The Burdens of Disease: Epidemics and Human Response in Western History.

The Burdens of Disease: Epidemics and Human Response in Western History. By J.N. Hays (New Brunswick, New Jersey, and London: Rutgers University Press, 1998. xi plus 36lpp.).

This work is an ambitious synthesis of literature--especially recent literature--on the history of disease and on the history of medicine that ranges from the civilizations of the ancient Greeks and Romans to the present AIDS epidemic and our own problems of confronting pathogenic peril. Throughout the author tries--and, for the most part, manages--to keep a promise made in the introduction, namely, to fashion a synthesis that steers clear of the old "positivist" medical history as well as the newer cultural constructionism and disease determinism, while, at the same time, extracting the best that these approaches have to offer.

After an examination of Western civilization's heritage of epidemiological notions from the Ancients, the book moves to the disease environment of the Middle Ages, the rediscovery of Galen and the beginnings of universities and medical training. It also pauses to look at two diseases of the period--leprosy and scrofula--before taking up the myriad "burdens" of disease that bubonic plague inflicted on Europe beginning in 1347.

The "new" European diseases of the late fifteenth and early sixteenth centuries--typhus, syphilis, and a "newly virulent" smallpox--are the subjects of chapter four, entitled "New Diseases and Transatlantic Exchanges," which briefly mentions the holocaust descending on the New World while leaving the impression that, for purposes of this work, the Americas are not a part of "Western civilization".

However, in winding up the next two chapters on what essentially are a medical history of Europe from the Middle Ages through the Enlightenment, Professor Hays focuses on Philadelphia, Benjamin Rush, yellow fever, and the Philadelphia medical community to answer the question of "How Complete was Enlightenment?" (p. 130). Then, in chapter seven, which takes the story of cholera to the rise of germ theory and scrutinizes the sanitation movement, the author reassuringly mentions Lemuel Shattuck and by the end of the following chapter on tuberculosis at least the United States (if not the rest of the Americas) has become fully a part of the West.

In chapter nine, the relationships that have been drawn by scholars between disease, Western medicine and Western imperialism are explored and the unraveling of the etiologies and epidemiology of vector-borne tropical diseases is discussed. This is followed by a look at the growth and "professionalization" of the various Western medical professions, and the advancement of germ theory, all of which nurtured a mid-twentieth century expectation of an end to epidemics. Such optimism is treated in chapter eleven, as are the influenza epidemic of 1918 and the polio outbreaks throughout the first half of the century, which had seemed to the optimists to have been archaic pathogenic stragglers of bygone days.

The final chapter takes up the questions of disease and power in which the Nazi definition of "race" as a disease to be eradicated is advanced as an extreme example of the power of the state to construct a disease as well as to deal with it. It is also an extreme example of the application of much that was (and is) inherent in the "science" of eugenics, parts of which, not incidentally, stimulated legislative initiatives and even underwrote legislation in some of the states of the United States. Mostly, however, this chapter is concerned with the relationship of social and economic power with AIDS--the epidemic that destroyed the optimism--and it concludes with a brief depiction of "Poverty as the Greatest Killer" (303-6).

This is a well researched book that is nicely written. The author's ability to sketch out the etiology and epidemiology of the various disease dealt with is commendable as is his judicious presentation and weighing of conflicting explanations of their often mysterious careers historically. One noticeable (but probably unavoidable) problem is the repetition occasioned by an attempt to unite a history of medicine with a history of disease and a struggle to keep them both in some kind of chronological order. Such repetition is compounded with frequent reminders to readers of where they have been and where they are going. One might also have wished for data on human stature (as a proxy for nutrition) to illuminate discussions of nutrition and mortality decline and, perhaps, a few pages on the new viral diseases (such as Ebola), that may join AIDS in mocking an end-of-epidemics ideas. Nonetheless, this book is a very impressive achievement.