Sozialgeschichte der Tuberkulose: Vom Kaiserreich bis zum Ende des Zweiten Weltkriegs unter besonderer Berücksichtigung Württembergs (review)

Sylvelyn Hähner-Rombach. Sozialgeschichte der Tuberkulose: Vom Kaiserreich bis zum Ende des Zweiten Weltkriegs unter besonderer Berücksichtigung Württembergs. Medizin, Gesellschaft und Geschichte, no. 14. Yearbook of the Institut für Geschichte der Medizin der Robert Bosch Stiftung. Stuttgart: Franz Steiner, 2000. 404 pp. Tables and graphs. DM 136.00; öS 993.00; Sw. Fr. 136.00 (paperbound, 3-515-07669-7).

While the medical history of tuberculosis is of great fascination, going from antiquity through Robert Koch's discovery of the tubercle bacillus and Selman Abraham Waksman's discovery of streptomycin (the first effective drug against tuberculosis), the social history likewise offers many aspects worthy of study and interpretation. Sylvelyn Hähner-Rombach has compiled a wealth of data and offers a careful analysis of TB's impact on society. She has done so in the context of her doctoral dissertation, using as her primary source archival material for the southern German state or province of Württemberg, limiting the time span to roughly between 1890 and the end of World War II (1945).

The introduction familiarizes the reader with tuberculosis as a disease, including societal aspects. When the infectious nature of tuberculosis became more and more known, measures to curb its spread involved economic and political issues. The dichotomy is well shown: on the one hand, it was a disease of the proletariat, while on the other hand it acquired a peculiar glamor in the arts--for example, in La Traviata, La Bohème, and Thomas Mann's Magic Mountain. Governmental regulations and their applications are dealt with in considerable detail, showing that sequestration of these patients at times bordered on imprisonment, generating its own culture (for example, with patient representatives). While institutionalization of the consumptives curbed the spread, it did next to nothing for its cure. Parenthetically, even for aggressive measures such as thoracoplasty and similar interventions no statistical evidence ever came forth to show their therapeutic benefit.

Hähner-Rombach underscores the resistance to some of the rather draconian public health measures in the population, where not infrequently the breadwinner or the mother was forcefully removed from the family. An excellent separate chapter is devoted to aspects of tuberculosis as experienced, seen, and described by the affected patients. Details are reflected in their letters, written complaints, and various self-help measures. Regrettably (and Hähner-Rombach acknowledges this), very little could be found about the specific experiences of the nurses and social workers who often bore the brunt of the management or treatment.

This detailed study is centered on regional aspects of tuberculosis as seen in southern Germany during half a century when Europe was in great turmoil. The conclusions are similar to yet not identical with comparable studies from North America: segregation limited the spread of this contageous disease. But it still has not been fully explained why TB morbidity and mortality declined wherever it has been studied, even before governmental interventions and, much later, the advent of effective therapy with tuberculostatic drugs. One can only wonder whether economic improvements within the population might have been the decisive factor in the decline of the disease. A less attractive theory is that the microbe spontaneously became less virulent.

A regrettably cavalier attitude toward tuberculosis has led to a recent resurgence, now compounded with increasingly drug-resistant mycobacteria. A new aspect is the not heretofore seen or appreciated shift, where new U.S. immigrants from Africa, Southeast Asia, and Latin America are primarily afflicted. These newer medical, social, and societal aspects of TB are certainly worthy of a future study, hopefully done as diligently as this book. Tuberculosis is not an affair of the past: the recent figures for cases in the United States range between 26,673 (1992) and 16,372 (2000). It is still the only disease for which...