Insights on the history of tuberculosis: Novalis and the romantic idealization Perceções da história da tuberculose: Novalis e a idealização romântica 7 Maria do Sameiro Barroso1,2a* Abstract Tuberculosis affected the world Resumo A tuberculose tem afetado a population since ancient times, being população mundial desde tempos antigos, known to Hippocratic physicians. It was not sendo conhecida pelos médicos hipocráticos, completely understood and it was difficult não tendo sido, no entanto, completamente to manage. From the eighteenth century compreendida na sua complexa abordagem. onwards, it became highly devastating A partir do século XVIII, tornou-se altamente with a high sociological impact until Robert devastadora, tendo produzido um grande Koch (1843–1910) identified the pathogenic impacto sociológico, até que Robert Koch agent of tuberculosis, in 1882. His discovery (1843–1910), em 1882, identificou o seu agente enabled a progressive identification and patogénico. A sua descoberta permitiu uma control of infectious diseases. Novalis, born progressiva identificação e controlo das Georg Philipp Friedrich von Hardenberg doenças infeciosas. Novalis, pseudónimo (1772–1801), an early German Romantic de Georg Philipp Friedrich von Hardenberg poet, struck by the suffering and death of (1772–1801), um dos primeiros representantes his fiancée, Sophie von Kühn (1782–1797), do romantismo alemão, foi marcado pelo who died of a liver abscess as a complication sofrimento e morte de sua noiva, Sophie von of pulmonary tuberculosis, is a major Kühn (1782–1797), que morreu vitimada por founder of the romantic idealizing of the um abscesso hepático que surgira como uma disease which lasted until the control of the complicação de tuberculose pulmonar, é endemic. Current medicine tends to identify um dos principais fundadores da idealização the condition which struck Novalis as cystic romântica da doença que durou até ao fibrosis. However, his name will always be controlo da endemia. A medicina atual tende associated with the white plague, the feared a identificar a doença que atingiu Novalis 1 Portuguese Medical Association, Department of History of Medicine, Lisbon, Portugal. 2 CIAS — Centro de Investigação em Antropologia e Saúde, University of Coimbra, Portugal. a orcid.org/0000-0002-2860-7387 * Autor correspondente/Corresponding author: [email protected] Antrop Port 2019, vol. 36: 7-25 • http://doi.org/10.14195/2182-7982_36_1 Artigo recebido: 14 de março de 2019 – Aceite: 29 de maio de 2019/Received: March 14th 2018 – Accepted: May 29th 2019 and ethereal disease that killed and inspired como mucoviscidose (fibrose quística do young artists and talented poets. pâncreas). O seu nome, no entanto, ficará sempre associado à peste branca, a temível e etérea doença que matou e inspirou jovens artistas e poetas geniais. 8 Keywords: Pulmonary tuberculosis; Palavras-chave: Tuberculose pulmonar; Novalis; romantic literature; social history of Novalis; romantismo; história social da tuberculosis. tuberculose. Introduction sy of the lower limbs associated with ver- tebral injuries, collapse, and crookedness Maria do Sameiro Barroso In the nineteenth century, tubercu- of the trunk. The condition affected weak losis killed one in five Europeans, taking children and adults before forty years of their victims slowly, racking their bodies age. It was associated with pulmonary and exhausting their minds, poorly un- tuberculosis (Pott, 1782). responsive to therapies, challenging the In 1819, the French physician René medical practice. The role of hereditary, Laennec (1781–1826), succeeded in hav- nutrition, environment and contagion ing an insightful grasp on the involve- were discussed, but most patients de- ment of other organs aside from the veloped a disability requiring long-term lungs and bone in tuberculosis: medical care, and most did not recover. Si on réfléchit que le développement des The old names of the disease, “phthisis” (a tubercules dans le poumon paraît être Greek word that means waste away) and ordinairement le résultat d’une diathèse consumption reflect the way the body is générale, que souvent on en trouve en slowly destroyed and exhausted to death. même temps dans les parois des intestins, It seemed to be a constitutional condi- où ils déterminent des ulcères, et, par une tion that passed from parents to children, suite nécessaire, la diarrhée colliquative ; destroying families over a generation or et que dans certains cas enfin les glandes two. For most physicians it was under- lymphatiques, la prostate, les testicules, stood as a “consumptive diathesis”, an les muscles, les os, etc., en contiennent 1 inherited predisposition in which poor également. (Laennec, 1819: 106) living conditions, a bad diet, and over- 1 Translation: