Bynum, Helen. Spitting Blood: The History of Tuberculosis.Oxford: Oxford University Press, 2015.
Tuberculosis is a serious and infectious social bacterial disease that affects the lungs and is very contagious through a simple cough or sneeze of an individual who has it. The most concerning part about the disease is that many people do not show signs of symptoms and the treatment process is extensive. In Spitting Blood: The History of Tuberculosis the author, Helen Bynum, who is a historian of science and medicine with a PhD, discusses this important and urgent issue that has affected nearly 200,000 people per year. She writes passionately about the history and terrors of Tuberculosis, how it is still a major threat, and she demands immediate action to take place throughout her book Spitting Blood: The History of Tuberculosis. She is able to do this in a manner that connects to audiences of all backgrounds, breaking it down in order to reach even the general public.
She promptly states in the first chapter that there is evidence of tuberculosis dating back to the medieval period, and on the first page calls it an “ancient disease” that still thrives today. She follows events in chronological order, which helps guide the reader through a thorough history of tuberculosis and various remedies. Bynum explores the history and development of the disease throughout the world, focusing on discoveries. The timeline she provides for the reader helps follow the history of this horrible disease that had impacted many lives today and centuries ago. She also dives into tuberculosis as a major disease widely connected to economics, politics, and culture that will inevitably entice and capture the hearts and minds of many, regardless of background.
Bynum tells a story of tuberculosis utilizing biology, scientific and clinical approaches, institutions, and social-cultural circumstances in a way that successfully reaches her readers. She also includes observations about trends in science, medicine, and society as a whole. She begins the book discussing the famous author, George Orwell, who unfortunately died due to tuberculosis at the young age of 46 and often complained about “spitting blood” during his struggle with the disease. This symptom is labeled hemoptysis and was intensified by the fact he was a chain smoker. She utilized Orwell as a prime example of the disease and describes his symptoms in immense detail that any reader could comprehend.
Bynum takes complex medical terminology and breaks the terms down into simple concepts. For example, Bynum labels Orwell’s disease at the beginning as Mycobacteria tuberculosis, and then further explains that it’s “the most common of the family of mycobacteria that causes this disease” on page xiii of the prologue. She obtained a majority of Orwell’s experiences with tuberculosis from a biography titled The Lifeby D.J. Taylor as well as studies on his life by other researchers such as Bernard Crick. She also examines Orwell using medical resources from various professionals, including online sources. She begins the prologue of her book with a famous writer most likely to engage her audience with the familiar figure that wrote the novels 1984 and Animal Farm.
Bynum classifies tuberculosis as an “ancient disease” that can be traced into the West through the Bering Strait, which separates Asia and North America on the first page of chapter one. She highlights the early reports of the disease by the Greeks and Romans, by referring to journals written by Christina Gutierrez, Michael Tibayrenc, Vincenzo Formicola, and several others in chapter one. Tuberculosis reemerged with other diseases such as smallpox, typhus, and the inevitable bubonic plague in the tenth century to the fourteenth century following the Dark Ages, in which the first observation of scrofula was discovered, which is tuberculosis in neck lymph nodes. In this early time period, it was believed that the cure was to touch someone of royal blood, which would purify them.
In the eighteenth and nineteenth centuries tuberculosis was officially defined in the anatomy of a disease during the golden age era by such important anatomists as Morgagni, Baillie, and Laennec. Bynum describes tuberculosis as a disease of the lungs. The dissemination of this disease away from scratches and wounds began to supply a base for the increasing understanding of the process of tuberculosis. This was an important moment in history, and Bynum does everything in her power to make this point clear, which she achieved.
Helen Bynum characterizes tuberculosis as a fashionable disease, taking the lives of many inspired and infamous writers such as John Keats and the Bronte sisters, whom Bynum claims as “consumption’s fashionistas” on page 77 at the very beginning of chapter four. She also describes one of the first medical advances in the field of tuberculosis by Robert Koch in the year 1882, the discovery of causative bacillus. This discovery lead to the observation that living conditions were not ideal in both Europe and the Unites States. There was very poor nutrition and housing, which contributed to the spread of tuberculosis after the disease was acknowledged as infectious by the public.
Bynum discusses rest cures and sanitoriums as well as the less successful therapeutic methodologies to tuberculosis that were practiced during this period. She begins by explaining Robert Koch’s therapy for the disease, which is the vaccination of a crude culture filtrate made from bacterial cultures. She also discusses their study of pneumothorax, which is the collapsing of the lung lobe, and phrenectomy, which is the crushing of the phrenic nerve and has the same outcome. This treatment for the disease often did more harm than good.
The last few chapters of the book are difficult to bear because the author describes the horrific treatment to children that were taken away from their homes, parents, and families. Children young as five years old were often placed in rural farms and establishments of Preventoriums, which were often tents along Long Island. They would have to be separated from their families until the age of thirteen because the survival rate for children in home containing tuberculosis was at approximately forty percent. That’s not the end of unpleasant reading either. Bynum then describes the influence of eugenics, which includes the exploitation of X-rays amidst the World War II in order to detect Polish and Russian individuals who could possibly have tuberculosis and then were killed immediately.
Helen Bynum completes her research by discussing the use of the Bacillus Calmette-Guerin (BCG) vaccine, which is primarily used to fight tuberculosis. She also talks about the use of antibiotics such as streptomycin and the alarming reality that tuberculosis is making a comeback again in the modern era, which is fueled by the associated outbreak of HIV, a virus that annihilates the immune defense of infected people and their ability to combat tuberculosis. Bynum brings the concept of stereotyping into the big picture. She says “Thinking on racial susceptibilities had significant and often unpleasant undertones” on page 181. Lower class and other minorities such as Irish-born immigrants were often stereotyped as not hygienic and they were negatively impacted socially because they were viewed as less superior and people assumed that they were more susceptible and could potentially spread the disease faster. In Germany tuberculosis was described as a racial poison. Bynum does not hold back or sugar coat any concepts at the end of her book, which demands action more than anything else throughout the reading.
At the end of the book Helen Bynum includes the sources she used in the section labeled “Notes” on pages 269-283, followed by “Further Reading” before the index is given. The reader will benefit from the “Further Reading” section on pages 284-304 if they want to understand why each source was used. After relaying a history about tuberculosis, she describes the sources she utilized throughout the book chapter by chapter, highlighting the most vital foundations of tuberculosis research by applying just enough detail, but not so much that it overwhelms her audience.
The major point of Helen Bynum’s monograph is that Tuberculosis is not just a severely infectious ongoing disease. Tuberculosis is a social disease that attacks the poor, underprivileged, and the most vulnerable of humanity, including the successful, wealthy, and elite. She accomplishes this goal by taking her readers on a chronological journey across an endless timeline concerning the fight to end tuberculosis, which was the goal of her book. Tuberculosis will finally be defeated through continued social progress with close attention to poverty, education, and housing just as from the science of medicines and vaccines. Helen Bynum demands immediate action to take place throughout her book Spitting Blood: The History of Tuberculosis, which she has done in a direct way anyone could understand.
“I hereby declare upon my word of honor that I have neither given nor received unauthorized help on this work.” Matthew Pang
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