. And the alarm of those with him does nothing to relieve his own terrible anxieties.

  But though the sensation is of being unable to take air in, the problem is actually the reverse; the air already inside cannot be expired as in normal breathing. It is the used air trapped within the swollen lungs that is keeping the child from breathing in the fresh air so desperately wanted. The struggle is to get the used air out.

  If the severity of the attack continues, if his strength begins to fail, the child will start to turn blue—the sign that he is in “status asthmaticus,” very near death from asphyxiation. With modern drugs, with potent bronchodilators like epinephrine, ephedrine, or aminophylline, such a state can usually be avoided, the attack kept within bounds. Oxygen can also be given. But no such drugs, no nebulizers or oxygen tents, were available in the Roosevelts’ day. How near Teedie came to dying during the worst of his attacks, whether, for example, he actually ever turned blue, is impossible to determine.

  Once the attack is ended, the ordeal at last over, the child commonly experiences an upsurge of good feelings, an exuberance unlike any other. Nothing seems too big or too difficult to tackle. The fact that Teedie could get up and do all he did the day after a bad attack—that his best, most strenuous days during the European year were often those immediately following his worst nights—fits the pattern exactly. The attack the night of the crossing to Trieste was among the most severe, yet the day after, literally within hours, having had almost no sleep, he was out happily exploring the city on his own. The day following he hiked two hours, “in the broiling sun,” up and back, to a castle on a hilltop in what is now Postojna, Yugoslavia.

  For the parents of the child, however, there is little such relief. As the attacks grow worse, their worry and frustration are compounded accordingly, as Mittie’s letter from the garden of the Schönbrunn Palace amply illustrates. Still, such concerns, like asthma itself, remain largely private matters. It is not the severity of the child’s condition or the anguish of the parents that the outside world sees. It is the special treatment the child gets, the costly, sometimes ostentatious things done in his behalf—special medicines, doctors, emergency travel to some distant, exotic change of scene. And if there happens to be money in the family, then such “signs” of the seriousness of the case are heavily accentuated, for while any family may be willing in theory to try almost anything to help the child, the family of wealth can in fact try almost anything. Money being no obstacle, the rich can respond to asthma in ways the poor or even the moderately well-to-do cannot, and this was particularly so in the days before public clinics and health insurance.

  With asthma and wealth combined in t
he same family, it is as if the drama of the problem—and asthma is nothing if not dramatic—can be played out on a much larger, showier stage. And naturally the leading player, the small, ailing child, becomes even more special and out of the ordinary, his influence on the family destiny larger by far.

  So it was not merely that Teedie was acutely asthmatic, but that he was acutely asthmatic in conjunction with virtually all the relief, diversion, every advantageous change of scene or consideration that money could buy. When he set things spinning, as every asthmatic does, the result was quite different from what it would have been for a child of lesser station. An attack comes at home and he is whisked into the night in a family carriage pulled by magnificent, matched horses, a carriage that may be summoned to the door at a moment’s notice, whatever the hour. It is a very privileged kind of resolution to the crisis, not to mention an exciting one.

  The ocean breezes at Long Branch do not suffice, so off he is taken to Saratoga. Visits to Philadelphia are arranged whenever need be. Or summers in the country. Or a year in Europe.

  This is not to suggest that his suffering was any the less for such treatment—or that the burden he presented was any less heartrending for Mittie and Theodore—but to emphasize the special circumstances within which the problem was cast. For in the light of what has since become known about asthma, there is little question that the family milieu, the specific ways in which the family responds to the problem—as individuals and collectively—bear directly on the severity of the disorder, even the timing of attacks.

  2

  The exact role of the emotions in asthma is still elusive, after nearly a century of study. Recent investigations strongly suggest that the disease is physiological in origin: something about the asthmatic makes him abnormally susceptible to an irritant of some kind—an airborne allergen in most instances—and so in the beginning stages, many physicians now contend, asthma can be properly described as allergic. But the interplay of emotions may also figure in the allergic process itself—nobody really knows—and once the asthmatic “mechanism” or “habit” is established, the part played by the emotions in “triggering” attacks is indisputable. It is as if the patient has somehow established a freak circuit and the emotions can trip it, setting him off. The attack is not deliberate (though it can be), rather it is provoked by certain painful feelings—buried anger, guilt, fear of abandonment, fears of all kinds—or of tensions that need not necessarily be unpleasant, the approach of a birthday or Christmas, for example. “It isn’t that the emotions of the asthmatic patients are different from those of other people,” stresses a specialist, “it is that with them the effects of an upset can be explosive.” If the patient is a child, the causes are essentially “wrapped up in the fears which beset most children and which they find so hard to acknowledge or discuss.” More important than the feeling itself is the fact that it remains bottled up inside. Dust, animal dander, the pollen season, damp night air, a hundred and one impersonal, external factors may play a part, but the psychological factors weigh heavy in the balance and it is in this sense that asthma is understood to be a psychosomatic disorder, like duodenal ulcers or hypertension. A view frequently heard among experts in pulmonary medicine is that there is no such thing as a totally nonpsychosomatic case of asthma—a view that, understandably, is often difficult for parents to accept.

  The medical paper regarded as the first study of asthma’s psychological side appeared in The American Journal of the Medical Sciences in 1886, too late to have any effect on Mittie or Theodore Roosevelt. A Baltimore physician, John Noland Mackenzie, reported on a severely asthmatic patient, a woman in her early thirties, whose attacks could be brought on by everything from thunderstorms to overeating to perfume, but who was particularly susceptible to the smell of roses. She was unable to be in a room where roses were present for more than a few minutes without having a violent attack. But then Mackenzie found that the sight of an artificial rose produced exactly the same result, a discovery, he said, that “opens our eyes to the fact that the association of ideas sometimes plays a more important role in awakening the paroxysm . . . than the alleged vital property of the pollen granule.”

