Get Well Soon

by Jennifer Wright

  The members of Mr. Crumpton’s club were—at least while they were together—liberated from shame about their disease. That is a great thing because shame is one of the enemies in the war on diseases. Shaming people cures nothing. Living in a state of silence cures nothing. It only means that more people are afraid to talk about their ailments. That means that they’re at a disadvantage, because they can’t protect themselves against things they barely know about. When we raise our voices, whether it’s in a small group, like Mr. Crumpton’s, or in a larger number, we say that we will not allow ourselves to be killed. We say that we don’t deserve to suffer, even if hypocrites in society believe we do. And once society begins to hear those voices, it will, we hope, begin to work harder to find a cure.

  Tuberculosis

  Dying of tuberculosis. The earth is

  suffocating … Swear to make them

  cut me open, so that I won’t be

  buried alive.

  —FRÉDÉRIC CHOPIN

  Throughout history, as we’ve seen with syphilis, people have wanted to glamorize certain diseases. They really shouldn’t. Diseases are not lovely under any circumstances. Pretending they are is about as effective as trying to paint a pretty face on a death mask. Applying some lipstick to a skull doesn’t turn it into Jennifer Lawrence. Diseases are the most fundamental enemy of the human race, and we must be at constant war against them.

  Here are some things that diseases don’t make people:

  • Cool

  • Poetic

  • Sexy

  • Classy

  • Genius

  Here is one thing they do make people:

  • Dead

  If only this was understood by the numerous people in the nineteenth century who thought that tuberculosis was just So. Damn. Glamorous.

  Tuberculosis—which was often called consumption—is a bacterial disease. It is very contagious. The bacterium is spread by droplets whenever sufferers cough or sneeze (or sing or laugh, for that matter). Those droplets are then inhaled by others. In some people, the bacterium remains latent for years. In others, it goes into remission. And in the most serious cases the bacterium settles in the lungs, where it eventually destroys their tissue. Symptoms include chest pain, coughing, severe weight loss, and that spitting-blood-into-a-handkerchief thing (the technical name for that is bloody sputum)you are definitely familiar with if you have seen the movie Moulin Rouge (2001).1

  In many literary works from the nineteenth century, consumption is the death of choice for beautiful angelic women. Their fictional final moments almost always have them dying peacefully and looking great as they slip away. For instance, in Harriet Beecher Stowe’s Uncle Tom’s Cabin, published in 1852:

  It soon became quite plain to everybody that Eva was very ill indeed. She never ran about and played now, but spent most of the day lying on the sofa in her own pretty room.

  Everyone loved her, and tried to do things for her. Even naughty little Topsy used to bring her flowers, and try to be good for her sake …

  One day Eva made her aunt cut off a lot of her beautiful hair. Then she called all the slaves together, said good-bye to them, and gave them each a curl of her hair as a keepsake. They all cried very much and said they would never forget her, and would try to be good for her sake … in the morning little Eva lay on her bed, cold and white, with closed eyes and folded hands.2

  In his lesser-known short story Metzengerstein, published in 1832, Edgar Allan Poe wrote: “The beautiful Lady Mary! How could she die?—and of consumption! But it is a path I have prayed to follow. I would wish all I love to perish of that gentle disease. How glorious! to depart in the hey-day of the young blood—the heart of all passion—the imagination all fire—amid the remembrances of happier days—in the fall of the year—and so be buried up forever in the gorgeous autumnal leaves!”3 You can certainly argue that Poe was enamored with death in general, but Victor Hugo wasn’t. His work didn’t usually fetishize death. And yet here is his description of Fantine on her deathbed in Les Misérables (1862):

  She was asleep. Her breath issued from her breast with that tragic sound which is peculiar to those maladies, and which breaks the hearts of mothers when they are watching through the night beside their sleeping child who is condemned to death. But this painful respiration hardly troubled a sort of ineffable serenity which overspread her countenance, and which transfigured her in her sleep. Her pallor had become whiteness; her cheeks were crimson; her long golden lashes, the only beauty of her youth and her virginity which remained to her, palpitated, though they remained closed and drooping. Her whole person was trembling with an indescribable unfolding of wings, all ready to open wide and bear her away, which could be felt as they rustled, though they could not be seen. To see her thus, one would never have dreamed that she was an invalid whose life was almost despaired of. She resembled rather something on the point of soaring away than something on the point of dying.4

  Something soaring like an angel.

