Two books on death and disease, but only one of them hits the mark

"Quarantine was often a death sentence for all members of the household," writes Andrew Doig in The Mortal Coil: A History of Death (Bloomsbury, 384pp, £25). Quarantine, a word we are too familiar with these days, meant something slightly different in the Tuscany of the 1500s. When the plague hit, a red cross was painted on each door, movement was restricted and death was imminent.

In this social history of death, Doig addresses the fact that things have changed immensely since then with a curious sentence: "Even though we rightly worry about infections like influenza, pneumonia or Covid-19, their power 
does not come close to those of cholera, smallpox or plague." He notes, in the book that took him 10 years to write, that we have "largely overcome ... famine and war".

It is a startling statement to read when you consider that more than five million people have died from Covid-19 in the past two years, as well as the growing global impact of climate change on food shortages. And while it may be factually correct, it is, frankly, a western perspective.

'Ancient Women' called Searchers, waving wands to warn the public, fulfilled the role of mystical data scientists who risked contracting the virus while counting the bodies

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“Ancient Women” called Searchers, waving wands to warn the public, fulfilled the role of mystical data scientists who risked contracting the virus while counting the bodies. Death was their income – they made money on every bloated corpse. Thematically there is a direct relationship with the times we live in and this tale, but an in-depth parallel is never drawn. The book casts an admirably wide net as it tackles death from infectious disease, obesity, genetic illness, addiction and childbirth. It roams.

In comparison, Vidya Krishnan's The Phantom Plague: How Tuberculosis Shaped History (Public Affairs, 320pp, £19.95) centres the reader immediately. The strong, compelling and addictive writing digs right into the exhumation of Mercy Brown in 1892, and tells how her death from consumption unearthed the vampire panics that led to Bram Stoker's Gothic horror novel Dracula. The story introduces the genesis of ignorance about infectious diseases, the xenophobic nature of western panic – the concept that a character from a faraway land could arrive, attack and spread something that would alter the very fabric of our world. And it introduces the foe itself: tuberculosis. It is literary nonfiction at its best.

The two books tackle the story of Dr Ignaz Semmelweis in very different ways. Semmelweis worked at a hospital in Vienna with two maternity clinics. The first clinic trained medical students and the second trained midwives. And there was a peculiar conundrum: one in 10 mothers in the first clinic were dying but the death rate at the second was less than 4 per cent. It was discovered that medical students handling dead corpses and subsequently delivering babies caused childbed fever, or deadly preventable infection.

Initiated handwashing

Semmelweis initiated handwashing with chlorine solution as a rule for medical professionals – the origins of infection control – and the mortality rate dropped from 18 per cent to less than 5 per cent per month. But he was shunned for his discovery. Doig tells us that the “hostile reception” drove him out of his job “and into an asylum where he died”.

Krishnan interrogates Semmelweis’s own letters to chart his dissenting voice and sets the scene as his inability to provide a theory for his discovery and his distrust of his peers destroy him – he is tricked into a straitjacket by his own wife.

We are told that in Semmelweis's post-surgery world, the doctors 'wore aprons that had so much dried blood on them, they could stand on their own'

The progression from the origins of infection control to germ theory are carefully mapped by Krishnan. She is not afraid to complicate it: “We prefer the single story of a genius with a game-changing eureka moment, but in truth, the revolutionary scientific progress” involved many. Imagery is masterfully composed – we are told that in Semmelweis’s post-surgery world, the doctors “wore aprons that had so much dried blood on them, they could stand on their own”.

Supportive materials, like the Bills of Mortality, helpfully arranged by Doig in a summary table in The Mortal Coil, interestingly show how causes of death have evolved from tracking plague epidemics to forming the basis of World Health Organisation data tables today. It is a fascinating resource, showing from 1692 onwards causes such as “Gripping in the guts”, “Melancholia” and “Sighing”. The writer hypothesises on their meaning. Some reasons are more self-explanatory: “Scalded in a brewer’s mash at St Giles Cripplegate.” A much more direct and gruesome death.

The voice speaking in The Mortal Coil feels like that of an obituary columnist sometimes weighed down by the very level of detail he must transmit. In rare moments the reader must do the heavy lifting required of a PhD examiner working to translate an enthusiastic student’s research into digestible language. In The Phantom Plague, the writer is on a myth-busting, truth-bearing mission to raise awareness of the infectious diseases the WHO estimates latently affect one-quarter of the world’s population.

'In Mumbai TB is everywhere and nowhere,' Kirshnan writes. 'The spread of TB is extensive, and it is extensively denied'

We are introduced to the way the western world has forgotten about the TB crisis. “In Mumbai TB is everywhere and nowhere,” Kirshnan writes. “The spread of TB is extensive, and it is extensively denied.” Doctors, patients and survivors talk about the ways simple things such as adequate housing and healthcare equity would make a huge difference.

In one instance, a doctor notes that one patient coughed so much from TB that “the foetus aborted”. The emphasis is on how black and brown people are left to die by a western world that allows treatable diseases to run rampant. Does this sound familiar?

In the final lines of The Mortal Coil, Doig writes about the future of medical technology – 3D organs, DNA editing and the end of chronic illness. “There seem to be no insurmountable obstacles to stop their use in humans, so soon we will have to address the ethical issues and choose whether or not to implement them,” he says. Why does he not delve bravely into these ethical issues he has raised here? The material is there but the issues are left unpacked.

That final line solidifies the undercurrent of disenchantment I have with this book, filled with interesting and familiar facts that are displayed but not interrogated. When read alongside The Phantom Plague, the many insurmountable obstacles are patently clear. Kirshnan names them and reminds us of our collective responsibility – to make visible the barriers and dismantle them.