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Category: History of Science; General Interest
The Power of Plagues is now available on Wiley.comMembers, use the code ASM20 at check out to receive your 20% discount.
How pathogenic microorganisms have shaped human civilization
The Power of Plagues presents a rogues' gallery of epidemic-causing microorganisms placed in the context of world history. Author Irwin W. Sherman introduces the microbes that caused these epidemics and the people who sought (and still seek) to understand how diseases and epidemics are managed. What makes this book especially fascinating are the many threads that Sherman weaves together as he explains how plagues past and present have shaped the outcome of wars and altered the course of medicine, religion, education, feudalism, and science. Cholera gave birth to the field of epidemiology. The bubonic plague epidemic that began in 1346 led to the formation of universities in cities far from the major centers of learning (and hot spots of the Black Death) at that time. And the Anopheles mosquito and malaria aided General George Washington during the American Revolution. Sadly, when microbes have inflicted death and suffering, people have sometimes responded by invoking discrimination, scapegoating, and quarantine, often unfairly, against races or classes of people presumed to be the cause of the epidemic.
Pathogens are not the only stars of this book. Many scientists and physicians who toiled to understand, treat, and prevent these plagues are also featured. Sherman tells engaging tales of the development of vaccines, anesthesia, antiseptics, and antibiotics. This arsenal has dramatically reduced the suffering and death caused by infectious diseases, but these plague protectors are imperfect, due to their side effects or attenuation and because microbes almost invariably develop resistance to antimicrobial drugs.
The Power of Plagues provides a sobering reminder that plagues are not a thing of the past. Along with the persistence of tuberculosis, malaria, river blindness, and AIDS, emerging and remerging epidemics continue to confound global and national public health efforts. West Nile virus, Lyme disease, and Ebola and Zika viruses are just some of the newest rogues to plague humans.
The argument that civilization has been shaped to a significant degree by the power of plagues is compelling, and The Power of Plagues makes the case in an engaging and informative way that will be satisfying to scientists and non-scientists alike.
Paperback, 494 pages, full-color illustrations.
Disease can be a personal affair. Peter Turner, a World War II veteran, was a commander of the Pennsylvania Division of the American Legion. In the summer of 1976, Turner, a tall, well-built 65-year-old, decked out in full military regalia, attended the American Legion convention in Philadelphia. As a commander, Turner stayed at the Bellevue-Stratford Hotel, headquarters for the meeting. Two days after the convention Turner fell ill with a high fever, chills, headache, and muscle aches and pains. He dismissed the symptoms as nothing more serious than a “summer cold.” His diagnosis proved to be wrong. A few days later he had a dry cough, chest pains, shortness of breath, vomiting, and diarrhea. Within a week his lungs filled with fluid and pus, and he experienced confusion, disorientation, hallucinations, and loss of memory. Of 221 fellow Legionnaires who became ill, Commander Turner and 33 others died from pneumonia. The size and severity of the outbreak, called Legionnaires’ disease, quickly gained public attention, and federal, state, and local health authorities launched an extensive investigation to determine the cause of this “new” disease. There was widespread fear that Legionnaires’ disease was an early warning of an epidemic. Though no person-to-person spread could be documented, few people attended the funerals or visited with the families of the deceased veterans.
In Stanley Kubrick’s classic film 2001: A Space Odyssey, Richard Strauss’s music (“Thus Spake Zarathustra”) provides a haunting and frightening background to the sequence of scenes that represent the dawn of humanity. The sun rises on a barren African savannah. A band of squat, hairy ape-men appear; they eat grass. Though herds of tapirs graze close by, the ape-men ignore them, since the means and the tools necessary to attack or kill the tapirs have not yet been developed. These ape-men are vegetarians who forage for roots and edible plants. On the dawn of the second day, the ape-men are seen huddled around a water hole; the landscape is littered with bones. One, the leader of the group, picks up a bone, smashes the skeleton of an antelope, and then the bone is used to kill a tapir (Fig. 2.1). Shortly thereafter, the raw pieces of tapir flesh are eaten and shared by other hairy apelike creatures, members of the clan. At the dawn of the third day, the meat-eating, tool-using man-apes drive off a neighboring band of apelike creatures. Bone tools used for killing animal prey are now used to threaten and drive off rival tribes. In slow motion, accompanied by the slowly building tones of Strauss’s music, the leader of the man-apes flings his weapon, a fragmented piece of bone, into the air. It spins upward, twisting and turning, end over end. There is a jump cut of 4 million years into the future, and the bone dissolves into a white, orbiting space satellite. Kubrick’s science fiction film has been described as a countdown to tomorrow, a visual masterpiece and a compelling drama of human evolution. Absent from the film is an examination of how the enlightened roving bands of early apelike humans settled down and become increasingly disease-ridden. Here is that part of the story.
