Barnes offers historical perspective on tuberculosis

For nearly a century, industrialized countries witnessed a steady decline in rates of tuberculosis (TB). However, since the mid-1980s, the disease has gradually made a comeback in the United States and Europe, and has remained a major killer in many less developed nations. David Barnes, assistant professor of the history of science in the Institute of the Liberal Arts, puts this resurgence in historical perspective in his new book, The Making of a Social Disease: Tuberculosis in Nineteenth-Century France (University of California Press).

Barnes' book, which was released this month, outlines the severe medical, political and social ramifications of TB in 19th-century France. The leading killer of the time, TB was considered a disease of the working class and the poor; prostitutes and others on society's margins were unjustly blamed for spreading the disease.

In fact, Barnes points out that although TB is contagious, even after exposure to the disease, only 10 percent will suffer from it. "Actually, TB is a very good index of wealth and poverty," Barnes said. "It is poverty which is the overriding cause of the resurgence of TB in the United States -- specifically, homelessness, malnutrition, drug abuse and alcoholism. These and other factors contribute to suppressing the immune system which fights off disease."

Barnes outlined the reasons why this resurgence is so dangerous. "The increase in immigration from third world countries where TB is endemic, cuts in public health funding during the Reagan years, and the spread of AIDS have all multiplied the effects of poverty on the health of the population," Barnes said. People with AIDS are extremely susceptible to immune deficiency diseases, including TB.

However, Barnes points out, TB is curable. "Many medications can cure or stop TB, but some strains of the disease are becoming drug resistant," Barnes said. The best prevention of TB is not medicine, Barnes added, but education and improving standards of living. "To put an end to TB as well as other deadly diseases, fighting poverty is the best strategy. Medicine was not responsible for the decline of TB the first time around, and medicine alone can't defeat TB today."

In an attempt to blend current historical, anthropological and epidemiological research on TB, and to discuss cultural barriers that limit access to health care, Barnes is organizing a conference to be held in San Francisco April 7-8. The conference, "Tuberculosis Then and Now," will bring together historians, anthropologists, physicians and epidemiologists from around the world to address the ramifications of TB today as well as its historical roots.

Barnes received grants from the Chateaubriand Fellowships, the George Lurcy Trust and the Mellon Fellowships in the Humanities to research and write his book.

--Bradley A. Singer