- Culturing Tuberculosis: The Multiple Meanings of Disease
The AIDS epidemic has inspired historians to reexamine tuberculosis in the nineteenth and twentieth centuries. This should not surprise us. Both diseases transformed the way Americans lived and the metaphors they lived by, and an examination of each reveals how society organizes and reorganizes itself when threatened by disease. To take one small example, the laws and rituals that evolved for disposing of used sputum cups and dirty needles contained within them complex understandings of contagion and disease and of individual and social responsibility. Similarly, chest x-rays and needle exchange programs came to symbolize the hope for prevention and the despair that far too many had already perished. Writing in the past tense about AIDS may seem odd as the epidemic continues on its relentless course. Yet, the AIDS of the 1980s is not the AIDS of the 1990s. In its short history it has been transformed from GRID (Gay-Related Immune Deficiency) to AIDS (Acquired Immune Deficiency Syndrome) to HIV (Human Immunodeficiency Virus) disease. As these shifts suggest, diseases change names, they change meanings, and they change the culture. These are the simple and compelling themes of Fevered Lives: Tuberculosis in American Culture since 1870, by Katherine Ott, a historian in the Smithsonian’s Division of Science, Medicine and Society.
Ott’s book joins several other recent publications on the history of tuberculosis. In Bargaining for Life: A Social History of Tuberculosis, 1876–1938 (1992) Barbara Bates chronicled the life of Lawrence F. Flick, a Philadelphia physician who contracted tuberculosis and dedicated his life to helping fellow sufferers. Flick founded medical institutions, sanatoriums, and voluntary organizations to fight the disease, all the while treating and corresponding with many patients. The letters he saved form the basis of Bates’s finely detailed analysis of the lives of the chronically ill and their caretakers. A different perspective is offered in Sheila M. Rothman’s Living in the Shadow of [End Page 600] Death: Tuberculosis and the Social Experience of Illness in America (1994). She excavates the lives of patients, largely from their letters, and in these narratives uncovers the variations in illness experiences by gender and location of treatment—at home, out West, or in an institution. By keeping her focus on the afflicted, she is able to analyze closely the shift from the early-nineteenth-century construct of invalidism to the late-nineteenth-century notion of health seeking, and finally to the twentieth-century concept of patienthood. A third recent work is Georgina D. Feldberg’s Disease and Class: Tuberculosis and the Shaping of Modern North American Society (1995), which examines tuberculosis policy in the twentieth century. She endeavors to explain why the United States fought the disease with hygiene and chemotherapy, eschewing vaccination with BCG (bacillus Calmette Guerin), which was the approach taken in the Canadian provinces and elsewhere. Feldberg argues that the answer lies in the interplay of biomedical science and social class as well as in the particular manifestations of the illness. Others have placed tuberculosis within the larger context of public health, analyzing its effects on domestic hygiene, exploring how it shaped the experience of different ethnic and immigrant groups and surveying its effect in particular locales. 1 Of all of these recent works, Ott’s is the broadest. Her synthetic interpretation, which builds on the insights of recent studies, paints a cultural portrait of the disease.
The narrative opens in the 1870s, when middle-class consumptives were perceived to die a spiritual death, escaping the tumult of a harsh and industrializing society for the everlasting tranquility of the world beyond. Ott moves gracefully from an investigation of the figurative and literary portrayals of the dying consumptive to an explanation of the popular and medical understanding of this ailment. Careful always to note the class and racial meanings of the disease, she concludes that only after “romantic connotations of the illness ceased” in the nineteenth century did its “association with poverty and a disordered society” (p. 28) develop...