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Epidemics and Society: From the Black Death to the Present

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This sweeping exploration of the impact of epidemic diseases looks at how mass infectious outbreaks have shaped society, from the Black Death to today, and in a new preface addresses the global threat of COVID-19. In a clear and accessible style, Frank M. Snowden reveals the ways that diseases have not only influenced medical science and public health, but also transformed the arts, religion, intellectual history, and warfare. 

A multidisciplinary and comparative investigation of the medical and social history of the major epidemics, this volume touches on themes such as the evolution of medical therapy, plague literature, poverty, the environment, and mass hysteria. In addition to providing historical perspective on diseases such as smallpox, cholera, and tuberculosis, Snowden examines the fallout from recent epidemics such as HIV/AIDS, SARS, and Ebola and the question of the world’s preparedness for the next generation of diseases.

582 pages, Paperback

First published October 22, 2019

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About the author

Frank M. Snowden III

7 books34 followers
Frank M. Snowden is Andrew Downey Orrick Professor Emeritus of History and History of Medicine at Yale University. His previous books include The Conquest of Malaria: Italy, 1900–1962 and Naples in the Time of Cholera, 1884–1911.

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Displaying 1 - 30 of 121 reviews
Profile Image for Henk.
875 reviews
January 21, 2023
Fascinating, terrifying and erudite. Brings together a lot of perspectives on past epidemics and very prescient on the current situation we find ourselves in.
Public health must be the highest law, and it must override the laws of the marketplace.

From Justinian, Napoleon, Mussolini to Barack Obama, this book offers a panoramic view on not just the epidemics but also the societies that faced their challenge. Plague, Cholera, Yellow fever, TB, HIV/AIDS and Ebola are examined in detail and the author brings interesting insights to the table.

I did mis a discussion of the Spanish Fever but overall a very interesting and also terrifying book that makes clear that all the debates we have nowadays about COVID-19 are far from new.

Frank M. Snowden III shows that the modern world complacency around infectious diseases is unwarranted: 345 diseases were discovered since the 1960’s. But Epidemics and Society: From the Black Death to the Present starts chronological with the Justinian plague that ravaged Byzantium, having 18 cycles and lasting centuries. The emblematic Black Death also raged for over 400 years. New for me, and a sign of my Eurocentrism, was that India and China were ravaged by plague at the end of the 19th century, with the industrialised West being spared.
Every description of the epidemics start of with a description of the disease and how it spreads, and bubonic plague is truly terrible with 42 degrees celsius fever and incredibly high case fatality rates of 60%. The disease causing flees unable to feed and hence more hungry and bite ready is one of the major contributors to virulence, as is the fact that flees fleeing a cooling (dead) body causing more infections with next of kin.
Lazaretto’s were erected as buffer-zones at ports, with 40 days quarantine for incoming ships.
The Hapsburg Cordon Sanitair was furthermore raised to stem land travel from the Ottoman empire
Only with the little ice age and brown rats being less social than the black rat did an end came to plague in Europe. The third plague pandemic ravaging the colonial cities of the British, with 20 million dead in India and the botched draconian attempts of the British worsening the crisis and leading potentially infected people fleeing cities to avoid lockdowns, spreading the disease further.

Snowden raises the interesting point that pandemics supported the development of power of the state, something a lot of conspiracy theorist nowadays believe as well, but when one reads of the general nastiness of pre-modern disease its very understandable that state tried everything they could to control outbreaks.
The toll on society was staggering: for instance 1/3 of all child-death in the 19th century being due from smallpox, with a 30-40% CFR.
Half the adults of Europe were disfigured by smallpox in the 18th century, with an Englishman giving a blanket of someone suffering of smallpox to native Americans in the 18th century a grizzly form of bio warfare avant le lettre.
Hispaniola’s indigenous population decreasing from 1 million to 15k in three decades after Columbus arrived, largely due to diseases. This led to African slave trade already being set up in 1517 due to the complete collapse of native populations. That the majority of slaves died in 5 years after coming to Hispaniola necessitate constant new slaves being scoured from Africa.
Lady Montague, wife of the British ambassador to the Ottomans inoculating her children against smallpox, and using her social standing to spread the practice in the West, is a small glimmer of hope in the history of the disease.

Yellow fever and dysentery
Hispaniola comes back in the history of yellow fever, with of the 65.000 military men send by Napoleon to quell the independence movement only 2.000 being able to battle due to a plethora of diseases endemic to the island. This in part contributed to the liberation of the island and the collapse of the French Caribbean empire, plus the sale of Louisiana to the US.
Another disease comes into focus in respect to Napoleon (besides him maybe having syphilis leading to his grand attack on Russia and ignoring his general.
The grand armee having as much people as Paris when it set of to Russia, but at halfway of the campaign more than 4.000 men per day were dying from dysentery.
Typhus is estimated to have killed 90.000 of the 100.000 soldiers leaving Moscow, with Napoleon fleeing on a sleigh. Hence disease definitely played a role in two of the major defeats of Napoleon and shaped the 19th century. I liked these chapters best, with the distinct interrelation between history and disease visibly at play.

Sanitary reform mainly meant to increase the workforce and achieve social stability in the 19th century. Cholera was a disease that in the end was tamed by sewers.
The disease led to a loss of up to 1 liter of water and blood-plasma, being too scatologic and dirty to depict in film or literature in a direct manner according to contemporaries. Hygiene was a crucial factor combatting the disease.
Naples being a case in point, including a aquaduct running besides the sewers and lettuce being dipped in open sewers since the ammonium made the produce look more fresh 🤮
The illness turned less deadly but endemic in the 20th century, even surviving in algae and fish when sea water was contaminated and with ceviche being the source of cholera in Peru.
Nepalese UN soldiers bringing cholera to Haiti, leading to over 1 million infections on a 10 million population.

Tuberculosis being found in 90% of the industrialized 19th century West.
Beauty standards, including anorexia, being transformed by tuberculosis, leading to very slim being fashionable for women, while for men “genius” was thought to be transferred by the illness, for instance by Keats his early death.

As an airborne disease it was seen as democratic, with upperclass victims, and with its slow progress over years and decades, no panic ensued.
Death rates were however proportional inverse to tax payments, showing that the disease was class based in the early 20th century.
Beards and moustaches falling out of favor due to the germ theory and fear of contagion
Sanitariums control over patients, removing potential causes of infection from the cities, being viewed quite positive at the time as almost monastic, and like the earlier quarantine practices.

Malaria, polio, HIV/Aids and Ebola
Malaria causing 100.000 deaths per annum at the end of the 19th century.
Only after half a century and with DET Sardinia was rid of the disease, leading to an erroneous belief in silver bullets to combat diseases.
Cuba being the first country to eradicate polio and churches offering services in praise for the development of a vaccine against polio

War and disasters leading to decades of health progress and campaigns being undone frighteningly easy.

Only 0.6% of whites versus over 15% of black people being affected by HIV in South Africa.
South Africa having the highest rape per capita figures in the world, compounding the problems.
Death rates increasing by 87% between 1997 and 2007 and 12.7% of the population being seropositive.
American homophobia impairing the response against AIDS, with nowadays HIV being as prevalent in black communities in big cities in the US as those in sub saharan Africa.
Incarceration (with the US having 25% of the worlds prison population) adding to spreading STD’s including HIV.

CFR of Ebola between 60% and 90% and with possibility of ending up blind and remaining contagious for months.
Palm oil deforestation leading to Ebola jumping from bats to people. Mining, lumbering and palm oil plantations easing the spread to cities with international airports. Social tensions and anti-plague like measures leading to riots. Death rituals spreading the virus to loved ones, while the initial flu like symptons helped the spread of the disease.
274 reviews22 followers
May 22, 2020
For decades now, I have been a sort of amateur epidemiologist emphasizing in pandemics and emerging infectious diseases. Every pandemic obviously has a biological and health related aspect. They also have a social and an economic aspect. A pandemic cannot be separated from cultural, historical geographic events taking place around it. Pandemics have major impacts on the direction of history, on civilizations, societies, and nations. What too often appears immediate and is most reported on (what is covid - 19 doing today, how many have died today, are the schools still closed, did Trump wear a mask, etc.) seem and are important . Often what is missed in such reportage, however, are the longer term effects which can span centuries and touch each and every one of us. These effects are far beyond the biologic. They are more significant then the current political debates (though, again, these are also important in themselves).

