BOOKS ARTS COMMENT Jersey; and the University of Geneva in MEDICAL HISTORY fow tht Mew arch Carin oak. Stemming the red tide lis work on market fluctu 1960s could have revolutionized finan cial economics if the fields equilibrium Lab luminaries jostle with consumptive cultural icons in a focused ideology hadn't pushed it aside for vivid history of tuberculosis, finds Stefan H. E. Kaufmann 30 years. Perceiving parallels in everything from fractured surfaces to stock-market movements, Mandelbrot coined the term uberculosis has killed more people Phthisis and scrofulosis were known in fractals and did more than to make T than all wars combined. and was tiquity. But it was not until the late Renais- it possible to talk about natural roughness a leading cause of death in many sance that anatomists came to recognize TB and disorder in a precise, scientific way. Western megacities as recently as the 1950s. lesions, and spotted similarities between the In 1979, he returned to Szolem's sug Historically, tuberculosis(TB)was hothousedmanifestations of the disease gestion of quadratic dynamics. Within a in overcrowded European and US cities: at the TB began to gain cultural cachet as art- year, his explorations of functional itera startofthe twentieth centuryin New York and ists succumbed. The death at 25 of English tions led him to discover the mandelbrot Berlin,it killed 40% of people aged 25-40. Yet Romantic poet John Keats(a trained surgeon) set-an astonishing pattern of infinite TB was in decline until the late twentieth cen- did much to glamorize the disease. In Rome richness produced by simple rules. This tury, when the HIV/AIDS epidemic in sub- in 1820, Keats"vomited near two cupfuls launched a whole branch of mathematics Saharan Africa triggered a resurgence. Now, of blood: he died a few months later. anne Much of what makes The fractalist fun it is the number one cause of death among Bronte and, possibly, her sister Emily suc to read is mandelbrot's scattered recol eople with HIV, and the incidence of multi-cumbed at 29 and 30Consumption became lection of encounters with luminaries drug-resistant strains is risin At MIT he discussed linguistics with the But the story goes beyond themedical. TBs bohemian life, as with thecourtesan Violetta young Noam Chomsky and argued with long history, wide spread and lethality irrevo n Giuseppe Verdi s 1853 opera La Traviat anthropologist Margaret Mead. Robert ably link it to social and cultural history, as Meanwhile, as Bynum shows, the medical Oppenheimer liked his ideas, and Man Helen Bynum reveals in her gripping historydisease began to emerge, and"consumption delbrot worked with the famed psycholo of the disease and its impacts, Spitting Blood. became tuberculosis". Louis Pasteur provided gist Jean Piaget in Geneva and computing Bynum kicks off with the case of George the first evidence that microbes caused cer- Orwell, which encapsulates the progression tain diseases. robert Koch showed that tB Mandelbrot recalls how after one of ofTBandits impact on culture. In1949,when was infectious, and demonstrated that a his lectures, a famous mathematician Orwell published Nineteen Eighty-Four, he single pathogen was responsible for its dif- eject he had made " absolutely was in the late stages of the disease, which erent forms. At the time. clinicians tried to no sense at all. Oppenheimer and von bly influenced his novels dy treat the disease using the pneumothorax Neumann sprang into action, explain tone; he died a year later. bynum goes on to ethod, collapsing the lung by inserting nee ing points that even Mandelbrot hadnt expertly turn the many facets of TB to the dles into the pleural cavity, in the hope that noticed. The meeting, he remembers light, from biology to medicine and socio- pressure on the lung would lead to acure. But went from abysmally low to unforgettably economics. She ends with a brief account of he unveiling ofTB as high. His appreciation of friends, music hy it has not been eradicated. bacteriological dis- and quirky mathematics colours every TB is caused by Mycobacterium tuber for page of The Fractalist Mandelbrots odd culosis, a bacterium that probably evolved SPITTING habits explain why he was so original: he from an environmental microbe to a human BLOOD effective drugs, diag nostics and a vaccine voided work involving direct competition pathogen. The signs of consumption o In the second half with others, and naturally worked in the thisis nary TB, triggered by aero of the nineteenth cen gaps between fields, in blind spots sol infection of the lung -are coughing and tury, efforts