A Pest in the Land: New World Epidemics in a Global Perspective (review)

The author's stated purpose is to provide a balanced perspective on the history of disease. The Columbian Quincentenary of 1992 —its preparations and aftermath—focused much attention on the spread of lethal pathogens from Europe to vulnerable native peoples, which has distorted certain truths about the trajectory of fatal diseases as an inexorable part of the human condition everywhere. In the first chapter the author is challenged to relate, in eight thousand words, what is known about Old World epidemiology before 1500 A.D. In contrast, the vague and tentative second chapter reflects the dearth of documentary evidence on disease in the pre-Hispanic New World. These two chapters set the stage for the discussion of the introduction and impact of Old World maladies in the Americas. The author then discusses Native American and European responses to epidemic disease, the impact of military conquest and colonialism, and questions of slavery, labor, and migration. A short epilogue invokes the 1918 flu pandemic, AIDS, bioterrorism, and other lethal microbes as more modern versions of the intercontinental flow of pathogens. Its disquieting tone contrasts with the progressive medical rhetoric of 50 years ago, when rapid advances in vaccinations, antibiotics, and pesticides had the industrial world ready to believe that disease could be conquered.

This work is not based on a careful winnowing of the vast literature or even on a critical evaluation of the rather limited number of sources repeatedly cited. The information comes from generally accessible English-language secondary sources, except for western South America, the author's area of scholarly investigation. Accounts of pestiferous outbreaks are interrupted by background information on tribes, environments, and events. Dependence on conventional formulations results in an outdated description of preconquest Amazonia as having been covered with dense forests, swidden farmers, and scant populations, whereas the accumulating evidence now indicates that much of the region was inhabited by complex cultures with dense populations practicing sustained agriculture. More disconcerting are the naive expressions of environmental determinism that mar the narrative— for example, "[J]ust as cold temperatures . . . limited the growth of native populations, heat and a scarcity of water had similar effects" (p. 41 ).

The author justifies her sketchy presentation of pre-Columbian disease history in the weaknesses of the historical record. Other leads, among them landscape epidemiology, traditional pharmacopoeias, and modern local etiologies, can be useful in reconstructing preconquest configurations if one is willing to probe complementary pathways. The zoonotic trio of American Chagas' disease, leishmaniasis, and bartonellosis deserves much more than the minimalist commentary offered. Leptospirosis is also described in this book as being a pre-Columbian disease without substantive evidence or citation.

In spite of the book's purported aim to provide balance, its true focus remains the mortality from epidemics of European-introduced diseases. Smallpox—so dramatic in its capacity to spread, its lethal impact, and its characteristic red pustules that make it readily detectable in the historical record—holds center stage. That ease of identification has overdrawn smallpox's impact vis-à-vis malaria, which is virtually ignored as a principal killer. Malaria epidemics were common, but it is its endemicness in coastal lowlands and hot valleys that made the virulent falciparum form of this disease loom so large in the postconquest New World. Annual attrition caused native populations to plummet; on the Peruvian coast, a large proportion of the 90 -percent demographic decline resulted from the undramatic wasting that is characteristic of malaria and that received little attention and no clear nomenclature in the chronicles. Likewise, yellow fever is unjustifiably ignored in this book. Alchon overlooked the irony that while African slaves carried yellow fever and falciparum malaria to the New World, they were affected much less, given their innate resistance, than were native peoples whose genes furnished no such protection.

The decimation evoked inevitably shifts attention to numbers. A section...