This particular book includes a description of the immediate impact of a number of the great pandemics of history. We learn about the virus or the bacteria involved, vectors and routes of transmission, how the disease manifests itself in the body, and the fight against it. We see it’s immediate devastating impacts on patients, healthcare workers, and the like. We watch the race to develop vaccines and treatments.

This book though does not end there. It only begins there. I can honestly say this is one of the better books which I have read on and about the subject of pandemics, especially from a historical context.

As we now find ourselves in the still early days of a frightening pandemic, battling a wiley virus, I heartily recommend it to those of you interested in such things. It is not a particularly difficult read. You don’t have to be a scientist to get something out of it. However, it also is not just some splashy popular read hoping to find a movie. It is an important and interesting read from which we can all learn a thing or two about past history - and our own future.

We are not all in this together or equally, but we are all in this.
Profile Image for Atila Iamarino.
411 reviews4,384 followers
January 4, 2021
Um livro excelente sobre pandemias, pré-COVID, com muitas lições que se transpõe agora. Snowden é um historiador que transformou seu curso sobre pandemias em um livro, o que gerou um material bastante abrangente e bem fundamentado.

Snowden dá um panorama sobre várias epidemias passadas, quais foram os organismos causadores e como mexeram com a sociedade. Só por essa parte, já seria um livro recomendadíssimo. Ele não só trás a informação que se encontraria de epidemias em outros lugares, como até na Wikipédia, como enriquece com a sociedade que passou pelos problemas e que lições ficaram. O exemplo de como a Sardenha precisou mudar a estrutura social para combater a malária (além de ações de combate ao mosquito e ao plasmódio) é excelente para se entender porque a COVID se manifestou de formas diferentes em cada país.

A informação sobre surtos mais recentes é mais detalhada e muito rica. Sua discussão sobre o papel de fatores como desmatamento e exploração ambiental no surgimento do Ebola, ou sobre a mentalidade de que estaríamos saindo da era das doenças infecciosas para uma era das doenças da velhice, quando na verdade entramos na era das doenças emergentes, deixam o livro ainda mais recente e mais relevante.
Profile Image for MaryCatherine.
191 reviews21 followers
July 3, 2020
“In the stark words of the US Department of Defense, ‘Historians in the next millennium may find that the 20th century’s greatest fallacy was the belief that infectious diseases were nearing elimination. The resultant complacency has actually increased the threat.’”

A comprehensive and well-organized text on the history of epidemics. I highly recommend this book, a textbook for a non-major course in epidemiology. The author is able to deftly present the material in an interesting and informative approach that is lively and captivating. I loved that each chapter was another historic battle with one of the plagues that have scourged human history—from, well, plague to AIDS— and the development and application of scientific method and cures to fight those battles, and the ways society and government responded and organized around pandemics. I did enjoy telling my family that I had just finished dysentery and camp fever one night and was moving on to cholera, smallpox, or malaria the next. It has become stunningly clear that eradication of disease —once a touchstone of public health, especially after modern developments in microbiology and vaccines, and success with eradicating smallpox—is nowhere in sight. Highly recommended.
Profile Image for Andrew Howdle.
495 reviews1 follower
August 7, 2020
Epidemics and Society developed out of a series of history lectures at Harvard. At times, the book reads like that - clotted, overloaded with facts to be absorbed, and not adapted for a general audience. There are some fine insights, however, and Snowden is compelling on early ideas of medicine, plague and death in art, the Romantic, tuberculosis myth, and the book contains one of the best accounts on the history of HIV in print. Snowdon's book makes for disturbing reading - especially the chapter on tuberculosis at the beginning of the C20. A fear of bacteria on money, the quarantining of books, pupils monitored for fever before entering school ... a precursor of where we are today! The most pertinent aspects of the book are the following: scientific overconfidence in relation to epidemics, a refusal by governments to act on scientific advice, and a failure to consider how epidemics link to social disadvantages. The book shines when it connects "plagues" to literature and art - modes of representation. A pity, therefore, that the HIV section, though powerfully explained, ignores any connection to poetry and memoir: two important educational methodologies. Generally, a fascinating book, but be prepared to skip sections!
Profile Image for Pavel Annenkov.
442 reviews115 followers
April 14, 2020
Книга составлена на основе лекций профессора Йельского Университета. Фундаментальный труд об истории смертельных болезней и пандемий. Автор нам показывает, как человечество боролось с этими напастями. Поражает и радует тот огромный путь, который мы прошли от времён, когда люди умирали пачками от простейших микробов, до прививок, лечения антибиотиками и главное нормальных привычек гигиены, которые не нужно никому сейчас объяснять.

Автор в хронологическом порядке описывает возникновение и последствия основных болезней, которые преследовали человечество. Подробно можно прочитать про чуму, холеру, оспу, туберкулез и СПИД.

Очень интересно и подробно рассказано, как эти болезни влияли на экономический и культурный уклад общества, как они формировали в нас новые ценности и привычки.

Каждый раз удивляюсь, какие всё таки Homo Sapiens живучие. Нам удается каждое столетие делать нашу жизнь лучше и длиннее, за счет новых открытий в медицине, биологии и создании новых лекарств.

- Мы побороли большинство болезней. Но эпидемии сопровождали нашу жизнь всегда. Ситуация в будущем не изменится. Человечеству надо всегда быть готовым к борьбе с новыми болезнями.

- Разобраться в истории основных пандемий и успокоить себя, что пройдёт и эта)

* Ни автор, ни многочисленные отчеты не предвидели, что самый мощный удар вирус нанесет благополучной Италии, Испании и США, а не бедной Индии и странам Африки, где антисанитария и беднейшее население.

* Авиаперелеты стали доступны большой части населения Земли. Более 2 млрд человек совершает перелеты ежегодно. Поэтому сейчас распространение любой инфекции произойдет по миру мгновенно. Как был прав автор(

* Столетиями и десятилетиями бактерии продолжают эволюционировать и меняться. Но мы сейчас ускоряем этот процесс и делаем ситуацию более опасной для себя. Бактерии меняются быстрее, чтобы приспособиться к новым лекарствам, которые мы используем сами и еще используем в огромных объемах в животноводстве и сельском хозяйстве. За дешевую еду нам всё таки придется заплатить.

* И опять автор прав, говоря о том, что удар новых пандемий будет очень серьезным, потому что в мире сейчас очень много старого населения у которых в силу возраста ослаблена иммунная система.

* Уже в 2000 году ЦРУ сделало огромный отчет, где предсказывало три сценария появления и развития новых пандемий. К сожалению, как мы видим, никаких глобальных мер на уровне государства, чтобы предотвратить эти сценарии сделано не было.

Еще больше ценить жизнь, которой мы живём последние десятилетия.

Стивен Пинкер «Просвещение сегодня» (Enlightenment Now)
Profile Image for WaldenOgre.
624 reviews53 followers
February 5, 2023


Profile Image for Sara Mesquita.
17 reviews5 followers
February 7, 2021
Epidemics and Society is a great book for readers who really want to know the details about the main epidemics that humans have faced so far. This book was written from a series of history lectures at Harvard, so it is expected to have some level of detail that can sometimes be considered excessive. However, it does offer a surprising overview of the social impacts of such extraordinary events and how we as a society continue to fail to manage and prevent such events.

From bubonic plague to Ebola, through cholera, tuberculosis, HIV, and many others, it covers the historical and political contexts in which these epidemics occurred. However, as the world is going through what could be another chapter in this book (Covid-19), it is still distressing that we have evolved little, as we continue to use the same methods (social distancing, quarantine, lockdown, etc.) and observe the same denialist behaviors of centuries ago.

A great acquisition for anyone entering the world of epidemiology.
Profile Image for DrWJK.
7 reviews1 follower
May 18, 2020
A Status Report on Darwinian Biological Warfare

Frank M. Snowden is sounding an alarm. The human species is engaged in biological warfare with microbes – bacteria, viruses, and parasites. Tens of 1000s of viruses, 300K species of bacteria, and multiple parasites lay in wait, ready to cause human misery, or even extinction. Microbes outnumber humans a billion to one.

Snowden says microbes cannot be eliminated. They reproduce so rapidly that they can mutate and adapt to any set of chemicals and drugs we throw at them. Indeed, the irresponsible use of antibiotics, and conditions in hospitals, are enabling “superbugs.”

