Book Review

Trachoma: A Blinding Scourge from the Bronze Age to the Twenty-First Century

N Engl J Med 2008; 358:1872-1873April 24, 2008

Article

Trachoma: A Blinding Scourge from the Bronze Age to the Twenty-First Century
By Hugh R. Taylor. 282 pp., illustrated. East Melbourne, Australia, Centre for Eye Research Australia/Haddington Press, 2008. $112. ISBN: 978-0-9757695-9-1

Perhaps in a tribute to the importance of stories to the aboriginal peoples of Australia, Hugh Taylor has organized his book as an interwoven storyscape, and a vivid one at that. Born in Melbourne, Taylor served as an ophthalmologist in the Australian National Trachoma and Eye Health Program (NTEHP) in the 1970s. During his time with the program, he cared for his first aboriginal patients with trachoma and was introduced to the health disparities that are too often borne by members of indigenous populations. Over the decades that followed, Taylor went on to become an internationally recognized authority on trachoma who has made important contributions as an advocate as well as in research, clinical care, and control programs. This book has grown out of his life's work.

Taylor begins Trachoma by placing the disease in historical context. Although it is difficult to distinguish among the various causes of the diseases that were historically classified as ophthalmia, Taylor describes how a range of ancient records, including Egyptian papyri, Chinese historical records, and Indian and Greek medical tracts, show that trachoma has blinded humans since antiquity, an assertion that is perhaps even more strongly supported by the ultimate historical record — the genome of Chlamydia trachomatis, whose 900 open reading frames make it one of the most parsimonious bacteria to infect humans (salmonella contains over 4000 open reading frames). Such a focused genetic repertoire in C. trachomatis strongly suggests a long and particularly intimate relationship between the disfiguring intracellular pathogen and humans.

After the historical introduction, Taylor proceeds with a series of chapters, each of which tells more focused stories in several topic areas, including clinical manifestations, epidemiology, immunopathogenesis, diagnosis, treatment, and control programs. Each chapter is a wonderful resource, not only as a summary of current knowledge, but also as a historical record of how we got to where we are today. For instance, the chapter on laboratory diagnosis summarizes which diagnostic assays are currently available (with critical or illustrative references), tells how these assays were developed, and describes their individual strengths and weaknesses. Similarly, the chapter on the role, importance, and shortcomings of trachoma control programs is an instructive review of the science, policy, and history that have given rise to the current global efforts to control and possibly eliminate trachoma through initiatives that are based on the SAFE strategy (Surgery for trichiasis, Antibiotic therapy, Facial cleanliness, and Environmental change).

Each chapter is concise, well written, well edited, and readable and contains wonderful photographs and reproductions of important, landmark, or particularly instructive tables and figures from the primary literature, all presented in an accessible manner. The book reflects Taylor's strengths in clinical care and immunopathology, as well as his grasp of the implications of field studies and control programs. The review of the biology of the C. trachomatis organism is cursory, but the fact that a single author wrote the book allows for a unified and immensely readable story that is peppered with personal perspectives and anecdotes. The result is a well-presented, authoritative, and comprehensive testament that nonexperts can easily understand. Written with the scope and expertise of an authority who has spent decades working on trachoma in the clinic, laboratory, field, classroom, and committee room, Trachoma will be a wonderful resource for a wide range of clinicians, researchers, public health officials, and policymakers.

The book ends with a status report on blinding trachoma in the indigenous population of Australia, the group that Taylor first studied decades ago. Despite impressive advances in the understanding of the pathogenesis of trachoma and the development of effective antibiotic treatment, rapid diagnostic tests, and control programs such as SAFE, it is sobering that trachoma still occurs in the indigenous population of Australia. The complex nature of this age-old scourge reminds us that despite all the advances of the past century, we cannot yet take our eyes off the prize.

Edward T. Ryan, M.D.
Harvard University, Boston, MA 02115

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