Prof: Good morning.
 
Our topic for this time,
and next, is another of the
really ancient diseases in our
course, which is tuberculosis.
Tuberculosis was present in
Ancient Egypt.
This is known from skeletons
and from mummies.
And it seems that tuberculosis
has been with human beings ever
since they first began to gather
in substantial settlements,
which are essential for its
transmission,
in ways we'll be discussing.
 
It was present in Ancient
Greece, and in Rome,
and Hippocrates and Galen
clearly knew patients suffering
from tuberculosis.
 
It persisted in the Middle Ages.
 
So, we're dealing not with a
new but a very ancient disease.
A question that you'll be
asking is whether indeed it's an
epidemic disease;
would it perhaps be better to
describe it as endemic?
 
And this again,
I think, as when we dealt with
malaria,
we see that some diseases are
both endemic and epidemic,
and I think this applies to
tuberculosis as well.
 
One way of thinking of it might
be in terms of its time frame.
If you look at any single
generation, it often seems that
tuberculosis isn't an epidemic
disease.
It's present,
after all, year after year.
It is contagious but it spreads
slowly from person to person.
Its course in the individual
body of a patient is often very
slow and capricious.
 
It's clearly different from
bubonic plague,
from influenza or Asiatic
cholera.
But if you take a long-term
perspective, it might seem that
tuberculosis does ebb and flow,
like an epidemic disease.
Perhaps one could think of it
in terms of an epidemic that
lasts for centuries,
perhaps, or decades in the case
of a body of a single patient,
at times.
In a sense, one could say that
tuberculosis could be an
epidemic disease in slow motion.
 
Our concern will be with Europe
and North America,
at a time of a vast
upsurge--and here I'm referring
to Western Europe--
that coincided with the
Industrial Revolution.
 
Here there are a number of
factors that lie in the
background that contributed,
probably.
One is a large-scale pace of
urbanization,
and we'll see the impact of
crowded housing and poor
ventilation,
which are decisive factors,
particularly in the case of a
disease that's a pulmonary
disease,
above all.
The rise of sweatshops and the
factory system again led to
crowding,
this time not in the home but
in the workplace,
and poor ventilation now during
the day,
as well as in the home at night.
I'm thinking of low wages,
and with that poor diet and a
compromised immune system.
 
Another factor that's very
important for diseases that are
respiratory is pollution of the
atmosphere,
and the smog in cities like
London due to soot from the
burning of coal,
or particles due to tobacco
from smoking,
or again particles in
mineshafts, or unhygienic
workshops,
all made their contribution.
 
In any case,
it's not by chance that
England,
the first industrial nation,
experienced an epidemic wave
that crested between the middle
of the eighteenth century and
the middle of the nineteenth.
And then in the case of
England, there was a slow,
steady decline from the later
decades of the nineteenth
century.
 
And we can see this as well
taking place in countries that
industrialized a little bit
later, say France,
Germany, Italy,
Russia.
The upsurge began later,
but did so remorselessly.
And then a decline set in,
but again slightly later,
from the beginning of the
twentieth century.
If you look at the geography of
tuberculosis in Europe,
it would also support this idea
of a clear relationship between
tuberculosis as a condition,
and the conditions created by
industrial development;
especially in its traumatic
early phases.
 
Tuberculosis was a major killer
in the northern industrial
nations--
Britain, Germany and
France--and it was less
prevalent in less industrial,
largely agricultural nations,
such as Italy and Spain.
So, there's this distinction to
be made.
But also if you looked at the
pattern of tuberculosis in Italy
and Spain,
you would see not only was it
less there,
but also it respected the
distribution of industrial
development.
Take Italy for example.
 
We already talked,
in the case of malaria,
about a major north/south
divide.
This is also true with regard
to tuberculosis,
but in reverse.
 
Tuberculosis,
in other words,
was an affliction above all of
Italy's northern cities,
and it was much less prevalent
in the agricultural south where
people worked outdoors.
 
Well, let's turn now to the
nature of the disease:
how it's transmitted,
its different forms,
and its symptomatology in the
body.
The pathogen,
to begin with,
was first discovered by someone
we know well now,
in a variety of contexts,
and this is Robert Koch,
who discovered it in 1882--the
Mycobacterium
tuberculosis,
which is that.
Now, transmission--tuberculosis
can be spread in more than one
way,
but we're concerned,
and will be concerned,
primarily with its dominant
mode of transmission,
which is through the air.
In other words,
a sufferer from tuberculosis
will say cough,
sneeze, spit,
and give off airborne droplets,
which are then inhaled by other
people.
 