Humanity’s current strategy of relying on chemistry favors the pharmaceutical companies, but that is NOT our strongest defense. Public education and sanitation efforts have been helpful. But the growth of “megacities” with huge areas of poverty, filth, lack of running water, sewers, and even flush toilets is a disaster waiting to happen.

Another area of undue vulnerability is government policy. Besides allowing over-crowded slums, poverty, and hygiene ignorance to exist, government priorities are endangering the human species.

Governments around the globe spend far more on their militaries than they due on their public health institutions. They allow corporations to treat medicine and health care as a commodity, rather than as a human right. (502)

When disease strikes, government’s first response is too often denial. Snowden shows how this has happened throughout history. But governments have NOT learned from their mistakes. Denial and slow response was the government reaction to AIDS/HIV. Then again to Ebola. When Snowden describes the government response to SARs, he does so without any knowledge of the COVID-19 pandemic, because the book was published a full year before the outbreak. Yet the reader will have to double check what he or she is reading about.

SARs is the first epidemic of the 21st century. It began in a province of China. The government saw it spread, but did not report it to the WHO, UN, or any other global agency. While the outbreak began in November of 2002, the WHO did not have enough information to declare its travel alert until March 2003. Hundreds of human deaths could have been prevented had China been more concerned with the fate of humanity. Incredibly, COVID-19 is Déjà vu all over again.

In 2000, the CIA issued its report on epidemics as a national security threat to US and world government. It was not optimistic.

Concerned about the fate of the human species, Snowden’s last sentence is that “public health must be the highest law – and it must override the laws of the marketplace.” 505

The rest is up to us.

William J. Kelleher, Ph.D.
April 28, 2020
I’m not sure how much this book succeeded in advancing theories of how epidemics impact society. I felt it was more descriptive of the etiology of diseases, responses to them, and the sociopolitical context of where the epidemics took place, rather than analyzing the disease’s impact on culture and society. Especially in the earlier chapters, references to literature and art created in response to epidemics was superficial. I felt a lot more could have been done in this regard. The two chapters on tuberculosis were excellent, however. But again, there could have been a lot more written on preparedness to respond to future epidemics, especially pandemics and our ability to work together as a global society, than was presented at the end. I don’t think Ebola is a good case study because the geographic impact was fairly limited to three countries, and, unfortunately, with those being West African countries, the international community had little incentive to respond. I think a more representative title would have been Epidemics and Public Health Responses, since little attention was given to wider public reactions, other than resistance to restrictionist measures. I would have like to have seen how the memory of past epidemics, especially those that struck generationally, were passed down to children and grandchildren. Even in the absence of written documentation, I’m sure something was at least passed down orally. That being said, it was mostly enjoyable to read, if a little dry at times.
Profile Image for Mariana Ferreira.
148 reviews72 followers
March 22, 2021
Impossível de resumir, esta obra é um exemplo de sobriedade e clareza científica. Acessível a leigos, apresenta dados e perspectivas que entrecruzam a ciência com a História e questões socio-politicas. O desenvolvimento de cada epidemia tem no seu centro uma poderosa rede de relações que devem ser descortinadas - guerras, sobreexploracao ambiental, pobreza, movimentos comerciais, assim como obstáculos culturais, económicos, obscurantismo e interesses de vários tipos. É uma viagem não só por parte da história da medicina e o nascimento de diversos tipos de interpretações e terapêuticas, como uma análise das principais epidemias que acometeram a humanidade ao longo dos séculos. Da peste negra à varíola, febre-amarela, disenteria, cólera, tuberculose, malária, poliomielite, HIV, Sars e Ébola. Viajamos também aos primórdios da Escola de Medicina de Paris, até ao desenvolvimento do Movimento sanitário, teoria dos germes, primeiros antibióticos e perspectivas presentes e futuras das doenças infecciosas - ao contrário de um otimismo abrupto do século XX, a humanidade não parece perto de ter quer a tecnologia, quer a organização prática/ aplicada no terreno, de prever, conter e tratar surtos graves de epidemias conhecidas ou desconhecidas. Vírus e bactérias sofrem mutações e a investigação sobre doenças infecciosas estagnou ao mesmo tempo que outras preocupações se sobrepunham - Quer medicamentos lucrativos para doenças crônicas do mundo civilizado ocidental, quer investimento noutras áreas que não um sistema de saúde e vigilância robusto.
A principal liç��o a reter é a interconexão inerradicavel que nos define enquanto raça. As epidemias não conhecem fronteiras, são uma ameaça omnipresente e inevitáveis pelo confronto cada vez maior entre o desenvolvimento humano e a degradação ambiental ou as condições insalubres que imperam no terceiro mundo e em zonas de conflitos bélicos constantes e corrupção.
Este livro foi terminado em 2018, pelo que a Covid 19 não é abordada senão num breve prefácio. No entanto, podemos refletir: é inegável que todo o aparato organizacional (vários fundos para organizações além da OMS, conferências e revistas) feito no passado para combater pandemias futuras similares ao Sars 1 e ao Ébola , com maior eficácia, ficou mais ou menos no papel com a Covid 19. O que se viu foi uma resposta tardia, negacionismo do governo Chinês (novamente) improvisações e medidas de contenção delineadas às cegas, coerção e falta de comunicação e controlo, sistemas nacionais de saúde sobrecarregados, falta de EPIS, falta de testes, investigações que foram paradas após o término da epidemia do Sars 1 (falta de mercado para vacinas !) e mortes evitáveis. Por fim, vacinas criadas a uma velocidade relâmpago, para tentar compensar e tratar uma destabilização primeiramente estrutural e política, profundas.

Temos de repensar acerca das investigações na área dos vírus e bactérias, doenças emergentes e reemergentes. A sustentabilidade ambiental, justiça social, educação e a visão global e universal da saúde pública.
Profile Image for Lefki Sarantinou.
590 reviews33 followers
September 4, 2021
Χωρίς υπερβολή, το συγκεκριμένο πόνημα το συγκαταλέγω ανάμεσα στα καλύτερα-αν όχι το καλύτερο-από τα βιβλία που διάβασα τελευταία ανάμεσα στην πληθώρα εκείνων που κυκλοφόρησαν προσφάτως για το συγκεκριμένο θέμα μετά από το ξέσπασμα της πανδημίας του κορονοιού. Για όσους από εμάς δεν είμαστε γιατροί ή βιολόγοι, δεν νομίζω να έχει γραφτεί άλλο πόνημα το οποίο να εξηγεί τόσο γλαφυρά και παραστατικά όλα όσα αφορούν τις φοβερές επιδημίες και τις λοιμώδεις νόσους που έπληξαν την ανθρωπότητα από τον Μεσαίωνα ως και τη σημερινή εποχή.

Ο ομότιμος καθηγητής Ιστορίας και Ιστορίας της Ιατρικής στο Πανεπιστήμιο του Γέιλ Frank Snowden εξηγεί στον πρόλογο και την εισαγωγή του βιβλίου του τους λόγους για τους οποίους οι πανδημίες των λοιμωδών νοσημάτων δεν έχουν εξαλειφθεί ούτε σήμερα.

Αρχικά επεξηγεί τη χυμοπαθολογία του Ιπποκράτη και το πως αυτή μετατράπηκε από εμπειρική μέθοδος σε καθαρή εξιδανίκευση των κειμένων από τον μεταγενέστερο φημισμένο γιατρό, τον Γαληνό. Κάτι τέτοιο είναι αναγκαίο, αφού η θεωρία των χυμών του Ιπποκράτη και οι μεταγενέστερες αλλαγές του Γαληνού στην ιατρική επιστήμη καθόρισαν τη συμπεριφορά των γιατρών καθ’ όλη τη διάρκεια του Μεσαίωνα, μέχρι και το ξέσπασμα της πρώτης μεγάλης πανδημίας που εξετάζει, της βουβωνικής πανώλης, η οποία ενέσκηψε τον 14ο αιώνα στην Ευρώπη. Αφού εξετάσει ενδελεχώς τα αίτια της ασθένειας, τη συμπτωματολογία, της γραμμές μετάδοσης, τα μέτρα αντιμετώπισης-τις καραντίνες και τα σχετικά-, καθώς και τις συνέπειες στην ανθρώπινη κοινωνία, ο Snowden συνεχίζει με την άλλη μεγάλη μάστιγα των νεώτερων χρόνων, της ευλογιάς.

