The disease that won't die

The White Death

January 14, 2000

There are shelves of books on tuberculosis and heavy files packed with learned articles, many of them in specialised journals devoted solely to the disease. There was often a sociological dimension to the medical material, connecting it with studies of poverty and urban life.

Thomas Dormandy's book draws on a wide variety of sources, but focuses less on social policy than on the creative powers of well-known men and women suffering from what in a pre-consumer society was often called "consumption".

One of the 18th-century books mentioned by him is Benjamin Martens' A New Theory of Consumptions: More Especially of a Phthisis or Consumption of the Lungs . Martens is relevant to Dormandy not because of his place in medical history, but because he emphasised the need to keep up the spirits of the sufferers, "Hope being the greatest Comfort they have and their only source of Enjoyment".

The relationship between suffering and hope in individual lives is Dormandy's main theme. "Individual case histories," he claims, "are often more revealing than general medical texts."

There are few statistics in his book, although chapter seven deals not with "celebrities" but with "the poor". The chapter titles include "Sacrifice and atonement", "The Romantic image" and "Seeking the sun". The last chapter is called "An imperfect civilisation". As a disease, tuberculosis was identified with that expression more than with the tuberculosis bacillus identified by Robert Koch in 1882.

The first person mentioned in the book is Sophie Munch, daughter of Edvard Munch, who painted her portrait a few months before her death from tuberculosis at the age of 14; and very quickly Dormandy moves to this first generalisation. Tuberculosis was not just a killer.

"It transformed the lives as well as causing the deaths of its victims. For a century and a half it became a formative influence in art, music and literature."

This was not only because of the geniuses or celebrities that it struck but also because it "imprinted" itself on the creations of the non-tuberculous majority.

For tuberculosis affected more than its immediate victims, more even than its immediate victims' parents, brothers, sisters, lovers, enemies and friends. "Like no other disease before or since it compelled doctors to question the very purpose of their calling." There is more than a touch of special pleading here, but it makes for what after the first page is a readable book.

John Keats, a medical student, is picked out in chapter two, less for the fact that his disease was misdiagnosed by leading physicians than for the manner of his painful death in Italy. The chapter is called "Half in love with easeful death", and the most memorable quotation in it comes not from a contemporary doctor but, long after the event, from the great William Osler, doctor guide to doctors for more than a generation. "Poor Keats had not even the hope of the tuberculous that often carries them to the very gates of death."

It was not a hope that long after Osler seems to have inspired George Orwell. Dormandy deals with him somewhat mistily, getting his date of death wrong (1950), but he points to one of the most interesting facts about his treatment. He was actually given streptomycin, an expensive drug not obtainable in England at the time - David Astor helped him get it and Aneurin Bevan authorised its import - but could not benefit from it as large numbers of people were to do in the years that followed. Orwell showed such severe hypersensitivity that administration of the drug had to stop.

Numbers counted less than names in the late 1940s. In 1947, one year before the start of the National Health Service, there were 23,000 deaths from tuberculosis, roughly the same figure as in 1945 and 1948, and 52,000 new cases. Ten years later the mortality figure had fallen to 4,480. It was not the National Health Service that was responsible for the fall, although, in Bevan's phrase, it made "a massive contribution to the equipment of a civilised society".

Dormandy's book has no happy ending. The hope that tuberculosis would disappear from Britain and the world was not realised. Between 1985 and 1991 tuberculosis increased by 12 per cent in the United States, by 30 per cent in Europe and in some parts of Africa by 300 per cent. Streptomycin did not provide a final answer.

Dormandy turns again to generalisation. "Medical consumerism, like all sorts of consumerism - but more menacingly - is designed to be unsatisfying. The law of diminishing returns necessarily applies." Where is the hope there?

Lord Briggs was formerly provost, Worcester College, Oxford.

The White Death: A History of Tuberculosis

Author - Thomas Dormandy
ISBN - 1 85285 169 4
Publisher - Hambledon
Price - £25.00
Pages - 433

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