HIST 234: Epidemics in Western Society Since 1600
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Epidemics in Western Society Since 1600
HIST 234 - Lecture 18 - Tuberculosis (I): The Era of Consumption
Chapter 1. Tuberculosis: Epidemic or Endemic? [00:00:00]
Professor Frank Snowden: 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.
Chapter 2. A Social Disease [00:10:14]
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 Timesreported, 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 encounteredMycobacterium 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.
Chapter 3. Symptoms [00:16:54]
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 René 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.
Chapter 4. Era of Consumption [00:25:09]
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, René 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 Brontë, Wuthering Heights; Victor Hugo, Les Misérables; Alexandre Dumas, Henri Murger. Or romantic opera: Verdi’s La Traviata, or Puccini’s La Bohème. 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.
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