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c R~ ~ , "': , , :· is .. 'nee $17 .00 mlU\ 1\\111\1\l\U\ \D U8C(; , RHIE/\.\H IT E PLAGUE : TUBE 'C,-:3;·35. 2_;_,;.·• i!EDlCRL & f[RUH , - \'~ ~.TPAID BOOK '.:;TORE · P THE WHITE PLAGUE THE WHITE PLAGUE Tuberculosis, Man, and Society Rene and Jean Dubos FOREWORD BY David Mechanic INTRODUCTORY ESSAY BY Barbara Gutmann Rosenkrantz RUTGERS UNIVERSITY PRESS New Brunswick and London First published in 1952 simultaneously by Little, Brown and Company, Boston, and McClelland and Stewart Limited, Canada. Copyright© 1952 by Rene and Jean Dubos. Copyright© 1987 by Rutgers, The State University British Cataloguing-in-Publication information available. Library of Congress Cataloging-in-Publication Data Dubos, Rene]. (Rene Jules), 1901- The white plague. Bibliography: p. Includes index. i. Tuberculosis-History. 2. Tuberculosis Social aspects. I. Dubos,Jean, 1918- Il. Title. [DNLM: 1. Tuberculosis-popular works. WF 200 D817w] RC310.D82 1987 614.5'42'09 86-22033 ISBN 0-8135-1223-9 ISBN 0-8135-1224-7 (pbk.) All rights reserved Manufactured in the United States of America Contents Foreword by David Mechanic vn Introductory Essay: Dubos and Tuberculosis, Master Teachers by Barbara Gutmann Rosenkrantz xm To Our Sources xxxv Introduction to the First Edition xxxvu PART ONE: THE WHITE PLAGUE IN THE NINETEENTH CENTURY I The Captain of All the Men of Death 3 n Death Warrant for Keats 11 m Flight from the North Winds 18 IV Contagion and Heredity 28 v Consumption and the Romantic Age 44 PART TWO: THE CAUSES OF TUBERCULOSIS VI Phthisis, Consumption and Tubercles 69 vn Percussion, Auscultation and the Unitarian Theory of Phthisis 77 vi CONTENTS VIII The Germ Theory of Tuberculosis 94 IX Infection and Disease 111 PART THREE: CURE AND PREVENTION OF TUBERCULOSIS x The Evaluation of Therapeutic Procedures 131 XI Treatment and Natural Resistance 139 XII Drugs, Vaccines and Public Health Measures 154 XIII Healthy Living and Sanatoria 173 PART FOUR: TUBERCULOSIS AND SOCIETY XIV The Evolution of Epidemics 185 xv Tuberculosis and Industrial Civilization 197 XVI Tuberculosis and Social Technology 208 Appendices 229 Bibliography and Notes 241 Index 271 Foreword THERE 1s A LONG epidemiological tradition that examines the in terrelations between disease agents, characteristics of the host, and the broader socio-cultural and environmental context. Rene Dubos, however, was unique in applying this perspective to a wide spectrum of issues ranging from microbiology to the qual ity of the environment. In his conception a combined epidemio logical/ecological approach was not simply a methodological im provement in the understanding of health, but the basis of a humanistic philosophy that could help preserve the best quali ties of mankind through the awareness of the complex inter relationships between populations and their environments. During the nineteenth century, and throughout most of this one, tuberculosis was a widespread and deadly infectious dis ease. It was the source of a staggering amount of illness and mortality and engaged some of the best minds in the medical sciences. For many of these physicians tuberculosis was not only a scourge, but a disease they experienced personally either through their own illnesses or those of their loved ones. Like many writers, philosophers, and artists who took up tuberculosis as a theme, medical scientists developed a respect for the mys tery of this disease, and its complex transactions with the envi ronment. Both authors of this classic volume, The White Plague: Tubercu losis, Man, and Society, had a personal as well as an intellectual in volvement with tuberculosis. Rene Dubos's first wife died of the Vlll FOREWORD disease in 1942, and Jean Dubos, his co-author and second wife, had the disease as well. Their book reflects not only a broad knowledge and erudition in medical science and the humanities, but a deep intuitive understanding as well. It was an early ex emplar of a now prevalent model for explicating the complex etiologic relations between agent, host, and environment, and an impressive analysis of how disease comes to be represented in public conceptions and how it serves as a metaphor for social ideologies. We have recently seen these themes brilliantly played out in Charles Rosenberg's The Cholera Years and Susan Sontag's perceptive essay Illness as Metaphor. The White Plague also serves as an instructive paradigm for such new threats as AIDS which fit more understandably within the analysis the Duboses present than within traditional biomedical conceptions. Like tuberculo sis, AIDS is a social disease whose patterns of transmission must be understood not only through the activity of a microbe but equally through the study of attitudes, behavior, and social organization. Dubos studied agricultural science in college in Paris, and be tween 1922 and 1924 was employed as the associate editor of the journal of International Agricultural Intelligence. As an editor in Rome, he worked as a tourist guide to finance his passage to the United States. He met Dr. Selman Waksman while working in this capacity and, fortuitously, on his way to New York in 1924, encountered him again aboard ship. Waksman headed the soil microbiology division at the Agricultural Experiment Station at Rutgers University, and became Dubos's teacher when Dubos joined him there as a graduate student. Dubos received his Ph.D. from Rutgers in 1927 while working as a research assistant in soil microbiology and an instructor in bacteriology. His disser tation on the decomposition of cellulose by soil organisms living in varying environments reinforced an earlier realization that was to stay with him throughout his life-that organisms de velop differently depending on environment, and that artificial,