Book Review

Captain of Death: The story of tuberculosis

N Engl J Med 1998; 339:1335October 29, 1998

Article

Captain of Death: The story of tuberculosis
By Thomas M. Daniel. 296 pp. Rochester, N.Y., University of Rochester Press, 1997. $49.95. ISBN: 1-878822-96-9

The history of tuberculosis has been the subject of numerous books by academic historians, physicians, and even journalists during the past five years. Daniel's Captain of Death: The Story of Tuberculosis gives a fine introduction to the fascinating history of the disease, told in an unusually friendly manner. Daniel successfully communicates his love of the subject, beginning with the appropriate horrible statistics detailing the current magnitude of tuberculosis worldwide, and his literary style will pull the reader along effortlessly. In his introduction, Daniel makes it clear that the book is intended for general readers, and I highly recommend it for such persons.

The reader should understand, however, that this is a history written by a physician, filled with stories of the heroes of the struggle against tuberculosis: the physicians. Although the chapters on Calmette and Guérin and on the early development of streptomycin and isoniazid are informative and interesting, Daniel is almost worshipful in his description of Robert Koch, who remains a central figure throughout the book. Given Koch's unscientific and unprofessional behavior with respect to injecting tuberculin and reporting his work to the world, I would be less sanguine than Daniel in attributing his actions to an excess of “hope, compassion, and desire outpac[ing] science and reason.” Many historians have provided far more critical — and I believe more objective — analyses of Koch's conduct.

Of course, there are tales of patients in the book, but they tend to be often-told tales — those of Keats, Chopin, and the Brontë family, along with those of a few more modern celebrities, including Josephine Baker and the tennis champion Alice Marble. I would have preferred more stories of the less famous rather than the same tale about Chopin that René Dubos told 40 years ago, but for the general reader these stories may be new and interesting; they are certainly told in an entertaining manner.

In describing the early public health measures taken to control tuberculosis, including the use of sanatoriums, Daniel weaves together nicely the stories of Harriet Ryan, Edward Livingston Trudeau, and Lawrence Flick, and readers with little or no knowledge of the subject will find the accomplishments of these people appropriately inspiring. Given the importance of the sanatorium movement, a few more facts and figures would have been welcome. This is not an academic history book, however, and there are neither primary sources nor more than passing references to the work in this field done by others, including that of Barbara Bates and Sheila Rothman, to mention nothing of that done by the Duboses. Nor is there an in-depth analysis of the complicated social and political dimensions of the disease.

The strongest parts of the book are the chapters that discuss the pathophysiology of tuberculosis, particularly its immunologic aspects. Here, Daniel does a masterly job of describing the development of the field of immunology, using language that a nonmedical person can easily understand, without oversimplifying. His passion for this part of the study is obvious, and it is a pleasure reading about the early use of tuberculin to diagnose bovine tuberculosis and Clemens von Pirquet's use of tuberculin in diagnosing human tuberculosis. Daniel discusses the causes of false positive and false negative tuberculin tests, tracing these causes as they were understood over time in a way that connects stepwise scientific discoveries with practical consequences, specifically the control of bovine tuberculosis.

Similarly, Daniel's detailing of Merrill Chase's experiments with guinea pigs that led to the discovery of the role of lymphocytes in cellular immunity is presented nicely in the context of the repeated failures of other scientists, who were using antibodies and passive immunity to treat patients. The chapter on the slow, frustrating labor involved in the discovery of streptomycin, beginning with Selman Waksman's work with organisms found in soil and proceeding through Albert Schatz's identification of Streptomyces griseus, presents nicely what unfortunately became a battle between two bacteriologists. Daniel wisely opts not to choose sides.

Daniel ends his book with a description of the current desperate situation in Haiti and his strong advocacy of more aid for programs to control tuberculosis in the countries where the disease remains rampant. He correctly points out that wealthier nations have a responsibility to help and that “it is a fallacy to think of tuberculosis in any but global terms.” Daniel's profound commitment to his subject is apparent, not only in this part of the book but throughout, and it makes this a work that I strongly recommend, both to the general reader and to the physician whose area of expertise may not be infectious diseases.

Karen Brudney, M.D.
Columbia–Presbyterian Medical Center, New York, NY 10032-3784