Date: 2014-08-01 08:04 am (UTC)
whizzy: (Default)
From: [personal profile] whizzy
There's a big pitfall when fans talk about historically accurate Steve Rogers, namely that the place where he lived was vastly different and in many ways far in advance of the rest of the country. (I am very sad for that meta going around which uses a reference from rural Texas to describe what Steve and Bucky's dating life would have been like in Brooklyn.)

I dug up some of this stuff when I was doing my prohibition-era fic, and the new stuff was just interesting, so apologies in advance if I went overboard.

In medicine, NYC led the country with things like establishing a board of health and a chief medical examiner. There's the NY Academy of Medicine operating since 1847 (which included a library open to the public), the country's first nursing school at Bellevue in 1873, The Rockefeller Institute for Medical Research since 1901 (and the first country's first clinical research facility in 1910). If I'm counting right, there four medical schools operating in the area before Steve was born and at least 9 hospitals in Brooklyn alone (that's probably a conservative estimate if you look at the list of hospitals that have closed).

The "social treatment" of asthma probably wouldn't have had much bearing on Steve for a couple reasons. He was living in a metropolitan area with a concentration of some of the best medicine in the country, and his mother was a nurse in a TB ward. That likely meant Steve had access to up-to-date medical advice and/or care. (I don't know if hospital fees might have been waived for relatives of needy employees, but I'd imagine that Sarah at the very least could consult colleagues at no cost or research on her own.) It also meant that Steve's primary caregiver was familiar with severe respiratory problems in general. So perhaps there should be a distinction, how society might have behaved toward Steve's asthma versus how his more experienced and (arguably) much better educated mother might have handled it.

The idea of asthma as an allergic inflammation (compared to a neurosis) existed as early as 1910. Two NYC doctors were experimenting with epinephrine/adrenaline and asthma patients in 1903. The treatment had caught on by 1905, and though it's not common it's still used today. Inhalation methods were around in the 30s but injection seems to have been preferred.

Basically, a modern approach to asthma and an effective treatment were in place before Steve was born.

It's entirely possible that they would know if Steve's asthma was triggered by something other than exercise, since there were studies by 1921 exploring the link between specific allergies and asthma. (Desensitization was a thing.) Another guy was doing protein sensitivity studies on kids in Harlem in 1922. (He later pushed recovery "camps" for asthmatic kids where they would be removed from environmental factors including family stress. The psychological aspect of asthma seemed to kick back in in the 40s with an article by French and Alexander about impaired mother-child relationships that I couldn't find the text for but sounds quite Freudian. This guy in '43 picks up with the psychological angle, but there's a good section on adrenaline as a treatment. Bonus: part of an article on the last page talks about an "asthmatic personality" and the case more than ten years earlier of kid who was "cured" when his overprotective mother stopped smothering him with anxiety and let him go play with the other kids. This article from 1947 compares treatment to 1931 and hits the neurosis angle as well.)

This article from 1933 explores early diagnosis by looking at other childhood ailments. (Steve wouldn't necessarily need to suffer acute attacks to be diagnosed.) This guy is kind of all over the place, describing a chronic "physically handicapped" condition but also claiming three in four outgrew childhood asthma and that fatal attacks were extremely rare. An abstract for a 20 year study (published in 1943) lists a bunch of potential treatment options, including epinephrine and some that were probably... less effective. I'd be curious to see the whole article.
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