  While the validity of Mackenzie’s experiment was to be challenged, it nonetheless inspired countless studies along similar lines, the results of which were often astonishing, Asthmatic children said to be sensitive to house dust, for example, have been hospitalized in rooms generously supplied with dust from their own homes, and in nineteen out of twenty cases no asthma has resulted. Physicians have developed techniques whereby patients can be talked out of an oncoming attack. Important work has been done in the “family dynamics” of asthma—chronic unresolved conflicts within the “family constellation” are probed for—and a major facility, the Children’s Asthma Research Institute and Hospital in Denver, Colorado, has been founded on the proposition that the best possible therapy for many acutely asthmatic children is to get them away from their families altogether.

  Asthma is now commonly explained to parents as a form of behavior; the child is unconsciously “using” his affliction for purposes of his own. “We tend to use what is available to us to influence our environment or to solve our problems,” writes a leading authority. “Children with asthma have asthma available to them . . . [and] behavior, not verbalization, is the language of children.”

  The likeliest source of the child’s anxieties, it has long been thought, is the mother. Asthma is repeatedly described as a “suppressed cry for the mother”—a cry of rage as well as a cry for help. The child has an intense fear of being abandoned by the mother or of any form of rivalry for her affection. If the advent of asthma coincided with actual separation from the mother—from either parent—this too is considered an important piece to the puzzle. Thus a present-day specialist analyzing Teedie’s case would take very seriously the fact that his troubles began during the Civil War, years of great confusion and tension for the Roosevelts, when Theodore was away months at a time and two new infants arrived on the scene to vie for Mittie’s attention. The whole “climate” of ill health within the Roosevelt household—Mittie’s palpitations and headaches and intestinal grief, Bamie’s troubles with her back, Conie’s asthma—would also be reckoned as much or more an environmental factor in Teedie’s asthma than, say, the quality of the air he happened to be breathing.

  Oncoming attacks in his case were often signaled a day or so in advance by moods of dark melancholy or homesickness. “I feel very, very homesick tonight,” he writes one Friday in Lucerne. “Teedie threatened with asthma,” Mittie notes in her journal the same evening. The attack followed in less than forty-eight hours.

  But in nothing the Roosevelts said or wrote during the year is there even a suggestion that his condition was the result of an allergy, or thought to be. There is no talk of the hay season, no obvious avoidance of dogs or cats or specific foods.

  Nor, we find, is there a seasonal pattern to the attacks. As the diary shows, they came in every season, year around. They happen in city and country, in damp, cold climates and the heat of summer, at sea level and in Switzerland. No one time of year or environment seems to be any more beneficial or harmful than another. The fact that he was abroad—away from New York and anything at the 20th Street house that might have been the cause—did him no apparent good. If anything, the year abroad appears to have been his worst yet.

  Indeed, from looking at the diaries one might be inclined to see the attacks as entirely random—that is if one were to note only where they occurred or in what season, rather than which day of the week. It is when the attacks are plotted day by day on a calendar for the years 1869 and 1870 that a distinct pattern at once emerges.

  His asthma strikes on weekends, usually Saturday night or what was actually early Sunday morning. There are exceptions, ordinary weekdays when he is “rather sick” or “still sick.” Tuesday, October 26, the day before his birthday, his condition was serious enough to cause a hurried departure from Berl
in, ahead of schedule, though in this instance apparently it was the sign of an oncoming attack, rather than an actual seizure, that set everyone in motion. (”I feel very doleful and sick and homesick and there is such a bustle my head aches. . . . Perhaps when I’m 14 I’ll go to Minnesota, hip, hip hurrah!”) But the number of times in which Sunday figures as his bad day is astonishing. The worst attacks, moreover, virtually all occur on Sunday.

  His first illness of the trip, it will be recalled, the siege of seasickness, his one bad day aboard ship, occurred Sunday, May 16. In July he was rushed from London by train to spend the weekend of the fourth, a Sunday, at Hastings with his father. Sunday, August 29, at Lucerne, he writes, “I was very sick on the sofa and lay in bed all day. . . .” The bad night at Lake Como mentioned by Mittie in her Schönbrunn garden letter happened the weekend of September 11–12. The attack on the way to Trieste began at approximately three o’clock the morning of Sunday, September 26.

  The following Sunday, October 3, was the morning Theodore took off with him from Vienna to Bad Voslau, the morning of Mittie’s letter.

  The attack at Munich described by Bamie took place the following Saturday night and Teedie’s diary entry for that Sunday, October 10, reads: “I was very sick last night and Mama was so kind telling me stories and rubbing me with her delicate fingers. I was so sick in the morning that in the afternoon Father, Ellie, and I went to Starnberg.”

  This made the third such emergency exit to spend a Sunday out of town. In Paris it would happen twice again. On two consecutive weekends, because of his condition, the child was hurried from the city to the fresh air of Fontainebleau, these expeditions coming immediately after the initial trip to see Bamie’s school.

  The intriguing question, of course, is why this should have been so. Why the weekends? Why Sunday?

  The pattern is too pronounced to be coincidental. How long it had been the pattern, what the timing of attacks may have been prior to that year abroad, is impossible to resolve, since there are no comparable records. References to his condition in earlier years rarely specify when the seizures came. Interestingly enough, however, the one bad time for which we do have a calendar date occurred on a weekend and reached its greatest severity on a Sunday. The letter in which Grandmamma Bulloch tells how Mittie and Theodore packed the child off from Long Branch to Saratoga—the first known mention of his asthma in family records—was written the day of their departure, Monday, June 22, 1863. The difficult time had been the day before.