The Black Angels

Lost Women of Science Conversations: Black Angels

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‍Virginia Allen: Well, I wasn’t aware that I was actually walking into a dangerous situation… I worked here when tuberculosis, there was no cure. I was here when the cure was discovered. But, looking back on it, I’m very happy that I was able to help. 

Carol Sutton Lewis: I'm Carol Sutton-Lewis, a co-host of Lost Women of Science. And this is the first episode from a new series we're calling Lost Women of Science Conversations. There are many great books about women in science whose stories we won't be able to tell. So we thought, why not have the authors of some of these stories come on the podcast and talk to us about them?

In the early 1900s, tuberculosis once called the plague of plagues was a leading cause of death nearly as deadly as pneumonia and influenza. And for this episode were delving into the story of the Black nurses involved in developing life-saving treatments for this disease. So, I’m delighted to welcome Maria Smilios, author of The Black Angels: The Untold Story of the Nurses Who Helped Cure Tuberculosis.

Hi Maria, thanks for joining me today.

Maria Smilios: Hi, good morning. Thank you for having me.

Carol Sutton Lewis: To start, I wanna go back to the voice you heard at the top of this episode, the voice of Virginia Allen. Virginia is one of the nurses who worked at Sea View, a hospital in Staten Island, New York, dedicated to treating tuberculosis patients who didn't have other options. It's the hospital at the center of Black Angels and Virginia, who is in her early nineties now is one of the last of these nurses still alive.

Virginia Allen: And I’m happy that you’re doing this interview… because it embraces the legacy of all of those nurses who made such a big sacrifice to be here and work with patients who had little hope and were so desperately ill.  

Carol Sutton Lewis: So first off, can you just tell me how you connected with Virginia Allen and how this project got started?

Maria Smilios: In August of 2015, I was working as a science editor and I was editing a book on rare lung diseases, and I came across a line that said the cure for tuberculosis was found at Sea View Hospital. I love stories about disease and how they move through the city, and I didn't know anything about this cure and this hospital. And so I Googled it and up came an article about the cure in Sea View, but tucked alongside of it was another article about this cohort of black nurses called the Black Angels. And it was featuring Virginia Allen and another nurse that has since passed. So I, I started Googling Virginia Allen tuberculosis and nothing came up and a couple of days later I called the Staten Island Museum and asked them if they knew her and they told me they did. And we met, we started talking. And then she invited me to her home and she lives in the Restored Nurse's residence, which sits in the middle of the abandoned Sea View complex. So when you walk out her door, 500 feet in front of you are the hollowed-out buildings of what used to be the adult pavilions and the children's hospital.

And we began walking around and she pointed to this building and that building and started to tell me parts of the story that she recalled.

Carol Sutton Lewis: And, and the story really came alive for you. I'm sure.

Maria Smilios: That that was the moment when it became real. Because there I was walking around these grounds where the story began and it lived for many, many years and continues to live with Virginia because she's living in this nurse's residence where she lived when she first came in 1947 on the same floor in a different apartment.

Carol Sutton Lewis: That's amazing. 

Maria Smilios: That’s pretty extraordinary. 

Carol Sutton Lewis: So you're back at Sea View with Virginia looking at these pretty decrepit buildings, but I wanna take you back in time before Virginia worked at Sea View back in the early 1900s when Sea View first became a tuberculosis sanatorium. Why was this massive hospital built on Staten Island to treat tuberculosis patients?

Maria Smilios: The, the idea for Sea View happened in the turn of the 20th century when tuberculosis was ravaging New York City. And so I want you to picture a time where it was the dawning of public health in New York, when immigrants started to pour into the city by the thousands each day and many of them found their way to the lower East Side of Manhattan. The lower East Side is about two square miles, and at the time it had 80,000 five-story tenement buildings. These were multigenerational homes. Sometimes you had ten to 12 people living in these tiny apartments that were about 300-square-feet. As the famous journalist, Jacob Reiss said they were quote, fever breeding structures. 

Tuberculosis, the microbe itself is beautifully rendered to torture and kill slowly. It thrives in dark and cool places. And so it found a home in the tenements where there was no ventilation. The single windows that existed in these apartments usually overlooked an air shaft, and the air shafts were piled high with garbage.

