- The Burdens of Disease: Epidemics and Human Response in Western History
In recent months three historians of medicine have published large works of synthesis. The Burdens of Disease is the last of these to appear, having been preceded by Roy Porter’s The Greatest Benefit to Mankind: A Medical History of Humanity from Antiquity to the Present (1997) and my Epidemics and History: Disease, Power and Imperialism (1997). We three historians take our intellectual nourishment from three very different cultural environments and have written three very different books. Hays lives in Chicago, in the heartland of middle-America; Porter lives in London, the capital of a postcolonial nation still searching for an identity; and I live in Cairo, capital of a country colonized by Britain in 1882.
Hays’s book is divided into twelve chapters. Beginning with Greco-Roman ideas, Hays next examines medieval responses to disease, giving a separate chapter to “the great plague pandemic.” Subsequent chapters treat transatlantic disease “exchanges”; “magic, religion, medicine, and science, 500–1700”; “disease [End Page 489] and the Enlightenment”; cholera; and tuberculosis. Chapter 10 examines the new post-1880s scientific view of disease and “the triumph of professional medicine,” followed by chapters on “the apparent end of epidemics” and “disease and power.” Though Hays tells us on p. 7 that “the impact of disease on Western civilization . . . is the central theme of this book,” in chapter 9 he examines “disease, medicine and Western imperialism.” This, I presume, can be justified by the assumption that the diseases of colonialized and post-1960s neocolonialized Others (if not entirely ignored by Westerners) affect Westerners’ perceptions of themselves as well as of the colonized.
In 1998 the director-general of the World Health Organization pointed out that, globally, “the gaps between the health status of rich and poor are at least as wide as they were half a century ago. . . . Infectious diseases . . . remain leading causes of premature death among adults [and children] in much of the developing world. Reducing these tolls depends largely on the political will and commitment of individual governments, and the active support of the international community.”1 These assertions (linking the past with the present, and at least hinting at power relationships between the poor and the rich 5 percent of the world who consume 86 percent of the world’s output) suggest that one mark of a worthy history of medicine and infectious diseases is its potential for consciousness raising.
Looked at from the perspective of Cairo, Hays’s work appears to lie within the confines of not-so-new American consensus history. Though he is aware of trendy words and phrases (dates are given as B.C.E. and C.E.., rather than B.C. and A.D.), he interprets new concepts in old-fashioned ways, taking care not to offend comfortably well-off Euro-Americans. Consensus history holds that elite Britons once set the tone for what the rest of the world was expected to regard as normal (modernization through industrialization in progressive stages), lauds the triumph of reason over superstition, accepts the definitions of “civilization” and “uncivilized” established at public schools and Oxbridge during the Age of Empire, and accepts that Britain’s former global role as “civilizer” has now passed to the United States. Consensus history also likes to suggest that “developing nations” have only themselves to blame for being impoverished and unable to provide their people with elementary health services. It ignores the role of the United States, the United Kingdom, and the French arms industry and other Western agencies, which channel money from the non-West to the West.
As an exercise in consensus history, The Burdens of Disease is a great advance on something like Frederick F. Cartwright’s Social History of Medicine (1977). However, Hays’s grasp of concepts (such as “disease as a cultural construct” [p. 303]) used in recent medical history and in the wider fields of social history and cultural history is less than secure...