As humans changed their lifestyles, their relationship with infectious diseases came to be altered. For 2 million years these human populations consisted of small groups of hunter-gatherers with limited contact with other such groups, and there were no domesticated animals. Such a population structure, with little or no exposure to new sources of infection and where parasite survival and transmission were minimized, led to a situation in which epidemic diseases were virtually nonexistent. Indeed, only those diseases with very high transmission rates that induced little or no immunity, as well as macroparasitic diseases that did not involve vectors for transmission and sexually transmitted diseases, were able to establish themselves in the groups of hunter-gatherers. Although some vector-borne diseases, such as malaria and yellow fever, may have been present at this stage of human history, it was only after human populations settled down and adopted an agricultural life, or continued a nomadic existence that depended on the husbandry of large herds of animals, that conditions favored the emergence of epidemic diseases (plagues). Historically, plagues (Fig. 3.1) came to be recorded only in our recent past, a time when we became farmers.
During the last 2,500 years, three great plague pandemics have resulted in social and economic upheavals unmatched by armed conflicts or any other infectious disease. In Constantinople, the capital of the Roman Empire in the East, it was the first plague pandemic (A.D. 542-543) that surely contributed to Justinian’s failure to restore imperial unity. In the year 1346 the second pandemic began, and by the time it disappeared in 1353, the population of Europe and the Middle East had been reduced from 100 million to 80 million people (Fig. 4.1). This devastating pandemic, known as the Black Death, the Great Dying, or the Great Pestilence, put an end to the rise in the human population that had begun in 5000 B.C., and it took more than 150 years for the population to return to its former size. Some believe this catastrophic crash in population to be Malthus’s prophecy come true, while others, such as the historian David Herlihy, consider the Black Death to be not a catastrophe promoted by “positive checks” (i.e., disease, war, and famine) but an exogenous factor that served to break a Malthusian stalemate. That is, despite fluctuations in population size, relatively stable population levels were maintained over prolonged periods of time due to “preventive checks” (i.e., changes in inheritance practices, delay in the age of marriage, and birth controls). The Black Death did more than break the Malthusian stalemate; it allowed Europeans to restructure their society along very different paths.
Flesh and muscle melt from the bones of the sick in packed hospital wards and lonely bush kraals. Corpses stack up in morgues until those on top crush the identity from the faces underneath. Raw earth mounds scar the landscape, grave after grave, without name or number. Bereft children grieve for parents lost in their prime, for siblings scattered to the winds. The victims don’t cry out. Doctors and obituaries do not give the killer a name. Families recoil in shame. Leaders shirk responsibility. The stubborn silence heralds victory for the disease: denial cannot keep (it) at bay.
Those attending a New York Philharmonic concert and listening to the cannons, the ringing of church bells, and the melody of “La Marseillaise” in Tchaikovsky’s 1812 Overture probably knew that it was composed in 1880 to mark the opening of the Moscow Exhibition of 1882 and the consecration of the Cathedral of Christ the Savior, built to give thanks for the Russian victory over Napoleon in 1812. They may have also known from the program notes that the first performance was given on August 20, 1882, to celebrate the 70th anniversary of Russia’s victory over Napoleon and that it was a great success. Although even today audiences continue to be impressed by the power of the work, Tchaikovsky felt little enthusiasm for it, and had it not been for a very lucrative commission, he probably would never have composed the overture. Everyone at the performance of the Philharmonic, conducted by Leonard Bernstein, was aware that the defeat of Napoleon, set to music, dealt with the impact of war on the people, the bravery of the Russian soldiers, and the role of the Russian winter, and that it celebrated the glory of the people of Russia. Few in the audience, however, would have known that the Russians had another ally—typhus fever—and that it was this disease that contributed in a significant way to Napoleon’s downfall (Fig. 6.1).
