Disease and Class

Until a decade ago, the conquest of tuberculosis seemed one of the great triumphs of modern medicine. The resurgence of TB in the wake of AIDS has to be understood, Georgina Feldberg argues, in the context of decisions the U.S. Public Health Service made, beginning in the 1930s, to prevent TB through improved hygiene and long-term treatment with medications, rather than program of BCG vaccination that Canada and many other countries adopted. Feldberg's aim is not to judge which was the right choice, but to explain why the U.S. rejected the vaccine and the consequences of that choice. To American physicians, TB, the conditions that fostered it, and the kind of people who got it were a direct threat to their own middle-class values, institutions, and prosperity. They prescribed vigorous social reform, and by the 1960s, they were convinced the strategy had worked. But, as the country's commitment to strong social welfare programs waned, the bacteriological reality of TB reasserted itself. Feldberg challenges us to recognize that the interplay of disease, class, and the practice of medicine can have unexpected consequences for the health of nations. The book is essential reading for students and professionals in public health, medicine, and the history and sociology of medicine. Georgina D. Feldberg is director of the York University Centre for Health Studies in North York, Ontario. She is coauthor of Take Care: Warning Signals for Canada's Health System.