If the seashore or the opera didn’t strike your fancy, there were many mountain sanatoriums for those who could afford them, like the one depicted by Thomas Mann in The Magic Mountain (1924). They were places where wealthy consumptives could spend their days enjoying rest cures while taking, at least if Mann’s depiction is to be believed, a great deal of pleasure in their elite diseased status. Their popularity originated with the German physician Hermann Brehmer’s initially unpopular theory that tuberculosis could be cured by plenty of rest in a high altitude. At these sanatoriums “guests” would rest on open, airy porches, eat decadent meals (Brehmer and his colleagues believed in feeding consumptives more than milk and vegetables), and go for walks in nature. And if you felt you needed more stimulation than a mountain sanatorium could provide, the poet Sidney Lanier proposed, in what is certainly the most bizarre suggestion I have found, that consumptives could move to the wonderful climate of Florida and begin hunting alligators, so as to sell the animals’ teeth at a handsome price from four to ten dollars a pound. He was not joking.30
The idea of becoming a professional alligator hunter when you can scarcely breathe sounds dicey. Lanier’s plan aside, sleeping for most of the day, traipsing to the opera in jewels, and traveling to Nice or the Alps “for your health” sounds like fun to me. Being constantly told you are beautiful/handsome and sensitive like an angel sounds even more enjoyable. The only part of this lifestyle that sounds terrible is the “dying in agony” part, which is—always—glossed over. Beddoes claimed he was facing an uphill battle in convincing the “ghostly beauties of court and city that to be robust and in ‘rude’ or vulgar health is not a ‘curse.’”31
It’s easy, given all of the associations regarding wealth and beauty, to forget that tuberculosis is caused by bacteria. It doesn’t have a brain. It doesn’t choose. It preys on absolutely anyone it comes into contact with, beautiful or ugly, rich or poor, smart or street smart, maybe—not book smart.
Bacteria don’t infect people based on their personality traits or income. However, given the glamor and status associated with the disease, Beddoes came to the conclusion that women were deliberately contracting consumption to look more chic.
Tragically, the fetishization of this sickly physical ideal did indeed lead some women who were naturally healthy to become sickly, even if they did not contract consumption itself. The unfortunate death of poor Lizzie Siddal was an example where glamorizing a tubercular aesthetic turned deadly. In addition to being a poet and painter herself, Siddal was perhaps the most famous artist’s model and muse of the Pre-Raphaelite era. You would probably recognize her from paintings like John Everett Millais’s Ophelia and Dante Gabriel Rossetti’s Beata Beatrix. She was known for her slimness and pallor, her long red hair, and for looking as if she was dying of tuberculosis. It was generally believed at the time that she had the disease; indeed, the scholar Katherine Byrne explained that “her attractiveness was inseparable from her perceived consumptive state.”32
Here’s the thing: she probably didn’t have tuberculosis. Today, it seems more likely that she was suffering from anorexia (she wrote letters to her lover Rossetti telling him that she had not eaten for weeks) and a serious addiction to opiates.33 Ideally—ideally!—good health would not be seen as a vulgar curse, and someone would have said, “Hey, Lizzie, you look very sick; let’s see if we can find a way to address this issue because it might have to do with you not eating for weeks on end and also your laudanum habit. I know we are in the Victorian age, and accordingly everything is awful, and mothers are giving their infants laudanum in an ill-advised attempt to soothe them, so babies are getting addicted. Seriously, it is amazing how many drugs everyone is doing right now, everyone is just drugged to the gills, but still, Lizzie. Still.”
That is just how we would say it. We are very good at confronting problems head-on. We would take Lizzie back to the future with us in our time machine. We would have to take Lizzie to a time when disordered eating and drug addiction aren’t problems for models and other women pressured to fit society’s definition of beauty, so … oh.
