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Spitting Blood/ glazing eyes

Spitting Blood: The History of Tuberculosis - Helen Bynum

In all of human history, no infectious disease has claimed more human lives than Tuberculosis ("TB"). The reason for the large numbers is that unlike other big killers (e.g. malaria) it exists in all climates. TB has causes epidemics among Eskimos, in the Sahara Desert, in New Guinea... etc. Everywhere. So that's why I picked this book up. 


Technically the book delivers what it promises, but it does so in a very distant, unengaging way. I'm sure all the information here is correct, but delivered in such a dry style as to  make it tedious and forgettable.Medical history doesn't have to be that way; three nonfiction medical history books with far superior narrative come to mind:


The Hot Zone: The Terrifying True Story of the Origins of the Ebola Virus  (Richard Preston);


The Great Influenza: The Story of the Deadliest Pandemic in History (John M. Barry);


and The Great Mortality: An Intimate History of the Black Death, the Most Devastating Plague of All Time (John Kelly).


The fix, I think, is one of either two things:  (1) give the book a more human element to make it more readable as a mainstream nonfiction book; or (2) give more technical detail and just make it a full-blown textbook that most people outside of the field probably wouldn't read for personal enjoyment. 


That said, I thought the first 1/3 of the book had some pretty good parts, describing how tuberculosis (TB) is actually a family of organisms, some of which infect humans, but some which live apart from us in the animal kingdom. Identifying DNA from TB can be recovered from ancient bones, and they show that a form of TB called Mycobacterium bovis resided in cows long before cows were domesticated by humans. TB was not seen in ancient humans before the time cows were domesticated, but afterwards a human-infecting form called Mycobacterium tuberculosis evolved. 


So cows gave us tuberculosis. Something to think about, when you're standing in line at McDonald's, I guess. 


The complexity of the tuberculosis family, and the many different subsets of Mycobacterium tuberculosis has confounded a lot of research over the years. Different strains have different resistances to various medications, and different geographic distributions. When immigrants from different places came to the "melting pot" of New York in the late 1800's, this created some weird patterns, where some populations seemed to come down with much more aggressive strains of TB than others... leading doctors of the time to believe that some populations had more "natural resistance" to TB. As you can imagine, this fed in to some ideas about race and eugenics which are pretty horrifying and embarrassing by 2017 standards. 


The book wraps up with interesting developments in India (a leader in TB research) just since 2000, which shows that short-course, aggressive (high-dose, high-intensity), home-based treatments (i.e. oral medications, as opposed to i.v. based or surgery-based) directed at the newly-infected have a much greater efficacy than long-term, sanitorium-based treatments. 


TB has not gone away, and may resurge with great force, if poverty, overcrowding, war, or evolution of the organism to more drug-resistant forms give it the opportunity. What probably has gone away is the age of large TB sanitoriums like are written about in The Rack (A.E. Ellis) or The Magic Mountain (Thomas Mann).