The Plague and I by Betty MacDonald

Betty MacDonald’s first memoir, The Egg and I, was a total hoot. The book created a small empire of Ma and Pa Kettle movies and several children’s books with similar characters. MacDonald’s second memoir, The Plague and I, takes on a more serious topic — tuberculosis — but is still written with the author’s wry sense of humor. There’s just not as much space for her to be as funny because TB requires constant stillness.

The Plague and I opens in 1931 near Seattle, Washington. MacDonald has left her husband from the first memoir and is living with their two girls. While she’s working, MacDonald struggles with what seems like an incessant cold, and it doesn’t help that she and everyone she knows smokes. But then she learns she has tuberculosis (TB), the dreaded White Plague. TB, much like COVID-19, spreads through the air in droplets when a person coughs or sneezes. According to the Centers for Disease Control, “In 1904, there were 115 sanatoriums with the capacity for 8,000 patients expanding to 839 sanatoriums with the capacity for 136,000 patients in 1953.” My only encounters with TB are the several times I’ve been tested for it before being permitted to work in crowded places (correctional facility, group home, etc.) and being sad when Val Kilmer dies in Tombstone without his boots on.

In 1931, MacDonald didn’t seem to know what TB really was either. She recalls:

I thought that the only real symptoms of tuberculosis were a dry hacking cough and a clean white linen handkerchief delicately touched to pale lips and coming away blood-flecked.

More of a romantic image than the serious one of millions dying of a bacteria in their lungs (and other body parts, apparently??). Leaving behind her children, sister, and mother, MacDonald enters The Pines, a TB sanatorium, for an undefined amount of time.

The Plague and I captures the feeling of the time period, with its overly stern nurses and authoritarian doctors. MacDonald’s feelings of confusion, being refused information about her own body and condition, and the coldness with which nurses treated all patients reminded me of horror films that hope to capture that old-timey hospital feel. You know, the movies in which doctors are quietly perform experimental surgery on patients?

One staff of The Pines explained, after refusing to call Betty “Ms. MacDonald,” her divorced name, “We do not tell the patients the rules, Mrs. Bard. We find that the trial and error method is the best way to learn them.” Because she doesn’t know the rules, MacDonald is on constant fear of being throw out of the sanitarium, a place she gets to stay at because her doctor brother-in-law asked a favor that would let MacDonald skip the wait list, and because The Pines accepts low-income individuals free of charge.

The rules the author is told early on make the memoir more menacing. We readers get the rules blatantly, much like the author did, and wonder the point of them:

Patients must not read. Patients must not write. Patients must not talk. Patients must not laugh. Patients must not sing. Patients must lie still. Patients must not reach. Patients must relax.

This is not a condemnation of the medical world, though. In fact, we later learn that the rules around movement and perhaps even joy stem from the fact that doctor’s believe (rightly? wrongly?) that any over use of the lungs — anything beyond very relaxed breathing — taxed the tissues and thus harmed the patient. For months, MacDonald napped every hour of the day unless she was eating good, nutritious food (a rule!). Thanks to holding back explanations of the rules, writing them later in the timeline when they were explained to her in real life, makes The Plague and I an effectively lonely, somewhat claustrophobic book.

MacDonald shares personal insight into the 1930s and how people responded to TB, educating readers on medical history, from her experience only, in the process. Doctors’ treatments sound absurd to me, but what if they still use such surgeries? I have no clue. For instance, “A successful collapse of the lung, whether it was accomplished by pneumothorax, thoracoplasty, phrenicectomy or stripping, favored rest for the infected part of the lung and facilitated healing of the disease.” Doctors collapse the lung so it cannot be used, MacDonald explains, as if the doctor had put a stint on an arm to prevent movement. I’d love for a blogger like Lou @ Lou Lou Reads, who is a nurse, to pick up The Plague and I and give some insight into what would be considered bonkers –or normal?? — in 2021!

You may be thinking, “Why would I read a memoir about a disease spread by wet air droplets when I’m living in a pandemic?” Honestly, I felt calmer about COVID-19 while I read The Plague and I because the world feels familiar. Masks, carefully disposing of coughed-on tissues, constantly wondering who is contagious, the mass numbers of people in medical care who don’t know what their outcome will be — death or home. Even the care with which a TB patient released must take reminded me of stories of the COVID long-haul folks, whose symptoms persist after infection. MacDonald’s thoughts aren’t too off from my own these days:

[A sanitarium patient] said, “I was workin’ in a candy factory dippin’ chocolates and one day I had a hemorrhage.” I asked her if she had had a cough. She said, “Oh, God, yes, for years and years. I never thought nothing of it.” I thought something of it. I thought of all those chocolates she had dipped and sprayed with germs.

