Agnes Hoekstra and Tuberculosis

TB_romanticized

Here is the main post for Agnes Hoekstra Roorda, Ancestor #4/52.

Family lore tells us that Agnes Hoekstra Roorda suffered from tuberculosis. I say “family lore” because I don’t have a single record showing that Agnes had the disease. Her death certificate lists cause of death as “Chronic Valvular Heart Disease.”

Agnes_deathCert

Detail of Death Certificate, Agnes Hoekstra Roorda, 19 Dec 1924, Elphis, Colorado

I find a few things about this death certificate worth noting. As someone working with family history records for a couple of decades, I’ve seen my share of death certificates, and I don’t think I’ve ever seen one where there were so many blank sections. The certificate is signed by the Coroner, Oren P. Penny, of Burlington, Colorado. I haven’t yet discovered how the coroner system worked in early 20th century Colorado; however I believe Mr. Penny probably was not a medical doctor. He was the (elected?) coroner for Kit Carson County, and his address is listed as the county seat, the town of Burlington.

A medical doctor filling out a death certificate would fill in the lines that ask when and where he or she attended the deceased, and when the M.D. last saw the person alive. Those lines are left blank, presumably because a coroner would not attend a person as her physician. The cause of death, in large, legible cursive writing, is “Chronic Valvular Heart Disease.” The duration of the disease is blank. The contributory (secondary) disease or case is blank. The question, “Where was the disease contracted if not at place of death?” is blank. “Did an operation precede death? No. Was there an autopsy? No What test confirmed the diagnosis is blank.

How did Mr. Oren P. Penny, Coroner of Burlington, Colo. know the cause of death for Agnes H. Roorda? What would have been the normal practice of a county coroner in Colorado in 1924? Would he have checked the medical records with the attending physician?

Another thing that bothers me that I just thought of today while looking at this record: This death certificate is not a copy of an original document. It was almost certainly copied from the original by a clerk in the documents office where I sent in my request for Agnes’s death certificate. What I really need to see is a copy of the original, just to make sure that the clerk didn’t leave anything off of the record. Whether or not these originals still exist, I don’t know, although the clerk got the information from somewhere, so it stands to reason that they do. Finding the original record is something I need to put on my research log for Agnes.

So if the death certificate doesn’t say she had tuberculosis, where did I get that idea? Richard Roorda, in his memoir, Tom, Dick, and Harry, written in about 1964 when RJR was 77 years old, mentions the illness for the first time when their first child was born in April of 1913:

Here [Sanborn, Iowa] on April 6, 1913, Anna came to us, but also I found that my loving wife had TB which explained why she was so often ailing and had to go slow, on doctor’s orders.

The question I have about this statement is this: Was Agnes actually diagnosed with the disease in 1913, or is this RJR remembering back to 1913 when “she was so often ailing” with the (future) knowledge that she had TB? Because if Agnes was actually diagnosed in 1913 with tuberculosis, then his actions in 1913 make no sense. He was working as a bookkeeper in the Sanborn State Bank, making $75 per week. The average annual salary in 1913, according to investmentwatchblog.com, was just over $55 per week. So RJR would have been doing just fine on that money, and had he been patient, instead of almost immediately asking for a 25 per cent raise to $100 per week, he undoubtedly would have been making more than that in a reasonable amount of time. Instead, he quit that job (or maybe he was fired, who knows, but we’ll take his word for it that he resigned) and hired himself and Agnes out as farm caretakers, for the same amount of money, plus room and board. The change in jobs would have meant a huge lifestyle change for his “often ailing” wife, one that would undoubtedly have increased not only the amount of work that she would have to do, but also her level of stress and anxiety. RJR’s description of farming for the next three years, where their crops are “frozen out” two years in a row, reads like a nightmare. Setting aside the three additional children the couple had by the fall of 1917, there would have been no “going slow” for Agnes for the years 1913-1917.

RJR’s next mention of Agnes’s health is in the fall of 1917:

And that year we froze out again. When the fall of 1917 arrived, my dear wife, mostly sick, the doctor advised a higher climate for her. . . . We hated to tell the relatives about our decision to leave Iowa, and only said it was for health reasons, without making any further explanation.

