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Bulletin of the History of Medicine 76.1 (2002) 152-153



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Book Review

The Geographical Structure of Epidemics


Peter Haggett. The Geographical Structure of Epidemics. Clarendon Lectures in Geography and Environmental Studies. Oxford: Clarendon Press, 2000. xv + 149 pp. Ill. $72.00 (cloth, 0-19-823363-9), $35.00 (paperbound, 0-19-924145-7).

In his Clarendon Lectures given at Oxford in 1998 (presented here in finalized form), Peter Haggett sought to demonstrate that statistical geographers have (or soon will have) important things to say to the medical profession. As he put it: "Mathematical models will increasingly supplement other epidemiological tools in global control [of infectious diseases]" (p. 129).

True believers will doubtless accept this as self-evident. However, scholars and others who are not statistical geographers may be put off by Haggett's rather narrow approach. For example, when dealing with foot-and-mouth disease (FMD) among cattle, he goes on at length about the wondrous conclusions reached by one of his model-making students, forty years ago (pp. 117-19)--but these conclusions failed to take into account the possible economic and political considerations that, it is now known, must form part of any general plan for disease control. Unaware of the holistic approach, Haggett (in this book published in the year 2000) avoids all mention of economic and political factors of the sort that have recently come to the fore in FMD-blitzed Britain. Given the perceived need to export meat that was guaranteed not to be contaminated, government authority simply did not regard the vaccination procedures and so on recommended by Haggett as worthy of serious consideration.

If contemporary planners will be disappointed in Haggett's book, one wonders if historians of medicine will be better served. Students of measles on island communities--Iceland, for example--may find something of interest in his discussion of findings first published in the late 1970s and early 1980s (pp. 33-52). Yet here again Haggett avoids the holistic approach. He does not remind us that until the early 1950s Iceland was an extremely poor country. He does not mention the likely connection between malnutrition (vitamin A deficiency) and epidemics of measles, a link commonly found in today's impoverished "developing world."

Living in Egypt, and associating with the sort of people Haggett calls "Egyptologists," I am aware that he has a rather elastic sense of time. Historians of medicine (and others) will, however, realize that 4,000 years is far too long a period about which to make generalizations (as Haggett does) about the presence of "smallpox" and "leprosy" (p. 74). I am also less than happy with his discussion of cholera, on several grounds. (1) It is well known that in 1883 cholera was introduced into Egypt's Mediterranean ports (conquered by Britain in 1882) by ships coming from cholera-endemic Bombay (under British control), resulting in a mortality rate among Egyptians of 8.95/1,000. (2) Robert Koch of Germany visited Alexandria in early 1884 and discovered cholera's causal agent, the vibrio. (3) It is also well known that the British Government of the day, its international prestige at stake, sent a cholera investigation commission to Egypt which (as the French and all other neutral observers expected) denied that the disease had been imported. The Commission claimed (with absolutely no clinical [End Page 152] evidence to back it up) that cholera had long been endemic in Egypt. Haggett's way of dealing with this is "interesting": reprinting a map he first produced in 1988 that is said to chart the movement of cholera in "1881-5," he omits any reference to Egypt, to Bombay, or to the Suez Canal (p. 70).

But aside from these topics, it is likely that statistical geographers will be impressed by the cogency of Haggett's arguments. His book is clearly written and nicely produced.

 



Sheldon Watts
Cairo

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