If we note that the development of work would contribute to the onset of the tubercles in the lungs, ordinarily presumed to the disease (Barnett, 2014: 112). be the result of a general diathesis, is often found at In 1769, the British physician Percivall the same time in the walls of the intestines, where they determine ulcers, and, as a consequence, of Pott (1714–1788) described a kind of pal- colicky diarrhoea; and, in some cases, finally the Twenty years later, the German physi- riological science would lead to control cian Johann Lukas Schönlein (1793–1864) over infectious diseases, what happened finally gave the name tuberculosis to the later (Magner, 1992). condition (Barnett, 2014) since the lesions were called tubercles (from the Latin Tuberculosis in Ancient History tuberculum, diminutive of tuber). 9 Pulmonary tuberculosis usually pre- The precise history of tuberculosis sents cough, frequently productive, mu- in ancient times is difficult to track. Ac- copurulent or purulent sputum, haem- cording to the Croatian-French historian optysis (not always a feature, volume of medicine Mirko Grmek (1924–2000): variable), breathlessness (gradual increase For its clinical nosology, tuberculo- rather than sudden), gradual weight loss, sis is not, strictly speaking, a disease, anorexia, fever (may be associated with since it has no symptomatic homo- night sweats), malaise, and wasting and geneity. Because it is defined exclu- terminal cachexia. But they are not specif- sively by its aetiology, tuberculosis ic. They may be present in other diseases includes a number of diseases that such as lung cancer. The diagnosis must differ among themselves in the place be confirmed by direct examination of affected, the symptoms, and the seri- sputum and culture to identify the Myco- ousness of the prognosis. Aside from bacterium tuberculosis (Campbell and Bah- the specific microbe, the tuberculous Sow, 2006). disease also has in common the his- The discovery of this specific mi- tological appearance of the funda- crobe was announced in London, during mental lesion, namely the tubercle the Seventh International Medical Con- and the caseous destruction of cellu- gress in 1881, by the German doctor and lar structures. (Grmek, 1991: 177) Insights on the history of tuberculosis: Novalis and the romantic idealization pathologist Robert Koch (1843–1910). Koch had already identified the aetiolo- The caseous degeneration often gy of anthrax, a primary disease of sheep ending in local destruction (cavities) and and cattle, as the Bacillus antracis, that the general poisoning of the organism in humans caused severe, localized skin by the metabolic products of the organ- ulcers, known as malignant pustules, a ism result in consumption, fever, fatigue, dangerous condition known as gas- cough and blood-spitting. The prefer- tric anthrax, and pneumonia, known as ence of the disease for the lungs may be woolsorter’s disease. Based on his work explained by high oxygen content and with anthrax, Koch believed that bacte- due to the transmission of the Koch´s bacilli by the air during the breath. The lymphatic glands, the prostate, testicles, muscles, evolution of the lesion depends on the bones, etc., also contain it. immune resistance of the patient. The of ancient Egypt dating from 3400 BC intestines and mesenteric lymph nodes and in later periods, in Europe, the Pacific are typically infected when bacilli are coast, and South America (Grmek, 1991: ingested orally in large amounts of con- 177–178). Ancient Egypt provides excel- taminated milk. Other localizations may lent data on Pott’s disease in mummies, st 10 involve the lymph nodes of the neck such as a mummy from the 21 Dynasty (scrofula), the genito-urinary organs, the (around 1000 BC) (Smith et al., 1910) (Fig- meninges, the bones, joints, and skin. ure 2). Ancient Egyptian mummies also Tuberculosis can affect the cranial provide excellent data on paravertebral vault. The most common skeletal form is caseous abscesses (Figure 3). the tuberculous spondylodiscitis with the destruction of the adjacent vertebral bod- Phthisis and consumption in ies, known as Pott’s disease. The caseous Greek-Roman time Maria do Sameiro Barroso destruction can lead to paravertebral ab- scesses that extend downwards, burrow- According to Grmek, tuberculosis ing under the sheath of the psoas major existed since pre-history in Greek terri- muscle. The collapse of vertebral bodies tory but osteological remains to prove it produces a sharp hump (angular kyphosis). are lacking. The representation of hunch The diagnosis of tuberculosis is backs is common in the art of later peri- quite simple through anatomopatho- ods. Literary sources give notice of pul- logical observation on a microscopic monary, osseous and