From that statement, it sounds as though there was a “further explanation” about why the couple was moving to Colorado. It might help to know that one of RJR’s many job changes had been to quit business school, which he was attending in Sioux City in 1908, and go with an acquaintance to eastern Colorado to work with him on the man’s 160-acre claim:

I decided this was going to be my new home, but as I was only 20 years old, I was informed that I couldn’t file a ‘claim’ until 21, and I would have to wait until December 6, my birthday. However, I did pay him $25 and he promised to hold a certain 160 acres for me. I tried to believe that piece of land was mine, but in August he came and said, ‘The homesteaders are coming in so thick and fast, I cannot hold it back for you any longer,’ and he returned my money. . . . when J.W., the daughter of Dr. Wheeler, found a boy friend, and had promised to marry him, I lost all interest in Colorado and became very homesick for a little girl in Colorado.

So back he went to Iowa and finished (actually finished!) his course in bookkeeping. But it doesn’t sound to me like he got that Colorado experience out of his system–and might the “further explanation” for leaving Iowa for Colorado, along with Agnes’s illness, have been RJR’s desire to return to Colorado? Here is the complete sentence from the memoir, and it makes more sense with the knowledge of RJR’s previous sojourn in Colorado:

When the fall of 1917 arrived, my dear wife, mostly sick, the doctor advised a higher climate for her, and when the landlord asked us to pay $9.00 per acre for 1918 we decided to sell out, pay our debts and moved to Colorado, where I had paid $200 on 160 acres of prairie, as we wanted to continue farming.

Research question: When did RJR buy the 160 acres in Colorado?

So let’s imagine, as RJR implies in the memoir, that Agnes actually was diagnosed with tuberculosis in 1913. A couple of questions come immediately to my mind: What would it have meant, in 1913, to be diagnosed with tuberculosis; or, in other words, what could Agnes have known about the disease and how would she have coped with it? And secondly, what might have been the reaction within her community to someone being diagnosed with tuberculosis? Would there have been a stigma? Would there have been an effort to hide the disease? I’ll take the second question first.

The Alton Democrat was a newspaper that would have been available to people living in the Sheldon/Sanborn area in about 1913. The newspaper reported on 27 July 1912 that “Tuberculosis caused the death of 1507 people in Iowa last year [1911].” It would be good to see the U.S. Census Bureau’s annual compilation of mortality statistics for Iowa for about 1911 to 1917, but I don’t as yet have that information. I have something that comes close to that from the Journal of the Iowa Medical Society. A summary of mortality statistics in Iowa shows that tuberculosis was in the top three of the leading causes of death, including also heart disease and pneumonia: “Until 1912 more deaths were due to tuberculosis than to any other single cause” (179). Clearly, tuberculosis was a big killer in at this time in Iowa. ChristmasSeal_1914

Communities were reminded and asked to donate every winter through the Red Cross Christmas Seals campaign, started in the U.S. in 1907. The special stamps were sold at Christmas specifically to raise money to fight tuberculosis.

Looking further at the same newspaper for the years around the time that RJR says Agnes was diagnosed with the disease, it’s possible to find any number of obituaries that mention tuberculosis as the cause of death. A sample of these obituaries from about 1912 to 1919 in the Sioux County / O’Brien County area where Agnes and RJR lived shows people, usually in their 20s and 30s, both male and female, “suffering from” and “succumbing” to the disease:

Oct 1919: the sad intelligence has been received of the death of Mrs. Zeta Kelly Carter in Sioux City. The lady’s death resulted from pulmonary tuberculosis from which she had suffered for the past seven or eight months.

Dec 1912: Mrs. Sip Sipma of Newkirk died at her home Monday after months of suffering from tuberculosis. Deceased was born in this place 24 years ago.

