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There is no easy segue from yesterday's Captain Underpants review to today's In the Shadow of Blackbirds. I primarily review children's books.  This one is definitely for young adults.

Winters, Cat. 2013. In the Shadow of Blackbirds. New York: Amulet.
Advance Reader Copy supplied by NetGalley.

Through the windows, I watched the boys proceed to a line of green military trucks that waited rumbling alongside the curb. The recruits climbed one by one beneath the vehicles' canvas coverings with the precision of shiny bullets being loaded into a gun. The trucks would cart them off to their training camp, which was no doubt overrun with feverish, shivering flu victims. The boys who didn't fall ill would learn how to kill other young men who were probably arriving at a German train station in their Sunday-best clothing at that very moment. (From Chapter 2, "Aunt Eva and the Spirits")

The year is 1918, and 16-year-old Mary Shelly Black is on her way from Portland to San Diego to stay with her widowed 26-year-old aunt. Her mother is dead. Her father has recently been arrested - swept up in the anti-German immigrant frenzy that's sweeping the country.

The sign in front of the eatery claimed the place specialized in "Liberty Steaks," but that was simply paranoid speak for We don't want to call anything a name that sounds remotely German, like "hamburger." We're pro-American. We swear! (from Chapter 13, "Ugly Things")

Young men are eagerly enlisting to fight in the trenches of Europe, and amidst it all, the "Spanish flu" ravages the population - their flimsy gauze masks are no match for the deadly virus.

The businessmen in smart felt hats rode with me, probably on their lunch break. They buried their gauze-covered noses in the San Diego Union, and one of them felt the need to read the October influenza death tolls out loud. "Philadelphia: over eleven thousand dead and counting - just this month. Holy Moses! Boston: for thousand dead." The use of cold statistics to describe the loss of precious lives made me ill. (From Chapter 17, "Keep Your Nightmares to Yourself")

The bleak situation is made all the worse by her recent discovery that her dearest Stephen, the only bright spot in her sad existence in San Diego, has enlisted in the Army, not because he desires to fight and kill German soldiers, but to show love for his country and free himself from living under the same roof as his brother, a drug-addled, "spirit photographer,"

So this is war. The declaration changed Coronado and San Diego overnight. The men are all enlisting and everyone is hurrying to make sure we all look like real Americans. One of our neighbors held a bonfire in his backyard and invited everyone over to burn their foreign books. I stood at the back of the crowd and watched people destroy the fairy tales of Ludwig Tieck and the Brothers Grimm and the poetry of Goethe, Eichendorff, Rilke, and Hesse. They burned sheet music carrying the melodies of Bach, Strauss, Beethoven, and Wagner. Even Brahm's "Lullaby."

In the Shadow of Blackbirds takes a decidedly darker turn when Mary Shelly learns of Stephen's death in the trenches of Europe.  She attends his funeral, but something is very wrong.  She can hear him, she can feel his torment.  His spirit is not at rest; and amidst the horror of war and the flu pandemic, something else is terribly, terribly wrong.  Spirit photography and séances are commonplace as millions across the country yearn to connect with loved ones lost to war or disease; but Shelly is a girl of science, of rationalism - raised in a house of reason and education.  But how can science and reason explain the anguished pleas of her deceased love?

In The Shadow of Blackbirds is gripping historical fiction and Mary Shelly Black is a tragic yet strong protagonist. Containing some of the same themes as Avi's dark, Seer of Shadows (Harper Collins, 2008) (spirit photography, rationalism vs. spiritualism), In the Shadow of Blackbirds examines these themes as well as romantic love and post-traumatic stress syndrome. The setting (San Diego and nearby Coronado Island) and the juxtaposition of love and war, disease and science combine to offer a dark and gritty debut novel.  The descriptions of trench warfare and everyday life during the massive flu pandemic are gritty and graphic, reminiscent of Mary Hooper's novel of Europe's 17th century plague, At the Sign of the Sugared Plum (Bloomsbury, 2003). The fear of death is almost palpable, made even more so by the reader's knowledge that garlic amulets and gauze masks are powerless against the killer flu. To read In the Shadow of Blackbirds is to be immersed in a grim period of American history that at times, bears resemblance to our own.


