Book Review

Sentinel for Health: A History of the Centers for Disease Control

N Engl J Med 1993; 328:671March 4, 1993

Article

Sentinel for Health: A History of the Centers for Disease Control
By Elizabeth W. Etheridge. 414 pp., illustrated. Berkeley, Calif., University of California Press, 1992. $42.50. ISBN: 0-520-07107-7

The history of the Centers for Disease Control (CDC), now the Centers for Disease Control and Prevention, is a compelling subject. Not only has this agency of the United States Public Health Service become an important and highly visible institution, but its development includes the elements of a winning story: emergence from obscure origins to attain scientific, social, and political prominence; duels with deadly and often mysterious diseases, sometimes in exotic foreign settings; and the involvement of many talented, lively, motivated people, who at times have clashed with one another.

Over the years, parts of this story have been told. For example, popular accounts by Berton Roueche have traced epidemiologic investigations by the CDC's “disease detectives” (The Medical Detectives. New York: Plume/Truman Talley Books, 1991), and books and articles on various public health topics have described its role. Sentinel for Health adds substantially to this literature, and helps unify it, by detailing the overall growth and development of the CDC.

Historian Elizabeth W. Etheridge, whose previous work includes a book on the social history of pellagra in the South, tracks the history of the CDC up to the mid-1980s. The book begins by recounting the agency's origins in the 1940s from malaria-control efforts during World War II, and it ends with a summary of the CDC's early work in investigating AIDS. In between, it describes how the CDC (the initials originally stood for Communicable Disease Center) expanded from an institution focused on preventing infectious diseases to one that, on the basis of principles developed in that area, has become much more broadly concerned with promoting public health.

The book draws extensively on official records of the CDC and interviews with prominent people there; it includes material on little-known aspects of the agency's history and presents relatively well known aspects in fresh contexts. Some parts of the book describe the visions, styles, actions, and achievements of major figures in the CDC's evolution. Others address such matters as why the CDC is located in Atlanta and how its location has affected its history, how the preceived threat of biologic warfare spurred the CDC's early growth and development, and how the agency has repeatedly struggled to obtain facilities. Still other parts of the book deal with such endeavors as the smallpox-eradication campaign, other immunization efforts, and the investigations of newly identified disorders such as legionnaires' disease and toxic shock syndrome. The book also discusses the CDC's entry into such areas as nutrition, family planning, occupational health and safety, environmental health, and the prevention of chronic diseases.

Combining breadth and depth, this book is highly informative and appears well balanced. In general, it is clearly written and cohesive, without technical inaccuracies or excessive simplification. Some portions are enlivened by catchy quotations (for example, D.A. Henderson's description of eating raw shellfish as “Russian roulette on the half shell”), lively anecdotes (including some demonstrating former director William Foege's resourcefulness and wit), or apt turns of phrase. The book might have been strengthened, however, by the inclusion of additional analysis -- for instance, of patterns in the CDC's history and of factors contributing to the institution's rise in prominence.

Sentinel for Health should interest a range of readers, including medical and public health professionals, historians, and some general readers. It should especially appeal to those with ties to the CDC., and it should greatly aid further research into the CDC's rich and continuing story.

Barbara Gastel, M.D., M.P.H.
Texas A&M University, College Station, TX 77843