  And this glamorous tuberculosis trope was not confined to novels. Verdi’s opera La Traviata (inspired by Alexandre Dumas’s La Dame Aux Camelias, published in 1848) was first staged in 1853. The story revolves around the tragic but decadent life of the courtesan Violetta. She is perhaps history’s most famous consumptive and was at least part of the inspiration for Nicole Kidman’s character in Moulin Rouge. Violetta dies singing: “The spasms of pain are ceasing / In me … is born / I am moved by an unaccustomed strength! / Oh! But I … oh! / I’m returning to life! / Oh, joy!” Her last note is a high B-flat, which no one with tuberculosis would ever be able to hit, partly because it would require too much lung expansion, and partly because tuberculosis often resulted in hoarseness owing to tubercular laryngitis.5 Oh well. It’s a good song.

  Owing in part to these euphemistic portrayals, during the nineteenth century people were not especially afraid of tuberculosis. The general thought was that, okay, you die, but it’s a really easy death and you’re all pale and sexy like an angel or a character in a Tim Burton movie.

  You know who didn’t feel this way? The men and women who actually had tuberculosis. The actress Elisa Rachel Félix would have begged to differ with anyone who thought she looked amazing when she was sick with consumption in 1855. She claimed: “You who knew Rachel in the brilliance of her splendor and the riot of her glory, who have so often heard the theater ring with her triumphs—you would not believe that the gaunt spectre which now drags itself wearily over the world is—Rachel.” She died of suffocation in 1858 while (trying) to cry out for her deceased sister.6

  It wasn’t just women with tuberculosis who were thought of as dying of a painless but beautiful malady. The poet Byron once told a friend, “I should like, I think, to die of consumption; because then the women would all say, ‘See the poor Byron—how interesting he looks in dying!’”7 The romantic poet John Keats was the poster boy for dying of “that gentle disease.” Percy Bysshe Shelley claimed that Keats contracted the disease because “the savage criticism of his [poem] Endymion produced the most violent effect on his susceptible mind. The agitation thus originated ended in the rupture of a blood vessel in the lungs.”8

  You can be upset, but I don’t think you can die from a bad review. This is the only time when I have seen literary critics called actual murderers, but Shelley said it, so think about the power you wield the next time you log on to Goodreads.

  When Keats was suffering the symptoms of maybe-bad-review-induced tuberculosis during his visit to Rome in 1820, he was treated by Dr. James Clark, who seemingly did not think things were all that dire. Upon learning that Keats had been put in a separate ward in a Roman hospital with other consumptives due to the risk of contagion, Dr. Clark sniffed that this arrangement was “maintained by the vulgar,” and that it originated from “the old and almost obsolete opinion of the contagious nature of this disease.”9 We will put aside the fact that referring to people maintaining a hospital as “vulgar” makes him sound lik
e a pretentious ass.

  Let’s focus instead on the fact that tuberculosis is in fact extremely contagious. The Roman hospitals were using sensible protocols. Dr. Clark would have been even more unimpressed if he had been to Spain, where the populace was even more vigilant in their attempts to prevent the spread of the disease. In that country not only did consumptives have to be reported and moved to a hospital immediately; following their deaths even their houses were declared virtually uninhabitable.

  But Dr. Clark had none of these quaint concerns. When he was trying to treat Keats, he put him on a diet of anchovies and bread. He claimed that the disease “seems seated in his stomach.”10 He was not alone in thinking that various foods might cure consumption. Daniel Whitney wrote in The Family Physician, and Guide to Health (1833) that “Dr. Mudge cured himself by keeping constantly open an issue between his shoulders of fifty peas, and by using at the same time a milk and vegetable diet.”11 The peas, which were presumably intended to agitate the skin and produce a discharge, seem to be a weird anomaly, but the milk and vegetable diet likely stemmed from the theories proffered by Dr. Edward Barry in his Treatise on the Consumption of Lungs (1726). Dr. Barry, who was one of the most acclaimed physicians of the time, claimed that British people of “a better sort” contracted tuberculosis because they tended to imbibe liquor and eat a lot of meat. He deduced they could therefore combat the disease through a diet of milk and vegetables.12

