Broussais et le matérialisme. Médecine et philosophie au XIXe siècle

The book is, however, far more than a psychological study of the tuberculous. It is a meticulously conceived work about tuberculosis in France, with intriguing sidelights on the differing experiences of other European countries. Whereas in Spain and Italy, and elsewhere in Southern Europe, the disease was considered contagious and its victims treated as lepers, ideas were more ambiguous in France and Northern Europe. The observation in the later eighteenth century that tuberculosis was plainly not contagious in the same way as smallpox and other acute infectious diseases, produced the theory of hereditary transmission or hereditary susceptibility, and with it a medical conspiracy of vagueness, whose primary purpose was to protect the victim and enable him to enjoy the protection of society. As a result, the researches of Villemin and Koch (here clearly and beautifully expounded) produced little but an ethical dilemma lasting nearly a hundred years in France. In spite of the intervention of the Rockefeller Mission in 1917, tuberculosis mortality remained higher than that of any other industrialized country until 1949, and the disease was made compulsorily notifiable only in 1963. Most aspects of tuberculosis, from despair in the eighteenth century to salvation in the twentieth, are examined here. The attitude of the victims to their own suffering; the ideas of the medical profession on causation and treatment, and the real nature of the doctors' function; the social and physical geography of the disease; attempts at control and prevention in the later nineteenth and twentieth centuries; the claustrophobic world of the sanatorium, and its reluctant disappearance (ninety per cent of French sanatorium physicians were themselves former tuberculosis victims, and identified totally with the world of the sana) before the power of streptomycin; all these are illuminated by Guillaume. The only dimension to the story which escapes detailed examination is the attitude of the healthy to the sick: although Guillaume repeatedly stresses the horror which the disease aroused in French society, he quotes no instances of, for example, local resistance to the siting of sanatoria, such as occurred in Britain. Added excitement comes from Guillaume's sensitive use of historical, and especially literary, sources to illuminate the experience of the tuberculous; his handling of this tricky method is exemplary. The book itself is very nicely produced, clearly printed, with a splendid cover picture. Like many French works, it is rather under-footnoted, and it is a pity that English spellings in the bibliography were not checked more carefully. Quibbles apart, Pierre Guillaume set out to restore the image of tuberculosis as the most feared of killers before our own age, in which it was replaced by cancer, and now more fittingly perhaps by AIDS, and he has succeeded. Du desespoir au salut deserves to become a classic of both medical and social history, and should be read by all with any interest in the world we have lost, and in the problems of our present.