Medical Memoirs

A 19th century German artist’s conception of cholera as personified by death.

A 19th century German artist’s conception of cholera as personified by death. Image courtesy the National Library of Medicine.

Christopher Hamlin. Cholera: The Biography. New York: Oxford University Press, 2009. x + 344 pp. $24.95.

Mark Jackson. Asthma: The Biography. New York: Oxford University Press, 2009. xi + 249 pp. $24.95.

Robert Tattersall. Diabetes: The Biography. New York: Oxford University Press, 2009. x + 229 pp. $24.95.

What does it mean to write the biography of a disease? Is it the same as writing the biography of a person? Not exactly. Telling a biographical story, though not simple, is made easier by the fact that people have limited life spans, interact directly with a relatively small number of people, and can never be in two places at once. People’s communications with others, when preserved, chronicle important thoughts and events. None of this holds true for diseases: many are ancient, have “interacted” with a plethora of people, and can manifest themselves at the same time in different places. Diseases communicate indirectly with the outside world (morbidity and mortality statistics are two ways we understand these communications). Also, their identities have varied significantly throughout history. Modern classifications, whether based on the cause of the disease, the mechanism by which it is caused, or symptoms should not, and I believe cannot, be mapped onto historical accounts of disease. And yet, as Hamlin, Jackson, and Tattersall aptly demonstrate in their respective books, it is possible to tell a life story, a biography, of a disease.

All three authors face a difficult task. In order to write such a biography each must link disparate historical accounts into a cohesive story that allows the disease to remain constant and, simultaneously, to change over time. Hamlin uses the symptoms of Hippocratic diseases associated with yellow bile (choler) to connect with modern beliefs about the bacterium Vibrio cholera; Jackson uses the ancient Greeks’ µ (asthma) to correspond to what is now considered a chronic inflammation of the lungs; and Tattersall uses the “pissing evil” of the ancient Egyptians as the equivalent of diabetes mellitus. The three authors take two different paths to achieve the necessary continuity in their stories: Hamlin and Jackson rely on patients’ and practitioners’ experiences of disease, while Tattersall recreates (primarily) the scientific history of diabetes.

These different methods of writing disease biographies produce two very distinct types of history. Hamlin and Jackson not only reconstruct the history of cholera and asthma in the diseases’ varied forms over time; the authors also show the ways in which the diseases were part of the political, economic, and cultural identities of various countries over long periods. These two biographers discuss how the diseases (regardless of how they were defined medically) significantly affected relationships among patients, practitioners, and researchers. In the middle of the 20th century, for example, the care of asthmatic patients changed drastically with the advent of psychosomatic treatments. With limited pharmacological and therapeutic treatment options available to asthmatics, physicians focused on preventing the onset of an asthmatic attack by ensuring a patient’s emotional stability through psycho-therapy, thereby turning asthma into essentially a psychiatric disorder. Another example is that of Robert Koch’s discovery of Vibrio cholera and its role in disease causation—that is, the germ theory of disease. While the discovery had limited impact on the treatment of disease (antibiotics did not become a factor until the German discovery of sulfa drugs in the 1930s), it did contribute to a reinterpretation of the stigma associated with disease causation: no longer would diseases like cholera be associated directly with the moral failings of an individual but rather with the unfortunate circumstance of being infected with a microorganism. Owing to these discoveries, cholera in the early 20th century was one of the diseases responsible for the rise of the public-health movement and the social, physical, and structural changes to urban environments. Tattersall’s account of diabetes, however, creates a different type of history. Though he briefly discusses ancient allusions to diabetes, his focus is on modern (post-18th century) medical experimentation. Tattersall’s account, in contrast to those of Hamlin and Jackson, details the investigative and then scientific work of physicians and medical researchers in their pursuit of the cause and treatment of diabetes. The result is an account disconnected from the broader social issues that Hamlin and Jackson make central to their work.

All three texts, it seems, overstate their claims in one small but significant way: each one is a biography but not the biography, as their titles suggest. Historical texts are laden with the biases of their authors, and those biases do help us understand history in new ways, ways that are neither better nor worse (for the most part) than previous historical accounts. Hamlin’s Cholera deftly demonstrates that people’s response to cholera transformed notions of class and race, the role of governments, and the course of modern biomedicine, especially with the advent of cheap pharmaceuticals to which all people and all nations could have access regardless of economic or political troubles. Jackson’s Asthma clearly shows that diseases can become a critical part of social identity, as when asthma became a fashionable illness among members of the late-19th and early-20th-century artistic elite, with author Marcel Proust providing a leading example. Tattersall’s Diabetes analyzes the disease within an increasingly globalized context and through the arsenal that science has developed over the last century to combat the threat diabetes poses. All three texts contribute to our understanding of the ways in which disease and its treatment are linked fundamentally to social and scientific history, and the ways in which biographies can shed new light on some very old diseases.

David J. Caruso is program manager for oral history at CHF.