Perspective

Chasing the white plague

Tuberculosis, romanticized by writers, is an awful way to die.

By HOWARD MARKEL Special to the Washington Post
Published June 17, 2007

Andrew Speaker, the 31-year-old Atlanta lawyer with a bad case of wanderlust and a worse case of tuberculosis, isn't just a media sensation. He's also the personification of a time machine, returning us to a not-so-distant era when diseases that we now casually assume are treatable claimed thousands of lives. And that grim part of our past could become our future.

Speaker got plenty of press as he was ordered into federal quarantine, having crisscrossed the Atlantic on commercial flights while infected with extensively drug-resistant tuberculosis (XDR-TB). But what hasn't garnered nearly enough attention is a sober consideration of just how deadly tuberculosis can be. The rising worldwide number of XDR-TB cases like Speaker's may herald the end of a glorious 60-year holiday from many common and highly contagious diseases such as polio, measles and cholera that once routinely ravaged vast swaths of humanity.

For those who consider tuberculosis a thing of the distant past, let me tell you a story. In 1913, Eugene O'Neill, the future playwright and winner of the Nobel and Pulitzer prizes, was confined for five months to a TB sanatorium. His family considered the initial diagnosis practically a death sentence - tuberculosis was then the leading cause of death for Americans ages 20 to 45. Under a regimen of rest, fresh air and exercise, with a diet rich in fat and protein, O'Neill recovered. A young woman he fell in love with there was not so fortunate. Emaciated, pale and weak, she entered her last bloody round of violent coughing 18 months later. Writing about her death, O'Neill described tuberculosis as a cruel game of drawing straws, with more short straws than long ones.

The ancient Greeks had a wonderful word to describe tuberculosis' ravages: phthisis, which describes a living body that shrivels with intense heat as if placed on a flame. The Romans used the Latin word consumere, to eat up or devour; indeed, when O'Neill's TB was diagnosed, the disease was still referred to as "consumption." This is precisely what untreated (or untreatable) tuberculosis does. It consumes with a passionate and incisive energy; it slowly, inexorably devours the very structure of the lungs and other critical organs, with the single goal of conquering its host - but not until its progeny have had the opportunity to travel to and settle in the lungs of another human, to start the horrific process all over again.

There has long been a disturbing tendency to romanticize the white plague, as tuberculosis is also known. The malady carried away the poet John Keats and the scribbling Bronte sisters; it rang down the final curtain on Moliere, Voltaire and Chekhov. Operas by Verdi and Puccini featured heroines struck down by it. The late literary critic Susan Sontag once called tuberculosis an "aphrodisiac, " a disease with "extraordinary power of seduction."

In reality, tuberculosis is messy, agonizing and debilitating. Once the tubercle bacilli proceed unchecked through the body, there is no romance to be found. The actual experience is one of exhaustion, not literary inspiration; drenching bouts of sweating, not hypersexual allure; groaning, not arias; a cough punctuated by uncontrollable spurts of blood, not the lover's kiss. This is the nightmarish reality that O'Neill and his peers understood all too well - and the one we so easily forget.

TB began to rise in developed nations in the 1980s, largely as a result of funding cuts for TB prevention and treatment programs and the emergence of the AIDS pandemic.

Today, more than one-third of the world's more than 6-billion people have been exposed to the tuberculosis germ. Five to 10 percent of them, or at least 100-million, will develop symptomatic TB. Each will infect 10 to 20 people before they are either successfully treated or they die. Last year, active - and contagious - tuberculosis was diagnosed in more than 8.8-million people. Approximately 420, 000, or 5 percent, of them have a drug-resistant strain that requires several more medications than drug-sensitive cases do; about 30, 000 of these 420, 000 cases are even more difficult and expensive to treat, the highly lethal XDR-TB.

Which brings me back to Andrew Speaker. Tuberculosis is a bad disease, and it's contagious. International air travel poses real risks in its spread. Coughing, sneezing, singing and even laughing can spread TB germs.

Those infected have a moral imperative not to put others in harm's way, even though it may mean postponing a honeymoon.

So if you're confronted with the slightest chance of spreading a terrible infection, assume you're contagious until proven otherwise. Someone's life may depend on it.

Howard Markel, a professor of communicable diseases and the history of medicine at the University of Michigan, is the author of When Germs Travel.

[Last modified June 16, 2007, 21:53:30]