The Deadly Truth: A History of Disease in America (review)

The Deadly Truth opens with a quote from biologist Rene Dubois: "each type of society has diseases peculiar to itself—indeed, . . . each civilization creates its own diseases." It is a fitting beginning to a work which examines American history through the lens of the diseases that have shaped and been shaped by the continent. Originally published in 2002, this fascinating work by Gerald N. Grob, in the History of Medicine Department at Rutgers University, has recently been released in paperback.

Grob's approach is chronological, beginning with an examination of the prevalent illnesses of pre-Columbian societies and culminating in our own era, with several underlying themes unifying the exploration. Grob's overarching thesis is that disease never disappears, but rather merely changes in character. The effects of social class, ethnicity, slavery, war, scientific progress, and geography on medicine consistently enrich the narrative. Whether discussing native populations, European colonization, the industrial revolution, warfare, immigration, or westward expansion, Grob returns to these themes, lending a coherence to his book. The examination and reexamination of various diseases—including but not limited to smallpox, tuberculosis, and chronic disease and disability—in the various eras of American history provides further structure. Given this broad, though tightly controlled, range of inquiry, The Deadly Truth is more than a book about medical history: it is a history of America at large.

Indeed, one of the most striking observations in The Deadly Truth is how closely the history of disease parallels the history of America. Grob highlights the prevalence of zoonotic and parasitic disease in pre-Colombian America, followed by the catastrophe of the introduction of infectious epidemics among native populations after the European "discovery" of the continent. The persistence of endemic disease, challenges posed by immigration, population growth, urbanization, and the United States' expansion to the Pacific coast occupy the book's middle chapters. The Deadly Truth ends with the occupational health hazards of the industrial revolution, the 20th century's apparent victory over infectious disease, the rising prevalence of chronic disease, and the recent emergence of "new" illnesses such as HIV/AIDS. The facts and stories presented will be familiar to many readers, but most will not have considered the surrounding historical continuum. The Deadly Truth presents these changing patterns of disease not as discrete events but within their historical context.

Grob eschews speculation, relying instead on painstaking documentation and copious primary sources. This does not mean, however, that the text is dry or uninteresting. Rather, Grob's lively style, peppered with quotes, diary entries, and even poems, makes for an engaging read. The depth of detail provides sufficient academic rigor without sacrificing oversight of the subject as a whole, and the result is a convincing and enjoyable history.

A good example of the book's style and content is Grob's examination of the changes wrought by America's urbanization in the latter half of the 19th century. Discussion of this subject begins with a colorful 1865 quote by Dr. Stephen Smith concerning New York City, a quote that both introduces the subject of urban health and situates it in the time and place when it became a concern: "Here infantile life unfolds its bud, but perishes before its first anniversary. Here youth is ugly with loathsome diseases and the deformities which follow physical degeneracy. . . . The poor themselves have a very expressive term for the slow process of decay which they suffer, viz.: 'Tenement-house Rot'" (p. 96). Grob proceeds to document the spectacular growth of metropolises such as New York City.

"Urban growth," writes Grob, "reflected social, economic, and technological changes. For much of the nineteenth century the conditions of urban life promoted the dissemination of a variety of infectious diseases" (p. 97). Among the challenges faced by early cities were inadequate public health codes, contaminated water supplies and waste disposal, industrial pollution, overcrowding, and the introduction of pathogens via expanded domestic and foreign trade. These problems are documented with data including...