Book Review

The Trembling Mountain: A personal account of kuru, cannibals, and mad cow disease

N Engl J Med 1998; 339:1646-1647November 26, 1998

Article

The Trembling Mountain: A personal account of kuru, cannibals, and mad cow disease
By Robert Klitzman. 333 pp. New York, Plenum, 1998. $27.95. ISBN: 0-306-45792-X

This book is ostensibly a personal account of the “grunt work” of field research — the experience behind the relatively sterile papers that appear in our medical, public health, and anthropologic journals. Who has not dreamed of venturing into the last pristine wildernesses to live among Stone Age people, whether in the name of science, lofty ideals, or individual challenge? The author spent a year among the Fore people in the remote Highlands of Papua New Guinea, investigating how kuru, a rare infectious prion (protein) disease, is transmitted and how long it incubates before slowly destroying its host.

In Klitzman's account of his work, scientific findings are often paled by the human experience of overcoming fears and uncertainties and ignoring dangers and difficulties. On the path to examining the changing nature of the kuru epidemic, the author documents the sweat and hardship that accompanied his own coming of age and his deepening understanding of sickness, healing, culture, and human nature.

The basic medical research story is of great interest. Kuru among the Highlands people constituted the majority of the world's cases of this infectious prion disease, and it was important to find out as much as possible about the disease while current epidemiologic information could still be gathered. The vector of spread was the bodies and brains of dead relatives consumed at now-defunct cannibalistic feasts. Klitzman was able to collect clinical histories and genealogic data on patients with kuru and to determine rigorously the time of exposure. This information allowed him to calculate precisely the natural incubation period for kuru after a cannibalistic meal.

The author's scientific work in Papua New Guinea took on new importance when mad cow disease (bovine spongiform encephalopathy) broke out in Britain. The long incubation periods for kuru — in some cases more than 40 years, Klitzman found — have implications not only for the Fore but also for those infected with other prion diseases. If the comparison between these two diseases is correct, it could mean that thousands of people in Britain are today harboring a disease from which they will eventually die, the result of an infected hamburger they ate decades earlier.

This book does not examine epidemiologic issues alone; it also examines the cultural and social implications of diseases. The author points out that we tend to fear invisible epidemics — whether they involve kuru, mad cow disease, or AIDS — but continue to put ourselves at risk, whether by denying the danger of munching on our dead relatives, eating British beef, or practicing unsafe sexual activities. Likewise, the author correctly notes the many similarities between Western and traditional New Guinean health care systems: the severe limitations in successfully treating many diseases and the same tendency to blame the patients for therapeutic failures. He comes to realize the need in medicine and science to closely examine “social and cultural contexts, implicit assumptions, and unproven theories.”

This book is often not “politically correct.” A certain naive ethnocentrism runs through parts of the narrative, particularly when Klitzman describes the often surly, opportunistic behavior of his native guides or the refusal of patients or their families to be examined because of their fears of sorcery and harm. What Klitzman views as “superstition” or “resistance . . . based simply on ignorance” may be part of the fabric of interwoven cultural beliefs that supports Highlands society and provides a sense of order in this jungle world.

Readers may partially forgive the author for this shortcoming, since his book is an account that follows his own travails and personal development, leading to the end of his romantic idealism. Anyone who has undertaken long fieldwork under difficult conditions quickly realizes that it is not all romance, adventure, and Indiana Jones. It is hard to be understanding, to be sensitive to ethnic differences, or even to keep an eye on research goals when bugs are eating at your flesh, when you are dirty, tired, hungry, and suffering from intestinal disorders, and when you are feeling alone in the world. Over time, Klitzman realizes that his experience in Papua New Guinea had affected him more than he thought. He emerges changed from his contact with a culture just emerging from the Stone Age, with new personal insights and a perspective that is helpful for future challenges.

Jeffrey M. Borkan, M.D., Ph.D.
Ben-Gurion University of the Negev, Beer Sheva 88840, Israel