to control A youthful decision set me on a mav pitting ofblood. Before the nineteenth cen public spitting began. ericks lonely ride, he writes. "Its conse- tury, another common form was scrofulosis quences took a long time to develop. in which the lymph nodes became pus-illed The History of set up, then sanatori- and ulcerated. It usually arises from ingest- ums for the rich, the Mark Buchanan is a physicist and writer bacteria, so the increasing eradication of HELEN BYNUM first in Germany in based in france. his latest book is the bovine TB and the sterilization of milk have Oxford Univ Press: the 1860s. Working Social atom. radically reduced its incidence. Pott's disease, 2012 352 ppE16.99, class sanatoriums e-mail:buchananmark@gmail.com a third, rare form, affects the bones 3495 ea cou Knocking on Heavens Door Survivors: The Animals and Plants that Time sa Randall (Ecco, 2012: $16.99) Has Left Behind What can CERN,s Large Hadron Collider (LHC) Richard Fortey (Harper, 2012: E9.99) reveal about the make-up of the Universe? Particle Palaeontologist Richard Fortey narrates the physicist Lisa Randall explains, alternating details history of life by looking not to the long-extinct, LISA of the LHC's inner workings with more general but to organisms that have survived, almost NDALL musings on the philosophy of science.(See unchanged, for millions of years. These survivors, Joseph Silk,s review: Nature 477, 30-31; 2011.) he says, speak to us of pivotal evolutionary events. 25 OCTOBER 2012I VOL 490I NATURE 1477 c 2012 Macmillan Publishers Limited. All rights reserved
Jersey; and the University of Geneva in Switzerland. In 1958, he began a 35-year career at the IBM Research Center in Yorktown Heights, New York. His work on market fluctuations in the 1960s could have revolutionized financial economics if the field’s equilibriumfocused ideology hadn’t pushed it aside for 30 years. Perceiving parallels in everything from fractured surfaces to stock-market movements, Mandelbrot coined the term fractals and did more than anyone to make it possible to talk about natural roughness and disorder in a precise, scientific way. In 1979, he returned to Szolem’s suggestion of quadratic dynamics. Within a year, his explorations of functional iterations led him to discover the Mandelbrot set — an astonishing pattern of infinite richness produced by simple rules. This launched a whole branch of mathematics. Much of what makes The Fractalist fun to read is Mandelbrot’s scattered recollection of encounters with luminaries. At MIT he discussed linguistics with the young Noam Chomsky and argued with anthropologist Margaret Mead. Robert Oppenheimer liked his ideas, and Mandelbrot worked with the famed psychologist Jean Piaget in Geneva and computing pioneer John von Neumann at Princeton. Mandelbrot recalls how after one of his lectures, a famous mathematician objected, saying he had made “absolutely no sense at all”. Oppenheimer and von Neumann sprang into action, explaining points that even Mandelbrot hadn’t noticed. The meeting, he remembers, “went from abysmally low to unforgettably high”. His appreciation of friends, music and quirky mathematics colours every page of The Fractalist. Mandelbrot’s odd habits explain why he was so original: he avoided work involving direct competition with others, and naturally worked in the gaps between fields, in blind spots. “A youthful decision set me on a maverick’s lonely ride,” he writes. “Its consequences took a long time to develop.” ■ Mark Buchanan is a physicist and writer based in France. His latest book is The Social Atom. e-mail: buchanan.mark@gmail.com Survivors: The Animals and Plants that Time Has Left Behind Richard Fortey (Harper, 2012; £9.99) Palaeontologist Richard Fortey narrates the history of life by looking not to the long-extinct, but to organisms that have survived, almost unchanged, for millions of years. These survivors, he says, speak to us of pivotal evolutionary events. Knocking on Heaven’s Door Lisa Randall (Ecco, 2012; $16.99) What can CERN’s Large Hadron Collider (LHC) reveal about the make-up of the Universe? Particle physicist Lisa Randall explains, alternating details of the LHC’s inner workings with more general musings on the philosophy of science. (See Joseph Silk’s review: Nature 477, 30–31; 2011.) Tuberculosis has killed more people than all wars combined, and was a leading cause of death in many Western megacities as recently as the 1950s. Historically, tuberculosis (TB) was hothoused in overcrowded European and US cities: at the start of the twentieth century in New York and Berlin, it