Contagion: How Commerce Has Spread Disease by Mark Harrison (review)

In his most recent book, Contagion, Mark Harrison revisits the theory positing a symbiotic relationships among commerce, war, and pestilence and the subsequent impact on the development of public health. Having previously explored the link between disease and war, Harrison turns to the connection between commerce and disease. He establishes that (1) there is adequate evidence to demonstrate the historical and contemporary influence of commerce on global pandemics and (2) consequently both the practicalities of commerce and overarching mercantile interests have played a significant role in the evolution of public health. Harrison thus legitimizes contemporary fears about the dangerous potential of infectious disease and reveals how this concern binds countries together.

The argument emerges through a series of case studies. Organized in roughly chronological order, Harrison starts by examining the Black Death and concludes with the recent SARS and H1N1 pandemics. Intending his study to be a truly global examination, Harrison traces key moments in the development of public health on an international stage. His framework, though, is clearly rooted in a Western and Anglophone perspective, reflecting Harrison's focus on Western commercial activities and politics as driving forces in the development of modern public health practices and institutions.

Each chapter is a case study framed to reveal fascinating moments of conflict and change that grip the reader's attention. Harrison weaves these snapshots of diverse pandemics and new public health institutions together in an intriguing new synthesis on the global origins and consequences of disease contagions. A key question he pursues is how and why non-medical and non-humanitarian concerns have dominated in the execution of public health measures.

In many ways, we can approach this book as a journey through the rises and falls of the practice of quarantine. In the first chapter Harrison examines the introduction of quarantine as a result of the spread of the plague across Eurasia in the fourteenth century. He continues to trace the commitment to quarantine and other aggressive public health tactics through the nineteenth century as new commercial relations and diseases emerged. Harrison concludes that a state's commitment to managing contagion depended on several factors including ideas of statecraft, contemporary political interests, and understandings of contagion and its link to commerce. The commitment to quarantine particularly took hold in European concepts of statecraft and was encouraged by quarantine's apparent success in quelling outbreaks of plague and new pandemics, such as that of yellow fever. The close relationship between political and mercantile concerns through the early modern period sets up Harrison's examination of changes in public health institutions in the nineteenth century.

On the whole, Harrison devotes substantial attention to the shifts and much heralded progress of public health in the nineteenth century. His focus on this period of massive global transformation allows Harrison to map the connections between public health at the national and international levels based on the role of commercial concerns. A particularly absorbing aspect of Harrison's argument is his establishment of the links among human, epizootic, and agricultural pests, such as phylloxera's attack on grape vines, in shifting understandings of public health. This discussion in chapter 8 lays the foundation for his argument about the broader relationship of disease with commerce beyond human infections, the interaction of different categories of contagion, and the failure of public health systems to prepare for global contagions.

The grand scope of this remarkable study can overwhelm one's sense of the human experience of disease. The focus on public health responses also complicates recognition of individual patients and even officials and physicians. The chapters in which Harrison narrows his view and personalizes the narratives, such as in his fascinating exploration of the 1844–45 Boa Vista outbreaks of yellow fever in chapter 4, stand out and invigorate his argument.

Harrison does begin with several assumptions about the nature and chronology of globalization, as well as about the possibility of diagnosing the nature of plagues in the past...