September 28, 1976

Dr. Yehuda Elkana
The Van Leer Jerusalem Foundation
P.O. Box 4070

Jerusalem, Israel

Dear Yehuda,

I have your question about sources on the role of bovine tuberculosis
as a possible protection against the human pulmonary form. This is a sheer
speculation, and you may not feel very well satisfied with this account, but
I will tell you what story there is.

I became interested in the queation through the teaching in my course
as Health in Human Ecology in the Human Biology Program. For a couple of
years I used as a source text the book by Thomas McKeown "Medicine in
Modern Society", Allen and Unwin, 1965. McKeown has written in quite a few
places his critique of the role of medicine, in contrast to environmental
changes, in the improvement in mortality in Britain, especially during the
19th century. I am enclosing a copy of a page from that book which gives
the hint about bovine tuberculosis. What little else I could find about the
disease suggests that it may indeed be quite credible that: (1) many more
children were infected with the organism than appeared in case statistics
attributed for bovine TB and (2) that this might be expected to offer some
protection along the lines of the BCG immunization now practiced,

McKeown does not make much of this point here and none at all in his
later writings on the same subject - for example a book which has just now
appeared "The Modern Rise of Population", Edward Arnold, 1976.

You may want to see an extensive critique of McKeown's interpretation
which appeared in: Razzell, P.E., "An Interpretation of the Modern Rise of
Population in Europe - A critique", Populations Studies 28:5-18, March 1974.

In addition, McKeown's latest book leans in the paper by M.W. Beaver
(Population, Infant Mortality and Milk", Population Studies 27:243-254,
July 1973). The latter says nothing about bovine TB as an immunization.
It does give some sources on the dairy industry during the period in question,

In looking over this material one should, I think, distinguish between
infant and adult mortality as somewhat separate phenomena, particularly with
respect to the burden of tuberculosis.

I hope this has been helpful to you. If € can find out anything else for
you that would be of interest, please let me know.