I wanted to sit up, but felt that I didn’t have the strength to, that I was paralyzed. The first signal of an imminent attack is a feeling of anxiety, which comes on suddenly and for no clear reason. Something has happened to you, something bad. If you believe in spirits, you know what it is: someone has pronounced a curse, and an evil spirit has entered you, disabling you and rooting you to the ground. Hence the dullness, the weakness, the heaviness that comes over you. Everything is irritating. First and foremost, the light; you hate the light. And others are irritating—their loud voices, their revolting smell, their rough touch. But you don’t have a lot of time for these repugnances and loathings. For the attack arrives quickly, sometimes quite abruptly, with few preliminaries. It is a sudden, violent onset of cold. A polar, arctic cold. Someone has taken you, naked, toasted in the hellish heat of the Sahel and the Sahara and has thrown you straight into the icy highlands of Greenland or Spitsbergen, amid the snows, winds, and blizzards. What a shock! You feel the cold in a split second, a terrifying, piercing, ghastly cold. You begin to tremble, to quake to thrash about. You immediately recognize, however, that this is not a trembling you are familiar with from earlier experiences—when you caught cold one winter in a frost; these tremors and convulsions tossing you around are of a kind that any moment now will tear you to shreds. Trying to save yourself, you begin to beg for help. What can bring relief? The only thing that really helps is if someone covers you. But not simply throws a blanket or quilt over you. The thing you are being covered with must crush you with its weight, squeeze you, flatten you. You dream of being pulverized. You desperately long for a steamroller to pass over you. A man right after a strong attack … is a human rag. He lies in a puddle of sweat, he is still feverish, and he can move neither hand nor foot. Everything hurts; he is dizzy and nauseous. He is exhausted, weak, and limp. Carried by someone else, he gives the impression of having no bones and muscles. And many days must pass before he can get up on his feet again.
“It was 1901. … The revolver was cold, like the grave. … The bullets nestled in their chambers. Max von Pettenkofer caressed the metal with liver-spotted hands. The gun was heavy. He put the muzzle to his temple … there was no audience. The shot echoed off the walls and down the hall. The last of the miasmatists slumped forward, blood pouring onto the desk.”
In 1521 the subjects of the Aztec Empire numbered in the millions. Incredibly, Hernan Cortes, with fewer than 600 troops, was able to topple it. The Aztecs were militaristic and wealthy, having subjugated other indigenous Indian tribes and then extracted tribute from them. Cortes and his Spanish conquistadors set out to explore and claim Mexico for their king, Charles V. They landed in the Yucatan on the eastern coast of Mexico. With their armor plate, swords, horses, rifles, cannons, and attack dogs, they appeared to the Aztecs as a formidable fighting force. They moved toward the Aztec capital Tenochtitlán (now Mexico City) without much incident, but at Tenochtitlán there were encounters that showed the limitations of guns, steel, and horseflesh. The outnumbered Spaniards lost one-third of their troops, and Cortes and his army were forced to retreat. Cortes expected a final and crushing offensive by the Aztecs, one that would result in their complete defeat. The attack never came. On August 21 the Spaniards stormed the city, only to find that a greater force had ensured their victory. Bernal Diaz, witness to the scene, wrote:
I solemnly swear that all the houses and stockades in the lake were full of heads and corpses. It was the same in the streets and courts. … We could not walk without treading on the bodies and heads of the dead Indians. I have read about the destruction of Jerusalem, but I do not think the mortality was greater there than here in Mexico. … Indeed the stench was so bad that no one could endure it … and even Cortes was ill from the odors which assailed his nostrils.
The year was 430 b.c., and Athens was being devastated by a plague. The Greek historian Thucydides wrote:
The infection first began, it is said, in parts of Ethiopia above Egypt and thence descended into Egypt and Libya and into most of the king’s country (i.e., Persia). Suddenly falling upon Athens, it first attacked the population in Piraeus … and afterwards appeared in the upper city, when the deaths became more frequent. Fear of gods or laws of men there was none to restrain them. As for the first, they judged it to be just the same whether they worshipped them or not, as they saw all alike perishing. As for the latter, no one expected to live to be brought to trial for his offenses … even the most staid and respectable citizens devoted themselves to nothing but gluttony, drunkenness and licentiousness.
