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  • Epidemics: Hate and Compassion from the Plague of Athens to AIDS by Samuel K. Cohn
  • Peter Baldwin
Samuel K. Cohn. Epidemics: Hate and Compassion from the Plague of Athens to AIDS. Oxford: Oxford University Press, 2018. xii + 643 pp. Ill. $125.00 (978–0–19–881966–0).

If not before, the digital has now arrived in the history of medicine. Not only could a book this big—640 enormous pages, many thousands of footnotes—never have been composed on analog technology, it is based on searches through massive databases of content, including the back runs of over five hundred newspapers. The result is an avalanche of material on epidemic disease (plague, cholera, syphilis, smallpox, yellow fever, influenza, AIDS) from ancient Greece to the present. An overwhelming amount of information is presented on reactions to epidemic disease globally across two millennia.

To what avail? Cohn seeks to drive a stake through the heart of a supposedly widespread assumption that epidemic disease invariably provokes antagonism and fear of “others” who are blamed for disease and therefore castigated, harmed, and spurned. While he concedes that pogroms were sparked by the black death in the fourteenth century and himself adds to this historical repertoire by detailing widespread attacks on smallpox victims in early twentieth-century America, he argues that epidemics did not invariably lead to outcasting, and in fact equally often sparked sympathy and compassion, as during yellow fever outbreaks in the nineteenth century, the 1918 influenza epidemic, and eventually with AIDS. It was thus not the lack of scientific information that fueled ostracization, since that continued even deep into the era of scientific medicine.

So what explains such varying reactions? While the book presents an onslaught of detail, less effort is made to analyze why the reactions to different epidemics varied. Multiple factors distinguishing the diseases are suggested: speed of onset, rapidity of death, unpleasantness of symptoms, and lethality. But in each case, exceptions are found, and the factor dismissed as not causally significant. Ultimately Cohn does not explain why the ancient world did not attack the diseased, the medieval world did for plague, the nineteenth century did for cholera in some places and times, the twentieth century did for smallpox, but not for yellow fever and influenza, nor AIDS.

Unfortunately Cohn distinguishes only vaguely among the various epidemics and their etiology and what effect that might have on reactions to them. Some of the diseases (pneumonic plague, smallpox, syphilis, influenza, AIDS) were directly transmissible, others (rat-borne plague, cholera, yellow fever) involved vectors. Such differences and their implications for how best to combat epidemics were not of course always known at the time, and this in turn influenced reactions. The epidemics that prompted the worst excesses were often those where the authorities intervened strenuously (plague, cholera, smallpox) while for others they were [End Page 114] more hands-off: quarantines against yellow fever were authorized and accepted, measures against the flu impinged only tangentially on everyday life (shutting down cinemas, obligatory face masks, etc.).

Nor does Cohn account with any precision for distinctions among the groups that were attacked. At least three sets of people were involved. Victims of disease were persecuted. This may have been an unpleasant reaction, but at a time when many diseases were thought to be directly transmissible and avoidance the best prevention, it was hardly an irrational reaction. People other than direct victims who were blamed for epidemics were also attacked—Jews during the fourteenth-century plague, alleged plague spreaders during later epidemics, prostitutes for syphilis, Cossacks and Persians for cholera in Russia, Europeans for the plague in India, Haitians and gays for AIDS. Hatreds were thus targeted at out-groups, the epidemic providing an excuse to vent prejudices. And finally, violence erupted against authorities carrying out preventive measures. Their prophylactic techniques may appear misguided in retrospect (cholera fumigations and quarantines) or may have been entirely justified (smallpox vaccination). But such attacks were clearly distinct from the other two.

Unfortunately Cohn lumps them all together. Thus violence against physicians removing cholera victims to quarantine or against smallpox vaccinators are treated as similar to pogroms against Jews. In terms of his overall Fragestellung, however, this is misleading...

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