Carol Sutton Lewis: Ah, that sounds terrible. No wonder people didn’t want to open their windows.

Maria Smilios: And so people started getting sick. And the people in charge of public health or the inception of public health did not like the immigrants. They thought they were, quote, uncouth, immoral, indigent consumptives who were making everyone else sick. And so what they wanted to do was find a way to quarantine them and excise them from the city to keep the city safe and healthy. So Herman Biggs, who was the head of public health at the time, he was determined to see this through. He knew the only way to do it, to cut the death rates down was to try and get rid of the people who he believed were spreading it. They did not look at the fact that the living conditions were part of it. The idea of germ theory was still, again, in its nascent stage. So he went to the city and he said to them, look, you have all these people living down here. We're never going to eradicate it. We need to build a hospital and to quarantine them.

Carol Sutton Lewis: So Maria Smilios, let me interrupt you for just one second to back up just a bit for listeners who aren't so familiar with the actual disease of tuberculosis can you talk a little bit about what it does and why it was so dangerous that so many people were being infected with it?

Maria Smilios: Tuberculosis is a deadly disease. Back then, where they had no antibiotics, it was considered a death sentence, and it stirred people's most potent fears. Physically the microbe replicates itself at a very slow rate. Unlike E. Coli that replicates within 20 minutes and you become sick very fast, the TB microbe replicates once every 24 hours, and so it begins to burrow itself. For example, let's say it goes into the lungs, it will burrow itself for weeks or sometimes months before you begin to have symptoms, and by the time you are diagnosed with it, you're pretty sick. That's what it physically did.

However, it was also a disease that stigmatized and ostracized people. If you had tuberculosis in your community, nobody wanted to be around you because they feared getting sick. But it was also conceived as a disease of being immoral, of doing something wrong. 

Carol Sutton Lewis: Yes, you mention in the book that people who were sick with tuberculosis were seen as quote “morally bereft spreaders of disease.”

Maria Smilios: And so when the city wanted to build Sea View Herman Biggs capitalized on this idea and turned the disease into a sort of like racialized microbe. I'm going to attack this socioeconomic class of people who are poor and because they're poor, they're immoral, they drink, they don't abide by American customs. The other population that was disproportionately affected were African Americans in Harlem. They were dying at three times the rate of white people. So you had these two populations that were considered second-class citizens.

Carol Sutton Lewis: So, Herman Biggs he says, let's round them all up and send them to Sea View, which was a hospital located in Staten Island. Okay, so now horrifically, everyone is rounded up and sent there. And then what happens? Virginia Allen had mentioned that the nurses like her answered the call to work at Sea View when the white nurses refused. So there's this influx of TB-ridden patients and the white nursing staff starts to leave. Is, is that right? 

Maria Smilios: Yes. So Virginia Allen's call was what I say in the book, it's a second call to nurses after World War II when the war created another nursing shortage. The first call happened in 1929, which is when her Aunt Edna answered the call. Back then white nurses began leaving Sea View Hospital for a variety of reasons. 

They were tired of seeing their colleagues fall sick and die. That was probably the main reason. But given that it was the end of the 1920s, white working women had a lot of options for jobs that wouldn't kill them. They could be secretaries, they could be librarians. New York telephone company had opened this gorgeous Art Deco building that was employing telephone operators, and so they decided to get jobs that were not in the health profession, or if they did, they transferred hospitals.

So the city was now in a crisis. They were either going to shut Sea View down and turn loose–it was almost at the time, a thousand patients that were gravely ill– or they were gonna fill the ranks. So somebody had an idea, how do we do this?

Carol Sutton Lewis: So tell us what they did.

Maria Smilios: They looked at the great migration and they said, this is working to bring up laborers. And they said, we can do something like this with nursing. At least we could give it a try. There were plenty of Black nurses down south who were un- or underemployed because of Jim Crow. You know, the same country that drew lines around water fountains and bus stations and waiting rooms also drew them around hospitals. White hospitals preferred to remain understaffed instead of hire black nurses. So you had this plethora of unemployed black nurses and the city puts out this call and says, we're gonna promise you good pay, a steady job in one of New York's integrated hospitals. We're also going to give you an opportunity to have a professional career and to leave the Jim Crow South.