Birthday cake candles before 2020, anyone? Sneezing and coughing directly into our hands? Ugh. Even after MacDonald leaves the facility, her old friends stay back and even shut their doors on her, which reminds me of when I scoot into my apartment to avoid running into my neighbors, in case any of us aren’t wearing masks. Is it weird to see my own life in a TB memoir? Unlikely. We’ve always had epidemics, pandemics, and outbreaks. We’ve just been too comfortable in the between times to admit that viral and bacterial calamity are kinda normal.

A highly recommended book, and you can read The Plague and I without picking up the first memoir. They are not linked content-wise.


  1. I’ve read two or three TB books from that period now, and yes complete rest was the only ‘cure’ – I don’t know whether the disease went away or just the symptoms. Horrifying as McDonald’s experience was, worse was a) as you imply, the number of people who kept working; and b) the number of poor who couldn’t get into sanitoriums and so were left to the care of what families they had (and what they could afford) and almost certain death.


    • Doesn’t that quote about the candy lady just blow you away? Coughing all over everything. Oh, boy. I know MacDonald mentions that there were folks at her workplace who had latent TB, which apparently is just there but doesn’t do anything to harm the person. I wonder if that means it’s not contagious in those folks? It seems a lot like people with COVID who are asymptomatic vs. on their death beds.

      MacDonald’s family tried to care for her at first, but a connection through an in-law helped her escape death. I wonder how much the average people knew about TB, because her family stood around her bed (despite how contagious TB is) and worried about her sickness, all while the entire clan, minus the children smoked.


  2. Artificial pneumothorax was the first successful treatment for TB! There’s an overview of the history here, in Applied Sciences – I don’t think it’s behind a paywall: .

    Thankfully, it was replaced initially by chemotherapy (I think) and then by streptomycin, but inducing a pneumothorax was the first thing that actually made a dent in the TB epidemic. It’s a vicious illness and must have been much worse to contract back when we could do so little about it. This does sound really interesting – I’ve read novels set against this backdrop but not a memoir. Betty MacDonald is already on my TBR, so I will be getting to this eventually!


    • MacDonald has four books, but based on the two I’ve read, you don’t have to go in order. Nothing really about The Egg & I carries over into The Plague & I. In fact, at the end of The Egg & I she’s married with a baby, and at the beginning of The Plague & I she’s divorced with two girls.

      I’m reading through the article you sent and just couldn’t believe (and yet totally believe) this statement: “Against all those who still rejected the contagious nature of tuberculosis, invoking constitutional, degenerative, food or toxic explanations, Koch advanced his overwhelming evidence.” I just saw a new book released that really pushes the theory that viruses are not real and that COVID is caused by 5G and wi-fi. Things have….not changed.


      • Okay, now that I’m home I’ve read the entire article. I smiled when I read in this science paper that the procedure was judged popular when it appeared in a novel. Books and science meet again!

        Do you know why the procedure took its time getting to the States? The article mentions it but not why (which I understand; that’s not the focus). I was also curious to learn more about the man in Russia who was killed because he performed the procedure they deemed “aristocratic therapy.”


        • I don’t know why it took so long – my general knowledge of early C20th medicine in the States is that it was a bit of a closed-off world unto itself and was often doing other stuff than that which was becoming commonplace in Europe, so it might just be an extension of that. The closed-off approach had pros and cons – lots of successful treatments were pioneered for the first time in the States in that period, but American doctors were sometimes missing out on good practice that was happening in Europe.


          • It’s wild how the article said that doctors in different places were coming up with the same treatment without having heard of the other folks’ ideas. Such happenings make human beings seem downright amazing.


  3. You’re right – I *was* wondering why you’d read a memoir about TB during a pandemic, ha ha! Not for me currently, but I know you loved her previous memoir so not too surprising. It does sound interesting – perhaps for another time!


