I’ve been reading John Green’s Everything is Tuberculosis, in which Green shows how cultural norms and unscientific assumptions shaped society’s view of tuberculosis and its victims over the centuries. In the 1800s, people thought TB affected the pure of heart, the highly intelligent, the emotionally sensitive, and the artistic. Being diagnosed with tuberculosis likely meant an early death, but on the upside, it also cloaked the patient in the aura of a gentle intellectual. In fact, the disease commonly known as consumption struck all strata of society. The deaths of celebrities like the Brontë sisters, Eugène Delacroix, John Keats, Henry David Thoreau, and Frédéric Chopin, however, helped transform this hypothesis, that only creative geniuses were susceptible, into a widely-held conviction, even within the medical community.
Green delivers a well-constructed treatise on how ignorance and inequity too often result in highly preventable loss of life. Rather than reviewing his book here, I wanted to dig into a letter he refers to, written by the French author George Sand in 1839. Born Amantine Lucile Aurore Dupin, Sand adopted a male pseudonym to further her writing career. She met Frédéric Chopin through mutual friends in 1836, and the two became lovers.
Chopin had contracted tuberculosis, and as the winter of 1838-39 approached, he and Sand decided it would be advantageous to sojourn in a warmer climate. They headed to Mallorca, Spain, but their stay did not go well. The weather was unseasonably wet, and the Spanish people wanted little to do with them. Spain was viewed as an ideal place to recover from consumption, in part because tuberculosis was less prevalent there. However, the climate wasn’t responsible for the lower infection rate. Spaniards correctly believed that TB was contagious. Their shunning of the sickly may not have been benevolent, but it kept disease from spreading.
Sand’s Description of Chopin’s Treatment in Spain
Sand wrote about her disappointing voyage in her travelogue Un hiver à Majorque, but throughout her stay, she also corresponded regularly with friends back in France. I thought I’d track down the letter that Green refers to in Everything is Tuberculosis. The following missive, sent to the la comtesse Marliani in February 1839, might not be it, but it illustrates Sand’s frustrations and reveals misguided perceptions of the time period.
Ma bonne chérie,
Me voici à Barcelone. Dieu fasse que j’en sorte bientôt et que je ne remette jamais le pied en Espagne ! C’est un pays qui ne me convient sous aucun rapport et dont je vous dirai ma façon de parler quand nous en serons hors, comme dit La Fontaine.
My Darling Friend,
Here I am, in Barcelona. May God see me leaving soon and never again walking on Spanish soil! This is a country that fails to suit me in any way, and about which I will candidly express my thoughts when we are beyond its borders, as La Fontaine would say.
Le climat de Majorque devenait de plus en plus funeste à Chopin, je me suis hâtée d’en sortir. Un trait des mœurs des habitants ! J’avais pour quitter ma montagne trois lieues de chemin très raboteux à faire jusqu’à Palma. Nous connaissions dix personnes qui ont voitures, chevaux, mulets, etc., aucune n’a pu nous prêter la sienne. Il a fallu faire cette course en patache de louage non suspendue si bien que Chopin a eu un crachement de sang épouvantable en arrivant à Palma.
Mallorca’s climate was becoming increasingly fatal for Chopin, so I was eager to leave. This tells you about the inhabitants’ mores! To leave my mountain, we had three leagues of extremely rough road to travel to reach Palma. We knew ten people who own carriages, horses, mules, etc., none of whom could lend us their means of conveyance. We had to make the journey in a rented suspensionless cart, so rugged that Chopin had a frightful spitting up of blood upon arriving in Palma.
Et pourquoi cette désobligeance ? C’est que Chopin tousse. Quiconque tousse en Espagne est déclaré phtisique, quiconque est phtisique est pestiféré, lépreux, galeux. Il n’y a pas assez de pierres, de bâtons et de gendarmes pour le chasser de partout parce que selon eux la phtisie se gagne et qu’en raison de cela on doit si l’on peut assommer le malade comme on étouffait les enragés il y a deux cents ans.
And why this unpleasantness? It’s because Chopin has a cough. Anyone who coughs in Spain is declared consumptive, anyone who is consumptive carries a plague, leprosy, scabies. There aren’t enough rocks, enough canes, or policemen to chase them from the country because, according to [the Spanish], consumption is contagious, and because of this, one must, if one can, knock out the sick just as people have smothered the rabid over the last two hundred years.
