Showing posts with label tuberculosis. Show all posts
Showing posts with label tuberculosis. Show all posts

Thursday, March 25, 2021

The Cup Cake Downfall of Dr. Koch, the Consumption Bug, and Popular Culture

                        Dr. Robert Koch at work in his laboratory.

Consumption, as it was then widely known, was a pervasive and enduring near world-wide epidemic that had no identifiable beginning or foreseeable end.  It brought slow, sure death to millions.  Most pervasive among the urban poor crowded together in fetid slums and the lowest levels of the rural peasantry whose large, multi-generational families often lived together in crowded hovels.

But consumption was no respecter of class privilege.  Those who read biographies of notables from the 17th to early 20th Centuries as well as literature from the same period are struck by the frequent references to the White Plague and its devastating effects.  Take, for instance, just the highly educated and largely affluent literary elite of Boston and the New England Renaissance.  Ralph Waldo Emerson saw a beloved brother, his child bride Ellen Louisa, and other friends and relatives succumb to the disease.  Theodore Parker was just one of several other leading figures of the Transcendentalist movement who died of it.  It was suspected to run in families—we would call it hereditary today—largely because devoted family members would tenderly nurse stricken kin giving them the long, close exposure we now know is necessary to transmit the disease.

In the 1938 weeper Three Comrades Margaret Sullivan dies beautifully, with self-sacrificing heroism of consumption in a mountain sanitarium leaving behind her grieving husband Robert Taylor, and his surviving World War I comrade Franchot Tone who also worshiped her.  Tragic death by consumption was a frequent theme of novels, plays, and film for generations.

The very memory of the disease haunted people even after it was on its way to being controlled.  Every movie goer knew that a cough in the first reel was certain foreshadowing of a tragic death bed scene in the last.

Consumption was commonly assumed to rise spontaneously, be caused by miasmas or foul air—and thus to be treatable by exposure to clean, fresh air in sanitariums away from the city—or, as noted, be hereditary.

On March 24, 1884 Dr. Robert Heinrich Herman Koch, Germany’s most distinguished physician and the Father of Microbiology published a paper sweeping away all of those suppositions and rendering them mere superstitions and as outdated in medicine as bleeding.  Consumption, or as he called it tuberculosis, was caused by a bacterium which he had isolated and named Mycobacterium tuberculosis.

Dr. Koch, of course, could not offer a cure for the dread disease, but by proving that it was a communicable infectious disease he laid the groundwork for eventual effective public health preventative measures and eventually treatment.  Infection rates began to decline in Europe and North America after World War I.  But it wasn’t until the development of the antibiotic streptomycin in 1948 that an effective treatment of the active illness was achieved.  That was followed by other effective antibiotics.

The development of a Tubercular skin test led to the discovery that many more people carry the infection in a latent, but communicable form.  Only 10-15% of those with latent infection get the active disease, generally when the immune system has been weakened by other illness, injury, and infection, or due to chronic malnutrition. 

By the turn of the 21st Century rates of active tuberculosis infections in the advanced industrialized nations had plummeted to near zero.  Most new reported cases involved immigrants and visitors.  Even high rates of infection in the Third World were coming down, albeit slowly.  Then in 2007 international rates began a sharp increase, particularly in sub-Saharan Africa and much of Asia.   Increases are blamed on the rapid development of anti-biotic resistant strains, tuberculosis as a secondary infection in those with HIV/AIDS, over whelmed and underfunded public health services in desperately poor and often politically unstable countries.  Drug resistance has even caused rates to begin to creep up in Europe and the U.S.

Internationally there were in 2012 8.6 million active chronic cases were, 8.8 million new cases diagnosed, and 1.20–1.45 million deaths, most of these occurring in developing countries.  Of these about 350 thousand occurred in those also infected with HIV.  That means that tuberculosis today is far more deadly than the widely reported panic infections of recent years until the Coronaviris struck down 2.7 million over the last 18 months.

Deadly Tuberculosis bacteria first isolated and identified by Dr, Kosh using the techniques and protocols that he invented and which are still the standard for microbiological research.

