A skiagram of the chest, showing miliary mottling, suggestive of Pulmonary Koch’s Disease in both lungs. there is also an opacity of the right upper lobe suggestive of active pulmonary disease. Patient was an 84 year old man, with a long history of TB for the treatment of which he was a multiple defaulter. The patient presented to the ER with severe respiratory distress and this skiagram was obtained. Nebulization with inhaled Bronchodilators and steroids and high flow moist Oxygen inhalation ameliorated the respiratory distress. The sharp costophrnic angles rule out pleural effusion.
Photo Credits: Author, Patient Consent: Obtained
“Voice hoarse; neck slightly bent, tender, not flexible, somewhat extended; fingers slender, but joints thick; of the bones alone the figure remains, for the fleshy parts are wasted; the nails of the fingers crooked, their pulps are shriveled and flat…nose sharp, slender; cheeks prominent and red; eyes hollow, brilliant and glittering; swollen, pale and livid in countenance; the slender parts of the jaws rest on the teeth, as if smiling; otherwise of cadaverous aspect…”
–De causis et signis diutornorum morburum, Aretaeus
Translated by Francis Adams
The history of mankind has been very closely entwined with the rise and fall of infectious diseases. Dramatic, hyperbolic accounts of plagues, pestilences and epidemics decimating human habitations abound in the texts of yore. Some, like the Bubonic Plague, inflicted a short course of intense illness, concluding in certain death, whilst others, like tuberculosis slowly set about destroying the body and death came slow, but sure. Understandably, while the Black Death is viewed with unmixed fear by the contemporary historians and literary accounts, tuberculosis, the White Plague, elicits a more complex response.
The association of tuberculosis with the human civilization is so old that it is practically impossible to trace the source or the index case for this disease. Predating the ancient age, this protohistoric companion of human civilization has therefore, had a huge impact on the art, literature and, of course, science down the ages. In this article, I will try to take a brief look into the impact of tuberculosis on the human civilization, especially on its art and literature. I endeavor to find some examples of literary evidence of the disease and try to analyze how a lethal and painful disease reached a cult status at one point of time.
The aftermath of the Renaissance was a rapid dissemination of interest in the arts and sciences. With the great intellects involved in the pursuit of knowledge, there was an explosion of new information, developments. Riding the tide was an industrial revolution and economic prosperity the likes of which the world had never witnessed before. This sudden growth led to a spurt in the population, leading to more congested cities. More people were traveling from the countryside to seek better lives. With the industrial revolution came the new working class, who, more often than not, lived in poverty in congested, crammed up parts of the city with poor sanitation and sewage system. And secondary to the boom, there was the inevitable gulf between the rich and the poor. Indeed, it was an ideal medium for the disease to spread. Let us keep in mind this socio-economic-intellectual backdrop as we move in to discuss how the disease affected the lives and works of some of the greatest minds of the time.
“’Tis called the evil…
Strangely visited people,
All swol’n and ulcerous, pitiful to the eye
The mere despair of surgery…”
– Macbeth, Act 4, Scene 3. 167, 171-3
Any discussion that touches on English literature and leaves out Shakespeare is incomplete. And that is probably more apt in this case, since few non-medical authors were so well-informed on medical topics. There are sparse, if vivid, descriptions of a “phtisick” “wasting disease” that caused “lethargies” and finally killed people of “rotten lungs” in many of his plays.
Contemporary English literature is rife with examples of consumptive protagonists fading away to death. The authors of the period seemed to be much attracted by the concept of a pale and fragile beauty that was like “pale primroses that die unmarried…” (The Winter’s Tale, William Shakespeare). The concept caught on fast and the maidens of the day would use white rouge to attain a pale complexion and drink vinegar to kill their appetite to become reed thin and wasting.
Another favorite stereotype of the Victorian authors were the consumptive children who would appear like pale and wasted fairies into the lives of their parents and enthrall them for a short while before tragically dying in denouements with tear-jerking climaxes.
Samuel Richardson, the author of the first English novel in 1740, kills Clarissa, the protagonist of the eponymous novel, from consumption. Even earlier, Swift describes chronic consumption “whose tainted breath destroys unhappy infants” (The Tale of a Tub: 1689). The Bronte sisters and Jane Austen have enthralled audiences with their themes of tragic love affairs which spiral to melodramatic, often unrealistically happy endings after rollercoaster rides on emotional paroxysms. Helen Burns in Jane Eyre (1847), “the wasted flesh” of Shirley (1849) and numerous other characters had “faded like any flower in drought” due to consumption much like their procreators, who were themselves afflicted with the same disease.
