#819 Pandemics past and present

Epidemics and the Modern World
by Mitchell L. Hammond

Toronto: University of Toronto Press, 2020
$54.95 / 9781487593735

Reviewed by Jody Decker

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This textbook by a history professor at the University of Victoria, Mitchell Hammond, focuses on epidemics of infectious diseases which, he argues, have left the greatest impact on the modern world, even ahead of wars, and it is our modern world that has led to an increase in the emergence of these diseases. Epidemics mirror who we are as human beings. They expose our morality, our political and economic priorities, our choice of social structures such as public health, the degree to which we accept and even normalize poverty, inequality, and racism, and they are a reflection of our relationship to the built and natural environment. Hammond’s aim is to explore how infectious diseases have shaped and have been shaped by societies in our modern world.

This is an ambitious yet curious textbook. Hammond is an historian, so predictably the text moves chronologically through eleven main chapters from the 14th century to the present, a time period he has chosen as the “modern world.” Although the germ theory of disease and its inception predominate this time frame, he provides necessary background information to previous disease concepts such as humoral (Galenic) medicine and miasmas from antiquity.

In order to engage readers of all levels and interests, each chapter consists of images, figures and maps, compelling narratives, helpful “science focus boxes” discussing scientific concepts and technologies, structured workshop sections that consist of primary sources, questions on interpretation that make connections and trends with those documents, a glossary, and suggestions for further reading and viewing. The assertion that such a text is suitable for an eclectic audience is indeed ambitious, but it mostly succeeds in that it amasses a lot of information, parts of which often read like a literature review, but which on the whole blend well into the narrative. Yet the book is clearly aimed at historians and the work they do. Over the last few years, a spate of new texts and books have appeared on individual emerging infectious diseases, zoonoses and ecology, epidemiology, and on epidemics and society; but still, Hammond’s reading list is primarily historical.

Epidemics and the Modern World does not purport to be a comprehensive history of medicine. And herein lies the problem with such a text: what topics do you choose to discuss? The usual criteria are issues of manageable length and topics that are representative of your argument. Hammond’s chapter on the 1918 pandemic influenza offers a short exploration of this global event that killed millions; but in its conclusion, he writes that it “carried no lessons about the differences between societies and environments” (p. 337), which is a surprising statement given the virus’s seasonality propensity, its transmission modes, the “othering” of some societal groups that arose from this pandemic, and its diffusion patterns through various cultural groups. Instead, he argues that it is tropical diseases that signified increasing gaps between nations and thus we have chapters on malaria and yellow fever. One chapter, “Illness, Disability and the Struggle for Inclusion,” is on polio with its focus on immunization reluctance. Other chapters are on the bubonic plague, smallpox, tuberculosis, rinderpest, and a final chapter on HIV/AIDS. It would have been more practicable to combine his early chapter in the text on syphilis (“Sex, Gender, and the Pox of Many Names”), with the chapter on HIV/AIDS, as both shed light on the theme of sexually transmitted infections.

The inclusion of smallpox is critical in such a text as it is one of the few good news stories in humanity’s triumph of eliminating a killer virus. But why rinderpest, a disease of livestock and a close human relative to measles and canine distemper? This chapter aptly illustrates the dynamics of zoonotic outbreaks, diseases that can spill over from animals to humans, just as COVID-19 has done. The Atlanta-based Centers for Disease Control and Prevention now estimates that three out of four emerging infectious diseases are zoonotic. Rinderpest killed millions of animals and had a profound social impact on the inhabitants of Africa and Southeast Asia, an economic impact on animal husbandry and on the agricultural economy, and forced an ecological transformation of the landscape. United Nations agencies played a key role in the eradication of this disease from nature and Hammond’s accounts of such agencies and their role in a globalized world is instructive throughout Epidemics and the Modern World.

