Some Confessions of a ‘T.B.’

“There is no walk of life which we have left entirely uninvaded. We are everywhere, in everything. If a climax is desired, even the throne has no immunity from our adventurous and versatile persistence in attempting occupations.”

Chateau Hachette Tuberculosis Hospital (Library of Congress)

It is necessary to tell first what a ‘T.B.’ is? For the reader’s sake I trust that it is necessary. He is to be congratulated, on the whole, if it has never been his lot to have to be much concerned about us, or to have to study us and our ways.

Not, however, that it is wise of the public to ignore us, or even possible. We are too many for that policy to be practicable, and there are too many reasons why it would not be a good policy, either for the public or for us. We are, in fact, a public question, whether the public likes it or not, and we cannot cease to be one till the public finds the indisputably right way to dispose to us—or our order ceases to exist. To know about us is a public necessity, a public duty, lucky as it may be for individual citizens to escape their share of it.

Yet not because we are a particularly lugubrious or depressing lot, either. On the contrary, it has often been remarked that we are rather surprisingly cheery and hopeful. There is no reproach in belonging to our brotherhood; no shame in telling what we are like. A Frenchman who has written a novel about us calls us The Half Dead (Les Demi-Morts). The phrase is good, but it is not quite accurate. Some of us are happy to feel that we are not nearly as dead as that; others of us claim, not without an equal sense of superiority, to be a good deal deader. We range, in fact, all the way from imperceptibly less than fully alive, to obviously as nearly dead as still alive can be. We are an unequal gallery of all the grades and shades of human vitality; a complete procession strung out over the entire length of our own particular road, — really, we do not find it especially dusty, even on the later reaches, — to the place where all roads end.

Another phrase in very common use sets us down as victims of ‘The Great White Plague’; but we do not understand it. We find no point in ‘white’ beyond its being in contradistinction to an historic something in the plague line that was ‘black’; and ‘plague’ suggests, though perhaps it does not really connote, a degree of contagiousness, and an epidemic quality, which in point of fact do not belong to that which binds us together; on this we have good reason to insist. We prefer, rather, the Western usage that designates us ‘lungers’; inelegant, perhaps, but not so practically damaging.

On the whole, however, we like best to call ourselves ‘T.B.’s.’ The suggestion of D.T.’s is but momentary, the recovery from it amusing, and by selecting this name for our brotherhood we indicate our preference for the modern and hopeful title, ‘tuberculosis,’ rather than ‘consumption,’ which medical science so long and despairingly shook its head over. I hasten to qualify. If ‘hopeful’ means anything like confident or cocksure, or anything more than insistent that there is hope, it were better, perhaps, if the more hopeful term were less widely used, and the daunting finality of the older nomenclature more often candidly accepted.

For on this part a great mistake has been made. Soon after the newer term came into use and soon after the discovery of the precise meaning of both terms, and because of certain other encouraging discoveries that quickly followed, the notion spread widely that science had won a complete triumph; that an immemorial scourge and woe of humanity had been surely mastered. Once, four or five years ago, when I had explained to a man of proved intelligence and fair information, that for some time I had had to live a life withdrawn and limited, that I was, in fact, not a complete and ordinary man but a T.B., and when I naturally expected an impressed and sympathizing response, I got instead an astonishingly unimpressed one. ‘Oh,’ he said carelessly, ‘I’m no longer afraid of that.’ There was pique, no doubt, but there was also deep concern in my remonstrance. His nonchalance appalled me. Yet it was, and still is, common.

It was that, really, which started me writing these confessions. For it is much better that people should know that once a T.B. is, in all but a very small minority of instances, always a T.B. Indeed it may be wiser and also more scientific and accurate, to make no exceptions at all—to insist that there is no way to withdraw entirely from our order, when one has once come into it—except, of course, by the exit we and all mankind are striving to delay. True, there are many who give up this active membership—some for a time, a few for good and all. They leave our habitats; they return to their old walks and ways. But they are very likely to reappear, and they retain always in their absences a sort of non-resident membership.

‘What,’ I hear the reader exclaim, ‘then there are no cures? You declare the thing incurable?’

