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And yet, the moral elevation that many writers and commentators saw as a by-product of consumption belied the fact that it was a disease above all spread by overcrowded homes, unhealthy working conditions and poor nutrition; it was in other words not a disease primarily of well-off artists, intellectuals and socialites, it was a disease of the poor. The Russian novelist Fyodor Dostoevsky, with his brutally realistic view of Russian society, saw this clearly enough.
Poverty appears as a cause of TB relatively seldom in literary and artistic representations of the disease. Murger, an impoverished writer, fell in love with a flower-girl, Mimi, who was already suffering from tuberculosis and indeed died a year after she moved in with him. But the characters in his book, as in the play and the opera, are poor by choice, and the life they live is one of idleness and pleasure; at the end, they decide to return to conventional bourgeois life.
Such an option was not open to the vast majority of TB sufferers in the nineteenth century. The reason why tuberculosis was a classic disease of the nineteenth-century and the poor despite the fact that it had been around for millennia can be found above all in the effects of industrialization and urbanization on European and American society. Factories and home fires fuelled by coal that was anything but smokeless generated massive atmospheric pollution.
As the towns and cities of Europe expanded with headlong rapidity, and new industries, coal, iron and steel, engineering, textiles, sprang up, turning villages into towns and towns into cities, as coal became cheaper and wood more scarce, so chimneys of all kinds belched increasing quantities of smoke and soot into the atmosphere over every major urban centre.
The London fog of the Victorian era became almost synonymous with the city, and artists like Claude Monet actually traveled to the British capital to paint it. So great was the quantity of soot and smoke in the atmosphere that people living in poor districts near to factories kept their windows permanently shut, helping to spread droplet infection within the home; in factories, heat and dust and poor ventilation had a similar effect.
TB hit the poorest most because the poor lived and worked in the most overcrowded, damp and unhealthy conditions. In the nineteenth century TB could be spread by infected milk, and the poor in the big cities were unable to download fresh and healthy food or keep it for long in an age before refrigeration. There were no regulations to prevent the adulteration of foodstuffs with harmful additives, as here in this Punch cartoon of a lozenge-maker.
The wealthy by contrast were better fed and lived and worked in light, airy and roomy conditions. In late nineteenth-century Hamburg, there is a clear negative correlation between the average income of the inhabitants of a city precinct and the average annual death-rate from TB. In the late s the average annual mortality from consumption stood at 6. The well-off, naturally, had much easier access to treatment for the disease in an age before universal health insurance and the welfare state.
There were of course many different opinions on what was the best cure. The eighteenth-century physician Thomas Beddoes considered over-exertion of the lungs to be a cause, and thought that players of wind instruments were particularly prone to the disease. Half a century later, however, the Belgian Adolphe Sax recommended playing wind instruments to strengthen the lungs, not surprisingly perhaps, since he had invented one, namely the saxophone, as seen here in this satirical cartoon, and was keen to promote its therapeutic qualities.
Some doctors recommended a starvation diet against the fever that was one symptom of the disease, others told their patients to eat plenty of lobster, a remedy only the wealthy of course could follow.
He himself proffered a syrup thought to have contained ground-up millipedes. Many patients alleviated their suffering by consuming opium in one form or another to dampen the coughing.
Other doctors tried collapsing and reinflating the lungs, surgically removing affected body parts, or getting patients to inhale gases of various kinds to purify the lungs. The most popular treatment of all was through providing fresh air, a dry and pure atmosphere, a healthy diet and rest for body and spirit, by moving to milder southern climates or to the seaside or to high mountainous regions. Patients were made to rest, given a solid diet, and plenty of fresh air, though none of this, illustrated here as patients are wheeled out to enjoy the open air in the well-ventilated solarium at the Waverley Hills Sanatorium, guaranteed survival; one estimate puts the number of patients who died at this Arkansas centre, first opened in , at 64, up to the end of the Second World War.
Typically for literary treatments of TB, Mann sees the experience of prolonged and dangerous sickness as the key to a transition to a higher, more mature form of awareness, rather than as something negative, squalid or emotionally debilitating.
Enforced idleness enables the characters to debate fundamental issues of the meaning and purpose of life, politics, duty, love, belief and much else besides. Mann conceived the idea of the novel while visiting his tubercular wife Katia at the Woodland Sanatorium in Davos, in the Swiss Alps, shown in this book cover, and she was indeed cured. The basic idea of the sanatorium was sensible enough; the problem was just that very few could afford it, though with the spread of health insurance in the first half of the twentieth century its benefits began to be extended beyond the upper and middle classes.
By this time, however, the incidence of TB had been falling for many decades. Despite continuing urbanization and industrialization the trend was steadily downwards.
Just how rapidly it went down depended very much on the location, however. Broad, global statistics could often conceal widespread variations from place to place. In three major New England towns for example, the death rate from TB actually rose for a couple of decades just after the middle of the nineteenth century, and in Manchester it only began to decline in the s.
What caused these fluctuations? Direct medical intervention, as with almost all nineteenth-century diseases, had little or no effect. Borrow Download ebook for print-disabled Prefer the physical book? Check nearby libraries with: WorldCat Library.
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