Now, a primary infection by
most people who come into
contact with Mycobacterium
tuberculosis doesn't lead on
to symptoms, it usually heals.
 
But in those with compromised
immune systems,
the disease,
as the expression was,
is disseminated.
 
It can then lie dormant for
years.
As I've said,
one of the things about
tuberculosis is its enormously
capricious quality.
Alternatively,
it could produce disease within
weeks of the primary infection.
 
Mycobacterium
tuberculosis can spread via
the bloodstream,
or the lymph system,
to infect a variety of organs,
and produce lesions in
virtually any tissue in the
body.
I'll show you now a number of
images of sufferers from
tuberculosis,
in various forms.
And I'm hoping that these
images won't be overly
distressing to anyone.
 
First, this is scrofula,
sometimes called the
"King's Evil,"
which was--here we have
scrofula of the neck.
 
There's tuberculosis of the
skin, called Lupus
vulgaris.
 
Tuberculosis can also infect
the meninges of the brain,
the bone and joints,
the kidneys,
the urinary and reproductive
system,
and can infect the spine,
leading to severe deformity and
hunchback.
 
I'll show you then that form;
it's called Pott's Disease.
And there's a skeleton from a
sufferer of Pott's Disease--or
this is what be what it would
look like.
The disease can also affect the
lining of the abdominal cavity
or the heart.
 
But overwhelmingly,
the most common form of
tuberculosis is of the lungs.
 
And this is what we'll be
dealing with primarily in the
course, pulmonary disease,
also known as phthisis or
consumption.
 
We'll mention in passing that
tuberculosis is also spread,
and was spread,
by meat or milk of infected
animals;
but that's a secondary tragedy
within the larger dominant
pulmonary form of the disease.
Now, you know from your reading
response questions,
and from Barnes' book this
week, that tuberculosis is
sometimes referred to as a
social disease,
and you'll see in your in trays
that I've just sent you an email
about social diseases and how we
might think of them.
But just for the moment,
you'll note that Barnes doesn't
define what he means by social
disease.
By saying that it was a social
disease,
he's arguing that tuberculosis
had a predilection for certain
social classes,
that it was a disease that was
unlike--
that it didn't affect all
classes equally.
 
Now, note that cholera,
for example,
was a disease that didn't
affect all social classes.
Tuberculosis did,
in fact, afflict royal
families,
aristocrats,
artists, writers and
professionals,
and this was an important
factor in the social response to
the disease.
 
Given the mode of transmission,
that is, through the air,
it was inevitable that that
would be the case.
So, even if we do decide to
call tuberculosis a social
disease, we need to make major
qualifications.
But to focus on the rich and
famous is distorting,
because out of all proportion,
tuberculosis did,
and still, afflicts the poor;
especially the urban poor.
Remember the risk factors we
said: living in cities rather
than the countryside;
crowded, unhygienic housing;
poor ventilation;
workplaces that were similar to
those of the home;
child labor en masse;
lowered resistance due to poor
diet or pre-existing diseases.
Tuberculosis then thrived in
slums and tenements,
among industrial workers,
and among the inmates of
almshouses, prisons,
barracks.
Let me give you some
illustrations,
and we'll look at some famous
pictures.
I think that we have no better
ones than the photographs taken
by Jacob Riis of tenements and
sweatshops in New York City in
the 1880s and nineties,
some of which were collected in
his really famous and
influential book,
How the Other Half
Lives, that was published in
1890.
 
And I'd like to show you some
of the pictures.
This is a slide of a tenement,
an ideal place for
tuberculosis.
 
We'll be looking first at some
pictures of housing,
and I'd like you just to make
the imaginative leap of thinking
what are the kinds of
conditions,
if you live in these places,
that facilitate the spread of
tuberculosis?
 
Again, this is from Jacob Riis,
a tenement in New York City.
Here we see the conditions in
which people were sleeping.
This is what was called
seven-cent lodgings in an
unhappy street,
Pell Street,
in New York City.
 
And you can see how
tuberculosis would thrive in
conditions like this.
 
