Rebecca's Interview with Thomas Dormandy
Author of
The White Death.

Rebecca :
The White Death is a history of Tuberculosis down the ages - what prompted you to write such an account?

Thomas :
I have been interested in tuberculosis since I was a medical student & visited friends in sanatoria in Switzerland. I also realised over the years that tuberculosis was one of the great formative influences on European literature, art & thought during the 19th century - this is not widely appreciated.

Rebecca :
I came up in an England that revered such luminaries as Keats, Shelley, Stevenson, the Brontës & Austen - not once were we taught how they died, although their deaths were romanticized. Most of us girls thought consumption was as a result of something they ate. Why have our attitudes about tuberculosis been so, well, demure?

Thomas :
I think cultural historians & biographers generally shy away from medical matters in case they are “shot down” by doctors. I think it's a great pity. Illnesses shape our lives as much as do material circumstances.

Rebecca :
I had no idea there was any other kind of TB than of the lungs. Why is tuberculosis unlike any other killer we've known?

Thomas :
That is a difficult question to answer - there are not many illnesses which can linger for many years & slowly consume the body while often “adding ardour to the soul”. Physical pain which is creatively sterile was often absent in tuberculosis: spikes of low-grade temperature which were often present can intensify feelings, perceptions & thought.

Rebecca :
Just before the Angry Young Men, the Teddy Boys & then The Beat Generations, being called a Bohemian implied you a person of artistic or poetic bent, living in an unconventional way. Where & when did “Bohemia” start & how did it connect with The White Death?

Thomas :
Originally (in the 18th century) the term referred to wandering gypsies who in Western Europe were thought, mistakenly, to originate from geographical Bohemia (today's Czech Republic). Literary-artistic Bohemia was born in the France of the 1840s & was a rebellion against the unshakable conventions, beliefs & repressive ethos of the newly emerging & immensely self-confident bourgeoisie. Today the term bohemian is widely used although the original Bohemia inevitably dispersed with the disappearance of a totally self-confident bourgeoisie. Both were destroyed by two world wars.

Rebecca :
Who was Réné Théophile Hyachinthe Laënnec(1781-1826) & why is he so important to modern medicine?

Thomas :
He was a Breton/French doctor & inventor of the stethoscope. This made the diagnosis of early pulmonary disease possible. He wrote brilliantly about lung diseases & he was something of an artist, musician & linguist as well. What he did not appreciate (amazingly enough) was that performing thousands of autopsies on bodies who had died of tuberculosis (without taking precautions) was virtually suicidal. He himself died of tuberculosis in 1826 aged 45 as did many of his colleagues.

Rebecca :
In your chapter, The Diathesis, (predisposition to certain diseases) you posit that the decades between Laënnec & the rise of the sanatoria movement were sterile yet men & women of all ages, especially the young, died by the millions. What were the main reasons doctors couldn't grasp the basics of this illness?

Thomas :
Doctors don't like to advertise their ignorance; & they are just as ignorant today about many diseases as they were about tuberculosis 150 years ago. Nineteenth century textbooks listed 100 “causes” of tuberculosis just as today's list 100 “causes” of cancer. In both cases 100 causes meant profound ignorance of the real cause.

Rebecca :
What is “hope of the tuberculous”? In what ways did the burgeoning bourgeoisie (European middle classes) during the 1800s contribute to death by tuberculosis?

Thomas :
Young people slowly “consumed” by tuberculosis often seemed to be imbued by the hope of ultimate recovery. In the great sanatoria hope was the lifeline. Common sense suggests that this was not really a specific “tuberculosis” phenomenon but many great & perceptive physicians were convinced of it & frequently referred to the “tuberculous hope” or (in medical Latin) “spes phthysica”. Urban overcrowding, malnutrition & poverty probably predisposed to the spread of tuberculosis.

Rebecca :
Twenty years ago, I was at a nadir & developed some worrying symptoms which the Emma Goldman clinicians diagnosed as TB. They gave me a white pill which I took for a year. What are today's likeliest perils that could put tuberculosis in our path? Does it matter if we're poor or rich or come from a particular ethnic lineage? Is how we live our lives a contributing factor?

Thomas :
Tuberculosis is already the commonest terminal illness - i.e., the illness of which patients actually die - than both AIDS or malaria. At some point tuberculosis will breach geographical & social frontiers & strike at rich countries & the middle classes just as it did in the 19th century. The worrying feature is that in its new form tuberculosis may be resistant to the antibiotics which are available today. This has not yet happened although tuberculosis is getting commoner in both the UK & the USA.

Rebecca :
When I was working with children I had to get a health certificate & part of that was having an upgrade to my European innoculation. Isn't TB under control? Don't we have a vaccine against it?

Thomas :
The efficacy of the antituberculous BCG vaccine is controversial. It is given to all children in the UK. It certainly reduces some of the most lethal forms of tuberculosis (such as tuberculous meningitis).

Rebecca :
Part of why I enjoyed reading The White Death are the numerous & curious notations with which you liberally flavor this otherwise, dreadful & dreary subject. How long did it take you to complete this detailed & eminently readable history of tuberculosis?

Thomas :
I have had a mental “file” on tuberculosis for so long that the writing did not take more than a year or two. When I shed some of my hospital & research commitments I had time to put pen to paper.

Rebecca :
Are you writing another such book for the general public?

Thomas :
I have just published a book which also grew out of a long-standing research interest, the biology of ageing. It is called Old Masters & discusses why great artists often created some of their best work in old age. I think it has been published in the US by New York University Press.

Rebecca :
That, Sir, I would also like to read. Thank you for taking the time to respond to my snail mail questions. It's been a pleasure corresponding with you across the world.

Readers, I do encourage you to check out Thomas Dormandy's The White Death - it is riveting reading & a superb way of learning about the connections between literature, industrialization & medicine!

(Published May 06, 2001)