Tuberculosis in the Americas, 1870–1945: Beneath the Anguish in Philadelphia and Buenos Aires by Vera Blinn Reber (review)

Contemporary historians are expected to put the local in conversation with the global, frequently a time-consuming and frustrating task. Vera Blinn Reber's Tuberculosis in the Americas, 1870–1945: Beneath the Anguish in Philadelphia and Buenos Aires, which synthesizes and distills a considerable amount of historical data into a concise and illuminating comparative study, is thus a welcome addition for those interested in the history of tuberculosis.

Blinn Reber compares the actions and beliefs of patients, physicians, and governments in Buenos Aires and Philadelphia, two influential port cities in the Western Hemisphere. Her narrative is bookended by two trajectory-altering discoveries: the tubercle bacillus and the first effective therapy for the disease. Blinn Reber contends that local patient experiences were markedly similar in these "two very different cities" due to global trends (p. 12). More specifically, she argues, "These two port cities, with diverse medical facilities, illustrate the growing international consensus between 1870 and 1920 as to the causes, prevention, and treatment of tuberculosis" (p. 2). Even though "Buenos Aires and Philadelphia exemplified growing international disagreements among physicians as to which specific medical therapies were most effective in preventing and curing tuberculosis" after the 1920s, likeness still prevailed, for "urban public health programs demonstrated increasingly similar approaches to tuberculosis prevention" (p. 2).

Most of the chapters are organized thematically, exploring scientific understandings of the disease; the medical establishment's influence on coalescing anti-tuberculosis campaigns; how gender, class, age, and ethnicity influenced TB mortality and treatment; changing therapies over time; the sanatorium age; and programs aimed at children. The final chapter expands its scope, comparing approaches to tuberculosis in Great Britain, France, Germany, Spain, Africa, and Asia. The epilogue carries readers through the post-1945 antibiotic age, concluding with current challenges.

Tuberculosis in the Americas will primarily benefit two audiences. The first is scholars who will find it a useful reference volume. It provides copious qualitative and quantitative data for Buenos Aires and Philadelphia (and, at times, for Argentina and the United States). The final two chapters are also encyclopedia-like in their geographical coverage. For instance, Blinn Reber has painstakingly put together a table of TB death rates across the twentieth century for an extensive list of countries and cities (pp. 239–43).

Second, the book would work well in a number of undergraduate health courses in a variety of disciplines. Its transnational historical overview can serve as a textbook for novices, while still including interpretative claims that can spur classroom discussion. In particular, students could tackle the central claim of the book. For example, in the fifth chapter, Blinn Reber argues, "Sanatoriums in both Argentina and Pennsylvania were remarkably similar because of the international medical consensus on the nature of tuberculosis and how to treat it" (p. 179). However, readers might pick up on a number of potentially significant differences between the two cases studies. In Argentina, the state funded sanatoriums, yet in the United States, private sanatoriums provided the bulk of beds. Patients in Argentina organized sanatorium strikes to push for better conditions, while patients in the United States took a less confrontational approach. (The sick at one sanatorium in Pennsylvania published satirical critiques in a monthly magazine delightfully titled Spunk.) A shortage of sanatorium beds existed for both populations, but in Argentina there was one bed for every thirty-three patients, while in the United States there was one bed for every eighteen patients (p. 179). Students can marshal these and other pieces of evidence to debate whether similarity or difference best characterize these local histories.

This reader wished for a more explicit discussion of the advantages and disadvantages of this particular comparison. If these two Atlantic cities were marked by similarity in patient and physician experiences, could the same be said for the rural hinterlands surrounding them? How would...