Plagues Upon the Earth: Disease and the Course of Human History

The Princeton Economic History of the Western World #85

by Kyle Harper

A sweeping germ's-eye view of history from human origins to global pandemics



Plagues upon the Earth is a monumental history of humans and their germs. Weaving together a grand narrative of global history with insights from cutting-edge genetics, Kyle Harper explains why humanity's uniquely dangerous disease pool is rooted deep in our evolutionary past, and why its growth is accelerated by technological progress. He shows that the story of disease is entangled with the history of slavery, colonialism, and capitalism, and reveals the enduring effects of historical plagues in patterns of wealth, health, power, and inequality. He also tells the story of humanity's escape from infectious disease--a triumph that makes life as we know it possible, yet destabilizes the environment and fosters new diseases.

Panoramic in scope, Plagues upon the Earth traces the role of disease in the transition to farming, the spread of cities, the advance of transportation, and the stupendous increase in human population. Harper offers a new interpretation of humanity's path to control over infectious disease--one where rising evolutionary threats constantly push back against human progress, and where the devastating effects of modernization contribute to the great divergence between societies. The book reminds us that human health is globally interdependent--and inseparable from the well-being of the planet itself.

Putting the COVID-19 pandemic in perspective, Plagues upon the Earth tells the story of how we got here as a species, and it may help us decide where we want to go.

Genres: History, Science, Nonfiction, Medicine, Health, Biology, Medical

688 pages, Kindle Edition

First published October 12, 2021

About the author

Professor of Classics and Letters and Senior Vice President and Provost at the University of Oklahoma. His research topics are the social and economic history of the Roman Empire and the early middle ages, and the environmental and population history of the first millennium, exploring the impact of climate change and disease on the history of civilization.

from http://www.ou.edu/flourish/about/team...

Reviews

[Ian · Rating 5 out of 5]

It is hard for us in the modern world to understand the burden of infectious disease in the past. Until the 20th century most humans died of infectious disease. Kyle Harper’s book tells the story of how infectious pathogens have affected human history. He also highlights that humanity’s victory over the last century or so is, as we well know, incomplete.

The author explains that there are 5 broad types of pathogen that infect humans - viruses, bacteria, protozoan parasites, helminths (i.e., parasitic worms) and fungi. Having mentioned fungi, the book doesn’t discuss them further, as fungal infections of humans are relatively minor.

It’s often argued that most of our diseases began with the domestication of animals, and with animal diseases that jumped to humans. However some major diseases had adapted to humans well before this. Our hunter-gatherer ancestors did not always live in a disease-free environment, particularly if they lived in tropical regions. Malaria took a heavy toll, and they were pervasively infected with worms, so that schistosomiasis (bilharzia) has been a deadly disease of humans across millennia.

One of the main points of the book is to highlight that evolutionary selection pressure has worked to produce organisms adapted to the new ecologies created by humans in the last 10,000 years, and that this process continues today. The development of agriculture meant that, for the first time, humans lived amidst their own excrement, as well as of course the excrement of animals. This provided opportunities for organisms that infected humans via the faecal-oral route, whilst the crowding of humans together in large numbers also benefited agents that passed via the respiratory route. The author comments that, whilst diarrhoeal disease and dysentery lack the notoriety of some other diseases, they were a huge source of suffering over most of human history. Dr Benjamin Rush has left us a distressing description of the agonising deaths of infants from diarrhoeal disease, at a time when doctors were basically helpless to combat it.

In terms of notoriety, probably no disease can equal bubonic plague, which in the 1340s may have killed half of Europe’s population. Half! The plague repeatedly flared up during the following centuries. Meanwhile Darwinian selection kept throwing up new or variant diseases. Typhus is thought to have evolved in the 16th century. At about the same time Smallpox seems to have become much more virulent than previously, becoming the dread disease that killed hundreds of millions in the succeeding centuries. The author discusses the demographic collapse of Native Americans following the Columbian Exchange, and how this assisted the European takeover. The reverse was true in the case of tropical Africa, which had the world’s most hostile disease environment. Reaching adulthood in tropical Africa meant you had come through an intense Darwinian struggle, and Europeans who ventured to the coast died in droves.

From the 18th century onwards we began to see “the great escape”, when humanity finally began to make progress in the fight against infectious disease. It should be noted though, that the 19th century also saw “the great divergence”. Whilst mortality fell in Europe and North America, life expectancy remained stagnant or even decreased in other parts of the world, as modernity promoted the spread of disease. It was not until the 20th century that global health started to coalesce again. As the author says, the population explosion that the world has seen in the last two centuries did not come about because we started breeding like rabbits, but because we stopped dying like flies. Even during this time Darwinian selection continued to throw up new responses, such as TB, polio, HIV and of course coronaviruses. More will continue to emerge.

