Realities and Romanticizing

In the nineteenth century, tuberculosis was "unquestionably the greatest single cause of disease and death in the Western world." for a great outbreak had occurred following the Industrial Revolution.^[1] Pulmonary consumption was "a disease so frequent as to carry off prematurely about one-fourth of the inhabitants of Europe, and so fatal as often to deter the practitioner even from attempting a cure," wrote Thomas Young in his Historical and Practical Treatise on Consumptive Diseases , published in London in 1815.^[2]

Often the disease killed young adults. "All the tragedy of consumption. . .and the ignorance of nineteenth-century medicine concerning its diagnosis, nature and treatment are exemplified in the story of John Keats, dead of tuberculous in 1821 at the age of twenty-five."^[3] In 1818, Keats, who had

once planned to become a doctor (he had completed the medical course at Guy's Hospital in London), nursed his brother, Tom, who died of tuberculosis that December. Thirteen months later, the poet himself first spat blood.

[Seized with a high fever,] he coughed and suddenly tasted blood in his mouth. . . . He looked at the bright red spot. . . and . . . said . . ., "I know the color of that blood. It's 'arterial' blood. . . .That blood is my death warrant, I must die." . . . [His friend] ran for the surgeon, who, according to the honored medical practice of the day, bled . . .[him] from the arm, the first of the many bleedings that were to hasten his course to the grave.^[4]

Along with their baleful bleedings, Keats's doctors kept him on a starvation diet because they believed that in that way they were combating the progress of the disease. The poet died after a year of their medical regimen.

The medical management of Keats's tuberculosis was not unique, unfortunately, for the nature of the disease was not uncovered until 1882, and curative medicines were not discovered until well into the twentieth century. Until 1839, in fact, the disease was called by a bewildering variety of names, including phthisis, consumption, scrofula (or the king's evil, from the old notion that a king's touch could cure it), hectic fever, and gastric fever. In that year, J. L. Schonlein, professor of medicine in Zurich, suggested that the name "tuberculosis" be used because "the tubercle was the fundamental anatomical basis of the disease."^[5] In 1882, the causative organism, the tubercle bacillus, was identified by Robert Koch, and from then on, tuberculosis was understood to be an infectious bacillary disease. But medicine as yet had no effective pharmaceutical remedies.

The most important development for the treatment of active tuberculosis occurred in 1944 with the discovery of streptomycin. Other drugs followed: para-aminosalicylic acid (PAS) in 1947, isoniazid (INH) in 1952, ethambutol

(EMB) in 1967. and rifampin (RFN) in 1972. Therapy is now very effective and easy to administer.^[6]

Perhaps because so 'many young adults died of tuberculosis in the nineteenth century and even into the twentieth, the disease was often romanticized in literature and opera. It was depicted as an affliction that made people more interesting or sensitive. A prime example of this is Hans Castorp in Thomas Mann's The Magic Mountain . Or it was portrayed as an ailment that, in consuming the body, caused suffering that purified the spirit or soul. This is evident in the novel and play by Alexandre Dumas fils, both entitled La Dame aux camélias , which served as the inspiration for Verdi's La Traviata , and also in Henri Murger's novel Scènes de la vie de bohème , which served as the basis for Puccini's La Bohème . At times, tuberculosis was also idealized as an illness that could cause a painless death, such as in "Consumption," a sonnet by the American William Cullen Bryant (1794–1878).^[7]

All these romanticized notions about tuberculosis are present in Verdi's opera La Traviata (The Fallen Woman), which was first performed at La Fenice in Venice in 1853.