196 www.thelancet.com/infection Vol 14 March 2014

Media Watch

BooksTrial and error: management of epidemic in the 19th century Epidemics have long provided historians and other observers with opportunities to examine and compare social, political, cultural, and medical responses to disease. In Knowledge in the Time of Cholera, sociologist Owen Whooley uses the cholera epidemics in 19th century America, particularly in New York, to study the so-called epistemic contest between mainstream (allopathic) medicine and alternative medical sects such as thomsonism (which promoted self-help with herbal medicines) and homoeopathy. Covering the cholera epidemics of 1832, 1849, 1866, and 1892, Whooley’s analysis emphasises the professional implications in each period.

According to Whooley, the challenge of mainstream medicine’s heroic (aggressive) therapies (especially blood-letting) by allegedly more successful treatments by homoeopaths and thomsonians during the fi rst epidemic contributed to the repeal of the licensing laws that favoured allopathic medicine in many states. From the second epidemic onwards, the recently founded American Medical Association constituted a defence of mainstream physicians’ understanding of the disease, be it more environmentalist (non-contagionist) or contagionist, particularly through the clause of non-consultation with homoeopaths.

The successful containment of the 1866 epidemic by the New York Board of Health, made up of people from various

professions, working on the basis of an unspecifi c fi lth-theory of cholera, made it diffi cult for allopathic physicians to claim leadership over other sanitarians. By 1892, the fi ght against cholera might have benefi ted from Robert Koch’s defi nition of the disease as an infection by the comma bacillus (Vibrio cholera), but was hampered by political manoeuvering. However, the bacteriological theory and the rise of the laboratory in American medicine (especially through support by Rockefeller funding) eventually helped mainstream physicians to claim “epistemic closure” regarding the nature of cholera and other infectious diseases. Initially, homoeo paths had claimed that Koch’s discovery confi rmed their approach, but allopaths were ultimately more successful in connecting his work with their type of medicine.

Whooley’s account is a bold and stimulating attempt to link the sociology of scientifi c knowledge with pro-fessionalisation studies. In acknowledging organi sational and institutional responses to fundamental disputes over epistemological claims, he helps to bridge a gap between sociological and philosophical approaches to the history of medical knowledge.

Andreas-Holger Maehle

Knowledge in the Time of Cholera: The Struggle over American Medicine in the

Nineteenth Century Owen Whooley

The University of Chicago Press, 2013.

Pp 328. US$30.00 ISBN 978-0-226-01763-1

Emerging infectious diseases: is history repeating itself? The study of emerging infectious diseases is a hot topic in infection biology, combining global-scale relevance with the challenge of uniting epidemiological, ecological, and molecular data. Barrett and Armelagos argue engagingly in their vivid anthropological tour of emerging infections An Unnatural History of Emerging Infectious Diseases that this is also an ancient topic, dating back 10 000 years to the emergence of agriculture among neolithic hunter-gatherers.

The crucial message, reinforced throughout, is that the emergence of new infections (and, conversely, the attenuation of old infections) is intricately tied to changes in human behaviour and social organisation, or, as the authors put it “all infectious diseases are social diseases”.

Settlement is, of course, a key notion in the establish-ment of farming from hunter-gather precursors, and provides an obvious platform for the emergence of acute infectious diseases reliant on dense and stable human populations. Additionally, the authors weave in fascinating archaeological data on how the reduced nutritional diversity of an agricultural diet weakened immunological defences—an eff ect compounded by heightened social inequalities that created sub-populations of vulnerable individuals.

The worldwide spread of agriculture is then described as a “plague of plagues”.

A review of how societal changes associated with the early industrial revolution provides a more hopeful note, with great reductions in the burden of infectious diseases (improved nutrition argued to be key), which triggered a demographic transition from high to low rates of births and deaths. By contrast, the later and ongoing industrial and demographic transitions in developing countries are characterised as coupling ongoing high burdens of infectious disease with the rapid spread of chronic non-infectious diseases.

The book closes with the more widely discussed scenario of modern emerging infectious diseases in a globalised, inter-connected, and unequal world, and leaves the reader with some important and practical food for thought: emerging infectious diseases are nothing new, nor are they spontaneous events, independent of human actions. Rather, they are a potentially predictable product of how we organise our societies, on a global scale.

Sam P Brown

An Unnatural History of Emerging Infections

Ron Barrett and George J Armelagos

Oxford University Press, 2013.Pp 160. £30.00

ISBN 978-0199608294