In the 1993 movie Tombstone, Val Kilmer brilliantly played the alcoholic, consumption stricken gunfighter Doc Holliday. But what is “consumption,” and how realistic was his portrayal of Doc?
“Consumption” is the old-fashioned term for the disease TB or tuberculosis, which is a highly infectious disease caused by an agent called a mycobacterium (technically a type of bacteria, just like the more commonly known strep or staph).
The disease has afflicted mankind for millennia; evidence of its devastating effects has even been seen in Egyptian mummies. Tuberculosis commonly affects the lungs and is spread easily by infected droplets spewed out when someone coughs or spits. In full blown cases, patients are afflicted by fatigue, weight loss, night sweats and episodic productive coughing, occasionally characterized by the presence of blood.
In the 1880s, doctors had no bona fide cure for pulmonary TB. They usually recommended that the “lunger” seek an area of the country where the weather was dry and cool. The finest respiratory hospital in the U.S., National Jewish Medical and Research Center, was established in Denver, Colorado, in 1893 for the care and treatment of “consumptives” and eventually those with other serious lung disorders.
Doc Holliday was born John Henry Holliday on August 14, 1851, in Griffin, Georgia. His mother Alice died of pulmonary TB on September 16, 1866, when Doc was 15 years old. His adopted stepbrother Francisco Hidalgo also died of TB in 1866.
Overcoming a difficult childhood, Doc enrolled in dental school in Philadelphia in 1870 and graduated from the Pennsylvania College of Dental Surgery in 1872. After practicing dentistry for a year in Atlanta, he too was diagnosed with TB, probably contracted years earlier from his mother or stepbrother. He traveled west, embarking upon many adventures (legend says he left for his health, although Dox expert Gary Roberts maintains that he left due to family complications). He ended up in Tombstone, Arizona, in the summer of 1879.
Kilmer:TB or Not TB?
Val Kilmer’s depiction of Doc Holliday is set at a time when the unfortunate dentist, by then an alcoholic gambler and gunfighter, had only about eight years to live before his disease became terminal.
With a few notable exceptions, a careful medical assessment of Kilmer’s character reveals that Hollywood finally “got it mostly right.” He was a pale, pasty, malnourished, debilitated wreck of a man, with red swollen eyes, who demonstrated episodic, short-lived bursts of energy that eventually landed him in bed (often with his partner and maybe wife, Big-Nosed Kate, played by Joanna Pacula). These physical decompensations were realistically portrayed.
The normal body defenses try to enclose the TB bacteria in the lung. These “walled off” pockets are called granulomas. Under a wide variety of circumstances (such as exhaustion and malnutrition, sometimes even silica exposure, if you are a hard-rock miner), these granulomas will break down and bleed, releasing the TB bacteria into the airways where they can be coughed up with blood and saliva.
On several occasions, Kilmer re-enacted these setbacks with clinical accuracy. They were heralded by severe coughing with hemoptysis (coughing up blood) followed by collapse. During these episodes, the real-life Doc’s disease would have probably spread within his own body and to others who were the target of his pulmonary secretions.
One target of these secretions in the movie was Kate, especially during episodes of deep kissing. How Kate avoided contracting pulmonary TB is remarkable and nearly miraculous (great immune system!), for she died in 1940 of “natural causes” just five days short of her 90th birthday.
Quackery (Just a Bit)
The movie departs from medical reality when Doc stands in for Wyatt in his successful gunfight with Johnny Ringo (played by Michael Biehn). This scene is a clinical stretch, especially given his recent collapse and confinement at the ranch of Henry Hooker (Charlton Heston), just a day or so before the showdown.
The real-life Doc died a quiet death from the complications of TB and alcoholism in a hotel in Glenwood Springs, Colorado, on November 8, 1887. One summer day, my wife Sally and I spent three hours on a windy hillside above this mountain town, trying to find his grave, only to learn that its precise location is known, only to the ages.