Medicine: Death’s Captain

To the Rockefeller Institute’s famed Bacteriologist Rene Jules Dubos. tuberculosis is a personal enemy. It killed his first wife; his assistant and second wife, Jean Porter Dubos, has suffered from it.

To French-born Dr. Dubos should go much of the credit for sparking the development of antibiotics—among them streptomycin, first and still the best of the “miracle drugs” which fight TB. But in The White Plague (Little. Brown; $4), Rene and Jean Dubos urge mankind to stop thinking of the disease in terms of drugs and individual patients: “Tuberculosis is a social disease and presents problems that transcend the conventional medical approach . . . The impact of social and economic factors [must] be considered as much as the mechanisms by which tubercle bacilli cause damage to the human body. On the other hand, the disease modifies in a peculiar manner the emotional and intellectual climate of the societies that it attacks.” Frail & Pale. Tuberculosis was so great a killer in the iyth century, that John Bunyan wrote of Mr. Badman: “The captain of all these men of death that came against him to take him away was the Consumption, for it was that that brought him down to the grave.” But the great outburst of the disease after the Industrial Revolution made its earlier ravages seem tame.— In the novels, plays, journals and poetry of the romantic era, Dubos & Dubos find revealing details of TB’s “psychic effects, its influence on behavior and tastes.” The ideal of feminine beauty, which the white plague made current, was epitomized by Dumas fils (mourning an ex-mistress) in La Dame aux Camelias: frail, pale, hollow-eyed and languid. To be like this type, healthy and otherwise sensible young women dosed themselves with lemon juice and vinegar. The cult of pallor extended to men and crossed the ocean so that Poet Sidney Lanier was shocked by Walt Whitman’s “healthy animality.” Tom Moore quotes Byron before a mirror, saying: “I look pale. I should like to die of a consumption.” “Why?” “Because the ladies would all say. ‘Look at that poor Byron, how in teresting he looks in dying.’ ” Hot & Cold. Toward the end of the century, this “attitude of perverted sentimentalism toward tuberculosis began to change.” Writers began to see the starved and miserable tuberculars of the slums.

“Consumption, which had been for half a century the muse of literature, became a blot on society, the symbol of all that was rotten in the industrial world. Against it, in a great crusade . . . turned the champions of a happier, more smiling life.” The change in attitude came at the same time as a great advance in knowledge. Robert Koch isolated the tubercle bacillus and proved what Italians and Spaniards had contended for centuries—that TB is contagious. Many of the greatest authorities on the disease scoffed, and kept on insisting that the taint was hereditary or connected with climate.

Debunking the importance of climate, the authors say: “Some of the highesttuberculosis mortality rates are observed among the Eskimos in the frozen North, the Bantu Negroes in dry, sunny Africa, the Hindus in tropical humid India, the whites in the island of Cyprus or in Latin America. By contrast, very low mortality rates are observed among special groups of the same races living under these very same climates.”—The final answer to the menace of tuberculosis must go far beyond treatment of current cases, say Dubos & wife. It is a way of life: “Cleanliness of body and habits, a room of one’s own where sunlight and fresh air enter freely, physical and mental rest . . . diets … to meet the unperverted demands of the body.” The authors admit that there is nothing new in this prescription. But. they say, the world needs a new spirit of evangelism to spread this gospel and make it work. “It will be,” they suggest, “the enviable task of the future to reconcile the glamour of modern life with the ancestral wisdom of the happy savage.”

— Today it ranks seventh among causes of U.S. deaths, second among infectious diseases. — From Arizona, long a Mecca of the tubercular, comes similar evidence. The State Superintendent of Public Health, Dr. Clarence G. Salsbury, reported last month that amongnon-Indians in Maricopa County (around Phoenix) are 11,820 suspected cases;2,610 of them are active, and of these, only 220 are victims who went west for “the cure.” Arizona has the worst TB death rate in the U.S., more than three times the national average.