Oh, no; by no means. The great profession which is most concerned with us has considered the matter, and at a national convention devoted entirely to our little abnormality, one member has declared it to be ‘so easily cured that it can be cured four or five times in the same individual!’ Even the most cautious and least sanguine of these learned gentlemen merely insisted that the word ‘cured’ should be always put in mental quotation marks, and that they do not guarantee that those they cure will stay cured. Another of them suggested that one who has thus recovered should always say, in relating his experience, not ‘I had the thing and am cured,’ but ‘I have it and am cured.’ Perhaps I should add that many of the most experienced and expert particularly avoid the active mood, — ‘I cure,’ or ‘I have cured,’ — partly for scientific accuracy, but also from modesty, knowing that their part in the business is less than in the combat with other human ailments. Indeed, I know but one orthodox and reputable expert who ever speaks at all of ‘curing’ his patients, with or without the mental quotation marks; and his usage is rather temperamentally than otherwise significant. The expert whom I myself most trust—not merely or mainly for his expertness, but for a still higher trustworthiness—has never, so far as I know, claimed to have cured anybody.

But again I hasten to qualify. To be ‘cured,’ in quotation marks is far indeed from being a negligible good fortune. It is in many ways ‘just as good’ as plain cured without them would be. In fact, with the gain in knowledge and caution and self-control that should be won from the experience, it may prove quite as good—even, with certain temperaments, actually better.

More still, there are yet lower degrees of recovery that permit members of our order to reënter normal life and share extensively in its activities. This indeed is our little joke on the public; for not infrequently we go about quite unsuspected. Even such of us as are not at all recovered, but steadily progressing the other way, can sometimes play such tricks of assumed vitality and competence successfully. Such adventures are fine; a little like the part that secret and proscribed orders sometimes play in novels—Dumas’s for instance, and The Wandering Jew.

We have thus our heroes and celebrities—some known for ours, and some, mostly, though still alive, whose membership is hardly even suspected. Among poets and men of letters, for instance, we have been particularly strong. Keats was ours, and Stevenson, and Sidney Lanier. Stevenson, indeed, is become almost a tutelary saint to us—though one of his dearest friends, the one to whom he wrote certain of his most priceless letters, once assured me that he never was quite as are the mass of us, but a case puzzlingly peculiar and irregular. At any rate, however, the life he lived was our life, and in his letters he has inspiringly disclosed its compensations and its possibilities. Yet I believe we must account the struggle of Sidney Lanier—cavalryman, musician, and poet—even more inspiringly heroical. Fancy doing ‘The Marshes of Glenn’ with one’s temperature at 103! And for resolute swinging on to man-size jobs neither John Richard Green nor John Addlington Symonds was a T.B. the brotherhood need ever bee ashamed of.

But our range is far wider than letters. If it were not, there might well be skepticism as to any exceptional pertinacity in our attempts at competence. Doubters could remind us of the puny but formidable Mr. Pope, of Heine and his mattress grave, of the sightless eyes of Homer and Milton, of many others who have contributed out of pain and weakness and solitude to the glory and delight of literature, not one of whom was ours. Letters, indeed, are the traditional refuge of men who are anywise less than whole. But what other order of half-alive mortals can match our boast of creditable representation in all the principal occupations and professions? Why, fully half the medical gentry who serve and rule us, are also of us. So are many of those who do the humbler offices about us, and many also of such as we encounter in the shops and banks and professional offices, and even in the manual trades of our chief habitats. In truth there is hardly one of these resorts, and they are many, that would not be practically depopulated if all who are of our order confessedly should make a sudden exodus.

But our really surprising adventures, of whole men’s careers, are in such quarters as take no special note of us; even in the great cities which are denied us altogether. More surprising still, of all such careers, the stage, I think, is quite the most fascinating, because the most unfit and dangerous. Probably few but us of the order discerned between the lines of the newspaper reports what it was that caused, not long ago, a very famous actor’s retirement and swift ensuing death; and doubtless only we fully understood the vocation, the habits, or the peculiar and haunting charm of two young actresses now at the very zenith of their success and popularity. There have doubtless been Richelieus who have found it only too easy to produce the racking cough with which the sly old Cardinal stimulated illness, and also Camilles who have smiled a little wearily out of their unhappily fuller knowledge of the conventional ‘business’ with which they have been required to indicate what was the matter with them. The novelists, by the way, are about as conventional as the playwrights in their attempts at depicting us. Mrs. Humphry Ward, for instance, prescribes too traditionally for two of her very up-to-date characters. But perhaps a more modern treatment would have puzzled her readers.

