(++++) SMALL KILLERS

Contagion: Plagues, Pandemics and Cures from the Black Death to COVID-19 and Beyond. By Richard Gunderman, M.D., Ph.D. Welbeck Publishing. $19.95.

     Simplifying the study of microorganisms that cause disease without making the discussion so simplistic as to be effectively useless, Indiana University professor and medical doctor Richard Gunderman produces in Contagion a brief (160-page), amply illustrated, easy-to-understand overview of topics that took on new urgency with the COVID-19 pandemic but that have in fact concerned humanity for hundreds, even thousands of years.

     Nor are diseases the only longstanding matter here. Consider the Hippocratics of some 2,600 years ago, followers of the teachings of Hippocrates, whose oath (although probably not actually written by him) is still recited by physicians today. “To understand a person’s state of health,” Gunderman writes, “Hippocrates believed, it is necessary to look at the whole person, including not only the whole body but the person’s way of life and how that mode of living fits into the larger context of a person’s environment. …The Hippocratics operated with great faith in the human organism’s ability to heal itself. The physician’s task, once a diagnosis was reached, was to remove impediments to this natural tendency toward health.” This sounds extraordinarily modern and is an attitude that, if anything, is in the ascendant in many cultures, with a focus less on the precise location of a problem and more on the holistic needs of the patient and where that problem fits into them.

     However, some problems, some diseases, so onerously affect the entire body that they require aggressive treatment lest they not only seriously harm or kill the patient but also spread far beyond one individual to infect, harm, even kill many others. Those are the diseases that are contagious – spread through contact – and they are the primary focus of Gunderman’s book. Having a holistic approach himself, he discusses not only the causes and effects of specific diseases on individuals but also the significant ways in which severe illness has affected societies and literally changed the course of history. This means not only writing about the plague that hit Athens in 430 B.C., killed one-quarter of the population, and sowed the seeds of the city-state’s eventual conquest by Sparta in the Peloponnesian War – but also the four-year Black Death in Europe (1347-1351), which killed more than 100 million people and produced societal effects still felt today.

     Gunderman tells of the long-lasting results of disease in order to impress on readers the seriousness that deadly microorganisms have not only for individuals but also for entire societies. The parallels between pandemics of the past and that of COVID-19 are many and will be eerily familiar to readers of Contagion. “The impact on social life was devastating,” writes Gunderman. “Most people scrupulously avoided contact with others, and even relatives and close friends rarely or never visited each other.” These are words about bubonic plague in the 14^th century, but they fit COVID-19 in the 21^st equally well.

     Gunderman deals – always briefly, but always carefully and accurately – with European diseases destroying New World populations such as the Aztecs; with the depredations of tuberculosis (known to have affected people as long ago as 2,500 B.C.); with malaria, the Spanish flu, and much more. Along the way, he highlights the amazing discoveries and anti-disease fights (often at great, even fatal personal cost) of well-known scientists and thinkers such as Joseph Lister, Louis Pasteur, and Florence Nightingale. But even in a book that is by its nature a once-over-lightly look at disease and pandemics, Gunderman finds ways to showcase crucial but little-known approaches to treatment – and to the advance of science. For instance, he devotes one of his short chapters to Max Pettenkofer (1818-1901), who adamantly fought the better-known Robert Koch (1843-1910) regarding the cause of cholera. Pettenkofer’s incorrect beliefs, focusing on keeping soil dry and clean, may have saved millions of lives – testament to the way in which scientific progress, far from occurring in a straight line, tends to lurch hither and thither, although hopefully progressing in positive ways over time. Also, in discussing the Spanish flu, Gunderman brings up the possibility that many deaths may have been caused by aspirin poisoning – since doctors often recommended what is now known to be eight times the safe maximum daily dose, thus giving patients so much medicine that bleeding and other symptoms could have been caused by fighting the flu rather than by the illness itself.

     Health-promoting posters and period photographs sprinkle the pages of Contagion along with ultra-modern electron microscopy and well-made diagrams showing the appearance of bacteria, the life cycles of microbes and their infectious agents, and much more. Gunderman eventually brings the book into today and directs it toward the future with discussions of bioterrorism, coronaviruses, and the near-certainty of pandemics and plagues to come. There is a mixture here of fatalism and optimism: disease-causing microorganisms will never be eradicated, Gunderman correctly explains, but understanding how they function and how they can be fought – through inoculation, medication, and the modern version of holistic Hippocratic practices – can help people survive future instances of contagion while, hopefully, preventing the depredations visited in the past upon Athens, medieval Europe, and the Aztec empire.