A Historical Perspective on Commerce and the Spread of Disease

Abstract

Throughout history, the spread of contagious disease has been linked with global trade routes. In Contagion: How Commerce Has Spread Disease, Oxford University professor Mark Harrison provides a scholarly account of the intimate relationship between the history of infectious disease and international commerce. The concomitant challenges of establishing standardized sanitary regulations that were compatible with the development of free trade are traced along the way. Chronicling the global spread of disease over seven centuries and six continents, Harrison mainly narrates this epic tale using primary source material. Starting with the origins of bubonic plague and ending with avian influenza, specific outbreaks are used to illustrate generalized themes. Throughout the entire volume, detailed attention is given to the political and economic impact of infectious disease transmission and prevention. Harrison uses many centuries’ worth of documentation to show that “Governments have always balanced the prospect of infection against the losses that may result from curtailment of commerce … [and] that balance has shifted as economies have become more intertwined” (p. xvi). Individual countries wielded public health policies (such as quarantine) as diplomatic tools and even “weapons of war” to gain economic leverage in the international community. Another common theme is the manipulation of scientific evidence to suit policymakers. Medical “experts” were sought who could provide the desired arguments for politically motivated policy decisions. Such decisions regarding sanitary regulations often had little to do with scientific evidence or logic. The relationship between politics and public health is particularly well-dissected and objectively portrayed with regard to the implementation of sanitary measures such as quarantine. Harrison elaborates on his thesis that the public health policy decisions of countries are determined equally by “diplomatic context” and by the prevailing public opinion. He concludes that, while “all sides appeal to science in an attempt to vindicate their arguments … there can never be a purely technical solution to the sanitary regulation of trade” (p. 282). At a time when new global epidemics can spread in an instant, Harrison reminds us that, “History shows us that … trade-related disease is best tackled through a range of measures … [and] unless we get the balance right … it is unlikely that we will enjoy either the security we crave or the commercial freedom essential to our prosperity” (p. 281). With well over 100 footnotes per chapter and an extensive bibliography, this book is noteworthy for its ambitious scope and objectivity. While Contagion will certainly appeal to serious students of the history of medicine, this book may not be suitable for a general audience due to its overabundance of dates, acronyms, and historical minutiae. Unlike many popular science books that bring infectious diseases to life through harrowing personal narratives or fictionalized imaginings, this tome is an exemplary tribute to historical scholarship. All readers will appreciate that the dense text is partially supplemented in two sections with reproductions of paintings, photos, sketches, and original documents spanning the 1500s to the present day. All of these figures are well worth poring over and are accompanied by insightful captions. Instructors may take advantage of Harrison’s extensive research and use specific examples from primary source material to present case studies in public health policy. In addition, some of the figures depicting artwork, cartoons, and public notices may be used as starting points for class discussions or homework. Undergraduate biology students will find this a challenging read, but those who undertake the task will find themselves with a new perspective on our collective history.