I asked yesterday what readers considered the most important diseases in history. This was prompted by a new ASM Press book, Twelve Diseases that Changed Our World, written by Irwin Sherman.

As I mentioned, Sherman included many diseases readers expected–plague, cholera, tuberculosis, smallpox, syphilis, malaria, influenza, yellow fever, and AIDS. He didn’t include a few that popped up repeatedly in the comments–leprosy, measles, and typhoid (or typhus, for that matter). While I think a study of these could have been illuminating (especially leprosy, since much of the stigma attached to that disease still resonates even in modern society), Sherman notes than an exhaustive study of diseases would have been “mind-numbing,” and that wasn’t his goal in writing the book. Rather, the book is “…about the we have or should have learned from our past encounters with unanticipated outbreaks of disease and how such understanding can be put to use when future outbreaks occur.” More after the jump…including the diseases Sherman chose that most readers missed.

Sherman gives his rationale for choosing the diseases he did: diseases that “…have shaped our history and illuminated the paths taken in finding measures to control them.” It’s for the former reason that he included the three diseases I wouldn’t have originally considered: porphyria, hemophilia, and potato blight. Obviously the first two aren’t big in terms of mortality, but Sherman argues that these diseases, because of their presence in European royalty, influenced the history of England, Spain, Germany, Russia, and the United States. Could, for example, the Bolshevik revolution have been avoided if the royal family had better genes?

Potato blight, of course, doesn’t infect humans–but the effect of the blight on the potato crops and the resulting famine in Ireland led to a million deaths and the scattering of the Irish across the globe, changing especially the political landscape of the U.S.

The remainder of the topics cover “the usual suspects:” infectious diseases that have had high mortality and typically large effects on society. While much of the descriptions of the rest of these diseases will likely be familiar to readers here, the historical and cultural context Sherman puts them in–and the larger downstream effects they’ve had in history–are valuable additions. Sherman also includes relevant digressions in many of the chapters, briefly introducing the basics of immunity and vaccination in the chapter on smallpox, for example, or discussing Paul Ehrlich’s search for treatments for a variety of infectious diseases in the syphilis chapter.

I do have a few criticisms. First, Sherman’s prose is a bit dry. Perhaps this is because he’s a scientist, or perhaps it’s more pronounced to me right now because I’m simultaneously reading another book where the writing sparkles a bit more, but the book has a flavor somewhat in between a text book and a “regular” popular science book: accessible to the layman, but lacking pizzazz, I suppose. He’s uneven in explaining some concepts as well, and has a few outright (but relatively minor) errors in the influenza chapter. Here he still claims that there are 15 instead of 16 hemagglutinin types, and puts heavy emphasis on the pig as a mixing vessel for strains of the virus, with more limited discussion of direct jumps from birds to humans. He also appears to confuse quarantine with isolation in the influenza chapter, suggesting that quarantine won’t work for influenza because patients are infectious prior to the development of symptoms. This is, indeed, why isolation doesn’t work well, but quarantine is precisely for those exposed but asymptomatic–so those in the shedding phase could be identified and put into quarantine prior to infecting others. It’s a minor nitpick and certainly isn’t something that would bother the average reader, but as an American Society for Microbiology (ASM) Press book, I expect higher standards.

Finally, a big limitation of Sherman’s book is its focus mainly on Western history and civilization. Granted, he does talk about Africa in some segments, but his treatment of the east is pretty much non-existent. (China, in fact, only shows up in the index regarding influenza pandemics). It’s too bad, because a book that brought all that together–different diseases through history and its effect on *worldwide* culture–would have been a more useful book, in my opinion. Nevertheless, Sherman’s book is a good primer for those looking for a concise overview of the effect various diseases have had on our political and social history–with a few novel nuggets for those of us who are already widely read on this topic.

Comments

  1. #1 Craig Helfgott
    September 27, 2007

    What about ergot fungus? I mean, yeah, it’s more subtle than potato blight, but if you’re going to include hemophilia and porphyria, you might as well.

  2. #2 JakeB
    September 27, 2007

    Funny, I wouldn’t have thought of potato blight necessarily, but inasmuch as my family tree is almost entirely Irish, it had a great effect on my coming to be, I guess.

  3. #3 Bob Airhart
    September 27, 2007

    Interesting. Sherman posits that the Phytophthora infestans caused the Irish potato famine in the 1840’s and therefore drove changes in history. According to a quick reading of Wikipedia (following the link provided in your blog entry) the disease existed for over 100 years and not only in Ireland but also on the continent prior to the Irish potato famine. Why, if the disease was prevalent over greater time and space was it only devastating in one location? Logic would suggest examining other factors that were more powerful than the Phytophthora infestans. The historians and contemporaneous sources cited in the Wikipedia article suggest that English policy, religious bigotry, greed, callous indifference the general plight of the Irish were powerful factors in creating the Potato famine.

