Tuberculosis Then and Now: Perspectives on the History of an Infectious Disease (review)

With the rise of HIV/AIDS and an increase in multidrug-resistant forms of tuberculosis (TB) in the twenty-first century, TB has reemerged from the shadows. Although no longer the leading cause of death, TB claims almost two million lives each year. Medical professionals, politicians, and historians increasingly look to previous treatments and understandings of the disease as they approach this global health problem. In Tuberculosis Then and Now, Flurin Condrau and Michael Worboys provide a fresh perspective of TB by presenting a collection that considers the “continuities and discontinuities” from the late nineteenth century to the present (3).

The majority of the essays in Tuberculosis Then and Now look at social contexts that helped shape medical treatment and public health campaigns in Great Britain, Australia, Spain, and India. In doing so, the authors give voice and agency to patients of TB and other disempowered groups, especially those considered “alien,” “undesirable,” or “other.” For example, Helen Valier draws attention to the ethics of drug trials in developing nations through a skillful examination of the Madras chemotherapy center testing in the 1950s and 1960s. The Madras trials in India provided irrefutable evidence that combination therapies did not need to be administered within a confined institutional setting. The findings were undeniably significant, especially for those countries that lacked funds for building and maintaining sanatoria, but Britain’s use of a former colony retained elements of exploitation rather than mutual gain. The British Medical Research Center often clashed with the local Indian government and drew attention away from contributing factors to TB, such as poverty. Valier’s essay serves as a reminder to researchers and scholars alike of the importance of balancing the goals of the larger drug trials with the needs of the local population.

The struggle over public policy is also portrayed in essays by Jorge Molero-Mesa, Peter Atkins, and Michael Worboys. Molero-Mesa explores agency of the working class in Spain during the Restoration in the formation of policies to combat TB. Middle class approaches had to accept the growing vocal demands of the working class for social change, including compulsory health insurance. Atkins shows how individuals inside and outside political spheres of influence could act as agents of change in policy for bovine TB in Great Britain between 1900 and 1939. Worboys examines contemporary explanations for the decline in TB in Britain during the turn of the twentieth century. He identifies five groups—insanitationists, infectionists, hygienists, diathesians, and tubercularisationists—that held interest in engineering the understanding of TB and the public policies used to combat it. Molero-Mesa, Atkins, and Worboys draw attention to the social and medical interests at play in creating both past and present public policies regarding TB.

Again speaking to current issues, David Barnes assesses the discovery of restriction fragment length polymorphism (RFLP) to locate the “primary case” of so-called outbreaks. Barnes argues that, while valuable in limiting the spread of infection, RFLP allows public fears and anxieties to seek a scapegoat. Location of patient zero can also fuel prejudices against the homeless, racial minorities, immigrants, and other marginalized groups. Barnes spotlights the unintended social consequences of technological advances and places emphasis on public health responses and the innate dignity of individuals suffering from TB.

Alison Bashford and John Welshman also consider how prejudice can influence treatment. Bashford discusses how nation-making in Australia stimulated nativist rhetoric of a pure Australia that needed protection from diseased immigrants, including Britons, but by 1976, TB became more closely associated with South Asian countries that had a higher infected population. Consequently, Australian immigration policies on disease became racialized. According to Welshman, immigrant screening in Great Britain resulted from similar views. Although some postwar Britons believed socioeconomic factors were more important to the causation of TB, these ideas co-existed with those that blamed immigrants and certain ethnicities, specifically Asians, for the spread of...