Selena Mellon Bio 248

The White Plague: Tuberculosis, Man and Society by Rene and Jean Dubos

Synopsis:

Tuberculosis is as much a "social disease" (Dubos, 1987) as a biological disease. Although the term social disease has been historically associated with sexually transmitted diseases, tuberculosis provides an example of an affliction that manifested itself more readily in those who confronted severe societal pressures for survival. Take, for instance, the prescribed treatment for tuberculosis (which was rest) and try to apply it to a man, who once was "found to have tuberculosis, received a notice to quit his job," and what one has is disease and discrimination. The aristocratic inclination to travel to one's country seat for recovery represented a genuine impracticality for those unable to flee from such responsibilities as supporting a family and maintaining a dependable working position. Unfortunately, even these constraints perpetuated a lifestyle that mandated recovery in overcrowded cities where the effects of industrialization and unfair working conditions affected everyday life. Without such basic necessities as proper nutrition and an environment devoid of excess stress, afflicted individuals coming from disadvantaged backgrounds never had a chance.

Because the method of transmission of tuberculosis (the bacillus) remained ambiguous until the discovery of the microbe by Koch in 1882 (Dubos, 1987), a multitude of seemingly discriminatory explanations have been offered as possible answers. These "explanations" range from the belief in an inherent physical vulnerability that was inherited from generation to generation (which perpetuated a sense of helplessness and a medical perspective that focused more upon treatment than prevention) to the belief that the inferior lung capacity of African Americans, as well as the inferiority of their mental capacities, made them less resistant to tuberculosis. This racial slur later found itself in "good" company when Dr. Samuel Sheldon Fitch offered the following "gender rejoinder:" that all things being equal, Tuberculosis occurred more prevalently in women, because they typically possessed longer life spans than men, and God was not unjust and impartial; rather he too was an equal opportunist.

Interestingly enough, the societal interpretation of Tuberculosis underwent a huge step backwards during the Romantic age. Instead of perceiving Tuberculosis as an infectious disease, or attributing a negative connotation to it, it became known as consumption, a source of divine genius and inspiration that possessed physical intensities sufficient enough to drastically sharpen an individual's wit. Offering a slew of examples to reinforce this societal interpretation, this point of view differs markedly from the violent need of individuals so desperate to cure their disease that they trampled one another in an effort to reach a king whose touch could supposedly heal them. The fact that Keats, a poet inevitably associated with the romantic era of literature, also suffered from this affliction created ramifications of its own: a consumptive cough was no longer a debilitating manifestation of the disease; rather, it was an indication of delicacy and transience. In the same manner that talents consumed the artists that created them, tuberculosis and its comsumptiveness represented the all-encompassing passion of genius and was valued as such.

Although such occurrences are acknowledged as having served as a historical background with regard to the "White Plague," Tuberculosis continues to be a potential epidemic during wartime, when populations are subjected to unreasonable amounts of stress or when malnourishment due to blockade or exportation occurs (Dubos, 1987). Even so, the efforts being made to confront the disease have not resulted in any miraculous panaceas; rather, attempts at immunization (in this case, BCG) have been met with a great deal of ambivalence from society. The answer lies not in the eradication of the disease (since it continues to occur even in the indigent rural areas of the United States), but in the importance of good personal hygiene and of breaking the chain of household infection in order to mitigate the disease's impact. The only question that remains is how much it will cost to do so and if America will be so inclined to pick up the tab.

Audiences who would most benefit from the book:

The individuals who would benefit most from reading the book are those who are interested in a historical perspective in relationship to Tuberculosis, but are willing to overlook a few politically antiquated references to racial class. If one is looking for a less superficial and more in depth description of the scientific aspect of the disease, he/she would be well-advised to try a journal or a more recent book. The authors did an excellent job of incorporating the social aspect of the disease, particularly in terms of their including specifics about literature and economics, resulting in a multi-faceted "discussion" regarding Tuberculosis.

Accuracy/Insightfulness of information covered and how it advances the understanding of disease and discrimination:

The accuracy and the insightfulness of the book originates from the ability of the authors to discuss human and societal response to an illness that could not be understood, but, nonetheless, generated a great deal of impact. With reference to accuracy, the book does not present the most recent information; but the rewarding aspect of this seeming downfall is the fact that the book elicits interest on behalf of the reader to seek further information - almost as if desiring a checkup on the status of Tuberculosis in America. The Dubos' words are almost prophetic: "However useful in specialized cases, vaccination, antimicrobial drug therapy, or other therapeutic measures cannot possibly solve the social problem of tuberculosis," (Dubos, 1987), meaning that perhaps humanity will have "the enviable task of the future to reconcile the glamour of modern life with the ancestral wisdom of the happy savage."

Citation: Dubos, Rene and Jean (1987). The White Plaque: Tuberculosis, Man, and Society. Rutgers University Press, New Jersey.

Pages: 228

Graphics: graphs in appendix; otherwise, no illustrations