But let's also remember that
tuberculosis also thrived
because of conditions at work.
 
And here's a sweatshop in the
Garment District in New York
City, again in the 1890s.
 
Or here again another picture.
 
I think you get the point.
 
Remember too that prison
populations,
then and now,
have been seriously affected
with consumption,
because the inmates there have
often lived in conditions like
those of tenements,
with poor ventilation or
lighting, pervasive damp,
overcrowding,
inadequate diet,
poor sanitation.
 
In conditions like that,
tuberculosis runs riot.
Indeed, the New York
Times reported,
in 1908, that it was a lie when
judges sentenced convicted
felons to hard labor.
 
The truth, the paper reported,
was that the sentence should be
labeled "to hard labor and
tuberculosis."
In an inspection in 1905,
the New York State
Superintendent of Prisons
declared that Sing Sing Prison
in particular--
and here I'm quoting from the
Superintendent of Prisons of New
York State--
he called it "a hotbed for
the culture and spread of
tuberculosis,
that should be abandoned as
unfit for human
habitation."
Well, even if a person is
infected, as I said,
in the vast majority of people
the immune system of the body
contains the disease.
 
In the nineteenth century,
say in Paris or Le Havre,
probably New York City as well,
it's estimated that virtually
every inhabitant had encountered
Mycobacterium
tuberculosis;
but most remained asymptomatic
and non-infectious.
 
An active infection was
promoted by a compromised immune
system;
let's say perhaps heredity,
alcoholism, malnutrition,
drug abuse, the presence of
concurrent infections that are
immunosuppressive.
In our own times,
one can think of malaria,
AIDS or diabetes as forming a
good substratum for
tuberculosis.
 
What are the symptoms of TB?
 
Well, it's extremely variable.
 
One of the mysteries of
medicine, in fact,
is the course of tuberculosis
in the human body.
It can be fulminant and lead to
death in months.
This is often called galloping
consumption, at the time,
or miliary tuberculosis.
 
Alternatively,
there can be an onset of
symptoms,
followed by recovery or
remission, and then a relapse,
and instead of leading to early
death,
it can lead to a long,
chronic illness,
often punctuated by prolonged
remissions and equally
mysterious relapses.
Before the age of antibiotics,
some eighty-percent of cases
were deemed to end fatally,
but in a time span that varied
from up to fifteen,
twenty years.
And in every age there were
spontaneous cures,
or apparent cures.
 
Let's look at two opposite
extremes, two famous cases,
the medical careers of two
famous nineteenth-century
British writers.
 
The first is John Keats,
who lived from 1795 until his
death from tuberculosis in 1821.
 
Note 1821;
because he fell ill in February
1820, and died the next year,
at the age of twenty-six,
from galloping consumption.
 
Keats, in fact,
became an icon of the
relationship of tuberculosis to
the arts and to genius.
An entire century was familiar
with the fact that he contracted
the disease while tending his
dying brother;
that he made a desperate
departure from Britain to Rome
in search of health;
and it knows,
the world knew,
at the time of his death and
burial there,
after a final period that was
widely and romantically regarded
as his most productive and
brilliant.
 
His life was described by
romantic writers as that of a
meteor, a comet,
or a candle that rapidly burned
itself out.
 
And this became a focal
point--and Keats himself did--
for the way this disease was
construed or socially
constructed in the middle of the
nineteenth century as a disease
of genius.
 
It was considered to be a
disease of sensibility and
civilization.
 
Let's look at the disease of a
different person,
whom you all know well.
 
This is Robert Louis Stevenson,
who lived from 1850 to 1894.
This is a picture of him in
about 1890.
Stevenson, unlike Keats,
battled tuberculosis for
decades.
 
He went in and out of health
spas and sanatoriums.
But he led a long and
productive life that was ended,
in fact ironically,
not by tuberculosis but
probably by a stroke.
 
Now, in the nineteenth century,
physicians regarded the course
of pulmonary disease as passing
through three stages,
as they saw it.
 
But remember though,
before the tuberculin skin test
and the development of
radiology,
tuberculosis was difficult to
diagnose,
as the symptoms mimicked those
of other common diseases.
And even if the diagnosis was
accurate, one stage merged
imperceptibly into another.
 
But for nineteenth century
physicians, there was still this
distinction.
 
