The White Death:
   A History of Tuberculosis
   Thomas Dormandy
  1999 New York U. Press, NY
   ISBN: 0814719279


From Antiquity, tuberculosis has been a killer on a huge scale, ever present yet lurking rather than epidemic; its explosion in the 1800s went hand in hand with industrialization abetted by bad housing & poverty.

For the Victorians, who elevated illness into art forms, the victims of TB were the ultimate in pale & interesting; the roll call of tuberculous genius reads like a who's who of artists & writers: Keats, Chopin, the Brontës; Robert Louis Stevenson, Chekhov, Orwell to name only a few.

Thomas Dormandy has written an engrossing account of the amazingly complex social, artistic & natural history of this ubiquitous disease as well as a telling chronicle of the medical profession at its worst & best.

The White Death has had its maiming & killing tendrils all around the globe wherever people huddle together in hopeless masses & yet - the Brontës lived at Haworth, deep on the Yorkshire moors, far from any industrial city.(I've been there!) What is this dread wasting disease that scythes down the young, the brilliant & the neglected? Thomas Dormandy sets out to explore.

On this incredible tour of the history of medicine & this malady in particular, The White Death takes us from prehistoric skeletons & Egyptian mummies discovered to have the characteristic lesions of the disease to tomb paintings of hunchbacks to the Greek word phthisis (wasting) which Hippocrates knew well. Images of pale, emaciated youths, fighting for breath, coughing up blood & dying young were common in antiquity from Arabia to Byzantium to Russia to Europe. The Americas became infected only when those intrepid explorers left behind sickly sailors.

In the general terror that tuberculosis created within a family, for this disease was not one that simply attacked its victim - it affected the entire family - the sufferers not only had to contend with the affliction that would eventually kill them, they also had to survive the moralistic & fickled attentions of the doctors of their age. The adored poet Keats was not only misdiagnosed, mishandled & misdirected, he was, basically, considered a hypochondriac. He was dead of the disease by 26.

Talk about the original snake oil treatments & salesmen! Reading some of the egotistical, superstitious ideas about this wasting disease dredges up the memories of the terror that swept through my boarding school when one girl out of 340 contracted polio from the vaccination program, during the 1950's epidemic in England. Thomas Dormandy peppers his broadsweeping panorama of the history of the tuberculous with the histories of some of the worst practitioners of medicine who ever penned a prescription.

He also gives us enticing glimpses into the mighty men of medicine who dared to seek different methods with which to diagnose & treat their patients. From Leopold Auenbrugger(1722-1809) who not only wrote his own book on “...the cause which occasions this diminution of resonance...” which led him to study the sounds that can be elicited by tapping the chest thus discovering the method of percussing the chest wall; to Napoleon's private physician, Corvisart to Laënnec, a contemporary of Beethoven, Goya, Byron & Goethe, who invented a brilliant device for “...listening to an extra-ordinarily wide range of sounds, from the sibilant susurration of air passing through a narrowed bronchus to the motoric lub-dub of the normal heart.”

The White Death stalked victim & physician alike with occasional decades of seeming relief until we enter the Industrial Revolution. Then the disease came into its own to blossom in the smoke-shrouded factory housing estates; in the airless confines of the workplace & during those fearsomely long work days. It attacked the young with pernicious persistence. For decades the death rate from TB in England & Wales was over 50,000 a year. Why?

No nursing order, convent, school, court nor slum was immune to consumption. You'd think that places far away from cities - like Wales or Ireland - would be havens. Not so, they were redoubts of tuberculosis & some of the most heavily tuberculous areas were the sparsely populated mountain districts of Norway as too the villages & farmsteads of the Great Hungarian Plain. Why?

Reading the chapter on The Cause is like watching a curtain slowly raise at sunrise only to find a frost-glazed window. Even so, along comes Antony Leeuwenhoek, Louis Pasteur & the obsessional Robert Koch. Three men on the trail of the elusive tubercles. Then came the rise, the dominance & the fall of those sanatoria - a phenomenon that swept across the Atlantic in the latter part of the 1900s & bloomed as far away as the American West - remember Doc Holliday?

In the 20th century at last, we face a truly major medical gaffe which the United States managed to curtail within a decade - the spread of TB through tuberculin infected cows' milk. It took England a bit longer because they had a couple of internecine squabbles to get over although the rest of Europe, when it got the news, ran with it.

In the interwar years, as Germany's Weimar Republic was imploding, there began a horrible medical mistake which cost the lives of over 200 infants all innoculated with the same vaccine. Outside the courtroom where the arrested medical professionals were on trial, Nazis & Communist workers paraded, relishing their heated melees. The Nazis, eager for scapegoats, latched onto the vaccines as a symbol of the accursed Versailles humiliation & the case became another nail in the republic's coffin. The real tragedy was that no one learnt anything - not where the vaccine came from, whether it was contaminated & how. The rabid opponents of vaccinations very nearly succeeded in suppressing this relatively new form of prophylactic medicine.

This is where I come into the picture - at the end of the Second World War when Europe faced an upsurge of tuberculosis more devastating than anything before. The disease was erupting among the millions of displaced people inhabiting former concentration camps & army barracks & was stalking every burnt-out & starving city. Over eight million babies & children were vaccinated & I was one of them.

Then it was time for the Third World to greet the great killer. Where once leprosy had blanketed Europe for centuries & left to lodge itself in far flung corners of the world to become known as a “tropical” disease, now tuberculosis crept across the oceans.

By the last quarter of the 20th century the United States Centers for Disease Control and Prevention confidently predicted that the US would be a tuberculosis-free zone by 2005, except for what President Bush might have called “that civilisation thing.” By the 1980s incidences of TB mortality were on the rise & a decade later cases diagnosed in the Developing World were estimated at around seven million.

Now there are two new vectors: the HIV pandemic & the as yet distant drum roll called MDR - multidrug resistance. Now prisons & orphanages have become the breeding grounds for an evolving White Death. It is still with us, folks!

This is one vitally informative, compelling & erudite volume on an affliction that has been with us since we before we began burying our dead, painting on walls & writing. It's all that connected history - sometimes I felt I was in a university amphitheater, soaking up this venerable professor's lifetime of study. At other times, I was in dank & drear factory town streets listening to the coughing; or at a doctors' symposium where they're arguing about who discovered what; or in an airless, opulent studio where an inspired victim writes of his visions. What an impressive & engrossing read!

Thomas Dormandy is a consultant pathologist who has published numerous articles & books on medical & scientific topics. His latest book on the inspiration of elderly artists: Old Masters is about to be released.

Do check out my Interview with this author - I think you will be as amazed as I!
(05/06/01)

Rebecca