  Eating vegetables is never a bad idea. Neither is drinking milk instead of brandy or claret or whatever else eighteenth-century British aristocrats were downing. If you want to keep a bunch of uncomfortable peas between your shoulders—okay, free to be you and me. However, this nutritional regime would not cure you. It certainly didn’t save Keats, and the bloodletting that was additionally prescribed probably hastened his decline. He died at age twenty-six. His life was so brief that he wished for his tombstone simply to read “Here lies one whose life was writ in water.” Meanwhile, Dr. Clark went on to become Physician-in-Ordinary to Queen Victoria and lived out his life in a magnificent estate, which seems unfair.

  Anchovies aside, Keats’s death is often remembered as something peaceful and romantic and dreamy. That’s partly due to his writing poems like “Ode to a Nightingale” that opine:

  Darkling I listen; and, for many a time

  I have been half in love with easeful Death,

  Call’d him soft names in many a mused rhyme,

  To take into the air my quiet breath;

  Now more than ever seems it rich to die,

  To cease upon the midnight with no pain

  Blame for this faulty angelic remembrance also lies with Keats’s good friend Joseph Severn, who was at the poet’s deathbed. Severn recalled Keats’s death in later years as a “good death,” toeing the whole “consumption is a beautiful way to go” party line.

  However, Severn’s private letters from the time when Keats was dying tell a very different story. He wrote to his friend Charles Brown on December 17, 1820, about a month before Keats died:

  Five times the blood has come up in coughing, in large quantities [around two cups’ worth] generally in the morning, and nearly the whole time his saliva has been mixed with it. But this is the lesser evil when compared with his Stomach. Not a single thing will digest. The torture he suffers all and every night and best part of the day is dreadful in the extreme. The distended stomach keeps him in perpetual hunger or craving, and this is augmented by the little nourishment he takes to keep down the blood. Then his mind is worse than all—despair in every shape. His imagination and memory present every image in horror, so strong that morning and night I tremble for his intellect.13

  That is what death from tuberculosis was like. It’s not cool and peaceful. There’s no such thing as a good death but especially not that one. Keats’s death sounds like something from a Lovecraft story.

  So how did a disease that is so gruesome and bloody gain this reputation for turning sufferers into beautiful angels?

  Tuberculosis was, even early on, associated with attractiveness. The first-century physician Aretaeus of Cappadocia described the typical sufferer as having a “nose sharp, slender; cheeks prominent and red; eyes hollow, brilliant and glittering.”14 Admittedly, big-eyed and skinny with rosy cheeks is a description that sounds a lot like today’s supermodels.

  So … do you have a boyfriend?

  The association of consumption and beauty endured for thousands of years. In 1726, in the aforementioned treatise on the Consumption of the Lungs, Dr. Barry wrote that people suffering from tuberculosis generally physically presented:

  [a] long Neck, Scapulae prominent like wings, Thorax compressed, and narrow, a clear florid Complexion, the Cheeks and lips painted with the purest red, the Caruncle [small piece of flesh] in the Corner of the Eye, from its intense Colour, appears like Coral; and all the vessels are so fine, as to appear almost diaphanous: Such Persons are likewise most frequently remarkable for a Vivacity of Mind.15

  And in 1833 Daniel H. Whitney still claimed that you could recognize a consumptive by “clean fair skin, bright eyes, white teeth, delicate rosy complexion, sanguine temperament, great sensibility, thick lips.”16

  This is a good moment to point out that tuberculosis doesn’t make your neck long. As late as the nineteenth century, the poet and physician Tomas Lovell Beddoes goes on about the long, lovely necks of consumptives.17 I (not a doctor) can attribute the other physical descriptions to the extreme weight loss that accompanies tuberculosis—because your body has to expend more energy keeping you alive—as well as being flushed with fever, but the idea that the disease either produces a long neck or is due to one is just incorrect. If you were thinking consumption would turn you into a Modigliani model, it won’t.

  It is also worth pointing out that a bacterial disease doesn’t make you smarter or more possessed of a “Vivacity of Mind.”