The first stage,
as they described it,
was marked by a persistent
cough, some difficulty in
breathing, especially after
exercise.
The patient would sweat
profusely.
There would be an elevated
pulse, pain in the chest and
shoulders,
general lassitude,
a loss of weight,
pallor, declining performance
at work or at school.
 
Then came a second stage when
the cough became tormenting and
frequent, and the patient would
begin to cough up a greenish
phlegm.
 
He or she would experience
intermittent fevers,
spiking twice daily,
with copious sweating and a
rapid pulse.
 
The patient would suffer from
severe fatigability,
from hoarseness that made it
difficult and painful to eat or
to speak above a whisper.
 
There would be extreme
shortness of breath on exertion,
pain in the joints of the body.
 
Then came the third stage of
advanced tuberculosis,
which gave the most common
nineteenth-century name to the
disease: consumption;
that is, a frightening
emaciation in which the body
wasted away, or seemed to be
consumed.
 
The face would be hollow,
the complexion pale.
Perhaps this was one of the
reasons that it was called the
white plague.
 
The eyes would be sunken in
their sockets,
and a patient could easily look
like this.
This is a picture of a
consumptive patient in 1892.
The cough now seemed like a
death rattle,
and the patient would cough
blood.
There would be constant pain in
the joints.
The legs would be swollen.
 
There would be fever,
often uncontrollable diarrhea,
and extreme shortness of
breath.
At that point,
the diagnosis was certain.
But at this advanced stage
death was imminent,
and its form was unpleasant and
painful;
often asphyxia,
as the patient virtually
drowned on the phlegm in his or
her lungs.
Or there could be a sudden and
unstoppable hemorrhage,
with blood rushing from the
mouth and nostrils,
and the patient again
suffocating.
Well, what was it that happened
to the lungs?
Here's a modern x-ray slide of
a TB patient's lungs.
And let's look behind the x-ray
at pictures of the lungs.
Here is a set of healthy lungs,
hopefully like all of yours.
And then I'd like to take you
through the drawings and
pictures of the process called
cavitation in the lungs,
and the way in which the
Mycobacterium
tuberculosis consumes the
respiratory organs.
This is a famous drawing by
Ren� Laennec,
you know of the Paris School of
Medicine,
who was a tuberculosis
authority, and he did this
drawing of the onset of the
cavitation in the lungs.
Let's look at a picture of it.
 
This is the process of necrosis
at work in the tissues,
and the end result would be the
destruction of the lungs,
which would look more or less
like that.
So, this was an enormously
painful, horrible and unpleasant
disease.
 
And I want to argue that there
are two great eras in the modern
history of tuberculosis in which
the disease was conceived or
thought of quite differently,
and without much relationship
to the reality of the quality of
the symptoms.
The two periods are divided by
the watershed of the germ theory
of disease,
established by Robert Koch from
about 1882,
and slowly then accepted
thereafter by the medical
profession,
and educated society as a whole;
not instantly,
but in the decades that follow.
 
I'd like to call the first era
the era of consumption,
or perhaps the romantic era of
tuberculosis.
Let's define it from the end of
the eighteenth century to the
middle, to about the time of
Robert Koch's discovery.
It was jolted first by,
in the 1860s and '70s,
by the work of Jean-Antoine
Villemin,
in France, who first
convincingly proposed the idea
that TB was contagious.
 
And then the romantic era
clearly came to an end with the
work of Robert Koch,
when society accepts this new
interpretation,
and the word consumption begins
to fade from popular usage.
 
Thomas Mann's great book,
The Magic Mountain,
is perhaps the last great
artistic expression of the
consumptive era and its
susceptibilities.
Now, what was the idea behind
the romantic or consumptive
theory?
 
Its most authoritative
formulation was by the great
authority of the Paris School of
Medicine, Ren� Laennec,
whose drawing you just saw;
the man who invented the
stethoscope and spent his life
listening to the lungs of
tuberculosis patients.
 
Laennec talked about what he
called the essentialist theory.
Ironically, given the
opposition of the Paris School
to Galen and humoralist
teachings,
we could see essentialism as
actually a form of humoralism
revived,
a kind of anti-contagionism in
classic dress.
 
Now, note the irony.
 
Your friend Ackerknecht--that
is, the historian of medicine--
observed dryly,
"After all,
things have to be explained
somehow."
Well, TB was explained
primarily by internal causes,
due to the inherited essence of
the patients;
his or her constitution,
or in Laennec's jargon,
the patient's diathesis,
which caused him or her to be
susceptible to the immediate
factors that triggered the
actual illness.
 
