History Reviewer

Spitting Blood: A History of Tuberculosis

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Tuberculosis has claimed many famous victims over the centuries, in fiction and in real life, from John Keats to George Orwell, from the Bronte sisters to Robert Louis Stevenson, from the heroines of Verdi’s La Traviata and Puccini’s La Bohème to the consumptives who whiled away the hours in conversation on Thomas Mann’s magic mountain. It became quite fashionable in the 19th century, seeming to lend its victims an air of noble suffering and heightened sexual allure. “I look pale,” Lord Byron is said to have remarked, gazing into the mirror during a visit by the diarist Tom Moore: “I should like to die of a consumption.” “Why?” his guest asked. “Because the ladies would all say: ‘Look at that poor Byron, how interesting he looks in dying!'”

In fact, tuberculosis was a disease of the poor, encouraged by inadequate nutrition and spread by cramped and overcrowded living conditions. As industrialisation spread across the world, packing the new working classes into damp mills, unhygienic factories and fetid slums, so TB casualties soared. In Hamburg between 1885 and 1894, death rates from the disease in the richest city precincts averaged 1.3 per 1,000 population, in the new working-class areas 2.6, in the waterfront tenements where the casual dock labourers lived, 3.4. The unlovely realities of the disease’s incidence were conveyed in a terrifying scene in Dostoevsky’s Crime and Punishment, when the consumptive, poverty-stricken widow Katerina Ivanova, thrown into destitution by the alcoholism of her irresponsible husband and even more so by his eventual death, becomes delirious and takes her small children out on to the streets to sing and dance for a few kopeks; arrested by a policeman, she runs breathlessly away, stumbles and falls dead in the street, blood gushing out of her throat. “I’ve seen it before,” says the policeman. “That’s consumption.” Her death is undignified and grotesque, the product of extreme poverty that has driven her not into an exalted, otherworldly state of mind but into madness and degradation.

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