But back to Dr. Koch.  His breakthrough discovery, for which he was honored with the Nobel Prize for Medicine in 1905, was the result of years of work in microbiology and the development of his famous Four Postulatesfour conditions, all of which must be met, that prove any disease is directly caused by an identifiable microbe.

Robert Koch was born in Clausthal, Hanover, Germany to a middle class family on December 11, 1843.  A very bright child, he reportedly taught himself to read from his parent’s books and magazines before he entered school in 1848.  At gymnasium—the equivalent of high school but with higher academic standards than in America—he excelled in math and science.  Koch entered the University of Göttingen at age 19 where he studied natural science for two years before switching to medicine.

Even as an undergraduate Koch’s proclivity for research and laboratory work drew notice.  He was asked to assist Jacob Henle, a noted anatomist who had published a pioneering theory of contagion in 1840, to participate in his research project on uterine nerve structure.  The next year he was conducting independent research into succinic acid secretion at the Physiological Institute culminating in his lauded dissertation. Koch graduated medical school in January 1866 with the highest honors and a bright future ahead of him.

In the summer of 1867 Koch married Emma Adolfine Josephine Fraatz and they had a daughter, Gertrude, the following year.  In 1870 he was called away from his established medical practice and family to serve as a surgeon in the Franco-Prussian War.

Dr. Koch examining a sheep for anthrax.

After the war Koch turned his attention to research in various plagues which he was convinced were communicable diseases.  His first break through came with anthrax, the deadly disease that annually did major economic damage by infecting herds of cattle and other domestic ruminants.  He identified the cause, the bacteria Bacillus anthracis.  He also discovered that spores of the bacteria could remain dormant for long periods of time and become activated under optimal circumstances.  Koch used microscopy, including dyeing his samples for examination on a slide, and identifying agar as an ideal culture medium in which to grow specimens for examination.  These became the standard techniques for microbiological research to follow.

Even more important was his development of the Four Postulates based on his experience with anthrax.  The postulates are

1)      The organism must always be present, in every case of the disease.

2)      The organism must be isolated from a host containing the disease and grown in a pure culture.

3)      Samples of the organism taken from pure culture must cause the same disease when inoculated into a healthy, susceptible animal in the laboratory.

4)      The organism must be isolated from the inoculated animal and must be identified as the same original organism first isolated from the originally diseased host.

Even using more advanced equipment and techniques than Koch had available, modern epidemiologists employ these same criteria and methods.

Dr. Koch about the time he gained fame for his breakthrough identification of the anthrax pathogen, 

The isolation of Bacillus anthracis was the first time in history a specific microbe had been identified as the cause of a disease and thus gave strong support to the still controversial germ theory and was a nail in the coffin of outdated ideas like spontaneous generation.

Koch was widely acclaimed for his discovery and it led to his appointment as a professor of medicine and an administrator at Berlin University.

He next turned his attention to a disease that regularly erupted, especially in semi-tropical and tropical regions in devastating epidemics—Cholera.  Koch collected samples and did field research during epidemics in Egypt and India.  He isolated and identified Vibrio cholera.  It turned out that in 1854 Italian anatomist Fillipo Pacini had isolated the same bug but had not widely published his findings nor definitively identified it as the cause of Cholera.

On the strength of these achievements Koch was recruited as an advisor to the Imperial Department of Health in the newly consolidated German Empire.  It was during this time that he performed his research on tuberculosis and published his result in 1882.  It was the apex of a brilliant career.  Not only would he be awarded the Nobel Prize for this discovery but also the Prussian Order of Merit in 1906.  In 1908 with support of a gift of 500,000 gold Marks from American philanthropist Andrew Carnegie the Robert Koch Medal and Award was established to be awarded annually to the scientist who does the most to advance research and discovery in microbiology.  The criteria of the judges is said to be, “What would Robert Koch be working on if he was alive today?”

Dr. Koch created a scandal when he divorced his wife of 25 years to marry his much younger mistress, actress Emma Hedwig Freiberg.

In 1893 he ended his 25 year marriage to Emma after becoming involved with a beautiful and much younger actress, Hedwig Freiberg who he had been seeing as early as 1889.  Indeed his scandalous involvement with her may have led to a not entirely voluntary retirement from Berlin University in 1890.  Koch married Hedwig after his divorce.