Carol Sutton Lewis: Your book, beautifully details how women who wanted to be nurses or that dreamed of leaving the Jim Crow South suddenly had this amazing opportunity and made their way to New York City where they could get additional education at Harlem Hospital if they weren't fully trained or go directly to Sea View.

So while the white nurses were fleeing seeking those other jobs, you mentioned these Black nurses were looking at this as an opportunity to experience a world where you didn't have to sit at the back of the bus and pursue their nursing dreams. So many of them came to Sea View. So lemme just ask you a quick question though. Back to the disease of tuberculosis for a minute. So we’ve heard how horrific it is. What were doctors doing at Sea View at that time to treat tuberculosis?

Maria Smilios: Unfortunately, this was the pre-antibiotic era. There was no real treatment or remedy or cure. If you got it, you got it. And the best thing that they could do was what they called the rest cure. So you went outside and it was fresh air and sunshine. In the beginning of 1930, surgery started to become a gold standard, and they were doing these surgeries called an artificial pneumothorax, which is they were purposely collapsing your lung. The idea behind this was that tuberculosis thrives on oxygen. And so if you take the oxygen away, the microbe dies, and hopefully you would be cured if you killed enough of those microbes. 

Carol Sutton Lewis: Oh, and this is major surgery that these nurses were attending. I mean, you write of the all of the work that the nurses had to do, which brought them in very close contact with all of these diseased patients. So I, I wanted to ask you about that. You know, I, you've talked about the amazing opportunities this presented for the Black nurses coming from various places in the … 

Maria Smilios: There were no masks. There were no gowns. The nurses had no protection and they, they were at bedside and they were in the wards where you, these were open wards. These were not private rooms. So I want people to think about a room, and on each side you had a bed, a nightstand, a bed, a nightstand, and then beds down the middle. So you imagine 30 or 40 people breathing live microbes. It was everywhere.

Carol Sutton Lewis: So this is the circumstance that the white nurses were fleeing as well. This was a dangerous environment. But on top of this, the black nurses they were potentially in danger after they left the hospital because despite the fact that they were in the North where there wasn't Jim Crow, they experienced a lot of racist behavior in the hospital from some of the patients even, and in the neighborhoods they lived in as well. Can you talk a little bit about that?

Maria Smilios: Staten Island did not welcome these nurses. The KKK had a big presence on Staten Island during that time. They did not want African American people moving into their space. So I talk about this in Chapter Five. I called it Contagion on the Island, because one of the nurses said they not only believed that we were contagious, but from our skin, we were contagious, that we were going to infiltrate their island.

Carol Sutton Lewis: And even within the administration of the hospital, as you say, there was not a lot of support for these Black nurses who were enduring this additional danger of work. And they experienced, even within the hospital, you tell a really compelling story about a patient who so did not want a Black nurse to take care of them. Can you talk a little bit about what that nurse had to endure?

Maria Smilios: One of the nurses that I talk about, Missouria Louvinia Walker-Meadows, came from Clinton, South Carolina by way of Howard University. She was hired and they gave her a job on the men's ward, which was notoriously a dangerous place. I interviewed somebody who worked under Missouria. And he told me to think of the men's ward as a body bar.  Men often snuck out. They drank, they came back drunk, they got angry. So the nurses that were put on this ward had to endure the temperament of men who were fist-fighting a lot.

In 1944 this patient shows up. He's a Nazi POW. And because he had TB, he was sent to Sea View and put on Missouria's ward, and he hates her. He wants her to die and she spends eight months taking care of this man. He was one of the most reviled men in the United States. He was a Nazi, he was an enemy, he was a POW. The United States was paying for his care, and he managed to find one person in the world that the United States saw as beneath him, this Black nurse. And so he got away with all of this. Nobody thought, let's transfer him out of there.

Nobody thought, let's come and help this woman who is being berated and has to deal with this man every single day.

Carol Sutton Lewis: More after the break.