From the Author's Note,

...the influenza pandemic of 1918 (this particular strain was known as the "Spanish flu" and the "Spanish Lady") killed at least twenty million people worldwide. (Some estimates run as high as more than one hundred million people killed." Add to that the fifteen million people who were killed as a result of World War I and you can see why the average life expectancy dropped to thrifty-nine years in 1918 - and why people craved seances and spirit photography. 

Note: If you've ever watched the classic Academy Award Best Picture, All Quiet on the Western Front (1930), this warning from Mary Shelly to her love will foreshadow and haunt,



Period photographs of life during the influenza pandemic of 1918 availabe at these sites:

• www.pbs.org/wgbh/americanexperience/films/influenzawww.flu.gov/pandemic/history/1918
• http://www.archives.gov/exhibits/influenza-epidemic/

There are great resources of all kinds (music, vintage video footage and photos) at Cat Winters' site.

Here's the trailer, just released today at the Mod Podge Bookshelf. I wish it hinted at the book's rich historical detail.

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Murphy, Jim and Alison Blank. 2012. The Invincible Microbe: Tuberculosis and the Never-Ending Search for a Cure. New York: Clarion.

The minute I saw this book, I knew that I would read it, not because I am a fan of nonfiction and Jim Murphy, but for personal reasons.  While my mother would often tell me stories of what it was like to be a child during WWII, my stepfather was older.  He lived what I considered to be a fascinating, history-book life. He was an orphan. He remembered the Great Depression.   He was a runaway. He was a "runner" on Wall Street.  He had tuberculosis.  He recalled being forced to march outside in the cold New York winter wearing nothing but a t-shirt and underpants, a common aspect of a patient's "curing" regimen.  I can only imagine that a poor orphan boy's regimen was harsher than most. To this day, I cannot look at a sepia-tinged photo of poor scantily clad children in the snow without thinking of my stepfather.  The girls on the cover of The Invincible Microbe, "curing" outside on a porch, may be smiling in the photo, but I don't believe for a minute that it was by choice. To the end of his days, my stepfather loved rich foods and warm temperatures - small wonder.


So, to me growing up, TB was a thing of the past - a disease like polio, generally eradicated and of no concern to me.  Then came the late 1980's and 1990's.  My sister lived in Manhattan, and lo and behold, tuberculosis was suddenly a topic of discussion again.  There was an outbreak in the City. She was worried.  So to me, tuberculosis was then an urban thing, of no concern to me, except where my sister was concerned.  My sister moved away from the City, and I thought little of it again ... until my children were born.  Then to me, TB was "the bubble test," and I thought little of it, except that it seemed to be an easier test than the "tine test" I remembered from childhood, and I was thankful that my kids were protected...

or so I thought, until I read The Invincible Microbe.

The Invincible Microbe: Tuberculosis and the Never-Ending Search for a Cure, tells the story of TB from its known beginning, in prehistoric times, through the days of magical, prayerful, and deadly "cures," until today, when TB is still a scourge in five areas of the world (Democratic Republic of Congo, Ghana, The Philippines, Swaziland, Vietnam) and is only as far away from you as a plane ride.

Thoroughly researched, sourced and indexed, with numerous photographs, The Invincible Microbe is a chronological look at the Tuberculosis germ, containing first-hand accounts (including a poem written by Robert Louis Stevenson en route to a sanatorium in Saranac Lake), period advertising, and quotes from scientific journals and other sources. It incorporates both the scientific and social aspects of infectious disease, answering such questions as:

How were breakthroughs in identification and treatment of the disease achieved? How did the medical community vet new procedures and ideas?  How was public health policy created? How did the germ mutate to survive?  How did Tuberculosis attack the human body?  How was it spread?  Who decided which patients received treatment and which do not?

Sadly, these questions are still being answered, and to date, Tuberculosis has no cure.

Comprehensive and engrossing, this is a book that will appeal to ages 10 to adult.