Στη συνέχεια ασχολείται με τις επιδημίες του κίτρινου πυρετού, του τύφου και της δυσεντερίας, οι οποίες έπληξαν τον στρατό του Μεγάλου Ναπολέοντα και καθόρισαν την έκβαση των μαχών του. Πρόκειται για ένα κεφάλαιο που θα καταπλήξει ακόμη και ιστορικούς που αγνοούσαν ενδεχομένως αυτή την “υγειονομική” πλευρά των εκστρατειών του Ναπολέοντα από την Αιτή μέχρι και τη Ρωσία.

Ακολούθως, ο Snowden αναλύει το πως άλλαξαν τα πράγματα στον κόσμο της υγείας με την ανακάλυψη των μικροβίων και την ανάπτυξη της μικροβιακής θεωρίας των νόσων. Παρ’ όλα αυτά, όμως, η θεραπεία ασθενειών όπως για παράδειγμα η χολέρα και η φυματίωση παρέμεναν εξαιρετικά θανατηφόρες ως την παραγωγή του πρώτου αντιβιοτικού της πενικιλίνης, αφού μέχρι τότε οι γιατροί ήταν στην ουσία ανίσχυροι απέναντι στους ύπουλους αυτούς μικροοργανισμούς.
Η υπόλοιπη κριτική στο tetragwno
Profile Image for Grant Kaminer.
24 reviews4 followers
June 16, 2022
Absolutely amazing. Exceptional well written, thought-out, and a good mix between introductory to infectious disease and graduate level teachings. Definitely the best book I have read this year, and maybe the best science book I’ve read.
Profile Image for Stone.
104 reviews14 followers
March 27, 2022
*Black Death
*Yellow Fever
*El Tor

*Divine and Demonic
*Humoral Framework (Hippocrates & Galen)
*Miasmatic Theory
*Miasmatic - Filth/Decay (Zymotic)
*Sydenham - Observation
*Solidism/Localism - lesion
*"Seed" theory
*Spontaneous generation

*Mass hysteria/riots/violence
*Upsurge/outbursts of religiosity
*Polarisation (oscillation)

*Food & water
*Warm spring wet hot summer + economy recession - lower wages - poverty - population growth exceeded output - famine

*Natural philosophy
*Dominant culture of individualism
*Exchange of ideas, practices and verification of hypothesis
*Establish mathematical, instrumental and print literacies for scientific advances
*Develop hand-on practices on experimentation and investigation of nature

*Economic plummet
*War/International standing
*Fiscal austerity
*Displacement of population
*Political oppression
*Environmental catastrophe
*Impoverished diets
*Counter-productive policies
*Advancement of medical understanding

*Vaccination ("vaccinus" - "from cows" - cowpox - limited duration)
*“Social” — social treatment, social work, social medicine, social problem, social care, social class, social disease, social outlook
*Three foot radius

Profile Image for Jenny.
783 reviews19 followers
September 17, 2022
This book was formed from a college course on epidemics for non-medical students. The history of how humans have approached disease is covered throughout the book. The epidemics covered are: the plague, smallpox, yellow fever, dysentery, typhus, cholera, tuberculosis, malaria, polio, HIV/AIDS, SARS and Ebola.

I'm not sure how this ended up on my to-read shelf. After reading a lot of beach-read/fluff novels in July, I thought maybe I was ready for something with a bit more tooth. I was not prepared for how toothy this was; this book is dense with information. I read 400 of the nearly 800-some pages and was feeling a bit overwhelmed and bored, but I was interested in some of the coming chapters so I persevered and took breaks between chapters by reading more fluff. I'm glad I read the book; there were some interesting things to think about. I learned primarily that many epidemics occur because of poverty, war and traveling/globalization.

Here are the notes I took of the interesting bits to me:

Socrates is the first person who addresses disease as normal and not from a divine or demonic problem, but disease at that point was not viewed as an individual problem. Rather, disease was viewed as an imbalance in the human body as a whole and you had to get the body back to equilibrium. The treatment for returning to equilibrium was not definitive, but a choice among many different kinds of healers at the time.

1500s during the 2nd plague was the first time it was thought up that some sort of invisible thing was passed from one person to another. contagion was more an idea that caught on with the uneducated at first because the educated couldn't find any backing from their medical textbooks.

There were actually 3 different plague pandemics that lasted for centuries. The plague infected people in the prime of their lives, leaving many widows and orphans. Once people contracted the plague they were abandoned by friends and family.

The plague has never been eradicated, but we can treat it now with antibiotics. That being said, people can still die from it today.

"Quarantine" comes from the Italian word for 40, which takes heed from the Bible and its numerous 40s (40 days of lent, 40 days Moses on Sinai, etc.). The thinking was that 40 days of quarantine wold be a holy amount of days to eradicate the plague from ships.

The plague receded in the middle ages because a different species of rat that skittered away from humans invaded the territory of the black rat and overtook it. The black rat then went out of existence. The rat still does exist elsewhere in the globe and it's in those areas where they have problems with the plague periodically.

One of the original treatments for smallpox was the red treatment, where the patient would be surrounded with the color red. Then there were a lot more treatments, but it was noticed that the rich died more frequently, so it was determined that the best treatment was no treatment, since the poor (who could not afford a treatment) stayed alive more than the rich.

Warfare is the cause of a lot of the spread of disease.

You could only catch smallpox once. The plague was a very public disease. Smallpox was just as deadly, but it was private and individualistic.

The first smallpox vaccine was from cowpox. The name "vaccine" means cows.

Black people died faster than the birth rate on Hispaniola/the Dominican Republic, so the slave trade was very active. Yet they died from overwork and insufficient diet and not from yellow fever, which killed the white people. The black in power on Hispaniola used yellow fever as part of their "weaponry" against the white French army who came to make sure the blacks went back to a system of slavery. There still is no treatment possible for yellow fever.

Dysentery is bacterial and caused by oral-fecal contamination. There is no immunity from it, even if you've had it before. Dysentery wanes in cold weather.

Typhus is a bacteria transmitted by lice. The bacteria is not inserted in the bloodstream. Instead the louse poops the bacteria out. The scratching from the louse bit then spreads the bacteria around.

In the late 1700s the Paris School of medicine began to see diseases and epidemics as individual diseases, instead of the idea of imbalance in the body. The method of treatment became: read little, observe a lot. The idea being observation is key and theory is not. Medicine becomes more secular. Patients did not fare better in the Paris School of medicine. Physicians grew in knowledge, but not in patient management and there were moral reservations in how the physicians treated their patients. Knowledge and advancement were what mattered. By the mid 1800s, the school lost its momentum as people sought out schools of medicine that focused on the laboratory.

In the mid-1800s the population begins to expand because the threat of infectious diseases goes down and lifelong chronic illnesses like heart disease became the focus as people aged into those diseases. The cause of longevity may not have had anything to do with medicine, but a focus on better nutrition, wages and sanitation.

The idea for sanitation came from Paris in the early 1800s. Doctors were getting a picture that certain diseases came from certain areas of the city. They were only sort of successful but the idea moved to England where it made a big difference.

Cholera was a lower class disease. It spreads by an oral-fecal route, so societies that had this disease did not have sanitation in place.

Tuberculosis (first known as consumption) is primarily an airborne disease that either strikes swiftly in death or lingers in waves for decades. At first the disease was thought to be hereditary. But because those in the higher class got it, it was seen as a disease that attacked all. The ideal for feminine beauty then blended with the look of one who suffered tuberculosis -- waify, pale, elongated. Women who were well would often seek out illness or losing weight in order to achieve the "beauty" of those who had tuberculosis. Avoiding exercise and imitating poor appetite. Women's fashion was then created to enhance the look of the physical ailments of tuberculosis (ie, lower back line to prominently show the curving shoulders and raised shoulder blades). FOr men, it was assumed that tuberculosis heightened their creativity and insight. The mind is able to soar while the body wastes away. TB was called the white plague because it was assumed to only inflict the white race.