As is, tragically, still the case today when some women engage in destructive behaviors, people didn’t want to help Lizzie so much as they wanted to praise how fashionable and skinny she looked. When the painter Ford Madox Brown visited her, he enthused, “Miss Siddal—looking thinner and more deathlike and more beautiful and more ragged than ever.”34 (Deathlike and beautiful went together so easily.)
In Tuberculosis and the Victorian Literary Imagination Katherine Byrne writes, “It seems that [Siddal’s] desirability lay in her fragility and that she was special because she always seemed hovering on the verge of death, and looked as though she was not quite of this world.”35 This poor depressed, drug addicted, possibly anorexic woman.
Elizabeth Siddal died horribly of a laudanum overdose in what may have been a suicide. She was age thirty-two.
Fortunately, ideals about beauty can change. As the years went on, romantic depictions of tuberculosis and the lives of those suffering from it gave way to more realistic descriptions. In 1877 when Tolstoy published Anna Karenina, he presented a very different vision of what someone dying of tuberculosis looks like from those pretty pictures of Fantine or Violetta. This one bears a closer resemblance to Severn’s description of Keats’s death, likely because Tolstoy based the scene on his brothers’ actual deaths from tuberculosis in 1856 and 1860.
[Nikolai’s brother] had expected to find the physical signs of the approach of death more marked—greater weakness, greater emaciation, but still almost the same condition of things. He had expected himself to feel the same distress at the loss of the brother he loved and the same horror in face of death as he had felt then, only in a greater degree. And he had prepared himself for this; but he found something utterly different.
In a little dirty room with the painted panels of its walls filthy with spittle, and conversation audible through the thin partition from the next room, in a stifling atmosphere saturated with impurities, on a bedstead moved away from the wall, there lay covered with a quilt, a body. One arm of this body was above the quilt, and the wrist, huge as a rake-handle, was attached, inconceivably it seemed, to the thin, long bone of the arm smooth from the beginning to the middle. The head lay sideways on the pillow. Levin could see the scanty locks wet with sweat on the temples and tense, transparent-looking forehead … Only at rare moments, when the opium gave him an instant’s relief from the never-ceasing pain, he would sometimes, half asleep, utter what was ever more intense in his heart than in all the others: “Oh, if it were only the end!” or: “When will it be over?” His sufferings, steadily growing more intense, did their work and prepared him for death. There was no position in which he was not in pain, there was not a minute in which he was unconscious of it, not a limb, not a part of his body that did not ache and cause him agony.36
Good for Tolstoy for making death from tuberculosis sound terrible. When diseases sound frightful, people stop thinking they are a minor ailment alleviated by eating anchovies or bathing in salt water or falling in love.
As the nineteenth century neared its close, it was becoming clear that at least some people were fed up with the whole “let’s just have people eat alternative foods and go on vacation” attempts to treat the disease. Jacques Offenbach’s opera The Tales of Hoffmann (1881) pokes fun at medical charlatans through the character of Dr. Miracle, whose inept methods inadvertently kill the lovely heroine Antonia in the second act. The absurdities of the doctor’s treatments would have been recognizable to many in the audience.
Now, were these new artistic characterizations of the disease anywhere near as popular as the depictions of women dying like gorgeous angels? No, of course not! Many people—though presumably not you, because you saw this disease-riddled book and said, “That is a book for me!”—don’t like hearing about the more gruesome aspects of life. In general people want to read about happy stuff and to feel good and to look at puppies
wearing party hats.
Who’s a healthy boy?!
Fortunately, there are individuals who can create art that is so good that it can’t help but educate people about life’s gritty realities. Those tales generally cleverly offset bad news with more appealing aspects. Nobody reads Anna Karenina because they want to see how Nikolai dies. They read it because they hate trains. Or because they love enduring tales of passion. Either/or. Nobody goes to The Tales of Hoffmann because they are into medical quackery of the nineteenth century. I think most people go for the music and costumes. But Tolstoy and Offenbach still managed to insert in their works enlightening messages about the realities of a terrible disease.
God bless anyone whose work holds up a mirror to the world.
