The Power of Plagues
Author: Irwin W. Sherman1Category: History of Science; General Interest
The Power of Plagues offers a fascinating examination of epidemic diseases within a historical context. Engagingly written, this new volume presents the science of plagues in an understandable and accessible manner, describing the nature and evolution of diseases and conveying their significance in shaping Western culture and civilization.
Chapters present individual, independent plague stories complemented by relevant and historical illustrations. Major historic outbreaks are covered, including those of the Greek and Roman empires as well as the infamous Black Death. Contemporary and emerging diseases are comprehensively detailed, including HIV-AIDS, tuberculosis, malaria, smallpox, SARS, West Nile virus infection, influenza, mad cow disease, and several others.
Despite advancements in the development of antimicrobials and vaccines and in securing clear water and food supplies, modern civilizations are not immune to epidemic diseases. The Power of Plagues provides insight into the struggle to attain disease control and eradication and explores the challenge of forecasting emerging plagues. In doing so, it offers readers a deeper understanding of modern public health issues and the role of infectious diseases.
Paperback, 431 pages, illustrations, index.
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Chapter 1 : The Nature of Plagues
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This chapter chronicles the recurrent eruptions of plagues that marked the past, influence the present, and surely threaten our future. The particular occurrence of a severe and debilitating outbreak of disease may be unanticipated and unforeseen, but despite the lack of predictability, there is a certainty: dangerous “new” diseases will occur. Parasitism is the intimate association of two different kinds of organisms (species) wherein one benefits (the parasite) at the expense of the other (the host), and as a consequence of this, parasites often harm their hosts. When a malaria-infected mosquito feeds, it injects with its saliva perhaps a dozen of the thousands of parasites that are present in its salivary glands. Measles, caused by a virus, provides an almost ideal pattern for studying the spread of a disease in a community. The virus is transmitted through the air as a fine mist released through coughing, sneezing, and talking. One of the reasons that measles may disappear from a community is immunity that may be the result of natural recovery from an infection or immunization. The spread of infection from an infected individual through the community can be thought of as a process of diffusion whereby the motions of the individuals are random and movement is from a higher concentration to a lower one.
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Chapter 2 : Plagues, the Price of Being Sedentary
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The earliest evidence of hominids, that is, animals ancestral to modern humans and not closely related to other monkeys and apes, is found in Africa. The name Homo habilis, or "handy man," is based on the fact that altered stones and animal remains have been found with the fossil bones. Researchers imagine that H. habilis lived at the edge of shallow lakes and in crude rock shelters. When the populations of H. erectus left Africa, some of their parasites went with them—but only those that could be transmitted directly from person to person. But as H. erectus encountered new environments with new kinds of animals, they were subjected to sources of new parasites; and with an increase in the number of humans living in more restricted geographical environments, the probability of large-scale infections was enhanced. Development of techniques and practices for agriculture and animal husbandry progressed step by step in sequential fashion. It may not be accidental that the first known and highly organized religions arose coincident with the agricultural revolution. Researchers have little precise information about the parasitic diseases that afflicted their ancestors more than 10,000 years ago. The crowd diseases of humans, such as smallpox, measles, pertussis (whooping cough), tuberculosis, and influenza, were initially derived from very similar ancestral infections of domesticated animals.