But why multiply instances? There is no walk of life which we have left entirely uninvaded. We are everywhere, in everything. If a climax is desired, even the throne has no immunity from our adventurous and versatile persistence in attempting occupations. Reading between the lines of court calendars we are sure that at least one king, and a spirited and charming one, too, is of our brotherhood; and we suspect it may not be long before we can also claim with assurance a queen—nay, an empress!

Yet the mass of us are exiles from the places that whole men do most frequent, barred from ordinary tasks; herded in habitats specifically assigned to us; living a life peculiar and separate. It is of that life, therefore, and not of our escapes from it, that it is most worth while to speak. But first a word of the way we enter upon it—of the initiation into our brotherhood.

Unfortunately, it is not always the same. On the contrary, the entrances are innumerable, however sole the exit. Indeed the initiation varies so widely that one would not be far wrong in saying that it is never twice the same. Yet many initiations have certain features in common; and in a general way it may be said that all belong to one of two great classes—the sudden, and the protracted. One discovers what one’s future is to be either promptly or after prolonged inquiry and uncertainty. It depends mainly upon the kind of oracles are consults.

My own initiation was of the protracted variety, and perhaps fairly representative of its class. There must, indeed, have been at least two years between the actual first beginning of my career as a T.B. and the final discovery that I was one; and it is quiet impossible to recall how many other ailments I was meanwhile found to be suffering from; for I was never particularly timid, as some are, about undergoing a doctor’s examination. Nervous exhaustion was one of the first things I learned was the matter with me. Overwork was perhaps the most frequently offered explanation of my not feeling or looking well—possibly because it was so readily accepted, notwithstanding my own better knowledge. For a long time, rest and a milder climate were the commonest recommendations, and both were measurably heeded. For whether or not I was overworked, I was certainly tired—tired even before my day’s work began.

Then came the suggestion of the sea and travel—I am not sure from what particular theory of my condition; indeed, I am not altogether sure that I did not myself contrive to suggest the suggestion! The sea and travel were accordingly tried, and not even the ultimate effect of them, or rather of the eager and reckless mood in which I essayed them, can ever make me quite regret that I did essay them, or become ungrateful for the peculiar exaltations, the intense and overwhelming delights and depressions, which in that mood I won from them. No; I would not even now begrudge the price I have had to pay for a single day of that mistaken summer—for a single one of the exquisite glooms and solemnities I had while I permitted the ‘misty mountain winds’ of Wordsworthshire and of the Highlands to blow upon me freely—for a single day of rapturous and feverish and exhausting exploration of hot Italian cities. For I had already begun to taste, unknowingly, the perilous delight of indulgence in certain kinds of excitement, with that peculiar and unequaled heightening which only the T.B. temperament can give them. For the T.B. temperament—but of that more later.

Home again, though still exalted, I soon had reason to take up again the old inquiry; and this time it could not be much longer baffled. It was now too plain that whatever was the matter with me was something specific and out of the ordinary. Ordinary weariness was too plainly insufficient to account for whole forenoons of sheer inability to get up and go about my business. Yet there were two more bootless examinations to endure. The first yielded a suspicion of typhoid, then of ptomaine poisoning, and finally an assurance that whatever was the matter it was not serious: the second no definite suspicion, but a quite decided assurance that the trouble, whatever it might be, was something serious. Then, on a sudden impulse, came the visit to a great diagnostician—the second to bear a name now famous for two generations; and it was fascinating, weak and near indifference as I was, to watch at last a master-scientist explore my worn-out body for the secret of my helplessness.

I have seen, indeed, but one other comparable master actually at work—a great French chef, now dead, personally completing a chef d’œuvre of the particular kind he was famous for; but a clean-cut pointer quartering a field came also to my mind. The master charged with finding me my fate was quick, curt, at first a little sharp and impatient; then gradually more deliberate and decided—and I surrendered, completely, to the charm of his manifest competence. Came finally, however, almost gentleness, and an invitation to the laboratory where, in due time, having performed a chemical rite, now long shorn of its mystery, over something infinitesimal that had come from me, he set eye to a big microscope and my tired brain began to comprehend. When he raised his head and glanced at me, he had no need to speak. For at that glance I had gone white and cold, and life in its every aspect and relation had turned utterly different, and my tenure of it utterly insecure and hazardous. I was a T.B. and had been one, probably, for some years; yet never once until the instant he raised his face form the microscope, had I suspected the truth, or even so much as specifically dreaded, among the remoter horrors that dimly encircle all our lives, this that had now so suddenly swept close and grappled me!