Ce que je vous dis est à la lettre. Nous avons été à Majorque comme des parias à cause de la toux de Chopin et aussi parce que nous n’allions pas à la messe. Mes enfants étaient assaillis à coups de pierres sur les chemins. On disait que nous étions payens, que sais-je ? Il faudrait écrire dix volumes si on voulait donner une idée de la lâcheté, de la mauvaise foi, de l’égoïsme, de la bêtise et de la méchanceté de cette race stupide, voleuse et dévote. Je crois que je ne pourrai jamais revoir la figure de Valdemosa.
What I’m telling you is the truth. In Mallorca, we were like pariahs because of Chopin’s cough and also because we didn’t go to mass. My children were assailed by stones on the roads. People said we were pagans, what do I know? I’d have to write ten volumes if I wanted to give you an idea of the cowardice, the bad faith, the egoism, the stupidity, and the meanness of this stupid race, thieving and bigoted. [No irony there.] I believe that I will never again be able to face the sight of Valldemossa [village on Mallorca].
Enfin nous avons gagné Barcelone qui nous semble le paradis par comparaison. Nous avons voyagé sur le bateau à vapeur en compagnie de cent cochons dont l’odeur n’a pas contribué à guérir Chopin. Mais le pauvre enfant serait mort de spleen à Majorque et, à tout prix, il a fallu l’en faire sortir. Mon Dieu, si vous le connaissiez comme je le connais maintenant vous l’aimeriez encore davantage, chère amie.
Finally we have reached Barcelona, which seems to us a paradise by comparison. We traveled by steamboat in the company of one hundred pigs, the smell of which did nothing to aid Chopin’s recovery. But the poor child would have died from melancholy on Mallorca, so we needed to leave at any cost. My God, if you knew him like I know him now, you would love him even more, dear friend.
C’est un ange de douceur, de patience et de bonté. Nous avons été transportés du bateau majorquin sur le brick français qui était dans le port. Le commandant de station est charmant pour nous, son navire est un salon pour l’élégance et la propreté. Le médecin du bâtiment a vu Chopin et m’a rassurée sur l’accident du crachement de sang qui durait encore et qui s’est arrêté enfin cette nuit à l’auberge. Il m’a dit que c’était une poitrine excessivement délicate mais qu’il n’y avait rien de désespérant, qu’avec du repos et des soins, il reprendrait bientôt sa petite santé.
He was an angel of sweetness, of patience, and kindness. We were transported from a Majorcan boat to a French brig that was in the port. We found the captain to be charming and his ship a salon of elegance and cleanliness. The ship’s doctor saw Chopin and reassured me about the spitting of blood mishap, which was still ongoing, but finally stopped last night at the inn. He told me that Chopin has an excessively delicate chest but that there was reason for hope, that with rest and treatment, he would return to his previous state of health.
Nous allons passer ici une huitaine pour le reposer après quoi nous irons par mer à Marseille. Là nous nous remettrons aux soins de votre bon docteur Cauvière qui nous dirigera soit à Hyères, soit à Nice selon sa sagesse et son expérience car il fait trop froid encore à Paris pour y retourner et nous attendrons le printemps dans un pays doux mais sec.
We’ll stay here for a week of rest before sailing to Marseille. There, we’ll resume care with your good doctor Cauvière, who will direct us either to Hyères or to Nice according to his wisdom and experience because it is still too cold in Paris to return, and we will wait for spring in a mild but dry region.
Majorque, nous vivions dans la vapeur tiède et moi-même j’ai été couverte de rhumatismes et j’y ai vieilli de dix ans. […] Soyez assez bonne pour dire à mes amis où je suis, et ce que je deviens. Je n’ai pas le temps d’écrire à d’autres qu’à vous car il y a un bateau en partance aujourd’hui même et je veux qu’il porte mon paquet. Adieu, mille baisers et tout mon cœur à vous.
George.
In Mallorca, we were living in warm humid weather and I myself was besieged with rheumatism and aged ten years there. […] Do be good enough to tell my friends where I am and what has become of me. I don’t have time to write anyone other than you because there is a boat leaving exactly today and I want it to deliver my package. Adieu, a thousand kisses and all my heart to you.
