A treatment of the world's ills, even Napoleon's piles

Disease and History
August 24, 2001

This is a revised and enlarged edition of a book published in 1972. Its authors are a medical historian (Frederick Cartwright) and a social historian (Michael Biddis). This is a suitable duo for a composite topic that embraces, at one extreme, the pandemics that have afflicted mankind since earliest time and are remembered for their fearsome mortalities and, at the other, the case histories that take their importance from the status of the individual - for example, Henry VIII, whose syphilitic infection as transmitted to his children seems to have brought the Tudor dynasty to a premature though not inglorious end.

Sandwiched between are a host of less well-defined disorders. Should we include Joan of Arc (on the ground that she heard voices) or Hitler (on the grounds of paranoia) or indeed the German people in the interwar period (on the ground that events had made them unusually suggestible)? Allow all three, as the authors do, and you have a book that is in danger of becoming a button box, a higgledy-piggledy collection of large and little, coloured and plain, and things that maybe are not buttons at all.

The authors' response is to fit their box with chronological partitions. This works best in the book's middle section, where syphilis, smallpox and cholera are treated in successive chapters focused respectively on the 16th, the 17th and 18th, and the early 19th centuries. The accounts of these diseases are conspicuously well done. You could not ask for a better precis of the variolation and vaccination programmes evolved for the prophylaxis of smallpox in the 18th century, and the public-health effort that backed them up and culminated with the disease's elimination in 1979.

Typhus finds no easy place in this sequence. Perhaps because of this it has to share a chapter with Napoleon, who suffered from piles and the sort of personality deterioration common in autocrats - but not typhus. Still, Napoleon's story is always worth telling, and good asides are acceptable compensation for the odd systems failure.

The section on tuberculosis, dubiously linked with gin and flu as diseases of overcrowding and industrialisation, is redeemed by an account of John Keats's brief existence. Hackneyed it may be, but it is difficult not to be moved by the tale of the pale youth watching with his friends as his life, and his great gifts, ebb away. A fledgling medical man as well as a poet, he had read his fate in his handkerchief. "I know that colour - it is arterial blood. I must die." And so he did, a year later, at the age of 25.

The disease least comfortable in its chronological allotment is bubonic plague, which is tied to the mid-14th-century episode known to history as the Black Death. The mechanism of spread was not understood then, and has its uncertainties today, but the thesis propounded here - that when a certain threshold is reached the disease becomes pneumonic, with dire consequences all round - is unlikely and unnecessary. In the Indian epidemic of 1896-99, the last outbreak of medieval proportions, it was found that plague quickly died out if villagers were evacuated to temporary camps in the open country. They could even be allowed home in the daytime without ill-effect. It was only if they spent the night there - where the house-bred, host-deprived, heat-seeking rat fleas could find them - that the disease reappeared. The conclusion is pretty clear: people alone are not a sufficient pabulum for plague; it requires a constant input of infected rat fleas to sustain it.

It is a pity that the book's procrustean divisions preclude any discussion of these observations, as, perhaps more surprisingly, they prevent the label bubonic from being attached to the plague of the Philistines, because it occurred in an earlier period and so falls in an earlier chapter.

Considering that this is a compilation, almost an encyclopedia in fact, there are very few slips, but a book's opening paragraph is a bad place to make a howler. Any reprint should omit the claim that the Chinese Great Herbal - the earliest known textbook of medicine - dates from "about 3000BC": this puts it some 1,800 years earlier than the invention of the Chinese script. The publisher should also do something about the illustrations, which are pointless. That said, this is a book that earns its place on the library shelves as a useful introduction to a vast subject.

Colin McEvedy is the author of The New Penguin Atlas of Medieval History .

Disease and History: The Influence of Disease in Studying the Great Events of History

Author - Frederick F. Cartwright and Michael Biddis
ISBN - 0 7509 2315 6
Publisher - Sutton
Price - £20.00
Pages - 230

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