Cholera: The Biography (review)

Hans Zinnser crafted the first explicit biography of a disease in his popular book on typhus, Rats, Lice and History (Boston: Little Brown, 1935). Zinsser knew exactly who his subject was, the typhus organism, and sketched to the best of his knowledge its appearance over time and its impact on history. Christopher Hamlin's biography of cholera is less self-assured. His topic is a shifting target, one that carried various meanings in various times and cultures, and his perspective is informed by a modern understanding of the pathogenic organism(s) of cholera as ever shifting and changing identity. Hamlin chooses to focus on ambiguity and confusion, and his story is accordingly richly nuanced and hedged with caveats, rather than offering the sort of simple timeline that Zinsser was able to put forward.

This volume is part of an Oxford University Press series on the biography of disease (which numbers seven subjects at the time of this writing); Johns Hopkins University Press likewise has a biography of disease series. Having written two disease-centered books myself I can say that this approach has its benefits and its difficulties. If nothing else, researching a single disease allows for easy access via indexes. But the historian has perpetually to struggle with the identity of his or her subject. Modern understanding of disease identity may or may not easily map on the concepts of an earlier era. Diseases that cause dramatic, deadly epidemics can usually be recognized by a sudden change in mortality patterns, by a crisis mentality that permeates medical and popular writing. As just one example, Hamlin struggles with the question of whether cholera newly emerged in 1817 from the polluted Ganges Delta at Jessore, or had it smoldered for centuries prior, not distinguished from the many other perennial causes of diarrhea and dysentery. Given modern knowledge about the mutability of the cholera vibrio, and the many nonpathogenic species of related organisms, it seems safe to say that at least a newly virulent type of cholera emerged then, or one newly able to travel globally.

Hamlin is more interested in the meanings attached to cholera than in speculating on its underlying biological history. He concludes, "[C]holera writ large is a work in progress—that it is not just an evolving organism but a composite of ideology, political structures, class relations, systems of food, water and sanitation, of learned knowledge . . . and even of changing environment and climate . . . . It is an evolving historical agent in its own right" (16-17). There is no doubt, Hamlin believes, that "It is in the magnitude of the reaction to it that cholera stands out as the signal disease of the nineteenth century" (4). Hamlin's perspective is largely that of a historian of English public health, and he brings this lens to explore cholera's meaning to the British. The disease was not particularly severe in England, when compared with other countries of the globe, but it was a major problem for British medical thinkers. "Cholera's greatest insult was to progress itself . . . . [C]holera violated a sense of a European identity that was being applied to other places as they succumbed to civilization" (4). Cholera brought into question the liberal agenda, and sharply challenged questions about the proper relation of the poor to the state, and the state to the poor. When broad questions of immigration and colonization were thrown in the pot, cholera engendered deep anxiety and reams of written responses to this "beast from the east" (55).

After taking the discussion of cholera's various rhetorical meanings up to the brink of Robert Koch's demonstration of the cholera bacillus, Hamlin goes back in time to set the stage for this discovery. He provides a particularly lucid account of mid-nineteenth century infectious disease theory that might be usefully excerpted for classroom reading. After describing Koch's work and the confusion that persistently surrounded the disease into the twentieth century, Hamlin...