Had it not been for the scandal Koch might have been as celebrated in America as his contemporary, the Frenchman Louis Pasteur. Certainly their accomplishments and advancement of modern medicine were at least comparable.  But the deep Puritanical strain of Americans would never allow that level of adoration for an open and unapologetic adulterer.

In the 1930 film classic The Blue Angel, nightclub singer Lola Lola--Marlena Dietrich--was the cause of the downfall and ruin of a distinguished professor--Emile Jannings--said to be modeled on Dr, Koch.

Their story is said to have inspired the 1930 German film Der blaue Engelshot simultaneously in an English version, The Blue Angel—and released by Paramount in the U.S.  The movie featured the fall of a distinguished professor played by Emile Jannings when he becomes infatuated by night club singer Marlene Dietrich in the memorable role that made her an international star.  The movie was based on Heinrich Mann’s novel Professor Unrat published in 1905 when Koch’s scandal was still in people’s minds. 

Ironically Jannings would go on to portray Koch is a German 1939 bio-pic.  The Nazi-era film was a propaganda piece celebrating the achievements of good Aryan science.

Luckily Koch’s fall was not as complete or lethal as the professor in the book and movie.  He accepted his major awards with Hedwig at his side.  She remained there until he died on May 22, 1910 as the health spa of Baden-Baden of a heart attack at 66 years of age.  He had been in declining health for years.

Tuesday, March 24, 2020

The Cup Cake Downfall of Dr. Koch, the Father of Microbiology

Dr. Robert Koch at work in his laboratory.


Note—The techniques and methodologies that modern epidemiologists used to identify and study the Coronavirus were developed more than 150 years ago by German physician Dr. Robert Koch.  But the legacy of his fabulous and storied career was endangered by a salacious sex scandal that inspired one a revered early talkie.
On March 24, 1884 Dr. Robert Heinrich Herman Koch, Germany’s most distinguished physician and the Father of Microbiology published a paper sweeping away all of those suppositions about common but lethal illnesses and rendering them mere superstitions and as outdated in medicine as bleeding.  Consumption, or as he called it tuberculosis, was caused by a bacterium which he had isolated and named Mycobacterium tuberculosis.
Dr. Koch, of course, could not offer a cure for the dread disease, but by proving that it was a communicable infectious disease he laid the groundwork for effective public health preventative measures and eventually treatment.  Infection rates began to decline in Europe and North America after World War I.  But it wasn’t until the development of the antibiotic streptomycin in 1948 that an effective treatment of the active illness was achieved.  That was followed by other effective antibiotics.

In the 1938 weeper Three Comrades Margaret Sullivan dies beautifully, with self-sacrificing heroism of consumption in a mountain sanitarium leaving behind her grieving husband Robert Taylor, and his surviving World War I comrade Franchot Tone who also worshiped her.  Tragic death by consumption was a frequent theme of novels, plays, and film for generations.
The development of a Tubercular skin test led to the discovery that many more people carry the infection in a latent, but communicable form.  Only 10-15% of those with latent infection get the active disease, generally when the immune system has been weakened by other illness, injury, and infection, or due to chronic malnutrition.  
By the turn of the 21st Century rates of active tuberculosis infections in the advanced industrialized nations had plummeted to near zero.  Most new reported cases involved immigrants and visitors.  Even high rates of infection in the Third World were coming down, albeit slowly.  Then in 2007 international rates began a sharp increase, particularly in sub-Saharan Africa and much of Asia.   Increases are blamed on the rapid development of anti-biotic resistant strains, tuberculosis as a secondary infection in those with HIV/AIDS, over whelmed and underfunded public health services in desperately poor and often politically unstable countries.  Drug resistance has even caused rates to begin to creep up in Europe and the U.S.
Internationally there were in 2012 8.6 million active chronic cases were, 8.8 million new cases diagnosed, and 1.20–1.45 million deaths, most of these occurring in developing countries.  Of these about 350 thousand occurred in those also infected with HIV.  That means that tuberculosis today is far more deadly than the widely reported panic infections of recent years.

