Pioneers of Medicine and Their Impact on Tuberculosis (review)

Thomas M. Daniel. Pioneers of Medicine and Their Impact on Tuberculosis. Rochester, N.Y.: University of Rochester Press, 2000. xiii + 255 pp. Ill. $65.00 (1-58046-067-4).

This is an interesting and engaging work with a clever structure. There are three parts to the book. In the first Thomas Daniel provides historical background and discusses the pathogenesis, possible origins, and epidemic spread of tuberculosis. In the second part, which is the bulk of the work, he discusses the six "pioneers" referred to in the title. These researchers represent different approaches to tuberculosis and, to some extent, different time frames: René Théophile Hyacinthe Laennec, 1781-1826 (pathology); Heinrich Hermann Robert Koch, 1843-1901 (bacteriology); Hermann Michael Biggs, 1859-1923 (public health); Clemens von Pirquet, 1874-1929 (immunology); Wade Hampton Frost, 1880-1938 (epidemiology); and Selman Abraham Waksman, 1888-1973 (antibiotics). Daniel thus approaches tuberculosis from six complementary perspectives and, at the same time, provides an almost continuous account of research on the disease covering a period of nearly two centuries.

While tuberculosis is the thread that unites the book, each chapter is a balanced account of the life and work of one of the six "pioneers." Daniel provides enough biographical information--sometimes complimentary, but occasionally not--on each of the researchers that the reader has a sense of the sort of person he was. For more recent figures, some of this information is based on Daniel's personal conversations with individuals associated with the researcher in question; thus, this book contains insights not likely to be available in other sources. Moreover, there are generous quotations from the main works of each of the six--not just isolated sentences but, frequently, one or more pages of continuous text. These excerpts provide enlightening glimpses into the thinking and research strategies of each. The second part also contains portraits of the six researchers, as well as a few illustrative graphs and tables.

The concluding third part reviews some current challenges to medical research--inadequate financial support, the inevitable fragmentation of increasing specialization, and the growing delays in the dissemination of knowledge that result from increasingly stringent peer reviews. As it stands, the epilogue comes across as much less personally engaging than the accounts of the six "pioneers," whereas one would normally expect the opposite. Daniel informs us that he deliberately chose not to include living persons in his book, and modesty may have blocked any suggestion that he regards himself as worthy of inclusion among the figures he discusses. However, he has spent a good part of his professional career dealing with this terrible and resurgent disease; some personal reflections would have been welcome at this point.

The book contains a useful glossary of medical and technical terms, and an index. Unfortunately, the footnotes, many of which contain factual information relevant to the narrative, are relegated to the end of the book--a serious inconvenience to the reader.

Pioneers is interesting, accessible, and well-crafted enough to make it appeal to general readers. Thus, Daniel has clearly succeeded in what he set out to do. The book may be too broad in scope to satisfy some professional historians, and its title and structure suggest an approach to medical history no longer in vogue. However, in reading this book, one does not have the sense of superficiality that might be expected. Moreover, Daniel knows enough about tuberculosis that anything he writes on the subject is likely to be informative and worth reading. This book is both.