May 1918: [this was the wife of the pastor of the Christian Reformed Church in Orange City, Iowa] the Rev. Mrs. R.L. Haan, 38 years old. She had seven children. The deceased was suffering from tuberculosis and when Rev. Haan in 1916 was called to Orange City, he accepted, hoping that the change of climate from Holland, Michigan to Iowa would be favorable to her health. Hope proved to be idle, when lately the patient became rapidly weaker and weaker and Saturday passed away.

Aug 1919: Miss Gertrude, the eldest daughter of Mr. and Mrs. W.H. Beacom, passed into eternity on Saturday at the paternal home after a lingering illness from the effects of tuberculosis. The young lady, age 21, had spent her childhood and girlhood in Sheldon and was graduated from the local high school in 1916. Not long after completing her education her health declined, and despite medical skill and the ministrations of kind hands and loving hearts the great white plague–always an insidious foe–proved victorious.

Nov 1912: Mrs. Mary vande Woude, wife of Dick vande Woude, whose death occurred at her home in Rock Valley of tuberculosis, removes from our community another splendid character in the noontide of life. She was 30 years. She resided continuously in Sioux County until her death. The past year her health became impaired, and for several weeks prior to her death she was the victim of intense suffering. She was married in 1906 and had 2 children.

May 1916: Henry J. Schumacher passed away at his home here after an extended sickness: cause, pulmonary tuberculosis. He was 31 years old. In the death of Henry Schumacher, the community has lost a good citizen, the home a kind and loving husband and father, the church a loyal and devoted son. Through his long sickness and suffering his unfailing patience and good nature was a source of inspiration to all.

So clearly, then, tuberculosis was not uncommon in the community in Iowa where the couple lived. They could have, with some regularity, read in their newspaper of young adults dying of the disease. No doubt there were people they knew from their church who either had the disease or who had people in their families with the disease. It doesn’t seem to have been a “taboo” subject, nor something that people necessarily kept hidden. Although “phthisiophobia” did exist (exaggerated fear of the presence of a consumptive), the community doesn’t seem to have shunned people with the disease, if their obituaries are any indication. Agnes was under the care of a doctor who saw her regularly, if for no other reason than to deliver her children: April 1913; May 1914; Jan 1916; Sep 1917. RJR’s Family History book indicates that all of these children were delivered by the same physician, Dr. Horton.

What would Agnes likely have been told about tuberculosis in 1913? First, she would very likely have been diagnosed by X-ray, a widely used diagnostic tool even in the early 1900s. (Pfahler, 1). Then, there was an available reference, easily readable for its audience of patient, nurse, social worker, or physician, was Tuberculosis: A Preventable and Curable Disease, by S. Adolphus Knopf, M.D., published in 1909. Throughout his comprehensive book, Knopf constantly emphasizes early diagnosis and the possibility of a cure. Although it’s unlikely that Agnes herself would have had a copy of the book, it’s to be hoped that her Dr. Horton would have been informed by this book or something like it. Additionally, Dr. Horton had an intelligent patient in Agnes, as she evidently had taken some sort of practical nursing course before her marriage in 1912.

So assuming “best case” and that her doctor carefully advised her about the disease, and her disease was caught at an early stage, here’s what Agnes would have been told:

  • There is every reason to be hopeful of a cure if the disease is caught in its early stages, and a patient’s condition can be greatly improved, provided the patient is placed under the careful guidance of a physician.
  • The tubercular patient must be exceedingly careful not to infect others or reinfect himself. Perhaps the most frequent cause of infection is the careless disposal of sputum containing the tuberculosis germs.
  • The cough as well as the sputum is also infectious due to the expulsion of small particles of saliva during coughing which may contain the bacilli.
  • Never kiss anyone nor allow oneself to be kissed. TB_dontKissAlso, Knopf advised tuberculous patients not to have children–or “obviously” to stop having children once they had been diagnosed. Also, a child should never be put to the breast of a tuberculous mother.
  • Patients were taught to control their cough, and cough only when they felt the need to expectorate. “A strong will can control a useless cough, which may otherwise become a habit rather than a necessity.”
  • Be hopeful and cheerful; avoid anxiety and worry as much as possible.
  • Have at least 9 hours’ sleep and retire early. If you have to work during the week and don’t get a sufficient amount of rest, remain in bed all Sunday morning.
  • Live as much as you can in the open air. Do not be afraid of cold weather. Remain indoors only on very windy and stormy days. The rest cure in the open air on a reclining chair can and should be taken in all kinds of weather. Take a bodily and mental rest on your comfortable reclining chair for about 30 minutes before and after the principal meals. Avoid all unnecessary exertions, mental or physical.
  • The most important curative agent is fresh, pure air.