As he watched his beloved wife Virginia dying from tuberculosis, Edgar Allan Poe penned the following lines:
“The Red Death” had long devastated the country. No pestilence had ever been so fatal, or so hideous. Blood was its Avatar and its seal—the redness and the horror of blood. There were sharp pains, and sudden dizziness, and then profuse bleeding at the pores, with dissolution. The scarlet stains upon the body and especially upon the face of the victim, were the pest ban which shut him out from aid and from the sympathy of his fellow-men. And the whole seizure, progress and termination of the disease, were the incidents of half an hour.
It was the fall of 1932, and syphilis was rampant in small pockets of the American South. The U.S. Public Health Service began a study of the disease and enlisted 399 poor, black sharecroppers living in Macon County, Alabama, all with latent syphilis. Cooperation was obtained by offering financial incentives such as free burial service, on the condition that they agreed to an autopsy; the men were also given free physical exams, and a local county health nurse, Eunice Rivers, provided them with incidental medications such as “spring tonics” and aspirin whenever needed. The men (and their families) were not told they had syphilis; instead, they were told they had “bad blood,” and annually a government doctor would take their blood pressure, listen to their hearts, obtain a blood sample, and advise them on their diet so that they could be helped with their “bad blood.” These men were not told, however, that they would be deprived of treatment for their syphilis, and they were never provided with enough information to make anything like an informed decision. The men enrolled in the Tuskegee Syphilis Study (as it was formally called) were denied access to treatment for syphilis even after penicillin came into use (in 1947). They were left to degenerate under the ravages of tertiary syphilis. By the time the study was made public, largely through James Jones’s book Bad Blood and the play Miss Evers’ Boys, 28 men had died of syphilis, 100 others were dead of related complications, at least 40 wives had been infected, and 19 children had contracted the disease at birth (Fig. 12.1).
Disease and death are represented by Violetta in Giuseppe Verdi’s opera La Traviata (1853) and by Mimi in Giacomo Puccini’s opera La Bohème (1895). The young heroines are tall, thin, and pale-faced with cherry-red lips and flushed cheeks, and their voices are like those of the nightingale. But Mimi and Violetta are also mysteriously ill with a disease called consumption (from the Latin con, meaning “completely,” and sumere, meaning “to take up”). To those living in the 19th century it seemed natural to link artistic talent to consumption, and Verdi and Puccini were well acquainted with this connection. Other composers and writers such as Keats, Shelley, the Brontës, Chopin, and Schiller were also consumptives. Consumption was characterized in an 1853 medical text as inducing the following features: nostalgia, depression, and excessive sexual indulgence. Indeed, at the time, it was believed that mental activity and artistic talent were stimulated by the poisons of this wasting disease.
There is a morbid interest in and dread of leprosy, largely stemming from frequent references in the Bible. To the readers of the Old Testament, leprosy was an abomination. Job says, “Pity me, pity me, and pity me, you, my friends, for the hand of God has struck me.” Although the Bible does not specify that Job suffered from leprosy, it was assumed that he did, and for a time he was considered the patron of lepers. Indeed, in medieval art Job is always depicted as being covered with black spots, and body spots are also seen in illustrations of lepers (Fig. 14.1). In Leviticus this account of the disease is given: “When a man shall have the skin of his flesh a rising, a scab or bright spot, and it be in the skin of his flesh like the plague of leprosy; then he shall be brought unto Aaron the priest or unto one of his sons the priests.”
Africa, with 12 million square miles, contains nearly one-fifth of the world’s land surface and is 3 times the size of the United States. The real Africa, what some historians have called “Black Africa,” stretches from about 15°N to the Limpopo River Valley in the south. Prior to the 19th century Black Africa had 80 million people. It was virtually unknown to the rest of the world, and for those who knew about it the knowledge was scant or ill informed. The reason for this was that there was little communication with the rest of the world except for brief incursions by the Phoenicians, the Romans on the Nile, and a few Arab caravans in search of slaves. Black Africa also appeared to lack the climatic attractions and plunder of the New World, and it was difficult to penetrate for several reasons. First, there were few deep bays or gulfs for the shelter of ships. Second, most of the rivers were not navigable because of sandbars at the mouth or rapids a short distance upstream. Third, beyond the shore lay miles of impassable mangrove swamps, and further inland was a tropical forest that obliterated the paths of traders, explorers, and natives. Fourth, for the Europeans the climate was oppressive, and there were savage animals, as well as hostile natives, and finally there were parasitic diseases.
“A creature without memory cannot discover the past; one without expectation cannot conceive of a future.” “Those who do not remember the past are condemned to repeat it.”