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Chapter 3 : Six Plagues of Antiquity
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The diseases of antiquity (5000 BC to AD 700) were characterized by parasites with long-lived transmission stages (e.g., eggs) as well as those involving person-to-person contact. Most diseases became established only when a persistent small number of infectious individuals could be maintained, i.e., when the disease became endemic; this required populations greater than a few hundred thousand. The cause of snail fever, the disease that set the Egyptian civilization on its inexorable downward spiral, was unknown to the ancient Egyptians because the transmission stages of the parasite (eggs, miracidia, and cercariae) are microscopic; in addition, the adult worms themselves are tiny and live within the small blood vessels, so they were unnoticed for thousands of years. Blood fluke disease, also known as snail fever or endemic hematuria, involves feces or urine, water, snails, and a flatworm. The life cycle and mode of transmission of the schistosome to a human was first demonstrated between 1908 and 1910 in Japan. Each day, hundreds of embryo-containing eggs move across the walls of the veins into the bladder or intestine, aided by the host’s inflammatory response, and in the process, eggs become enclosed in a small tumor called a granuloma. Diagnosis of schistosomiasis is made by examining stools and urine under the light microscope and finding eggs. The plague of Athens demoralized the citizenry, destroyed the fighting power of the Athenian navy, and prevented the launching of an attack against Sparta.
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Chapter 4 : An Ancient Plague, the Black Death
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During the last 2,000 years, three great bubonic plague pandemics have resulted in social and economic upheavals that are unmatched by those caused by any armed conflict or any other infectious disease. The contagious nature of plague led to the belief that the only way security could be achieved was total isolation of the sick. Plague-infected rodents, now assisted by modern steamships and railways, quickly spread the disease to the rest of the world. In the three pandemics, it is estimated that rat-borne bubonic plague killed more than 200 million people. Agriculture could not keep up with the population rise, and over the next century famines occurred every few years. The result was poverty and misery, especially in the crowded and filthy cities. Deaths from plague radically reduced the average life expectancy from 35 or 40 years to 20. Medieval society had four kinds of medical practitioners: academic physicians, who knew theory but did not care for the sick; surgeons, who learned their trade as apprentices and who were the principal caregivers of the sick; barbers, who did bloodletting and minor surgery; and those who practiced folk medicine, mostly women.
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Chapter 5 : A Modern Plague, AIDS
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Acquired immunodeficiency disease syndrome (AIDS) is a deadly disease for which there is no cure or vaccine. The irony is this: most of us living today, especially those under the age of 25, cannot remember a time when we had to be concerned about an outbreak of typhoid or were endangered by lockjaw (tetanus). AIDS, according to the World Health Organization, afflicts 15 million people worldwide and occurs both in developed and less developed countries. The viral nucleic acid is packaged within a protein wrapper called the core, which in turn is encased in an outer virus coat or capsid; the outermost layer, called the envelope, is partly of host origin. Rous examined the filtrate and the sarcoma under the light microscope and found that neither contained bacteria; he concluded that he had discovered an infectious agent capable of causing tumors and that the infective agent was smaller than a bacterium. The transmission of disease from animals to humans is called a zoonosis. In the case of HIV, an extremely rare zoonosis established itself as a human-to-human infection. The linear array of nucleic acid bases that form the genes of human immunodeficiency virus (HIV) can be used to show how closely related the immunodeficiency viruses are. A political dictatorship, a lack of clinics, severe poverty, and reluctance on the part of wealthy countries to invest or offer assistance makes the disease problem worse.
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Chapter 6 : Typhus, a Fever Plague
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Typhus fever is sometimes called “war fever” because frequently it is a companion to hostilities. During wartime, individuals are subjected to increased stress, they become more susceptible to new diseases, and endemic diseases may become more severe. Today, there is usually little in the way of epidemic disease in the industrialized countries of the world because of improvements in hygiene, but elsewhere typhus can and does surface, especially in places where there is war, famine, and poverty. The infected peasants served as a source of infection, and their lice were effective vectors. Typhus is not the same as typhoid fever, which is a water-borne disease caused by a bacillus, Salmonella. Today we know the causative agent of typhus to be Rickettsia prowazekii, related to R. rickettsii, the organism that produces Rocky Mountain spotted fever. It is human lice—including the body louse Pediculus humanus corporis and the head louse Pediculus humanus capitis, as well as the crab louse Phthirus pubis—that are involved in rickettsial transmission of typhus from human to human by means of fecal contamination of the bite wound. Typhus is not dead. It will live on for centuries, and it will continue to break into the open whenever human stupidity and brutality give it a chance, as most likely they occasionally will. But its freedom of action is being restricted and more and more it will be confined, like other savage creatures, in the zoological gardens of controlled diseases.
