Spitting blood: the history of tuberculosis.

I approached this book with some interest, as my own maternal grandmother (who I never knew) died of tuberculosis (TB) in a Liverpool sanatorium in the pre-streptomycin days of the 1930s. That sanatorium later became Fazakerley Hospital, where I have worked for over 20 years (albeit with the now more politically correct name of “Aintree University Hospital”). Helen Bynum is a respected and prolific academic medical historian, and predictably makes an excellent job of the difficult task of analysing the history of such a complex disease as tuberculosis. It is also a disease inextricably enmeshed with the socio-economic background of the population it affects. The book deals comprehensively with the ancient history of the disease and includes explanations of the terms “consumption”, “phthisis” and “scrofula”. The pathological discovery of “tubercles” in the lungs, in the early 19 th century, would later lead to the modern name of the disease. But like everything about TB, its pathology is complex and variable, perhaps explaining the variable clinical course. For centuries it was known that some could self-cure of consumption, but that it could also run a chronic, or very fulminant, course (“galloping consumption”). The introduction of the stethoscope by Laennec (also in the early 19 th century) gave doctors a new tool to describe the wheezes, crackles and dullness that tuberculous lungs may exhibit – but did nothing to help the patient’s outcome. The discovery by Robert Koch of the “tubercle bacillus” was a real advance, and led to more accurate diagnosis, and the ability to follow the course of the disease microbiologically. The story of famous TB sufferers such as John Keats and the Brontë Sisters are recounted. Keats had taken the “good weather” option popular for the rich in the late 18 th and early 19th centuries. This was often extended to a bizarre “tuberculous grand tour”. Other ineffective treatments abounded. Standard bleeding and purgation was practiced of course; but more unusually, frankincense and myrrh (not apparently,