Curiously, three infectious diseases that started off the 21st century and woke up the modern world, SARS, Ebola, and Avian influenza, warrant only passing references here. In fact, if you did not know that SARS stood for “severe acute respiratory syndrome,” as it is listed in the index, you would not have found it at all. On the first page in the Introduction, Hammond fleetingly mentions SARS as the emergence of a “new problem because the social, ecological, and environmental changes of the last several centuries have transformed the planet’s landscapes of health and illness” (p.1). He mentions SARS again in a paragraph in the conclusion around debates on control of epidemics and health resources. The 2003 SARS pandemic offered us an opportunity to understand how one person makes a difference in disease transmission, how societies plan for future pandemics, and why data-sharing in a global world where diseases do not recognize boundaries, is critical. Most importantly, it gave us all insight into where these diseases emerge from and how they can be contained. Canada and its health care system played a huge role in this pandemic, not least because 44 people died. Despite that, several of the lessons learned fell largely on deaf ears, and a chronically underfunded and under-appreciated public health system is now struggling to manage this latest pandemic.

Mitchell Hammond. Photo by Philip Cox

I wish Hammond had titled this book more convincingly; it is, above all, about relationships. These epidemics are complex, interdisciplinary relationships that help us reflect on continuity or change, causes and consequences, and longer term processes vs triggers (such as the recent introduction of COVID-19 into the world, which has left science scrambling to develop a vaccine). The concepts he uses on relationships to infectious disease range from institutions, such as public health, to migration, to perceptions of suffering, sexuality and disability, and ecological changes. This latter point is one of the key concepts Hammond explores, but at times he stretches these relationships, for example when he reviews the genome sequence of syphilis and yaws. In one large leap, he writes, “the diseases caused by each probably reflect the influence of climate change … changes in the environment may have influenced the spread of a new scourge as much as changes in the pathogen’s genome signature” (p. 60). This relationship is much clearer in the case of malaria, a vector-borne disease whose natural nidus is shifting due to more northern and environmental hospitable habitats as these areas warm up.

Wood engraving by John Warner Barber, 1853

While there are a few references to Canadian situations and experiences, and scattered references to Indigenous peoples (one of the workshops focuses on Indigenous people, Jesuit Missionaries, and smallpox), the text is primarily written from an Anglo-European perspective. Besides SARS, there have been other opportunities for Hammond to have been generous with Canadian-focused examples, such as the smallpox epidemic in Montreal in the 1880s and the tuberculosis epidemic among the Inuit in the 1940s.

Overall, Epidemics and the Modern World is varied in its usefulness to a wide audience. Its chronological format leaves it scattered in topic and detail. For example, a lengthy discussion of Pasteur and the germ theory is somewhat lost in the middle of a chapter on cholera and the industrial city. Moreover, the maps lack any referenced sources. While the final chapter of Epidemics and the Modern World appropriately focuses on emerging infectious diseases, at only five pages it is agonizingly short as a summary of the themes explored, including the relationships between zoonotic diseases and their relationship to our modern world. This brief summary seems unworthy of the length of the book (519 pages), the many topics it covers, and what it attempts to accomplish.

Perhaps this textbook attempts too much. However, the social determinants of pandemics, the ecologies of human infectious diseases, the search for origins and subsequent transmissions of viruses, the public health implications, and complacency in the usage of antibiotics and resistance to immunizations, are all prescient topics. Like most sweeping accounts of the history of infectious diseases, Epidemics and the Modern World does not purport to be inclusive, but it is a practical addition to this genre and offers up a readable array of instructive insights.

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Jody Decker

Dr. Jody Decker combined a career in acute care nursing with a doctorate (York University) and post-doctorate (Queen’s University) to specialize in medical geography. Her extensive teaching interests, ranging from geographic thought and methodology, to cultural heritage landscapes, to native issues and to geographies of health and disease, led to a National Excellence in Teaching Geography Award by the Canadian Association of Geographers. She was also the recipient of a Queen Elizabeth 11 Diamond Jubilee Medal for her work with the Royal Canadian Geographic Society. Jody Decker specializes in infectious diseases with research interests on the impact of historical infectious diseases on Native groups in Canada, concepts of disease and illness, the use of evidence from historical infectious disease outbreaks, and more recently, surface microbial loads and infection control plans in high-density universities. Decker also reviewed Beyond Germs: Native Depopulation in North America (University of Arizona Press, 2015) for The Ormsby Review (no. 106, March 18, 2017). Recently retired from Wilfrid Laurier University, she lives in Toronto.

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