–George Santayana
Diseases caused by infectious agents can affect the course of human events. They have in the past, and it is certain they will do so in the future. Great plagues, such as the bubonic plague or influenza, can happen again. Plagues are natural and almost predictable phenomena. Although remarkable scientific advances have been made in controlling diseases through sanitation, chemotherapy, antisepsis, antibiotics, improved nutrition, and immunization, we continue to live in evolutionary competition with microbes, and there is no guarantee that we can always beat them at their own game. Lurking out there are germs and worms that may spread to our domestic animals, our domesticated plants, and us. These are the seeds of coming plagues.
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Microbiology nonfiction books tend to fall into the academic category, basically as curated collections of review articles that detail a relatively specialized niche of the field. At the other end of the spectrum lie those books written purely for a general audience that might bring in microbiological themes within a larger scope, usually human health.
To make a theological comparison, the latter can be like reading the book of Ruth (which doesn’t even mention God), and the former like Leviticus (which is filled with laws and measurements related to dealing with God). Both are valuable. The casual, uninitiated reader isn’t usually keen to drown in dry details, while the discerning reader with foundational knowledge might crave something more than a surface skim. The Power of Plagues is an example of a much rarer book that attempts to balance those two extremes. The many readers of this blog who have a deep interest in microbiology or disease – but who aren’t specialists that need to pour over drier minutiae – will appreciate this book, now in its second edition.
Sherman, a Professor Emeritus (UC Riverside), Visiting Professor (UCSD), and researcher into the biochemistry of malaria has the background to give readers microbiological details. And he frequently does so, such as when discussing mechanisms of artemisinin activity and resistance in Plasmodium. But he avoids going too deeply into that rabbit hole of scientific detail, or getting caught up in the style of academic review articles. Instead he writes with a straight-forward and naturally flowing text that emphasizes historical anecdotes and cultural references. For example, in a chapter on Yersinia pestis, Sherman describes actions taken by the Venetian Republic to restrict dis-embarkment from cargo ships for 40 days (a quaranta that gave rise to our word quarantine). Soon after he discusses cultural impacts of the Plague, from Bruegel paintings to Monty Python and the Holy Grail.
The Power of Plagues devotes most of its chapters to the stories of a specific pathogen/disease that has affected humans on a large scale through outbreak or epidemic. Most of these 'plagues' are bacterial (e.g. Cholera, Typhus, Leprosy), with HIV and Smallpox featured from the viruses, and a chapter on malaria including the sole featured protist. However, other viruses (e.g. Influenza, Measles) appear in a chapter devoted to Immunization, and Sherman discusses some viruses, protists, and animal parasites within chapters entitled "Six Plagues of Africa" and "Emerging and Re-Emerging Plagues." As far as I can recall, fungi don’t appear, besides being mentioned as secondary AIDS-related infections. Given the increasing problems of fungal infection to animals in general (including humans), I find this unfortunate.
The strong focus of each chapter is a strength of the book, one that makes it not only a good book for general reading, but also for use in classes with specific chapters as supplemental material, or the entire text in a history of disease survey. However, the organization of the chapters themselves in the book perplexes. The book opens and closes with reasonable topics. But in between, the chapters are placed seemingly randomly.
The first chapter defines "The Nature of Plagues," and the two that follow provide historical context, one regarding how plague outbreaks are affected by human civilization and then one with a survey of "Six Plagues of Antiquity." The actual microbiological agent responsible for some of these ancient plagues remains controversial in some cases, but Sherman addresses the predominant interpretations and the data that has led researchers to particular conclusions. Unfortunately, this chapter first introduces the problem that some diseases or species are mentioned across different chapters of the book, leading to redundancies in the text.
Rather than continuing on a temporal organization of chapter topics, Sherman follows these chapters of context with one on the Black Death, but then jumps to AIDS, and then to Typhus. In the middle of this disease-specific heart of the book is the aforementioned chapter on immunization and one that follows on antisepsis and antibiotics. The end of the book then features the chapters mentioned above on 'miscellaneous' African diseases and emerging diseases. This last chapter is new to the second edition of The Power of Plagues, and may not be substantive enough to warrant a new copy if you've already read the first. I'm unclear exactly how much other chapters have been updated, although errors from the first edition that were subsequently noted have been corrected.
