[books] in which I grouch about The Lost Future of Mrs Pepperharrow

[kaberett]

Overall, this was as pleasantly readable as Pulley's stuff always is, and I only did a bit of quiet internal screaming.

Spoilers contained within!

So first of all there's the weird racism, right, including an absolutely consistent conflation of "geisha" with "sex worker".

And then there's the Noble Honourable Secret Wife who Dies Tragically to get out of the way of the m/m ship (specifically, the eponymous Mrs Pepperharrow).

AND THEN. AND THEN THERE IS THE TUBERCULOSIS. Quoting from the epilogue, explicitly set in 1891:

... 'Six happened to mention that the doctors think you've got tuberculosis,' Grace said.

'I...' Thaniel shook his head a little, surprised. 'Yes? Why?'

'Well,' she said, 'at the Aokigahara station, we invented a lot of new things with all the electricity everywhere. Just cobbled together. One of them is going into industrial production now. An electron microscope. Its magnification is far superior to an ordinary microscope. I was using it to try and observe ether particles. It's no good for that, but I got talking with a friend in the biology department not long ago, and he's overjoyed, because with the new microscope, he has finally isolated the bacteria which causes tuberculosis.' She opened her hands a little to say, ta-dah. 'He's pretty sure he's got a cure. He's looking for people for the clinical trials. It looks very promising indeed. If you'd like to give it a try.'

NOW a thing it is IMPORTANT TO KNOW about these books is that the entire point of them is that they're a weird alt-history that features all sorts of magic shit including clairvoyancy. (This book purports to provide a scientific explanation of the clairvoyancy and it's, ah, dubiously consistent with how we're shown it working, but leaving that aside for the moment...)

As such, I do not have a problem with the electron microscope being invented in 1888 instead of 1926. This you can have! It is explicitly "the course of history was nudged to make this happen earlier than it would have done without the nudging", which, fine. EVEN I will grudgingly grant that "clinical trials" (also invented in the 1920s) could have been similarly nudged, though that would involve a whole lot of changes in How Characters & Their Societies Think About The World that is in no way actually documented on page.

HOWEVER.

The tuberculosis bacillus was identified and in 1882, six years before the main timeline of the story! YOU DO NOT NEED AN ELECTRON MICROSCOPE TO IDENTIFY THE RELEVANT BACTERIA. You just CATEGORICALLY DO NOT.

Additionally and furthermore, the treatment of tuberculosis was "sucks to be you [shrug emoji]" until 1944, when the first effective antibiotic against M. tuberculosis was isolated. This wasn't turned into an actually useful oral-delivery drug until 1952.

And, like, again, I would be willing to suspend disbelief about the timing of the development of antibiotics, but that's simply never mentioned -- instead the driving motivation of one of the protagonists for the entire book is "getting the electron microscope invented early i.e. by 1891, so that the tuberculosis bacillus can be identified" when... it already had been! using conventional microscopy! and some actually pretty cool staining techniques! SIX YEARS, I repeat, BEFORE THE MAIN EVENTS OF THE BOOK.

And, you know, I can absolutely see how this wouldn't spoil things for people who aren't me, but. But. Goodness I find it frustrating.

Comments

[shanaqui]

Ehhh, treatment of tuberculosis before 1944 was attempted, with apparent successes (often more due to consistent nutrition, most likely, allowing the immune system to make a comeback and safely wall the bacteria up again in granulomas). So that someone would think there was treatment before that is okay -- collapsing lungs, rest cures, that kind of thing.

The idea of clinical trials happening in some kind of consistent way where you would talk about "clinical trials" bothers me slightly more! Like for TB it was way more faddish, "Dr So-and-so swears by tuberculin [which was invented by Koch in 1890 so theoretically available in 1891], why don't you go see him?" Not... proper clinical trials.

...Sorry. [sits down and tries not to get Hello This Is My Special Interest all over you]

[kaberett]

PLEASE DO THIS IS AN OPEN INVITATION

The thing is for me the specification of a *cure*, which is implied by the text to be a cure in the sense that we'd think of it now -- I didn't mean to suggest that treatment wasn't attempted, merely that it was only dubiously effective!

But yeah no it's very much "clinical trials" being treated as an understood and established term.

[shanaqui]

Hm, Koch insisted that tuberculin was a cure, despite evidence to the contrary -- and it was Koch, after his research on anthrax, so people believed it really was a cure. So you could make an argument that characters might fully believe in it as a cure... (Same for some of the other types of "treatment" -- people did get discharged from sanatoria as being healthy again, albeit usually early-stage patients rather than late. Which, they kinda were and kinda weren't, since most likely their infections went back to being latent rather than actually being cleared, but people didn't understand that at the time.)

Also! This is slightly related. Did you know that people actually figured out the problem of antibiotic resistance quite early? I was always under the impression that we screwed up streptomycin by using it as a monotherapy without knowing about resistance, but the book I read recently suggested otherwise. (Even if they'd had effective adjuvant therapies, though, even the state of the art therapies today combining three or more drugs can still fail. Tuberculosis is! so! clever! I could talk all day about how clever it is and all the different ways it says "fuck you, no" to antibiotics.)

[ludy]

Yeah, they did the lung draining thing on my Granddad when he had tuberculosis in the late 40’s early 50’s (along with at the time semi-experimental antibiotics). And it did relieve the symptoms - but also because they were not sufficiently careful with not sharing needles/other equipment gave him hepatitis which he then transmitted to my young uncles…

(After a second bout of TB he was treated with newly available more effective antibiotics)

[ludy]

Re:treatment v cure - I get the impression that when it was still really common TB was often diagnosed just from symptoms without always following that up with blood work and therefore other conditions (some of which were curable or self-limiting) got lumped in with it*. And the sometimes episodic pattern of the illness was not well understood (there was a lot of debate, at the time, about whether Granddad had tuberculosis twice or one infection with two acute episodes). So things like fresh mountain/sea air where genuinely believed to sometimes be curative and not just therapeutic - because taking breathing-compromised people out of pre-clean-air-act cities did make them dramatically better, sometimes better enough for their immune systems to get the infection under control for several years.


*Randomly my Mum (other side of the family from TB Granddad) had (the chronic form of) the autoimmune lung disease sarcoidosis in the 80s/90s which in earlier decades was often misdiagnosed as tuberculosis.

[vass]

There's a thing about the collapsing lung treatment in Galina Vishnevskaya's autobiography. She had TB and that was the suggested treatment, but it'd have ended her opera career. And someone suggested that she could try the new miracle cure and get a series of injections over the Russian black market. Which were antibiotics, and the needles were gruesomely awful (I can't remember why: not sharp enough? not clean?) but she made a full recovery and did not lose a lung.

[kaberett]

AND ANOTHER THING -- the OTHER reason they kind of desperately need antibiotics is THE PROTAG GOT SHOT. Through the arm/shoulder, "nothing important hit", but -- do you know what gunshot wounds, even simple ones, need? 48H INTRAVENOUS ANTIBIOTICS IS WHAT: https://emj.bmj.com/content/17/4/284.2

[oursin]

Over here, screaming in medical historian.
(Okay, technically James Lind was doing clinical trials on scurvy in C18th, but I still don't give this any kind of pass.)

[lunabee34]

Oh that kind of thing drives me absolutely nutso.