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Chapter 7 : Malaria, Another Fever Plague
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Malaria is a fever plague, and it has been said that this disease has killed more than half the people who have ever lived on this planet. Today, every 10 seconds a person dies of malaria—mostly children under the age of 5 living in Africa. Worldwide malaria infections are on the rise, and as the fever plague spreads, it will continue to affect us in the places we live, work, travel to, and fight in. The human malarias caused by Plasmodium falciparum, P. vivax, P. ovale, and P. malariae are transmitted through the bite of an infected female anopheline mosquito when, during blood feeding, she injects sporozoites from her salivary glands. All of the pathology of malaria is due to parasite multiplication in erythrocytes. The primary attack of malaria begins with headache, fever, anorexia, malaise, and myalgia. P. falciparum infections are more severe and, when untreated, can result in a death rate of 25% in adults. Complications of malaria include kidney insufficiency, kidney failure, fluid-filled lungs, neurological disturbances, and severe anemia. Mosquito transmission of malaria is dependent on a complex array of factors, including the incidence of infections in the human population, the suitability of the local anopheline population—density, breeding and biting habits, the availability of susceptible or nonimmune hosts, climatic conditions, and the local geographic and hydrogeographic conditions that contribute to mosquito breeding sites. The major threat of malaria today is not an increasing range of endemicity, but rather a rise in the intensity of antimalarial drug resistance.
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Chapter 9 : Smallpox, the Spotted Plague
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Smallpox was at one time one of the most devastating of all human diseases, yet no one really knows when smallpox began to infect humans. The best evidence of smallpox in humans have found in three Egyptian mummies, dating from 1570 to 1085 BC. The first outbreak of smallpox in the Americas was among African slaves on the island of Hispaniola in 1518. There are two pathologic varieties of the smallpox virus: Variola major and Variola minor. In the 17th century, smallpox was Europe's most common and devastating disease, killing an estimated 400,000 each year. With the outbreak of war in 1775, the most dangerous enemy the colonists had to fight was not the British but smallpox. Eradication of smallpox was possible for three reasons: First, there were no animal reservoirs. Second, the methods of preserving the vaccine proved to be effective. Third, the vaccine was easily administered. Smallpox is the first and only naturally occurring disease to be eradicated by human intervention. Smallpox also provided the incentive for the development of protective measures (variolation and vaccination), affected the cultural responses to disease, and contributed to the establishment of more humane public health policies. The eradication of smallpox has demonstrated that through vaccination there is the possibility for the elimination of other infectious diseases that continue to plague humankind.
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Chapter 10 : Preventing Plagues
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The Plague of Athens, described by Thucydides, raged for 4 years, during which time 25% of the population died. Many historians regard this plague as a “turning point” in the history of Western civilization. An antitoxin is one of many kinds of active materials found in immune serum after a foreign substance is injected into humans, rabbits, horses, chickens, mice, guinea pigs, monkeys, or rats; the general term for the active material is antibody. Toxoids made from diphtheria, pertussis, and tetanus toxins are used to make a vaccine known as DPT. The Schick test for susceptibility to diphtheria also involves toxoid: a small amount of diphtheria toxoid is injected just under the skin; failure to react (i.e., failure to produce a red swelling—inflammation—at the site of injection) indicates a lack of protective immunity. Antibodies were found to be made up of a large number of amino acids; that is, they were proteins. In immune serum, the gamma globulin is increased, and that is where the antibodies were found. The gamma globulin that contains antibody is called immunoglobulin, because it is produced in response to the antigen, an immunogen. A key to understanding the protective mechanisms of the immune system is an appreciation of the role of the body’s bloodstream and lymphatic system. The majority of vaccines being developed today use new technologies: DNA vaccines and subunit vaccines (purified proteins or polysaccharides), as well as genetically engineered and virus-transmissible antigens.