Deady Tuberculosis bacteria first isolated and identified by Dr, Kosh using the techniques and protocols that he invented and which are still the standard for microbiological research.
But back to Dr. Koch.  His breakthrough discovery, for which he was honored with the Nobel Prize for Medicine in 1905, was the result of years of work in microbiology and the development of his famous Four Postulatesfour conditions, all of which must be met, that prove any disease is directly caused by an identifiable microbe.
Robert Koch was born in Clausthal, Hanover, Germany to a middle class family on December 11, 1843.  A very bright child, he reportedly taught himself to read from his parent’s books and magazines before he entered school in 1848.  At gymnasium—the equivalent of high school but with higher academic standards than in America—he excelled in math and science.  Koch entered the University of Göttingen at age 19 where he studied natural science for two years before switching to medicine.
Even as an undergraduate Koch’s proclivity for research and laboratory work drew notice.  He was asked to assist Jacob Henle, a noted anatomist who had published a pioneering theory of contagion in 1840, to participate in his research project on uterine nerve structure.  The next year he was conducting independent research into succinic acid secretion at the Physiological Institute culminating in his lauded dissertation. Koch graduated medical school in January 1866 with the highest honors and a bright future ahead of him.
In the summer of 1867 Koch married Emma Adolfine Josephine Fraatz and they had a daughter, Gertrude, the following year.  In 1870 he was called away from his established medical practice and family to serve as a surgeon in the Franco-Prussian War.

Examining a sheep for anthrax.
After the war Koch turned his attention to research in various plagues which he was convinced were communicable diseases.  His first breakthrough came with anthrax, the deadly disease that annually did major economic damage by infecting herds of cattle and other domestic ruminants and was transmittable to humans with gruesome and deadly results.   He identified the cause, the bacteria Bacillus anthracis.  He also discovered that spores of the bacteria could remain dormant for long periods of time and become activated under optimal circumstances.  Koch used microscopy, including dyeing his samples for examination on a slide, and identifying agar as an ideal culture medium in which to grow specimens for examination.  These became the standard techniques for microbiological research to follow.
Even more important was his development of the Four Postulates based on his experience with anthrax.  The postulates are:

1)     The organism must always be present, in every case of the disease.
2)     The organism must be isolated from a host containing the disease and grown in a pure culture.
3)     Samples of the organism taken from pure culture must cause the same disease when inoculated into a healthy, susceptible animal in the laboratory.
4)     The organism must be isolated from the inoculated animal and must be identified as the same original organism first isolated from the originally diseased host.
Using more advanced equipment and techniques than Koch had available, modern epidemiologists employ these same criteria and methods.


Dr. Robert Koch about the time he gained fame for his breakthrough identification of the anthrax pathogen,

The isolation of Bacillus anthracis was the first time in history that a specific microbe had been identified as the cause of a disease and thus gave strong support to the still controversial germ theory and was a nail in the coffin of outdated ideas like spontaneous generation.
Koch was widely acclaimed for his discovery and it led to his appointment as a professor of medicine and an administrator at Berlin University.
He next turned his attention to a disease that regularly erupted, especially in semi-tropical and tropical regions in devastating epidemics—Cholera.  Koch collected samples and did field research during epidemics in Egypt and India.  He isolated and identified Vibrio cholera.  It turned out that in 1854 Italian anatomist Fillipo Pacini had isolated the same bug but had not widely published his findings nor definitively identified it as the cause of Cholera.
On the strength of these achievements Koch was recruited as an advisor to the Imperial Department of Health in the newly consolidated German Empire.  It was during this time that he performed his research on tuberculosis and published his result in 1882.  It was the apex of a brilliant career.  Not only would he be awarded the Nobel Prize for this discovery but also the Prussian Order of Merit in 1906.  In 1908 with support of a gift of 500,000 gold marks from American philanthropist Andrew Carnegie the Robert Koch Medal and Award was established to be awarded annually to the scientist who does the most to advance research and discovery in microbiology.  The criteria of the judges is said to be, “What would Robert Koch be working on if he was alive today?”

