American Plagues: Lessons from Our Battles with Disease by Stephen H. Gehlbach (review)

Before he was dean of the School of Public Health and Health Sciences at the University of Massachusetts, Amherst, Dean Emeritus Stephen H. Gehlbach was a medical detective. He served in the Epidemic Intelligence Service with the Centers for Disease Control and Prevention, Atlanta. In the years following his service, he has sought to "make epidemiology contagious" (p. viii). His intended audience is composed of the medical and public health students "who need to understand how diseases operate in populations and how best to control them" (p. viii). The updated version of his 2005 volume, American Plagues: Lessons from Our Battles with Disease, succeeds admirably. It conveys Gehlbach's infectious enthusiasm for his subject so effectively that general readers will also relish the historical detective's account of medical mysteries stretching back to the founding of the nation.

Founding Father Benjamin Rush was also an early medical detective. Gehlbach begins his volume with Rush's response to the deadly 1793 yellow fever epidemic in Philadelphia, which took four thousand lives, almost 10 percent of the city's population. Attributing the disease to miasmas, Rush was mistaken in his understanding of the epidemic's cause. His bleeding of yellow fever victims failed to cure them. However, without a sneer of condescension, Gehlbach describes Rush's mistakes and why other physicians came to different conclusions.

Not long before Rush, a clergyman effectively curbed a smallpox epidemic, and not by prayer alone. Cotton Mather's advocacy of inoculation, echoed by Zabdiel Boylston in Boston and Benjamin Franklin in Philadelphia, led to a comparison of outcomes with interventions, a kind of "natural experiment," to answer questions about the efficacy of preventive procedures. Later, Benjamin Waterhouse would conduct America's "first public health experiment" to learn whether cowpox could prevent smallpox as Englishman Edward Jenner claimed. Jenner and Waterhouse are no strangers to students of public health history, but Gehlbach explains how their achievements contributed to the expanding field of disease prevention and control.

The relationship of environment to disease vectors was explored by Daniel Drake in the 1840s to understand what caused autumnal fever. Offering the example of malaria and the mosquito, Gehlbach explains how comprehending environmental factors such as those that favor mosquito breeding could assist physicians hoping to prevent malaria transmission.

In his discussion of Lemuel Shattuck, a pioneer in the collection and analysis of vital statistics, Gehlbach reminds readers that it is impossible to determine the health patterns of any population without systematic data collection. He describes how physicians and statisticians in Massachusetts jointly lobbied for state legislation in the 1840s that improved the "recording of vital events, such as births, deaths, marriages, and standardize the system of morality classification" (p. 84). The 1850 Report of the Sanitary Commission of Massachusetts compiled under Shattuck's leadership became a public health classic.

Gehlbach's chapters on tuberculosis, polio, cancer, heart disease, and HIV/ AIDS amply demonstrate how advances in medical science resulted in public health programs to curb the spread of some diseases and to prevent others. In his chapter on polio, Gehlbach traces the hundred-year life cycle of the epidemic from its first identification in the 1890s, to the Salk and Sabin vaccines that stopped the catastrophic summer epidemics in the United States, to the current patterns of prevention that have all but extinguished the disease as a world public health threat.

Gehlbach's updated edition includes chapters on fresh patterns of infectious disease and their spread, sometimes by the very health care providers and in hospitals dedicated to battling such diseases, a circumstance first identified 170 years ago by Dr. Oliver Wendell Homes. The bacterium called MRSA (methicillin-resistant Staphylococcus aureus), for example, is often contracted in hospitals where there has been a breakdown of sterile procedures.

The volume's last chapter, "Another Kind of Plague," refers to the plague of misunderstanding and misinformation that Gehlbach associates with the antivaccine movement, especially...