What was Consumption?

This article has been written as part of a series in the lead up to the Centenary of Dr Sutherland’s speech Consumption: Its Cause and Cure and in which aspects of the speech are explained. The first answers the question: “What was Consumption”?

Consumption was caused by the tubercle bacillus. Under a microscope, it appeared as “short, slender, straight, or slightly curved rods with rounded ends”. It was very small: “placed end to end, twenty-four thousand would measure an inch [2.54 centimetres], and four hundred millions could lie side by side on the surface of a postage stamp”. (Sutherland, 1936, p. 133)

But despite its small size, the tubercle bacillus caused “gigantic evil”. (Sutherland, 1936, p. 133) In 1911, it killed 50,000 people in Britain each year, or 11 percent of the total death rate. A further 150,000 people were disabled and 500,000 infected. It was the direct cause of 9 percent of the pauperism in England and Wales. (Sutherland, 1911)

The suffering the disease caused was intensified by whom and when it struck. According to E.B. Smith:

“…it prodigally disabled and killed men and women at all ages and especially at the peak of their early maturity between 15 and 35. In its various manifestations it was a major destroyer of young life. Tuberculosis wrecked hopes, broke courtships, crushed breadwinners as they neared their maximum earning capacity and bereaved young families.”

The manifestations of the disease differed so widely that it was not clear to doctors that they were dealing with a single organism.

In the lungs, it was referred to as consumption “since the body seems to be consumed from within.” Symptoms included: “a chronic, hacking cough, often mixed with blood; night sweats and fever; and progressive loss of weight”. It was accompanied by the “the stinking breath of the consumptive and ‘the odour of rotting flesh”. (Evans, 2012)

Other names were the “wasting disease”, “decline”, “phthisis”, “delicacy of the lungs”, “graveyard cough” and “lung weakness”. (Smith, 1988)

Sometimes the bacillus caused the “inflammation and degeneration of the lymph nodes at the sides of the neck with ulceration of the surface skin”, known as “scrofula” or the “King’s Evil” (so-called because it was believed that the touch of the King would cure the condition). (Smith, 1988)

The “inflammation and degeneration of the abdominal lymph nodes”, known as “Tabes Mesenterica”, tended to afflict infants and children. Lupus vulgaris was the “infection of the skin” shown “as brownish nodules in the inner layers of the skin with ulceration at the surface, especially of the soft facial tissues”. (Smith, 1988)

In the brain it became tubercular meningitis which was “acute and fatal”. (Smith, 1988)

Or it would become “tubercular caries of the vertebrae” evidenced by the “spidery figures” and “spindly legs” or a “hunchback”. “Most of these afflictions were chronic, painful, debilitating, some were disfiguring, and all could kill. None could be certainly cured.” (Smith, 1988)

The cause of the disease was mysterious. As with all diseases, knowledge of the cause is essential, because without this knowledge, you cannot start to prevent and cure the disease. The debate over whether the disease was caused by the inherent heredity of the sufferer, or caused by an external infective agent, had continued for the previous 1,700 years.

Perhaps the best-known depiction of the disease is The Scream by Edvard Munch (1863-1944). Munch created the picture the year after his wife and mother died from tuberculosis, and the wasting, emaciated figure depicted the physical and metaphysical aspects of the disease. (Evans, 2012)

Sources:

Evans, R. J., 2012. The White Plague. London, The Gresham Institute.
Smith, F., 1988. The Retreat of Tuberculosis 1850-1950. London New York Sydney: Croom Helm.
Sutherland, H., 1911. The Extent of the Disease. In: Dr. H. Sutherland, ed. The Control and Eradication of Tuberculosis: A Series of International Studies by Many Authors. Edinburgh and London: William Green and Sons Medical Publishers.