    I think the debate would be well served to bring in historians who are not quite so impressed with the single-cause theories and can put in context how different societies over time dealt with these diseases.

    The logical fallacy (that because they appeared together, in sequence, in Ireland, therefore the infestans caused the famine) needs to be thoroughly examined as well.

    Judging form the numerous publications, tenured position at UCR and academic administrative role at UCR, Dr. Sherman has had an illustrious career in Biological sciences. Based on the 60 minutes of random research I did on the assertions put forth in your blog entry (mostly attributable to him, or traceable out from him) Dr. Sherman’s foray into things historical needs to be closely examined.
    Bob

  4. #4 Tara C. Smith
    September 27, 2007

    The historians and contemporaneous sources cited in the Wikipedia article suggest that English policy, religious bigotry, greed, callous indifference the general plight of the Irish were powerful factors in creating the Potato famine.

    That’s the context it’s discussed in–he brings up all of that. I don’t want to do a dissertation on the potato famine, but the big issue was that absentee English landlords and policies thereof led to smaller and smaller farms and poverty wages for Irish renters. During the famine, they were still exporting crops to England, but the only crop that they could grow enough of to feed their families on the small plots and poor soil was the potato. When the blight wiped that out, the farmers were left with nothing else to eat, and frequently run off the land by their landlords. The infection was just the match in what was already dry timber, so to speak–and Sherman discusses the downstream ramifications the blight and the subsequent Irish diaspora had on the fates of various countries, but most notably the U.S.

  5. #5 Toby
    September 27, 2007

    “The historians and contemporaneous sources cited in the Wikipedia article suggest that English policy, religious bigotry, greed, callous indifference the general plight of the Irish were powerful factors in creating the Potato famine.”

    That’s a pretty sweeping indictment; but surely there can be no doubt that the immediate cause of the Famine was the blight. Why millions of Irish people had come to depend on the potato as their staple diet is more complex.

    “English policy and religious bigotry” are more related to the reason why relief measures were unsuccessful. Most Irish historians are careful in weighing the evidence – and the British government must take their share of blame. But the claims of “genocide” are far-fetched.

    The best analogy I can think of is the response of the Reagan administration to the AIDs epidemic. In many ways the British did better (ok, the catastrophe was an order of magnitude higher). Queen Victoria donated generously to Famine relief; Ronald Reagan never uttered a single word of sympathy for the bulk of the AIDs victims. The “Great Communicator” was apparently oblivious that tens of thousands of Americans were dying of a deadly disease in the most powerful and prosperous country on Earth.

    Sso also in the Famine, where the phenomena of donor exhaustion and blaming the victims were displayed in full measure.

    We have records of prosperous farmers (good Catholics, no doubt) complaining of (starving) people stealing their turnips. The starving poor were landless labourers, or owners of tiny potato plots, the lowest social class in the land. In many ways the Irish middle classes were as flint-hearted as any English snob.

    Near where I was born, there was generous menories of a Protestant landlord who died of typhoid contracted when trying to help his starving tenants. The division into English Protestant oppressors and Irish Catholic victims is not that easy. The Famine was an enormously complex event that lasted about 10 years in total.

    Which brings me back to typhoid – often diseases were the major killers in the Famine. Once people were weakened sufficiently, they had no resistance to other killers of the period – cholera and typhoid wich often took people quickly before they actually died of malnutrition.

  6. #6 Sock Puppet of the Great Satan
    September 27, 2007

    Tara said: That’s the context it’s discussed in–he brings up all of that. I don’t want to do a dissertation on the potato famine, but the big issue was that absentee English landlords and policies thereof led to smaller and smaller farms and poverty wages for Irish renters. During the famine, they were still exporting crops to England, but the only crop that they could grow enough of to feed their families on the small plots and poor soil was the potato. When the blight wiped that out, the farmers were left with nothing else to eat, and frequently run off the land by their landlords.

    Not wanting to turn it into a dissertation also, but there were several reasons for the intensity of the impact of the famine. There was the reliance of the Irish tenant class on the potato, and the splitting of land held in tenancy amongst all sons, rather that primogeniture, meant that plots held by tenants grew smaller and smaller and smaller. As the potato is very productive per unit of land, it was the chosen crop. Unfortunately, being a tuber crop, it has little genetic diversity.

    Also, about 90% of those who died in the Great Famine died of disease (mostly typhoid) rather than starvation, compared to ~50% in other famines. Now, most relief was at the workhouses (which to enter you had to have no land assets either owned or rented), so to receive relief you had to abandon your land. The workhouses were overcrowded and very effective at spreading disease.

