Katie Connell

January 28, 1999

Disease and Discrimination

Ott, Katherine. Fevered Lives. Cambridge, MA: Harvard University Press, 1996. 242 pages, 32 pages of illustrations and photographs.

Fevered Lives by Katherine Ott is predominantly a historical look at the sociology of tuberculosis. The book addresses how perceptions of the disease and of its victims have changed from the mid nineteenth century up to the present. There is some discussion of how medical professionals' ideas have changed about the cause and nature of the disease. Diagnosis and treatment developments are also addressed, especially in the context of their connection with the current society's views on tuberculosis.

The format of Fevered Lives is approximately divided into chapters by time period. The book begins in the 1870s and 1880s. In this era, the term tuberculosis was not used; consumption and phthisis were the general terms used to describe several related diseases including the disease which we would now refer to as tuberculosis. Physicians and the general public believed that certain people had a predisposition for becoming consumptive. In this era, consumption was romanticized, the sickbed was an honored image, and stigma was generally not attached to invalidism.

Ott then addresses some early ideas about cures for consumption. A popular treatment option known as "climate cures" came into vogue which Ott considers ultimately ineffective (Ott 49). A landmark development in tuberculosis research came in 1882 when Robert Koch asserted that the disease is caused by infection with microorganisms, a revolutionary idea in its time (Ott 53). Debate continued through the early years of the 1900s over this idea. The microorganism theory was slowly accepted by doctors and new diagnostic and treatment technologies followed. Eventually the bacillus became universally recognized as a symbol for tuberculosis and germ theory became prevalent throughout the medical world.

After presenting these changes in the medical aspect of tuberculosis, Ott goes on to discuss the resulting changes in the sociology of the disease. She suggests that by the late 1800s the romance of invalidism was lost, health and strength became the ideal, and the popular focus was on the job of getting well. A stigma becomes associated with tuberculosis labeling it as a lower class disease.

Treatment of tuberculosis during this time period took place predominantly in the home. Doctors believed that rest and nutrition were critical to combating the illness, as was fresh air. As a result, many houses were equipped with special sickrooms and sleeping porches on which the patient could rest. After the turn of the century tuberculosis treatment was more and more handled by surgeons. Various surgical procedures were developed and used until the advent of chemotherapy in the mid 1900s.

Ott then returns to the sociological issues confronting people about tuberculosis in the early 1900s. At this time, ethnicity and race were considered important factors in natural immunity and susceptibility. The Progressive Era brought with it questions about how tuberculosis is spread, the need for sanitary conditions, and new bureaucratic institutions to help with such problems. Returning to the patient, Ott describes the alienation that comes with being identified as a tuberculosis victim in this era of zealous cleanliness efforts. Another issue which plagued doctors and patients alike was whether or not victims should be forced to register with authorities.

Ott contends that an important aspect of tuberculosis in the early twentieth century was standardization of treatment, sanitation, and other types of regulation in hopes of containing the disease. A perfect example of this principle was the new setting for tuberculosis, the sanitarium. In this institution, the sick could be isolated from the rest of the healthy community, victims could come together to commiserate, and strict order and rules which were thought to be essential to treatment, could be enforced.

The final chapter of Fevered Lives addresses the resurgence of concern about tuberculosis in the United States and other developed countries which had considered it to be a thing of the past. Ott stresses that although it is currently returning to the world's attention, the disease never actually left the world, or even in America. She briefly mentions the problem of prejudice and assumptions which are involved in the identification of risk groups for the disease and the blame placed on foreigners for supposedly bringing back tuberculosis. Finally, Ott closes with a discussion of the new problem of multi-drug resistant strains of the bacteria.

The audience for which Fevered Lives is most appropriate is people interested in the history of tuberculosis in general. It is neither an in-depth medical history nor a complete sociological history, but it treats well the cause and effect relationship and interface between the two. The author weaves together the medical discoveries with the changes in popular opinion that they cause, the resulting actions which are taken, and finally the effect of all of these factors on the tuberculosis patient.

Katherine Ott's profession, as given on the book jacket, is that of historian at the Smithsonian's Division of Science, Medicine, and Society. Her historical perspective is evident throughout the book. In many places this historical training helps her arguments. Conclusions drawn in the book are strongly backed by examples and supporting evidence. Unifying themes keep the book together and readable. For example, Ott periodically returns to the image of the typical tuberculosis patient's environment. The changes in perceptions of the illness can be measured by Ott's tracing of this environment throughout history. The image changes from the respected deathbed to the specially designed and functional home sickrooms, to the sanitarium and hospital room. Descriptions of the tuberculosis patient's physical location become familiar to the reader who can use them as a map for the progression of attitudes about the disease.

In other areas, Katherine Ott's historical perspective creates a bias or some other weakness of the book. Her bias toward the importance of historical analysis of diseases in current programs is evident when she states that "A 1993 congressional report on tuberculosis... includes no historians among its eighty-five consultants... The resulting portrayal is that of a static science in a static society coping with a timeless illness" (Ott 156-7). Bringing such an obvious personal bias into a serious writing is somewhat disturbing. At other times, it seems like she may be trying too hard to generalize and summarize individual experiences into one generic whole. Ott says that for people in the mid nineteenth century, "A consumption was not a stigma, but a herald, a welcome auspice of the rapid approach of everlasting peace. Death was an intensely anticipated and almost welcome event" (Ott 14). Even considering her early mention that death was a much greater part of life than it is today, it is hard to imagine an entire society in which the populace looked forward to a dreadful disease and impending death.

Despite these slight biases, Fevered Lives is an effective description of how perceptions of tuberculosis have changed in America in the past 130 or so years. Though by no means a complete study of the discrimination associated with tuberculosis today, the book provides important insights into the way tuberculosis was viewed by society throughout the past. Coupled with a thorough examination of current conditions of discrimination due to tuberculosis, this book provides insight into the origins of current practices and problems. There is a complete index in the back of the book making it useful for general research. In addition, there are 60 pages of endnotes which include bibliographic information from which the names of further sources can be easily extracted. Finally, there are many pictures of tuberculosis patients throughout the years and various treatment methods used.