  Not only were those suffering from tuberculosis supposedly beautiful and brilliant; according to Christian tradition they were also godly and good. That belief was mostly due to the association of plumpness with worldly appetites of many kinds. If you were as bony as someone with consumption, you must have been depriving yourself in this world to feast with Jesus in the next.18

  You will be hard-pressed to find any portrayal where consumptives aren’t gorgeous—beautiful, otherworldly, and quite sexy. Sexy because, as Hippocrates noted in the fifth century, consumption tended to attack young people, chiefly between the ages of eighteen and thirty-five.19

  Given the age and perceived attractiveness of the sufferers, in the seventeenth century tuberculosis was thought to be a disease caused by lovesickness. Gideon Harvey, the physician to King Charles II of England, was certain that consumption was linked to love. In Of an Amorous Consumption, he explains that “when Maids do suddenly grow thin-jawed and hollow-eyed, they are certainly in Love.”20 Weight loss, a lack of appetite, and eye glitter could be caused by some unrequited passion. They just weren’t in the cases of people who were actually ill with tuberculosis. The theory went further. If sadness from a lack of love caused the disease, it could be cured by love. That was utterly untrue, but the idea of dying from lovesickness is more palatable than the idea of dying from rotting lungs. Unfortunately, this reasoning meant that a terrifying, deadly disease was reduced to something seen as delightful and ladylike.

  By the late eighteenth century—and certainly the turn of the nineteenth—even women who did not have consumption wanted to look as though they did. Of course, to be concerned about fashionable appearances you had to have money and time to spare. Medical attention and information about consumption were accordingly targeted directly to a “well-bred” audience. In John Armstrong’s Art of Preserving Health (1744), he directs his thoughts on tuberculosis to “ye finer souls / Form’d to soft luxury.”21 At the turn of the nineteenth century, Beddoes complained of boarding schools that had “greatly contributed to multiply the genteel, linear, consumptive make, now or lat
ely so much in request.” The nineteenth-century doctor Thomas Trotter likewise lamented: “So unnatural and perverted are fashionable opinions on this subject, that a blooming complexion is thought to indicate low life and vulgarity in breeding. What a false standard for beauty: to prefer a sickly sallow hue of the countenance to the roses of health!”22 Women began covering themselves in whitening powder during this period—the idea of a suntan to show health and an outdoorsy spirit wouldn’t be popular until the twentieth century.23

  All of these conceptions about the disease being for the well-born were incorrect. Of course tuberculosis could affect any member of society regardless of their social rank. Between 1829 and 1845, 10 to 13 percent of white prisoners in large cities on the East Coast of the United States died of tuberculosis; the rate was even higher among black prisoners.24 Overcrowded housing conditions in the nineteenth century meant that tuberculosis was prevalent among the poor, so much so that Marx and Engels later labeled the disease a “necessary condition to the existence of capital.”25 In 1815 the physician Thomas Young claimed that it was “a disease so frequent as to carry off prematurely about one-fourth part of the inhabitants of Europe.”26 Indeed, about 4 million people were thought to have died from consumption in England and Wales alone between 1851 and 1910.27

  The fact that even today tuberculosis is often associated with dying aristocrats is probably because there was a whole lifestyle marketed to well-heeled sufferers. Inducements to visit the warm climate of the Mediterranean promised that it was “the last ditch of the consumptive.”28 Every seaside village seemed to claim that its salt water could cure the disease. And then there was the big-city opera cure. In The White Plague: Tuberculosis, Man and Society, Jean and René Dubos explain: “Nice was the most fashionable rendezvous for those who tried to dodge death every winter by escaping from northern frosts. At the Opera House, performances of the ‘cooing, phthisical’ music of the Romantic Era nightly attracted throngs of corpselike consumptives. The young women were smartly dressed and lavishly jeweled, but so pale beneath their curls that their faces appeared to be powdered with ‘scrapings’ of bones.”29 Jewels! Gowns! Romantic music! It all sounds so glamorous! No wonder the musician character in Henri Murger’s 1851 Scènes de la Vie de Bohème gripes, “I would be famous as the sun if I had a black suit, wore long hair and one of my lungs was diseased.”