Once tuberculosis was discovered to be infectious and not hereditary, it was then a reviled illness. Although it did affect the elite, it was still infecting the poor at a greater rate and, thus, became abhorrent to people because it was viewed as a disease of the poor. Once they discovered antibiotics, and then some that would effectively treat TB, the rates of tuberculosis went significantly down and they thought the disease would be eliminated in 2010. But an upsurge in the late 1980s from poor countries and HIV/AIDS has quashed that goal. Now TB bacteria are becoming drug resistant, especially if the whole course of treatment is not followed.

Human malaria is 5 different diseases caused by 5 different species of parasite.

Malaria was eradicated in Italy eventually using a multi-prong approach of treatment, education, restoration of the economy, and spraying of DDT. To solve the malaria problem in sub-Saharan Africa, it is well to remember that malaria is treatable but that societal problems such as malnutrition, economic instability, illiteracy, inadequate housing, etc. feed into the problem of malaria and that a single-prong approach of merely spraying to remove the insects will not work. A quick fix will not work.

Polio is caused by 3 strains of virus. If you've had one, you're immune to that one, but not to the other two. It is spread by oral-fecal or mucus routes, but incubation is 1-3 weeks and during that time those infected are asymptomatic but shed the virus. Polio tended to infect the wealthier white families in the United States. In impoverished parts of the world, the infantile paralysis version of polio was more common, but ignored.

More women than men have HIV in South Africa because of sexual violence committed agains women in the male-dominated country. HIV spreads most quickly through blood, so women are both exposed through sexual fluids as well as through wounds they have from rough sex/rape.

From WWII to the early 1990s, people believed that we could conquer infectious diseases because of our technology. However after that point in the early 1990s, people realized they were still vulnerable from diseases in part because of the "new" HIV disease discovered in the 1980s, followed by a number of epidemics that broke out in the 1990s, such as cholera, the plague, ebola, etc.

Since WWII, the world has changed enough in how we live that now it almost encourages epidemic diseases to flourish. The biggest change is the rapid movement of goods and populations. Mixing gene pools and giving microbes populations of non-immune people to attack, microbes have an advantage over humans to cause a devastating impact. Elective air travel, mass immigration and demographic growth (especially in urban areas) are the biggest factors that invite new and old microbes to flourish.

Additionally, since medical technology is so advanced, even that opens the possibility of more infectious diseases because those who are undergoing treatment and procedures are more susceptible to infections arising in the hospital/nursing home setting. Furthermore, increased medical technology invites the problem of antimicrobial resistance. Antibiotics are a nonrenewable resource whose efficacy is limited. Thus our current treatments for diseases such as malaria, AIDS and TB may become ineffective, causing a major problem around the world.

On average, since 1970, a new disease is discovered more than once a year.
Profile Image for Paul Gaglio.
120 reviews1 follower
April 3, 2020
This was a truly remarkable, tour de force book. It covers the history of epidemic diseases and the way society has attempted to contain and eradicate them. It also points out has society has been changed and altered by these events.
This book is not an easy read. Every page is teeming with information. There is a tremendous amount of information that is distributed. The author is obviously highly intelligent and I’m sure tried to disseminate the text into as easily understandable as possible. It is a difficult read but definitely worth worthwhile. Especially in light of everything doing on in the world today.

P.S. Interestingly, the book does predict what we are experiencing today and Dr Fauci appears multiple times in the text.
535 reviews132 followers
April 7, 2020
A brilliant tour of the social impact of major pandemic disease episodes, focused above all on the impact in Europe. Began as what must have been a riveting class at Yale, and is presented in a series of beautifully-written (and horrifying in its precise medical detail) chapters describing the plague (which Snowden rightly describes as the paradigmatic pandemic disease), smallpox, HIV/AIDS, and concluding with SARS and Ebola. Snowden is highly attentive to the contemporary medical-intellectual interpretations and interventions in response to the disease and along the way makes the case that responding to pandemics, perhaps almost as much as war-making, is what made the modern “population security”-focused state. He also looks at cultural responses to the various diseases, in literature and the arts, and uses these to help describe what living with and through these diseases meant for the people who experienced them. A great general introduction.
Profile Image for Ali.
1,353 reviews110 followers
June 19, 2021
This is a fascinating and thought-provoking ride through pandemics - from the Black Death to HIV, through cholera, dysentery, yellow fever, malaria and more. Obviously topical, this is not only an excellent discussion of what pandemics do to societies - including how pathology and social context create differing responses - but also a chilling explanation of why pandemic risk is rising, despite advances in vaccine technologies.
I have a few quibbles - there are two full chapters of what seems to be mostly military history (Haiti and yellow fever felt more on point than Napoleon's failed advance into Russia, which was less about disease and more about strategy. On the other hand, the examination of how colonialism impacted on Black Death outbreaks in Mumbai and Hong Kong was excellent, and the decision to discuss HIV in Africa, where it has been most devastating, before the US, where it has been most written about, placed it in an enlightening context.
Reading about gruesome deaths is not going to be everyone's cup of tea (Snowden does keep this to the necessary minimum), but I found the book fascinating and helpful to operate sanely in a COVID world.
Profile Image for Cheryl Gatling.
1,065 reviews14 followers
August 19, 2022
This book was written by a Yale University professor who taught a class on the subject. The author, in his introduction, says this is not a textbook, but I think it reads very much like a textbook. With organized thoroughness he delves into the historical medical understandings of disease, going back to Hippocrates and Galen: the theory of the four humors, the miasma theory, and the idea that God sent disease as a punishment. Later he traces the discovery of the germ theory of disease, and the development of vaccines.

For every disease he discusses the symptoms, the course of the disease, the mode of transmission, the CFR (case fatality rate, or kill ratio), the geographical course of its spread, the way people tried to treat it, the way people responded, the way the disease affected politics, art, religion.

I won’t say the book is dry, but I definitely zoned out a couple of times. I think the book would have been dry if the subject matter had not been fascinating. I mean, thousands dying, sometimes in agony, sometimes in a putrid odor, those are real dystopian scenarios.

Plus, the book is full of interesting tidbits that I never knew. Like these facts about bubonic plague: We know now that the disease is spread by infected fleas who jumped off of infected rats. I never knew that the disease makes the fleas sick, too. The bacteria cause a blockage in the flea’s gut, so that when it feeds, the blood meal can’t go down and get digested. The flea is starving. The desperately hungry flea bites and bites and bites, but because its gut is blocked, it keeps throwing up the blood it sucks, blood that is full of plague bacteria. It’s almost like a system perfectly designed to spread as many microbes as far and as fast as possible.

And this: In the Middle Ages, textiles were expensive and valuable. When someone died, his clothes were immediately taken by others, as were the bedsheets. Sometimes the clothes still had live fleas in them. Fleas infected with plague. Fleas that would go infect the next person wearing the clothes of the dead.

And this: One of the factors that caused plague to spread in the Middle Ages, and helped it to decline later, is that there was a change in the species of rats. In the Middle Ages the common rat was the black rat, which was relatively friendly. When people had them in their houses, they sometimes made pets of them. Later, the Norway rat, or brown rat, was introduced. Brown rats are meaner, and drove out all the black rats. But they are also shyer. They like to keep their distance from humans. They prefer to run and hide from people, making it harder for their fleas to jump from rat to human, and this may have been one factor in the plague’s eventual decline.

And that is only for plague. There is also smallpox, yellow fever, dysentery, typhus, cholera, polio, TB, AIDS, and Ebola. Each disease has its fascinating facts.

For smallpox, the only disease ever to be eradicated, that was possible because smallpox was a disease that only infected humans. There were no animal vectors involved. We will never be able to eradicate bubonic plague, for example, because there are rodent reservoirs out there, and we will never be able to eliminate all the rodents (or vaccinate all the rodents).

There is a long description of how Haiti won its independence from France because Napoleon’s troops were wiped out by yellow fever. And that Napoleon failed to conquer Russia because dysentery and typhus killed most of his army. We are usually told that it was winter that defeated Napoleon in Russia, but disease was at least an equal partner. All this is to show that epidemic diseases can determine the fate of empires, who rules nations and who doesn’t, and we don’t usually give it this credit.

For TB, it was interesting that people at first didn’t know the disease was contagious. They thought it was hereditary, and even though thousands were dying in the 19th century, people weren’t afraid. Because of John Keats writing his most beautiful poetry while dying, and the beautiful Mimi singing lyrically while dying in the opera La Boheme, TB was seen as a romantic disease. Its sufferers were thought to fade in languorous beauty, with willowy frames and bright eyes, while really they died choking on bloody sputum and gasping for air.

