Ancient diseases and the benefits of technology
La tuberculosis marcó durante siglos la vida de millones de personas hasta que los avances de la microbiología y los antibióticos transformaron su tratamiento y modificaron profundamente la práctica médica.
When we try to picture the drama of tuberculosis in our country back in the 1930s or 1940s, postcard images come to mind: the hills of Córdoba in general, and the hospital in the Punilla Valley in particular, as a Mecca and source of hope for patients and their families. At the time, the mountain climate was regarded, if not as a panacea, as almost the only thing that offered any hope of recovering one’s health. But people usually died.
A rather macabre story by Cortázar is connected with that setting and those dramas. The title of the story referred, if we remember correctly, to the famous “Toscanito” Marimón. He ran a funeral business in Cosquín, one of the many people who remained in the mountains as a precaution after recovering. As a sideline to conducting funerals, he transported dead bodies back to Buenos Aires.
He necessarily had to do it at night and at high speed in order to reduce problems caused by decomposition and to avoid provincial taxes and restrictions on transporting corpses. His solution was completed by a macabre ritual. He seated the dead person in the front seat, dressed and wearing a hat, and even placed a cigar in his mouth —hence the nickname “Toscanito”— to make the highway police believe he was simply a companion dozing off.
The irony of the story is that, thanks to the driving skill he acquired during so many rapid nighttime journeys, he eventually became a road-racing champion behind the wheel of his competition Chevrolet.
The literary classic dealing with the drama of the “white plague” and the high-altitude sanatorium is undoubtedly Thomas Mann’s The Magic Mountain. An engineer, the central character, enters a sanatorium in Davos, Switzerland, to cure his diseased lung. The author traces Hans Castorp’s spiritual journey as he abandons all practical concerns and immerses himself in the melancholy sensuality of sanatorium rituals, the social life of the obsessive hygienic colony, sensual reveries and metaphysical discussions. The result is a massive work of art, poignant and disturbing.
The remarkable change that has taken place with these two images —Davos and Cosquín— is that neither the Cosquín hospital nor the Davos sanatorium exists anymore in its former role. The first has been converted into an institute, the second into a hotel.
This change reflects the trajectory of the disease. For thousands of years, consumption was one of humanity’s greatest curses. It affected the poor above all, but it did not stop at the doors of palaces, whether their occupants were named Richelieu or Eleanor Roosevelt. Artists were among its favorite victims, and they were legion. Chopin, Kafka and Chekhov are examples. In Puccini’s La Bohème, through the death of its heroine, something else is evoked that now seems curious: until the end of the nineteenth century, tuberculosis was not regarded as contagious.
Its eradication was due especially to antibiotics, the extraordinary innovation that completely transformed medical practice. As the world learned through Paul de Kruif’s legendary bestseller Microbe Hunters, Robert Koch announced in 1882 his discovery of the specific bacillus. It then became known that tuberculosis was contagious and that what had previously been explained vaguely —for example, as a “family of consumptives”— was, in such cases, due to the transmission of a pathogenic germ.
German chemists were the most successful in the search for remedies against infectious diseases in general. Ehrlich discovered Salvarsan, the “magic bullet” against syphilis, in 1910. Domagk isolated the sulfonamides and patented Prontosil in 1935. But it was only when Waksman, a Russian-American, announced his success with streptomycin that people could begin to believe tuberculosis had been defeated.
From 1945 onward, hope spread among millions of patients and their families. But the drug, although it did stop the bacillus from multiplying, did not kill it.
The stories connected with the awards for these achievements are curious. In October 1939, Domagk received a telegram from Stockholm informing him that he had won the Nobel Prize. But Hitler, angered by the earlier award of the Nobel Peace Prize to a political prisoner of the Gestapo, forbade him from accepting it. It was not until 1946 that the scientist was able to travel to Sweden and receive the medal —only the medal: the prize money had passed into what we might call the Foundation’s “general revenues.”
Waksman received the Nobel Prize in 1952, but his fame was later overshadowed. The true discoverer of streptomycin had been one of his assistants, the young Jewish biochemist Albert Schatz, who worked in the basement of the laboratory while Waksman announced the discovery in these terms: “In September 1943, my assistants and I succeeded in isolating in our laboratory an organism that produces an antibiotic…”.
The plural in the sentence was an act of modesty he imposed upon himself because of Schatz’s relegation. The world of scientific research does not escape the failings inherent in the human condition.
In the United States, immigration from poorer countries has been assigned part of the blame for the return of tuberculosis. A popular science book titled Silent Travelers states that cases of active tuberculosis in New York rose from 2,545 in 1989 to 3,673 in 1991. The incidence was 56 percent among African Americans, 52 percent among Hispanics and 46 percent among Africans, compared with 13 percent among native-born whites.
But this, of course, merely shifts the question rather than answering it. Scientists instead explain the resurgence largely through its coincidence with AIDS. This would appear to be the greater culprit.
People who contracted tuberculosis during childhood or youth and apparently recovered may retain bacilli in the scars left by their lesions, normally kept under control by the body’s immune system for years or even decades. When the immune system is destroyed by AIDS, the dormant bacillus becomes active again.
It must also be remembered that victories over deadly bacteria are rarely definitive. Natural selection leads to the multiplication of mutants that can once again overcome our defenses.
Yet all of this is said within a human society that, at least in its less unfortunate countries, maintains an almost childlike confidence in science, based on a record of success even more solid than the one that led Macaulay, in the middle of the optimistic nineteenth century, to write:
“Science has lengthened life, mitigated pain, banished diseases, increased the fertility of the soil, given new securities to the mariner, multiplied the power of the human muscle, annihilated distances…”.
