Viruses, Plagues, and History

Natural History, Sept, 1998 by Paul Farmer

VIRUSES, PLAGUES, AND HISTORY, by Michael B. A. Oldstone. Oxford University Press, $25; 211 pp., illus.

Review Viruses, Nobel laureate Peter Medawar once observed, are merely "pieces of nucleic acid surrounded by bad news." Along with bacteria, fungi, protozoa, and other microscopic pathogens, viruses continue to spell bad news. Three decades after a United States Surgeon General declared that it was "time to close the book on infectious diseases," these illnesses, most of which are readily treatable or preventable, remain the world's single most common cause of death, accounting for 17 million of the estimated 52 million deaths in 1995.

In Viruses, Plagues, and History, virologist Michael Oldstone chronicles past epidemiological successes and predicts high yield on future investments in the basic sciences to combat viral challenges. In Epidemics and History, historian Sheldon Watts covers social and economic aspects and takes a less sanguine view. Both the scientist and the historian agree that the eradication of smallpox in 1977 was a feat of unprecedented importance, but Watts notes that "in the viral world out there, niches emptied are soon refilled."

Oldstone, who works at the Scripps Research Institute in La Jolla, California, recounts the history of viral plagues through a series of sometimes rambling narratives. Like previous works of this genre, including Hans Zinsser's often zany 1934 classic, Rats, Lice, and History, Oldstone's is a book by a laboratory scientist who has discovered history and the persuasive power of anecdote. We learn that in World War I, some 80 percent of deaths among United States Army soldiers were caused "not by bullets, shells, or shrapnel but by influenza." Particularly virulent epidemics, such as the yellow fever that decimated Memphis in the "dark year" of 1878, are rendered in vivid detail. Oldstone is sketchy, however, on Lassa fever, Ebola, and hantavirus, which have excited worldwide interest even though they are, statistically speaking, small-time players.

Another cavil: Oldstone's book has little sense of scale. A discussion of scrapie, or mad cow disease (which may or may not be the same as the rare human affliction known as Creuzfeldt-Jakob disease), is sandwiched between HIV and influenza, which together have killed tens of millions. And there's no revealing information on controversies surrounding scrapie's etiology, although the subtitle for that chapter asks, "virus or prion disease?" There's a fine discussion of polio and influenza, but Oldstone's brief chapter on HIV will likely irk the AIDS cognoscenti (he uses terms like "the heterosexual community") and will not satisfy inquiring minds. When he writes that "the history of virology would be incomplete without describing the politics and the superstitions evoked by viruses and the diseases they cause," we're disappointed that we don't get an insider's account of, say, the Gallo-Montagnier feud over the discovery of HIV.

Science, in Oldstone's view, will prevail if allowed to flourish, but one keeps wondering about recent outbreaks of tuberculosis, plague, cholera, typhoid, and diphtheria--all with heavy loss of life--in settings as diverse as Eastern Europe and Latin America. Those skeptical of cheerful medical triumphalism may prefer Epidemics and History, a more scholarly work. The richly documented narrative has considerable moral bite but is also suffused with irony and wit. Watts, a visiting associate professor of history at the American University in Cairo, is well-grounded in social responses to a host of plagues, from smallpox to syphilis. The black death, for example, generated hysteria in Renaissance Florence, where officials burned down the houses of plague victims and locked the dying in quarantine (we have the Italians to thank for this word). In seventeenth-century Egypt, in contrast, "many rich men, emirs, great merchants and others, joined in charitable work and assisted personally with the burial of a great number of plague dead."

Where Oldstone sees mainly microbes, Watts also sees the socially constructed entities that drive forward responses to these plagues and the "swampy frontier" lying between objective medical "truth" and subjective, culturally derived perceptions. But Watts, who dates modern medicine to Robert Koch's discovery of the tubercle bacillus, wonders why modern doctors and technicians, building on Koch's insights, haven't been able to control all epidemic diseases. At the heart of Epidemics and History is a keen appreciation of the contribution, both to plagues and our responses to them, of social inequalities.

Watts's familiarity with colonial history informs his wry dissection of several of imperial medicine's darker episodes, including its dealings with leprosy and malaria. Early practitioners of tropical medicine regarded these diseases as "imperial dangers" that posed threats chiefly to the colonists. As early as the seventh century, while many in the Muslim world understood leprosy clinically as an infectious disease, much of Christendom regarded it as "God's punishment for dark, hidden thoughts, words, and deeds, usually involving disgusting forms of sex." This persistent medieval notion was transported to colonial Africa. I am willing to predict that Watts's trenchant examination of African leprosaria will become classic medical history.