    • I know on the news and in social media people keep saying THIS IS NOT NORMAL, referring to both the pandemic and the wild political state of affairs. Looking at history, both are normal for the U.S. Knowing more about that history makes me feel better. In fact, what we see of American riots, like the Jan. 6th riot, is very on brand for America, according to Isabel Wilkerson. She talked about how America is being very America right now. Given that her books are so connected to present day, I’m even more motivated to read them.

      Liked by 2 people

  4. The parallels you see between that crisis and our current one are fascinating. Doctors were largely working in the dark when they first encountered TB, so having to experiment just as our medics are currently. One thing that the medical profession can benefit from today is the huge array of drugs and, as we’ve seen, the ability of pharma companies to ramp up research to produce new vaccines quickly.


    • Interestingly, the foundation of the COVID vaccine was based on research on other vaccines, so we were lucky they didn’t have to start from zero. However, folks sure seem convinced that this vaccine was non-existent and then forced through and it’s going to change us into frogs, or something, because it uses mRNA.


      • It’s worrying indeed how many people who I would think of us intelligent, are questioning the effects of the vaccine. Which means they are putting themselves and others at risk. The low take up in care homes in the UK is particularly worrying. I fortunately have my jab tomorrow – almost three months ahead of when I expected it so I am dancing with joy

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  5. There is something oddly comforting about knowing that humans have survived plagues before and we can survive this one too. It does sound like it would be hard to relax if you’re not allowed to do anything relaxing!


  6. I remember reading a short novel about a young woman in a sanitarium (that’s a word that I can never spell correctly the first time) in a small town in the same province I live in, when I was just a few years older than she was in the story, and the feeling of confinement and desolation has stayed with me ever since. Such a curious topic to think of now. Also, random note, that’s a phrase that was in my family growing up too, something being a real ‘hoot’. 🙂


    • “Sanitarium” throws me off on the spelling because there are actually multiple accepted spellings. My great-great grandfather, so the story goes, went missing one day. It was later learned that he had been headed home from work and was found by police slurring his words. They put in him jail to sober up, only he didn’t. So, they sent him to a sanitarium where he later died. All signs sound like a stroke, but for almost the entirety of my great-grandma’s life, she thought her father had run off and abandoned her mother and siblings. A single woman with several children couldn’t survive on her own, so because my great-grandma was still an infant, she was put up for adoption because she had the best chances of finding a home.


      • Aww, that’s such a sad story. There are so many tales of abandonment, sad to think that there are tales among those, which don’t actually need to be sad stories, if only the truth were known.

        Liked by 1 person

  7. I can see why reading this now would bring comfort actually-there’s a lot to be said with the simple knowledge of knowing this has happened before, and it will happen again. It’s sad of course, but as we’ve talked about before, the medical marvel of this vaccine being developed so quickly also offers a much-needed dose of hope, pun intended 🙂


  8. Great review, this sounds so interesting! And it definitely sounds like the sort of old(ish) book that should come with an afterword about how it relates to the modern world. Given the current health situation this seems like a great time for a publisher to add a relevant bit of commentary like that into the book!


    • I’m not sure how many editions of MacDonald’s work are out there. I don’t think she’s ever been out of print since she started publishing in the 1940s. It doesn’t seem to matter what book I’m reading lately, my eyes are more apt to see connections and reflections of myself in the lives of others. I just finished Moses, Man of the Mountain by Zora Neale Hurston and had a SUUUUUUPER hard time writing the review because there were so many connections across history that I wanted to make.

      Liked by 1 person

  9. Thank ye kindly for the excellent review. I loved reading the comments on this one. I have added it to the list. One of the books I have read about disease talked about how widespread the ideas of consumption being romantic and beautiful were in literature and culture. Seems nuts for something that kills ye. Arrr!
    x The Captain


    • And for some reason I didn’t connect that consumption was the same thing as TB; they just hadn’t identified the bacteria yet, I think. If you’re in the mood for something funny, be sure to add The Egg and I to your list as well.

      Also, I have NO clue how people thought consumption was romantic. MacDonald describes how a person gets to coughing and hacking and phlegming…. EW.


  10. I love the sound of Betty MacDonald’s memoirs. But, oh boy, am I ever going to be able to thoroughly enjoy my favourite dipped chocolates again?

    The first thing I always think of when I hear about TB is Ruby Gillis’s death of consumption in Anne of Green Gables. That was my first encounter with it, and I thought it was so sad.


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