The Power of Plagues, Second Edition

The American Journal of Tropical Medicine and Hygiene Review

05 March 2019

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

18 April 2018

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

18 April 2018

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