Roy Porter

Hunting Hookworms

Tropical Diseases: From 50,000 BC to 2,500 AD

By

HarperCollins 256pp £18.99 order from our bookshop

Among the healing arts, tropical medicine has traditionally claimed a particularly heroic status. We conjure up Boy’s Own images of intrepid medical explorers deep in darkest Africa or Amazonia hunting the carriers responsible for calamitous diseases such as malaria, yellow fever, dengue and sleeping sickness – and, in our own day, terrifying viruses like Ebola and Marburg. Often the parasitologist put himself personally at risk, serving as his own experimental volunteer. So much so that no fewer than six major medical scientists died between 1900 and 1930 while investigating yellow fever alone.

This stirring, if familiar, saga of the conquest of tropical diseases is told again, with some panache, by a self-confessed ‘old stager’ in the business, Robert S Desowitz, a retired professor of tropical medicine and author of earlier forays into this field like The Malaria Capers. Desowitz, however, gives his tale a fresh twist by focusing on the conquest of ‘tropical diseases’ largely within the United States. It is easy to forget (though global warming may soon jog our memory) that many diseases assumed to be unique to the tropical girdle were traditionally endemic in more temperate climes. Bubonic Plague afflicted Europe until the eighteenth century; malaria (albeit of the benign variety) was common in the Fens until the present century; while yellow fever was still rampant in the Southern states of the USA up to the Great War there were even occasional outbreaks in European ports such as Nantes and Swansea.

Amidst daring tales of the heroes of bacteriology and parasitology, Desowitz is at his best in telling a story less well known in Britain: the work of the Rockefeller Foundation, which funded research into these deadly disorders and above all launched gigantic eradication crusades. The model was the hookworm campaign in the American South conducted after 1910. The hookworm parasite, typically picked up by walking barefoot over faecally infected soil, affected millions of poor Southerners, black and white alike, leaving them anaemic, pot-bellied and weak. Combined public health and educational initiatives involving millions of leaflets, public meetings and visits by officials produced a dramatic decline. Similar campaigns followed in Latin America and elsewhere. Some of the natural wealth which Standard Oil had snatched from Mexico was at least given back in the form of Rockefeller medicine.

Of course, as Desowitz recognises, John D Rockefeller was aware of the fact that better health in his workers helped create a better workforce for capitalism without rocking the political boat. But the magnitude of the philanthropic achievement is not to be gainsaid. Desowitz adopts a congenial persona in his book: as a mud-on his-boots old stager, half admiring, half distrusting the new breakthroughs brought about by hi-tech DNA and RNA research in the lab; and this makes the book an agreeable read. But his rambling, fireside-chat style could have done with fiercer editing. And for a book that purports to be a work of history, there are too many elementary factual mistakes. We are told, for instance, that the great breakthrough against malaria was made ‘on the fourth of July, 1898, when Ronald Ross in Calcutta nailed the mosquito to the malaria cross’. In actuality, the decisive discovery was made by Ross in his laboratory in Secunderabad on what he called ‘Mosquito Day’, 20 August 1897.

Not least, the book exudes an air of complacency about the benevolence of medical science which is not altogether warranted. We are told, for instance, that since the ‘abominations revealed at Nuremberg [sic]’ involving the use of ‘humans as experimental subjects’, medical research has maintained high ethical standards.

Yet how can this be squared with the Tuskegee experiment, begun in Alabama in 1932 by the United States Public Health Service, in Desowitz’s own backyard? This programme involved callously depriving hundreds of syphilitic blacks of proper medical therapy, under the pretence that they were being treated, so as to make a study of the long-term degenerative effects of syphilis on the central nervous system. The Tuskegee study was not wound up till 1972. The obvious racial implications of the experiment confirm suspicions that the investigation of ‘torrid diseases in a temperate world’ all too often had a tacit political agenda, about which we are told too little here.

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