Carol Sutton Lewis: Now Maria, let's talk about the nurses’ involvement in the development of the cure for this disease. So first can you talk about how the move from removing ribs and puncturing lungs in the 1940s to the role of these Black angels played in helping find and develop a cure.

Maria Smilios: A soil microbiologist by the name of Dr. Selman Waksman, he was from Rutgers University, is working with a graduate student, Albert Schatz, and they discover this drug, which is subsequently called streptomycin, and it becomes the first antibiotic to actually fight the microbe. The problem with streptomycin was that it's short-lived, it only worked for four months. What it did was created an urgency to find something that really would work. And so fast forward in 1951, the labs at Hoffman La-Roche, which were only about 12 miles from Sea View, one of their researchers, a guy by the name of Herbert Fox, he was known as kind of a maestro of molecules,  discovers isoniazid or rediscovers isoniazid because as people later learn, the drug is unpatentable because it had been discovered in 1912 by two Austrian chemists working on a Ph.D. And so the, the cure for TB was sitting on a shelf, collecting dust. So he rediscovers this formulation isoniazid that fights the microbe, and they test it on animals at Hoffman La-Roche. And they call Sea View and they say, you know, this drug we've been testing has been working on these animals. Would you like to test it on humans?

When they called to ask about this drug trial, Dr. Robicek, who oversaw the trial with his colleague, Irving Selikoff, said, yes we will do this. And so the criteria had to be that death was imminent, that every other possible medication or form of treatment had been tried. And so they picked five patients, to start the patients were asked their consent, they were told, you're dying. Death is imminent. We have this drug that might help you. Do you want to participate in it? All of them said yes. One woman said, had they offered us arsenic, we would've taken it. And that just goes to show you how desperate people were to live. You know, it's no different. Now you say to somebody, we have a clinical trial that may help you.

This is where the nurses come in. And when I interviewed Dr. Robicek's son, he told me, my father always said, if quote, “it wasn't for those black nurses, none of this”, this meaning this trial “would have been possible.”

Carol Sutton Lewis: Mm-hmm.

Maria Smilios: The reason is these nurses had been working at Sea View for decades. They knew the disease intimately. They knew how it ebbed and flowed. They knew its moods. They knew how in one minute somebody could appear, okay, and the next minute they could be hemorrhaging. All of these nuances became really important because when they gave them the drug again, it was the first time human beings were taking it. The nurses were tasked to be at bedside. Robicek could only be in one place at one time for a certain amount of time. He was not. Doctors don't do bedside. They don't do it now. It's the nurses. And the nurses knew these patients. One of them had been on Missouria's ward for many years. So in addition to taking the daily vitals and actually administering the medication, they looked at the emotional and physical state of these patients.

What were their moods? Were they physically showing any outward symptoms, bruising swelling? Were they getting jaundiced? The story that I like to tell, to show how meticulous these records were, the nurses began to notice that people were twitching in their sleep. So just to give you an indication, how many eyes were on these patients? Eventually, the trial went to ninety-two patients. So we're, we're looking at these nurses overseeing ninety-two different people.

They would write down all their observations and at night, at the end of the day, Dr. Robichek and his colleague would collect them and then go into a room and collate them. So if you think of a spreadsheet, they started to see patterns. And this is how they began to understand how this drug was working because the nurses observed what was happening. And this is where Robichek said, had it not been for them, none of this would've been possible. All that data came from them.

Carol Sutton Lewis: Hmm. It, it enabled them to figure out proper dosage and to understand what side effects were, and the length of the side effects. So these women were integral to the process of this experimental drug becoming what is now known to be the cure for tuberculosis.

Maria Smilios: Absolutely. It was the gold standard. It still is used isoniazid. It's used in combination. It took them eight years after to tweak the drug and finally close Sea View. And so these women basically worked themselves out of a job. They figured out that isoniazid worked best as a cocktail, as part of, it's a multi-combination drug. So they, they went on to save tens of millions of lives.

Carol Sutton Lewis: Wow. It's such an amazing story and so amazing as well, that it's a story that we've not heard of until now. That is a story of these black angels helping to find the cure. And so that actually leads me to something else that I wanted to chat with you about, and that is the process of telling this story.