Want to know more about TB?  Check the Tuberculosis section of the World Health Organization (WHO) website.

• Today's Nonfiction Monday roundup is hosted by Wrapped in Foil.

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1 December is World AIDS Day. Here Kenneth Mayer, MD, explains what makes the 2012 observance different from all those before – and, hopefully, those to come. Dr. Mayer is Co-Editor of Clinical Issues in HIV Medicine, Co-Chair of the HIVMA/IDSA Center for Global Health Policy’s Scientific Advisory Committee, founding Medical Research Director of Fenway Health, a visiting professor at Harvard Medical School, and an attending physician and director of HIV Prevention Research at Beth Israel Deaconess Hospital in Boston.

By Kenneth Mayer

Last year, on World AIDS Day, U.S. President Barack Obama set ambitious goals to reach more people with treatment and fundamental prevention. Echoing U.S. Secretary of State Hillary Clinton’s call for an “AIDS-free generation,” he envisioned a tipping point in a 30-year battle to subdue the world’s costliest epidemic.

This World AIDS Day, the administration’s release of a global AIDS roadmap takes the vision into practice. Outlining the U.S. government’s commitment to apply research to reality, with the efforts of affected countries and other donors, it is as much a promise as a challenge.

The plan serves as a solid indication that three decades into a struggle that began without direction, and that sometimes seemed futile, the U.S. has set a course to continue the pace it has achieved in the last year, while giving partners encouragement and reason to match those efforts. It underscores, at a time of worldwide economic challenges and competing concerns, that this investment will yield gains, this is a battle that can be won, and this is not the time to stand still.

The global health community and its researchers, policy makers, donors, field workers, and affected populations know what to do to begin to end this epidemic, and now need to do it. To realize the magnitude of this opportunity, compare where we are now to where we were 31 years ago when fear, ignorance, and prejudice stymied responses while AIDS’ death toll multiplied exponentially as it circled the world. With little clue as to how the virus was transmitted from 1981 to 1985 rumors and mistrust also spread. Through epidemiological research we overcame the terror of those years, understanding that without blood exchange or intimate sexual contact the virus was not readily transmitted. Researchers’ discovery in the mid-1990s that combinations of antiretroviral drugs could arrest the virus changed it from a death sentence into a manageable disease, for many. Shamefully, the cost of those drugs kept the benefit of that breakthrough from being shared in the poor countries where relief was most needed. Finally, in the last decade, with the importation of generic medicines, the establishment of The Global Fund to Fight AIDS, Tuberculosis and Malaria, and the President’s Emergency Plan for AIDS Relief, work to confront the epidemic emerged from laboratories and wealthy countries, to what are now some of the most formidable front lines.

Yet we continue to fall short. We know that injection drugs are a major vector for HIV transmission, but many countries punish users of those drugs rather treat them with opioid substitution therapy and protect them with needle exchange programs. Homophobia and criminalization of gay sex threaten efforts to even count the toll in countries where HIV is most prevalent. Programs to prevent transmission of the virus from mothers to infants are hobbled by constraints on family planning commodities. Sex workers are marginalized by efforts that exclude their input. Treatment and prevention programs fail to reach people with physical and mental disabilities. While tuberculosis is the primary killer of people living with HIV, screening and treatment for the two diseases remain unlinked. While donors have imported some of the means to fight the epidemic, too often they have imported answers as well, failing to allow for the diversity of needs and affected populations in different countries.

With a plan that includes the needs of all affected populations, the tools we have now will be powerful. The study known as HPTN 052 showed that early initiation of antiretroviral therapy could decrease the transmission of HIV in couples in which only one partner was HIV-positive by 96 percent. The use of an antiretroviral drug as pre-exposure prophylaxis in combination with other risk-reduction measures, was shown to be effective in protecting men who have sex with men, and heterosexual men and women from acquiring the virus.

These discoveries will be useless, however, if people who need medicine to save their lives don’t get it. While eight million people are getting treatment, 34 million are living with the virus. Maintaining the momentum of treatment coverage that the U.S. has achieved in the last year in Africa is imperative to meet the original humanitarian mission of the response as well as to continued progress.

