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Consider two polar images of the same medical condition: the pale and fragile Camille ensconced on a chaise in a Victorian parlor, daintily coughing a small spot of blood onto her white lace pillow, and a wretched poor man in a Bowery flophouse spreading a dread and deadly infection. Now Katherine Ott chronicles how in one century a romantic, ambiguous affliction of the spirit was transformed into a disease that threatened public health and civic order. She persuasively argues that there was no constant identity ...
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Consider two polar images of the same medical condition: the pale and fragile Camille ensconced on a chaise in a Victorian parlor, daintily coughing a small spot of blood onto her white lace pillow, and a wretched poor man in a Bowery flophouse spreading a dread and deadly infection. Now Katherine Ott chronicles how in one century a romantic, ambiguous affliction of the spirit was transformed into a disease that threatened public health and civic order. She persuasively argues that there was no constant identity to the disease over time, no "core" tuberculosis.
What we understand today as pulmonary tuberculosis would have been largely unintelligible to a physician or patient in the late nineteenth century. Although medically the two terms described the same disease of the lungs, Ott shows that "tuberculosis" and "consumption" were diagnosed, defined, and treated distinctively by both lay and professional health workers. Ott traces the shift from the pre-industrial world of 1870, in which consumption was conceived of primarily as a middle-class malaise that conferred virtue, heightened spirituality, and gentility on the sufferer, to the post-industrial world of today, in which tuberculosis is viewed as a microscopic enemy, fought on an urban battleground and attacking primarily the outcast poor and AIDS patients.
Ott's focus is the changing definition of the disease in different historical eras and environments. She explores its external trappings, from the symptoms doctors chose to notice (whether a pale complexion or a tubercle in a dish) to the significance of the economic and social circumstances of the patient. Emphasizing the material culture of disease—medical supplies, advertisements for faraway rest cures, outdoor sick porches, and invalid hammocks—Ott provides insight into people's understanding of illness and how to combat it. Fevered Lives underscores the shifting meanings of consumption/tuberculosis in an extraordinarily readable cultural history.
Viewing illness as both a cultural and a physical phenomenon, Ott, a historian of science and medicine at the Smithsonian, considers perceptions of, and approaches to, pulmonary tuberculosis. In the mid19th century, consumption's pallid languor conferred an air of elegant beauty on women and one of sensitive genius on men, provided they were middle class and white. As medical theories came and went, consumptives were exhorted to head for the mountains, to exercise strenuously, to remain in bed. These approaches respected the autonomy of the patient, but by the 1890s, after the discovery of the tubercle bacillus, physicians came to see intervention as a "moral imperative," and Progressive Era faith in technology endorsed such approaches as deliberately (albeit dangerously) collapsing lungs and taking x-rays (even when the new machines produced blurry, useless images). About the time people appreciated that tuberculosis was contagious and scientists designated sputum and dust as disease carriers, physicians and laypeople alike blended science and prejudice to conclude that poor people, immigrants, and nonwhites offered particular sources of contagion. Socially ostracized, the patient became a ward of physicians and the state, dominated by "laboratory tests, peculiar instruments, and . . . jargon," while medical science falsely congratulated itself for conquering a disease that still has a grip on certain populations and is gaining a new one among AIDS patients. Remarkably unpreachy, Ott merely notes that various trends—e.g., promoting the latest medical technologies and stigmatizing people with certain illnesses—still play out today. The text generally supplies sufficient information to keep nonspecialist readers in the picture; however, those whose conversation seldom runs to "auscultation" and "phagocytic immune response" may occasionally pine for a glossary.
Ott's integrated, well-drawn picture offers food for thought to those interested in history and—one dearly hopes—medicine.
|Introduction: Thinking about Disease||1|
|1||Sickbed and Symptoms in the 1870s and 1880s||9|
|2||The Ecology of the Chest||29|
|3||Into the Germ Zone||53|
|4||Laboring to Get Well||69|
|5||Goods for the Medical Marketplace and Invalid Trade||87|
|6||Race-ing Illness at the Turn of the Century||100|
|7||Mapping the Hygienic State||111|
|8||Playing the Lone Game of Illness||135|
|9||No Magic Mountain: The Latest Tuberculosis||156|