FEVERED LIVES

An enlightening interdisciplinary look at how genteel consumptives have evolved into medicalized tuberculosis ``cases.'' 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. (50 halftones, not seen)