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Chapter 11 : The Plague Protectors
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Secular medicine, which developed in parallel to the religious approach, is usually dated from the time of the Greeks in the fifth century BC and most often is personified by the physician Hippocrates of Cos. Hippocrates, often regarded as the father of modern medicine, believed there was a rational basis for disease. His theory on the mechanism of disease was based on an imbalance in the body of the four humors (fluids). The majority of people were treated by the literate clergy, especially the monks (who became physicians), women who were acquainted with medicinal plants, and lay surgeons who treated wounds. By 1918, few “old guard Listerians” still believed in antiseptic surgery. At this time (and even before), surgery was an unsafe practice because control of infection (by asepsis and antisepsis) and anesthesia were unknown. Sanitation, antisepsis, asepsis, and anesthesia prevented disease from needlessly destroying human life, but perhaps the most important point of these advances in health and medicine was their influence on the social climate and the greater acceptance and recognition of scientific truths. A review of how one of the more recent antibiotics, sulfa drugs, was discovered shows how its development was linked to aniline dyes. In concert with improvements in immunization, these plague protectors—imperfect as they were and as they continue to be—benefited the health of many people, but regrettably not all of humankind.
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Chapter 12 : The Great Pox Syphilis
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Syphilis was so ubiquitous by the 19th century that it could be considered to be the AIDS epidemic of that era. In the 1700s, syphilis was a dangerous but not an explosive infection. Clearly, either the people were developing an increased resistance, or the disease’s pathogenicity was changing. Port cities with their characteristics of high sexual activity and prostitution provide the locale for the possibility of high transmission rates of sexually transmitted diseases. In the past, diseases such as syphilis were called venereal diseases, or VD. The highly infectious secondary stage does not last very long. Then the patient enters the early latent stage, in which he or she appears to be disease-free, i.e. there are no clinical signs. Indeed, the most dangerous time is during the early latent stage, because the infected individual can still transmit to others. Transmission can also occur by blood transfusion, but this is rare, because the spirochetes do not survive longer than 24 to 48 hours under blood bank storage conditions. Syphilis can be transmitted from the mother to the developing fetus via the placental blood supply, resulting in congenital syphilis; this is most likely to occur when the mother is in an active stage of infection. In the chancre stage, syphilis is rarely diagnosed by growth and isolation of Treponema pallidum itself. Fluorescent antibody absorbed tests and hemagglutination assays are used to confirm a positive nontreponemal (nonspecific) test.
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Chapter 13 : The People's Plague: Tuberculosis
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Tuberculosis is an ancient disease that has plagued humans throughout recorded history and even before. Tuberculosis of the lungs (called pulmonary TB) is the form of the disease we are most familiar with, giving rise to the slang word “lunger". Three mycobacteria, Mycobacterium tuberculosis, M. leprae, and M. avium, are human pathogens that respectively cause TB, leprosy, and a pulmonary disease with swollen glands in the neck. Genetically, M. bovis and M. tuberculosis have been shown to be >99.5% identical, so differences in their pathogenic nature are still to be explained. The increased density of people provided ideal conditions for the aerial transmission of M. tuberculosis and pulmonary TB. Tubercle bacilli are rather robust and can survive in moist sputum for 6 to 8 months. Infection may result if as few as 5 bacteria reach the grape-like clusters of the thin-walled air sacs (alveoli) of the lung. Primary tuberculosis is a self-limiting infection that often goes unnoticed: it appears to be a cold, and usually there is little impairment of lung function. If there is a protective immune response, which occurs in 85 to 90% of cases, the disease may progress no further, calcification of the tubercles may take place, and the tuberculin test remains positive. Chest X rays show tubercles and fluid in the lung, and sounds of gurgling and slush can be heard through a stethoscope placed on the chest.