Once it was established that TB was infectious, people got disgusted by anyone coughing or spitting in public, and started fumigating all the surfaces. TB sufferers were sent away to sanitariums, where fresh air was supposed to restore their health. Patients were bundled up and set outside on porches, in all weather.

But I can’t tell you all the fascinating things, because my already long review would be even longer.

One repeated theme is that there is a connection between death and standard of living. Anyone can catch a disease, and anyone can die of it, but epidemic diseases take their greatest toll among people who live in crowded slums, with poor sanitation, poor diets, exhausted from overwork. It has been argued in history whether poverty causes disease or disease causes poverty, but they are linked, and whatever we as a society do to bring a better life to the poor will help protect the health of everybody.

Likewise, the degraded state of our environment can promote disease. The Ebola outbreak in Africa happened when the forests were cut down for palm oil plantations, and the bats who had lived in the forests moved into people’s gardens. A boy played in a hollow tree where bats lived, he breathed in their infected droppings, died of Ebola, and started an outbreak. Preserving wild spaces and biodiversity can keep humans and animals apart.

This book was written before Covid. An introduction makes mention of it, but it was not necessary to say much about Covid, as the reader can easily draw his own conclusions. I was struck by how many things have not changed. Some people were horrified when Americans committed acts of violence against Asian people, blaming them for having created Covid, perhaps on purpose. But scapegoating foreigners has been a part of many epidemics. In the plague years it was Jews who were murdered. Likewise, it has been common to close borders, to prevent travel, to cancel public gatherings. And there have always been some people who resisted, who distrusted the state, who thought that vaccines were poisoned, that the whole thing was a conspiracy to eradicate poor people. This is disappointing, but there is some comfort in it. At least we aren’t becoming worse humans than we were in the past.

But we hope for better. The book ends on the note that epidemics have happened in the past, and we know they will happen again in the future. Maybe new diseases will arise, or maybe an old disease will evolve to become more virulent. Either way, we should be expecting it. We should be vigilant, and have systems of surveillance and tracking in place, and a plan. But so far, after each epidemic dies down, people forget. We can always hope to do better next time. Because we know there will be a next time.
Profile Image for Benjamin Britton.
149 reviews3 followers
June 21, 2023
“A major aspect of the official response to the challenge of emerging and reemerging diseases is that microbes are regarded as threats to the security of states and to the international order”

“In the most afflicted regions of the world, such as sub-Saharan Africa, the report anticipated “economic decay, social fragmentation, and political destabilization”

“Disease, therefore, would heighten international tensions”

“In practice, the first test of the new structures was the SARS pandemic of 2002–2003, which was the first major emerging disease threat of the twenty-first century”

“After appearing in the Chinese province of Guangdong in November 2002, SARS erupted as an international health threat in March 2003, when WHO received notification and declared a global travel alert”

“As retrospective studies have demonstrated, SARS presented many of the features that most severely expose the vulnerabilities of the global system”

“SARS demonstrated no predilection for any region of the world and was no respecter of prosperity, education, technology, or access to health care.”

“For four months following the November outbreak of SARS in the province of Guangdong and its subsequent spread to Beijing, the Chinese authorities followed a policy of concealment and obfuscation”

“On the other hand, the Chinese party-state was determined to project an imagine of mastery and control, both to its own people and to the outside world. The Communist Party also feared that too much information would expose the reality in the country of impoverished living standards, an inadequate health-care system, and a lack of preparedness for public health emergencies”

“The Chinese instead minimized the extent of the crisis, manipulated figures for public consumption, banned all unfavorable news from appearing in the press, and denied WHO teams access to affected areas of the country”

“Chinese policies clearly reveal, therefore, that a major factor in the containment of SARS was serendipity. The world was fortunate that the disease is spread by droplets and therefore requires extended contact for transmission, unlike classic airborne diseases such as influenza and smallpox”

“As poorly transmissible as it was, however, SARS exposed the absence of “surge capacity” in the hospitals and health-care systems of the prosperous and well-resourced countries it affected”

“Without substantive changes to the way we manage the delivery of health care, both locally and on a worldwide scale, we risk the otherwise preventable annihilation of millions of people, either by this virus, or the next”

“In Toronto, Dr. Caulford, as we have seen, had commented in 2003 that the world needed to be “forever changed.” His hope was that no outbreak would ever again find the international public health system so unprepared”

“In principle, spillover can occur due to contaminated bush meat when forest dwellers hunt, butcher, and eat bats or other previously infected animals”

“Not by accident, the three countries afflicted by Ebola were subject to a frenetic pace of deforestation and land clearance to meet international demand for resources from the woods”

“Clearest and most illustrative is the example of the palm oil industry, which has been the most dynamic sector in world agriculture since the 1990s, when its production tripled, with the forests of West and Central Africa as an important center”

“The oil palm is native to West Africa, and its scientific name—Elaeis guineensis—even specifies its origins in Guinea”

“This large-scale enclosure, which some sources describe as a “land grab,” provided cheap and extensive acreage to plantation owners, while the army enforced the entrepreneurs’ claims against rural resistance to mass dispossession”

“There is a burgeoning literature on the negative social, economic, and environmental impact of the new palm oil monoculture, and a vociferous opposition to it has been mounted by such “green” NGOs as the World Rainforest Movement, the Union of Concerned Scientists, and Greenpeace”

“In addition, the emergence of Ebola demonstrates that deforestation also has direct implications for health and disease”

“The link between Ebola and deforestation is the fact that the fragmentation of African forests disrupts the habitat of fruit bats. Before the arrival of agrobusiness, the bats normally roosted high in the forest canopy, far from human activities”

“In the wake of clear-cutting, however, these “flying foxes,” as they are known locally, forage ever closer to human settlements and grow dependent on household gardens with their scattered trees and crops”

“In the twelve outbreaks of Ebola known to have occurred between 2004 and 2016, the index cases have been consistently traced to the edges of forest fragmentation and deforestation that happened during the previous two years”

“Therefore, not only does forest fragmentation bring humans into more frequent contact with bats, but it also ensures that such contact involves precisely those species that carry the disease”

“Those who staffed the front lines paid a heavy tribute to Ebola, certainly in death and disease, since 20 percent of the Ebola victims in the three countries of the Mano River Basin are estimated to have been health-care personnel”

“All direct contact with patients was hazardous”

“But the specific conditions of the health-care systems in West Africa greatly magnified the inherent dangers involved. Guinea, Liberia, and Sierra Leone were among the world’s poorest nations”

“Poverty of such depths profoundly affected the ability of West Africa to build health-care infrastructures”

“The story of Ebola is not only a narrative of poverty, but also one of the poor distribution of resources and the suspect quality of prevailing moral priorities”

“As Ebola erupted, preparedness in all three countries was nonexistent. For example, there were virtually no health-care workers”

“Hospitals fared equally badly. They seldom possessed isolation wards, electricity, or running water and had no diagnostic facilities, protective equipment for staff, or training in response to a public health emergency”

“Already overcrowded, they also lacked surge capacity in the event of an emergency”

“In such an environment, it was inevitable that many of the health-care workers who remained at their posts would contract the disease. Local medical staff had none of the tools, facilities, equipment, or training to protect themselves, and their high rate of contracting Ebola themselves further undermined a health-care system that was already crumbling.”

“What transformed the epidemiological history of Ebola was the fact that West African forests are intimately linked to urban centers”

“Above all, mines were a school for migratory behavior. Probing ever deeper into the forests, they set in motion an immense movement of young men hungry for work and willing to travel”

“Thereafter, Ebola erupted in slums that, like the hospitals within them, lacked sanitation, adequate space, and facilities of every kind”

���If transformation of the forest environment allowed Ebola to break out, the degraded and overcrowded conditions of the built environment of West Africa’s cities enabled it to spread exponentially.”