Dr. Koch created a scandal when he divorced his wife of 25 years to marry his much younger mistress, actress Emma Hedwig Freiberg
In 1893 he ended his 25 year marriage to his wife Emma after becoming involved with a beautiful and much younger actress, Emma Hedwig Freiberg who he had been seeing as early as 1889.  Indeed his scandalous involvement with her may have led to a not entirely voluntary retirement from Berlin University in 1890.  Koch married Hedwig after his divorce. 
Had it not been for the scandal Koch might have been as celebrated in America as his contemporary, the Frenchman Louis Pasteur. Certainly their accomplishments and advancement of modern medicine were at least comparable.  But the deep Puritanical strain of Americans would never allow that level of adoration for an open and unapologetic adulterer.

In the 1930 film classic The Blue Angel, nightclub singer Lola Lola--Marlena Dietrich--was the cause of the downfall and ruin of a distinguished professor--Emile Jannings--said to be modeled on Dr, Koch.
The story of Dr. Koch and Hedwig is said to have inspired the 1930 German film Der blaue Engelshot simultaneously in an English version, The Blue Ange—and released by Paramount in the U.S.  The movie featured the fall of a distinguished professor played by Emile Jannings when he becomes infatuated by night club singer Marlene Dietrich in the memorable role that made her an international star.  The movie was based on Heinrich Mann’s novel Professor Unrat published in 1905 when Koch’s scandal was still in people’s minds.  
Ironically Jannings would go on to portray Koch is a German 1939 bio-pic.  The Nazi-era film was a propaganda piece celebrating the achievements of good Aryan science.
Luckily Koch’s fall was not as complete or lethal as the professor in the book and movie.  He accepted his major awards with Hedwig at his side.  She remained there until he died on May 22, 1910 at the health spa of Baden-Baden of a heart attack at 66 years of age.  He had been in declining health for years.


Monday, March 26, 2018

Looking Backward at the Utopian Socialism of Edward Bellamy

Edward Bellamy in 1889.

Edward Bellamy was a literary man of no great distinction.  Frail and tubercular, he had to abandon journalism as too strenuous and took up writing novels in a desperate attempt to make a living. The novels sold moderately, perhaps enough to eke out a living on the bottom rung of middle class respectability.  They had no particular merit or anything to distinguish them from hundreds of others published annually.  Certainly none would be remembered or read today.
Then he tried his hand at a social fantasy.  Overnight, it seemed he and his book Looking Backward were both famous and the center of an exciting popular reform movement.
Bellamy was born March 26, 1850 in Chicoppee Falls in western Massachusetts. He was the son and grandson of Baptist ministers.  A word about New England Baptists of this period.  Do not get them confused with today’s Southern Baptists.  Although Evangelical the Baptists were radically egalitarian and having been oppressed by the established churches of the Standing Order—the Congregationalists and, yes, the Unitarians—they reveled in the status of dissenters and outsiders.  Since members of the established churches tended to be first Federalists, then Whigs, and finally Republicans, Baptists tended to be Democrats largely out of loyalty to Thomas Jefferson and his steadfast devotion to Freedom of Religion.
After what public education Chicoppee Falls could offer and reading in his father’s library, Bellamy went off to Union College in Schenectady, New York.  For whatever reason, he dropped out of school after completing just two semesters.  He somehow found the money for a trip to Europe, spending most of his time in Germany, still the epicenter of romanticism and a hotbed of Biblical criticism and various socialist schemes.  It was enough to shake out any cobwebs of theological and economic orthodoxy he may have retained.
On returning to the States he seemed a young man at loose ends.  He tried his hand at reading law but quickly abandoned it.  He drifted into newspaper work.  Probably through connections from Union College, he found work at the New York Daily Post which was co-owned and managed by John Bigelow, an 1835 Union graduate and benefactor of the college.  Editor-in-chief, William Cullen Bryant, the noted poet and former abolitionist was also a vigorous advocate and defender of labor.  Although he did not spend long on the paper, as a young man absorbing influences like a sponge, it was formative.
Bellamy chose to move closer to home, taking a job with the most important paper in western Massachusetts, Springfield Union.  Now we come to the scene where, if this was a bio-flick, we would see Bellamy hunched over a desk, pen in hand.  Probably in his shirtsleeves with arm garters, cravat loosened, celluloid collar unhooked, hair a tad disheveled.  He is working furiously by oil lamp.  He coughs. Foreboding music swells.  He presses a handkerchief to his mouth, coughs again, and stares at the crimson splotch of blood on the cloth.  We know in an instant that he has consumption and is ultimately doomed.
In 1877 Bellamy went to the Hawaiian Islands for a yearlong rest cure.  Most New Englanders of the period were going south to places like Charleston or even Cuba.  A few were taking the long train trip to the desert southwest.  Bellamy’s choice was influenced by reading Mark Twain’s popular accounts of his time in the Sandwich Islands nearly a decade before.  He took to the palm trees, sea, and native girls.  He also took to writing.  He completed his first novel, Six to One while there. 
The book did not make much of a splash, but sold well enough to Bellamy to decide that he could no longer stand the stress and demands of daily journalism. 
In his second novel, Dr. Heidenhoff’s Process, published in 1880 Bellamy dabbled in some fantastic elements.  A doctor invents a process which can erase painful memories from the brain.  When the woman he loves is seduced and abandoned by a cad he uses the process on her.  She is cured and about to fall gratefully into his arms when the doctor awakes, realizes it was all a dream, and his beloved has committed suicide.  Pot boiler stuff.
In real life, despite his inevitably fatal condition, Bellamy fell in love and in 1882 married Emma Augusta Sanderson. Their marriage was apparently happy and produced two children, a boy and a girl.
After another novel, Miss Ludingto’s Sister, in 1884, Bellamy tried something daringly new.  Utopian novels were not new.  They dated back to Sir Thomas Moore’s Utopia published in Latin in 1516 which gave birth to the genre.   But such novels were not common.  Bellamy was probably inspired by the work of pioneer science fiction author Jules Verne whose work in translation from the French was beginning to be popular stateside. 
He was also well aware of a body of works on cooperative societies, Christian socialism, and even Marxism that included Charles Fourier, Robert Owen and Henri Saint-Simon, as well as to the Associationism of Albert Brisbane whom Bellamy had met in the 1870s.  Two more recent works were also influential in his thought, Laurence Gronlund’s The Co-operative Commonwealth in 1884, and August Bebel’s Woman in the Past, Present, and Future in 1886.

