Epidemics Laid Low: A History of What Happened in Rich Countries (review)

This is a short, but not sweet, book. It accounts for one of the undeniable triumphs of human ingenuity over nature, the taming of epidemic disease. Ending as it does with AIDS, but before SARS and avian flu, it cannot quite be a story of unblemished progress. But even though it concludes on a bittersweet note, surely this is as happy as endings get. Whether the causes of this uplifting story, from plague to the present, were general improvements in humanity's physical state and surroundings, technical developments like vaccinations and medicines, or the increasingly effective public health activities of central and local governments—or, as the book points out, some combination of all—the results were to everyone's benefit. The very fact that our main public health concern today (apart from the excesses of prosperity) is the state of the underdeveloped world demonstrates backhandedly how far the industrialized countries have come.

Though it is an inspiring story, this is not an inspired book. It is succinct, but it is also spotty, lumpy, and meandering. It claims to be about the rich countries, but in fact it deals largely with France. The Italian states get a mention during the early modern period for their quarantine and other public health regulations. Sir Edwin Chadwick gets three pages, and that is about it for English sanitary reform (pp. 67–70). Germany appears scarcely at all, except for a few tangential mentions of Robert Koch as someone who followed in Pasteur's footsteps. The United States makes an entrance briefly in a discussion of illnesses spread in hospitals during the twentieth century. Scandinavia gets a nod on account of its unusual public health measures against VD. The rest of the book deals with France, where the story is often overfilled with detail that is counterproductive for a brief account such as this (e.g., pp. 93–94).

For a book of this scope and pitch to be of value, not to mention worth translating, it should be a magisterial overview of the field, or at least an interesting take on the subject. Epidemics Laid Low is neither. It tells a conventional story on the basis of a geographically narrow perspective. When Bourdelais strays from the French case, he often garbles matters. He claims that England was unusual in requiring notification of various epidemic diseases (p. 84). But Britain did not implement measures that were unknown elsewhere; the point is that it did so via local regulations, rather than national laws as on the Continent. When, by the 1890s, nearly 85 percent of the population was covered, this does not mean, as Bourdelais suggests, that most of the British were subject to unusually draconian regulations; it means only that the majority of the English lived in areas that had adopted mandatory notification, while, for example, 100 percent of Germans were covered by similar rules laid down in the 1900 Contagious Disease Law. He claims that the British extended their system of isolating the ill to prostitutes (p. 82), when the Contagious Disease Acts in fact introduced a variant of the French custom of inspections for prostitutes in certain towns. He finds Protestantism "probably" a sufficient cause of the unusual features of Sweden's public health system (p. 84).

Bourdelais also strikes too many odd notes for comfort. He claims that the techniques used to stem cholera and other epidemics in the nineteenth century had all manner of causes—political, economic, and social—but were not based on any "established epidemiological knowledge" (p. 87), which seems very inadequate to the endless battles fought over why disease was propagated, however unsupported by modern science they may have been. His claim that opposition to vaccination arose most fervently where governmental attempts to...