So, your diathesis was an
inborn, inherited defect.
Precipiting or immediate causes
supervened, and these were
thought to be some irregularity
in the patient's life.
Very important in the
literature were alcoholism and
sexual excess.
 
Laennec postulated that two
sorts of issues were important
to him.
 
One were what he called les
passions tristes:
melancholy, sorrow,
despair, and again sexual
excess.
 
The loss of bodily fluids was
thought to weaken the body and
lead to illness.
 
But both were almost an aspect
of an individual's fate,
his or her nature.
 
So, consumption,
unlike the other great epidemic
killer of the nineteenth
century--
that is, cholera--was not
thought to be contagious but
hereditary,
and therefore its victims
weren't feared or thought to be
dangerous.
And tuberculosis was a slow
killer, not a cause of sudden
death.
 
And its symptoms,
by the canons of the day,
were deemed to be respectable,
and not thought to be
disgusting or a source of
unbearable torment.
And death was private;
unlike cholera,
not a public spectacle.
 
Furthermore,
tuberculosis wasn't so
frightening because it was also
an endemic disease and was
ever-present in society.
 
So, the effects on society were
not at all like those of Asiatic
cholera.
 
We mustn't think of diseases as
interchangeable causes of death
that have the same effects on
the societies they afflict.
Tuberculosis didn't lead to
terror, hysteria,
xenophobia, revolt,
and in its first phase it
didn't lead to stigmatization,
but its opposite.
Patients with tuberculosis were
thought to be glamorous,
sexy, and chic.
 
They were blameless,
as it was their hereditary that
was responsible.
 
And there weren't outbursts of
religiosity.
There was a recognition that,
in fact, large numbers of the
social elite fell victim to the
disease.
There was no poisoning frenzy.
 
This disease was too slow,
too unrelated to digestion,
too associated with the
powerful, as well as the poor,
and it was true that doctors
and officials paid their tribute
to the disease.
 
But it did have major social
effects, and let's think about
what some of them were.
 
A first was the widespread
experience of patients.
This is the career of
invalidism.
Tuberculosis,
after diagnosis,
became a lifetime's career.
 
The rest of one's life,
after receiving diagnosis,
was unknown and unpredictable.
 
And this would affect every
possible decision:
career choices;
whether to marry and have a
family, whether to place one's
normal responsibilities on hold
and to devote life to seeking to
recover health.
And, so, the sufferers tended
to undertake a new and
all-consuming occupation,
restoring health and learning
to accept what would probably be
an early death.
Let's think,
for example,
of Anton Chekhov,
who's the man in the left,
pictured here with Leo Tolstoy.
 
Now, Chekhov,
who lived from 1860 to 1904,
was a sufferer from
consumption.
He was forced to abandon his
own career, and his actress wife
in Moscow, in the attempt to
restore his shattered health.
To do so, he went to the mild
climate of the Crimea.
His plays were all written in
the period of his illness,
and all subtly have invalidism
as a hidden but unmentioned
theme.
 
The protagonists in Chekhov's
plays, not by chance,
seem oddly unable to act.
 
They seem to be waiting and
waiting for events beyond their
control to unfold.
 
The middle classes tended to go
off to what was called
"taking the cure";
that is, they traveled--in
Europe, they would go to a
climate that was thought to be
favorable;
spas and health resorts in
southern Europe,
on the French Riviera,
or in Italy.
 
Those were favorite
destinations.
And the list of distinguished
travelers is lengthy.
Keats and Shelley went to Rome.
 
Tobias Smollett went to Nice.
 
The Brownings went to Florence.
 
Chopin went to Majorca.
 
Paul Ehrlich went to Egypt.
 
But this was also true in our
own country.
In the United States,
people took sea journeys to
recover their health,
or they traveled to the west
and the southwest.
 
And here the famous frontier
thesis in American history has
yet another meaning.
 
Health seekers formed a
substantial current--
that is, of a movement
west--and turned into a
large-scale movement,
with the availability of the
railroad from the 1870s.
 
Colorado Springs and Pasadena
are examples of communities that
were founded by,
and for, tuberculosis
sufferers.
 