killed 40% of people aged 25–40. Yet TB was in decline until the late twentieth century, when the HIV/AIDS epidemic in subSaharan Africa triggered a resurgence. Now, it is the number one cause of death among people with HIV, and the incidence of multidrug-resistant strains is rising. But the story goes beyond the medical. TB’s long history, wide spread and lethality irrevocably link it to social and cultural history, as Helen Bynum reveals in her gripping history of the disease and its impacts, Spitting Blood. Bynum kicks off with the case of George Orwell, which encapsulates the progression of TB and its impact on culture. In 1949, when Orwell published Nineteen Eighty-Four, he was in the late stages of the disease, which arguably influenced his novel’s dystopian tone; he died a year later. Bynum goes on to expertly turn the many facets of TB to the light, from biology to medicine and socioeconomics. She ends with a brief account of why it has not been eradicated. TB is caused by Mycobacterium tuberculosis, a bacterium that probably evolved from an environmental microbe to a human pathogen. The signs of ‘consumption’ or phthisis — pulmonary TB, triggered by aerosol infection of the lung — are coughing and spitting of blood. Before the nineteenth century, another common form was scrofulosis, in which the lymph nodes became pus-filled and ulcerated. It usually arises from ingesting bacteria, so the increasing eradication of bovine TB and the sterilization of milk have radically reduced its incidence. Pott’s disease, a third, rare form, affects the bones. Phthisis and scrofulosis were known in antiquity. But it was not until the late Renaissance that anatomists came to recognize TB lesions, and spotted similarities between the manifestations of the disease. TB began to gain cultural cachet as artists succumbed. The death at 25 of English Romantic poet John Keats (a trained surgeon) did much to glamorize the disease. In Rome in 1820, Keats “vomited near two cupfuls of blood”; he died a few months later. Anne Brontë and, possibly, her sister Emily succumbed at 29 and 30. Consumption became linked to the punishment and redemption of a bohemian life, as with the courtesan Violetta in Giuseppe Verdi’s 1853 opera La Traviata. Meanwhile, as Bynum shows, the medical disease began to emerge, and “consumption became tuberculosis”. Louis Pasteur provided the first evidence that microbes caused certain diseases. Robert Koch showed that TB was infectious, and demonstrated that a single pathogen was responsible for its different forms. At the time, clinicians tried to treat the disease using the ‘pneumothorax’ method, collapsing the lung by inserting needles into the pleural cavity, in the hope that pressure on the lung would lead to a cure. But the unveiling of TB as a bacteriological disease paved the way for effective drugs, diagnostics and a vaccine. In the second half of the nineteenth century, efforts to control public spitting began. Dispensaries were set up, then sanatoriums for the rich, the first in Germany in the 1860s. Workingclass sanatoriums emerged courtesy MEDICAL HISTORY Stemming the red tide Lab luminaries jostle with consumptive cultural icons in a vivid history of tuberculosis, finds Stefan H. E. Kaufmann. 25 OCTOBER 2012 | VOL 490 | NATURE | 477 BOOKS & ARTS COMMENT Spitting Blood: The History of Tuberculosis HELEN BYNUM Oxford Univ. Press: 2012. 352 pp. £16.99, $34.95 © 2012 Macmillan Publishers Limited. All rights reserved
COMMENT BOOKS ARTS of national-insurance programmes and hilanthropy. People with joint and bone TB, often children, underwent orthopaedic treatments, such as wearing shells and jackets that left just face and ears exposed. In 1921, as Bynum reveals, Albert Cal- mette and Camille Guerin devised the first breakthrough: the vaccine bacille Calmette-Guerin(BCG). Twenty years later. Albert Schatz and Selman Waksman discovered the second: the TB drug strep tomycin Intensive research spawned others, and the 1950s saw the first broad scale fight against TB, with mass X-ray screening and drug therapy. But although national TB-control programmes sprang up, interrupted treatments and poor patient compliance led to drug resistance, notably in regions of conflict and asylum camps. From the beginning, resistance gainst single dr ugs was n cal trials spearheaded by the UK Medical Research Council revealed that multi drug therapy was essential for preventing he development of drug-resistant strains. A rigorous multi-drug treatment programme led by the World Health Organization(WHO)effectively defeated non-resistant TB, but