An ambitious project this. Personally, I think the author has pulled it off. I found this a tremendously informative read.

[zed · Rating 5 out of 5]

I have no intention of writing too much about this excellent book. GR friend Ian has written an outstanding review that I commend to anyone that has yet to read it.

https://www.goodreads.com/review/show...

This is one of two audiobooks I have listened to on this subject recently, the other being Pathogenesis: How Germs Made History by Jonathan Kennedy.

https://www.goodreads.com/book/show/1...

As fascinating as that was, Harpers is superior in my opinion.

One comment I will make from a discussion from this audiobook is that the common fly that occasionally gets past the screens of my abode is now ruthlessly hunted down.

Recommended to those with an interest in the subject.

[Graeme Newell · Rating 3 out of 5]

I have such conflicted feelings about this book. It contains amazing flashes of wonderful insights on how disease has shaped the history of the world. But it also contains endless pages of minutia laying out statistics and disease progression through the ages.

I knew malaria was a bad thing, but I never fully appreciated just how insidious it can be. It is the Machiavelli of maladies. After reading this book I finally understand exactly how it develops, who it victimizes and why it is such a tough disease to fight. The book was full of these kinds of great insights. The author explains things plainly and simply so that even the non-scientists among us clearly understand.

I really learned a lot about how these diseases developed, and the powerful role they have played in shaping humanity. I really loved this part of the book.

However, once the author had flashed these incredible insights, then the book would regress into a dive deep about how the disease progressed through the southern valleys of Bulgaria amongst left-handed women who like to bathe on Thursdays. The minutia he would lay out was just agonizing.

I wish he had written a book that was shorter. This huge tomb reads a bit more like a textbook than a popular non-fiction book. It was in desperate need of a good editor.

If you have a strong stomach for mindless detail, I would definitely recommend suffering through this book. The insights are absolutely amazing. There is definitely a pony inside this book, but you’re going to have to shovel a lot to find it.

[Tanja Berg · Rating 4 out of 5]

If you want confirmation of why this is a good day and age to live in, read this book. It’s a fairly comprehensive take on our contagious diseases, and how they have spread and mutated through the aeons. It’s not until recently that we have had the first true inclination of what actually makes us sick - microbes and viruses. You will learn about the difference between typhus and typhoid fever and why “cow” (vacca) is indicated in the word “vaccination”. Enjoy! 🦠

[The Inquisitive Biologist · Rating 5 out of 5]

A magnificent environmental history of infectious disease, Plagues Upon the Earth stands out for its nuance and readability. See my full review at https://inquisitivebiologist.com/2021...

[Camelia Rose · Rating 4 out of 5]

Plagues Upon the Earth: Disease and the Course of Human History is a history of infectious disease, or the co-evolution of microspotic pathogens and the human race. Organised in chronological order. Starting from the beginning of homo sapiens to the current Covid 19 pandemic. It is a history of plagues and pandemics, their roles in the rise and fall of dynasties, and how they shaped the trajectory of human history. It is also a history of progress in medical science and public health management. Comprehensive. The book covers the entire globe, not Eurasian centric.

The topic makes me grateful for living in the modern age. The author argues against population growth anxiety. Modern history has proved that the mortality rate decline in a society always triggers birth rate decline within 2 to 3 generations. This is too simple and he fails to consider the importance of women’s equal rights movement in the population equation.

[Cassia Attard · Rating 4 out of 5]

Solid 4.5 - Very long but very good. An under-discussed lens on history. Yeah, I quite liked it.

[Susan Paxton · Rating 4 out of 5]

Well up to the high standard set by his preceding book on the fall of Rome, this time Professor Harper expands his focus to the effect disease (one of the topics of his last book) has had on the entirety of human history. Fluently written, endlessly interesting.

[Erin · Rating 3 out of 5]

Explores the interactions of various disease and parasites and humans. Explains why and how our unique pathogens are intertwined with our genetic history.

Overall, this was a little dry. Less time was spent on some disease than I would have expected. While it touches on disease world wide, many of the most in depth portions were European/North American centric.

[Jim Fitzgerald · Rating 5 out of 5]

About a generation ago the eminent biologist from Harvard E.O. Wilson wrote a book titled “Consilience.” This book written by Kyle Harper is a wickedly wonderful journey built upon the platform of Wilson. I could hardy put it down. Instructive, engaging, interesting in so many ways. Superb.

