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A wide ranging study of the great epidemic scourges of humanity - plague, leprosy. smallpox, syphilis, cholera and yellow fever/malaria - over the last six centuries. Sheldon Watts, applies his perspective to the study of global disease, exploring the connections between the movement of epidemics and the manifestations of imperial power in the Americas, Asia, Africa and in European homelands. He shows how the perceptions of whom a disease targeted changed over time and effected various political and medical responses. He argues that not only did western medicine fail to cure the diseases that its own expansion engendered, but that imperial medicine was in fact an agent and tool of empire. Watts examines the relationship between the pre-modern medical profession and such epidemic disasters as the plague in western Europe and the Middle East; leprosy in the medieval west and in the 19th-century tropical world; the spread of smallpox to the new world in the age of exploration; syphilis and nonsexual diseases in Europe's connection with Asia; cholera in India during British rule; and malaria in the Atlantic basin during the eras of slavery and social Darwinism. He investigates in detail the relation between violent environmental changes and disease, and between disease and society, both in the material sphere and in the minds and spirit of rulers and those who where ruled. This book is an account of the way diseases - arising through chance, through reckless environmental change engineered by man, or through a combination of each - were interpreted in western Europe and in the colonized world.
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In ancient Greece, the great medical teacher Hippocrates taught his students that medicine may consist of many things, but it is always concerned with the patient, the physician, and the disease. In the past two decades, spurred on, no doubt, by a worldwide AIDS epidemic that caught the Western world unprepared to acknowledge that infections can still be such threats to our well-being, the history of disease has become a veritable scholarly industry. Epidemics have always struck terror and have always been of dramatic interest.
Nancy Gallagher, a historian of medicine and public health in Tunisia, described three main historical approaches to the analysis of epidemics in the past: epidemics as causative agents of change, epidemics as mirrors reflecting social processes, and epidemics as ways of illustrating changing medical theories and practices (Medicine and Power in Tunisia, 1780-1900. New York: Cambridge University Press, 1983). In Epidemics and History, a large and at times complex work of historical synthesis, historian Sheldon Watts, who has taught in Nigeria and Egypt and lives in Cairo, brings together all three of these approaches and an immense body of secondary literature on the history of diseases and their social, political, economic, and cultural consequences. Watts has read widely and perceptively. He is not the first to tackle the subject of disease and the public health response to it as a tool of empire building, nor is he alone in showing that disease is one of the ties that binds industrialized societies to those in the Third World. "Migration of man and his maladies is the chief cause of epidemics," Alfred Crosby noted in Columbian Exchange: Biological and Cultural Consequences of 1492 (Westport, Conn.: Greenwood Publishing, 1972).
The heart of Watts's book consists of six long chapters about seven diseases that have plagued humankind: bubonic plague in Western Europe and the Middle East from 1347 to 1844, leprosy in the West in the Middle Ages and as a tropical disease in more recent times, smallpox from 1518 to its eradication in 1977, syphilis in Western Europe and East Asia from 1492 to 1965, cholera in Great Britain and India from 1817 to 1920, and yellow fever and malaria from 1647 to 1928. To give some notion of the breadth and depth of this book, the last chapter is 55 pages long and has 213 notes, most with multiple references.
The convenience of so much history of disease in one place is obvious. To obtain such broad coverage, readers would have to consult the dozens of monographs Watts has read and cited. Curiously missing from his extensive list of readings is The Cambridge World History of Human Disease, edited by Kenneth Kiple (New York: Cambridge University Press). Published five years ago, Kiple's book, with nearly 160 contributors and more than 1100 pages, is an indispensable source of information about the history of disease, both epidemic and endemic.
For readers who do not want to consult many separate monographs or an encyclopedic work such as The Cambridge World History, this book is a good place to start. Epidemics and History is very well written, though dense in parts. It is also remarkably free of the jargon that too often characterizes discussions of the social consequences of disease. That the germ theory is a theoretical construct and that diseases may be viewed as both biologic and social constructs now finds wide agreement. Watts unfortunately adds yet another variant, the notion of a leprosy construct or a yellow fever construct. If what he means to imply here is the political or social responses to the disease, I would have preferred simply speaking in terms of response.
One oversimplification Watts indulges in is to ascribe the advent of modern scientific medicine to the work of one man, Robert Koch, which ignores the much more complex story of our understanding of the germ theory of disease. To blame Koch for the excesses of his followers in turning medicine into a highly specialized undertaking with more emphasis on disease than on those who suffer from illness is also an oversimplification. By now, most medical readers are quite used to such charges. They can be overlooked in this otherwise engrossing book.
Reviewed by Gert H. Brieger, M.D., Ph.D.
Copyright © 1998 Massachusetts Medical Society. All rights reserved. The New England Journal of Medicine is a registered trademark of the MMS.
"At the heart of Epidemics and History is a keen appreciation of the contribution, both to plagues and our responses to them, of social inequalities. I am willing to predict that Watts's trenchant examination of African leprosaria will become classic medical history." -- Paul Farmer M.D., Harvard Medical School, in Natural History September, 1998.
"Based in Cairo and hence immune from automatic Eurocentrism, Watts is as sceptical of the medical profession as of the governments and business interests they ultimately served. His case carries much conviction." -- Roy Porter, Wellcome History of Medicine, London, in The Times, London, November 20, 1997
"[Watts] has taken upon himself the task of crossing the no man's land between the liberal arts and sciences and deserves a pat on the back...its fascinating." -- Alfred Crosby, University of Texas, in The Washington Post August 18, 1998.
"[Watts] shows how widely human predatory instincts have always conditioned attitudes to disease so as to exploit any prevailing epidemic--the darker side of history as it were--and a compelling and dramatic read." -- Alan Cameron in Lloyds List, London, January 10, 1998.
"a bold and imaginative attempt at synthesis. Yellow fever and malaria provide him with striking examples of how disease was used to bolster arguments about racial superiority and segregation in the American south and colonial west Africa." -- David Arnold, School of Oriental and African Studies, London, The Times Higher Education Supplement, January 16, 1998.
"a large and at times complex work of historical synthesis. The convenience of so much history of diseases in one place is obvious. [An] engrossing book." -- Gert Brieger M.D., Johns Hopkins School of Medicine, in The New England Journal of Medicine July 2, 1989.
"a massive work of synthesis...Watts's book draws on recent critical studies which demonstrate how during times of epidemic disease, and in the heyday of communicable diseases such as leprosy and syphilis, coercive power was imposed on the weak, the politically and socially undesirable, and especially, on the colonized, under the guise of disease prevention." -- Andrew Wear, Wellcome Hist of Medicine, London, in The Times Literary Supplement June 19, 1998.
Despite Watts' aversion to Eurocentric scholarship, his mastery of six centuries of Western-influenced infectious disease and sanitation history is impressive. He also writes with authority about the pre-modern and modern medical profession. -- The Los Angeles Times Sunday Book Review, Claire Panosian
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