Doctors who made successful forays into the domain of literature remain some of the most accurate chroniclers of this disease. Smollet, a failed physician of a rather volatile disposition, and a long time patient of tuberculosis himself, describes the disease very closely. Anton Chekhov, the author-physician who admitted that “medicine is my lawful wife and literature my mistress” has confided to his mistress, through numerous characters, the sufferings he went through before succumbing to tuberculosis himself in 1904.
Even in the French literature, the disease left an indelible mark, with some masterpieces being centered around it. Some of the landmark novels included Dumas’ La Dame aux Camelias, Murger’s Scenes de la vie de Boheme, Victor Hugo’s Les Miserables, the Goncourt brothers’ Madame Gervaisais and Rostrand’sL’ Aiglon.
In his memoirs, Alexandre Dumas notes:
“… it was the fashion to suffer from the lungs; everybody was consumptive, poets especially; it was good form to spit blood after each emotion that was at all sensational, and to die before the age of thirty…”
Poets have typically been the mystics of the literary world. It seems that the poets who were afflicted with tuberculosis were more inclined to write on themes dark and melancholic. Almost as if the mood of their poetry was set by the state of their diseased bodies. The assumption was that, as consumption slowly but surely destroyed the body, the mind grew keener and imagination, more vivid. This notion successfully established the status of consumption as a disease of the enlightened, the artist and the intellectual. So much so, that Lord Byron himself admitted:
“I should like to die from consumption.”
Closer to this age, the poetic prodigy, Dylan Thomas, was under the delusion that he was consumptive and used this excuse to justify his alcoholism. He eventually died at the ripe old age of 39 from consumption… of excess alcohol! Whether the consumption killed him or not maybe a debate for believers of symbolism, but what is beyond debate is the riches that English literature has gained from his work, which was largely fuelled by his own disability and death wish.
Hidden beneath poetic euphemisms, imagery and allegories, we can find exquisite descriptions of how consumption affected the lives of people. Keats, himself a sufferer, with a degree in medicine, has numerous allusions to the disease “Where youth grows pale and spectre thin and dies.” Thomas Gray also suffered from consumption, until “…melancholy marked him for her own.”
Another poet whose struggle with the disease marked his work was Edgar Allan Poe. He lost both his parents at a very young age and then, his very beautiful wife to the disease. Understandably, his poetry is fraught with the tragedy that this disease inflicted on him. One of the most tragic tales of struggle with consumption is that of the English poet Lovelace’s. When he eventually died in 1658, he was reduced to such poverty that he was in rags and living with the beggars.
Penury and squalor dogged the lives of the medieval artists and poets. Eccentric lifestyles, addictions added to the poison of the tubercle bacilli. And although one wonders how a lethal and ubiquitous disease such as tuberculosis gained such a cult status, it was soon to be replaced by a stigma. As more medical research unearthed the science behind the disease, it soon started losing its charm. And soon, it was reduced to a disease of the poor. It has only been a couple of decades that the social stigma associated with tuberculosis has been tempered, thanks to active socio-medical intervention and the rise of HIV/AIDS (which has taken on the mantle of a stigmatized disease now).
One cannot but wonder how much progress has been hindered by this slow but sure killer. How many great minds have gone to their graves too soon. One cannot but wonder how much the human race would have been benefited but for this scourge. After all, Samuel Johnson was true when he, a long time sufferer of tuberculosis, said:
“…there are perhaps few conditions more to be pitied than that of an active and elevated mind laboring under the weight of a distempered body.”
References and Further Readings:
- Dubos, Rene and Jean. (1987) The white plague: Tuberculosis, Man and Society. Piscataway, New Jersey. Rutgers University Press. (preview available on http:// books.google.com: Special interest: Chapter 5, Page 44: Consumption and the Romantic Age.)
- Chalke H.D. The impact of tuberculosis on history, literature and art. Med Hist. 1962; 6: 301-18.
- http://en.wikipedia.org/wiki/tuberculosis_in_popular_culture: Accessed on 16thMay, 2010.
- http://en.wikipedia.org/wiki/history_of_tuberculosis: Acceessed on 16th May, 2010
- Chalke H.D. Some historical aspects of Tuberculosis. Public Health. 74 (3): 83-95
DANIEL, T. (2004). The impact of tuberculosis on civilization Infectious Disease Clinics of North America, 18 (1), 157-165 DOI: 10.1016/S0891-5520(03)00096-5