    Relief before 1847 by the Tory Prime Minister Peel to import maize (called ‘Peel’s Brimstone’) was fairly effective in staving off the worst of the famine. However, in 1847 the Whig Trevelyan, more free market in ideology, replaced Peel. Early indications in 1847 were that the harvest would not be affected, and relief plans were cut back. Unfortunately, the harvest was much worse than 1845 or 1846. Many local poor relief districts were already broke.

    Different customs in landlord-tenant relations and inheritance of tenancy rights meant that the famine impacted what’s now Northern Ireland much less.

    Cormac O Grada and Joel Mokyr are the best economic historians of the famine.

    There’s a strong Irish-nationalist reading of the famine as being a result of British neglect and oppression. And it has some validity. But there’s also a better case for the role of social customs, an inadequate framework for relief, a punitive model of poor relief, and a failure to understand that free markets are inadequate to respond to such disasters.

  7. #7 Sock Puppet of the Great Satan
    September 27, 2007

    ” Queen Victoria donated generously to Famine relief”

    My arse. She gave 5,000 quid: but gave four times as much to a dog’s home.

    By contrast, the Choctaw Indians gave 15,000, as they felt pity havign went throught their own trial of tears. Their generousity never fails to choke me up.

  8. #8 Neuro-conservative
    September 28, 2007

    What are some of the lessons the author draws from his 12 examples for contemporary epidemiology and public health?

  9. #9 Toby
    September 28, 2007

    “the Choctaw Indians gave 15,000″

    The figure was more like $170, see:

    http://en.wikipedia.org/wiki/Choctaw

    Not denigrating the Choctaws, their generosity was incredible given their poverty and trestment on the Trial of Tears.

    However, it must be pointed out that the mean “Famine Queen” was an invention of later Irish Nationalists. Contemporary Ireland of the 1840s generally liked the Queen – she was made very welcome here in 1849. Early in her reign, Victoria liked Ireland and was sensitive to the Famine catastrophe.

    Later in her reign, both sides became a bit disillusioned with each other. Victoria thought the Irish disrespected her dear, dead Albert and her children. Irish ardour cooled somewhat after the Fenian outbreaks of the 1860s.

  10. #10 jspreen
    September 28, 2007


    Which brings me back to typhoid – often diseases were the major killers in the Famine.


    cholera and typhoid wich often took people quickly before they actually died of malnutrition.

    Now, why don’t ye’all think a bit and draw conclusions instead of sheepishly laughing when someone writes that famine causes disease. It’s not your tiny microbes, it’s the famine that alters the body.

    Still laughing? Then google Ryke Geerd Hamer

  11. #11 Sock Puppet of the Great Satan
    September 28, 2007

    “”the Choctaw Indians gave 15,000″

    The figure was more like $170, see:”

    Yeah, I realised that afterwards: old Irish nationalist myths that Victoria had given ~50 pounds had stuck in my head, and the generosity of the Choctaws compared with that (erroneous) figure was what had stuck in my head.

    My bad.

  12. #12 Bob Airhart
    September 28, 2007

    >>>Cormac O Grada and Joel Mokyr are the best economic historians of the famine.

    There’s a strong Irish-nationalist reading of the famine as being a result of British neglect and oppression. And it has some validity. But there’s also a better case for the role of social customs, an inadequate framework for relief, a punitive model of poor relief, and a failure to understand that free markets are inadequate to respond to such disasters.

    (Posted by: Sock Puppet of the Great Satan | September 27, 2007 7:10 PM)
    ******

    Precisely the point I was making. British economic policy, laws that divided the (Roman Catholic-held) land differently for one group that led over time to poverty and privilege that made it ok to neglect the starvation of others are the unique factors. The potato blight apparently was widely destroying the potato crop in the British Isles and Europe at that time, but only in This part of Ireland was 25% of the population removed by death or migration when the crop failed.

    My comments were not derived from, nor were they intended to incite, accusations against the British or sectarian divisions among us. Instead, they were meant to direct attention to the systems of law and government, the social structures and the conceptualizations of reality that allowed the blight to become a massive tragedy. Similar circumstances exist in recent history: Responses to AIDS in the early days, and today in some parts of Africa for instance.

    Bob

  13. #13 MyaR
    September 28, 2007

    Re: porphyria — Mad King George? Or vampires? (I have a personal interest. Chances are fairly high I have it.)

    I can’t decide from your review whether it’s worth getting or not. Well, I guess anything that mentions porphyria probably is worth mentioning.

  14. #14 Tara C. Smith
    September 28, 2007

    Porphyria and hemophilia are covered in the first chapter together, and yes, he briefly covers King George and the possibility that he may have had porphyria–and again, lingering effects that his “madness” have had on Britain and the U.S.

  15. #15 Monado, FCD
    March 19, 2008

    Some people put “King Typhus” first for changing the course of so many battles.

    Then there are the nameless plagues in China that wiped out 98% of households (implying more than 98% of people).

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