The Deadly Truth: A History of Disease in America.

The Deadly Truth: A History of Disease in America. By Gerald N. Grob (Cambridge MA: Harvard University Press, 2002. x plus 349 pp. $35.00).

This is a fine example of Consensus History in the style of that written in the 1950s. The author is the Henry E. Sigerist Professor of Medical History Emeritus at Rutgers University. In his own lifetime Henry Sigerist (1891-1957) was passionately committed to the pursuit of social justice. By way of contrast, in his preface Gerald Grob states that he will not give much attention to issues touching on "gender, class and racial differences in health and sickness...." [p. "x"] This being the case some readers may perhaps feel there is a mismatch between the contents of this book and the position the author holds. Indeed, there is very little here that would raise the hackles of the dominant majority in today's USA.

In the first two chapters Grob presents an account of various diseases that impacted on people in the Western Hemisphere in the centuries before 1492 C.E. and the onset of sustained contact with Europeans. Then beginning in Chapter Three he directs his attention more specifically to the mainland English colonies, excluding Canada, rehearsing the well-known contrast between New England (longish life expectancy) and the Middle Atlantic and Southern colonies (short life expectancy). He then continues by discussing changing disease situations through the periods of the political break with Britain, white American expansion over the Appalachians, the onset of mass immigration from Europe, industrialization, urbanization, and America as world power. He brings the story more or less down to the present, avoiding mention of unpleasant experiences such as the Vietnam War which impacted so heavily on the mental health of a generation of working-class male Americans.

Giving a certain degree of unity to the book is the author's frequent mention of the straw-man argument (which may have been common at the Chicago World's Fair in the mid-1920s) that "disease" is somehow unnatural and that modern science has the potential to banish it entirely. To refute this claim, Grob argues that "the disappearance of one category of disease invariably sets the stage for the emergence of others" [p. 274] The logic underlying this dogmatic affirmation might not be apparent to everyone.

Readers with a smattering of knowledge about world history, economic history and social history may be a bit troubled by Grob's conviction that Europeans arriving in the sixteenth and seventeenth centuries in what is now North America and Meso-America came upon an essentially Empty Land. No mention here of the Mounds Culture, the Natchez empire and the like. Even more surprising is the author's unawareness that south of the Rio Grande in 1492 was a great imperial entity, centered around Tenochtitlan. This was a city larger than any then found in West Europe into which clean water was brought by a sophisticated system of aqueducts and where sanitary arrangements were found in private homes.

Even more troubling is Grob's apparent conviction that Europeans (the forefathers of modern Americans), beginning in 1492 were the first people to have engaged in long-distance trade. As he puts it: "before that time human habitants and environments tended to be locally oriented." [p. 27] This of course ignores fifty years of scholarly study of the extensive trading networks that in the half millennium or so before 1492 C.E. linked Imperial China, India and the Middle East. It is now known that during that whole long era, Europe remained very much on the fringe of the great civilizations. From Grob we also learn that "human kind may have had a common biological origin" and that "Genetic research has not demonstrated that the [original] inhabitants of the Americas were genetically 'inferior' ..." [italics mine, pp. 15, 44].

Troubling too are Grob's statements that by 1492 Europe was organized into coherent Nation States, that Europeans were already semi-industrialized and primarily motivated by "market values" and that they no longer explained sickness in terms of supernatural forces [p. 46]. Basically, it would seem that Grob's general ideas about European history (as prologue to US history) are those which were found in school history textbooks published in the USA in the 1930s and 1940s.

Medical historians too might have some problems with this book. For Grob, Europeans (as forbearers of Americans) were the only humans capable of carrying disease agents, or indeed of doing anything else. From reading him, for example, one would not realize that the Inca Empire (Peru) was badly hit by smallpox from Meso-America in 1524-25 brought in (presumably) by Native-American runners, long before the first Spaniard (Francisco Pizarro) arrived on the scene (in 1531).

But aside from this one example, medical historians who have kept up with the field will find themselves shaking their heads in disbelief when reading Grob's discussions of measles, cholera, tuberculosis, malaria, dysentery, and several other infectious diseases. In the case of yellow fever, for example, Grob relies on secondary sources which were shown to be culturally biased and outdated by an article found in the Journal of Social History in the summer issue of 2001 (Vol. 34 number 4).

Grob's references to the diseases of Old Age are brief and incomplete. There seems, for example, to be no discussion of Alzheimer's disease which results in the deterioration of the mind. For many people of a certain age, this condition is dreaded more than any other. Grob also fails to mention the several disease conditions at the other end of the age spectrum, among teenagers, brought on by obesity and boredom. He also fails to mention that among the millions of Americans (not necessarily of European extraction) who have no health insurance there is a direct connection between the therapeutics for profit health industry on the one hand and, on the other, the bankruptcy, the collapse of an accustomed standard of living, and the mental anguish brought on by long term illness of self or of a beloved family member.

For a coherent and objective discussion of the deadly truth about the disease situation in the USA one should turn, not here, but to the relevant chapters in Roy Porter, The Greatest Benefit to Mankind: London, HarperCollins, 1997.

Sheldon Watts

The American University in Cairo