[Chris Allan · Rating 2 out of 5]

DNF. Poorly written, repetitive with broad sweeping statements and little evidence behind them, jumping across five centuries and several continents in single sentences. Very disappointing

[Ginger Griffin · Rating 5 out of 5]

Dense, deep dive into humanity's history with pathogens. Good discussion on how human activity (from taming fire to adopting agriculture to building today's megacities and international trading networks) has repeatedly exposed people to new microbes and parasites. 

The suffering caused by the major infectious killers of the past (plague, smallpox, typhus, cholera, and dozens of others) was horrific. We've beaten back many of the worst diseases with vaccines, antibiotics, and modern sanitation. But microbes never stop evolving. And with almost 8 billion people on Earth, any virus that manages to hack the human immune system will have an enormous field to exploit. 

[Melissa · Rating 4 out of 5]

Three and a half stars rounded up. This one was a bit of a slog for me at times, probably mostly because I’m a lot more interested in biology than political history or economics. It’s truly not possible to fully understand one without the others, though, and Harper does a good job of laying it all out. I’m glad I read it…although it didn’t make me fear for the future of humanity any less.

[Dr G · Rating 4 out of 5]

This is an extremely thorough examination of the diseases which have significantly affected the human race throughout history – and before. One expects work by Kyle Harper to be thorough, of course. That is his approach.
He specifically mentions that the methodology he will use is consilience, “the joining together of knowledge from different domains.” That, again, has been his approach in a number of his books; I thought it worked outstandingly well in The Fate of Rome. Climate, Disease & the End of an Empire . However, I do not think it is as successful in Plagues Upon the Earth. Disease and the Course of Human History . Harper is, by training, a classicist, specialising in Roman history. For this work, the centre of the study is actually microbial pathogenicity, describing certain pathogens and how these operate. That is not his core discipline. I don’t fault how he describes or explains these areas (with one qualification which I shall come to later); these are certainly outside my expertise. Presumably, however, he is not adding to the knowledge of these areas; having researched thoroughly from the works of specialists, he has synthesised the information into a summary. Where he is adding something is in his consilience. He describes the operations of the pathogens within a broader structure of history (his discipline), demography and anthropology. And he occasionally adds a little populist politics as well.
Harper structures the book around historical epochs:
a) Prehistoric globalization.
b) Iron Age globalization
c) Peak Old-World globalization
d) The Columbian Exchange
e) Fossil-energy transport.
f) The Age of the Jet Plane
And his chapter headings are:
Introduction
Part I Fire
1. Mammals in a Microbe’s World
2. Prometheus Among the Primates
3. Where the Bloodsuckers Aren’t
Part II Farms
4. Dung and Death
5. The Sneezing Ape
6. The Ends of the Old World
Part III Frontiers
Part IV Fossils.
Now the first thing I must say is that I find Harper’s use of an introduction is very irritating; in this, as in several of his other books, his introduction is just too long, covering material which is repeated later in the book and intruding upon the structure of the rest of the work, and upon the reader’s capacity to organise what is being offered. Obviously academic writing has its formal expectations, but this is not an academic paper for an academic journal. It is a monograph being offered to lay readership.
More importantly, though, I found myself confused by the organisation of material. We are introduced to the various forms of pathogen early in the work, with some explanation of how they operate. Then we move to a historical/anthropological structure which describes phases in humans’ occupation of the Earth and intersperses that with reference to particular diseases and how these interacted with their environment. As a result, the reader’s focus is switched about quite a lot. I found it difficult to keep all these strands together. I felt that it would have made more sense for the basic organisational structure to be individual diseases, presumably arranged according to the pathogen types. Then, if the mechanics of the disease were explained and this was fitted into a historical explanation of environmental and social factors, I think I would have come away with a stronger grasp of the whole picture. I suspect that the wish to apply consilience actually made everything more tangled.
I had another fairly major criticism of the book, to which I alluded earlier in this review. Early on, Harper states: “Our germs have no intentions or consciousness. We can anthropomorphize them for the sake of simplicity—we speak of them ‘trying’ to do things like evade our immune system or adapt to new circumstances. That is fine, so long as it is understood that evolution is a blind, physical process that rewards those individuals whose traits are most effective at transmitting genes to succeeding generations.” This is sensible and important. However, Harper then ignores his own stricture. How do we reconcile that statement with “Viruses are little more than strands of nefarious genetic code enclosed in organic armor” or “The solutions that parasites have devised to meet these challenges are many and cunning” or “Vector-borne transmission is a high-risk, high-reward strategy. The challenges are daunting. A microbe must learn to survive not one but two hostile immune systems” or “some of the craftiest diseases in the world use blood-sucking bugs as their intermediaries.” Or “The lymphatic system is heavily patrolled by our immune cells, but this brash worm is undeterred” or “It is hard to imagine what more could have been done to cater to the convenience of this insidious creature”. Or “The key to the pathogen’s success in humans is insidious stealth.” And these are just a randomly collected sample of the purposive, morally loaded anthropomorphising.
The book’s style is irritating in other ways as well, periodically using metaphor to illustrate a point when the metaphor seems childish and really does not assist. “The cell wall of a tuberculosis bacterium is covered with common molecular patterns that should immediately give it away to our immune system, but it wears an outer lipid layer as a cheap disguise, like a trench coat”. “Imagine the parasitic lifestyle as an ongoing embezzlement scheme (where bilking money translates into genetic success). The best strategy might be one that is restrained enough to avoid detection by not bankrupting the victim. From a selfish perspective, the best strategy is not always the most harmful in the short run.”
At times, the expression is oddly infantile (cytoplasm is “the crowded goop inside the cell”) and at other times the word choice is erroneous and ought to have been picked up by an editor: “The Plains Indians of North America from the late eighteenth century suffered egregious mortality in smallpox epidemics transmitted on long-distance networks.” What on earth is “egregious mortality”? And when he wrote “This delousing scene is a picaresque comment on the inhumanity of a conflict…” did he really simply mean “a sad comment”? I do not see how a comment can be “picaresque”. He refers, at one point, to the several diseases known as cholera and states that they are “extremely unrelated”!
Oh for the days when book editors demanded standards of their authors. Oh for the days when academics applied high standards themselves.
I was uncertain what the author’s final position was on the issue of whether diseases imported into countries by colonialists wreaked havoc because the indigenous peoples had lower resistance. He seemed to be sitting on the fence or, at least, moving from one side of the fence to the other. I suppose that is one of the difficulties with writing a book in which the major part of the information is outside the author’s expertise. Finally, I was unimpressed that, once the seventeenth century is reached, the book concentrates a little much on the US situation. Perhaps he is writing for an American audience, but on a topic such as this, I should have thought that there would be a large international audience available and it would make sense to be more cosmopolitan.
Notwithstanding these complaints, overall, I thought Harper did a good job of gathering an impressive amount of information together. Discounting the fact that he encourages us to perceive pathogens as sneaky little sentient creatures conspiring to afflict us with disease, and for the fact that (I would argue) the material could have been much more helpfully arranged, this is a valuable study.
Ultimately, however, the most important point made by this book is that, whatever we do to counter pathogens, they are always evolving into different forms which will require new responses from the human race. No amount of human brilliance will ever eliminate the threat they pose. Harper quotes from the report Emerging Infections: Microbial Threats to Health in the United States to the Institute of Medicine: “‘Because of the evolutionary potential of many microbes,’ the panel warned, ‘the use of these weapons may inadvertently contribute to the selection of certain mutations, adaptations, and migrations that enable pathogens to proliferate or non-pathogens to acquire virulence.’”

