Truths and Consequences: Writing the History of Disease

Gerald N. Grob. The Deadly Truth: A History of Disease in America . Cambridge, Mass.: Harvard University Press, 2002. xii + 349 pp. Notes and index. $35.00.

"The Deadly Truth." It has the ring of a medieval mystery or a contemporary courtroom thriller. But readers expecting beach or bedtime fare will be disappointed. This is neither mystery nor thriller. Some might call it a jeremiad: a caution against medical hubris, a testimony to the limits of human agency, and a tale of the unintended consequences of the best of intentions. "The Deadly Truth" is one historian's caveat to clinicians, policy-makers, and the public: disease has been and will be with us always. And woe to the historically challenged, who persist in believing that progress in the medical sciences accounts for our longer, healthier lives and will one day relieve us of the burdens of illness. In this instance ye should have little faith.

In The Deadly Truth, Gerald N. Grob has pooled his vast experience researching and teaching about the historical relationship between health and the environment with the recent extensive historiography of morbidity, mortality, medicine, and public health to create a sweeping synthesis of the biological experience of disease throughout the American past. This book works on three levels. As a survey of the past, the book traces the changing patterns of morbidity and mortality from the pre-Columbian epoch to the present and demonstrates the connection between the predominant diseases of an era and the social, economic, and geographic environment. As a blueprint for writing the history of disease, the book privileges the biological experience of disease over cultural constructions of illness, highlights a unitary human experience, and applies the tools of modern medicine to explorations and explanations of the past. Finally, as a cautionary tale, the book uses history to warn us that wholehearted faith in medicine's ability to relieve humans of the burdens of disease is misplaced and that as one disease is conquered, another is sure to take its place. Likewise, a rising standard of living is no guarantee of a healthier population; neither material progress nor medical progress will eliminate disease from our midst. Along with its history, The Deadly Truth offers a reality check to cock-eyed medical optimists.

Grob's study begins with a story of demographic catastrophe—the decimation of native populations in the centuries after 1492 as Europeans settled their diseases in the Americas along with their social, political, and economic patterns of life. It is a familiar tale, recounted in almost every U.S. history survey textbook. In The Deadly Truth, however, we are advised first to remember that the Americas were not a health utopia before the arrival of the Europeans; war, accidents, and diseases (tuberculosis, for example) formed the parameters of pre-Columbian mortality patterns. Nevertheless, the arrival of the Europeans made things worse. The colonial invaders brought with them infectious diseases—smallpox, measles, and respiratory infections—endemic to fifteenth-century Europe, but unknown in the Americas. The genetic homogeneity of the population, the lack of prior immunity, and in some instances the possibility that the Europeans introduced particularly virulent strains of some diseases combined to account for mortality rates of monumental proportions. Grob dismisses the thesis put forth by David Stannard that attributes the decimation of the population primarily to the brutality of the Spanish conquistadores. ¹ Grob's explanation, however, is not built entirely on biology, for he finds that the impact of the new diseases was intensified by indigenous cultural and medical practices. The unfamiliar pathogens proved most deadly for those at mid-life, the nurturers and caretakers, and the disproportionately high death rates for this age group disrupted indigenous cultures and contributed to the catastrophic results. As death rates mounted, traditional belief systems collapsed turning demographic catastrophe into cultural genocide. Disease, as Grob's reckoning of contact suggests, is scarcely a passive factor in human history; pathogens...