A Modern Plague to Understand the Germ Theory NABILA SHAIKH and and Had Identified Bacteria As the Cause of Many Infections

BOOKS of disease; they were beginning A Modern Plague to understand the germ theory NABILA SHAIKH AND and had identified bacteria as the cause of many infections. But DAVID L. HEYMANN penicillin—the first antibiotic— Pale Rider: The Spanish Flu of 1918 was only discovered a few years and How It Changed the World later, and first used in humans in by Laura Spinney. New York, NY: the 1940s. The idea that disease PublicAffairs, 2017, 352 pp. could be caused by a contagion much smaller than a bacterium—a filter-passing organism that could cause disease—was just gaining For anyone who thinks of influenza recognition by 1918, though as a biomedical problem with technology did not allow for full biomedical solutions, there is a viral discovery until later in the lesson to be learned from Laura twentieth century. Spinney’s book on the 1918 flu And in 1918, as Spinney points pandemic, Pale Rider: anthropology out, much of the world was at is a tool to be used to understand war, with troops deployed across why disease control methods are Europe, transported from and to not accepted by communities, and the United States, England, France, understanding anthropology—and Germany, India, and elsewhere. the associated socioeconomic impact Furthermore, immigrants and of pandemics—is just as much disempowered populations around an integral aspect of the control the world were living in squalid of influenza as is the provision tenements and environments. With of antiviral drugs and vaccines. the world in such a disheveled state, Combining epidemiology, anthropology, novel, nonseasonal influenza viruses many people accepted the flu pandemic and meticulously researched evidence, such as the virus that caused the 1918 of 1918 as an act of God, as punishment Spinney documents the so-called pandemic remains higher, medical for their sins and for allowing the Spanish flu, underscoring the impact interventions have also effectively inequalities that had developed the disease had on the world as it was decreased their associated mortality. But throughout the world. In the Spanish city in the early twentieth century, and how the lessons from anthropology remain. of Zamora, the bishop defied a health that has influenced and shaped modern In fact, it could be concluded from Pale authority ban on mass gatherings and history and science. The 1918 pandemic Rider that the Spanish flu pandemic will ordered citizens to gather and pray for an is still used today as a benchmark for the remain a benchmark not only because of end to the pandemic. The rate of death potential of novel influenza viruses— its associated widespread mortality, but in Zamora was listed as the highest in those flu viruses that enter humans by also because of the social and economic Spain, so much so that by October 1918 breaching the species barrier between the disruption that it caused—disruption wood for coffins was hard to come by. animal and human kingdoms. that continues to be associated with Spinney also makes deductions With the advent of antibiotics to treat seasonal and pandemic influenza today. about when influenza first appeared bacterial superinfections, antivirals As a history of science, politics, in humans. Understanding that novel that appear to be effective if given religion, and the arts, Pale Rider is flu viruses—those considered to have early enough in a flu infection, and a fascinating read for health and pandemic potential—require an animal the potential to rapidly develop new science professionals and the general host in which to live and reproduce, and seasonal vaccines each year, mortality public alike. By 1918, scientists had close contact with susceptible humans in among people with seasonal influenza discredited the theory of miasma order to breach the species barrier (thus has decreased. Although mortality from (“bad, foul smelling air”) as the cause becoming what’s called a zoonotic dis- 86 ISSUES IN SCIENCE AND TECHNOLOGY books ease), Spinney deduces that flu likely health of a nation’s military was a guard- grandchildren—the baby boomer genera- emerged and caused outbreaks among ed secret, but reporting on the flu in neu- tion of today. humans only about 12,000 years ago, tral Spain gave the impression that the Spinney concludes that disease has when hunter-gatherers started living in pandemic was especially rampant there. long played a part in shaping society and larger, more sedentary communities. Spinney presents three theoretical sites of will continue to do so despite advances Spinney also goes further, presenting origin for the pandemic: a troop deploy- in medicine and technology. Worrying- evidence that she feels supports the hy- ment base in Étaples, France, in 1916; ly, Spinney is less confident about the pothesis that major outbreaks of infec- labor camps in the United States that anthropological advances—or lack of tious disease in general may play a role housed a large influx of Chinese