Romanticizing the White Death: How Tuberculosis Shaped the Arts

My first public health teacher, with whom I have stayed in touch for 40 years, is a renaissance man. He has found a harmonious existence between medicine, public health, literary writing and watercolor painting. We often share our exploration in artistic expression.

A couple of days ago he shared on Instagram his latest painting. Suddenly, and perhaps because of the latest book I read, I was not looking at a watercolor painting on my computer screen but to a Ziehl-Neelsen stain of Miliary Tuberculosis under the microscope. The canvas was now filled with acid-fast mycobacteria and my mind immediately traveled back to the mid-1990s when I was involved in developing national guidelines for the treatment and public health implications of pulmonary tuberculosis. The first paper I co-authored ⁽¹⁾ in 1998 soon found echo by the World Health Organization and is still widely cited in the medical literature. For the next few years I got involved in epidemiological studies about the resurgence of tuberculosis in South East Asia and Africa.

I had not thought about these years much lately as my life is now mostly dedicated to explorations in art forms I am learning about in the American Southwest. Yet, the watercolor painting I looked at on my screen perhaps stressed the fact that we really do not forget, but just get used to the fact that things existed.  This is an idea proposed in a French song by Jacques Brel where he says:

                                        On n'oublie rien de rien
                                       On n'oublie rien du tout
                                      On n'oublie rien de rien
                                     On s'habitue c'est tout

But there is more. A book published in 2017, which I read recently, addresses the idea that in the 1800s tuberculosis was “chic”! It is a delightfully sociological book by Carolyn A. Day ⁽²⁾ where she documents how during the Victorian years women infected by the mycobacterium Koch later discovered, were seen as the epitome of beauty. Indeed, the rosy cheeks, the red lips, their translucid skin, the silky hair and the loss of appetite gave women a glow while the disease consumed them slowly.

Verdi would have never written La Traviatta without Violetta being consumed by tuberculosis; Niccollo Paganini would have never composed his Caprice No. 24; we would have never known the genius of Chopin, the conflict in the work of A. Chekhov, the colors of P. Gauguin, the poems of J. Keats, or the macabre world of F. Kafka.

Growing up, I was most attracted to romantic poetry that I avidly read in Armenian, French and Arabic. My favorite Armenian poet of the early 1900s is Matéos Zarifian, who is said to have contracted tuberculosis from infected soldiers in the Turkish Army. His poetry still helps me surpass the daily implications of being alive, but his diary makes me discover generic moments about human life. For example, he writes about this Kurdish soldier, one of many occupying a small cell in prison, who had tuberculosis. The man was also a raconteur, so all would surround him to hear his stories. When he had to cough, he would take his head cloth wrap, cough in it, and then wrap it back around his head as a turban. Then, someone would give him a freshly rolled cigarette and ask him to continue his story.

… Tuberculosis, which is now back on the rise worldwide due to other infectious diseases that weaken our immune system and allow opportunistic infections to also become symptomatic, has a unique place in our cultures as an almost positive, romantic, creativity-enhancing disease. Among the host of infectious diseases associated with artists and beauty are sexually transmitted or lifestyle diseases, but these do not have the positive aura that tuberculosis does. Although many of these diseases now pave the way for the resurgence of tuberculosis and other infectious diseases which are increasingly antimicrobial treatment resistant.

So, 20 years have passed since I was involved in the epidemiology of tuberculosis and have seen many monks in South East Asia with bright red lips. This morning I picked up Zarifian’s tome of complete works published in 1956 and made strong coffee. And I recalled a line from “Metzengerstein” by E. Allen Poe I once read in Baltimore:

                       “I would wish all I love would perish of that gentle disease”

March 3, 2019

© Vahé A. Kazandjian, 2019

( (1)   Chalk CP, Kazandjian VA. Directly observed therapy for treatment completion of pulmonary tuberculosis: Consensus Statement of the Public Health Tuberculosis Guidelines Panel.  JAMA. 1998 Mar 25;279(12):943-8.

(   (2)   Carolyn A. Day  Consumptive Chic: A History of Beauty, Fashion, and Disease London, Bloomsbury, 2017.Pp. 208. ISBN 978 1 3500 0938 7.