"Six Plagues of Africa" illustrates, in part, the only significant critique I have of The Power of Plagues, namely that the text often seems outdated in cultural perspective and representation. Lumping these diseases together based on geography and given them only cursory treatment is problematic, when each warrants the same in-depth treatment as the previous topics receive. Similar issues arise in the earlier chapter on AIDS that Sherman ends with ideas that seem stuck in the conservative 1980s.
Despite such criticism, The Power of Plagues is a fantastic read overall, with broad appeal, and could be effectively read in parts and in whatever order desired. It includes appendices that cover biological concepts that might not be familiar to some readers, as well as a bibliography and works cited for those facts that are referenced in text. The full-color photos and illustrations are wonderful, significantly adding a visual perspective to many of the historical events Sherman addresses.
Daniel Haeusser,Small Things Considered Book Review, posted 25 February 2019
https://schaechter.asmblog.org/schaechter/2019/02/book-review-the-power-of-plagues.html
The world is awash in books about disease, and most of these fall into one of two categories. First are the ones with chipper, upbeat (and virtually always incorrect) advice about how “one simple trick,” whether via diet, exercise, supplements, or another practice, can cure all ills and save the reader from the dire medical establishment and Big Pharma. Alternatively, we have what I call “Ebola is coming and we are all going to die” books, which invoke grim statistics about the state of our readiness to deal with the new epidemic that is about to spiral out of control.
Mercifully, Irwin Sherman’s new edition of The Power of Plagues follows neither of these overworked tropes. In the spirit of full disclosure, I should point out that the author and I were colleagues at the University of California, Riverside, for many years, and that he wrote the first edition of the book as an accompaniment to a nonmajors course that he, and later I, taught there. The book, and the course, was designed not only to show student show important human diseases have been in the course of history, but also to teach basic principles of biology such as the differences between bacteria and viruses or the nature of the immune system. Understanding T cells and lymph nodes for their own sake is not nearly as compelling as understanding them because they provide an insight into how vaccination works or why acquired immune deficiency syndrome (AIDS) is so difficult to treat. The book is thus a window into biology motivated by interest in pathogens and how they have changed—and been changed by—human behavior.
The Power of Plagues takes a very loosely historical approach to a host of important diseases, starting with the way that ancient diseases such as tuberculosis, malaria, or measles were facilitated by humans settling down into sedentary communities. It does not attempt to be comprehensive, and readers may find that their “favorite” parasite is left out, but each disease is a fulcrum for making a larger point. Thus, cholera serves to illustrate how microbes were eventually recognized as the cause of many diseases, with a lesson about the classic experiments by Francesco Redi, Lazzaro Spallanzani, and Louis Pasteur along the way (Incidentally, I often ask classes to predict the outcome of the famous swan neck flasks with broth experiments that Pasteur designed; it is surprising how difficult a task they find this, underscoring how nonintuitive the results of such experiments can be.) Smallpox highlights the social context of vaccination, and Sherman notes that compulsory vaccination has a long history. The Germans required that all citizens, and especially members of the army, be vaccinated against smallpox by 1869, whereas no such rule existed in France, with the result that in the Franco–Prussian War, smallpox killed nearly eight times more French than German soldiers.
Every chapter is filled with people who were instrumental in describing, treating, or curing a disease, and although Sherman mentions the usual suspects—Ross, Selman, and Jenner—he also highlights some of the lesser known figures in the history of disease, such as William MacCallum and Eurgene Opie from Johns Hopkins,who used avian malaria to elucidate the life cycle of the blood parasites in humans. He also notes some controversies surrounding major achievements in medical history: why, for example, did Salk, Koprowski, and Sabin not share in the Nobel Prize for developing the polio vaccine? According to Sherman, in Salk’s case, it is because “Salk had broken two of the commandments of scientific research. Thou shalt give credit to others. Thou shalt not discuss one’s work in newspapers and magazines.” It is interesting to reflect on the relevance of the latter statement in this age of social media—if Twitter were available, Salk would have been a formidable tweeter, I suspect, and it likely would have done him more good than harm.
Other controversies are almost consoling to read about because they remind us that acrimony over scientific credit and accomplishments is nothing new, particularly when the conflicts are overlain with nationalism. The Italian scientist Giovanni Battista Grassi demonstrated that mosquitoes transmit human malaria and expected that he—and his country—would be recognized for this groundbreaking accomplishment, but was challenged by the British physician Ronald Ross, whose name is more commonly associated with the discovery. The two squabbled about priority, literally for decades, and it was Ross, but not Grassi, who received the Nobel Prize in 1902.