[Lia Patterson · Rating 5 out of 5]

This is an entirely novel look at the history of humankind, focusing on the development of diseases and starting from the time that homo sapiens began to divert from other primates. As humans began to shape the world around them, they also shaped a unique disease environment.

I found this a fascinating read, as I had never really considered before how much the environment affects the diseases we suffer from. For example, becoming farmers led to a lot more gastrointestinal disease, as we stayed in one place, surrounded by farm animals, while living in densely packed cities fostered aerially transmitted diseases. In fact some diseases like measles cannot survive if the population is below a certain threshold.

It was also an eye-opener how a successful society, for example the Romans, might be less healthy than a more primitive society like the tribes that lived outside the Roman Empire. Also I did not know before how much the disease environment changed over time and how recent some diseases are - even the common cold wasn't always around.

Throughout history, it's been an arms race between humankind and the microbes that surround us, and it's only recently that humankind has pulled ahead. Reading this book makes you realise how unusual the times we live in are, when for the first time in history the majority of people die from other causes than infectious disease.

If you're interested in the wider causes that have shaped human history, I definitely recommend this book to you.

[Barbara Williford · Rating 1 out of 5]

Don’t let the title confuse you!!!

I guess I’m going to be the oddball and give this book a one star and it’s only because I have to rate it. Let me begin by saying I’ve been a Science teacher for 20 years and geek out with anything Science related…..except with this book.