laborers them—in the fight against infectious in altering the earth’s natural weather arriving in 1917; and a military base in diseases, which are at least as important systems. She argues that just as the Kansas in 1918. in dealing with pandemics as medicines Industrial Revolution resulted in a sus- But perhaps even more compelling and vaccines. As evidence, she draws tained increase of the levels of carbon than ruminations on the pandemic’s attention to the religiously motivated an- dioxide in the atmosphere that con- source of origin are the intertwining tivaccination movements of 1918 and the tribute to global warming, widespread stories that Spinney tells of individuals antivaccination movements of today. She death from epidemics and pandemics who were both affected and infected by also draws parallels between Confucian- such as the bubonic plague, which de- the flu, tales that illustrate the immense ism and filial piety in China hampering populated villages and allowed for the breadth of the global crisis and its im- quarantine efforts because a child’s first subsequent reforestation of Europe and pact. The Spanish flu is thought to have allegiance is to a sick parent, not to au- Asia, led to the absorption of carbon taken the life of the son of the British thorities who wanted to establish isola- dioxide and a cooling of the earth’s writer and physician Arthur Conan tion or quarantine procedures; she sees atmosphere. Doyle, leading the author further away similar impediments today in efforts to On the anthropological side, Spin- from his Sherlock Holmes novels to a ca- fight Ebola and other disease outbreaks. ney provides a vivid example of how reer devoted to researching spiritualism. Spinney is explicit in presenting random flu outbreaks appear to the The Hungarian physicist Leo Szilard, worst-case pandemic scenarios to general public, in this instance to the who played a crucial role in establishing emphasize why the world should not gold mining town of Rand and the di- the Manhattan Project, survived the become complacent about infectious dis- amond mines of Kimberley, in South Great War with a bout of influenza that ease. She highlights the importance of an Africa. Although the flu struck first hospitalized him just before his regiment anthropological as well as a biomedical in Rand, the Kimberley mines experi- was sent to the front and annihilated in approach to infectious disease preven- enced the deaths of almost one-quarter battle. And Mustafa Kemal Atatürk, later tion and control. Human encroachment of the miners, 35 times higher than the the founder and first president of the Re- on forestry and spreading urbanization deaths recorded in Rand. The same public of Turkey, documented his expe- appear to be increasing the rate at which was true for soldiers living in crowded rience of the Spanish flu after surveying zoonotic diseases emerge in humans; conditions on transport vessels or in troops in Germany. climate change is associated with unex- the field. With advances in under- Spinney also draws links between the pected outbreaks of known infectious standing influenza transmission, we flu and the success of Mahatma Gandhi disease; and common diseases such as can now also understand that proximi- and the Indian independence movement measles, which were nearly eliminated in ty of travel routes to population centers that culminated in partition of the sub- the United States and Europe, have reap- increased the potential for internation- continent in 1947. And she mentions the peared due to factors such as antivacci- al spread. Ocean shipping routes and experience of Fred Trump Sr., who re- nation movements that are threatening troop deployments ensured that the ceived an insurance settlement following the lives of children and young adults. epidemic spread widely and progressed the death of his father from the Spanish Pale Rider offers lessons for us all, and it into a pandemic that circled the world. flu in 1918 that allowed him to build a is hoped that they will help lead us and Without a global reporting system real estate empire. Also of importance to our political leaders to more seriously during this period, establishing where Spinney is the generational impact of the confront the threats posed by infectious the outbreak originated is difficult. Spanish flu, which was associated with diseases. Spinney points out that despite its the death of 2.5% of the world’s popu- name, Spanish flu was unlikely to have lation; many of the pandemic’s victims Nabila Shaikh is a research assistant originated in Spain; the name may had preexisting debilitating conditions at the London School of Hygiene and just be an unfortunate by-product of such as tuberculosis. The survivors, who Tropical Medicine (LSHTM). David wartime censoring across the rest of had developed immunity or were not L. Heymann is a professor of infectious Europe, where information about the affected, produced healthy children and disease epidemiology at LSHTM.

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