In addition to chapters centered on particular diseases and their associated concepts (cholera and public sanitation, AIDS and the immune system), The Power of Plagues considers the ways in which anesthesia, antiseptics, and antibiotics transformed medicine. The history of the first is particularly colorful, and Sherman explains that until reliable anesthetics were available, surgeons prided themselves on the speed with which they could accomplish their task. One such surgeon, Robert Liston, is said to have “amputated a leg in two and a half minutes, but the patient died shortly thereafter from gangrene (as was often the case in those days): in addition, he amputated the fingers of his young assistant, who also died later from gangrene, and slashed the coattails of a distinguished surgical spectator, who was so terrified that the knife had pierced his vital organs that he dropped dead in fright. So ended the only operation in history with 300% mortality!” We would all do well to remember those days, as did a Thanksgiving essay by A. J. Jacobs on gratitude from the New York Times, which mused, “Whenever I start to mythologize the past, I repeat a three-word mantra I made up: ‘Surgery without anesthesia.’ (https://www.nytimes.com/2018/11/17/opinion/sunday/thanksgiving-gratitude-thanks.html?action=click&module=Opinion&pgtype=Homepage).
The chapter on syphilis gives a particularly compelling lesson on how public perception of a disease influences the way it is managed; the notion that those who contracted a sexually transmitted infection were to blame for their sins led to misinformation about syphilis being transferred on pens, drinking cups, or toilet seats. Immigrants and sex workers were also targeted as centers of infection, with an anti-sexually transmitted infection effort during World War I resulting in the quarantine of thousands of women living and working near military training sites.
This new edition includes more images, most in color, than the first edition, which was published in 2006. They range from historical illustrations, such as the one showing the first operation conducted with the patient anesthetized with ether, to the obligatory gory photographs of people afflicted with river blindness or Hansen’s disease. The new edition also provides a useful “coda” at the end of each chapter, offering a succinct summary of the major events in history affected by each disease and how the disease illustrates scientific advances.
The book is written for a general audience, and works well as an undergraduate text, although it probably does not have enough biological detail for a class focusing on the biology, rather than the social and historical context, of disease. It makes for good coffee-table browsing, although perhaps not for the overly squeamish (see aforementioned images), and serves as a valuable reminder that plagues, perhaps even more than the poor, will always be with us.
Marlene Zuk, Department of Ecology, Evolution and Behavior, University of Minnesota, Minneapolis, MN
Am J Trop Med Hyg, 100(2), 2019, p. 480-481
Clinical Infectious Diseases Review
The Power of Plagues, second edition, updates the author’s 2006 original work (also reviewed in Clinical Infectious Diseases [1]), and includes all of the first edition’s topics plus an additional chapter, “Emerging and Re-emerging Plagues.” The author states that among his objectives is providing a “status report” on emerging infectious diseases, and indeed this final chapter does include recently emerging pathogens, such as Ebola and Zika viruses. It is unclear to what extent other chapters were revised; the chapter on human immunodeficiency virus (HIV) is particularly outdated. The book is written with topical rather than chronological organization, and the author states that his intent was for the chapters to be more or less independent; however, when read from start to finish, this book felt duplicative and disorganized.
The book begins with several introductory chapters on the nature of plagues and how they have affected human civilizations throughout history. The author then shifts to more disease-focused discussions of plague, HIV, cholera, and smallpox, before diverting back to more general chapters on immunization, antisepsis, and antibiotics (which include tangential sections on various anesthetics), then returning to disease-specific chapters on syphilis, tuberculosis, and leprosy. He concludes with summary chapters on “6 Plagues of Africa” and the aforementioned “Emerging and Re-emerging Plagues.”
The author introduces a number of different historical characters and themes and attempts to to weave them together throughout the book, with limited success. For example, he delves into immunization as relevant to each disease, but then in the chapter focusing on immunization midway through the book, rather than discussing vaccines as a coherent theme, he introduces numerous other diseases, such as measles, mumps, varicella, influenza, and pertussis. Rather than focusing on their contribution to our understanding of immunization, he delves into each in clinical detail that just ends up feeling tangential. Similar to the arrangement of the book as a whole, the organization of each chapter often seems illogical, with historical background, pathogenesis, epidemiology, clinical impact, and prevention often intermixed in a seemingly haphazard fashion.