If you want a book to help you get to sleep, this is the book If you like books written like a textbook, this is definitely the book. This book is written as an educational, academic style book. It also includes so much information that is not necessary to the topic of this book. Once you wade through all this, there is some interesting information. But there’s A LOT to wade through. You also have to endure soooo much information that is completely off topic. This author chases so many rabbits down the rabbit hole. I was confused on whether he was sharing plagues of the earth or a science lecture on evolution or irrelevant history lessons.

Another thought, if I had a nickel for every time he said “evolution” within the 704 pages I would be a billionaire. We got it in the introduction we didn’t need it in every sentence for 704 pages especially when the author would contradict himself or Science.

I have two regrets…that I spent over $30 for this book and wasted soooo much time hoping it would get better. It was a DNF for me.

[emma]

Given that it’s been over a month since I’ve picked this up, I’m going to give it a soft DNF at 40%.

I loved the first few chapters—Harper has done a really good job of giving an overview of the human history of disease and parasite ecology, starting with pre-human hominins (ily, Homo erectus) before moving into prehistoric human societies and eventually into periods for which written records exist. The first handful of chapters were rich with biological minutiae and anthropological theories about human-pathogen coevolution, and it was (as a huge anthropology, ancient DNA, deep time nerd) a really fascinating read. And this holds for the first 150 pages or so.

Where I started to lose interest in the book is when Harper moves into historical periods replete with written accounts of human disease. Harper’s background is in history and classics, so it makes sense that he will capitalize on written evidence when it’s available. But for me, coming from a biological and genetic background, I grew frustrated with the subtle idea that the biological evidence only serves to supplement written accounts. Harper also treated palaeogenomics and phylogenetics (which he, for reasons I do not understand, insisted upon calling “time travel” and “tree thinking” throughout the book) with this kind of hand-wavy perspective wherein a lot of the nuance and (extremely valid!) criticisms of aDNA studies were not discussed. This is very much a me problem—everyone reading non-fiction adjacent to their field of expertise is going to be hypercritical of how that field is discussed in the text. But I’m still allowed to be frustrated when I see the nuance stripped from a very controversial field of biology, when ancient DNA studies are presented (without the necessary disclaimers) as biological and evolutionary fact.

I also really liked Harper’s initial aims of giving an account of the global history of human disease, but I still felt that the book was overly tangled in Old World histories without being upfront about that or discussing why this may be “necessary” from an historian’s perspective. The first few chapters about pre-agricultural societies and pre-AMH hominins cover a broad geographical range, but this more or less flies out the window once the written record comes into play. Which, like, I do understand when considering the lack of evidence (historical or biological) from certain regions and time periods, but still found mishandled. Harper dedicates a lot of his bandwidth to talking about how a collection of European doctors unraveled the mechanisms of an ancient pathogen rather than detailing how that pathogen operated in prehistoric or ancient times. It also reads, in some places, as a history of science rather than a scientific text, which is a wonderful and perfectly valid thing to write about that also happens to be different than what I was looking for.

The bottom line, though, is that Harper writes with a really great and accessible tone about topics that are biologically and historically complex, and I have to commend him for that. If your thing is the history of science, you may love this one, but if you’re looking for a more biologically-grounded overview of disease throughout human evolution and history, I might encourage you to look elsewhere.

[Mark Galassi · Rating 5 out of 5]

This book is so engrossing that when I finished reading it I started it again right away.

Kyle Harper takes on a very ambitious task: complete coverage of what we know about how infectious diseases have shaped/been-shaped-by human history. He pulls it off with a very non-lazy comprehensive tale.

Doing this is not at all easy: you have to decide how to inform the narrative, and the topic is vast and the book is long.

I recommend reading the introduction very closely: in it he does the best thing a writer of non-fiction can do: give convincing motivation for the book and how he approached it. The introduction is crystal clear, insightful, and charming.

I recommend this book very strongly to anyone who has an interest in reading about history and likes to get into the details of a particular thread in history. And if you view detailed reading of history with concern, don't worry too much: the big picture is kept present at every page.

[Ben · Rating 3 out of 5]

Listened to this as an audiobook. The first 90% of the book covers, as the title implies, a history of infectious diseases (Typhus, Yellow Fever, Yaws, Smallpox etc.) and was incredibly repetitive and admittedly boring to me. It did however serve as a great backdrop to a few stressful work days (I’m grateful I don’t have yaws) and was effective in showcasing just how bad these sicknesses were. It felt like he raced over all of the most interesting bits in the last 10% (Vaccination, polio, AIDS, penicillin, how our history of infectious disease lead us to Covid-19). Everything that was said in the last bit could’ve been its own chapter but was barely touched on. There’s probably something better out there on the topic lowkey

[Clara · Rating 4 out of 5]

This is a very informative history of humanity and its diseases. I enjoyed deepening my knowledge from Guns, Germs and Steel and feel like I have a more complete picture on this topic. On the less great side, to me some of these chapters could have been more concise. Especially in the end it became a bit repetitive.