The First edition of Looking Backward: 2000-1887
In Looking Backward: 2000-1887 Julian West falls into a deep, hypnotic induced sleep in Boston in 1887 and awakens in the same city, but utterly transformed city in the year 2000.  He is introduced to his new surroundings by a kindly and scholarly Doctor Leete who regards the cut throat world of the 19th Century as a barbaric Dark Age.
In the new world all industrial production is controlled by the state and it products shared equally among the population.  Technical innovation has greatly reduced the hours of labor needed to produce any item and distribution though common warehouse like stores has cut out layers of middlemen and the goods are delivered to the door.  Everyone is paid in equal credits on which they can draw to purchase the necessities of life and access to enriching culture.  Those doing hard physical labor work a few hours a day.  Those whose work requires intellectual rigor and specialized training are rewarded with even fewer hours.  Everyone retires at age 45 with the same guaranteed benefits as working members of society.

These lines from Looking Backward sumarize its central theme,
With all of the extra leisure, everyone has the opportunity to enjoy the arts.  Symphony concerts and lectures by the greatest minds in the world are delivered to homes over the telephone lines in a manner later readers have compared first to radio and more recently to the internet.
Most people eat daily at communal dining halls where nutritious meals are deliciously prepared by expert chefs.  Travel is provided on free public transportation.  Despite these communal aspects to society, every family has their own comfortable home with the privacy that entails.
On the social level, women are respected and treated as equals and partners both professionally and in the home.  Most crime, which arose out of want, privation, and ignorance, has been eliminated.  Remaining crime is considered the result of disease and atavism, a tendency in some to revert to a savage ancestral type.  These conditions can be medically treated.  What criminals exist are tried by a triumvirate consisting of a chief judge, a prosecutor, and a defender, all of whom must ultimately agree on a sentence after dispassionately reviewing the evidence and the accused’s  prospects for ultimate rehabilitation.
In dialog, one by one West brings up objections to the new order, asking pointed questions and Dr. Leete patiently explains the near perfection of the new system.
West arouses from his slumber, but is convinced that he has been shown the future:
I had visited a world incomparably more affluent than this, in which money was unknown and without conceivable use.... These exchanges money effected—how equitably, might be seen in a walk from the tenement house districts to the Back Bay—at a cost of an army of men taken from productive labor to manage it, with constant ruinous breakdowns of its machinery, and a generally debauching influence on mankind which had justified its description, from ancient time as the “root of all evil”.          
Bellamy shied away from, but did not totally shun, the use of the word socialism which then, as now, was burdened with political and social baggage.  He preferred to call the system he described as Nationalism because all of the means of production and distribution had been nationalized.  This is not to be confused with the use of nationalism as the exhalation of the nation state in its fierce, self-interested  completion with all other nation states.