“By the end of the epidemic MSF had strained its resources to a breaking point. As 2014 began, the agency had prioritized the need to confront humanitarian crises in Sudan, Syria, and the Central African Republic. Suddenly the international charity was confronted with the need to control a public health emergency on an unprecedented scale”

“On March 31, 2014—three months after the outbreak began—MSF declared that the crisis in West Africa was an “unprecedented emergency” demanding an immediate and coordinated international effort”

“Far from acting, WHO engaged in a war of words with the messenger bearing bad news it preferred not to hear”

“Safely seated at a desk in Switzerland, Hartl contradicted the MSF assessment and the view of all experts, announcing: “The fortunate thing with Ebola is that it’s quite difficult to transmit”

“Adopting instead the perspective of the industrial world, it decided no longer to prioritize infectious diseases. Accordingly, it drastically cut its budget for surveillance and response and dismissed senior and experienced experts in the field”

“As people continued to die by the thousands in three countries and the epidemic spread, the standoff continued. In June 2014 MSF announced that Ebola was “out of control,” with more than sixty infectious hot spots, and it again denounced what it had already criticized in March as a “global coalition of inaction”

“Without evidence, the hapless UN spokesman opined, “This is not a unique situation—we have faced it many times—so I’m quite confident that we can handle this.” MSF officials were aghast”

“The New York Times, for example, was scathing in its comments on WHO “leadership” as the disease worsened during July and August. The agency, it noted, “has snoozed on the sidelines for months”; its response was “shamefully slow”; and its African regional office was “ineffective, politicized, and poorly managed by staff members who are often incompetent.”

“Governments both in the afflicted area and abroad were no more forthcoming.”

“In this spirit, President Alpha Condé of Guinea opted to paint a rose-tinted picture of events in order to avoid alarming mining and palm oil companies: his government reported only a fraction of the known and suspected cases”

“On the contrary, during the early months of the epidemic, he adopted the alternative strategy, it was said, of applying quarantine not to the virus, but to journalists who reported its predations”

“Farther afield, medical authorities and political leaders in the developed world adopted a laissez-faire policy. The European Union, Russia, and China, for example, folded their hands while somber statistics accumulated and physicians on the front lines appealed for help”

“Inaction on the part of the United States was due to a form of public health isolationism. What America wanted to know was whether the epidemic in West Africa posed a direct threat of crossing the Atlantic and causing death, not in Monrovia or Conakry, but in New York, Houston, and Los Angeles”

“In the New York Times, David Quammen spoke for those who felt safely ensconced behind the bulwarks of American modernity, science, and civilization, penning an article complacently titled “Ebola Is Not the Next Pandemic”

“It was, frankly, a rare disease caused by the “grim and local misery” endured by a small number of Africans who “are obliged by scarcity of options to eat bats, apes and other wild creatures, found dead or captured alive.”

“The illness of Brantly and Writebol was a politically transformative experience, as fear spread across the United States with the realization that the country could be in danger from Ebola”

“Then every American’s worst fears materialized in September 2014. A traveler not involved in patient care, the Liberian Thomas Eric Duncan, flew to Dallas from West Africa. There he fell ill, was misdiagnosed as having sinusitis, and discharged from Texas Health Presbyterian Hospital. He was readmitted and died on October 8, but only after infecting two nurses who treated him (they both recovered). In addition, thirty European medical volunteers were infected and transported to Spain, the United Kingdom, France, Germany, and Italy for care.”

“CDC director Thomas Frieden also contributed to the tide of opinion favoring intervention”

“The situation, he said, was an absolute emergency, and only massive and prompt outside help could prevent disaster.”

“After a further six long weeks of preparation, the agency set up the UN Mission for Ebola Emergency Response, which was tasked with coordinating policy and managing the campaign to defeat the disease. Officially at least, WHO had taken charge.”

“The US president was stunned by a wave of criticism in Congress and in the press, which described his administration as “rudderless” and “inadequate.”

“Meanwhile, President Obama was convinced that the epidemic constituted a risk to the United States, first as a medical threat that could—and did—reach American shores.”

“Ebola was no longer simply a humanitarian crisis in distant lands but a matter of national security. As the first week of September ended, Obama declared the epidemic a national security crisis and directed the Department of Defense to deploy three thousand US soldiers to Liberia in engineering and logistical support roles—a mission termed Operation United Assistance”

“In the meantime, the CDC started training courses in Alabama to prepare volunteer medical personal in the use of personal protective equipment (PPE), which consisted of gloves, goggles, face shields, rubber gowns, biohazard overalls, and rubber boots—the modern-day equivalent of the plague costumes that physicians wore to confront the Black Death”

“Donning and doffing the equipment correctly while following a precise sequence was essential to preventing exposure to the virus.”

“It was safe to wear the modern plague costume for only fifteen minutes at a time. Another”

“Cuba stood apart as a resource-poor nation that both intervened beside the major powers and sent its aid—4,651 trained doctors and nurses—without regard to national borders”

“Not surprisingly, therefore, the campaign at the outset was thoroughly militarized. Many of the coercive means adopted echoed early modern Europe’s effort to defend itself against bubonic plague, such as extraordinary executive powers, sanitary cordons, quarantines, curfews, and lockdowns. Compulsory treatment facilities surrounded by troops even closely resembled lazarettos”

“Daniel Defoe would have found the response familiar”

“Famously, Liberia then quarantined strategic urban communities, in particular the slum neighborhood in Monrovia named West Point because of its location on a sandy peninsula”

“Such conditions remind us of similar circumstances in the history of plague and cholera, when military measures of public health gave rise to violence, as they did again in India during the late nineteenth and early twentieth centuries”

“This tense atmosphere was inflamed by multiple conspiracy theories”

“Some regarded health-care workers as cannibals or harvesters of body parts for the black market in human organs”

“The state, rumor also held, had embarked on a secret plot to eliminate the poor. Ebola perhaps was not a disease but a mysterious and lethal chemical”

“Perhaps whites were orchestrating a plan to kill African blacks, or mine owners had discovered a deep seam of ore nearby and wanted to clear the surrounding area.”

“With this background, resistance in many forms flared up, not as the pitched battles of West Point, but as the guerrilla actions of small rural communities”

“Elsewhere, armed with machetes, terrified peasants raided treatment centers to snatch away their relatives, killing or wounding the staff and all who opposed them”

“The sudden intervention of major outside powers with trained medical personnel, diagnostic facilities, protective equipment, and an array of well-supplied and well-staffed treatment centers transformed the situation”

“But the impact of the 2014 epidemic on West Africa was particularly immense on multiple fronts most obviously in terms of the burden of death and suffering it imposed on the three nations it ravaged”

“But the indirect medical costs are perhaps far greater, as the epidemic destroyed the already inadequate health-care systems of all three countries.”

“Economists estimate that the direct cost of containing and extinguishing the epidemic of 2013–2016 was approximately US $4.3 billion”

“Similarly, investment dried up, with significant consequences for employment, growth, and foreign exchange. Businesses closed to protect their employees, and retailers lost their customers”

“Ebola painfully exposed the extent of global unpreparedness to face the challenge of epidemic disease despite the warning provided by SARS”

“One is the treatment of health as a commodity in the market rather than as a human right”

“Pharmaceutical companies prioritize treating the chronic diseases of industrialized nations, where profits are to be made, over the development of drugs and vaccines for the infectious diseases of the impoverished. As a result, tools to deal with diseases like Ebola lag far behind in the pipeline”

“A further consequence of the perspective of health-for-profit was painfully evident in 2013–2016. This was the absence of functioning health-care systems accessible to everyone”

“A public health infrastructure and guaranteed access to it are the essential means needed to”

“sound the alarm, provide timely information, isolate infectious cases, and administer treatment”

“Treating health as a commodity implies that decisions affecting the life and health of millions are placed in the hands of politicians whose power depends on generating development, trade, and profit”

“The siren song of military expenditure further completed the diversion of resources away from the construction of a robust health-care infrastructure, leaving West Africa perilously vulnerable.
Finally, Ebola was able to cause an epidemic because of the prevailing illusion that national borders matter in a globalized medical environment”

“But epidemic diseases are an ineluctable part of the human condition, and modernity, with its vast population, teeming cities, and rapid means of transport between them, guarantees that the infectious diseases that afflict one country have the potential to affect all”

“To survive the challenge of epidemic disease, humanity must adopt an internationalist perspective that acknowledges our inescapable interconnectedness”

“The first is the establishment of functioning health-care systems everywhere”

“Second, it is essential to ensure direction and coordination from an internationalist perspective through a well-funded, competently staffed, and ever-vigilant World Health Organization”

“Lastly, the relationship between the global international system and public health cannot be ignored”

“An economic system that neglects what economists euphemistically call “negative externalities” will ultimately exact a heavy cost in terms of public health”

“Epidemic diseases are not random events. As we have seen throughout this book, they spread along fault lines marked by environmental degradation, overpopulation, and poverty”

“In the ancient but pertinent wisdom, salus populi suprema lex esto—public health must be the highest law—and it must override the laws of the marketplace.”
Profile Image for Larissa.
143 reviews1 follower
August 1, 2022
Despite temporal, geographic, and epidemiologic limitations on his areas of focus, the scope of Snowden's work here is enormous. It's already a pretty long book, but I still found myself wishing for more details (a larger number of illustrative examples mainly) re: the intertwining of sociological concepts and communicable disease. I guess what I really ought to do if that's what I want is read a whole book on every individual epidemic, because how could you properly do more than scratch the surface with a text like this. The real benefit of the scope here is to identify patterns.

