The White Death: A History of Tuberculosis (review)

Thomas Dormandy. The White Death: A History of Tuberculosis. New York: New York University Press, 1999. xi + 433 pp. Ill. $29.95 (0-8147-1927-9).

Many histories have been written about tuberculosis, which pathologist Thomas Dormandy describes as "one of the most historical as well as historically important diseases" (p. 1). He distinguishes The White Death from existing work in two ways. First, he provides "a less than triumphalist look" (p. xiv) at a history that too often has emphasized the success of human efforts against disease. Second, he focuses on the impact of tuberculosis on the lives of its victims and physicians. Countless biographical sketches demonstrate the relentless impact of consumption on famous artists, intellectuals, and politicians, from Chopin to Chekhov, Kafka, Emerson, and Cecil Rhodes. Remarkably clear explanations bring to life the medical efforts of all the usual suspects, from Galen to Laennec, Koch, Trudeau, and Waksman.

These stories, well known to any historian of medicine, are supplemented with an impressive variety of less-familiar episodes, from an eight-year-old boy murdered to provide fresh blood for a consumptive Andalusian nobleman, to patients who sought refuge in hot-air balloons that carried them to an atmosphere free of dust and germs. Dormandy's chapters on sanatoriums are particularly strong, tracing their development and national styles from Nordrach and Davos to Saranac.

But despite impressive research and elegant writing, The White Death is more exhausting than exhaustive. Few readers will have the energy for the countless life stories, and if they do, they will realize that much has been left out. Dormandy hopes to describe the "brotherhood" of people bound together by their common suffering from tuberculosis (p. xiii), but he ignores the different meanings carried by that diagnosis in different times and places. Although the book has an air of comprehensiveness (from Egyptian mummies to HIV), it deals almost entirely with Europe between 1800 and 1950. As Dormandy reviews countless biographies, he only rarely and superficially discusses the social questions central to the history of tuberculosis: the nature of susceptibility, the relationships between tuberculosis and poverty, and the causes of its decline in the developed world. Thomas McKeown, for instance, does not appear. Where Dormandy does discuss social issues, such as debates about the etiologic contributions of poverty, housing, ethnicity, and diet, his conclusions are vague and unsatisfying: "the trouble with aetiological factors of tuberculosis was that the truth was rarely clear-cut and almost never politically correct" (p. 242). The book also includes some striking errors, such as attributing directly observed therapy (which began in the 1950s) to the rise of drug-resistant tuberculosis in the 1980s. The footnotes, though extensive, are inconsistent and inadequate, with direct quotations often going unreferenced.

Beyond these strengths and flaws, two aspects of The White Death remain particularly puzzling. First, Dormandy's tone is inconsistent. He mocks the explanations of early physicians (e.g., "Childish hypotheses were often expounded at length" [p. 9]), but provides sympathetic discussions of their practices (e.g., bloodletting [p. 16]). While he reveals the misguided optimism of those who believed that tuberculosis would disappear, he remains a self-conscious victim of the "spes phthisica." Tuberculosis has always inspired hope that it will be overcome: "To the eyes of one astonished observer it still does" (p. 392). Second, his desired audience is unclear. Historians will find little insight in this book that cannot be found in Dubos's White Plague. Someone looking for analyses of the history and meaning of tuberculosis would be better served by Randall Packard, Katherine Ott, Sheila Rothman, or David Barnes. General readers will find much of interest in Dormandy's stories and anecdotes, but his narratives of shattered lives and medical struggles provide little sense of the meaning of it all.

David S. Jones
Harvard University

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