George.
The Fight to End Tuberculosis
Sadly, misconceptions regarding infectious diseases persist to this day, including how various illnesses spread, how to prevent them, whether they are treatable, and how. Chopin died of TB at the age of 39, but his privileged status in society likely extended his lifespan well beyond what a working-class or impoverished person could expect.
Today, tuberculosis is curable, yet people still die from it. And the numbers aren’t small. According to Green, in 2023, “more people died of TB than died of malaria, typhoid, and war combined.” Factors like poverty and poor healthcare play a critical role in determining who gets sick. Prevention is key and far less expensive than treatment, especially when the disease is allowed to reach an advanced stage before detection.
Green and his brother, Hank, are contributing up to $4 million to a $57 million project to test for and treat tuberculosis in the Philippines. If you’re interested in learning more, I encourage you to pick up a copy of Everything is Tuberculosis or donate to one of several charities working to treat the infected and develop a cure, including Partners in Health and the TB Alliance.
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How fascinating! I read Everything is Tuberculosis earlier this year and I second the recommendation.
Glad you enjoyed the post. Thanks for stopping by Charity.
Most likely you’re right that the more accurate Spanish view of tuberculosis helped to protect them from the disease. It’s a sad fact that many diseases are infectious from person to person, and thus in the absence of modern medicine, avoiding contact with the sick is the best defense. Throwing rocks seems extreme, but the fact that Sand writes so vehemently of “the cowardice, the bad faith, the egoism, the stupidity, and the meanness of this stupid race, thieving and bigoted” suggests that she harbored very negative views of the Spanish or at least of the Mallorca natives all along, and likely let it show from time to time, thus antagonizing them. Nobody likes foreigners who come and radiate that kind of contempt for the locals.
Just pronouncing the word phtisie would probably make you sound like there was something wrong with you.
As your second-to-last paragraph points out, the impact of disease on the world is much greater than most people realize, and greater than the calamities we more easily recognize as such. For example, I have seen an estimate that smallpox killed between three and five hundred million people in the twentieth century alone. If that’s true, it means that if you could somehow change history to make smallpox vaccination universal starting in January of 1901, you would save four to seven times as many lives as you could save by preventing World War II.
That’s a funny comment about pronouncing phtsie (fti·zi). The English equivalent, phthisis (thai·sus), isn’t much better.
Your point about smallpox and the lives that might have been saved dovetails into Green’s final thesis. He argues that there are many factors that produce illness and in the case of TB, factors like poverty and corporate greed (Johnson and Johnson refused to sell their cures at an affordable price that would have still been profitable, then tried to over extend their patent) may play bigger roles in the spread of TB than the actual bacteria that makes people sick.
As you say, misconceptions about fighting infectious diseases persist to this day. Early on during the Covid-19 pandemic, the idea that the disease was spread through aerosols was pooh-poohed, in favor of the theory that transmission occurred through contact. And this from the leading experts at the WHO. Thus we obsessively washed our hands, cancelled our newspapers, etc. when we should have been keeping the windows open. This is not to fault the experts, it was a terrifying and confusing time, and they were doing their best. Instead it goes to show that even with the best intentions, errors are made (at least for a time.)
That’s a good point Keith, well-meaning people are still fallible and it takes awhile to arrive at the most effective methods for preventing illness and treating outbreaks. Sadly, in the case of tuberculosis, there have been many examples of poor decision making.
One problem has been that people with TB must be treated for months with daily doses of multiple antibiotics. Researchers knew it was important for patients to take all of their pills. Stopping before the regimen is completed leads to drug-resistant strains that become harder to kill. So, in their infinite wisdom, the medical professionals said that patients had to come to the dispensaries every day to receive their pills. That way, care providers could make sure patients took all of the pills because they were closely observed. The problem is that many patients couldn’t adhere to this requirement. They lived miles from the clinic where drugs were dispensed and once they began to feel better, they stopped coming. Had patients been able to pick up multiple weeks worth of drugs with clear instructions on how to consume them, they might have faired better. Instead, there are now strains of TB that are even harder to combat.