[Hannah · Rating 4 out of 5]

I really appreciated how the author was able to break down concepts here in an engaging and understandable way for the average reader. this was a very dense and comprehensive read and I feel like I learned a lot!

[Ben · Rating 4 out of 5]

This was a good book.

An interesting read on disease.

Similar to some of the other books on disease I have read over the last couple years, but still a good one. This one was long!

4.0/5

[Ali Lloyd · Rating 4 out of 5]

a lot, but so cool

[Timothy · Rating 5 out of 5]

Encyclopedic, brilliant, and astonishingly well written balance of science and history. Will be my textbook for HisQ213 pandemics going forward.

[Grrlscientist · Rating 5 out of 5]

Summary: Plagues upon the Earth is a comprehensive environmental, ecological, economic, demographic and political history of humans and their infectious diseases, and it is distinguished by its nuance and readability.


Contrary to what most people think, nearly all infectious human diseases appeared quite recently — some as recently as just a few hundred years ago. In his sweeping masterpiece, Plagues upon the Earth: Disease and the Course of Human History: 106 (The Princeton Economic History of the Western World) (Princeton University Press, 2021), author Kyle Harper, a Professor of Classics and Letters and Provost Emeritus of the University of Oklahoma, expertly interweaves economic and demographic history with data gathered by the newest cutting-edge genetic advances (phylogenetics — genetic “tree thinking” — and paleogenomics — genetic “time travel”) to throw a light upon the hidden evolutionary histories and trajectories of human viruses, bacteria and parasites, and shows how infectious diseases are a major reason for the ebb and flow of human societies. This intellectual and literary agility is really an impressive feat.

Professor Harper is a historian of the ancient world whose work has connected economic, environmental, and social history. He says he was inspired to write this book after publishing The Fate of Rome: Climate, Disease, and the End of an Empire (The Princeton History of the Ancient World, 2) (Princeton University Press, 2017). In this, his newest book, Professor Harper relies on his vast expertise to tell the compelling story of how pandemic disease is entangled with the history of slavery, colonialism, and capitalism, and how the enduring effects of historical plagues are still visible today in modern patterns of wealth, health, power, and inequality. Professor Harper also tells the story of humanity’s progress in medical science and public health, which facilitated our escape from the tyranny of infectious disease. This escape makes modern life possible, even as it damages and destroys the natural environment, thus accelerating the evolution of even more deadly diseases.

This book is divided into four parts and comprises a total of twelve lengthy chapters. It progresses in chronological order, starting with the evolutionary beginnings of Homo sapiens and our dynamic and growing mob of infectious diseases, and continues up to the current COVID-19 pandemic. In chapters 1 and 2, the reader is introduced to the basics of all infectious diseases, particularly the ‘goals’ that predicate disease evolution. “Parasites depend on their hosts and, for purely selfish reasons, they may benefit by limiting the damage they do to their victims”, Professor Harper explains (p. 41). “Imagine the parasitic lifestyle as an ongoing embezzlement scheme (where bilking money translates into genetic success). The best strategy might be one that is restrained enough to avoid detection by not bankrupting the victim. From a selfish perspective, the best strategy is not always the most harmful in the short run. This is the pathogen’s dilemma, and it is fundamental to the evolutionary history of infectious disease.”

Keeping in mind that there are, of course, plenty of situations where damaging the host as much as possible, even until death, is also a viable option.

This, then, sets the stage for the remainder of the book. In chapters 3 to 5, we follow human progress from our hunter-gatherer origins to farming, keeping livestock, urban (colony) living, long-distance travel and trade up through the collapse of the Roman Empire. Along the way, we meet a variety of infectious human diseases — vector-borne parasites (chiefly protozoa and helminths), fecal-oral diseases (primarily bacteria) that are often the agents of intestinal turmoil, and respiratory diseases (mostly viruses) — and learn a little about their specific evolutionary strategies and disease ecologies. Significantly, we also are treated to an extensive analysis and discussion of vivax and falciparum malarias, the latter of which, like an unwelcome and especially violent neighbor, turns up again and again throughout the book (and human history). Chapter 6 goes on to detail how human society was inadvertently engulfed in an outbreak of a rodent pandemic: plague. Although I did learn quite a bit about this bacterial pathogen in my university microbiology classes, I never thought of it an infectious disease of rodents with humans merely as collateral damage on the sidelines. In this chapter, the reader learns the current state of our knowledge about the evolutionary origins, life cycle and impacts of plague on human civilizations that resulted from construction of a system that supports the rapid intercontinental transmission of animal germs.

