“Good Tuberculosis Men”: The Army Medical Department’s Struggle with Tuberculosis by Carol R. Byerly (review)

Micobacterium tuberculosis is an ancient—and still quite active—nemesis to society and the medical profession at large. Its insidious and aggressive natures have been chronicled by historians, romanticized and deplored in the open literature, and monitored closely by scientists and public health professionals for over a century. In “Good Tuberculosis Men” Carol Byerly offers a fresh and engaging account of an old tale. Framing her story in the U.S. Army and its Medical Department, ca. 1899–1950, Byerly has captured the struggle against tuberculosis in one of the most TB-vulnerable segments of American society during a half century of tremendous politico-military upheaval and medical change. Moreover, in this exhaustively researched and superbly written account she has opened a window not only to an untold chapter in Army Medical Department history, but also to a human drama of dedication to duty and personal sacrifice.

After a succinct introduction of the mycobacterium and its characteristics, the reader is transported to Fort Bayard, New Mexico, 1899. The first three chapters chronicle the trials and tribulations experienced and eventual success in establishing this tiny desert outpost as a TB sanitarium. Colonel George E. Bushnell, Medical Corps, the erudite, administratively efficient post commander from 1904 to 1917, recognized the potential benefit of the sanitarium to provide a more detailed understanding of TB, including its diagnosis, therapy, and prognosis. As a TB victim, Bushnell understood that the treatment of TB—that is, the TB lifestyle of seclusion from society in a dry climate, long hours of outdoor exposure, plenty of rest, high protein diet, and attention to respiratory hygiene—required strict discipline tempered by compassion and common sense. The human drama recounted in South Carolina Congressman George S. Legare’s days as a patient at Fort Bayard speaks to Bushnell’s remarkable success as commander and clinician.

In chapter 4 Colonel Bushnell is brought to Washington with the advent of World War I to establish and direct the Office of Tuberculosis in the Division of Internal Medicine. Bushnell’s office provided appropriate criteria with which to assess TB in draftees, established TB surveillance in Europe, and defined the resources needed to care for TB patients. By war’s end it would also assist in defining the magnitude of the disease in young Americans. Of 22,000 cases diagnosed during the war, some “18,500 [were] from training camps in the United States” (p. 122). The government was now responsible for the treatment of these veterans, and Fort Bayard was wholly inadequate to the task.

Chapters 5, 6, and 7 describe governmental, military, and medical efforts to detect, treat, and control TB in the “modern” albeit pre-antimicrobial inter-war years. These efforts were expensive—made even more so by the Great Depression—and consumed tremendous physical, therapeutic, and human resources. Byerly provides a concise account of the administrative factors and political machinations that finally achieved Fitzsimmons Army Hospital. However, as in the first three chapters, she takes the reader beyond the dry and mundane to the human aspect of the story: the physicians and nurses—who were exposed to and often contracted TB—their patients, and the frequently brutal pre-streptomycin therapeutics.

The last two chapters provide an appropriate denouement to the story and bring the reader into the twenty-first century. The criticality of M. tuberculosis airborne transmission, the fielding of streptomycin and other anti-TB drugs, the subsequent development and spread of drug-resistance, and lack of an efficient immunological remind one that medical victory is often fleeting. Even vaccine-preventable diseases are being ignored today, as evidenced by the measles epidemics in Britain and Continental Europe (2012–13) and in the United States this year. Society must remain eternally vigilant for its health. And last, the narrative of World War II Army Nurse Margaret E. Gaule, in which dedicated service and...