You say in your notes to the readers at the beginning of the book, that you recall your earliest meetings with Virginia Allen, and she was your way into the story. And when you, she asked that you tell the story, you asked if there are archives, and she said, no, no archives. No records. No documents. No letters. Now tell us how you as as a journalist, as someone who wants to tell a story, how did that hit you and what did you decide to do then?

Maria Smilios: Well, when she told me that, I thought, what am I gonna do? I have to, this has to be based on oral history, and I knew that if I wanted to get the story, it would require me talking to not only Virginia, and Virginia really remembered when she came, but I said this story starts way, way before.

So she gave me the names of families. Missouria’s is family, for example. Dr. Robicek's son had the trial records and he had the names of the patients. And so I began calling people and I tracked down two original trial patients. I wanted the book to read like a novel. I knew I wanted a scene set heavily. So I asked them questions like, what color nail polish did Missouria wear? Did she file her nails? What shape did she file them? These very minute questions that make individuals who they are. What did she do when somebody died? What were the Bible passages that your mom would turn to again and again? How were they treated? And I’m not saying you don't have to cross-check and I, I will stress this. When I came to this project, we decided with my editors we were going to honor the lived experience of people who were part of Sea View. So for example, Virginia remembers her time on the children's ward very differently than what the nurse's log said. And so I was able to honor her lived experience in the book, but also say, Hey, this is the way the other nurses were chronicling it.

Carol Sutton Lewis: Hmm. So what would you say to listeners about the importance of chronicling stories? What, what can people do now who have stories that they think are worth saving? What should they do in terms of documenting them?

Maria Smilios: So I made the fatal mistake of not doing this. I come from an immigrant family. My grandfather had fled what was at the time Constantinople. It's now Istanbul.  I did not record these stories. I should have recorded them. And I think it was because I heard them again and again. And I tell people, you will hear your familial stories again and again, and they will be boring to you. And they're not. They're history. They're part of your history. And whether you write a book or not, they're important to pass down because this is how history becomes misconstrued and gets lost by the people who have lived it and are telling us their experience.

For example, like Virginia, and it, it doesn't get recorded.

Carol Sutton Lewis: So, you know, as we close here, I I'm glad you, are talking about Virginia again, because I'm gonna return to her because she was key to your ability to tell the story. I mean, she asked you to tell the story. So can you say what it's been like to have the opportunity to get to know Virginia Allen over the course of writing this book and to share her story and the story of the Black Angels with the world?

Maria Smilios: It's been life-changing. It's been heartening in so many ways to be able to see a story that was important to her and to the families come out into the world. Somebody asked her, what would you tell these nurses now? And, and she said, I would tell them that you're being seen. And that was very powerful for me because this was a person who experienced something that was terrible. You know what those nurses saw on those wards? It's unimaginable. I mean, you wanna talk about PTSD. And every family said they never thought about it. They just did their job. They went to work. And so it's, in many ways, it's been humbling. It's been fantastic. She's happy that the story is finally out there and that all of these women that were so meaningful in her life are finally getting the recognition they deserve, and I hope they get more and more recognition.

Carol Sutton Lewis: Well, Maria Smilios, thanks to your great book, Black Angels: The Untold Story of the Nurses Who Helped Cure TB, they will be. And with that, I wanna thank you so much for joining us on Lost Women of Science. 

Maria Smilios: Thank you so much for having me. It's been a pleasure.

Carol Sutton Lewis: This episode of Lost Women of Science Conversations was hosted by me, Carol Sutton Lewis. Our thanks go to Maria Smilios for taking the time to talk with us. Sophie McNulty was our producer and sound engineer. Lizzy Younan composes all of our music. Keren Mevorach designs our art and Lekshmi Santhosh vetted the science for us. Thanks to Jeff DelViscio at our publishing partner Scientific American, and thanks also to our executive producers Amy Scharf and Katie Hafner as well as to our senior managing producer Deborah Unger. Lost Women of Science is funded in part by the Alfred P. Sloan Foundation and the Ann Wojcicki Foundation. We are distributed by PRX. Thanks for listening and do subscribe to Lost Women of Science and lostwomenofscience.org so you’ll never miss an episode.