When Germs Travel: Six Major Epidemics That Have Invaded America Since 1900 and the Fears They Have Unleashed
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《新英格兰医药杂志》
In Howard Markel's engaging book, the second word of the title is a good clue that the author writes for the general reader rather than for the specialist. The book contains an introduction and an epilogue, with each of the six intervening chapters devoted to an infectious-disease episode in the past century: tuberculosis, plague, trachoma, typhus, AIDS, and cholera (the last being the only case that proved to be a false alarm).
Germs are nature's primordial terrorists. The language of terror we encounter in our daily news is everywhere in this book, beginning with the title: "invaded," "fears," "unleashed." Indeed, one of the accepted definitions of terror as "living in dread of death or outrage" conveys quite well how epidemics have been experienced throughout history and in the six cases presented in this book.
Markel describes modes of transmission, incubation periods, clinical features, and common outcomes of infectious agents in lay terms, but it is the behavior of public officials, infected persons, and the public at large that proves to be the most interesting and disturbing. Each chapter tells its story by presenting accounts of people who bore the infection and of those who were in positions to respond to the outbreak. One of the perennial discouragements of public health workers is the predictability of such responses. We might forgive some of the foolish reactions early in the last century, when characteristics of infections, modes of transmission, and effective controls were little understood, but judging from our responses to more recent threats, we appear not to have learned much. Fear, irrational policy, and misdirected blame are still common.
In the epilogue, titled "Public Health Is Purchasable," Markel admonishes the wealthy nations of the world to contribute toward a "cooperative partnership of nations, health care professionals, researchers, public health specialists, concerned corporations, philanthropies, and individuals . . . to safeguard the world against the many public health problems we face today." He gives little attention to the many such attempts that are already under way, however. For the general reader learning about these issues for the first time, perhaps the admonition alone is sufficient, but public health professionals will be disappointed by the lack of more detailed recommendations.
Epidemiologists, public health officials, specialists in infectious disease, and most practicing physicians will find no new principles described here. Infectious agents are not new; epidemics are not new; the public and professional responses are not new; the observation that "germs" can travel fast is not new; and even the author's call for coordinated action and support from wealthy nations is not new. Nonetheless, the details of the six epidemics described in the book are fascinating, and the narrative is brisk and highly readable. No two "invasions" are the same, and the public health goals of avoiding overly restrictive measures during an epidemic while not ignoring the risks between epidemics need to be constantly reemphasized. Those who teach epidemiology and public health will find useful material, with excellent documentation and footnotes, to engage students. Reading When Germs Travel is a rewarding yet disturbing trip.
Alfred O. Berg, M.D., M.P.H.
University of Washington
Seattle, WA 98195(Howard Markel. 263 pp., i)
Germs are nature's primordial terrorists. The language of terror we encounter in our daily news is everywhere in this book, beginning with the title: "invaded," "fears," "unleashed." Indeed, one of the accepted definitions of terror as "living in dread of death or outrage" conveys quite well how epidemics have been experienced throughout history and in the six cases presented in this book.
Markel describes modes of transmission, incubation periods, clinical features, and common outcomes of infectious agents in lay terms, but it is the behavior of public officials, infected persons, and the public at large that proves to be the most interesting and disturbing. Each chapter tells its story by presenting accounts of people who bore the infection and of those who were in positions to respond to the outbreak. One of the perennial discouragements of public health workers is the predictability of such responses. We might forgive some of the foolish reactions early in the last century, when characteristics of infections, modes of transmission, and effective controls were little understood, but judging from our responses to more recent threats, we appear not to have learned much. Fear, irrational policy, and misdirected blame are still common.
In the epilogue, titled "Public Health Is Purchasable," Markel admonishes the wealthy nations of the world to contribute toward a "cooperative partnership of nations, health care professionals, researchers, public health specialists, concerned corporations, philanthropies, and individuals . . . to safeguard the world against the many public health problems we face today." He gives little attention to the many such attempts that are already under way, however. For the general reader learning about these issues for the first time, perhaps the admonition alone is sufficient, but public health professionals will be disappointed by the lack of more detailed recommendations.
Epidemiologists, public health officials, specialists in infectious disease, and most practicing physicians will find no new principles described here. Infectious agents are not new; epidemics are not new; the public and professional responses are not new; the observation that "germs" can travel fast is not new; and even the author's call for coordinated action and support from wealthy nations is not new. Nonetheless, the details of the six epidemics described in the book are fascinating, and the narrative is brisk and highly readable. No two "invasions" are the same, and the public health goals of avoiding overly restrictive measures during an epidemic while not ignoring the risks between epidemics need to be constantly reemphasized. Those who teach epidemiology and public health will find useful material, with excellent documentation and footnotes, to engage students. Reading When Germs Travel is a rewarding yet disturbing trip.
Alfred O. Berg, M.D., M.P.H.
University of Washington
Seattle, WA 98195(Howard Markel. 263 pp., i)