Media Watch
Book
To download an electronic copy
of the book see www.york.ac.uk/
media/history/documents/
globalhealthhistories/pdf/
TB-A%20Short%20History.pdf
Images were shown as part of an
exhibition at the University of
York (York, UK) between Sept 27,
and Oct 9, 2013
WHO
A public health nurse visits a refugee family in the Karachi slum area in 1956
1020
A historical portrait of tuberculosis
Tuberculosis is an ancient disease that has plagued
populations for centuries. The history of attempts to
eradicate this consuming illness can be charted through the
work of international charities, national governments, local
health-care groups, and dedicated individuals. The Centre
for Global Health Histories at the University of York (York,
UK) has now brought together a wide variety of information
in Tuberculosis: a short history to allow people to explore the
more recent history of this endemic global disease. Thought-
provoking images from the Wellcome Library’s collection and
WHO’s photographic archives are combined with written
chapters in this book, which is available to download and was
originally produced to accompany an exhibition of images.
Replicas of early 20th century posters from around
the world—produced to disseminate information about
tuberculosis—are dotted throughout the book. The images
pull on different emotions through depictions of the victims,
villains, and heroes in the disease’s story. In a simple 1905
print, a distressingly helpless girl appeals for donations to
support treatment for children with tuberculosis. Similarly,
the 1930s French public are encouraged to purchase
fundraising stamps featuring Albert Calmette, who is
heroically labelled as “the saviour of children” because of
his role in the development of the BCG vaccination along
with Camille Guerin. By contrast, another poster portrays
an industrial worker named Dirty Vlas as an enemy of public
health who spreads the infection by spitting in the street.
Aside from the poster campaigns, professionally
produced photographs link the history of detection,
prevention, and treatment of tuberculosis. With 200 children
dying worldwide because of the disease every day, it is
understandable that many images feature families and
young people. One such photograph shows a public health
nurse educating a mother about tuberculosis recognition
and prevention during a visit to a slum in Karachi, Pakistan,
after completing a 9 month WHO fellowship in the UK. This
1956 photograph still appropriately represents the goal of
the present-day WHO strategy that recognises the strong
link between poverty and the burden of tuberculosis, while
also taking steps to overcome barriers preventing vulnerable
groups from accessing treatments and services. An image of
a crowd awaiting BCG test at a temporary structure outside
a church in the Philippines portrays the urgency in the mass
screening and diagnosis of the world’s poorest populations.
Further on in the book, an almost comical image of a bare-
bottomed Mosotho boy shows screening in a mobile
radiography unit mounted in an off-road vehicle. It is not
difficult to imagine the bewilderment the young child must
have felt embracing the emotionless medical machine as
it imaged his chest in a country that today has the fourth
highest incidence of tuberculosis in the world.
In the early 19th century, management of tuberculosis was
focused on what is now known to be only basic symptomatic
relief through open-air treatment in dedicated sanatoriums.
A photograph featuring a row of smiling girls at the first of
these establishments in Britain would not be out of place
in an advertisement for a summer holiday camp, but the
reality of these cold institutions—which offered little more
than a method of segregating the sick from the healthy—is
obvious in another image that shows a health-care worker
fumigating a dingy corridor of a sanatorium in Kuwait.
New treatments focusing on the causes of tuberculosis
were developed through the invention of antibiotics and
vaccines, but medicine now faces challenges of extensive
drug resistance and the association between tuberculosis
and HIV. The importance of the continuing efforts by WHO to
manage these issues through engaging groups in their Stop
TB strategy should not be understated.
The publication provides the reader with five intro-
ductions that deliver appropriate context and further topics
to explore. Details about the contributions of Nobel Prize
laureate Robert Koch—whose presentation in 1882 on his
work to discover the bacterium tubercle bacillus “stood out
as a model of infectious diseases at large”—are included,
and the controversy surrounding the efficacy of the BCG
vaccination and the first introduction of antibiotics in the
fight against tuberculosis are also discussed. For visitors
to the exhibition, this accessible publication would have
completed a particularly informative and insightful display,
but it also stands alone to educate us about the world’s
second deadliest infectious disease.
Andrew J Hogben
www.thelancet.com/infection Vol 13 December 2013