The romantic appeal of the disease dissipated further in 1882 when the German bacteriologist Robert Koch identified the bacilli that caused consumption by using a microscope and a stained sample (which was extremely cutting-edge technology at the time). He also determined how tuberculosis spread from one person to the next, proving it was not caused by having a lot of feelings, being rich, or being beautiful.37
In his writings, known for their realism, the American author Upton Sinclair began associating the disease with working-class people, not “finer souls, form’d to soft luxury.”38 The opera La Bohème (1895) also associated the disease with poor people. Admittedly, poor creative people, but poor nonetheless. It also didn’t portray it as a disease that went hand in hand with love and a glamorous life on earth. The beautiful Mimi’s consumption causes her to be abandoned by her lover, as he sings, “Amo Mimi, ma ho paura” (I love Mimi, but I’m afraid).
As tuberculosis came to be regarded less as an ailment specific to the stylish elite and more (correctly) as a huge public health problem, clinics like the Victoria Dispensary for Consumption and Diseases of the Chest began opening. The French declared “War on Tuberculosis,” and in 1886 the Conseil d’Hygiène et de Salubrité voted to outlaw public spitting. By 1909 the radical Thaddeus Browne was writing poetry about consumption as a disease that was “malignant, repellent, appalling.”39 People raced to develop vaccine therapies, and any notions about how captivating consumption was faded in the light of medical knowledge.
By 1921 the Bacille Calmette-Guérin vaccine, which is still used today, was developed. It is currently administered to around 100 million children worldwide. In areas where tuberculosis is still prevalent, it is recommended that children receive the vaccine as soon as possible after birth. In the event that someone contracts tuberculosis, there are now ten antibiotics approved by the FDA to treat the disease over a course of six to nine months.40
The good news is that we now know tuberculosis isn’t a cool blessing. We don’t look at a woman with consumption and think, Oh, man, she is withered like a ghost and spitting blood; I want her to be my Victorian bride. The fact that we are at least slightly less inclined to wholeheartedly glamorize conditions that kill people is a step forward for humans. The downside is that we often don’t think about those suffering from tuberculosis at all. The disease is still around, it’s still contagious, and despite the fact that the vaccine costs approximately sixteen cents to produce, and $3.13 to buy, tuberculosis continues to ravage periphery countries.41
Millions of people worldwide die from tuberculosis every year—and it’s totally treatable. This is a disease we can eradicate in our lifetime. Because we are modern people! We know that diseases aren’t friendly, they aren’t cool, and they’re not even a good excuse to become an alligator hunter. So you have two options in fighting the good fight against a universal enemy. Either you can create great art that illustrates the plight of people dying from tuberculosis, as Tolstoy did, or you can donate $1.30 (for the 1.3 million people who die of the disease each year) to any of the worthy organizations that fight tuberculosis. If you’re going with the latter option, I recommend the Stop TB Partnership, which is endorsed by the United Nations Foundation and does amazing work. If you choose the former, I hear wine helps some people write books.
Cholera
His examination revealed that he had
no fever, no pain anywhere, and that
his only concrete feeling was an
urgent desire to die. All that was
needed was shrewd questioning …
to conclude once again that the
symptoms of love were the same as those of cholera.
—GABRIEL GARCÍA MÁRQUEZ
Once people think they understand how something works, it takes a veritable force of nature to convince them differently. Seriously. Try it. Try to change someone’s mind about one fact or situation or process they believe they understand fully. You can use as much data as you want. You can make diagrams. You can write a song and put on a damn musical. They will not believe you—because their fourth-grade teacher told them something different, and they are certain they already know how it works.
Remember how much it upset people when we were told that Pluto wasn’t a planet anymore? I’m still mad about that. The only thing I knew for sure about space was “the order of all the planets” (My Very Educated Mother Just Served Us Nine Pizzas), and then that one bit of knowledge was ripped away from me. What mnemonic do kids even use now? I’m aware there are reasons Pluto was demoted, but in my heart, I do not care what Neil deGrasse Tyson says. (Even though I know in my mind he’s right, in my heart, I feel he’s wrong.)