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Chapter 14 : Leprosy, the Striking Hand of God
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The pandemic of leprosy reached epidemic proportions in the 12th century and had its peak in Europe in the 13th and 14th centuries; records showing the construction of 19,000 lazarets document this increase in leprosy in Europe. The disease involves cell-mediated immunity with T-helper cells and interleukin-2 secretion in tuberculoid leprosy, but since the bacteria multiply within the Schwann cells that insulate the nerve, there is damage to the nerves, and anesthesia results. In lepromatous leprosy, the T-helper cells do not respond to the bacilli—gamma interferon is not produced, macrophages are not activated, and as a consequence the bacteria multiply within the macrophages and the disease spreads with multiple organ involvement, leading to facial deformity and blindness. Mycobacterium bovis BCG vaccination for tuberculosis has had a positive effect on leprosy by reducing the incidence by 20 to 80%. The vaccine stimulates the immune system of leprosy patients by disrupting immune tolerance and provoking an immune response that kills and clears M. leprae from the body. Leprosy has been a dreaded and disfiguring disease since time immemorial. Although today we know that for transmission to occur there must be prolonged contact with the infected individual, and that the disease is curable, one still does not know the precise mode of transmission or how nerves are destroyed. But, most important, as with AIDS, one still does not know how to completely remove its stigma from the consciousness so that discrimination of those afflicted is abandoned.
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Chapter 15 : Six Plagues of Africa
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One of the most deadly African diseases is sleeping sickness. It is undoubtedly of African origin and today remains indigenous to that region. Inoculation of blood containing trypanosomes into healthy animals produced surra. Trypanosoma gambiense gives rise to a mild chronic infection found in western and central Africa and is transmitted by riverine species of Glossina (G. palpalis and G. tachinoides) that are associated with human habitation. Asymptomatic individuals may harbor parasites in the blood for long periods of time and could be a source of infection for the vector. The disease is an anthroponosis: fly, to human, to fly, to human. T. rhodesiense is the East African form and is the more virulent subspecies, producing an acute infection. The spread of sleeping sickness was increased about 1890 because of another infection brought into Africa by cattle from outside the continent: rinderpest, a virus of cattle and game with high mortality. Treatment of sleeping sickness is of limited value and depends on early use of rather toxic drugs administered intravenously. Pentamidine, melarsopol, and suramin are all used. River blindness is transmitted by a blackfly called Simulium damnosum, which carries the microscopic infective juvenile stages (called microfilaria) of Onchocerca. The economic and social consequences of river blindness are profound, and surely much of the local history is tied to the progressive depletion of human resources.
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Chapter 16 : Plagues without Germs
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The red plague, pellagra, is a disease almost unheard of today but, in its time, it was a killer. The flaming of the skin was the signature of the disease, but a loss of balance, a staggering gait, and senseless mutterings also characterized the disease. An epidemiological study conducted by Goldberger and his associates from 1917 to 1921 showed that the lower the income, the greater the incidence of pellagra. In 1916, Joseph Goldberger organized "filth parties", where gelatin capsules were filled with the skin scrapings, urine and feces from pellagra patients, and each volunteer swallowed a capsule. None became ill with pellagra. The red plague of pellagra was a plague of corn: hominy grits, corn mush, and corn bread all lack the P-P factor. Once the dietary cause was appreciated, the key to understanding the disease of pellagra had been found. The P-P factor was heat-resistant and was contained in dried brewer’s yeast. Yeast would both prevent and cure pellagra. Nicotinic acid and its amide were renamed niacin. Niacin, a water-soluble B vitamin, was the specific preventative of black tongue and pellagra, and it was Goldberger’s P-P factor. Pellagra clearly shows that the proposal that microbes cause all diseases is misleading. Some diseases are related to the food eaten and to economic conditions. The many-feathered story of identification of the cause of beriberi once again demonstrates how, on occasion, even the best prepared scientific sleuth can be handicapped by adherence to prevailing dogma—germs as the cause of disease.