Chapters 7 and 8 follow the movement of infectious diseases from the Old World across the Atlantic during the European conquests of the Caribbean, Mesoamerica and South America. This conquest triggered the Columbian Exchange, which refers to the whole ensemble of transfers of animals, plants, insects and, of course, pathogens, that ensued when people began to cross the Atlantic regularly to the New World. The Old World benefitted by adopting energy-rich New World foods, such as maize and sweet potatoes, that had been carefully cultivated by the Indigenous Peoples for thousands of years, whereas the New World was left staggering under the weight of an entire suite of dangerous Old World pathogens, particularly respiratory pathogens, but also fecal-oral germs, providing opportunities for new (European) societies to pop up in the desolation left behind. Of course, it wasn’t this simple. As Professor Harper reminds his readers, focusing on infectious diseases makes it easy to view “the depopulation of the New World [as] a lamentable accident, minimizing the role of violence and deliberate exploitation” (p. 243).

At the same time that the Indigenous Peoples of the New World were being depopulated, Africans were involuntarily shipped across the Atlantic as slaves in the biggest forced migration in human history; and Europeans started a process of colonization, settlement and exploitation of the New World that would last several hundred years, reaching its zenith in the nineteenth century. “Over the course of the sixteenth century, the result was one of the greatest demographic catastrophes in the history of our species”, Professor Harper writes (p. 247).

Chapter 9 explores the broader pattern of the ‘general crisis of the seventeenth century’, where war, famine and plague were seemingly everywhere in the Middle Ages. This synchronicity of crises is thought to be due to three events: climate change and climate instability caused by the Little Ice Age, human overpopulation, and frequent outbreaks of infectious diseases, especially plague, which was accompanied by typhus and by a new and more virulent strain of smallpox.

Finally, chapters 10 to 12 discuss the relationship between wealth and health in modern history, arguing that both were influenced simultaneously by the growth of scientific knowledge and the emergence of centralized states with the power to enact and enforce public health campaigns. These last three chapters also detail the convoluted intellectual journey that humanity followed in our quest to ultimately understand and then overcome many infectious diseases.

The book also discusses the current COVID-19 pandemic in the light of what we have learned from other, historic pandemics. Professor Harper’s view of how to control infectious disease is one where evolutionary threats constantly push back against human progress, and where the devastating effects of modernization contribute to the great divergence of overall health between societies. As Professor Harper warns us at the beginning of his book: “We do not, and cannot, live in a state of permanent victory over our germs. Eternal vigilance is the price of liberation from infectious disease, but interruptions are inevitable, not anomalous” (p. 3). At the end of his book, he once again reminds us that we have been warned again and again that another pandemic is inevitable.

The evolution of pathogens is the basic reason we can never entirely escape the risk of global pandemics. Evolution is the source of new diseases and new strains of old diseases. New diseases emerge when microorganisms that infect animals cross the species barrier and adapt the ability to transmit between humans. New strains of old diseases evolve in response to selective pressures we place upon them. Antibiotic resistance, for example, is a form of evolutionary response to our ample use of a select number of chemical weapons against bacteria. Similarly, microbes have strong incentive to change their outward appearance in order to escape from our vaccines. On basic Darwinian principles, those strains that adapt the ability to survive and reproduce in such an environment will pass their genes on to future generations — to our peril. (p. 505)

With more than seven billion of us alive on the planet today, any infectious disease that can sneak past the human immune system will have an enormous field to exploit. This book reminds us that human health is globally interdependent — and inseparable from the well-being of the planet itself.

This powerful, meticulously-researched and timely analysis is a brilliant crowning achievement. There is so much interesting information in this book that I haven’t mentioned in this review — the many diseases, like measles, rinderpest and influenza (just to name a very, very few of the pathogens you’ll meet in this book). The roles of women and non-European peoples in combatting pathogens. Chinese medical science. Domestic animals as the unwitting victims of many human pathogens rather than the source (as widely believed). Crop diseases. This is, quite simply, the most rigorous and most complete book I’ve read in many years. It will appeal to microbiologists, epidemiologists, medical professionals, economists and political historians — actually, it’s difficult for me to think of anyone who will not find something eye-opening and enlightening in the pages of this comprehensive, beautifully written and eloquent book.


NOTE: Originally published at Forbes.com on 31 July 2022.

[Ogi · Rating 5 out of 5]

I love love love this book.

This book was a first of its kind for me. As i havent read much on this subject, i have no other comparison yet j can say that i gained so much new knowledge and perspective thanks to this book.

