(no subject)
Sep. 30th, 2018 12:54 pm![[personal profile]](https://www.dreamwidth.org/img/silk/identity/user.png){kind=small}
seekingferretMy mother, at Rosh Hashanah dinner, after listening to me babble about the flu: "This doesn't sound like an interest. This sounds like an obsession."
Me: What's the difference?
The Remedy: Robert Koch, Arthur Conan Doyle, and the Quest to Cure Tuberculosis by Thomas Goetz
This one had good parts and less interesting parts. The premise is that Conan Doyle's life briefly intersected Koch's life when Koch announced to the world that he had discovered a remedy for tuberculosis , which he called Tuberculin, and Conan Doyle, then a doctor and occasional writer, was hired by a newspaper to travel to Berlin to cover the announcement. The intersection is very brief, and Doyle's influence on the story of Koch's remedy is arguably minimal- at best he was one of the earliest voices questioning the efficacy of Koch's remedy, but that criticism would then build over the subsequent months after Doyle left Berlin until it became clear to the whole world that Tuberculin didn't work.
But the story of Koch's discovery of the tuberculosis bacteria and his efforts to cure it are a worthy story in and of themselves, without the Doylebaiting additions. What's most fascinating is that even though Tuberculin didn't work, Koch had already without entirely comprehending it discovered an effective remedy for tuberculosis: the germ theory itself. In the decades after Koch's discovery of the tuberculosis bacillus, massive public health campaigns to limit tuberculosis's effectiveness as a contagion drastically reduced tuberculosis's endemic condition, well before the 1950s discover of an effective antibiotic treatment for the disease. That irony is what drives the book, the tension between the desire for an easy magical cure and the actual enormous amount of changing of minds and habits required to fight the disease.
Goetz enlists Doyle again here as an avatar for that change, arguing that Sherlock Holmes, scientific detective borne of the pen of an actual doctor and devotee of the germ theory, was a lodestar of the evolving attitudes toward science and the scientific method in the late 19th and early 20th centuries. Because what allowed that massive change in societal norms surrounding hygiene that ultimately helped fight tuberculosis was the sudden embrace of science by the popular culture. When Goetz is making this argument, the book is at its most synergistic. Otherwise, the pairing of Doyle and Koch seems forced- both are incredibly interesting people on their own, but their connection is insubstantial.
America's Forgotten Pandemic by Alfred Crosby
I <3 this book. Okay, it is not a very storyful book. It is not dramatic, doesn't have the twists and turns and heroic singular figures that populate many of the other medical history books I've recently reviewed. But this is a wonderful story about the difficulty of working with numbers, and I love it for what it is.
In 1918, when the Spanish flu struck the world, killing twice as many people as World War I did, the infrastructure of public health had already been built to fight diseases like tuberculosis, as I mention above. But it was not a holistic disease surveillance system. Relatively little was known about disease, compared to today, and contrariwise disease was so much more commonplace than it is today. So the public health infrastructure of the day generally didn't track flu- flu was relatively harmless, and affected so many people that tracking it would've been difficult and costly. And also there was no way to actually distinguish a flu from a bad cold, or various other diseases with 'flu like symptoms'. They could track deaths from pneumonia, a frequent way in which influenza killed, or deaths from fever or heart problems that may have been caused by influenza or various other mechanisms. But they didn't have the laboratory tools to profile a sample and say "Oh, this is H1N1 influenza." The antibody tests and ultimately the RNA sequencing were decades away.
This lack of tracking by the public health infrastructure was a problem for the people trying to treat the disease, as they had limited mechanisms for disease surveillance and containment. It also poses huge problems for the chronicler of the disease. So Crosby, writing in the 1960s, has to figure out how to determine what happened based on almost invisible clues in the record. He looks at life insurance claims, he looks at death records and applies deductive reasoning to them to guess which deaths were flu related, he tracks novels and newspaper reports and memoirs and other accounts of first person experience, he analyzes troop movements against the expectations for a flu free world. It is an amazing numbers detective story.
Like, there's a passage in his narrative of the flu outbreak in San Francisco where he notes that immigrants were particularly affected: The death rate in the Italian community skyrocketed. The death rate in the Irish community skyrocketed. The death rate in the Chinese and Japanese community... didn't change at all. Crosby flatly calls this "A patent impossibility." He then builds a case for why the public health record keepers ignored Chinatown and what alternate inferences might be drawn about the severity of the disease in Chinatown based on anecdotal evidence. (starlady, I think you might be particularly interested in the dueling pair of chapters about the outbreaks in Philadelphia and San Francisco... Crosby attempts to generalize on the differences between the two cities based on their response to the flu, but doesn't go that far. But at least some of the differences do seem connected to our general sense of the difference in outlook between an East Coast city and a West Coast city. )
It's also a great counter to those narratives of singular heroic figures fighting disease. So often the conclusion when a cure arises is that these researchers were in the right place in the right time. Science had progressed, equipment had progressed, the researcher had personal experience or motivation... The story of the 1918 flu is a story of people in the wrong place at the wrong time. Researchers had no idea what a virus was (and had an incorrect belief that a common opportunistic infection from Pfeiffer's Bacillus was the actual flu germ), public health had limited ideas about how to quarantine a disease capable of spreading as easily as flu, and the needs of the war machine prompted people to mass in public places and travel far distances far more than is ordinarily the case. All of these circumstances conspired to make the flu worse than it would have been in a story about researchers in the right place at the right time.