Agnes and RJR chose to continue having children, despite her diagnosis. They chose to try to farm, both in Iowa and in Colorado, despite the fact that RJR never seems to have been very successful at it and despite his having marketable skills with his degree in bookkeeping, or, as he says in TD&H: “I finished a complete course in Bookkeeping, Stenography, Commercial Law, Banking, etc.”

I knew my grandfather, RJR, and I know that he had an overbearing personality (read: he was stubborn and although he had a very sweet side, he also had a temper and was sometimes a colossal jerk). I never knew Agnes, but her son, the Rev. Garrett Roorda, writes of her: “her courage and decisiveness in a crisis; her warm eyes of deep brown, looking at her family and the world with a steady gaze of intelligence and purposefulness.”

Why did Agnes keep having children? Why did they really move to Colorado? There are things about Agnes and RJR that I can never know for sure, but there are many things about them that, without knowing but based on research into her life, I believe to be true:

I believe Agnes continued having children, despite her diagnosis, because she thought it was her Christian duty to do so. I believe Agnes loved those children more than her own life–literally. I believe that RJR loved her very much and would have done anything in his power to keep her alive. I believe that Agnes agreed to move to Colorado because she wanted to move there, and not because she was somehow browbeaten or coerced into the move. I believe that even though the move to Colorado didn’t save his “darling” wife’s life, living in all that sun and fresh air might very well have saved him and his children from contracting the disease from her. I believe that he really (really) wanted to farm; that more than anything he wanted a farm with a herd of black and white cows like the ones back home in Friesland. I believe that RJR was often too stubborn and stiff-necked to ask (or take) anyone’s advice, and I believe that he often made poor decisions. I believe that, even though RJR was often knocked down and disappointed by life, he always had the courage and faith in God that made him get up and try again–every time. I believe RJR missed Agnes every day until the day he died.

Agnes_1920

The last photo I have of Agnes, taken surrounded by her family, summer 1920.

References

Knopf, M.D., Adolphus. Tuberculosis: A Preventable and Curable Disease. Moffat, Yard, and Company, New York, 1909.

Pfahler, M.D., G.E. The X-Ray in the Diagnosis of Pulmonary Tuberculosis. Philadelphia, 1905.

“Principal Causes of Death: Census Bureau’s Summary of Mortality Statistics for 1917.” Journal of Iowa State Medical Society, Vol. X, No. 6. Des Moines, Iowa, June 15, 1920. No Author. 179-181

Research Note

Two other sources I would like to spend more time with when I have a chance [both on my shelf]:

Ellis, Anne. Sunshine Preferred: The Philosophy of an Ordinary Woman. Houghton Mifflin Co., Boston and NY, 1934.

Ott, Katherine. Fevered Lives: Tuberculosis in American Culture since 1870. Harvard UP, Cambridge, 1996.

Advertisements
This entry was posted in Uncategorized and tagged . Bookmark the permalink.

One Response to Agnes Hoekstra and Tuberculosis

  1. Pingback: 52 Ancestors: #4 of 52 – Close to My Heart, Agnes Hoekstra Roorda (1894-1924) | The Shoebox Under the Bed

Leave a Reply

Fill in your details below or click an icon to log in:

WordPress.com Logo

You are commenting using your WordPress.com account. Log Out / Change )

Twitter picture

You are commenting using your Twitter account. Log Out / Change )

Facebook photo

You are commenting using your Facebook account. Log Out / Change )

Google+ photo

You are commenting using your Google+ account. Log Out / Change )

Connecting to %s