Tuberculosis ain't what it used to be

TUBERCULOSIS is back, so the World Health Organisation tells us. More likely, it never went away. What Albert Camus said of bubonic plague is true also of the tubercle bacillus: it never dies or disappears, it simply bides its time.

TB is popularly thought to be a disease only of the poor, the undernourished and the badly housed, yet I have, in the past 10 years, seen three well-nourished, middle- class, professional women contract it. It never was a respecter of social class, but simply moved faster through the insalubrious dwellings of the poor.

It is not a disease that generates much excitement, or even interest, these days. Even when a teacher is found to have active tuberculosis, this rates less attention in the press than an outbreak of salmonella, although it is an infectious disease and the young are particularly vulnerable to it. We have become blase, because it has been tamed.

Before the Forties it was a different matter. TB was a disease so widespread that it was both familiar and dreaded. You always knew several people who had died of it, some of them had been your playmates. It had a particular penchant for little children and frail young women, sometimes carrying them off with alarming speed: galloping consumption, they called it. More often, it simply ground its victims down over a period, with intermittent fevers, night sweats, progressive weight loss, the exhaustion of constant coughing and a final, dramatic choking on bloodstained sputum. The saliva was highly infectious - spitting in public was a punishable offence.

Of all afflictions, TB was the one which most attracted writers. If it had simply been a disease of poverty and squalor it would probably never have achieved such literary status. But it had the great merit, from the writer's point of view, of being a universal scourge which dealt even-handedly with the rich and the poor, the old and the young, the guilty and the innocent.

Whether you figured in La Boheme or Little Women, The Magic Mountain or L'Immoraliste, you trod the same path to oblivion. There was no moral stigma attached to consumption: the purest heroine could safely succumb. What always mattered was the inevitability and the manner of your dying, so that the novel or film set in a sanatorium became a potent metaphor for the existentialist dilemma.

My husband's grandmother died, far too young, of tuberculosis. The family called it phthisis, a word so difficult to pronounce that it must have been an effective shibboleth, a way of excluding the vulgar sufferer. As her strength and energies waned, her husband took to carrying her up to her room at the end of the day. That was my mother-in-law's enduring memory of her mother: a fragile, lace-bedecked creature, carried nightly to the bed in which she would die.

If my own parents had been the sort of people to do a thorough investigative job on my prospective in-laws, they would have advised me not to marry into that family. The received wisdom, even before scientists had the means to confirm it, was that there was a genetic predisposition to the disease. Many a budding romance, in both life and literature, was brutally terminated because one of the families concerned was suspected of being tainted.

Before antibiotics, the only treatment was cold air, good food (including plenty of milk) and prolonged bed rest. Those who could afford it took themselves off to the mountains, where they died a little less quickly but a lot more comfortably than the rest. There were public health measures designed to limit the spread of the disease, of which the most distressing was the advice to sufferers not to have children or to work with the young. The French were particularly fierce in this matter.

I had a number of student friends in the Fifties who would go to ingenious lengths to avoid the mandatory medical before they took their final examinations, because they were afraid of being told they cculd not go into teaching. One of my husband's friends nobly gave up the girl he loved because he had been told, wrongly as it turned out, that he was consumptive and should not marry. It was a disease which, even when it did not kill, could still blight your life and prospects.

Now that we have such powerful weapons against disease, the developed world is unlikely to see another affliction like tuberculosis used to be, with its eclectic choice of victims, its ubiquity and its inescapable consequences.

We still have horrible, incurable diseases to contend with, but none with which the general population has such daily familiarity, in the family, the neighbourhood or on the streets. When I was a child it was not rare to see someone coughing painfully and protractedly into a handkerchief. You didn't need to ask anybody what was wrong: you just learnt not to look at the handkerchief when the coughing stopped. Those days, thankfully, will not return.

(Photograph omitted)