Bellamy was idolized by his followers
No one was more astounded than Bellamy, who at first insisted that he did not mean to spark a social revolution only to offer “a literary fantasy, a fairy tale of social felicity,” when the book became an overnight sensation, flying off shelves faster than the publisher could issue new editions.  There were not then whole books shops filled with alternative universes and visions of the future.  This was new and exciting to most readers.
It also struck a deep chord in a nation that was in the midst of a brutal ongoing class war  in which the capitalists and bosses offered no quarter—11 years after the era began with the Great Railroad Strike of 1877 and just two years after the launch of a national movement for the Eight Hour Day and the Haymarket Affair.
Literate workers were inspired by any vision of a socialist utopia.  The middle class, particularly the educated elite, were charmed with a vision of socialism that did not seem rooted in the implacable class conflicts of Marxism, but offered a cooperative solution that erased class differences without destroying comfortable civilization.
How popular was Looking Backward?  In the little more than a decade remaining in the 19th Century, it became the second most widely read American novel, trailing only the ante bellum Uncle Tom’s Cabin, and edging out the wildly popular Ben Hur by Lew Wallace published in 1880.
Overnight Bellamy and Nationalist Clubs sprang up first to discuss the ideas in the book and quickly to find ways of implementing them.  By 1890 there were more than 160 such clubs all around the country.  Among the leading intellectuals that were involved were heavy weights like William Dean Howells and Edward Everett Hale. Eugene V. Debs, Grand Secretary and Treasurer of the Brotherhood of Locomotive Firemen and other labor leaders were also attracted.
At first Bellamy held himself aloof from the movement he had inspired.  But within a year he became energized with the idea that his Utopia might just be achievable.  He threw himself into the movement, touring and speaking widely and writing articles in many of the top publications in the country.  In 1891 he established his own magazine, The New Nation as an organ of the movement.
Bellamy believed that political action by an educated leadership could usher in his vision of socialism.  He and many of his followers threw themselves behind the new People’s Party or Populists as a vehicle for that transformation.  After a while efforts of the Nationalist Clubs and the People’s Party became so enmeshed as to be indistinguishable.  Many elements of the Nationalist program did make it into the Populist’s platforms.  But there were also other forces and visions at work, especially the agrarian populism growing out of the Grange Movement, remnants of the Green Back Party, and followers of Henry George, exponent of another popular reform plan the Single Tax.
Meanwhile the class war was only getting uglier with the Homestead Strike of 1892, and industrial warfare in the coal fields and Western metal mining districts.  Labor leaders like Debs were growing disenchanted with the Nationalists gradualist approach and the reliance on middle class leadership rather than working class self liberation. 
The coalition behind the Nationalist movement began to fall apart almost as quickly as it formed.   Bellamy had to close The New Nation in 1894 for lack of revenue.  Most clubs had dissolved.  Working class militants looked increasingly to Marxism and the middle class looked for milder reform models.

Bellamy's vision of complete moral, political, and social equality of women was perhapsis  more deeply radical than his socialism.  Which may be why Equality was not nearly as popular as his Utopian novel.

By 1895 Bellamy, increasingly fragile, retreated from active political activity.  He dedicated himself to writing a sequel to Looking Backward that would concentrate on his vision of equality of women.   Equality expanded many of the themes of the first book.   But its time had already passed.  It sold moderately well to devotees, but was not a huge success.
It was Bellamy’s last effort.  On May 22, 1898 he succumbed at last to tuberculosis in the ancestral home in  Chicoppee Falls where he had long lived with his wife and children.  He was only 48 years old.