Also popular were other
destinations;
Florida and the Caribbean.
 
And the cure became a kind of
industry.
It was stimulated by a flood of
medical books;
by rumor and anecdote;
by brochures prepared by
interested parties,
such as the railroad companies.
There were other exotic but
more affordable ways of seeking
the cure.
 
One was altitude therapy,
in which you'd go up high in a
hot-air balloon.
 
More commonly,
people moved outdoors simply
where they lived.
 
In New York City,
at the turn of the century,
the buildings were dotted with
people who'd moved to live in
tents on the roofs and porches
of apartment buildings,
or in their backyards,
if they had them.
Let me remind you of Professor
Irving Fisher,
of Yale University,
who in 1907 promoted health by
inventing a tent that he claimed
was perfectly ventilated for
those who took to the out of
doors life,
and he wanted his tent to make
outdoor living affordable for
the poor.
 
He himself was a consumptive,
but he regained his health
after living out of doors,
and he aimed to make the cure
universally available.
 
If you read the New York
Times,
you would see there were people
who moved not only to tents,
but also to tree houses that
they constructed in their yards;
an example being Charles
Battersby of Wrentham,
Massachusetts,
a consumptive who constructed a
house between two adjoining pine
trees and moved into it fulltime
in the winter of 1906.
 
Who knows to what extent the
travels of people were also a
means to escape the regimens
that if they stayed at home,
their physicians would have
subjected them to at home?
The treatments weren't
especially enjoyable.
There was bleeding and cupping,
to release the noxious agents.
There were direct applications
to the lesions;
poultices, ointments, infusions.
 
There was also the spray
therapy;
that is, inhalations in which
the doctors were attempting to
attack the disease at its seat,
as you inhaled gas mixtures;
creosote and carbolic acid,
had a large vogue in these
centuries.
 
Well, what about the
effectiveness of the travels?
In some cases,
it's probably safe to say that
the travels were beneficial.
 
For pulmonary tuberculosis,
it probably did help to escape
the urban smog of a place like
London.
For Lupus vulgaris,
the disease of the skin,
sunlight is known to be
beneficial.
And it was probably beneficial
just to have hope,
and to have the belief that you
could do something to help
yourself;
that probably did more good
than harm.
 
Tuberculosis also clearly had
economic and demographic
effects.
 
Tuberculosis was the greatest
killer of the young,
at the time,
and it inevitably limited the
growth of population.
 
It limited the expansion of the
economy and caused widespread
poverty.
 
There was a new awareness and
sensitivity to this death,
with romanticism.
 
Tuberculosis,
I want to say,
was not the cause of
romanticism,
but it is true that romantic
literature,
and the arts,
did fit some qualities about
tuberculosis.
 
That is, romanticism stressed
the transience of youth,
early death,
melancholy, life as ephemeral,
the importance of autumn as a
symbol;
no longer now a symbol of the
harvest, but as a time of
falling leaves and dying
flowers, as death sets in.
Genius was part of it.
 
The redemptive and ennobling
idea of suffering,
that releases the life of the
soul, as the gross material body
wastes away.
 
And there was a poetic quality
that was attributed to
tuberculosis.
 
It was said to release genius
and creativity.
One sees this portrayed in
romantic works in the century.
Emily Bront�,
Wuthering Heights;
Victor Hugo,
Les
Mis�rables;
Alexandre Dumas, Henri Murger.
Or romantic opera:
Verdi's La Traviata,
or Puccini's La
Boh�me.
Then I would argue that
tuberculosis also--so,
it had an effect,
and the effect,
the causal chain worked in both
ways;
an effect in promoting
romanticism,
and romanticism in turn
promoted a certain understanding
or social construction of the
disease itself--
had a major impact then on
literature,
and was portrayed often in
literature,
and indeed in the opera.
 
Tuberculosis also had an effect
on gender issues.
I would argue that it helped to
promote a new idea of feminine
beauty: thin,
elongated;
tubercular, in short.
 
Pallor.
 
At the time,
white powders--not suntan oil,
as today--were the fashion.
 
Let me show you an example.
 
This is a famous painting of a
woman at the table,
by Toulouse Lautrec.
 
And you'll note that she looks
extremely pallid,
and is quite thin.
 