It made me realize that any plague or sickness that spread on this earth cannot be taken out of the context of the whole period it happened, or many periods before it. And that everything is interconnected, in a ways i have never even dreamt of. And also many things which we take as given, are very recent developments and in the 18, 19, 20th century we as a human have made so many discoveries and have came so far. Just imagine that only a hundred years ago, in many countries the average age at the time of the death was around 20. And nothing happened just one day, rather through so much trial n error and hard works of many many generations.
I know that everyhing i write seems so obvious, yet this book make me appreciate so many things on a completely different level.

I would sugges this book to everyone who is motivated to read 700 pages or listen 19 hours on audible. Was a challenge in itself, yet so rewarding!

[chris geralds · Rating 4 out of 5]

Actually 3 1/2 stars, no half stars allowed for some reason.

[Jacqueline · Rating 3 out of 5]

I had heard the author on a late night radio talk show, and thought it would be an interesting and insightful read. It is a very deeply researched, huge book. The size of it turned me off. I struggled with it after having read a great summary or introduction. I hoped to isolate certain periods of history, e.g., Black Death or Influenza of 1918, but it wasn’t organized in that fashion. I’m certain it is a great book well executed, but it was too in depth for me. I did really appreciate the higher view of major categorical reasons for continuing man versus invader situations.

[Linda Shane · Rating 5 out of 5]

This is a very detailed review of the history of micro-organism borne disease and the arc of plagues/pandemics in human history. The information is dense and annotated fully with copious notes. As such it is not an easy quick read, but the message that we humans need to pay attention and try to prepare ahead it abundantly clear.

[Andy · Rating 2 out of 5]

I think this book could be OK for people who are new to the topic of the history of infectious diseases. The author does a nice job with stuff like describing the life cycle of the malaria parasite, but something went wrong between the biology basics and the take-home points. It felt like the author climbed the mountain to find the Answer of how to protect humanity from horrible diseases, then after all the travails involved, once he gets within sight of his destination, he closes his eyes and walks off a cliff into the abyss.

Alternatives:
The Origins of Human Disease
The Making of a Tropical Disease: A Short History of Malaria
Rats, Lice, and History: A Chronicle of Pestilence and Plagues
Epidemics and Society: From the Black Death to the Present
Plagues and Peoples



Nerd addendum:
Maybe the issue is that this book is in the series on the "economic history of the western world" so that the answer for how we have succeeded in decreasing infectious disease deaths has to include "economic growth" even when this makes no sense. As the author points out, economic growth is neither necessary nor sufficient for explaining the decline of plagues and the resulting enormous increase in life expectancy. In fact, as he describes in detail, the path to the Industrial Revolution and urbanization made things worse. But then he twists this around in a sort of self-satire to argue that economic growth made things so bad that then the world had to have a sanitarian reaction, which eventually fixed things. This is like the argument that we need to get rid of civil rights in the US so that we can fight racism: https://www.cc.com/video/1zj4bl/the-c....

Along the same lines, he keeps giving credit to "medical science" even though he points out that medicine had very little in the way of effective treatments at the relevant time. He also clearly explains how what did work was the war on filth, and that was based on Miasma Theory, which is the opposite of the bio-medical scientific model of specific germs causing specific diseases. If his point is that epidemiology and public health are the real "medical sciences" then that is interesting, but this seems very confusing in terms of what 99% of readers today would understand is meant by "medical science." And so that seems like another missed opportunity to clarify what mattered for saving millions or billions of lives.

I was baffled by the decision to frame the concluding section around the "Great Escape," which I think is a book with fundamental flaws. The Great Escape: Health, Wealth, and the Origins of Inequality

Although the author starts out by correctly explaining how microbes have no intentions regarding anything, the rest of the book pullulates with mentions of "our enemies" the germs and how they are trying to kill us. This is vaguely okay in a bio-thriller, but I think is a problem for serious non-fiction.

The author correctly distinguishes between life expectancy and lifespan early on. Nevertheless, these concepts are used interchangeably afterwards and this creates confusion.

The repetition about the wonders of time travel with "tree thinking" from genetic code analysis is irritating, because this turns out to contribute little to understanding of the big question. Neither does the treasure trove of trivia on all those outbreaks. For example (p. 359) as we try to understand why horrible scourges like bubonic plague come and go, we are left with: "riddle," "mysterious ways," "no satisfying reason," "defies complete understanding," "puzzle," and "enigmatic." This is better than lying and making up an explanation, but it is a let-down to wade through hundreds of pages of factoids and eventually end up with nothing new.