about 50 million peo- ple currently harbour multi-drug-resistant tubercle bacilli. Of these, nearly half a mil lion develop the disease each year. With around 15 million people co-infected with HIV and tubercle bacilli, and nearly 1 mil lion active TB cases a year among people with HIV, we are seeing a perfect storm. If Bynum's book has a weakness, it is that it lacks an outlook on how the WHOs goal to eliminate TB by 2050 could be achieved. Spitting blood provides impressive insight into TB as a medical and social disease. Meanwhile, photographer James resistant Tb(wWw.xdrtb. org)comple nents this work on a disease that is still very much with us. In 2009, London alone harboured nearly 3, 500 TB cases: an almost 50% increase over the preceding decade. m ●● Stefan H E. Kaufmann is director of the department of immunology at the Max Planck Institute for Infection Biology in berlin e-mail: kaufmann@mpiib-berlin. mpg. de A More Perfect Heaven: How Copernicus Margaret Sanger: A Life of Passion Revolutionised the Cosmos Jean H. Baker(Hill and Wang 2012: $1700) Dava Sobel ( Bloomsbury, 2012: E8. 99) Margaret Sanger emerges as a daring and Mixing drama with history, Dava Sobel offers a determined character in historian Jean Baker's biography of Copernicus with a twist, working vivid life. Sanger's fervent belief that women two-act play in which a student convinces uld be able to limit the size of their families led him to publish his revolutionary work.( See Owen to the development of the contraceptive pill. (See Gingerichs review: Nature 477, 276-277; 2011.) W. F. Bynum's review: Nature 478, 318: 2011. 478I NATURE I VOL 4901 25 OCTOBER 2012 G 2012 Macmillan Publishers Limited. All rights reserved
of national-insurance programmes and philanthropy. People with joint and bone TB, often children, underwent orthopaedic treatments, such as wearing shells and jackets that left just face and ears exposed. In 1921, as Bynum reveals, Albert Calmette and Camille Guérin devised the first breakthrough: the vaccine bacille Calmette–Guérin (BCG). Twenty years later, Albert Schatz and Selman Waksman discovered the second: the TB drug streptomycin. Intensive research spawned others, and the 1950s saw the first broadscale fight against TB, with mass X-ray screening and drug therapy. But although national TB-control programmes sprang up, interrupted treatments and poor patient compliance led to drug resistance, notably in regions of conflict and asylum camps. From the beginning, resistance against single drugs was noted, and clinical trials spearheaded by the UK Medical Research Council revealed that multidrug therapy was essential for preventing the development of drug-resistant strains. A rigorous multi-drug treatment programme led by the World Health Organization (WHO) effectively defeated non-resistant TB, but about 50 million people currently harbour multi-drug-resistant tubercle bacilli. Of these, nearly half a million develop the disease each year. With around 15 million people co-infected with HIV and tubercle bacilli, and nearly 1 million active TB cases a year among people with HIV, we are seeing a perfect storm. If Bynum’s book has a weakness, it is that it lacks an outlook on how the WHO’s goal to eliminate TB by 2050 could be achieved. Spitting Blood provides impressive insight into TB as a medical and social disease. Meanwhile, photographer James Nachtwey’s gallery of people with drugresistant TB (www.xdrtb.org) complements this work on a disease that is still very much with us. In 2009, London alone harboured nearly 3,500 TB cases: an almost 50% increase over the preceding decade. ■ Stefan H. E. Kaufmann is director of the department of immunology at the Max Planck Institute for Infection Biology in Berlin. e-mail: kaufmann@mpiib-berlin.mpg.de Margaret Sanger: A Life of Passion Jean H. Baker (Hill and Wang, 2012; $17.00) Margaret Sanger emerges as a daring and determined character in historian Jean Baker’s vivid life. Sanger’s fervent belief that women should be able to limit the size of their families led to the development of the contraceptive pill. (See W. F. Bynum’s review: Nature 478, 318; 2011.) A More Perfect Heaven: How Copernicus Revolutionised the Cosmos Dava Sobel (Bloomsbury, 2012; £8.99) Mixing drama with history, Dava Sobel offers a biography of Copernicus with a twist, working in a two-act play in which a student convinces him to publish his revolutionary work. (See Owen Gingerich’s review: Nature 477, 276–277; 2011.) 478 | NATURE | VOL 490 | 25 OCTOBER 2012 COMMENT BOOKS & ARTS © 2012 Macmillan Publishers Limited. All rights reserved