But what I wanted to point out
is what she has in front of her,
which is a pot of rice powder
that she puts on her face to
imitate the pallor of a
consumptive.
One can see this also in the
paintings of the
pre-Raphaelites,
whose favorite models were
often women with tuberculosis.
 
Elizabeth Siddal,
for example,
was a model for ten years,
and then became the wife,
of Dante Rossetti,
and became also a model for
Millais.
 
Jane Burden became the model,
and also the wife,
of William Morris.
 
And one can see some of
the--you can see the
elongated--this is Mariana;
this is the Beata Beatrix.
In any case then,
consumption was a fatal,
debilitating and excruciatingly
painful disease.
But paradoxically then it was
given positive associations in
the way it was described at the
time.
Tuberculosis was said to make
the body beautiful,
to make a person spiritual by
wasting away the gross flesh,
and it was said to enhance
creativity and genius.
How can this be explained?
 
Well, in the United States,
tuberculosis was also thought
to be the white plague,
partly because it was popularly
regarded as a disease that
affected the white race and not
African-Americans,
who were thought to have a
different affliction in the
middle of the nineteenth
century.
 
Tellingly, it was called
"the white man's
plague" and "the white
man's scourge,"
in this country.
 
And in Europe,
it wasn't associated in the
popular mind with the working
classes,
and people remembered that
aristocrats and artistic
celebrities often contracted it.
 
You can see the power of what
we might call advertising,
the endless stream of novels,
poems,
operas, that extolled the
beauty and sensitivity of those
afflicted.
 
In addition,
recalling what we said about
bubonic plague,
tuberculosis did not evoke the
fear of mors repentina:
sudden death,
so dreaded with bubonic plague
or Asiatic cholera.
With consumption,
there was no danger that a
person would be caught unaware
and not even have time to write
his or her will.
 
The disease was spiritual,
in part,
because it warned the sufferer
of death in ample time to work
out one's relationship with God
and with the community.
There was also a simple matter
of comparison.
Consumption death,
consumptive death,
was perhaps construed as
beautiful because pulmonary
disease didn't disfigure in the
manner of smallpox.
Its symptoms weren't degrading,
in the manner of Asiatic
cholera.
 
Well so to make the point,
let's turn to a work that
probably all of you know,
the most influential,
best-selling novel of the
nineteenth century,
which was Harriet Beecher
Stowe, Uncle Tom's Cabin.
You probably know very well
that it was a religious novel,
about social justice and God's
way with man,
that it was about Simon Legree
and the horrors of slavery,
and called for abolition.
 
But you've probably forgotten
that it was also a major
tuberculosis novel,
and that the heroine,
the child Little Eva,
dies of consumption.
Let me remind you of how
Harriet Beecher Stowe described
approaching death.
 
And she wrote:
"For so bright and placid
was the farewell voyage of the
little spirit--
by such sweet and fragrant
breezes was the small bark borne
towards the heavenly shores--
-that it was impossible to
realize that death was
approaching.
The child felt no pain,
only a tranquil soft weakness,
daily and almost insensibly
increasing.
And she was so beautiful,
so loving,
so trustful,
so happy, that one could not
resist the soothing influence of
that air of innocence and peace
that seemed to breathe all
around her.
Her father found a strange calm
coming over him.
It wasn't hope--that was
impossible;
it was not resignation;
it was only a calm resting in
the present that seemed so
beautiful that he wished to
think of no future.
 
It was like that hush of spirit
that we feel amid the bright,
mild woods of autumn,
when the bright hectic flush is
on the trees,
and the last lingering flowers
by the brook;
and we joy in it all the more,
because we know that it will
soon pass away."
Now, I would argue that this
bears little relationship to the
actual extraordinary suffering
of tuberculosis at the very end,
and I think it makes a good way
to have a transition from the
consumptive era to what I would
call the era of tuberculosis,
when the way that disease,
this disease,
was constructed and understood
changes radically.
And this comes about after the
germ theory of disease and the
work of Robert Koch,
when the disease was found not
to be hereditary and due to
one's diathesis,
but to be a nasty,
contagious disease,
when sufferers became objects
of fear,
and stigma attached to them;
when the glamour of consumption
was stripped away,
as was its association with
feminine beauty,
and male genius and poetry,
and its appeal as a period of
spirituality and sexuality
disappeared.
 
So, that's what I want to talk
about next time,
which is the movement from the
era of consumption to the era of
tuberculosis.
 
 
 