So, on that note, remember how during the bubonic plague everyone thought that the disease might be caused by foul, smelly air? The doctors wore cool bird masks filled with cloves and potpourri, which they believed would stop them from catching the disease. And remember how we all laughed and collectively said, “That’s dumb!” because we know diseases aren’t caused by bad smells in the air? Well, the belief that diseases stemmed from bad smells lasted longer than you could possibly imagine. Five hundred more years. It lingered—like the stench of a dead fish—all the way into the 1850s. In 1844 Professor H. Booth even went so far as to claim in the journal of architecture the Builder that “from inhaling the odour of beef the butcher’s wife obtains her obesity.”1
This seems like an unfair stereotype about butchers’ wives.
In 1846 the social reformer Edwin Chadwick gave a speech before British parliament claiming: “All smell is, if it be intense, immediate acute disease; and eventually we may say that, by depressing the system and rendering it susceptible to the action of other causes, all smell is disease.”2 Even the celebrated nurse Florence Nightingale believed that measles, scarlet fever, and smallpox were caused by bad odors.
This theory led to some bizarre ideas. For instance, Chadwick thought that tall structures like the Eiffel Tower could be used to allow people to collect clean, good-smelling air from the top levels, which would then be distributed, “warmed and fresh,” to people below.3 I am fascinated by the mechanics of how Chadwick thought this could be done. I don’t know how he was going to effectively transport air from the highest point of the Eiffel Tower. A basket? Maybe jars. I guess jars would be best. I imagine he was going to have hundreds of people climb to the top of the Eiffel Tower with jars, collect fresh air, and then transport it to ground level, where they’d heat it like a loaf of bread and share it with everyone. It seems like an unworkable idea, but a fun image to have in your head when you visit the Eiffel Tower.
Definitely a super practical structure
The conviction that bad smells caused disease had some upsides in London. It resulted in a massive effort to clean up the streets and houses, which were filled with filth, which was generally the source of noxious odors. Chadwick was quoted in the Times in 1849 saying that the effort should apply first to the “purification of the dwelling house, next of the street and lastly of the river.”4 The Nuisances Removal and Diseases Prevention Act of 1846 seemed to proceed in accordance with the order Chadwick later suggested.
Any movement toward sanitization is usually also a step forward in combatting disease. Lon
don during the mid-nineteenth century was wildly overcrowded. Its population of 2.5 million made it the largest city in the world at that time. (That’s roughly the size of Chicago today.) One census described a single room where five families were living, each in their own area. They claimed they were doing well with four families (and four corners) until someone took in a lodger in the middle. And then there was the livestock that people kept inside their houses. We’re not talking about livestock in the sense of “a few people had some chickens.” We’re talking cows in the attics. They’d be levered up by pulley and kept in the attic as long as they had milk to give. (If I had such a cow, I would name her Bertha Mason.) It wasn’t always even one or two cows; there might be as many as thirty cows in what were known as “cow houses.”5 One man kept twenty-seven dogs in his one-room apartment! Another woman down the street had seventeen cats, dogs, and rabbits.
Meanwhile, the city’s waste disposal systems hadn’t evolved in two hundred years. As you might imagine, running a veritable farm out of your studio apartment could produce a lot of waste. People had cesspools in their basements, where they disposed of their feces and urine—human and animal. According to Steven Johnson, the author of The Ghost Map: The Story of London’s Most Terrifying Epidemic—and How It Changed Science, Cities, and the Modern World, “They would just kind of throw the buckets down there and hope that it would somehow go away and of course it would never really go away.”6 Ugh, of course it did not. The amount of feces abounding in London did lend itself to an economy, though. “Pure Finders” roamed the street collecting dog poop, which they sold to tanners, who would smear it on leather skins to remove lime from them. As happy as I am that the Pure Finders managed to make money, I don’t think anyone wants to live in a city with such an abundant shit supply.
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