Spitting Blood

This thorough and highly readable study of the history of tuberculosis makes grim reading at times. The prologue tells the story of the struggles of George Orwell, who was only 46 when he died of TB at the height of his fame in 1950. The main narrative is a history of Western medicine with special reference to the growing understanding of TB and sheds light on the evolution of medical thinking. Galen was one of the first people to systematise medical diagnosis. The 'tubercle' hypothesis covers the 18th century and includes the work of Giovanni Morgagni from Padua and Matthew Baillie, then Rene Laennec in the early 19th century. There is an extensive description of John Keats' case and his treatment by James Clark (Keats' house in Rome is well worth a visit). Changing fashions and sedentary lifestyles had an effect on the 'fashionable' disease in the 19th century and it was not until the pioneering work of Robert Koch in the 1880s that the disease was properly understood at a bacterial level. The contagion implied transformed the disease into a public health issue and coincided with the rise of the sanatorium. Then we come to the successful antibiotic era of streptomycin. At the end, however, as in other fields, we are seeing the rise of multi-drug resistant tuberculosis as the bacteria evolve through natural selection to challenge our therapeutic interventions. This is an ideal overview for the general reader that will also be of interest to historians.