The Forgotten Plague - How the Battle Against Tuberculosis Was Won and Lost  by Frank Ryan, M.D. Back Bay Books, 1993.

Review by Del Meyer, MD

Dr. Ryan opens this volume with a chapter on “The Reign of Terror.”  It seems incredible, he states, that during the past two centuries, a single disease, tuberculosis, was responsible for the deaths of a billion human beings; and the story of the cure that changed human history has never been told; it could not be more relevant.  One in seven of all human beings die from tuberculosis.

Tuberculosis was evident in Egyptian mummies as early as 4000 BC.  It may have even occurred earlier, as suggested by characteristic vertebral lesions found in graves near Heidelberg dated at 5000 BC.  It was well established in Europe by 2500 BC and in England 1000 years later.  Tuberculosis is enduring and once it arrives in a community, it stays. 

TB has interrupted the careers and affected the lives of many famous people.  Alois and Adolf Hitler, father and son, had TB.  Vivien Leigh, wife of Laurence Olivier and heroine of Gone with the Wind, writer Betty MacDonald, composers Chopin and Paganini, Jean Jacques Rousseau, Anton Chekhov, German poet Schiller, Cardinal Richelieu, Sterne, Shelly, Edgar Allen Poe, Eugene O’Neill, and Sir Walter Scott all suffered from consumption.

There was a common association between TB and great art.  The disease seemed to be invested with a specious romanticism and glamour.  It was believed that tuberculosis could inspire genius.  Real life consumptive beauties inspired the arts.  Mimi, of the opera La Boheme, was based on the true story of a beautiful flower girl of humble origins who died from the disease.  Alphonsine Plessis, another consumptive beauty, was Verdi’s model for his great opera, La Traviata.  Little Blossom dies gracefully from the disease in David Copperfield.  Emily Bronte displayed a calm acceptance of this dreadful mortality of mere children throughout her writings.  Her great novel, Wuthering Heights, became a tragic prophecy of real life when, following the death of her brother, Branwell, Emily developed consumption herself and, refusing to rest or to see a doctor, died three months later.

Ryan takes us through the scientific excursions on the discovery of the Mycobacterium, the visions, the tragedies, the premature celebrations, the prejudices, the cures, and the controversies.  He describes Dr. John Crofton’s outline concerning the eradication of TB and then, in the final chapter, "The Alliance of Terror," what went wrong.  He recalls a lunch at Rockefeller Center in 1990 when it was mentioned in passing that New York was gripped by the worst outbreak of tuberculosis since the 1960s.  Ryan had thought his story was neatly parceled up and brought to a satisfying conclusion.  He then became aware that the new danger was not confined to New York, but the entire world was facing a new and very frightening tuberculosis threat.   How utterly incredible to discover that the new virus of AIDS was coming together with this equally dangerous if more ancient enemy, in the most sinister alliance imaginable.  Publication was then delayed until Ryan could write this new and fourth section to this book, “The Time Bomb.”

Although this treatise is well researched and referenced, Ryan states that he did not write a scholarly work for doctors or scientists.   He wrote it “for everybody, for the ordinary man and woman, regardless of whether they know a jot about medicine or science.”  As he states, most surprising of all, and of very great relevance to our world today, the story is not over.  More than one billion people have died from TB in only the last two centuries; the number over the past 70 centuries is unknown; more people died from TB in the first world war than from gunshot; three billion people have received BCG vaccine; and there is more active TB in the world today than ever before in history.  Yes, this book is very relevant to us, our loved ones, and the patients we serve.