That was the worst, the very worst, — those first few moments of terror and conviction and lightning — swift review and forecast of all my life. Much of suffering and sadness and almost despair was to come after, but nothing quite to be compared with what then struck and chilled clear to the heart of me; nothing that has quite so profoundly stirred in me the love of life, the fear of death, the daunting and appalling and shameful sense of my own and all men’s pitiful mortality. It had happened to me; the lightly acknowledged possibility had become reality; had come upon me, of all men; and yet, until that moment, though youth was gone, or nearly gone, nothing had ever completely deprived me of youth’s illusion of immunity, of immortality!

Almost as swiftly came the reaction; the reaction that alone keeps even our lesser overthrows less than fatal or maddening; first the detaching sense of the thing as happening not quite really, but as in a story, a novel, and not quite to me but to some other—this as I went out rather stumblingly into the street, appropriately cold and damp: then with the thought of what to do immediately, the positively exhilarating sense of a new importance, the expectation of sympathy and uncommon attention. To the grown man’s full and awful acceptance of supreme disaster there succeeded the pride of the small boy none of us ever ceases to be, in the possession of an ailment not to be ignored. First the chill of the terror of death, and then the dignity of Mark Twain’s hero when he appeared with a sore toe at school!

That first discovered compensation was mightily effective the two or three days that preceded the beginning of exile. Time has wrought some serious changes in my estimate of the value of different kinds and manifestations of sympathy; but at first all that came to me was precious and potent. I remember now that I was a little piqued to find one or two old friends, who are still old friends, and in whom there has been never a shadow of turning, rather undemonstrative and silent; but I was correspondingly gratified at the ample demonstrations in others of a concern that has somehow, as the years have passed, completely evaporated. Of this concern there were some curious manifestations.

The fact is, there is still no proper and convincing etiquette accepted for recognizing a newly found T.B.’s importance. In my case, unusual social attentions seemed to be the prevailing impulse. One of them was an invitation to luncheon at Delmonico’s! It was not entirely inappropriate: I only wish it had been an arrangement to take Delmonico’s or some similar institution with me in my wanderings. These have been many and devious, by sea and land, but they have had very simple objects. They have sought, for the most part, things that should not be so very hard to find. The chief and most essential of these have been merely food and air, — good food and good air of course, — and both in plenty, in abundance. But the trouble is that they both must be had together. Even so, they should not be unattainable. They ought to be rather easily attainable, even with merely moderate means. But they are not.

It is now seven years and more since I began my quest for a place and an arrangement to breathe freely and constantly the right kind of air, and eat in abundance the right kind of food, yet I can say with perfect honesty that I have not yet found anywhere the combination of these two factors of cure worked out satisfactorily at moderate cost for me and such as I am. The rich, of course, can have them easily. But the great majority of our order are not rich; they are cut off from their customary earnings; they are often forced to depend on the sacrifices of others—sacrifices which they would not willingly increase. The fact of this dependence, indeed, is the hardest part of their lot. They cannot escape the thought of it for a day. They are loath to have what they need, if it costs too much, and nothing could be more trying and worrying than the constant necessity to pull and strain, to fight and nag, as they must do if they would have it at reasonable cost.

Now that, simple as it seems, is the true problem of the average T.B.’s existence. It is not in the main a medical problem at all, but a practical problem, a sordid problem; a mere matter of food and air—and dollars. Yet to present it candidly as it is, is here my principal purpose and motive. For it is a problem the public will in the long run, for its own self-defense, have to deal with; it is the public’s problem ultimately, although as yet it is left to us and to those who, from kinship or benevolence, are specially concerned with us.

It has some aggravations that are peculiarly exasperating. Not the least of these, in this particular country, is American cookery—that is to say, the cookery of such Americans, doubtless the majority, as can be induced to ‘take boarders,’ and particularly such as can be induced to take boarders who are sick. Many of these last, by the way, are such as have already failed to minister acceptably to boarders who are well. Theirs is, as a rule, not merely unenlightened American cookery, but cookery stimulated by no aspiration and but little competition: cookery seasoned with a lax indifference: cookery without any compelling need to be better, and with an obvious reason for being as careless and unlaborious as it can be and continue to be endured. To take ‘lungers’ at all, it would seem, confers rather than incurs an obligation. For is not that surrendering the chance of any other kind of gainful hospitality?