Then, with shared responsibility and political will, the next World AIDS Day can be one on which we can see the end of the road, far ahead but certain, when we can stop the further spread of HIV.

To raise awareness of World AIDS Day, Dr. Mayer and Daniel Kuritzkes, MD (Co-Editor of Clinical Issues in HIV Medicine) have selected recent, topical articles, which have been made freely available for a limited time by  The Journal of Infectious Diseases and Clinical Infectious Diseases. Both journals are publications of the HIV Medicine Association and the Infectious Diseases Society of America.

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Image credits: World AIDS Day press images via worldaidsday.org media centre.

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With a title like this, you know that this book will have shelf appeal! But will the readers keep with it after it’s on the table? Did the Romans poop in public?!

In this fast and gross history, readers will learn all sorts of interesting bits about the history of our bathroom habits. The first two chapters “Poop Matters” and “Bad Plumbing, Bad News” set the scene giving readers a sense of the sociology of waste, and making them hone their minds on to the idea the how and the why of poop and fashion and poop and class. Set at a furious pace, author Sarah Albee then gets to the history starting with the Romans and ending with disposable diapers and fitting all sorts of fascinating facts in between.

For example, if someone asked you who invented the toilet, chances are you would say Thomas Crapper. Guess what? You’d be wrong. In fact, in 1596 Sir John Harington invented a flush toilet for himself and Queen Elizabeth (p.132). It’s just too bad there weren’t any sewers. Thomas Crapper doesn’t come along until 1884! But go back 5000 years further and it turns out that the Harrapan civilization (in what is now Pakistan) built sewers, and private bathhouses that drained into covered sewers.

It’s not all about toilets either. Albee explores the frightful diseases that caused havok among cities like London, New York and Paris. Cholera, dysentery, escherichia coli (E. coli), polio, schistosomiasis and typhoid are all waste related and all took out large portions of the human population (and unfortunately continue to do so in poorer and developing nations).

There are highlighted boxes throughout the book that outline topics such as waste related jobs (Fullers, Paleoscatologists, Tanners, Gongfermors, Barber Surgeons, Knight’s Squires, Delousers, Chair Men), “Hygiene Heroes” (Florence Nightengales, Ambroise Pavé, Leonardo da Vinci, Sir John Harington, Benjamin Franklin, Dr. John Snow) and “Too Much Information” (filled with some fun, gross-out facts that are somehow related to poop). There is also an interesting look at fashion and the bathroom (for example, how do you go while wearing a hoop skirt?).

Overall, this is a fun and gross book that has many points of entry. It would make a fabulous book-talk or browsing book and has enough information to help out on projects dealing with diseases, fashion, ancient civilizations, tenement life, royalty, and even colonial times.

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By Mark Hanson

We are failing to deal with one of the most important issues of our time – in every country we are getting fatter. Although being fat is not automatically linked to illness, it does increase dramatically the risk of cardiovascular disease, diabetes, and other so-called non-communicable diseases. We are starting to see very high rates of these diseases in some places, sometimes affecting 50% of the population. Even in some of the poorest parts of the developing world, where such disease itself is not yet common, we nonetheless see warning signs of its arrival. There is great concern that it may soon outweigh the burden of communicable disease such as HIV/AIDS. The humanitarian and financial cost of this non-communicable disease in such parts of the world will be unbearable, and made even worse because the risk is passed across generations, so children born today and tomorrow will have a bleak future.

It seems that we don’t know how to tackle this problem, because current attempts are obviously failing and obesity continues to increase. Governments, doctors, and even NGOs seem to have adopted the same strategy – to focus on our sins of “gluttony and sloth” and to transfer the responsibility for slimming down to each of us as individuals. Of course it’s true that we can’t get overweight unless we eat more than we need to, and the wrong types of foods, and get too little physical exercise. Our biology did not evolve to protect us from obesity and its consequences in today’s sedentary world with such easy access to food. But why is it that we find it so hard to lose weight and, if we do shed the kilos, it seems very hard not to put them back on again?