Crosby also deploys a wonderful dark sense of humor throughout the book, as he struggles to comprehend foolish decisions from public health officials that surely exacerbated the disease's spread. Books about a lethal flu should not be this funny. After the head of the San Francisco public health department convinced the city to legally mandate the wearing of gauze masks outdoors, the flu infection rate dropped precipitously. Looking back from the '60s, Crosby knows these two things cannot be causally related in a significant way- gauze is not fine enough to stop the passage of the tiny influenza virus, and plenty of other cities that enforced a mask ban did not see a similar drop in infection rate. Crosby knows that the reason for the drop was most likely just the standard way an influenza outbreak burns out over time, but he still can't help but marvel at how tight and convincing is the mask/flu correlation: "Rarely has the evidence in support of a scientific hypothesis been more overwhelming and more deceiving," he writes.
The best narrative chapter in the book is the discussion of the negotiations of the Treaty of Versailles. I've seen this story from a decent handful of angles over the years and Crosby's angle slots in surprisingly naturally and totally changes everything. Because I'm sure that littered throughout all of those other accounts, there'd be an occasional mention of how at some dramatic moment, something was delayed because someone was sick. I'm sure I read those and skimmed over them because people get sick sometimes, I didn't realize the import. But Crosby shows how the sickness was a systematic part of the 1918 pandemic and it was totally affecting the negotiations in all sorts of ways. Wilson's chief foreign policy advisor, Edward House, was nearly taken out of the negotiations by a combination of flu and later kidney troubles that were no doubt exacerbated by flu. Lloyd George missed some negotiations because of it, Clemenceau had flu symptoms after being shot that seem to have left him seriously affected, and Wilson caved on the Saar a week after collapsing mid-meeting with the flu. (and many medical historians believe the flu he caught in April 1919 laid a path to his later, devastating stroke) And everyone around them was bouncing in and out of meetings with the flu, too! The medical team for the US delegation was treating hundreds of people for flu, out of the thousand member delegation! Crosby builds an incredibly straightforward case that the path of history in the wake of Versailles was driven as much by the flu pandemic as by the desires of the negotiators.
Me: What's the difference?
The Remedy: Robert Koch, Arthur Conan Doyle, and the Quest to Cure Tuberculosis by Thomas Goetz
This one had good parts and less interesting parts. The premise is that Conan Doyle's life briefly intersected Koch's life when Koch announced to the world that he had discovered a remedy for tuberculosis , which he called Tuberculin, and Conan Doyle, then a doctor and occasional writer, was hired by a newspaper to travel to Berlin to cover the announcement. The intersection is very brief, and Doyle's influence on the story of Koch's remedy is arguably minimal- at best he was one of the earliest voices questioning the efficacy of Koch's remedy, but that criticism would then build over the subsequent months after Doyle left Berlin until it became clear to the whole world that Tuberculin didn't work.
But the story of Koch's discovery of the tuberculosis bacteria and his efforts to cure it are a worthy story in and of themselves, without the Doylebaiting additions. What's most fascinating is that even though Tuberculin didn't work, Koch had already without entirely comprehending it discovered an effective remedy for tuberculosis: the germ theory itself. In the decades after Koch's discovery of the tuberculosis bacillus, massive public health campaigns to limit tuberculosis's effectiveness as a contagion drastically reduced tuberculosis's endemic condition, well before the 1950s discover of an effective antibiotic treatment for the disease. That irony is what drives the book, the tension between the desire for an easy magical cure and the actual enormous amount of changing of minds and habits required to fight the disease.
Goetz enlists Doyle again here as an avatar for that change, arguing that Sherlock Holmes, scientific detective borne of the pen of an actual doctor and devotee of the germ theory, was a lodestar of the evolving attitudes toward science and the scientific method in the late 19th and early 20th centuries. Because what allowed that massive change in societal norms surrounding hygiene that ultimately helped fight tuberculosis was the sudden embrace of science by the popular culture. When Goetz is making this argument, the book is at its most synergistic. Otherwise, the pairing of Doyle and Koch seems forced- both are incredibly interesting people on their own, but their connection is insubstantial.
America's Forgotten Pandemic by Alfred Crosby
I <3 this book. Okay, it is not a very storyful book. It is not dramatic, doesn't have the twists and turns and heroic singular figures that populate many of the other medical history books I've recently reviewed. But this is a wonderful story about the difficulty of working with numbers, and I love it for what it is.