Ordinarily, yes, it is—unless the lunger successfully lies about the nature of his ailment. That, indeed, is by no means the limit of his temptation—his necessity at times—to deceive, or to pretend to deceive. For while some communities and hosts are really afraid of him, some merely demand that he help them to hoodwink the other customers whom they wish to attract. In these communities, if he respects appearances, his hosts—whether mere keepers of boardinghouses or managers of hotels—will be discreetly blind. And such communities are by no means rare; the practice is common; it involves, of course, much the most serious danger to the public which our problem presents. That is why the public must in time take more account of it and of us. Until the public does, it must continue to owe far more to our consciences than we do to the public’s conscience.

That is the truth, and very mildly stated. The public depends for protection from such danger as our continued existence involves, not on its own exertions but on ours. To render that protection we must burden ourselves with both expense and trouble. We must incessantly take, for the sake of the public, precautions which are disagreeable and costly; and meanwhile a great part of the public is, by its attitude toward us, steadily tempting us, and even sometimes fairly compelling us, if we would live, to discontinue those precautions and go on as if there were nothing the matter with us. The folly and stupidity of this attitude it is impossible to overstate. It is of itself by far the chief cause and source of the persistence of this scourge.

Known and recognized and decently entreated, we are not dangerous. Shunned and proscribed and forced to concealments, we are dangerous. Victims ourselves of this same régime of ignorant and self-deceiving inhumanity, we are called on every hour of our lives for a magnanimous consideration of others. Society can hardly find it surprising or a grievance if our human nature should sometimes weaken under the strain of the incessant provocation it endures from this strange working of human nature in general. Why should we alone be expected to be guiltless, always to our own cost and sacrifice, of that very form of man’s inhumanity to man, from which we ourselves are suffering more than anybody else? Yet I can honestly attest that the vast majority of us are guiltless of any merely resentful offense: that, as a rule, when we fail to protect the public it is only because the public compels us to disregard its interest, its safety. This is what I earnestly entreat the public, for its own sake, candidly to consider.

Candidly means fully. If the public is to be safe from us, if the public is to continue to have our protection from that against which it failed to protect us, then the public must make it possible for us to get—it must certainly cease to make it impossible for the mass of us to get except by subterfuge—what we must have to live. We are neither criminals nor mendicants. We do not ask favors, we merely revolt against a mean and stupid oppression. We revolt against ignorance and against a lie. The public would get rid of us and thereby makes us inescapable. It would pretend, and would have us pretend, that we are nowhere. It thereby insures that we shall be everywhere. It proscribes us, and thereby admits us.

But how be practical with this most impractical and illogical attitude of the public? Well, I have thought of that. I am practical now, for of course there can be no sweeping change till the public is brought to its senses, and that is what I am trying to help to do. But it is slow business enlightening stupidity, and something should be possible with those who are already enlightened and who have some power of initiative. Something should be immediately possible. I think something is.

The men who, as things stand, can do most for betterment are, I am persuaded, the diagnosticians, and particularly the diagnosticians in the greater cities, who as a rule do not treat the malady themselves, but who do in large measure decide whither we shall first go in our wanderings. It is to these men very largely that the various resorts and the resort specialists look for their patients and boarders. That vies the diagnosticians power, and I conceive that it also imposes on them a duty to exercise it. They can insist on better provision for us wherever they send us, and to do that intelligently they should personally know more than they now know of how we fare after they have placed us. It is my observation that they now leave such things mainly to the local practitioner, or to the heads of sanitariums. It were better if they themselves kept in closer touch with both of these two arrangements for disposing of us.

In general, it is my opinion that for the mass of us—the well-to-do excepted—the sanitarium is much the better arrangement: but that must be taken with the admission that many so-called sanitariums are not sanitariums at all, but mere T.B. boardinghouses, irresponsibly conducted for profit. The real sanitariums are far too few. They have their own deficiencies. The red tape and reliance upon rules, unfailing marks of every kind of ‘institution,’ are even exceptionally manifest. I cannot, from my own experience, name a single one where the cookery is really good—as good, say, as one finds in the homes of ‘nice’ people, even those of very moderate means, and in America. The life is in many ways trying, although everywhere relieved by that resolute cheerfulness—sometimes, I think, a trifle too resolute—which we T.B.’s affect. But for the mass of us a proper sanitarium is best. There alone are in some fashion assembled all the factors that make for improvement! — or for keeping us alive. There—

[The author was interrupted and the manuscript was never finished. – The Editors, 1915.]