The Bioarchaeology of Tuberculosis: A Global View on a Reemerging Disease (review)

To my knowledge this book is the first all-encompassing work on the history of tuberculosis. There have been works on specific time periods or institutions, edited collections of articles, and many clinical texts starting with an historical chapter, of course. But I could think of no single, modern, jointly authored text that outlines what we know of the disease historically, from all specialties and academic fields. Now that such book has come along, my next question is whether it is any good.

This book by Roberts and Buikstra approaches the history of tuberculosis from three viewpoints. The first two chapters summarize the knowledge of modern public health. The next two cover the perspective of physical anthropology and paleopathology, and the fifth chapter discusses matters from the standpoint of medical history. This task would be tough enough for three authors, one from each background. However, both Roberts and Buikstra are physical anthropologists. Speaking as someone who is trained in these three areas, I can say that they have done surprisingly well. Anyone interested in infectious diseases, however knowledgeable, will put down this book having learned something new.

The book starts with chapters on reemerging infectious diseases in general and tuberculosis specifically. This section summarizes the clinical aspects of the disease, explores the stigma associated with its diagnosis, and quotes seemingly every statistic imaginable. Although the section may be useful from an academic perspective, parts do become hard to digest as a result. By highlighting the relationship between tuberculosis and population density, diet, hygiene, immunological compromise, cattle domestication, and pollution, it helps set the scene for the following chapters.

The next two chapters discuss the archaeological evidence for tuberculosis in the Old World and New World. The authors are currently vice president and president of the Paleopathology Association and certainly know what they are talking about here. They have been thorough in tracking down examples of tuberculosis from around the world and appropriately skeptical of those cases that do not match up to the tough criteria required to demonstrate skeletal cases of tuberculosis. The role of recently developed biomolecular testing for tuberculosis in archaeological samples is explained, such as ancient DNA and mycolic acid analysis. Convincing archaeological cases date from 5800 B.C.E. in Europe and 4500 B.C.E. in the Near East. The disease was present in South America by 300 C.E., in North America by 1000 C.E., and in the Pacific islands prior to contact with European ships. The prevalence appears to have increased markedly in areas where high population density developed, and this fact ties in well with our modern knowledge of the transmission of infectious diseases.

The fifth chapter covers medical historical aspects of the disease. Early references to texts from a range of cultures lead to later advances that followed the development of microscopy, radiography, sanatoria, antimicrobials, and vaccines. Examples of paintings, sculptures, pottery, and metalwork believed to depict Pott's disease of the spine are discussed. The chapter reads well and provides a reasonable overview of the field. However, it is not of the same scholarly standard as the earlier sections. Almost all references to texts and records prior to the twentieth century are quoted from secondary or tertiary works. This ellipsis is perhaps understandable for Asian, Arabic, or Greek texts, but even edited works available in English translation were not themselves referenced. In their defense, the authors are not medical historians and have written a better chapter than most historians could manage on an archaeological topic. However, I suspect that a review of this chapter by a medical historian prior to publication, or even the addition of a historian as coauthor, would have improved the book.

I recommend this book to medical historians interested in the evidence for tuberculosis before texts were written, to medical students and clinicians who require a sound overview of the area, and to physical anthropologists who seek...