Tuberculosis: Why "The White Plague"?

TUBERCULOSIS: WHY "THE WHITE PLAGUE"? ALLEN B. WEISSE* The imprints that diseases leave upon the societies they have descended upon are reflected in the various terms that have been applied to them historically. Tuberculosis, for example, has frequently been referred to as the "white plague" in years past, although both components of that designation may be called into question. To my way of thinking, tuberculosis has never constituted a plague, and ascribing whiteness to it also raises serious doubts in my mind. According to Merriam-Webster, a plague (from the Latin "to blow or strike") is "an epidemic disease causing a high rate of mortality: pestilence ." Although tuberculosis can be traced back to prehistoric times, the most important early descriptions of tuberculosis come from the ancient Greeks, and it is unlikely that they ever considered it a plague. Rest assured they knew a plague when it hit them, the plague of Athens (430-426 bc) being the most famous. It claimed over 130,000 lives in a five-year period and included almost one-third of the city's foot soldiers and cavalrymen. Hippocrates (460-370 bc), who is credited with the best early descriptions of tuberculosis, was alive in Greece during this plague but, fortunately for him, not located in that stricken city. He and other Greeks of the time used the term "phthisis" (from the Greek for "to decay or waste away") to describe the final manifestations of tuberculosis. This emphasized the fact that although the rapidly progressive pulmonary form of the disease, which later came to be called "galloping consumption ," could take off a victim in a relatively short time, many patients lived for a great number of years, sometimes as many as 20 or 30, before succumbing. The terminal phase of phthisis, with extreme weight loss, was, at least in some patients, probably due to malabsorption of foodstuffs and diarrhea secondary to intestinal involvement; these symptoms *Department of Medicine, University of Medicine and Dentistry of New Jersey, New Jersey Medical School, 185 South Orange Avenue, Newark, New Jersey 07103.© 1995 by The University of Chicago. All rights reserved. 0031-5982/95/3901-0935101.00 132 I Allen B. Weisse ¦ Why "The White Plague"? likely gave those dying of the disease their characteristic premortem appearance. Even in the 18th and 19th centuries, when tuberculosis was reported in the United States and parts of Western Europe to be the most common cause of death, the usual chronicity of the disease was well recognized . To use the term "plague" in reference to tuberculosis is obviously a misnomer. What about "white"? The greatest currency given to the term in recent years might be ascribed to the use of White Plague as the title of the excellent book about the disease written by René Dubos and his second wife, Jean, and published in 1952 [I]. Dubos's first wife had died from the disease in 1942, and his second was afflicted with it during the time the book was being written. Inexplicably, nowhere in the book do the authors indicate the source of the term which they had chosen as its title. Selman Waksman (1888-1973), who was awarded a Nobel prize for his part in the introduction of streptomycin, the first effective medical therapy for the disease, mentions "white plague" three times in his own book about the disease, The Conquest of Tuberculosis, published in 1964—but again without revealing the source of the term [2]. His codiscoverer , Albert Schatz, is still alive, but when contacted by me in the course of this research, he was unable to shed any further light on the origin of the term. I wondered if the "white" in "white plague" related to race, pathology, the appearance of the patients, or perhaps some other aspect of the disease. Given the demographics of Western Europe and the United States, the popular use of the term might have been related to the preponderance of whites among their populations. However, as it has become evident that non-whites are even more susceptible to the disease than whites and as the proportion of whites continues to diminish among all these population groups, the ethnocentricity of the term is hardly...