Die "Wiener Krankheit": Eine Sozialgeschichte der Tuberkulose in Osterreich (review)

This is a monumental study of the history of tuberculosis in Austria from the time of the Austro-Hungarian monarchy until the 1950s, when Austria had become a small nation-state within Europe. The author brings together a vast amount of primary sources covering the historical epidemiology of tuberculosis and the administrative history of tuberculosis control, as well as the history of medical intervention and therapy.

Since the mid-1980s, there has been an amazing surge of research activity in the history of tuberculosis, and specialist monographs now exist for many countries. Dietrich-Daum makes a very commendable effort to engage with this literature, even if it is not always clear what, precisely, the Austrian case can add to the historiography of tuberculosis.

The book follows an established pattern, addresses research questions that have been asked about other countries before, and it is very much indebted to the social history paradigm. This is not to the study's disadvantage, as it helps to maintain a sense of purpose when dealing with a stupendous amount of primary material, making this a well-argued and thoroughly researched case study.

I particularly liked the chapter on dispensaries and structures for local poor relief. Dietrich-Daum is among the very few historians who are taking the dispensary seriously, and she provides interesting source material with which to elaborate on its history within social policy, medical specialism, and wider issues of health care policy. Another strong chapter is devoted to tuberculosis in the Nazi era, after 1938, when Nazi Germany formally gained control over Austria. Here the author demonstrates how the emphasis of tuberculosis control shifted to accommodate Nazi ideology and how a diagnosis of tuberculosis could often become a death sentence—euthanasia programs and human experimentation with tuberculous children are particularly sad stories to read. Dietrich-Daum successfully integrates this into a wider history of tuberculosis while perhaps not quite going far enough in explaining the continuity issues before 1938 and after 1945.

These innovative and well-argued chapters do, however, remain somewhat constrained by the book's conceptual limitations. Its strengths match those of the social history paradigm: the administrative history of tuberculosis is mapped in abundant detail, the analysis of mortality rates is presented with a lot of care, and the institutional history of tuberculosis is well written. The book provides less detail where medical practice, individual institutions in a localized context, actions, or experiences are concerned and does not elaborate on how a patient's perspective might be different from the master narrative provided. The conceptual limitations become obvious in the underlying categories, too: the book opens with a discussion of several terms for the disease, and the author clearly understands the various shifts in the meaning of tuberculosis. But this does not inform the remainder of the book, in which a modern understanding of tuberculosis prevails. The analysis of post–World War II developments is a little bit problematic and reveals the inherent weakness of an approach that is largely blind to the historicity of medical sciences and their categories. Statements about BCG or the arrival of antibiotics tend to be less informed by an increasingly available historiography than most of the book's other chapters.

On balance, this is a well done if somewhat conventional history of tuberculosis that manages to put Austria firmly on the map of the international historiography. The book particularly impresses with plenty of empirical detail and deserves praise for the longue durée it aims to analyze.