Book Review

Epidemics and Ideas: Essays on the Historical Perception of Pestilence

N Engl J Med 1993; 328:669March 4, 1993

Article

Epidemics and Ideas: Essays on the Historical Perception of Pestilence
Edited by Terence Ranger and Paul Slack. 346 pp. New York, Cambridge University Press, 1992. $49.95. ISBN: 0-521-40276-X

A lengthy introduction and a rondo capriccioso of 12 discrete essays around a unifying theme form this interesting and surprisingly current book. The theme is the historical perception of pestilence, from the first classical report -- Thucydides' description of the plague in Athens, circa 430 to 427 B.β -- to the AIDS epidemic of the 1980s. In between we are taken on a vertiginous tour through more than two millennia. We visit regions of Europe, India, Hawaii, Africa, and the United Kingdom, going from classical times to the early Islamic societies, the Dark Ages, and the 18th, 19th, and 20th centuries. We learn much about dragons and saints; about how early-modern Italy reacted to the plague and to the poor; about dearth, dirt, fever epidemics, and public health in Britain; about cholera and its relation to European revolutions.

The authors describe the depopulation of Hawaii as a model for the Amerindian experience; panic and epidemic politics in colonial India from 1896 to 1914; prophetic responses to plagues of beasts and men in eastern and southern Africa; and finally the early years (1981 through 1986) of AIDS in England. We review epidemics and pandemics of bubonic plague, cholera, syphilis, influenza, contagious fevers, smallpox, venereal diseases, and the like. Above all, we become aware of how ignorance, fear, power and powerlessness, social structures, mores, traditions, beliefs, the conflict between political controls and opportunistic movements and between popular superstitions and the superstitions of science are all entangled in the chaotic reactions of societies to the massive irruption of grave communicable diseases and multitudinous deaths.

This book is a compilation of papers presented at a conference on “epidemics and ideas” at Oxford in the fall of 1989 (plus one published a year before), all updated. The high scholarly quality of the essays is sustained throughout the book in spite of the uneven styles of the writers, and it is evidenced by the breadth and depth of the bibliographic index. The book leads one to the conclusion that human responses to the shock of epidemics have been so far rather similar in very different historical and geographic contexts, to the point that one of the participants at the original conference wondered, half seriously, whether there is a common “dramaturgy” to all epidemics.

As Santayana warned, we see here anew how the past is repeated again and again by those who have ignored it. Any predominant group promulgating a particular religious, moral, or political point of view, whether “civilized” or “primitive,” has always “known” a priori how events should be interpreted and managed, even when in truth they were not understood at all. When panic and hurry fan the flames of blind action, the results are inevitably chaotic. Catastrophes and epidemics test to the extreme the fabric and the capability of any government, elite, society, people, or group.

Nevertheless, we are now at a point in history when we can study in detail our evolution since the systematic recording of human events began. We can now see much more clearly what happened; how, when, and where it happened; and even why it happened. Contemporary historians have at their disposal better tools, possess many more organized facts, and have learned wiser, more subtle ways to interpret our development, our vicissitudes, our errors, our stupendous accumulation of knowledge, and our ancestral irrationality as a species. Therefore, we have now -- and in the future -- much less excuse to err again when presented with facts, even if they appear in new contexts.

This book will be of interest not only to the medical profession, but to sociologists, anthropologists, political scientists, and statesmen. It is also, of course, a work that can greatly help physicians now involved in public health, the treatment of infectious diseases, preventive medicine, and the fight to control and even eradicate the pestilences that have afflicted humankind since time immemorial. We have already achieved a total victory over smallpox. We are doing well against several of the old scourges. In the past decade we have been challenged by a new, formidable, and elusive enemy: the human immunodeficiency virus. Whoever reads this book and is aware of the history of medicine can take heart: beyond the fumbling, the stupidity, the cowardice, and the cruelty, there is something in human nature that is also brilliant, heroic, generous, and perseverant against all odds. In the end, this side of ours is the one that wins the race.

Ruben D. Rumbaut, M.D.
P.O. Box 231, Sugar Land, TX 77487