An example of something I found pretty show-stopping was the line drawn from famine 30 or so years before, to the second plague outbreak (the so-called Black Death beginning in the 1340s), wherein an entire generation of children suffering from chronic malnutrition leads to immunologic weakness in the adults who lived to became infected. Of course, the rich always managed to eat somehow, contributing to a class effect. This kind of system of consequences, obviously, is still observed in contemporary infectious disease many centuries later.

Stray observations:

- I was also struck, at times, by the incredible scope of death experienced in certain epidemics. For example (from chapter 7, on smallpox), the population of Hispaniola went from 1 million people to only 15,000 in less than 30 years with the introduction of novel disease from European colonisers
- Super interesting to learn (in chapter 17) how cyclic fevers work in malaria: Plasmodium (a type of parasite) enter the bloodstream via mosquito bites, but then escape to hide out, undetected by circulating immune cells, in liver tissue. They replicate there, until there are so many of them that they burst through the host cells, returning to the bloodstream, attacking and entering red blood cells instead. From here, cycles made up of asexual reproduction inside the cells, bursting through, and infection of other red blood cells, occur in patterns such as every 48 or every 72 hours (depending on the specific species), which is reflected by paroxysmal fever! Patients can later develop noncyclic or less clear patterns of fever when infected with multiple strains of plasmodium which operate on different cycle lengths!
637 reviews
March 16, 2021
Livro indispensável, cujo conteúdo vou esmiuçar em fichas de leitura. O valor deste livro está nas ligações que são feitas entre as doenças e a sociedade humana, como a irrupção de epidemias e de doenças endémicas pôde determinar o rumo dos acontecimentos em várias partes do mundo.
Da mesma forma, no contexto em que nos encontramos, é desconcertante verificar que fomos avisados pelo SARS e pelo Ébola do que poderia acontecer no caso de uma pandemia e não levámos a sério, como humanidade.
Concluo com uma citação:

«Na antiga, mas pertinente, 'sabedoria,salus populi suprema lex esto' - a saúde pública tem de ser a lei suprema - e ela tem de superar as leis do mercado.» P. 639
Profile Image for Kevin Maness.
119 reviews10 followers
November 14, 2021
This book should be assigned to every high school biology student, or maybe every freshman or sophomore taking any kind of life science or history class. It is that important a story: looking at the last 1000-2000 years of human history through the lens of our disease epidemics.

I learned so much from this book that there's no way to do it justice in a review of any length. If the fact that I made 900 highlights in the book tells you anything, well, there you go. (Although I am someone who highlights a ton when I read non-fiction.)

My major take-away from this book is the connectedness of all human systems and the myriad connections between that system of systems and the most devastating diseases humans have encountered in the past 1000 years.

Let me get at that with a micro-level metaphor. I'm 51, and I feel like I remember that for most of my life, some pretty clear lines were drawn between different aspects of an individual human's life and wellbeing. There was physical wellness and illness, emotional or psychological wellness and illness, cognitive or intellectual wellness or illness (also strength and weakness), and social... You get the picture.

But now, all that seems so stupid. Every aspect of a person's life is intertwined with ever aspect: if your social life is severely limited or dysfunctional, all other aspects of your life are at risk, even things like memory, heart health—not just happiness or stress, etc. If you're suffering with depression, you're at risk for a host of other emotional issues, physical conditions and ailments, cognitive impairments, and social limitations.

This book makes the same point over and over again, but with epidemics and society (hence the title). The problems that we like to separate and assign to their own particular agencies and organizations are not several problems; they are one problem. And so, lethal pandemics of the past, present, and future are made possible and/or more deadly (and, crucially, more likely) by climate change, deforestation, urbanization, encroachment on animal habitats, lack of access to clean water, malnourishment, drug addiction, poverty, homelessness, racism, classism, ableism and stigma against sick people, dismissive attitudes about the "shithole" countries in the global South, illiteracy and poor education, willful ignorance, superstition, anti-intellectualism and an anti-scientific bias, religious moralism mostly by fundamentalist extremists or all faiths, neoliberalism and capitalism (including as they are embodied in organizations like the World Bank, the International Monetary Fund, and the combined efforts of the G20 nations), the influence of big money in politics, war and militarism, the staggering proliferation of refugees and other displaced people, over-confidence that technology will save the day, top-down "solutions" that ignore local people and their cultures and circumstances, corruption, cover-ups, nationalism ("America First"), the reification of national borders, and so forth.

To make things simple, one thing Snowden stated or implied over and over in his book is that eradicating poverty will likely do more protect humanity from deadly epidemics and pandemics than any other single approach.

Given that simplified "lesson"
of "Epidemics and Society," I have a feeling there will be more and more deadly pandemics. Keep those masks handy...

Snowden's conclusion in his own words:

"For these reasons, the experience of Ebola clearly indicates three initial steps that urgently need to be taken to prepare for the inevitable—and possibly far greater—next health challenge, whether from Ebola virus or from a different microbe. The first is the establishment of functioning healthcare systems everywhere. As former CDC director William Foege argues, public health is the protection of the health of all, and it therefore implies measures of social justice. Second, it is essential to ensure direction and coordination from an internationalist perspective through a well-funded, competently staffed, and ever-vigilant World Health Organization. The West African epidemic revealed that neither measure has yet been implemented and that, in their absence, the world runs a severe risk of tragic and avoidable suffering.

"Lastly, the relationship between the global international system and public health cannot be ignored. An economic system that neglects what economists euphemistically call 'negative externalities' will ultimately exact a heavy cost in terms of public health. Chief among these externalities are the negative effects of certain models of development on the relationship between human beings and their natural and societal environments. The establishment of oil palm monocropping and chaotic, unplanned urbanization in West and Central Africa are just two examples among many. Epidemic diseases are not random events. As we have seen throughout this book, they spread along fault lines marked by environmental degradation, overpopulation, and poverty. If we wish to avoid catastrophic epidemics, it will therefore be imperative to make economic decisions that give due consideration to the public health vulnerabilities that result and to hold the people who make those decisions accountable for the foreseeable health consequences that follow. In the ancient but pertinent wisdom, salus populi suprema lex esto—public health must be the highest law—and it must override the laws of the marketplace."
6 reviews1 follower
March 7, 2021
This book was a worthwhile challenge. It is written with the depth and sophistication of a university course because it is based on a real university course. (Available online, the Yale course is open to the general public. See: https://oyc.yale.edu/history/hist-234.) Our planet is overpopulated with potential human vectors that travel everywhere and anywhere, and this book provides timely background and information necessary to deal with the inevitable. Epidemics are integral to the history of society, past, present and future.
Profile Image for Valerie.
1,054 reviews16 followers
March 19, 2021
Excellent overview of a huge bummer of a subject. Nice balance between science and history, paying close attention to the social and economic factors that affect the response to the diseases and their effects on the population and culture.
57 reviews2 followers
December 16, 2022
Written before the global Covid pandemic, "Epidemics and Society" offers an amazing insight into the world of epidemic diseases and was prescient in warning humanity that epidemic diseases are not random events and very much part of the world we live in.
Profile Image for Margherita.
1 review
May 3, 2020
This is definitely the book I was looking for! Extremely interesting and well written with a very good bibliography. Now I am eager to learn more about some of the topics discussed. A public health must-have.
Profile Image for Annika.
28 reviews3 followers
August 15, 2020
So good. One of the best I've read. Compelling, well written, so comprehensive. In these times, a must read. For everyone.
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