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Chapter 17 : Plagues on Order
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Many factors lead to the emergence of infectious diseases, some of which are obvious: a change in a parasite’s virulence, a breakdown in public health and surveillance measures, a change in human behavior, crowding, alterations in the environment, technological advances, economic downturns, poverty, and even something as innocent as foreign travel for a vacation. The disease is more prevalent in men than in women, probably as a result of the greater occupational exposure of men to rodents. Human-to-human transmission did not occur, but one wonders what would have been the result if the virus had acquired the capacity for pulmonary transmission, as happened with pneumonic plague. West Nile virus (WNV) was first isolated in 1937 from the blood of an infected woman in the West Nile country of Uganda. The woman had a rapid onset of fever, headache, backache, muscle pains, and anorexia. The most significant factor in all of the outbreaks was the involvement of the common house mosquito Culex pipiens as the vector. It is likely that WNV will advance through the United States within the next several years, and its path of death will be marked by the local and regional flyway patterns of virus-infected birds. Although sheep farmers tended to believe that scrapie was a hereditary disease, there was now mounting evidence that transmission was by sheep eating the afterbirth of an infected animal or grazing in a pasture where infected animals had been kept.
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Doody Enterprises
17 August 2013
At A Glance
"The Power of Plagues" offers a fascinating examination of epidemic diseases within a historical context. Engagingly written, this new volume presents the science of plagues in an understandable and accessible manner, describing the nature and evolution of diseases and conveying their significance in shaping Western culture and civilization. Chapters present individual, independent plague stories complemented by relevant and historical illustrations. Major historic outbreaks are covered, including those of the Greek and Roman empires as well as the infamous Black Death. Contemporary and emerging diseases are comprehensively detailed, including HIV-AIDS, tuberculosis, malaria, smallpox, SARS, West Nile virus infection, influenza, mad cow disease, and several others. Despite advancements in the development of antimicrobials and vaccines and in securing clean water and food supplies, modern civilizations are not immune to epidemic diseases. "The Power of Plagues" provides insight into the struggle to attain disease control and eradication and explores the challenge of forecasting emerging plagues. In doing so, it offers readers a deeper understanding of modern public health issues and the role of infectious diseases.
Description
The author's goal with this book is to help readers understand the impact that outbreaks of disease have had on the course of history. He is skilled at summarizing complex political events and describing how plagues influenced the outcome. The book is written in an interesting style, but it would have been improved by having a person with a strong medical and public health background review the content. Important concepts, such as how control of latent tuberculosis prevents spread of the disease, are not mentioned.
Purpose
The purpose is to describe the nature and evolution of diseases and to show how the past can help us prepare for future encounters with infectious diseases. These are worthy objectives and the book will be of interest to the lay reader and might have a place in the curriculum of public health students. The book meets the author's objectives, although the facts of medical science as understood today are not always stated correctly.
Audience
Although the author does not describe the intended audience, one may assume that it consists of persons who do not have a strong medical background, because of the care taken to describe technical terms that a medical professional would already know. It is my impression that a well-educated lay audience is the main target of this book. If the description of the medical aspect of the diseases of interest were more accurate, this book would be suitable for use as a text for classes on public health topics.
Features
The book covers a broad range of diseases, with the common theme being the lessons to be learned from understanding what happened. It is written in an entertaining style. The photographic illustrations are chosen carefully and help explain the text. The description of historical events is brief but illustrates the point the author wants to make. The main shortcoming is the author's failure to check medical facts. In some cases, the error is minor but in at least one instance, an important point was missed.
Assessment
The quality of the book is moderately high. It makes history and medical science interesting and accessible for an audience that might not otherwise attempt to read about these topics. I'm not sure it should be used as a textbook unless its errors were to be corrected.
Doody Enterprises
Reviewer: Susanna Von Essen, MD (University of Nebraska Medical Center)
Review Date: Unknown
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