The White Plague: Tuberculosis, Man, and Society (1952)


The role of disease and the understanding of the causes of sickness in human history reveals the way that science emerged from a combination of elegant practice and diligent observation of responses to treatments such that mistakes were made in comprehending the precise causes and therapies of widespread diseases. The strange case of tuberculosis is a window on the slow accumulation of evidence based on diagnosis and the errors in prognosis based on insufficient understanding of the complexity of viruses, bacteria and the mammalian immune system.

Part One: The 19th Century | Part Two: The Causes of TB | Part Three: Cure & Prevention of TB | Part Four: TB & Society

By 1900 "tuberculosis remained the greatest killer of the human race…" (186)

"The passion for financial gains made acquisitive men blind to the fact that they were part of the same social body as the unfortunates who operated their machines. TB was, in effect, the social disease of the 19th century, perhaps the first penalty that capitalistic society had to pay for the ruthless exploitation of labor." (207)

Manchester Board of Health, 1796, Report of an appointed commission to the Board

Industrial labor conditions

"Children and others who work in large cotton factories are particularly disposed to be affected by the contagion of fever, and when such infection is received, it is rapidly propagated, not only amongst those who are crowded together in the same departments, but in the families and neighborhoods to which they belong."

The environmental interpretation of disease.


"To him who follows her way, Nature reveals many roads that lead in the direction of truth."

"… he felt convinced that there was in the marine air something that protected from disease."

p. 90.

Manifest symptoms

Hippocratic corpus: 400 BCE, Of Airs, Waters, and Places, "do no harm"

malaise -- a symptom of many diseases; listless
phthisis --wasting of the body due to lung infection
catarrh -- chest pain


Three phases of understanding TB:

    1. Descriptive diagnostics
    2. Anatomo-Pathology diagnostics
    3. Diagnostic - Germ Theory inoculation, & drug therapies


Difficulty of any degree of certainty in curing phthisis believed to be in some cases TB

Doctrine of the Four Humors relation apparent imbalances
Phlegmatic sputum -water listless, sluggish, subdued, unemotional
Sanguine blood -fire passionate, excitably cheerful
Bilious green bile -air peevish, quarrelsome, fractious
Melancholic black bile -earth sad, depressed, morose, sullen, angry

In the absence of physiological data; description runs amok and error abounds.


lymph nodules infected -- tubercles (1679) of diverse shape, appearance, location in lungs, stomach, bowels.

1650, Fernal; 1679, 1700, Manget; 1790, Baille
insufficiency of descriptive science in health studies
Integration of pathological & clinical techniques
sound of the lungs -- percussion 1761
stethoscope for auscultation in 1816
microscope -- 1590 first invented; TB in 1840s

René Théophile Hyacinthe Laënnec; 1781-1826
"Laënnec gave precise and original descriptions of clinical symptoms and post-mortem appearances of pulmonary tuberculosis, pneumonia,… " based on the description of heart and chest sounds (87)

within 10 years of 1819 the technique of "mediate auscultation" with a stethoscope was widely practiced.

Empiricism -- the capacity to actually test an assumption with a technique, or mind experiment.

necessity of experimental proof

Diagnostic (germ Theory)
18th Century rationalism and the “cult of human reason”

Prevailing belief in the salutary influences of nature, fresh air, healthy living
Seaside as a curative atmosphere

Mineral springs (German spas, Arkansas Hot Springs, thermal baths: Turkey, Russia, China)

"hundreds of sanatoria sprang up along all the European shores." well respected by 1882

Edward Livingston Trudeau brought the idea of sanatoria to America after discovering Koch's definitive work on the causes of tuberculosis

Saranac Lake

at Saranac Lake in the Adirondack Mountains because, in part, sometime after 1865 he contracted tuberculosis.

"fond of hunting and of life in the wilderness."

"a longing I had for rest & peace in the great wilderness." " a rough inaccessible region" (179)"Tuberculosis has waxed and waned several times in the course of human history."

"A peculiar fact emerges…,that TB began to decrease long before any specific measures had been instituted against the disease - before there was any scientific basis on which to formulate anti-tuberculosis campaigns." (185-86)

Fundamental materials of physical existence, are never to be ignored.


Part One: The 19th Century | Part Two: The Causes of TB | Part Three: Cure & Prevention of TB | Part Four: TB & Society