What we are missing is a focus on our early development. We’re just not adopting the right approach to the problem. And it seems that the generals who are leading us in this global war on obesity and disease have adopted the wrong strategy, and they stick resolutely to it as if they were wearing blinkers. They blame us for the failure to win the war, for our greed and laziness; they blame parents for letting their children get fat; they blame the food industry for peddling unhealthy food, and so on. As if we choose to be fat. It’s important to realise just how limited this way of attacking the problem is on a global scale. Does the little girl force-fed before marriage in Mauritania have any choice in her life? Does the 12-year-old child bride in rural India have any choice when she becomes pregnant and drops out of school? Does the little toddler in Detroit have any choice when his mother feeds him French fries? Does the little boy from Tonga whose mother had diabetes in pregnancy have any choice about developing obesity? Does the little girl in Beijing have any choice in being an only child? And yet every one of these scenarios, and many more, sets that little child up to be at greater risk of becoming obese and to have non-communicable disease.

But new research is uncovering many things that will give us new tactics and strategies for the war against obesity and non-communicable disease, and so we’re hopeful. We now know that we will have to give much greater focus to the mother and unborn child. We may well have to give emphasis to the lifestyle of the father as well. And most importantly of all, we’re starting to realise that behaviours such as propensity to exercise, or appetite and taste for certain foods, which we previously thought to be based on individual choice, have a large constitutional component – in part based on inherited genes, in part on epigenetic changes to gene function in response to the developmental environment, and

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by Caroline Relton

Epidemiology, a well established cornerstone of medical research, is a group level discipline that aims to decipher the distribution and causes of diseases in populations. Epigenetics, perceived by many as the most fashionable research arena in which to be involved, is a mechanism of gene regulation. What brings these perhaps unlikely partners together?

Epigenetic processes are key features in gene regulation. Epigenetic patterns are laid down in early development and are moulded through in utero and early postnatal life and continue to show some degree of plasticity across the lifecourse. Many environmental, behavioural, nutritional and lifestyle factors are believed to influence epigenetic patterns and in some case the evidence base is substantial. What is less clear is the role of this environmentally modifiable ‘epigenome’ on disease risk in populations. This is where epidemiology can help. A good starting point for an epidemiological engagement with epigenetics is clearly identified by Nessa Carey, in her recent popular science book The Epigenetics Revolution:

“The majority of non-infectious diseases that afflict most people take a long time to develop, and then remain as a prob­lem for many years if there is no cure available. The stimuli from the environment could theoretically be acting on the genes all the time in the cells that are acting abnormally, leading to disease. But this seems unlikely, especially because most of the chronic diseases probably involve the interaction of multiple stimuli with multiple genes. It’s hard to imagine that all these stimuli would be present for decades at a time. The alternative is that there is a mechanism that keeps the disease-associated cells in an abnormal state, i.e. expressing genes inappropriately. In the absence of any substantial evidence for a role for somatic mutation, epigenetics seems like a strong candidate for this mech­anism”.

Recent literature points to a role for epigenetic variation in a range of diseases including neurological disease, cardiovascular disease, osteoarthritis and obesity but in most instances these are correlations without robust evidence of causality. Indeed, epigenetics is often proffered as the answer to many unresolved causes of disease. The enthusiasm for establishing whether epigenetic mechanisms link the environment with disease development must be tempered by the knowledge that the epigenome is dynamic and has as much  potential to  respond to disease as respond to the environment. Therefore it is very difficult to disentangle cause from consequence when studying epigenetic variation and disease.

This is just one of the many challenges that face researchers interested in understanding the role of epigenetics in common complex disease. Other challenges include the differences in interpretation of the term ‘epigenetics’ itself – in a field that attracts cell, developmental and evolutionary biologists, epidemiologists and bioinformaticians, amongst others, it is unsurprising that epigenetics means different things to different people and discussions of its relevance to disease can sometimes suffer misinterpretation.

The methods at our disposal to accurately measure epigenetic variation and in turn assess the impact this has upon disease risk are still being developed and there is much to do in this arena with respect to when, where and how to look at the epigenome. The complexity and interplay of multiple factors in determining d

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