In 1918, when the Spanish flu struck the world, killing twice as many people as World War I did, the infrastructure of public health had already been built to fight diseases like tuberculosis, as I mention above. But it was not a holistic disease surveillance system. Relatively little was known about disease, compared to today, and contrariwise disease was so much more commonplace than it is today. So the public health infrastructure of the day generally didn't track flu- flu was relatively harmless, and affected so many people that tracking it would've been difficult and costly. And also there was no way to actually distinguish a flu from a bad cold, or various other diseases with 'flu like symptoms'. They could track deaths from pneumonia, a frequent way in which influenza killed, or deaths from fever or heart problems that may have been caused by influenza or various other mechanisms. But they didn't have the laboratory tools to profile a sample and say "Oh, this is H1N1 influenza." The antibody tests and ultimately the RNA sequencing were decades away.
This lack of tracking by the public health infrastructure was a problem for the people trying to treat the disease, as they had limited mechanisms for disease surveillance and containment. It also poses huge problems for the chronicler of the disease. So Crosby, writing in the 1960s, has to figure out how to determine what happened based on almost invisible clues in the record. He looks at life insurance claims, he looks at death records and applies deductive reasoning to them to guess which deaths were flu related, he tracks novels and newspaper reports and memoirs and other accounts of first person experience, he analyzes troop movements against the expectations for a flu free world. It is an amazing numbers detective story.
Like, there's a passage in his narrative of the flu outbreak in San Francisco where he notes that immigrants were particularly affected: The death rate in the Italian community skyrocketed. The death rate in the Irish community skyrocketed. The death rate in the Chinese and Japanese community... didn't change at all. Crosby flatly calls this "A patent impossibility." He then builds a case for why the public health record keepers ignored Chinatown and what alternate inferences might be drawn about the severity of the disease in Chinatown based on anecdotal evidence. (
starlady, I think you might be particularly interested in the dueling pair of chapters about the outbreaks in Philadelphia and San Francisco... Crosby attempts to generalize on the differences between the two cities based on their response to the flu, but doesn't go that far. But at least some of the differences do seem connected to our general sense of the difference in outlook between an East Coast city and a West Coast city. )It's also a great counter to those narratives of singular heroic figures fighting disease. So often the conclusion when a cure arises is that these researchers were in the right place in the right time. Science had progressed, equipment had progressed, the researcher had personal experience or motivation... The story of the 1918 flu is a story of people in the wrong place at the wrong time. Researchers had no idea what a virus was (and had an incorrect belief that a common opportunistic infection from Pfeiffer's Bacillus was the actual flu germ), public health had limited ideas about how to quarantine a disease capable of spreading as easily as flu, and the needs of the war machine prompted people to mass in public places and travel far distances far more than is ordinarily the case. All of these circumstances conspired to make the flu worse than it would have been in a story about researchers in the right place at the right time.
Crosby also deploys a wonderful dark sense of humor throughout the book, as he struggles to comprehend foolish decisions from public health officials that surely exacerbated the disease's spread. Books about a lethal flu should not be this funny. After the head of the San Francisco public health department convinced the city to legally mandate the wearing of gauze masks outdoors, the flu infection rate dropped precipitously. Looking back from the '60s, Crosby knows these two things cannot be causally related in a significant way- gauze is not fine enough to stop the passage of the tiny influenza virus, and plenty of other cities that enforced a mask ban did not see a similar drop in infection rate. Crosby knows that the reason for the drop was most likely just the standard way an influenza outbreak burns out over time, but he still can't help but marvel at how tight and convincing is the mask/flu correlation: "Rarely has the evidence in support of a scientific hypothesis been more overwhelming and more deceiving," he writes.
The best narrative chapter in the book is the discussion of the negotiations of the Treaty of Versailles. I've seen this story from a decent handful of angles over the years and Crosby's angle slots in surprisingly naturally and totally changes everything. Because I'm sure that littered throughout all of those other accounts, there'd be an occasional mention of how at some dramatic moment, something was delayed because someone was sick. I'm sure I read those and skimmed over them because people get sick sometimes, I didn't realize the import. But Crosby shows how the sickness was a systematic part of the 1918 pandemic and it was totally affecting the negotiations in all sorts of ways. Wilson's chief foreign policy advisor, Edward House, was nearly taken out of the negotiations by a combination of flu and later kidney troubles that were no doubt exacerbated by flu. Lloyd George missed some negotiations because of it, Clemenceau had flu symptoms after being shot that seem to have left him seriously affected, and Wilson caved on the Saar a week after collapsing mid-meeting with the flu. (and many medical historians believe the flu he caught in April 1919 laid a path to his later, devastating stroke) And everyone around them was bouncing in and out of meetings with the flu, too! The medical team for the US delegation was treating hundreds of people for flu, out of the thousand member delegation! Crosby builds an incredibly straightforward case that the path of history in the wake of Versailles was driven as much by the flu pandemic as by the desires of the negotiators.
(no subject)
Date: 2018-10-01 06:13 am (UTC)Ever since writing that paper (and a talk I heard in college about the cytokine storm immune response mechanism which is the proximate cause of the distinctive 'cranberry jelly' lungs) I have gotten my flu shot every year. Although of course, ironically, a flu shot is no actual defense against a bona fide new pandemic flu strain.
(no subject)
Date: 2018-10-03 01:58 pm (UTC)(no subject)
Date: 2018-10-02 05:08 pm (UTC)(no subject)
Date: 2018-10-03 01:52 pm (UTC)