American Plagues: Lessons from Our Battles with Disease
http://www.100md.com
《新英格兰医药杂志》
In 1793, a massive epidemic of yellow fever terrorized Philadelphia. Frustrated by fruitless trials of sundry remedies, Dr. Benjamin Rush finally hit on a putative cure: plentiful bloodletting and purging with the use of the potent laxatives calomel and jalap. As Stephen Gehlbach dryly notes in his new book, the first patient "lost 3 pints of blood, the entire contents of his gastrointestinal tract, and any shreds of dignity. But he survived." Not everyone believed in Rush's gospel of phlebotomy and catharsis. The gloriously abusive journalist William Cobbett, writing under the pseudonym Peter Porcupine, pointed out that obstinate Philadelphians persisted in dying in record numbers, despite the widespread application of Rush's regimen. Rush failed to appreciate this early use of medical statistics to debunk his claims. The politically well-connected Rush, a signatory of the Declaration of Independence, successfully sued the rebarbative "Porcupine" for libel, driving him into bankruptcy and out of the city.
In American Plagues, Gehlbach selects 10 such historical tales to illustrate the birth pangs and development of public health in America. Each tale also highlights some principle of epidemiology or evidence-based medicine. Gehlbach describes the disputes in colonial Massachusetts regarding smallpox inoculation and vaccination; Daniel Drake's attempts to unravel the riddle of malaria in the Midwest; and the more recent heroic struggles against tuberculosis, poliomyelitis, and AIDS. American Plagues does not deal exclusively with infectious diseases, as the title might suggest. There are also chapters on the initially contentious link between cigarette smoking and lung cancer and the enormous importance of the Framingham Heart Study to our understanding of cardiovascular disease.
Gehlbach weaves some unifying themes through this diverse subject matter. We see how disease so frequently arises from social ills and how the dogmas of today painfully evolved out of the dogged debates of yesteryear. Despite great achievements, the history of public health has seldom been a linear, rational, triumphal progress; more often, it has been a fitful forging ahead amid great obstacles and uncertainties and on a murky, muddy battleground.
We also see how public health, like politics, sometimes makes strange bedfellows. In 18th-century Massachusetts, the euphoniously named physician Zabdiel Boylston, a proponent of smallpox inoculation, found an unlikely ally in the clergyman Cotton Mather. A Puritan intellectual who was a curious mixture of empiricism and credulity, Mather was an enthusiastic naturalist and a member of the Royal Society, although he is best known today as a vigorous defender of the Salem witch trials.
Gehlbach attempts to straddle the line between writing for lay and medical audiences, and for the most part he succeeds. His style is engaging and erudite, and his tone is at times sardonic. American Plagues is both a lively history of public health in the United States for medical and general readers and a splendid, painless introduction to the fields of biostatistics and epidemiology suitable for students.
John J. Ross, M.D., C.M.
Caritas St. Elizabeth's Medical Center
Boston, MA 02135
jrossmd@cchcs.org
In American Plagues, Gehlbach selects 10 such historical tales to illustrate the birth pangs and development of public health in America. Each tale also highlights some principle of epidemiology or evidence-based medicine. Gehlbach describes the disputes in colonial Massachusetts regarding smallpox inoculation and vaccination; Daniel Drake's attempts to unravel the riddle of malaria in the Midwest; and the more recent heroic struggles against tuberculosis, poliomyelitis, and AIDS. American Plagues does not deal exclusively with infectious diseases, as the title might suggest. There are also chapters on the initially contentious link between cigarette smoking and lung cancer and the enormous importance of the Framingham Heart Study to our understanding of cardiovascular disease.
Gehlbach weaves some unifying themes through this diverse subject matter. We see how disease so frequently arises from social ills and how the dogmas of today painfully evolved out of the dogged debates of yesteryear. Despite great achievements, the history of public health has seldom been a linear, rational, triumphal progress; more often, it has been a fitful forging ahead amid great obstacles and uncertainties and on a murky, muddy battleground.
We also see how public health, like politics, sometimes makes strange bedfellows. In 18th-century Massachusetts, the euphoniously named physician Zabdiel Boylston, a proponent of smallpox inoculation, found an unlikely ally in the clergyman Cotton Mather. A Puritan intellectual who was a curious mixture of empiricism and credulity, Mather was an enthusiastic naturalist and a member of the Royal Society, although he is best known today as a vigorous defender of the Salem witch trials.
Gehlbach attempts to straddle the line between writing for lay and medical audiences, and for the most part he succeeds. His style is engaging and erudite, and his tone is at times sardonic. American Plagues is both a lively history of public health in the United States for medical and general readers and a splendid, painless introduction to the fields of biostatistics and epidemiology suitable for students.
John J. Ross, M.D., C.M.
Caritas St. Elizabeth's Medical Center
Boston, MA 02135
jrossmd@cchcs.org