Where the book proves most interesting is in its discussion of the historical context of each disease and the interplay/competition between different scientists, and the author includes many artistic works that help demonstrate how these diseases were viewed at the time. However, much of this history is interspersed between the various chapters (probably because many of the scientists worked on more than one disease), feeling redundant and making the book unnecessarily long. At nearly 500 pages, it would benefit from tighter editing and focus.
At the same time, despite stating an objective to demonstrate “how past experience can prepare us for future encounters” in the preface (p vii), the author missed opportunities to discuss the response to the 2009 influenza pandemic or to even mention either HIV treatment as prevention or preexposure prophylaxis in the section titled “Control of AIDS” (instead focusing on abstinence, monogamy, and changing risky behavior). Similarly, there is relatively brief discussion of the 2014 Ebola outbreak, without any mention of the cases diagnosed in the United States and the massive public health response that continues to this day. Some material just seems out of place; for example, the introductory chapter includes a brief discussion of the 2015 Disneyland measles outbreak linked to undervaccination, but there is no mention, in the measles or other sections of the immunization chapter, of the antivaccination movement and the threat it poses of disease reemergence.
Unfortunately, this second edition suffers from many of the same problems noted by the reviewers of the first edition [1], including absence of specific references, some frank factual errors (eg, that single-tablet antiretroviral regimens are currently available for $100 per year [p 106]; that only 1 dose of varicella vaccine is recommended for children [p 250]), and lack of clinical insight, with incorrect or outdated statements about clinical treatment (eg, that antiretrovirals are offered only at CD4 cell counts
Overall, those particularly interested in medical anthropology and the historical context of infectious disease outbreaks would find this book worthwhile, along with Jared Diamond’s Guns, Germs and Steel and Steven Johnson’s The Ghost Map. Those interested in a more clinically accurate and relevant text should look elsewhere.
Marci Drees, MD, MS, Christiana Care Health System, Newark, Delaware
Thomas J. Marrie Review
A usual dictionary definition of plague (a highly infectious, usually fatal epidemic disease; a pestilence; https://www.thefreedictionary.com) differs from that used by Irwin W. Sherman in his book The Power of Plagues. To accomplish his purpose in writing this book (“to make the science of epidemic diseases—plagues—accessible and understandable”), Sherman borrows his definition from historian Asa Briggs: “Plagues are a dramatic unfolding of events; they are stories of discovery, reaction, conflict and resilience of local and administrative structures.”
This book is a history of humanity as influenced and shaped by plagues of known and unknown etiology. One of its strengths is also one of its weaknesses. To trace our journey from 4 million years ago to the present, weaving in plagues, people, microorganisms, and advances in technology, is no small feat. However, for the most part, Sherman accomplishes this goal in what is a very readable book that should appeal to a wide variety of audiences. Indeed, it should be read by every student of medicine and the health professions.
Did you know that Pharaoh’s plague and snail fever are the same disease, or that war fever and jail fever are also caused by the same microorganism? Can you name 10 famous people who had syphilis or 20 famous people who died of tuberculosis? Did you know that heroin at one time was a treatment for the very troublesome cough of tuberculosis? Along with the answers to these questions, in this book you will find how plagues shaped history from ancient times to Napoleon’s invasion of Russia to the very modern plagues of HIV/AIDS, influenza, and Lyme disease.
The art or photographic reproductions, usually placed at the beginning of a chapter, are a most powerful method of connecting the reader to what life was like at a given time in history. For example, look at Figure 6.1, Eugen Le Roux’s engraving of Napoleon’s troops in Vilna after the Russian Campaign in 1812, or Figure 5.1, a photograph of Lorraine, age 11, who has AIDS, being comforted by her grandmother.
Errors in the first edition, noted by Rigau-Perez (1), have been corrected. The placement of AIDS in Chapter 5 (A 21st Century Plague, AIDS), immediately after the chapter on the Black Death, is out of order chronologically and disrupts the history timeline. Chapters 10 (Preventing Plagues: Immunization) and 11 (The Plague Protectors: Antisepsis to Antibiotics) could easily be deleted in favor of more detail or artwork. However, these criticisms are minor. The major strength of this book is that it is a very readable history of humanity as shaped by plagues, making it attractive to a wide audience.
Thomas J. Marrie, Dalhousie University, Halifax, Nova Scotia, Canada