Disease and the Modern World: 1500 to the Present Day (review)

Despite the title, this work is a history of medicine as well as a history of disease, and one that begins (again despite the title) with a chapter on "Disease and Medicine before 1500." In an introductory chapter Mark Harrison announces the book's major theme (sustained throughout): that infectious disease played a major role in the emergence of the modern world with its nation states, capitalism, new social classes, empires, and plantation slavery. In part, this theme grew out of his original aim, which was to produce a history of disease since ancient times: the "modern world" stood out as a coherent whole, and the original manuscript was considerably pared. In this same chapter he grapples (perhaps unavoidably) with concepts such as the social construction of disease, and disease "framing"—thereby plunging into historiographic issues that seemingly belie the publisher's promise of accessibility (on the book jacket) to those with no knowledge of medical history.

The work itself, however, is a straightforward historical treatment of the impact on the West of the world's major diseases, which are introduced in chronological order, starting with the plague (explaining why chapter 1 begins before 1500) and quarantining against it, which became "an important stimulus to the emergence of the modern state" (p. 26). The plague is visited again in the second chapter, entitled "Early Modern Europe," in which syphilis also makes an appearance. Chapter 3 ("Disease and the Social Order: The Enlightenment and Its Legacy") introduces the reader to the medical thought of the day, before taking up smallpox along with public health measures used against it such as variolation and vaccination; it then deals with scurvy, and closes with the decline of the plague.

The ravages of smallpox and other Eurasian diseases in the New World are considered in chapter 4 ("The World Beyond Europe"), along with the tropical diseases of Africa that traveled with the slave trade, such as malaria and yellow fever. "Disease in an Age of Commerce and Industry" (chapter 5) treats the controversies surrounding vaccination and quarantine, and the nineteenth-century threat posed by cholera. "The Individual and the State" (chapter 6) covers the period 1870 to 1914, the rise of scientific medicine, and the discovery of the etiology and epidemiology of many of the major diseases. The transformation of "consumption" into "tuberculosis" is used to illustrate the change from the concept of diseases of the individual to one of social diseases for which the state was assuming increasing responsibility, both at home and in the colonies with the rise and application of the new tropical medicine. States were also confronted with the threat to public health that came with the massive migration of the period, a challenge that was met as they managed to initiate the epidemiologic transition and mortality decline that are still with us today.

Typhus makes an appearance in chapter 7 ("Disease, War, and Modernity"), as do the influenza epidemic of 1918, malaria and its control, and the problem of treating sexually transmitted diseases. The many subjects covered in the final chapter are hinted at in its title, "Health for All? Affluence, Poverty and Disease since 1945." The diseases introduced here are poliomyelitis, AIDS, and the new hemorrhagic fevers such as Lassa, Marburg, and Ebola in Africa, and Hanta, Junin, and Machupo in South America.

Throughout, Harrison keeps a careful eye on the demographic circumstances that gave rise to the illnesses under discussion, as well as on their demographic consequences, and the debates that still swirl around these matters are carefully considered and judiciously sorted out. The endnotes and bibliography are impressive documentation of the vast amount of literature consulted, and a glossary is appended to help readers with some of the concepts and terms in the text. In short, this is a well-crafted and well-written synthesis that meets the goal of accessibility for undergraduate...