A book to make you think

Abstract

Fevered Lives: Tuberculosis in American Culture since 1870 Katherine Ott, Harvard University Press, $16.95, pp 296, ISBN 0 674 29911 6 In 1992, the New York Post ran the headline: “TB time bomb. Homeless contaminate public areas in city.” This headline encapsulated much of the city's anxiety about the resurgence of the public health threat that is tuberculosis and the cultural forces that influenced the response. The recent epidemic in New York resulted in a reassessment of the role of public health officials, greater awareness of clinicians to drug-resistant strains and nosocomial spread within homeless shelters, prisons, and hospitals, and an increased public awareness of an ancient disease that many thought had been eradicated in the West. In the late 20th century, American society, and in particular New York society, re-evaluated its relationship with tuberculosis. And many of its responses were mirrored in the past. In Fevered Lives, first published in 1996, Katherine Ott traces the cultural transformation of tuberculosis in America from 1870. She describes the changing “layers of meaning” that surrounded a diagnosis of tuberculosis and how, among the middle classes, this “most flattering of all diseases” of the 1870s was, as awareness of the social associations grew in the 1880s, transformed into a disease that was the consequence of either acquired or inherited degeneracy. She also describes how the disease mirrored “ethnic and racial fears and prejudices.” For example, many believed that very different disease processes occurred in black people. “The seed of negro consumption is not in the lungs, stomach, liver or any organ of the body, but in the mind.” By the turn of the century, however, the enthusiasm for blaming individual weaknesses was tempered by an increasing awareness that society's strictures were in part responsible. Ott tells a fascinating story in describing the technology associated with medical advances, how these were interwoven with changing responses to and perceptions of disease, and how physicians' authority increased as they cornered the market in interventional expertise and microbiological understanding. At this time epidemiological awareness arising from “data-gathering techniques... gave regularity and consistency to understanding of the disease,” further contributing to the medical profession's authority. Despite its subtitle (“Tuberculosis in American Culture since 1870”), Ott's book largely concentrates on the period before the 1920s. Somewhat disappointingly, little is made of the advent of effective treatment and the more contemporary issues of drug resistance and the disease's associations with HIV. These issues, and the United States' response to them, have undoubtedly been influenced by past approaches. In April 1993, increasing rates of tuberculosis led to the World Health Organization declaring a global emergency. As tuberculosis has enjoyed a resurgence, allied as it is to economic and social fractures and the HIV epidemic, so books on the disease are also enjoying something of a revival. The fact that several overlap in the period they cover, the issues they address, and their interpretation of their research findings is perhaps not surprising. Ott, however, offers much that is fresh. She argues persuasively that “the history of tuberculosis chronicles how a romantic, ambiguous affliction became first a dreaded and mighty social truncheon, and finally an entity bound up in the public health and civic order,” and she uses powerful images to support her thesis. Overall, Fevered Lives offers interesting insights into doctors', patients', and the public's changing understanding of, and response to, tuberculosis in the United States over a period of dramatic transition, and it describes well how different attitudes were reflected in the changing roles adopted by the different actors in the cultural tableau.